EXPANDED PROGRAM ON IMMUNIZATION

Immunization (WHO)

 Immunization is the process whereby a person is made immune or resistant to an infectious disease,
typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to
protect the person against subsequent infection or disease.

 Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and
is estimated to avert over between 2 and 3 million deaths each year. It is one of the most cost-
effective health investments, with proven strategies that make it accessible to even the most hard-to-
reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively
through outreach activities; and vaccination does not require any major lifestyle change.

Expanded Program on Immunization (DOH)

 Children need not die young if they receive complete and timely immunization. Children who are not
fully immunized are more susceptible to common childhood diseases. The Expanded Program on
Immunization is one of the DOH Programs that has already been institutionalized and adopted by all
LGUs in the region. Its objective is to reduce infant mortality and morbidity through decreasing the
prevalence of immunizable diseases (TB, diphtheria, pertussis, tetanus, polio and measles)
 Special campaigns have been undertaken to improve further program implementation, notably
the National Immunization Days (NID), Knock Out Polio (KOP) and Garantisadong Pambata (GP)
since 1993 to 2000. This is being supported by increasing/sustaining the routine immunization and
improved surveillance system.

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.

The EPI Target Disease

 Measles
 Tuberculosis
 Diphtheria
 Pertussis
 Poliomyelitis
 Neonatal Tetanus
 Hepatitis B

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.

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.

 Bacillus Calmette-Guérin (BCG)

 Minimum age at 1st dose: At birth or anytime after birth
 Number of dose/s: 1
 Dose: 0.05 ml
 Route: Intradermal
 Site: Right deltoid region of the arm
 Reason: BCG given at earliest possible age protects the possibility of TB meningitis and
other TB infections in which infants are prone

 Oral Polio Vaccine (OPV)

 Minimum age at 1st dose: 6 weeks
 Number of dose/s: 3
 Dose: 2-3 drops
 Minimum Interval between Doses: 4 weeks
 Route: Oral
 Site: Mouth
  Reason: The extent of protection against polio is increased the earlier the OPV is given.
Keeps the Philippine polio free

 Hepatitis B Vaccine (Hep B)

 Minimum age at 1st dose: At birth
 Number of dose/s: 3
 Dose: 0.5 mL
 Minimum Interval between Doses: 6 weeks interval from
1st dose to 2nd dose,
8 weeks interval from
2nd dose to third dose.
 Route: Intramuscular
 Site: Upper outer portion of the thigh
 Reason: An early start of Hep B reduces the chance of being infected and becoming a carrier.
Prevent liver cirrhosis and liver cancer.

 Measles Vaccine
 Minimum age at 1st dose: 9 months
 Number of dose/s: 1
 Dose: 0.5 mL
 Route: Subcutaneous
 Site: Upper outer portion of the arms
 Reason: At least 85% of measles can be prevented by immunization at this age.

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 Percent Protected Duration of Protection

TT1 As early as possible

during pregnancy

TT2 At least 4 weeks later 80%  Infants born to the

mother will be
protected from tetanus
 Gives 3 years protection
for the mother
TT3 At least 6 months later 95%  Infants born to the
mother will be
protected from
neonatal tetanus
 Gives 5 years
protection for the
 mother
TT4 At least one year later 99%  Infants born to the
mother will be
protected from
neonatal tetanus
 Gives 10 years
protection for the
mother
TT5 Al least one year later 99%  Gives life time
protection for the
mother
 All infants born to
that mother will be
protected

The EPI Vaccines and its Characteristics

Type/Form of Vaccines Storage Tempearture

Most Sensitive to Heat Oral Polio (live attenuated) -15°C to -25°C (at the freezer)

Measles (freeze dried) -15°C to -25°C (at the freezer)

Least Sensitive to Heat DPT/Hep B +2°C to +8°C (in the body of

the refrigerator)
“D” Toxoid which is a weakened toxin
“P” killed bacteria
“T” Toxoid which is a weakened toxin
Hep B +2°C to +8°C (in the body of
the refrigerator)
BCG (freeze dried) +2°C to +8°C (in the body of
the refrigerator)
Tetanus Toxoid