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, 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].

Vaccine	Minimum Age at 1st Dose	Number of Doses	Dose	Minimum Interval Between Doses	Route	Site	Reason
Bacillus Calmette-Guérin	Birth or anytime after birth	1	0.05 mL	--	Intradermal	Right deltoid region of the arm	BCG given at earliest possible age protects the possibility of TB meningitis and other TB infections in which infants are prone[3]
Diptheria-Pertussis-Tetanus Vaccine	6 weeks	3	0.5 mL	4 weeks	Intramuscular	Upper outer portion of the thigh	An early start with DPT reduces the chance of severe pertussis[4].
Oral Polio Vaccine	6 weeks	3	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	0.5 mL	6 weeks interval from 1st dose to 2nd dose, 8 weeks interval from 2nd dose to third dose.	Intramuscular	Upper outer portion of the thigh	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	0.5 mL	--	Subcutaneous	Upper outer portion of the arms	At least 85% of measles can be prevented by immunization at this age[10].

==General Principlach vial for adding the diluent to the powder in a single vial or ampoule of freeze-dried vaccine^[11].

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^[12].

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^[13].

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 neonatal 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 1 year later	99%	infants born to the mother will be protected from neonatal tetanus gives 10 years protection for the mother
TT5	At least 1 year later	99%	gives lifetime protection for the mother 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^[14].

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^[15]. Inappropriate storage, handling and transport of vaccines won’t protect patients and may lead to needless vaccine wastage^[16].

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 ^[17].

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. 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)
12. Hoekstra, Edward. "Immunization: Injection Safety". UNICEF Expert Opinion. UNICEF. Retrieved 2007-05-12. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
13. "Tetanus - The Disease". Immunization, Vaccines and Biologicals. World Health Organization. Retrieved 2007-05-12.
14. "Maternal and Neonatal Tetanus" (PDF). UNICEF. 2000-11. Retrieved 2007-05-12. {{cite news}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
15. "Temperature Sensitivity of Vaccines" (PDF). Immunization, Vaccines and Biologicals. World Health Organization. 2006-08. Retrieved 2007-05-12. {{cite news}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
16. "Handle Vaccines with Care" (PDF). British Columbia Center for Disease Control. Retrieved 2007-05-12. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
17. Expanded Program on Immunization Manual. Manila, Philippines: Department of Health, Philippines. 1995.