EXPANDED PROGRAM ON IMMUNIZATION Immunization (WHO) Immunization is the process whereby a person is made immune or resistant to an infectious disease,

, typically by the administration of a vaccine. Vaccines stimulate the bodys own immune system to protect the person against subsequent infection or disease. Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert over between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change. Expanded Program on Immunization (DOH) Children need not die young if they receive complete and timely immunization. Children who are not fully immunized are more susceptible to common childhood diseases. The Expanded Program on Immunization is one of the DOH Programs that has already been institutionalized and adopted by all LGUs in the region. Its objective is to reduce infant mortality and morbidity through decreasing the prevalence of immunizable diseases (TB, diphtheria, pertussis, tetanus, polio and measles) Special campaigns have been undertaken to improve further program implementation, notably the National Immunization Days (NID), Knock Out Polio (KOP) and Garantisadong Pambata (GP) since 1993 to 2000. This is being supported by increasing/sustaining the routine immunization and improved surveillance system.

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. The EPI Target Disease Measles Tuberculosis Diphtheria Pertussis Poliomyelitis

Neonatal Tetanus Hepatitis B

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 20 mg per day), minor infections with low fever (below 38.5 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 freezedried 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. 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. Bacillus Calmette-Gurin (BCG) Minimum age at 1st dose: At birth or anytime after birth Number of dose/s: 1 Dose: 0.05 ml Route: Intradermal Site: Right deltoid region of the arm

 Reason: BCG given at earliest possible age protects the possibility of TB meningitis and other TB infections in which infants are prone Oral Polio Vaccine (OPV) Minimum age at 1st dose: 6 weeks Number of dose/s: 3 Dose: 2-3 drops Minimum Interval between Doses: 4 weeks Route: Oral Site: Mouth Reason: The extent of protection against polio is increased the earlier the OPV is given. Keeps the Philippine polio free Hepatitis B Vaccine (Hep B) Minimum age at 1st dose: At birth Number of dose/s: 3 Dose: 0.5 mL Minimum Interval between Doses: 6 weeks interval from 1st dose to 2nd dose, 8 weeks interval from 2nd dose to third dose. Route: Intramuscular Site: Upper outer portion of the thigh Reason: An early start of Hep B reduces the chance of being infected and becoming a carrier. Prevent liver cirrhosis and liver cancer.

Measles Vaccine Minimum age at 1st dose: 9 months Number of dose/s: 1 Dose: 0.5 mL Route: Subcutaneous Site: Upper outer portion of the arms Reason: At least 85% of measles can be prevented by immunization at this age.

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.

Vaccine TT1

Minimum Age/interval As early as possible during pregnancy

Percent Protected

Duration of Protection

TT2

At least 4 weeks later

80%

TT3

At least 6 months later

95%

TT4

At least one year later

99%

TT5

Al least one year later

99%

Infants born to the mother will be protected from tetanus Gives 3 years protection for the mother Infants born to the mother will be protected from neonatal tetanus Gives 5 years protection for the mother Infants born to the mother will be protected from neonatal tetanus Gives 10 years protection for the mother Gives life time protection for the mother All infants born to that mother will be protected

The EPI Vaccines and its Characteristics

Type/Form of Vaccines Most Sensitive to Heat Oral Polio (live attenuated) Measles (freeze dried) Least Sensitive to Heat DPT/Hep B D Toxoid which is a weakened toxin P killed bacteria T Toxoid which is a weakened toxin Hep B BCG (freeze dried) Tetanus Toxoid

Storage Tempearture -15C to -25C (at the freezer) -15C to -25C (at the freezer) +2C to +8C (in the body of the refrigerator)

+2C to +8C (in the body of the refrigerator) +2C to +8C (in the body of the refrigerator)