Expanded Program on Immunization (Philippines)

Introduction

The Expanded Program on Immunization (EPI) in the Philippines began in 1986 in 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 ^[1]

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, DPT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3 and measles vaccines before the child is 12 months of age^[2].

Vaccine	Minimum Age at 1st Dose	Number of Doses	Minimum Interval Between Doses	Reason
Bacillus Calmette-Guérin	Birth or anytime after birth	1	--	BCG given at earliest possible age protects the possibility of TB meningitis and other TB infections in which infants are prone[3]
Diptheria-Pertussis-Typhoid Vaccine	6 weeks	3	4 weeks	An early start with DPT reduces the chance of severe pertussis[4].
Oral Polio Vaccine	6 weeks	3	4 weeks	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	6 weeks interval from 1st dose to 2nd dose, 8 weeks interval from 2nd dose to third dose.	An early start of Hepatitis B vaccine reduces the chance of being infected and becoming a carrier[6]. Prevents liver cirrhosis and liver cancer which are more likely to develop if infected with Hepatitis B early in life[7] [8]. About 9,000 die of complications of Hepatits B. 10% of Filipinos have Hepatitis B infection[9]
Measles Vaccine (not MMR)	9 months	1	--	At least 85% of measles can be prevented by 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^[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 20mg 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].

References

1. Public Health Nursing in the Philippines. Manila, Philippines: National League of Philippine Government Nurses, Inc. 2007. p. 141. ISBN 978-971-91593-2-2.
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. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
3. Puvacic, S. (2004-02). "Protective effect of neonatal BCG vaccines against tuberculous meningitis". Bosnian Journal of Basic Medical Sciences. 4 (1): 46–9. Retrieved 2007-05-11. {{cite journal}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
4. "Immunisation". Dialogue on Diarrhoea Online (30): 1–6. 1987. Retrieved 2007-05-11.
5. 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): 874–5. Retrieved 2007-05-11. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help)
6. Ni, Y. H. (2001-11-06). "Effects of Universal Vaccination for Hepatitis B". Annals of Internal Medicine. 135 (9): S53. Retrieved 2007-05-12. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
7. "A Look at Each Vaccine: Hepatitis B Vaccine". Vaccine Education Center. The Children's Hospital of Philadelphia. Retrieved 2007-05-11.
8. Chang, MH (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): 1906–7. Retrieved 2007-05-12. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
9. Salazar, Tessa R. (2004-05-24). "Cancer Preventable Says US Doctor" (PDF). The Philippine Daily Inquirer. Retrieved 2007-05-11. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
10. Orenstein, WA (1994-05). "Worldwide measles prevention". Israel Journal of Medical Sciences. 30 (5–6): 469–81. Retrieved 2007-05-11. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
11. "Measles (Catch Up Campaigns) - Toolkit for Volunteers". Health Initiative 2010. African Red Cross & Red Crescent. Retrieved 2007-05-12.
12. Zimmerman, Richard Kent (2000-01-01). "Practice Guidelines - The 2000 Harmonized Immunization Schedule". American Family Physician. Retrieved 2007-05-12. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
13. "Management of the Traveler: Vaccination". Travel Medicine. Portal de Saúde Pública. 1997. Retrieved 2007-05-12.
14. "General Recommendations on Immunizations" (PDF). Epidemiology & Prevention of Vaccine-Preventable Diseases--The Pink Book 10th Edition. Centers for Disease Control and Prevention. 2007-02-14. Retrieved 2007-05-12.
15. Department of Vaccines and Biologicals (2000-12). "WHO Recommendations for Diluents" (PDF). Vaccines and Biologicals Update. World Health Organization. p. 3. Retrieved 2007-05-12. {{cite news}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
16. Hoekstra, Edward. "Immunization: Injection Safety". UNICEF Expert Opinion. UNICEF. Retrieved 2007-05-12. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)