EXPANDED

IMMUNIZATION
PROGRAM
 Rationale

The Expanded Program on Immunization (EPI) was

established in 1976 to ensure that infants/children and
mothers have access to routinely recommended
infant/childhood vaccines. Six vaccine-preventable diseases
were initially included in the EPI: tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and measles. In 1986, 21.3%
“fully immunized” children less than fourteen months of age
based on the EPI Comprehensive Program review.
 Global Situation
In 2002, WHO estimated that 1.4
million of deaths among children
under 5 years due to diseases that
could have been prevented by
routine vaccination. This represents
14% of global total mortality in
children under 5 years of age.
 THE GOALS
The Program Objective and Goals

Overall Goal: To reduce the morbidity and mortality among children against
the most common vaccine-preventable diseases.

Specific Goals:
1. To immunize all infants/children against the most common
vaccine-preventable diseases.
2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis b and German measles.
6. To prevent extra pulmonary tuberculosis among children.
 Mandates:
Republic Act No. 10152
“Mandatory Infants and Children Health
Immunization Act of 2011”
Signed by President Benigno Aquino III in July 26,
2010. The mandatory includes basic immunization
for children under 5 including other types that will
be determined by the Secretary of Health.
 VACCINES
• BCG
• HEPATITIS B
• PENTAVALENT VACCINE
• ORAL POLIO VACCINE
• INACTIVE POLIO VACCINE
• PNEUMOCOCCAL CONJUGATE
VACCINE
• MMR
• ROTAVIRUS
• TETANUS TOXOID (MOTHER)
BCG

Bacillus Calmette–Guérin
BCG, or bacille Calmette-Guerin, is a vaccine for
tuberculosis (TB) disease. Mycobacterium tuberculosis
(Mtb), the ethiological agent of tuberculosis (TB), is a
leading cause of human disease and death, particularly in
developing countries. In the global context, TB in
intimately linked to poverty. BCG vaccine has a
documented protective effect against meningitis and
disseminated TB in children. It does not prevent primary
infection and, more importantly, does not prevent
reactivation of latent pulmonary infection, the principal
source of bacillary spread in the community. The impact
of BCG vaccination on transmission of Mtb is therefore
limited. (WHO, 2018)
HEPATITIS B

Hepatitis B is a viral infection that attacks the liver and

can cause both acute and chronic disease. It is a major
global health problem, and the most serious type of viral
hepatitis. It is estimated that about 780,000 people die
each year due to consequences of hepatitis B, such as
liver cirrhosis and liver cancer. WHO recommends that all
infants should receive their first dose of vaccine as soon as
possible after birth, preferably within 24 hours. Delivery of
hepatitis B vaccine within 24 hours of birth should be a
performance indicator for all immunization programmes.
The birth dose should be followed by 2 or 3 doses to
complete the primary series. (WHO, 2018)
PENTAVALENT VACCINE

Pentavalent Vaccine is a vaccine that contains five antigens

(diphtheria, pertussis, tetanus, and hepatitis B and Haemophilus
influenzae type b).

DIPHTHERIA
Corynebacterium diphteriae is a bacterium which can
cause myocarditis (inflammation of the heart muscle),
inflammation of nerves and kidney problems. It is
transmitted by contact, by contaminated objects or
through the air. According to World Health Organization
(WHO) data, incidence of diphtheria is on the rise:
countries reported more than 7,000 cases in 2016, and
almost 17,000 in 2018. Death occurs in 5% to 10% of those
infected, mainly in children under 5 years of age.
PENTAVALENT VACCINE

TETANUS

Caused by Clostridium tetani bacterium, which is

commonly found in soil, saliva, dust and manure, the
infection is characterised by muscle spasms. The tetanus
toxoid vaccine protects effectively against all forms of
tetanus and has reduced incidence rates globally.
Neonatal tetanus continues to be a major killer of
newborns and can be prevented by providing the vaccine
to women of childbearing age, either before or during
pregnancy. According to WHO, there were a total of 15,103
cases of tetanus in 2018.
PENTAVALENT VACCINE

PERTUSSIS (WHOOPING COUGH)

Pertussis or whooping cough is a highly infectious

airborne bacterial disease. It spreads easily from infected
persons and is fatal in 1 in 200 cases among infants. The
pertussis vaccine is effective at preventing illness, but its
protection may wane after three to six years.
PENTAVALENT VACCINE

HAEMOPHILUS INFLUENZAE TYPE B

Haemophilus influenzae type b (Hib) is a deadly bacterium
which can cause meningitis, pneumonia and septicaemia.
Hib is the third-leading vaccine-preventable cause of death
in under-fives. In developing countries, where the vast
majority of Hib deaths occur, the disease leaves up to 35% of
survivors with disabilities. By 1999, 10 years after being
licensed, Hib vaccine was only available in one low-income
country. Spread through sneezing and coughing, Hib in the
pre-vaccine era was the leading cause of childhood
meningitis – inflammation of the membranes covering the
brain and spinal cord. Many survivors suffer paralysis,
deafness, mental retardation and learning disabilities.
OPV

Oral Polio Vaccine

OPV consists of a mixture of live attenuated poliovirus
strains of each of the three serotypes, selected by their
ability to mimic the immune response following infection
with wild polioviruses, but with a significantly reduced
incidence of spreading to the central nervous system. OPV
produces antibodies in the blood ('humoral' or serum
immunity) to all three types of poliovirus, and in the event of
infection, this protects the individual against polio paralysis
by preventing the spread of poliovirus to the nervous
system. OPV strains also produce a local immune response
in the lining ('mucous membrane') of the intestines - the
primary site for poliovirus multiplication.
IPV

Inactivated Polio Vaccine

IPV is produced from wild-type poliovirus strains of each
serotype that have been inactivated (killed) with formalin.
As an injectable vaccine, it can be administered alone or in
combination with other vaccines (e.g., diphtheria, tetanus,
pertussis, hepatitis B, and haemophilus influenza). IPV
provides serum immunity to all three types of poliovirus,
resulting in protection against paralytic poliomyelitis.
PCV

Pneumococcal Conjugate Vaccine

The pneumococcal conjugate vaccine (PCV13) and the
pneumococcal polysaccharide vaccine (PPSV23) protect
against pneumococcal infections, which are caused by
bacteria. The bacteria spread through person-to-person
contact and can cause such serious infections as
pneumonia, blood infections, and bacterial meningitis.

PCV13 protects against 13 types of pneumococcal bacteria

(which cause the most common pneumococcal infections
in kids). PPSV23 protects against 23 types. These vaccines
not only prevent infections in children who are immunized,
but also help stop the infections from spreading to others.
Rotavirus

Rotavirus is the leading cause of severe, dehydrating

diarrhoea in children less than 5 years old. Rotaviruses are a
double-stranded RNA virus of the genus Reoviridae. The
virus is composed of a triple-layered viral particle. The
outermost viral layer contains the structural viral proteins
VP7 and VP4 that are considered important for protective
immunity. Vaccine development has focused on live
attenuated rotavirus strains of human or animal origin
which mimic those found in human disease. Currently
marketed vaccines include a monovalent human rotavirus
vaccine and a pentavalent bovine-human reassortant
rotavirus vaccine propagated in cell culture. Both vaccines
are administered orally.
MMR

Measles, Mumps, Rubella

Combined live vaccine for measles, mumps and rubella
(MMR) is used widely for the immunization of children in
certain regions of the world because of its advantages over
the individual vaccines. Combined vaccine provokes an
adequate immune response in children simultaneously for
the three infections and facilitates the implementation of
current immunization strategies.
Measles
Measles virus is an enveloped, ribonucleic acid virus of the
genus Morbillivirus. Although at least 20 different genotypes
have been isolated in various parts of the world, there is only
one serotype. Measles is highly contagious, and an infected
person will often transmit the virus to over 90% of
unprotected close contacts. The envelope of measles virus
contains haemagglutinin that is responsible for the binding
of the virus to the host cell surface and a fusion protein that
facilitates viral uptake into the cell. Antibodies to
haemagglutinin correlate with protection against the
disease. A number of live, attenuated measles vaccines are
available, either as monovalent vaccine or in combination
with either rubella vaccine (MR) or mumps and rubella
vaccines (MMR).
Mumps
Mumps is an acute disease of children and young adults,
caused by a paramyxovirus of which there is only a single
serotype. Mumps virus produces no symptons in about one-
third of infected people. In those with a clinical response,
glandular and nerve tissue are most often affected. The
most common signs are fever and swelling of the parotid
glands. The most common complication of mumps in
children is meningitis, sometimes associated with
encephalitis, and in young adults orchitis. Most
complications due to mumps infection resolve without
permanent damage.
Rubella
Rubella (German measles) gives rise to a mild
exanthematous illness, accompanied by few constitutional
symptions, and occurs most commonly in childhood. If the
infection occurs in a woman in early pregnancy however,
the virus may cross the placenta to reach the fetus, in which
the infection can induce birth defects. These defects may
be serious and permanent and include congenital heart
disease, cataract formation, deafness and mental
retardation. The prevention of fetal infection, therefore, is
the primary purpose of rubella immunization.
Tetanus Toxoid for pregnant
women
Tetanus is an acute disease caused by an exotoxin
produced by Clostridium tetani. Neonatal infection usually
occurs through the exposure of the unhealed umbilical
cord stump to tetanus spores, which are universally present
in soil, and newborns need to have received maternal
antibodies via the placenta to be protected at birth.
Neonatal disease usually presents within the first two weeks
of life and involves generalized rigidity and painful muscle
spasms, which in the absence of medical treatment leads
to death in most cases. Tetanus toxoid vaccination is
recommended for all pregnant women, depending on
previous tetanus vaccination exposure, to prevent neonatal
mortality fromtetanus.
Strategies
Conduct of Routine Immunization for
Infants/Children/Women through the
Reaching Every Barangay (REB) strategy.

REB strategy, an adaptation of the WHO-

UNICEF Reaching Every District (RED), was
introduced in 2004 aimed to improve the access to
routine immunization and reduce drop-outs. There
are 5 components of the strategy, namely: data
analysis for action, re-establish outreach services, ,
strengthen links between the community and
service, supportive supervision and maximizing
resources.
Strategies
Supplemental Immunization Activity (SIA)

Supplementary immunization activities are

used to reach children who have not been
vaccinated or have not developed sufficient
immunity after previous vaccinations. It can
be conducted either national or sub-national –
in selected areas.
Strategies
Strengthening Vaccine-Preventable Diseases
Surveillance

This is critical for the eradication/elimination

efforts, especially in identifying true cases of
measles and indigenous wild polio virus

Procurement of adequate and potent

vaccines and needles and syringes to all health
facilities nationwide
 STATUS OF IMPLEMENTATION
•All health facilities (health centers and barangay health stations) have at least
one (1) health staff trained on REB.

Polio Eradication
•The Philippines has sustained its polio-free status since October 2000.
 STATUS OF IMPLEMENTATION
Measles Elimination
•Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011.
Implemented the 2-dose measles-containing vaccine (MCV) in 2009
MCV1 (monovalent measles) at 9-11 months old
MCV2 (MMR) at 12-15 months old.

•As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were
laboratory confirmed, 5 cases were epidemiologically-linked and 27 clinically
confirmed. This means we have at least 60 “true” measles at present. Measles is
said to be eliminated if we have 1 case per million or below 100 cases in a year
 STATUS OF IMPLEMENTATION

Maternal and Neonatal Tetanus Elimination

•10 areas were classified as highest risk for neonatal tetanus (NT). Figure 3 shows the
areas categorized as low risk, at risk and highest risk based on the NT surveillance,
skilled birth attendants and facility based delivery and the tetanus toxoid 2+ (TT 2+)
vaccination.
• Three (3) rounds of TT vaccination are currently on-going in the 10 highest risk
areas. An estimated 1,010,751 women age 15 - 40 year old women regardless of their
TT immunization will receive the vaccine during these rounds. This is funded by the
Kiwanis International through UNICEF and World Health Organization.
•Control of other common vaccine-preventable diseases (Diphtheria, Pertussis,
Hepatitis B and Meningitis/Encephalitis secondary to H. influenzae type
•Continuous vaccination for infants and children with the DPT or the combination
DPT-HepB-HiB Type B. Annex1 EPI Annual Accomplishment Report. DOH procures all
the vaccines and needles and syringes for the immunization activities targeted to
infants/children/mothers.
 STATUS OF IMPLEMENTATION
Hepatitis B Control
•Republic Act No. 10152 has been signed. It is otherwise known as the “Mandatory
Infants and Children Health Immunization Act of 2011, which requires that all
children under five years old be given basic immunization against vaccine-
preventable diseases. Specifically, this bill provides for all infants to be given the
birth dose of the Hepatitis-B vaccine within 24 hours of birth.
•The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate as
measured by HBsAg prevalence to less than 1% in five-year-olds born after routine
vaccination started 100% Hepatitis B at birth vaccination.
 STATUS OF IMPLEMENTATION
Vaccines and cold chain management
•An effective vaccine management assessment was conducted last December 2011
and revealed cold chain capacity gaps from the national up to the implementers
level.

Introduction to New Vaccines

•For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the national
immunization program. Immunization will be prioritized among the infants of
families listed in the National Housing and Targeting System (NHTS) for Poverty
Reduction nationwide.
•The Government of the Philippines has allocated PhP 1.6 billion for the procurement
of these 2 vaccines.
 Future Plan/ Action
• Strengthening the Cold Chain to
support the Immunization Program
• Capacity Building for Health
Workers for the Introduction of
New Vaccines
• Advocacy for the financial
sustainability for the newly
introduced vaccines for expansion.
• Development of the
comprehensive multi-year plan for
immunization program.
Other Information
• One significant milestone is that the
budget allocation for the
immunization program has continued
to increase year by year
• The Government of the Philippines
allocated budget for the
immunization of all infants /children
/women /older persons nationwide.
For 2012, the budget for EPI is PhP1.8
billion and another P1.5 Billion for the
immunization for senior citizen and
children for the NHTS families. This is
great leap towards universal access to
quality vaccines for the prevention of
the most common vaccine-
preventable diseases.