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EXPANDED PROGRAM IMMUNIZATION

Because of the global burden on child morbidity and mortality, last 1976 the Expanded Program on Immunization shortly known as EPI was developed. It primarily focuses on reaching the bright goal of Fully Immunized Child (FIC) and to improve the rate for Child Protected at Birth (CPAB) in the country. EPI was established to ensure the access of infant and children (0- 12months old) to the recommended vaccines which in return could prevent the seven common diseases, i.e.: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis or whooping cough, measles and hepatitis. According to DOH, the specific goals for the Expanded Program on Immunization are: 1. To immunize all infants/children against the most common vaccine-preventable diseases. To make sure that all children in the country are Fully Immunized Child (FIC), the Department of Health utilizes several strategies such as the Reaching Every Barangay or REB strategy adapted from WHOUNICEFs Reaching Every District (RED) strategy, Supplemental Immunization Activity (SIA) to reduce the rate of missed children or drop outs from routine immunization, and also through a strengthened disease surveillance. The routine schedule for immunization is every Wednesday, which is done monthly in every bagangay health stations and quarterly in far flung areas. Vaccine Dose Route Site Min. No. of Age at Doses 1st dose Min. Interval between Doses

Reason It is given the earliest possible to protect the child from TB meningitis and other forms of TB infection.

BCG (Bacillus CalmetteGuerin) DPT (Diphtheria, Pertussis, Tetanus)

0.05ml

Right Birth or deltoid anytime Intradermal of the after arm birth Upper outer Intramuscular 6 weeks portion of thigh

0.5ml

4 weeks

It reduces the chance from severe pertussis.

OPV (Oral Polio Vaccine)

2 drops depending on manufacturers instructions

Oral

Mouth 6 weeks

HBV (Hepatitis B Vaccine)

0.5ml

Upper outer Intramuscular At birth portion of thigh

The extent of protection from polio is increased 4 weeks if given earlier. It keeps the Philippines poliofree. 6 weeks It reduces the interval from chance of being 1st dose to infected and 2nd dose and becoming a B weeks carrier; prevents

interval from an individual 2nd dose to from having liver 3rd dose cirrhosis and liver cancer. Outer part of 9 Subcutaneous the months upper arm At least 85% of measles can be prevented at this age.

Measles

0.5ml

A child is said to be a Fully Immunized Child if he receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HBV and one dose of Measles before his first birthday. 2. To sustain the polio-free status of the Philippines. As one concept in the eradication of disease initiative is to sustain the country from being poliofree for global certification. The Polio Eradication Project was established last 1992. It has gained high regard in implementing its core advocacy, achieving 92% of its routine coverage and happy to say that the country has maintained to be polio- free since October 2000. Being polio- free is never an assurance for cases, so there is still an on-going polio mass immunization for children aging 6 weeks up to 59 months old in high risk areas in the country for neonatal tetanus. 3. To eliminate measles infection. Last 2011 the DOH conducted the 4th mass Measles Rubella Campaign nationwide. The theme, Iligtas sa Tigdas ang Pinas lead the campaign last April to June 2011. All children with ages 9 months up to 8 years were given with one dose of Measles-Rubella Vaccine (MR). They utilized Supplemental Immunization strategy and Rapid Coverage Assessment (RCA) to make sure that there is no missed child for the campaign. Reports from the RCA tell that in general, 97.6% were vaccinated with MR in all randomly selected barangays. 4. To eliminate maternal and neonatal tetanus Pregnant women are also the target of this program. Tetanus Toxoid (TT) is given not only to protect the mother from tetanus during childbirth but also to prevent the occurrence of neonatal tetanus. TT (0.5ml) is given intramuscularly at the deltoid region of the upper arm. The following schedule for injection should be followed to attain the ideal percentage of protection for both the mother and the infant. Vaccine TT1 TT2 Min. Age/ Interval As early as possible during pregnancy At least 4 weeks later 80% Infants: Protected from neonatal tetanus Percent Protected Duration Protection

TT3

At least 6 weeks later

95%

Mother: 3 years protection Infant: Protected from neonatal tetanus Mother:5 years protection Infant: Protected from neonatal tetanus Mother: 10 years protection Infant: Protected from neonatal tetanus Mother: Lifetime immunity

TT4

At least 1 year later

99%

TT5

At least 1 year later

99%

5. To control diphtheria, pertussis, hepatitis b and German measles. The recent combination of DPT, Hepatitis B and HIB or Haemophilus Influenza Type B is being continuously given to control the rate of cases of these diseases. One disease that is prevented by giving this recent vaccine for children is purulent meningitis which causes acute inflammation of the epiglottisleading to suffocation in infants and small children. 6. To prevent extra pulmonary tuberculosis among children. Part of the ENC or Essential Newborn Care Package is the giving of BCG and Hepatitis B at birth in compliance to R.A. 10152 or the Mandatory Infants and Children Health Immunization Act of 2011. In adherence to eradication of common preventable disease, vaccines should be well taken care and stored accordingly to maintain its potency. Vaccines are very sensitive substances to heat and cold temperatures. It is also a NO-NO for spoilage thus proper handling, transporting and storing should be put into consideration. The policy of FEFO or First Expiry First Out guarantees that all vaccines are used prior to its expiry dates. That is why vaccines should be properly labelled with its expiry dates and they should be organized accordingly. On the other hand, the temperature of storage should be monitored twice a day (early in the morning and in the afternoon) and plotted in a temperature monitoring chart. The purpose is to determine if there is a break in the cold chain. Characteristics of Vaccines Type and Form of Vaccine Most Sensitive to Heat OPV (Live Attenuated) Measles (freeze dried) Least Sensitive to Heat DPT and Hepatitis B Vaccines Storage Temp. -150C to -250C (freezer) +20C to +80C

D Weakened toxin P Killed Bacteria T Weakened toxin BCG (freeze dried) Tetanus Toxiod

(body of the refrigerator)

Nursing Roles and Responsibilities


Maintain a master list of eligible children for immunization. Administer immunization following the protocols in right administration of vaccines (right dose, right route, right schedule and interval, and proper utilization of cold chain). Infuse proper aseptic technique and infection control (one syringe: one child and proper disposal of syringes) Provide health teachings regarding EPI i.e. scheduled immunization activity to enhance the awareness of community and motivate them to adhere with the campaigns. Conduct visits in the community to assess their needs and to identify cases of EPI diseases. Have an updated record of children who had received immunization and the like and report cases if there is.