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. 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 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.

Minimu Numb Minimum

m Age er Interval
Vaccine Dose Route Site Reason
at 1st of Between
Dose Doses Doses
 BCG given at earliest
Birth or Right possible age protects
Bacillus
anytime 0.05 deltoid the possibility of TB
Calmette- 1 -- Intradermal
after mL region of meningitis and other
Guérin
birth the arm TB infections in which
infants are prone.
Upper
Diptheria- An early start with
outer
Pertussis- 0.5 Intramuscula DPT reduces the
6 weeks 3 4 weeks portion
Tetanus mL r chance of severe
of the
Vaccine pertussis[.
thigh
The extent of
protection against
polio is increased the
Oral Polio 2-3
6 weeks 3 4 weeks Oral Mouth earlier the OPV is
Vaccine drops
given.
Keeps the Philippines
polio-free.
An early start of
Hepatitis B vaccine
reduces the chance of
6 weeks
being infected and
interval
becoming a carrier.
from
Prevents liver
1st dose
Upper cirrhosis and liver
to 2nd
outer cancer which are
Hepatitis B 0.5 dose, Intramuscula
At birth 3 portion more likely to develop
Vaccine mL 8 weeks r
of the if infected with
interval
thigh Hepatitis B early in
from
life.
2nd dose
About 9,000 die of
to third
complications of
dose.
Hepatits B. 10% of
Filipinos have
Hepatitis B infection.
Upper At least 85% of
Measles
outer measles can be
Vaccine 0.5 Subcutaneou
9 months 1 -- portion prevented by
mL s
of the immunization at this
(not MMR)
arms age.

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 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.
• 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.

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.

Percent
Vaccin Minimum
Protect Duration of Protection
e Age/Interval
ed
As early as
TT1 possible -- --
during pregnancy
TT2 At least 4 weeks 80% • infants born to the mother will be
later
 protected from neonatal tetanus

• gives 3 years protection for the mother

• infants born to the mother will be
At least 6 months protected from neonatal tetanus
TT3 95%
later
• gives 5 years protection for the mother
• infants born to the mother will be
At least 1 year protected from neonatal tetanus
TT4 99%
later
• gives 10 years protection for the mother
• gives lifetime protection for the mother
At least 1 year
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.

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

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.
Original article: Facilitating the WHO expanded program of
immunization: the clinical profile of a combined diphtheria, tetanus,
pertussis, hepatitis B and Haemophilus influenzae type b vaccine

Abstract

Background: Vaccines are important weapons in the fight against infectious

diseases. The World Health Organization (WHO) Expanded Program on
Immunization (EPI) has been extended to include recommendations for hepatitis B
and Haemophilus influenzae type b (Hib) vaccinations. The WHO has
recommended that combined vaccines be used where possible, to reduce the
logistic costs of vaccine delivery. This paper reviews the efficacy, safety and cost-
effectiveness of Tritanrix-HB/Hib, the only commercially available combined
diphtheria, tetanus, whole cell pertussis, hepatitis B and conjugated Hib vaccine.

Methods: The immunogenicity and reactogenicity results of five published clinical

trials involving Tritanrix-HB/Hib in a variety of immunization schedules and
countries were reviewed. Based on these data and cost-effectiveness studies, an
assessment of its suitability for use in national immunization programs was made.

Results: Tritanrix-HB/Hib has shown excellent immunogenicity in clinical trials

using a variety of schedules, with no reduced immunogenicity observed for any of
the components of the combined vaccine. It has similar reactogenicity to DTPw
vaccines alone. Pharmacoeconomic analyses have shown combined DTP-HB/Hib
vaccines to be cost-effective compared to separate vaccines.
Conclusions: Replacement of DTPw vaccination by Tritanrix-HB/Hib can be done
without modifying the existing national immunization programs. This should
facilitate widespread coverage of hepatitis B and Hib vaccinations and their rapid
incorporation into the EPI.

Article Outline

• References

Corresponding author. Address correspondence to H. L. Bock, G1axoSmithKline

Biologicals, Rue de l'Institut, 89,1330 , Rixensart, , Belgium.

(Source : http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7CPT-4BM4R4D-
57&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_ver
sion=1&_urlVersion=0&_userid=10&md5=e0c3d79f92db80a64975ee0eeb3eaf64)

JOURNALS

Research Communication: Integration of Vitamin A Supplementation

with the Expanded Program on Immunization Does Not Affect
Seroconversion to Oral Poliovirus Vaccine in Infants1

To whom correspondence should be addressed.

Childhood immunization programs may provide infrastructure for delivering vitamin

A supplements to infants in developing countries. The effect of giving vitamin A, an
immune enhancer, on antibody responses to trivalent oral poliovirus vaccine
(TOPV) is unknown. A randomized, double-blind, placebo-controlled clinical trial was
conducted to determine the effect of giving vitamin A simultaneously with TOPV on
antibody responses to poliovirus. Infants (n = 467) received oral vitamin A, 15 mg
retinol equivalent (RE), 7.5 mg RE or placebo with TOPV at 6, 10 and 14 wk of age.
Antibody responses to poliovirus types 1, 2 and 3 were measured by a microvirus
neutralization assay at enrollment and at 9 mo of age. Seroconversion rates to
poliovirus types 1, 2 and 3 ranged from 98 to 100% in the three treatment groups,
and there were no differences in mean antibody titers to poliovirus types 1, 2 and 3
among treatment groups. This study demonstrates that oral vitamin A does not
affect antibody responses to poliovirus vaccine when integrated with the Expanded
Program on Immunization.

(Source : http://jn.nutrition.org/cgi/content/abstract/129/12/2203 )
 Expanded Program
on Immunization

Borromeo, Carlos-Eliezer C
FS2 – NCM201 – Group 5