Expanded Immunization

Program and other Vaccines

Mondero Peter
Morano Ingrid Pauline E.
Morasse, Warunee
 Objectives
1. To Discuss the Expanded Program of Immunization
of DOH
2. To present the different Vaccinations for both
pediatric and adult
3. To present the schedule of each vaccinations
• History of Vaccines
• Expanded Program immunization
• Route Of vaccine
• Types Of Vaccine
• Passive and Active vaccine
• Adult Vaccinations
• Pediatric Vaccinations
Edward Jenner
•British physician
•credited with ushering in the modern concept
of vaccination.
•1796
• He used matter from cowpox
pustules to inoculate patients
successfully against smallpox, which
is caused by a related virus.
• 1897 and 1904
• Louis Pasteur’s experiments
spearheaded the development of
live attenuated cholera vaccine
and inactivated anthrax vaccine
in humans
• Late 19th Century
• Plague vaccine was also
invented.
• Between 1890 and 1950
• Bacterial vaccine development
proliferated, including the
Bacillus-Calmette-Guerin (BCG)
vaccination
20th century
• Other vaccines that protect against once commonly fatal infections
such as pertussis, diphtheria, tetanus, polio, measles, rubella, and
several other communicable diseases were developed.
 



1974 

Expanded Programme on Immunization (EPI)

 What is Expanded Program of Immunization
(EPI)?
• The Expanded Program on Immunization (EPI) was established
in 1976 to ensure that infants/children and mothers have access to
routinely recommended infant/childhood vaccines.
• Six vaccine-preventable diseases were initially included in the EPI:
tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and
measles.
• In 1986, 21.3% “fully immunized” children less than fourteen
months of age based on the EPI Comprehensive Program review.
 PRESIDENTIAL DECREE No. 996 

September 16, 1976



• PROVIDING FOR COMPULSORY BASIC IMMUNIZATION
FOR INFANTS AND CHILDREN BELOW EIGHT YEARS OF
AGE
 GOALS
Over-all Goal:
•To reduce the morbidity and mortality among children against the most common
vaccine-preventable diseases.

Specific Goals:
1.To immunize all infants/children against the most common vaccine- preventable
diseases.
2.To sustain the polio-free status of the Philippines.
3.To eliminate measles infection.
4.To eliminate maternal and neonatal tetanus
5.To control diphtheria, pertussis, hepatitis b and German measles.
6.To prevent extra pulmonary tuberculosis among children.
 





July 26, 2010. 

REPUBLIC ACT No. 10152

AN ACT PROVIDING FOR MANDATORY BASIC IMMUNIZATION SERVICES FOR INFANTS AND
CHILDREN, REPEALING FOR THE PURPOSE PRESIDENTIAL DECREE No. 996, AS AMENDED

 Strategies:

1. Conduct of Routine Immunization for Infants/Children/
Women through the Reaching Every Barangay (REB) strategy
2. Supplemental Immunization Activity (SIA)
3. Strengthening Vaccine-Preventable Diseases Surveillance
Routes of Administration
IMMUNIZATION





MORASEE,WARUNEE
OBJECTIVES
 VACCINATION

• It is the administration of a vaccine to help the immune

system develop protection from a disease.

• Vaccines contain a microorganism in a weakened or killed

state, or proteins or toxins from the organism.
Goals of Immunization
 Immunization

• “Immunization is the process whereby a person is made

immune or resistant to an infectious disease, typically by
the administration of a vaccine.
• Vaccines stimulate the body's own immune system to
protect the person against subsequent infection or
disease.” - WHO
Types of Immunization
 Active Immunization
• The administration of all or part of a micro-organism or a
modified product of that organism(toxoid or purified
antigen) to evoke an immunologic response that mimics
that of the natural infection but usually presents little or no
risk for the recipient.
• It may provide life long protection ,partial protection or
may require administration at regular intervals.
 Passive Immunization
• It is the administration of preformed antibodies to recipients.
It is available as:
➢Human Immunoglobulin (Ig):
➢Intravenous Immunoglobulin (IVIG)
➢Subcutaneous Immunoglobulin (SCIG)
➢ Hyperimmune globulin • Monoclonal antibodies
Herd Immunity
• It exists if a number of people in the community who
have active immunity against an infection exceeds a
critical level.
• If this level is achieved, then, non-vaccinated
individuals are protected from the disease. In this way,
transmission fails or stops without universal immunity.
 What is a Vaccine?

• A vaccine is usually a protein similar to part of a

virulent infectious organism, that can be recognized
by an individual’s immune system.
• It produces antibodies or cell-mediated immunity
against the antigen in the vaccine.
Types of Vaccines
  Live Vaccines
• Live vaccines produce active immunity by causing a mild infection. • A
virulent organism is weakened so that it produces an antigenic response
without serious consequences.

Vaccines included:
• BCG
• Oral Polio
• MMR
  Killed/Inactivated Vaccines
• They are prepared from virulent organisms or pre-formed antigens inactivated by heat, phenol,
formaldehyde or any other means.

Vaccines included:
• Pertussis
• Cholera
• Influenza
• Injectable Polio
• Rabies
 Toxoids

• • They are based on the toxin (poison) produced by

certain bacteria that has been made harmless but
elicits an immune response. (e.g. tetanus or
diphtheria).
 Polysaccharide Vaccines

• Pure & Conjugated

• They are a unique type of inactivated subunit vaccine
composed of long chains of sugar molecules that make up the
surface capsule of certain bacteria.
• The response to polysaccharide vaccines is incomplete and
unreliable and are sometimes conjugated with other antigens
to improve immunological response
 Principles of handling and storing Vaccines
• Vaccines are temperature sensitive. Strict temperature
monitoring should be done to ensure a maintained cold
chain*.
• FEFO- “first expiry and first out”
• Cold chain includes all of the materials, equipment and
procedures used to maintain vaccines in the required
temperature range of +2 °C to +8 °C from the time of
manufacture until the vaccines are administered to individuals.
 Recommended temperatures
Type Storage temp
Most sensitive to heat •Oral polio(live -15 °C to -25 °C (at the
attenuated) freezer)
15°C to -15 °C (at the
•Measles (freeze dried) freezer)
Least sensitive to heat •DPT/Hep B +2 °C to +8 °C (in the
•BCG (freeze dried) body of the refrigerator)
•Tetanus Toxoid
VACCINATION FOR

PEDIATRIC
13 recommended vaccinations for Filipino children, ages 0-18
y/o.

•The original objective was to reduce the morbidity among

infants and children caused by the childhood diseases
DIPTHERIA
TETANUS
TOXOID AND
PERTUSSIS
VACCINE- 4
DOSES
 A fully immunized child

Receives
❖one dose of BCG and HEPA-B at birth,
❖3 doses of OPV
❖3 doses of PENTA
❖1 dose of measles vaccine before the child’s 1st birthday
 Bacillus Calmette-Guerin (BCG)
• Intradermally (ID): 1 dose (Live Attenuated- Bacterial)
• Right deltoid region
• DOSE:
o 0.05 ml at Birth to <12 months of age
o 0.1 ml Children >12 months of age
• Given at earliest possible age at birth, preferably within 2 months of life.
• this protects the possibility of TB meningitis and other TB infections in
which infants are prone.
 Hepatitis B Vaccine (HBV)
• Intra Muscularly: 3 doses (Monovalent vaccine)
• 1st Dose- At birth to all newborns >2kgs w/in 24hrs of life
• 2nd Dose- 1-2 months interval after the birth dose
• 3rd or Final dose: not earlier than age 24 weeks. (6 months)
Another dose is needed if the last dose was given at age <24 weeks
• Given at upper outer portion of thigh
• This prevents liver cirrhosis and liver cancer caused by HEPA B
virus
 Diptheria, Tetanus toxoid and Pertussis vaccine
• Is a weakened toxin, Pertussis as killed whole cell bacterium
• IM
• Given at upper outer portion of the thigh
• Minimum interval: 4 weeks
• Minimum age of: 6 weeks(DPT 1), 10 weeks (DPT 2), 14 weeks (DPT 3), 1 year
(DPT 4)
• The recommended interval between the 3rd and 4th dose is 6 months (minimum of 4
months is valid)
• 5th dose may not be given if the 4th dose was administered at age 4 years or older
• An early start with DPT reduces the chance of severe pertussis
 Haemophilus influenzae Type b Conjugate
Vaccine (Hib)
• IM
• 3-dose primary series
• minimum age of 6 weeks; minimum interval of 4 weeks
• Booster dose is given between 12-15 months of age with an
interval of 6 months from the 3rd dose
 Poliovirus Vaccine (OPV/IPV)
• 3 doses
• Oral polio vaccine (OPV) - LIVE ATTENUATED – 2-3 drops
• Inactivated polio vaccine (IPV) - coexists w/ OPV 3 – 0.5ml
• Given at a minimum age of 6 weeks with a minimum interval of 4 weeks.
• The primary series consists of 3 doses.
• A booster dose should be given on or after the 4th birthday and at least 6
months from the previous dose.
• Gives protection against polio diseases
 Pneumococcal Conjugate Vaccines (PCV)

• IM
• Minimum age: 6 weeks for PCV10 and PCV13
• Primary vaccination: 3 doses with an interval of at least 4 weeks between doses
plus a booster dose given 6 months after the 3rd dose.
• Healthy children 2 to 5 years old who have no previous PCV vaccination may
be given 1 dose of PCV13 or 2 doses of PCV10 at least 8 weeks apart.
• Routine use of PCV is not recommended for healthy children 5 years and
above.
 Rotavirus Vaccine (RV)
• Given orally
• Minimum age: 6 weeks
• Minimum interval of 4 weeks
• Last dose: not later than 32 weeks of age
• The monovalent human rotavirus vaccine (RV1) is given
as a 2-dose series and the pentavalent human bovine
rotavirus vaccine (RV5) is given as a 3-dose series.
 Influenza Vaccine (Trivalent/Quadrivalent)
• Trivalent influenza vaccine: IM/SQ
• Quadrivalent influenza vaccine: IM
• Minimum age of 6 months
• DOSE
• 0.25 mL for children 6-35 months
• 0.5 mL for children 36 months- 18 years.
• Children 6 months to 8 years receiving influenza vaccine for the first time
should receive 2 doses separated by at least 4 weeks. If only 1 dose was given
during the previous influenza season, give 2 doses of the vaccine then 1
dose yearly thereafter.
• Children aged 9 to 18 years should receive 1 dose of the vaccine
yearly.
• Annual vaccination should begin in February but may be given
throughout the year.
 Measles Vaccine

• SC; 1 dose
• Age of 9 months
• may be given as early as 6 months of age in cases of outbreaks
• In lieu of monovalent measles vaccine, MMR may be given if
recommended by public health authorities
 Measles-Mumps-Rubella Vaccine
• SC; 2 doses
• Minimum age of 12 months
• Minimum interval between doses is at least 4 weeks:
• Two doses are recommended (2nd dose is usually given
from 4-6 years of age but may be given earlier)
• Children below 12 months of age given any measles-
containing vaccine (Measles, MR, MMR) should be given 2
additional doses.
 

Hepatitis A Vaccine

• IM
• 2-dose series
• Minimum age: 12 months
• 2nd dose: at least 6 months from the 1st
dose
 

Varicella Vaccine

• SC
• Minimum age: 12 months
• Two doses are recommended
• 1st dose: 12-15 months of age
• 2nd dose: 4-6 years of age but may be given earlier at an
interval of 3 months from the first dose.
• For children below 13 years the recommended minimum
interval between doses is 3 months. However, if the 2nd dose
was administered at least 4 weeks after the 1st dose, it is
considered valid.

• For children 13 years and above, the recommended minimum

interval between doses is 4 weeks.
 HUMAN PAPILLOMA VIRUS
• IM
• Minimum age- 9y/o
• 2 dose series: ages 9-14 years of age
- given at 0 and 6 months.
- If the interval bet. The 1st dose and 2nd dose is less than 6 months a 3rd dose is needed. The
minimum interval bet the 2nd and 3rd dose is 3 months.
3 dose series: ages 15 years and older

•Given at 0, 1-2months and 6months

•The minimum interval bet the 1st dose and the 2nd
dose is 1 month and the minimum interval bet the 2nd
and 3rd dose is 3 months. The 3rd dose should be given
at least 6 months from the 1st dose.
•For males 9-18 years of age, a 4vHPV and 9vHPV
can be given for the prevention of anogenital warts
and anal cancer.
 Vaccine Side Effects/Risks
• mild.
• can be serious, or even deadly.
Adult immunizations
 Measles, Mumps, Rubella (MMR)
Type Route Target Individuals Schedule Contraindications
Live SC • Adults who have not received 1-2 dose given • Pregnancy
attentuated complete vaccination for at least 28 days • Immunocompromised
measles, mumps, or rubella apart • HIV infection CD4
during childhood
• Women planning to become count <200
pregnant
 Rabies Vaccine
Type Route Target individuals schedule contraindica
tions
• Purified ID, IM  Pre-exposure prophylaxis
Vero cell •Healthcare workers directly caring for (PrEP)
(PVRV) rabies patients ID: 0.1 ml on days 0, 7, 21/28
•Individuals directly involved in rabies
• Purified IM: 0.5 ml on days 0, 7, 21/28
control
chick •Pet owners and household members Post-exposure (PEP)
embryo cell •Veterinarians and veterinary students 2-site ID: days 0, 3, 7 and 28
(PCEC) •Children 5 to 14 years old living in given at a dose of 0.1 ml on the
aras where there is high incidence of left and right deltoids
rabies IM:
•Victims of human-, dog-, cat-bite and •
PVRV: 0.5 ml on days 0, 3, 7,
other domestic and wild animals
including bats 14, 28
  •PCEC: 1 ml on day 0, 3, 7, 14,
28
 Pneumococcal
Type Route Target Individuals Schedule Contraindications

Polysaccharide IM • Immunocompetent For elderly, A person with a severe

(PPSV-23)
Conjugate (PCV-13) SC • Elderly individuals >
adults immuncompetent: allergy to any
•PCV-13 then PPSV-23 after component of this
50 years old 1 year vaccine
For immunocompromised:
•PCV-13 then PPSV-23 after
8 weeks
For those with previous
PPSV-23:
•PCV-13 at least 1 year
after the most recent dose
•PPSV-23 5 years after
initial dose
 DTP
Type Route Target Individuals
Inactivated IM • Adults aged 19 to 64 years if
their last vaccination was at
least 10 years ago
• Adults in close contact with
an infant aged less than 12
months
• Women of childbearing age
before pregnancy or
immediately after delivery
• Healthcare personnel with
direct patient contact
Schedule Contraindications
1 dose TdaP then Td
of 0.5 ml each with
second dose given
4-8 weeks after the
first dose, and third
dose given at 6-12
months after the
second dose.
May be given as
booster every 10
years.
 Varicella
Type Route Target Individuals Schedule Contraindications
Live attenuated sc • Healthcare workers 2 doses, 0.5 ml at 0, 1-2 • Pregnancy
without history of months • Immunocompromised
varicella   • HIV infection CD4 count
• Immunocompetent Post exposure <200
adults who may need prophylaxis (PEP):
post-exposure Single dose given within
prophylaxis 72 hours of exposure
 Herpes Zoster
Type Route Target Individuals Schedule Contraindications
Live attenuated sc 60+ years old with or without Administer two doses of • Pregnancy
prior episode of herpes zoster recombinant zoster vaccine (RZV) • Immunocompromised
(Shingrix) 2-6 months apart to adults • HIV infection CD4 count
aged 50 years or older regardless of <200
past episodes of herpes zoster or
receipt of zoster vaccine live
 Human papilloma virus
Type Route Target Individuals Schedule Contraindications

• Bivalent inactivated IM • Immunocompetent 0.5 ml dose at 0, 1-2, 6 A severe allergic reaction (e.g.,
• Quadrivalent adult females until the months anaphylaxis) to a vaccine
inactivated age of 26 component
• Nanovalent • Immunocompetent
inactivated adult males until the Anaphylactic allergy to latex is a
age of 26 contraindication to bivalent
HPV vaccine in a prefilled
syringe since the tip cap might
contain natural rubber latex.

A moderate or severe acute

illness is a precaution to
vaccination, and vaccination
should be deferred until
symptoms of the acute illness
improve
 Meningococcal
Type Route Target Individuals Schedule Contraindications

Quadrivalent sc • High risk groups Single 0.5 ml dose 10 A person who has ever
polysaccharide • Adults who travel days before travel had a severe allergic
(MPSV4) to endemic and   reaction (e.g.,
hyperendemic areas For high risk groups: anaphylaxis) after a
for meningococcal give 2 doses, 2 months previous dose or
disease (African apart, with a booster allergic reaction to any
meningitis belt) vaccination every 5 vaccines
years
 Hepatitis A

Type Route Target Individuals Schedule Contraindications

Monovalent, IM Immuno-competenet adults Single dose of Life threatening

Inactivated 1440 ELISA allergies to vaccines
units/ml/vial;
booster dose after
6 to 12 months
 Hepatitis B

Type Route Target individuals Schedule Contraindications

Recombinant IM • All healthcare workers 3 doses at 0, 1, 6 months Severe allergic reaction
monovalent • Those without   (e.g., anaphylaxis) after
documented evidence Accelerated schedule: 0, 2, 6 a previous dose of any
of immunity weeks; booster dose 1 year hepatitis B-containing
after the 1st dose if anti-HbS vaccine
< 10 U/L