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 Schedule of Immunization Every Wednesday is designated as immunization day and is adopted in all parts of the country. Immunization is done monthly in barangay health stations, quarterly in remote areas of the country. 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. 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 20 mg per day), minor infections with low fever (below 38.5 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. 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,a 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 wont 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

http://en.wikipedia.org/wiki/Expanded_Program_on_Immunization_(Philippines)

Pentavalent vaccine, Easyfive, removed from WHO list of prequalified vaccines WHO 17 AUGUST 2011 - Following a routine audit conducted by a WHO team of one of the manufacturing sites of the vaccine manufacturer, Panacea Biotec, and the subsequent conclusions of an ad hoc committee convened by WHO, the pentavalent vaccine, Easyfive, has been delisted from WHO's list of prequalified vaccines. Easyfive, containing diphtheria, tetanus, whole cell pertussis, hepatitis B andhaemophilus influenzae type b components, and two other vaccines a DTwPhepatitis B vaccine and a monovalent hepatitis B vaccine produced by Panacea, were delisted as a result of deficiencies in quality systems found at the company's Lalru manufacturing site. The decision to delist was made because of the risk, unless corrective action is taken by the manufacturer, that the quality and safety of future batches of these vaccines will be compromised. Batches of these vaccines already distributed to countries should not be recalled and should continue to be used. This is because there is no evidence of quality or safety defects with batches already distributed whereas there is a real risk, if immunization is withheld, of death or morbidity from the diseases against which the vaccines protect. With regard to vaccine supply, the main concern brought about by this situation relates to sufficiency of supply of the pentavalent vaccine. WHO and UN procurement agencies have assessed that demand for pentavalent vaccine in 2011 can be filled by existing suppliers of prequalified pentavalent vaccine. Options to ensure sufficient supply to meet demand for pentavalent vaccine in the mid- to long term are being reviewed. The prequalified oral polio virus vaccines manufactured by the company remain prequalified, given that they are produced at a different site to that which was recently audited and the fact that there is no evidence available to WHO of inadequate quality assurance. http://www.who.int/immunization/newsroom/newsstory_dtp_hepb_removed_prequal_list /en/index.html

The MMR vaccine is a "3-in-1" vaccine that protects against measles, mumps, and rubella -- all of which are potentially serious diseases of childhood. Information WHO SHOULD GET THIS VACCINE The MMR is one of the recommended childhood immunizations. Usually, proof of MMR vaccination is needed to go to school.

The first shot is given when the child is 12 to 15 months old. To make sure the child is properly protected, the vaccine must not be given too early. A second MMR shot is given before a child enters school at 4 - 6 years, but may be given at any time after that. Some states require a second MMR before a child starts kindergarten.

Adults 18 years or older who were born after 1956 should also receive the MMR vaccine if:

They are not sure whether or when they received an MMR They had only had one MMR vaccine before starting school

Adults born during or before 1956 are believed to be immune. Many people within that age group had the actual diseases during childhood. Women of reproductive age who have not received the MMR vaccination in the past should have a blood test to see if they are immune. Being immune means they have had the disease or the vaccine in the past, and are now protected. If they are not immune, they should receive the MMR vaccine. Women should NOT receive this vaccine if they are pregnant or planning to become pregnant within the next 1 to 3 months. This may harm the baby. BENEFITS One MMR shot will protect most people from contracting measles, mumps, or rubella throughout their lives. The second MMR shot is recommended to cover people who may not have gotten full protection from the first MMR shot. Measles is a virus which causes a rash, cough, runny nose, eye irritation, and fever in most people. It can also lead to pneumonia, seizures, brain damage, and death in some cases.

The mumps virus causes fever, headache, and swollen glands. It can also lead to deafness, meningitis, swollen testicles or ovaries, and death in some cases. Rubella, also known as the German measles, is generally a mild disease. However, it can cause serious birth defects in the child of a woman who becomes infected while pregnant. RISKS AND SIDE EFFECTS Most people who receive the MMR will have no problems from it. Others may have minor problems, such as soreness and redness where the shot was given, or fevers. Serious problems from receiving the MMR are rare. Potential mild to moderate side effects include:

Fever (1 in 6 children) Rash (1 in 20) Swollen glands (rare) Seizure (1 in 3,000) Joint pain/stiffness (1 in 4, usually young women) Low platelet count/bleeding (1 in 30,000)

If a rash develops without other symptoms, no treatment is needed. It should go away within several days. Severe side effects may include:

Allergic reaction (less than 1 per million) Long-term seizure, brain damage, or deafness (so rare that the association with the vaccine is questionable)

There is NO evidence linking MMR vaccination with the development of autism. See also:

Immunizations - general overview The Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines)

The potential benefits from receiving the MMR vaccine far outweigh the potential risks. Measles, mumps, and rubella are all very serious illnesses. They each can have

complications that lead to lifetime disability or even death. For every 1,000 children who get measles, 1 or 2 will die from it. CONSIDERATIONS If the child is ill with something more serious than just a cold, immunization may be delayed. Tell your health care providers if your child had any problems with the first MMR vaccine before scheduling the second one. The MMR vaccine should not be given to people who have:

An allergy to gelatin or the antibiotic neomycin that is serious enough to require medical treatment A weakened immune system due to certain cancers, HIV, steroid drugs, chemotherapy, radiation therapy, or other drugs that suppress the immune system

You should not receive this vaccine if you are pregnant or planning to become pregnant within the next 3 months. People who have received transfusions or other blood products (including gamma globulin) or who have had low platelet counts should discuss the proper timing of the MMR vaccine with their health care provider. CALL YOUR DOCTOR IF:

You aren't sure if a person should get, avoid, or delay the MMR vaccine You have moderate or serious symptoms after receiving the vaccine Other symptoms that are not common side effects of the MMR vaccine develop You have any other questions or concerns related to the vaccine http://www.nlm.nih.gov/medlineplus/ency/article/002026.htm

Measles Vaccine A number of live, attenuated measles vaccines are currently available, either as monovalent vaccine or as measles-containing vaccine combinations with one or more of rubella (R), mumps (M) and varicella vaccines. The measles/ mumps/rubella (MMR) or measles/rubella (MR) vaccine is given in many countries instead of monovalent measles vaccine. The measles vaccines that are now internationally available are safe and effective and may be used interchangeably in immunization programmes. Every child should receive two doses of measles vaccine. The second dose may be given as early as 1 month following the first, depending on the local programmatic and epidemiological situation. Special attention must be paid to all children and adolescent/young adult travellers who have not received two doses of measles vaccine. Measles is still common in many countries and travel in densely populated areas may favour transmission. For infants travelling to countries experiencing extensive measles transmission, a dose of vaccine may be given as early as 6 months of age. However, children who receive the first dose between 6 and 8 months of age should subsequently receive the two doses according to the national schedule. Older children or adults who did not receive the two lifetime doses should consider measles vaccination before travel. Given the severe course of measles in patients with advanced HIV infection, measles vaccination should be routinely administered to potentially susceptible, asymptomatic HIV-positive children and adults. Measles vaccination may be considered even in individuals with symptomatic HIV infection, provided that they are not severely immunosuppressed. Where the risk of contracting measles infection is negligible, physicians who are able to monitor CD4 counts may prefer to delay the use of measles vaccine until CD4 counts are above 200. Following measles vaccination no increased risk of serious adverse events has been demonstrated in HIV-positive compared with HIV-negative children, although lower antibody levels may be found in the former group.

http://www.who.int/ith/vaccines/measles/en/