Expanded Program on Immunization (Philippines)
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The Expanded Program on Immunization (EPI) in the Philippines began in 1976[1] through Presidential Decree No. 996 signed by President Ferdinand Marcos.[2] And, in 1986, made a response to the Universal Child Immunization goal. The four major strategies include:[3]
- 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; and
- eliminating neonatal tetanus by 2008.
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.[4]
| Vaccine | Minimum Age at 1st Dose |
Number of Doses |
Dose | Minimum Interval Between Doses | Route | Site | Reason |
|---|---|---|---|---|---|---|---|
| Bacillus Calmette-Guérin | Birth or anytime after birth |
1 dose |
0.05 mL |
none |
Intradermal |
Right deltoid region of the arm | BCG given at earliest possible age protects the possibility of TB meningitis and other TB infections in which infants are prone[5] |
| Diphtheria-Pertussis-Tetanus Vaccine | 6 weeks old |
3 doses |
0.5 mL |
6 weeks(DPT 1), 10 weeks (DPT 2), 14 weeks (DPT 3) |
Intramuscular |
Upper outer portion of the thigh, Vastus Lateralis (L-R-L) | An early start with DPT reduces the chance of severe pertussis.[6] |
| Oral Polio Vaccine | 6 weeks old |
3 doses |
2-3 drops |
4 weeks |
Oral |
Mouth | The extent of protection against polio is increased the earlier the OPV is given. Keeps the Philippines polio-free.[7] |
| Hepatitis B Vaccine | At birth |
3 doses |
0.5 mL |
4 weeks interval |
Intramuscular |
Upper outer portion of the thigh, Vastus Lateralis (R-L-R) | An early start of Hepatitis B vaccine reduces the chance of being infected and becoming a carrier.[8] Prevents liver cirrhosis and liver cancer which are more likely to develop if infected with Hepatitis B early in life.[9][10] About 9,000 died of complications of Hepatitis B. 10% of Filipinos have Hepatitis B infection[11] |
| Measles Vaccine (not MMR) |
9 months old |
1 dose |
0.5 mL |
none |
Subcutaneous |
Upper outer portion of the arms, Right deltoid | At least 85% of measles can be prevented by immunization at this age.[12] |
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.[13]
- 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.[14]
- 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.[15]
- 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.[16]
- 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.[17]
- 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.[18]