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The Expanded Program on Immunization (EPI)

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:

Sustaining high routine Full


Immunized Child (FIC) coverage of at least 90% in all provinces and cities, Sustaining the polio-free country for global certification Eliminating measles by 2008, 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 ANTI- measles vaccines before the child is 12 months of age.

Vaccine

Minimum Age at 1st Dose

Number of Doses

Dose

Minimum Interval Between Doses

Route

Site

Reason

Bacillus Calmette-Gurin

Birth or anytime after birth

1 dose

0.05 mL

none

Intradermal

BCG given at earliest possible age protects the Right deltoid region of the possibility of TB arm meningitis and other TB infections in which infants are prone[3

Diphtheria-PertussisTetanus Vaccine

6 weeks old

3 doses

0.5 mL

6 weeks(DPT 1), 10 weeks (DPT 2), 14 weeks (DPT 3)

Intramuscular

Upper outer portion of the An early start with DPT thigh, Vastus Lateralis (L- reduces the chance of R-L) severe pertussis.[4

Oral Polio Vaccine

6 weeks old

3 doses

2-3 drops

4 weeks

Oral

Mouth

The extent of protection against polio is increased the earlier the OPV is given. Keeps the Philippines polio-free.[5

Hepatitis B Vaccine

At birth

3 doses

0.5 mL

4 weeks interval

Intramuscular

An early start of Hepatitis B vaccine reduces the chance of being infected and becoming a carrier.[6] Prevents liver cirrhosis Upper outer portion of the and liver cancer which are thigh, Vastus Lateralis (R- more likely to develop if L-R) infected with Hepatitis B early in life.[7][8] About 9,000 die of complications of Hepatitis B. 10% of Filipinos have Hepatitis B infection[9]

Measles Vaccine 9 months old (not MMR) 1 dose 0.5 mL none Subcutaneous

At least 85% of measles Upper outer portion of the can be prevented by arms, Right deltiod immunization at this age.[10]

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.

General Principles in Infants/Children Immunization

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)

General Principles in Infants/Children Immunization

diarrhea, malnutrition, kidney or liver


disease, heart or lung disease, nonprogressive 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.

General Principles in Infants/Children Immunization


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.

General Principles in Infants/Children Immunization

Only the diluents 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 diluents to the powder in a single vial or ampoule of freeze-dried vaccine.

General Principles in Infants/Children Immunization

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

Vaccine

Minimum Age/Interval As early as possible during pregnancy

Percent Protected

Duration of Protection

TT1

80%

protection for the mother for the first delivery

TT2

At least 4 weeks later

80%

infants born to the mother will be protected from neonatal tetanus gives 3 years protection for the mother infants born to the mother will be protected from neonatal tetanus gives 5 years protection for the mother infants born to the mother will be protected from neonatal tetanus gives 10 years protection for the mother

TT3

At least 6 months later

95%

TT4

At least 1 year later

99%

TT5

At least 1 year later

99%

gives lifetime protection for the mother all infants born to that mother will be protected

a classification for countries close to maternal and neonatal tetanus elimination.

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,

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

Care for the Vaccines


and further down at the outreach
sites Inappropriate storage, handling and transport of vaccines wont protect patients and may lead to needless vaccine wastage.

(FEFO)

A "first expiry and first out"


vaccine system is practiced to assure that all vaccines are utilized before its expiry date.

Proper arrangement of vaccines


Proper arrangement of vaccines and/or
labelling 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.

cold chain equipment


Each level of health facilities has for
use in the storage vaccines which included cold room, freezer, refrigerator, transport box, vaccine carriers, thermometers, ice packs, cold chain monitors temperature monitoring chart and safety collector boxes

Cold Chain under EPI


Most sensitive to heat: Freezer (-15 to -25 degrees C)
OPV Measles

Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)


BCG DPT Hepa B TT

References
^ Public Health Nursing in the Philippines. Manila, Philippines: National League of Philippine Government Nurses, Inc. 2007. p. 141.ISBN 978-97191593-2-2. ^ "Six Out of Ten Children 12 to 23 Months Are Fully Immunized". Final Results from the 2002 Maternal and Child Health Survey(National Statistics Office). 2003-06-02. Retrieved 2007-05-11. ^ Puvacic, S.; Dizdarevi, J; Santi, Z; Mulaomerovi, M (2004-02). "Protective effect of neonatal BCG vaccines against tuberculous meningitis". Bosnian Journal of Basic Medical Sciences 4 (1): 46 9. PMID 15628980.

References
^ "Immunisation". Dialogue on Diarrhoea Online (30): 16. 1987. Retrieved 2007-05-11. ^ Centers for Disease Control and Prevention (2001-10-12). "Public Health Dispatch: Acute Flaccid Paralysis Associated with Circulating Vaccine-Derived Poliovirus --- Philippines, 2001". Morbidity and Mortality Weekly Report 50 (40): 8745. PMID 11666115. Retrieved 2007-05-11. ^ Ni, Y. H.; M.H. Chang, L.M. Huang, H.L. Chen, H.Y. Hsu, T.Y. Chiu, K.S. Tsai, and D.S. Chen (2001-11-06). "Effects of Universal Vaccination for Hepatitis B". Annals of Internal Medicine 135 (9): 796 800. PMID 11694104. Retrieved 2007-05-12. ^ "A Look at Each Vaccine: Hepatitis B Vaccine". Vaccine Education Center. The Children's Hospital of Philadelphia. Archived from the original on 2007-06-29. Retrieved 2007-05-11.

References
^ Chang, MH; C.J. Chen, M.S. Lai, H.M. Hsu, T.C. Wu, M.S. Kong, D.C. Liang, W.Y. Shau, D.S. Chen (1997-06-26). "Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group". The New England Journal of Medicine 336 (26): 1855 1859. doi:10.1056/NEJM199706263362602. PMID 91 97213. ^ Salazar, Tessa R. (2004-05-24). "Cancer Preventable Says US Doctor" (PDF). The Philippine Daily Inquirer. Archived from the original on 2007-0221. Retrieved 2007-05-11.

References
^ Orenstein, WA; L.E. Markowitz, W.L. Atkinson, A.R. Hinman (1994-05). "Worldwide measles prevention". Israel Journal of Medical Sciences 30 (56): 46981. PMID 8034506. ^ "Measles (Catch Up Campaigns) - Toolkit for Volunteers". Health Initiative 2010. African Red Cross & Red Crescent. Archived fromthe original on 2007-04-15. Retrieved 2007-0512. ^ Zimmerman, Richard Kent (2000-0101). "Practice Guidelines - The 2000 Harmonized Immunization

References
^ "Management

of the Traveler: Vaccination". Travel Medicine. Portal de Sade Pblica. 1997. Retrieved 2007-05-12. ^ "General Recommendations on Immunizations" (PDF). Epidemiology & Prevention of VaccinePreventable Diseases--The Pink Book 10th Edition. Centers for Disease Control and Prevention. 2007-02-14. Retrieved 200705-12. ^ Department of Vaccines and Biologicals (2000-12). "WHO Recommendations for Diluents" (PDF). Vaccines and Biologicals Update(World Health Organization): pp. 3. Retrieved 2007-0512. ^ Hoekstra, Edward. "Immunization: Injection Safety". UNICEF Expert Opinion (UNICEF). Retrieved 2007-05-12.

References
^ "Tetanus - The Disease". Immunization, Vaccines and Biologicals. World Health Organization. Retrieved 2007-05-12. ^ "Maternal and Neonatal Tetanus" (PDF). UNICEF. 2000-11. Retrieved 2007-05-12. ^ "Temperature Sensitivity of Vaccines" (PDF). Immunization, Vaccines and Biologicals (World Health Organization). 2006-08. Retrieved 2007-05-12. ^ "Handle Vaccines with Care". British Columbia Center for Disease Control. Archived from the original on 2007-10-07. Retrieved 2007-05-12. ^ Expanded Program on Immunization Manual. Manila, Philippines: Department of Health, Philippines. 1995.