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. 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.

Minimum
Minimum
Number Interval
Vaccine Age Dose Route Site Reason
of Doses Between
at 1st Dose
Doses

BCG given at earliest

Right
Bacillus Birth or possible age protects the
0.05 deltoid
Calmette- anytime 1 -- Intradermal possibility of TB meningitis
mL region of
Guérin after birth and other TB infections in
the arm
which infants are prone[3]

Diphtheria- Upper
An early start with DPT
Pertussis- 0.5 outer
6 weeks 3 4 weeks Intramuscular reduces the chance of
Tetanus mL portion of
severe pertussis[4].
Vaccine the thigh

Oral Polio 6 weeks 3 2-3 4 weeks Oral Mouth The extent of protection
Vaccine drops against polio is increased
the earlier the OPV is
given.
Keeps the Philippines
 polio-free[5].

An early start of Hepatitis

B vaccine reduces the
chance of being infected
6 weeks
and becoming a carrier[6].
interval from
Prevents liver cirrhosis and
1st dose to Upper
liver cancer which are more
Hepatitis B 0.5 2nd dose, outer
At birth 3 Intramuscular likely to develop if infected
Vaccine mL 8 weeks portion of
with Hepatitis B early in
interval from the thigh
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]

Measles Upper
At least 85% of measles
Vaccine 0.5 outer
9 months 1 -- Subcutaneous can be prevented by
mL portion of
immunization at this age[10].
the arms
(not MMR)

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 38.5º 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 [17].

Percent
Vaccin Minimum
Protecte Duration of Protection
e Age/Interval
d

As early as possible
TT1 -- --
during pregnancy

 infants born to the mother will be protected from neonatal

TT2 At least 4 weeks later 80% tetanus
 gives 3 years protection for the mother

 infants born to the mother will be protected from neonatal

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

 infants born to the mother will be protected from neonatal

TT4 At least 1 year later 99% tetanus
 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.

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.