EXPANDED IMMUNIZATION PROGRAM

The Expanded Program on Immunization (EPI) in

the Philippines began in July 1979. And, in 1986, made a response to
the Universal Child Immunization goal. The four major strategies
include:

1. Sustaining high routine Full Immunized Child (FIC) coverage of

at least 90% in all provinces and cities,
2. Sustaining the polio-free country for global certification
3. Eliminating measles by 2008,
4. Eliminating neonatal tetanus by 2008.

Routine Immunization Schedule for Infants

The standard routine immunization schedule for infants in the
Philippines is adopted to provide maximum immunity against the
seven vaccine preventable diseases in the country before the child's
first birthday. The fully immunized child must have completed BCG 1,
DPT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3, HB 1, HB 2, HB 3 and
measles vaccines before the child is 12 months of age.

Minimu
Minimu Numb m
Vaccin m Age er D Interval
Route Site Reason
e at 1st of ose Betwee
Dose Doses n
Doses

Bacillus Birth or 1 0.05 -- Intradermal Right BCG given

Calmett anytime mL deltoi at earliest
e- after d possible
Guérin birth regio age
n of protects
 the
possibility
of TB
meningitis
the and other
arm TB
infections
in which
infants are
prone

Uppe An early
Diptheri
r start with
a-
outer DPT
Pertuss 0.5 Intramuscul
6 weeks 3 4 weeks portio reduces
is- mL ar
n of the chance
Tetanus
the of severe
Vaccine
thigh pertussis.

The extent
of
protection
against
polio is
Oral 2-3
Mout increased
Polio 6 weeks 3 drop 4 weeks Oral
h the earlier
Vaccine s
the OPV is
given.
Keeps the
Philippines
polio-free.

Hepatiti At birth 3 0.5 6 weeks Intramuscul Uppe An early

sB mL interval ar r start of
Vaccine from outer Hepatitis B
1st dose portio vaccine
 reduces
the chance
of being
infected
and
becoming a
carrier.
Prevents
liver
cirrhosis
and liver
to 2nd
cancer
dose,
which are
8 weeks
more likely
interval n of
to develop
from the
if infected
2nd thigh
with
dose to
Hepatitis B
third
early in life.
dose.
About
9,000 die
of
complicatio
ns of
Hepatits B.
10% of
Filipinos
have
Hepatitis B
infection

9 1 0.5 -- Subcutaneo Uppe At least

Measle months mL us r 85% of
s outer measles
Vaccine portio can be
n of prevented
(not the by
MMR) arms immunizati
on at this
 age.

General Principles in Infants/Children Immunization

 Because measles kills, every infant needs to be vaccinated

against measles at the age of 9 months or as soon as possible
after 9 months as part of the routine infant vaccination schedule. It
is safe to vaccinate a sick child who is suffering from a minor
illness (cough, cold, diarrhea, fever or malnutrition) or who has
already been vaccinated against measles.
 If the vaccination schedule is interrupted, it is not necessary to
restart. Instead, the schedule should be resumed using minimal
intervals between doses to catch up as quickly as possible.
 Vaccine combinations (few exceptions), antibiotics, low-dose
steroids (less than 20mg per day), minor infections with low fever
(below 38.5º Celsius), diarrhea, malnutrition, kidney or liver
disease, heart or lung disease, non-progressive encephalopathy,
well controlled epilepsy or advanced age, are not contraindications
to vaccination. Contrary to what the majority of doctors may think,
vaccines against hepatitis B and tetanus can be applied in any
period of the pregnancy.
 There are very few true contraindication and precaution conditions.
Only two of these conditions are generally considered to be
permanent: severe (anaphylactic) allergic reaction to a vaccine
component or following a prior dose of a vaccine, and
encephalopathy not due to another identifiable cause occurring
within 7 days of pertussis vaccination.
 Only the diluent supplied by the manufacturer should be used to
reconstitute a freeze-dried vaccine. A sterile needle and sterile
syringe must be used for each vial for adding the diluent to the
powder in a single vial or ampoule of freeze-dried vaccine.
 The only way to be completely safe from exposure to blood-borne
diseases from injections, particularly hepatitis B virus (HBV),
 hepatitis C virus (HCV), and human immunodeficiency virus (HIV)
is to use one sterile needle, one sterile syringe for each child.

Tetanus Toxoid Immunization Schedule for Women

When given to women of childbearing age, vaccines that contain

tetanus toxoid (TT or Td) not only protect women against tetanus, but
also prevent neonatal tetanus in their newborn infants.

Minimum Percent
Vaccine Duration of Protection
Age/Interval Protected

As early as
possible
TT1 -- --
during
pregnancy

 infants born to the mother will

be protected from neonatal
At least 4 weeks tetanus
TT2 80%
later
 gives 3 years protection for
the mother
 infants born to the mother will
be protected from neonatal
At least 6 tetanus
TT3 95%
months later
 gives 5 years protection for
the mother
TT4 At least 1 year 99%  infants born to the mother will
later be protected from neonatal
 tetanus

 gives 10 years protection for

the mother
 gives lifetime protection for
the mother
At least 1 year
TT5 99%
later
 all infants born to that mother
will be protected

In June 2000, the 57 countries that have not yet achieved elimination
of neonatal tetanus were ranked and the Philippines was listed
together with 22 other countries in Class A, a classification for
countries close to maternal and neonatal tetanus elimination.

Care for the Vaccines

To ensure the optimal potency of vaccines, careful attention is
needed in handling practices at the country level. These include
storage and transport of vaccines from the primary vaccine store
down to the end-user at the health facility, and further down at the
outreach sites. Inappropriate storage, handling and transport of
vaccines won’t protect patients and may lead to needless vaccine
wastage.
A "first expiry and first out" (FEFO) vaccine system is practiced to
assure that all vaccines are utilized before its expiry date. Proper
arrangement of vaccines and/or labeling of expiry dates are done to
identify those close to expiring. Vaccine temperature is monitored
twice a day (early in the morning and in the afternoon) in all health
facilities and plotted to monitor break in the cold chain. Each level of
health facilities has cold chain equipment for use in the storage
vaccines which included cold room, freezer, refrigerator, transport
box, vaccine carriers, thermometers, cold chain monitors, ice packs,
temperature monitoring chart and safety collector boxes
REFERENCE:
http://en.wikipedia.org/wiki/Expanded_Program_on_Immunization(Phi
lippines)