Expanded Program on Immunization (Philippines)

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]

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[2].

Minimum
Minimum
Number Interval
Vaccine Age Dose Route Site Reason
of Doses Between
at 1st Dose
Doses
BCG given at
earliest possible age
Right
protects the
Bacillus Birth or deltoid
0.05 possibility of TB
Calmette- anytime 1 -- Intradermal region
mL meningitis and
Guérin after birth of the
other TB infections
arm
in which infants are
prone[3]
Upper
Diphtheria- An early start with
outer
Pertussis- 0.5 DPT reduces the
6 weeks 3 4 weeks Intramuscular portion
Tetanus mL chance of severe
of the
Vaccine pertussis[4].
thigh
Oral Polio 6 weeks 3 2-3 4 weeks Oral Mouth The extent of
 protection against
polio is increased
the earlier the OPV
Vaccine drops is given.
Keeps the
Philippines polio-
free[5].
An early start of
Hepatitis B vaccine
reduces the chance
of being infected
and becoming a
6 weeks
carrier[6].
interval
Prevents liver
from
Upper cirrhosis and liver
1st dose to
outer cancer which are
Hepatitis B 0.5 2nd dose,
At birth 3 Intramuscular portion more likely to
Vaccine mL 8 weeks
of the develop if infected
interval
thigh with Hepatitis B
from
early in life[7][8].
2nd dose to
About 9,000 die of
third dose.
complications of
Hepatits B. 10% of
Filipinos have
Hepatitis B
infection[9]
Upper At least 85% of
Measles
outer measles can be
Vaccine 0.5
9 months 1 -- Subcutaneous portion prevented by
mL
of the immunization at
(not MMR)
arms this age[10].

[edit] 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[11].
 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.[12].
 Vaccine combinations (few exceptions), antibiotics, low-dose steroids (less than 20 mg
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[13].
 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[14].
 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[15].
 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[16].

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[17].

Minimum Percent
Vaccine Duration of Protection
Age/Interval Protected
As early as
TT1 possible -- --
during pregnancy
 infants born to the mother will be protected from
At least 4 weeks neonatal tetanus
TT2 80%
later  gives 3 years protection for the mother

 infants born to the mother will be protected from

At least 6 months neonatal tetanus
TT3 95%
later  gives 5 years protection for the mother

 infants born to the mother will be protected from

neonatal tetanus
TT4 At least 1 year later 99%
 gives 10 years protection for the mother

 gives lifetime protection for the mother

TT5 At least 1 year later 99%  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[18]. sus

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[19].
Inappropriate storage, handling and transport of vaccines won’t protect patients and may lead to
needless vaccine wastage[20].

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 [21].