The National Immunization Program (NIP) of the Department of Health — still widely called the Expanded Program on Immunization (EPI) — provides free vaccines to protect infants, children, adolescents, and pregnant women from vaccine-preventable diseases. It is one of the most cost-effective public health programs; high coverage also produces herd (community) immunity that protects those who cannot be vaccinated.

Legal basis: the Mandatory Infants and Children Health Immunization Act of 2011 (RA 10152) requires basic immunization for children under 5, free in government health facilities, and the hepatitis B birth dose within 24 hours of birth.

Types of immunity

• Active — the body makes its own antibodies (after infection or vaccination); long-lasting
• Passive — ready-made antibodies (maternal antibodies across the placenta and in breast milk, immune globulins such as HBIG or rabies immune globulin); immediate but short-lived

Types of vaccines

• Live attenuated: BCG, oral polio vaccine (OPV), measles-mumps-rubella (MMR) or measles-rubella (MR)
• Inactivated, subunit, toxoid, conjugate: hepatitis B, pentavalent (DTwP-Hib-HepB), inactivated polio vaccine (IPV), pneumococcal conjugate vaccine (PCV), tetanus-diphtheria (Td), human papillomavirus (HPV)

Routine NIP schedule (DOH, as shown in the 2026 Philippine childhood immunization calendar)

School-based immunization (reinstated as "Bakuna Eskwela" in 2024)

• Grade 1 and Grade 7: MR and Td
• HPV for girls: Grade 4 in school, or at 9 years in the community — 2 doses 1 year apart

Pregnant women: Td to prevent maternal and neonatal tetanus — 2 doses at least 4 weeks apart in the first pregnancy, working toward 5 doses for lifetime protection (see the maternal health topic).

Catch-up in the NIP (per the calendar): BCG up to 1 year of age; hepatitis B birth dose up to 14 days; pentavalent up to 2 years; PCV up to 2 years; MMR up to 2 years and MR up to 5 years during catch-up campaigns. Do not restart an interrupted series — continue where it stopped. Minimum interval between doses of the same vaccine series is 4 weeks.

Special situations

• Infant of an HBsAg-positive mother: hepatitis B vaccine and HBIG within 12 hours of birth.
• Infant under 2 kg: the birth dose of hepatitis B is not counted; the infant needs 3 more doses.
• HIV: BCG is given to infants and children with HIV who are clinically well and immunologically stable on antiretroviral therapy; OPV is contraindicated in people with HIV or other immunocompromise — IPV is used.

Contraindications and precautions (consistent with pediatric immunization guidance)

• Anaphylaxis to a previous dose or component — do not give that vaccine.
• Live vaccines (BCG, OPV, MMR): not in severe immunodeficiency or pregnancy.
• Pertussis-containing vaccine: encephalopathy within 7 days of a previous dose is a contraindication.
• Moderate or severe acute illness — a precaution; postpone.
• Not contraindications: mild illness or low-grade fever, current antibiotics, malnutrition, prematurity, breastfeeding, diarrhea, family history of seizures, local reaction to a previous dose. Malnourished and sick-but-not-severely-ill children should be vaccinated — they are at highest risk.

Cold chain — the system that keeps vaccines at the right temperature from manufacturer to client.

• Store refrigerated vaccines at 2–8 °C (36–46 °F); monitor and record temperature at least twice daily.
• Do not freeze hepatitis B, pentavalent, PCV, IPV, Td, and HPV — freezing destroys adsorbed vaccines. Suspect freezing → shake test (frozen vaccine sediments faster than a control that was deliberately frozen).
• Vaccine vial monitor (VVM): a heat-sensitive label; do not use once the inner square is as dark as or darker than the outer circle.
• Reconstituted BCG and MMR: use only the manufacturer's diluent (cooled like the vaccine) and discard 6 hours after reconstitution or at the end of the session, whichever comes first; protect from light.
• Transport in vaccine carriers with conditioned ice packs.

Immunization session steps

1. Prepare: check the cold chain, VVMs, and expiry; bring the emergency kit (epinephrine 1 mg/mL), auto-disable syringes, and a safety box.
2. Screen each child: immunization card and target client list, age, previous reactions, illness today, immune status.
3. Give all due vaccines at the same visit at separate sites (at least 2.5 cm apart); give oral vaccine first.
4. Techniques: BCG intradermal raising a small wheal; IM in the anterolateral thigh for infants; MMR subcutaneous.
5. Do not recap needles; discard at once into the safety box.
6. Observe the child for at least 15 minutes after vaccination.
7. Record on the card and target client list (FHSIS); tell the caregiver the next visit date.
8. Teach expected reactions: fever and soreness after pentavalent or PCV (paracetamol as advised); BCG — a small papule after a few weeks that may ulcerate and heals with a small scar; do not apply anything to the BCG site; fever or mild rash about 1–2 weeks after MMR.

Adverse events following immunization (AEFI)

• Anaphylaxis (usually within minutes): call for help, epinephrine 1 mg/mL IM in the anterolateral thigh, 0.01 mg/kg (maximum 0.3 mg in children, 0.5 mg in adolescents and adults), repeat every 5–15 minutes as needed, position, oxygen, transfer.
• Report serious AEFI (death, hospitalization, clusters, events causing public concern) through the DOH surveillance system; investigate programmatic errors (wrong diluent, contamination, cold chain failure).

Coverage monitoring

• Use target client lists to find defaulters (missed doses) and track them through home visits and reminders by BHWs.
• Coverage indicators include the proportion of infants who complete all recommended doses (fully immunized), dropout rate (for example, first pentavalent dose minus third dose, divided by first dose, × 100), and measles-containing vaccine coverage. Coverage of 95% is the usual target for measles elimination.
• Reasons for low coverage: missed opportunities, fear of side effects, misinformation, distance, stock-outs.

• Plan immunization sessions (fixed sites, outreach to far barangays) and estimate vaccine needs from the target population.
• Manage the cold chain and vaccine stock; report breaches.
• Administer vaccines safely with correct dose, route, and site; ensure injection safety.
• Screen correctly — avoid false contraindications that cause missed opportunities.
• Educate and counter misinformation with clear, respectful explanations; rebuild trust after vaccine scares.
• Track defaulters and conduct catch-up and supplemental campaigns.
• Monitor and report coverage and AEFI; lead or support investigations.
• Supervise and train midwives and BHWs.

• RA 10152: basic immunization is mandatory and free for children under 5; hepatitis B birth dose within 24 hours.
• Informed consent: parents receive information on benefits and risks; answer questions honestly. Document a refusal, the information given, and continue to offer vaccination at later visits.
• Beneficence and justice: reach underserved and geographically isolated areas; herd immunity protects others.
• Nonmaleficence: never give a vaccine that has been frozen (if freeze-sensitive), exposed to heat beyond its VVM, expired, or mixed with the wrong diluent.
• Accountability: medication errors (wrong vaccine, dose, route, or diluent) must be reported and the client monitored; wrong-diluent errors have caused deaths.
• Confidentiality: immunization and health records are protected under the Data Privacy Act (RA 10173).

Case 1. A 10-week-old with a mild cold and a temperature of 37.6 °C (99.7 °F) arrives for her second doses.

• Action: vaccinate — pentavalent, OPV, and PCV dose 2.
• Why: mild illness and low-grade fever are not contraindications; delaying causes missed opportunities.

Case 2. A 6-month-old missed the 14-week visit and now comes back.

• Action: give the third doses of pentavalent, OPV, and PCV and the first IPV; do not restart the series.
• Why: interrupted series are continued.

Case 3. During a session, a 4-month-old develops hives, wheezing, and pallor 5 minutes after vaccination.

• Action: call for help and give IM epinephrine 0.01 mg/kg in the anterolateral thigh immediately, then supportive care and transfer; report the AEFI.
• Why: anaphylaxis — epinephrine first, without delay.

Case 4. The refrigerator thermometer reads −2 °C in the morning.

• Action: isolate the vaccines, do a shake test on freeze-sensitive vaccines, discard any that fail, report the cold chain breach, and fix the refrigerator.
• Why: frozen adsorbed vaccines lose potency and may cause local reactions.

• Treating low-grade fever, diarrhea, or malnutrition as contraindications.
• Restarting an interrupted series.
• Freezing hepatitis B, pentavalent, PCV, IPV, Td, or HPV vaccines.
• Using reconstituted BCG or MMR beyond 6 hours or with the wrong diluent.
• Giving BCG subcutaneously (it is intradermal) or MMR intramuscularly (the calendar lists subcutaneous).
• Forgetting HBIG plus vaccine within 12 hours for infants of HBsAg-positive mothers.
• Giving OPV to an immunocompromised child — use IPV.
• Recapping needles.
• Not observing after vaccination.

• RA 10152: mandatory, free basic immunization for children under 5; hepatitis B within 24 hours of birth.
• Birth: BCG (0.05 mL ID) and hepatitis B.
• 6, 10, 14 weeks: pentavalent, bOPV, PCV.
• IPV: 14 weeks and 9 months.
• MMR: 9 and 12 months.
• School: MR and Td in Grades 1 and 7; HPV for girls in Grade 4 or at 9 years, 2 doses 1 year apart.
• Live vaccines: BCG, OPV, MMR — avoid in severe immunodeficiency and pregnancy.
• Cold chain 2–8 °C; do not freeze adsorbed vaccines; shake test; VVM.
• Reconstituted BCG and MMR: discard after 6 hours.
• Observe at least 15 minutes; anaphylaxis = IM epinephrine 0.01 mg/kg immediately.
• Continue, do not restart, an interrupted series.