Judee Marie A.

Malubay

Most cost-effective public health intervention In the Philippines, EPI was launched by DOH on July 12, 1976 Main Objectives:
To reduce the morbidity and mortality rates of the 6 EPI diseases To reduce the incidence of neonatal tetanus by giving pregnant women tetanus toxoid shots

Implementation of EPI contained in PD No. 996 providing for compulsory immunization for infants and children below 8 years old In 1993, the number of EPI diseases was expanded from 6 to 7 with the inclusion of hepatitis B

FULLY IMMUNIZED CHILD one who has received 1 dose of BCG at birth or any time before reaching 12 months, 3 doses of DPT and OPV with at least 4 weeks interval between each dose, 1 dose of measles at age 9 months or before 12 months, and 3 doses of hepatitis B with at least 4 weeks interval between doses

Vaccines in the EPI include BCG, DTwP, OPV, Measles and Hepatitis B. MMR and Hib are now part of the 2010 DOH EPI

Vaccine BCG

Age Newborn >1 mo

Dose 0.05 ml 0.1 ml

Route intradermal

Adverse Reactions Abscess or ulcers at site; axillary lymphadenopathy; induration; pustular formn

DPT (2-4-6)

6, 10, 14 weeks; 15-18 mos, 4-6 years

0.5 ml

intramuscular

Fever, convulsions, irritability, prolonged crying (2448hrs)

OPV (2-4-6)

6, 10, 14 weeks; 15-18 mos, 4-6 years

2-3 drops

Per orem

Vaccine associated paralytic poliomyelitis Alternative: inactivated polio vaccine

Local redness, warmth and swelling

Hepatitis Soon after birth 0.5 ml B if mother is +HBsAg or if not 6wks old Measles 6 months 9 months (ideal) 0.5 ml

intramuscular

subcutaneous

Fever 5-12 days after vaccination; rashes

Given intradermally Should be given at the earliest possible age after birth, preferably within two months of life PPD is not necessary for healthy infants and children > 2 months of age who were not given BCG at birth

PPD is recommended before BCG vaccination when:

Suspected with congenital TB With history of close contact to known or suspected infectious cases of TB Clinical findings suggestive of TB and/or chest X-ray suggestive of TB

In the presence of any of these conditions, an induration of 5 mm is considered positive The dose of BCG is 0.05 mL for infants <12 months of age and 0.1 mL for children 12 months of age

Given subcutaneously Given at 9 months of age but may be given as early as 6 months of age in cases of outbreaks

Given intramuscularly The first dose is given in a 3 dose primary series, at least 4 weeks apart A fourth dose is needed for the following:
If the 3rd dose is given at age less than 6 months If no birth dose is given using the EPI schedule of 6,10,14 weeks For preterms less than 2 kg, the initial dose should not be counted in a 3 dose immunization schedule.

Given subcutaneously Minimum age is 12 months Administer second dose at age 4 through 6 years 2nd dose may be administered before age 4 provided an interval of 28 days has lapsed since the first dose

Not part of the Philippine EPI MMRV, Hepatitis A, DTaP, Tdap, IPV, Pneumococcal, Rotavirus, Influenza and Human Papillomavirus

Given subcutaneously Combination MMRV may be given as an alternative to separately administered MMR and Varicella vaccine for healthy children 12 months to 12 years of age

Given intramuscularly Minimum age for Pneumococcal Conjugate Vaccine (PnCV) is 6 weeks and for Pneumococcal Polysaccharide Vaccine (PPV) is at 2 years old PPV is recommended for certain high risk children 2 years of age in addition to PnCV. For healthy children, no additional doses are needed if PnCV series is completed.

Given intramuscularly Recommended for children 12 months and above Second dose is given 6-12 months after the first dose

Per orem Monovalent (RV1) is given as a 2 dose series Pentavalent human bovine rotavirus vaccine (RV5) is given as a 3 dose series 1st dose is administered from the age of 6 weeks to 14 weeks and 6 days Minimum interval between doses is 4 weeks 2nd dose of RV1 should not be administered later than 24 weeks of age 3rd dose of RV5 should not be administered later than 32 weeks of age

Given subcutaneously 1st dose is administered at 12-15 months of age 2nd dose is recommended at 4-6 years of age but may be administered at an earlier age provided the interval between the 1st and 2nd dose is at least 3 months A 2nd dose is recommended for children, adolescents and adults who previously received only one dose All individuals aged 13 years and above, without previous evidence of immunity should receive 2 doses of varicella vaccine given at least 4 weeks apart.

Given intramuscularly or subcutaneously 6 months to 18 years Children 6 months to 8 years receiving influenza vaccine for the first time should receive 2 doses of the vaccine separated by at least 4 weeks If only one dose was administered during the previous influenza season, administer 2 doses of vaccine then one dose yearly thereafter Children who receive a single dose of influenza vaccine for 2 consecutive years should continue receiving single annual doses Preferably be given between February to June

Given intramuscularly Primary vaccination consists of 3 dose series administered to females 10-18 years of age Recommended schedule
Bivalent HPV: 0,1,6 months Quadrivalent HPV: 0,2,6 months

Minimum interval between the 1st and 2nd dose is at least one month and the minimum interval between the 2nd and 3rd dose is at least 3 months Use in males 10-18 years of age for the prevention of anogenital warts is optional

Given intramuscularly For children 10-18 years of age if they have not completed the recommended childhood DTwP/DTaP immunization series and if they have not received either Td or Tdap Td booster every 10 years is recommended Interval of at least 5 years from the last Td dose is recommended if Tdap is used as booster to reduce the risk of local and systemic reactions

Rabies Typhoid Meningococcal

Intramuscular or intradermal Anti-Rabies Act 2007 recommended routine rabies pre-exposure prophylaxis for children 5-14 years in areas where there is high incidence of rabies (incidence >2.5 human rabies/million population) 2 recommended regimens
Intramuscular: PVRV of 0.5 mL or PCEC 1 mL on deltoid area in days 0,7,21 or 28 Intradermal: PVRV or PCECV 0.1 mL given in deltoid area on days 0,7 and 21 or 28

Should never be given on the gluteal area because absorption is unpredicatable

Given intramuscularly Recommended for travelers to areas where there is high risk of exposure to S. typhi and for persons with frequent exposure Single IM dose may be given as early as 2 years of age with revaccination every 2-3 years if there is continued exposure

Intramuscularly or subcutaneously Single dose is recommended for all children aged 2 years known to be high risk for disease In outbreaks, infants <2 years of age (minimum of 3 months of age) may be given 2 doses at 3 months apart Revaccination may be considered 3-5 years after the 1st dose for person who remain at high risk for infection

April 12, 2011