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Expanded Program on Immunization (Philippines)

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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,

Sustaining the polio-free country for global certification

Eliminating measles by 2008,

Eliminating neonatal tetanus by 2008.

Contents

[hide]

1 Routine Schedule of Immunization

2 Routine Immunization Schedule for


Infants

3 General Principles in Infants/Children


Immunization

4 Tetanus Toxoid Immunization Schedule


for Women
5 Care for the Vaccines

6 References

[edit] 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.

[edit] 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[2].

Minimum Numb Minimum


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

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

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

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

Hepatitis B At birth 3 0.5 6 weeks Intramuscu Upper An early start of


Vaccine mL interval outer Hepatitis B vaccine
reduces the chance
of being infected
and becoming a
carrier[6].
from
Prevents liver
1st dose
cirrhosis and liver
to 2nd
cancer which are
dose,
portion more likely to
8 weeks
lar of the develop if infected
interval
thigh with Hepatitis B
from
early in life[7][8].
2nd dose
About 9,000 die of
to third
complications of
dose.
Hepatits B. 10% of
Filipinos have
Hepatitis B
infection[9]

Upper At least 85% of


Measles outer measles can be
Vaccine 0.5 Subcutane
9 months 1 -- portion prevented by
mL ous
(not MMR) of the immunization at
arms this age[10].

[edit] 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 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[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].

[edit] 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
Protect Duration of Protection
e Age/Interval
ed

As early as
TT1 possible -- --
during pregnancy

infants born to the mother will be protected from


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

infants born to the mother will be protected from


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

infants born to the mother will be protected from


At least 1 year neonatal tetanus
TT4 99%
later
gives 10 years protection for the mother

At least 1 year gives lifetime protection for the mother


TT5 99%
later 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[18]. sus

[edit] Care for the Vaccines

To ensure the optimal potency of vaccines,a 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[19]. Inappropriate storage, handling and transport of vaccines won’t
protect patients and may lead to needless vaccine wastage[20].

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 [21].

[edit] References

^ Public Health Nursing in the Philippines. Manila, Philippines: National League of Philippine Government Nurses, Inc.
2007. p. 141. ISBN 978-971-91593-2-2.

^ "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.
http://www.census.gov.ph/data/pressrelease/2003/pr0351tx.html. Retrieved 2007-05-11.

^ Puvacic, S.; Dizdarević, J; Santić, Z; Mulaomerović, M (2004-02). "Protective effect of neonatal BCG vaccines against
tuberculous meningitis.". Bosnian Journal of Basic Medical Sciences 4 (1): 46–9. PMID 15628980.

^ "Immunisation". Dialogue on Diarrhoea Online (30): 1–6. 1987. http://rehydrate.org/dd/su30.htm. Retrieved 2007-05-
11.

^ 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.
PMID 11666115. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5040a3.htm. Retrieved 2007-05-11.

^ Ni, Y. H.; M.H. Chang, L.M. Huang, H.L. Chen, H.Y. Hsu, T.Y. Chiu, K.S. Tsai, and D.S. Chen (2001-11-06). "Effects of
Universal Vaccination for Hepatitis B". Annals of Internal Medicine 135 (9): S53. PMID 11694104.
http://www.annals.org/cgi/content/summary/135/9/796. Retrieved 2007-05-12.

^ "A Look at Each Vaccine: Hepatitis B Vaccine". Vaccine Education Center. The Children's Hospital of Philadelphia.
http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75730. Retrieved 2007-05-11.

^ Chang, MH; C.J. Chen, M.S. Lai, H.M. Hsu, T.C. Wu, M.S. Kong, D.C. Liang, W.Y. Shau, D.S. Chen (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. PMID 9197213.

^ Salazar, Tessa R. (2004-05-24). "Cancer Preventable Says US Doctor" (PDF). The Philippine Daily Inquirer.
http://liver.stanford.edu/files/040529manilla_times.pdf. Retrieved 2007-05-11.

^ Orenstein, WA; L.E. Markowitz, W.L. Atkinson, A.R. Hinman (1994-05). "Worldwide measles prevention". Israel Journal
of Medical Sciences 30 (5-6): 469–81. PMID 8034506.

^ "Measles (Catch Up Campaigns) - Toolkit for Volunteers". Health Initiative 2010. African Red Cross & Red Crescent.
http://www.ifrc.org/WHAT/health/archi/strategy/measles.htm. Retrieved 2007-05-12.
^ Zimmerman, Richard Kent (2000-01-01). "Practice Guidelines - The 2000 Harmonized Immunization Schedule".
American Family Physician. http://findarticles.com/p/articles/mi_m3225/is_1_61/ai_59426909. Retrieved 2007-05-12.

^ "Management of the Traveler: Vaccination". Travel Medicine. Portal de Saúde Pública. 1997.
http://saudepublica.web.pt/04-PrevencaoDoenca/Travel/TravelVaccines.htm. Retrieved 2007-05-12.

^ "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.
http://www.cdc.gov/nip/publications/pink/genrec.pdf. Retrieved 2007-05-12.

^ Department of Vaccines and Biologicals (2000-12). "WHO Recommendations for Diluents" (PDF). Vaccines and
Biologicals Update (World Health Organization): pp. 3. http://www.who.int/vaccines-
documents/DoxNews/updates/updat34e.pdf. Retrieved 2007-05-12.

^ Hoekstra, Edward. "Immunization: Injection Safety". UNICEF Expert Opinion (UNICEF).


http://www.unicef.org/immunization/23244_safety.html. Retrieved 2007-05-12.

^ "Tetanus - The Disease". Immunization, Vaccines and Biologicals. World Health Organization.
http://www.who.int/immunization/topics/tetanus/en/index1.html. Retrieved 2007-05-12.

^ "Maternal and Neonatal Tetanus" (PDF). UNICEF. 2000-11.


http://www.unicef.org/immunization/files/MNTE_strategy_paper.pdf. Retrieved 2007-05-12.

^ "Temperature Sensitivity of Vaccines" (PDF). Immunization, Vaccines and Biologicals (World Health Organization).
2006-08. http://www.who.int/vaccines-documents/DocsPDF06/847.pdf. Retrieved 2007-05-12.

^ "Handle Vaccines with Care". British Columbia Center for Disease Control.
http://www.bccdc.org/downloads/pdf/epid/reports/GP%202-HANDLE%20VACCINES%20WITH%20CARE.pdf?
PHPSESSID=85793516774767a844e11dc04a118d5f. Retrieved 2007-05-12.

^ Expanded Program on Immunization Manual. Manila, Philippines: Department of Health, Philippines. 1995.

Retrieved from "http://en.wikipedia.org/wiki/Expanded_Program_on_Immunization_(Philippines)"

Categories: Vaccination | Health in the Philippines

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