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Expanded Program on Immunization

From Wikipedia, the free encyclopedia

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 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 Minimum
Age Number Interval
Vaccine Dose Route Site Reason
at 1st of Doses Between
Dose Doses
Bacillus Birth or 1 0.05 -- Intradermal Right BCG given at
Calmette- anytime mL deltoid earliest possible
Guérin after birth region age protects the
of the possibility of
arm TB meningitis
and other TB
infections in
which infants
are prone[3]
An early start
Diphtheria- with DPT
Pertussis- 0.5 reduces the
6 weeks 3 4 weeks Intramuscular portion
Tetanus mL chance of
of the
Vaccine severe
The extent of
against polio is
increased the
Oral Polio 2-3
6 weeks 3 4 weeks Oral Mouth earlier the OPV
Vaccine drops
is given.
Keeps the
An early start
of Hepatitis B
vaccine reduces
the chance of
being infected
and becoming a
6 weeks
Prevents liver
cirrhosis and
liver cancer
1st dose to Upper
which are more
2nd dose, outer
Hepatitis B 0.5 likely to
At birth 3 8 weeks Intramuscular portion
Vaccine mL develop if
interval of the
infected with
from thigh
Hepatitis B
2nd dose
early in life[7][8].
to third
About 9,000
die of
of Hepatits B.
10% of
Filipinos have
Hepatitis B
Upper At least 85% of
outer measles can be
Vaccine 0.5
9 months 1 -- Subcutaneous portion prevented by
of the immunization
(not MMR)
arms at this age[10].
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
• 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].

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].

Minimum Percent
Vaccine Duration of Protection
Age/Interval Protected
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%
• gives 5 years protection for the mother
• infants born to the mother will be
At least 1 year protected from neonatal tetanus
TT4 99%
• 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

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

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[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