433118693-Expanded-Program-on-Immunization.docx

**EXPANDED PROGRAM ON IMMUNIZATION (EPI)** 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...

**EXPANDED PROGRAM ON IMMUNIZATION (EPI)** 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. Vaccines under the EPI are BCG birth dose, Hepatitis B birth dose, Oral Poliovirus Vaccine, Pentavalent Vaccine, Measles Containing Vaccines (Antimeasles Vaccine, Measles, Mumps, Rubella) and Tetanus Toxoid. In 2014, Pneumococcal Conjugate Vaccine 13 was included in the routine immunization of EPI. This 2016, the Expanded Program on Immunization will transition to become the National Immunization Program. It will include immunizations of other populations such as senior citizen immunization, school-age immunization, and adolescent immunizations. **B. PROGRAM GOALS:** **Over-all Goal:** To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases. **SPECIFIC GOAL:** - To immunize all infants/children against the most common vaccine-preventable diseases; - To sustain polio-free status of the Philippines; - To eliminate measles infection; - To eliminate maternal and neonatal tetanus; - To control diphtheria, pertussis, hepatitis b and German Measles; - To prevent extra pulmonary tuberculosis among children. **C. PROGRAM TARGET:** Achieve 95% Fully Immunized Child Coverage. **D. PROGRAM STRATEGIES:** Conduct of routine immunizations for infants/children/women through Reaching Every Purok Strategy. The Reaching Every Purok Strategy is an innovation of the Reaching every Barangay. **SUPPLEMENTAL IMMUNIZATION ACTIVITIES (SIA)** Supplemental immunization activities are conducted to reach children who have not been vaccinated or have not developed enough immunity after previous vaccinations. **VACCINE-PREVENTABLE DISEASE SURVEILLANCE** Surveillance is conducted for all vaccine-preventable diseases most especially for measles cases and indigenous wild poliovirus. **Mandates:** ***Republic Act No. 10152"MandatoryInfants and Children Health Immunization Act of 2011Signed 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.*** **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]** +--------+--------+--------+--------+--------+--------+--------+--------+ | **Vacc | **Mini | **Numb | **Dose | **Mini | **Rout | **Site | **Reas | | ine** | mum | er** | ** | mum | e** | ** | on** | | | Age** | | | Interv | | | | | | | **of | | al | | | | | | **at | Doses* | | Betwee | | | | | | 1st | * | | n | | | | | | Dose** | | | Doses* | | | | | | | | | * | | | | +========+========+========+========+========+========+========+========+ | Bacill | Birth | 1 dose | 0.05 | None | Intrad | Right | BCG | | us | or | | mL | | ermal | deltoi | given | | Calmet | anytim | | | | | d | at | | te-Gué | e | | | | | region | earlie | | rin | after | | | | | of the | st | | | birth | | | | | arm | possib | | | | | | | | | le | | | | | | | | | age | | | | | | | | | protec | | | | | | | | | ts | | | | | | | | | the | | | | | | | | | possib | | | | | 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died | | | | | | | | | of | | | | | | | | | compli | | | | | | | | | cation | | | | | | | | | s | | | | | | | | | of | | | | | | | | | Hepati | | | | | | | | | tis | | | | | | | | | B. 10% | | | | | | | | | of | | | | | | | | | Filipi | | | | | | | | | nos | | | | | | | | | have | | | | | | | | | Hepati | | | | | | | | | tis | | | | | | | | | B | | | | | | | | | infect | | | | | | | | | ion. | +--------+--------+--------+--------+--------+--------+--------+--------+ | Measle | 9 | 1 dose | 0.5 mL | None | Subcut | Upper | At | | s | months | | | | aneous | outer | least | | Vaccin | old | | | | | portio | 85% of | | e | | | | | | n | measle | | | | | | | | of the | s | | (not | | | | | | arms, | can be | | MMR) | | | | | | Right | preven | | | | | | | | deltoi | ted | | | | | | | | d | by | | | | | | | | | immuni | | | | | | | | | zation | | | | | | | | | at | | | | | | | | | this | | | | | | | | | age. | +--------+--------+--------+--------+--------+--------+--------+--------+ **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 38.5º 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. - 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 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. - 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. **[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 | **Minimum | **Percent | **Duratio | **Route** | **Site** | | ** | ** | ** | n | | | | | | | of | | | | | **Age/Int | **Protect | Protectio | | | | | erval** | ed** | n** | | | +===========+===========+===========+===========+===========+===========+ | TT1 | At 20th | 0% | Protectio | Intramusc | Deltoid | | | weeks AOG | | n | ular | | | | | | for the | | | | | (As early | | mother | | | | | as | | for the | | | | | possible | | first | | | | | during | | delivery | | | | | pregnancy | | | | | | | ) | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | TT2 | At least | 80% | Infants | Intramusc | Deltoid | | | 4 weeks | | born to | ular | | | | later | | the | | | | | | | mother | | | | | | | will be | | | | | | | protected | | | | | | | from | | | | | | | neonatal | | | | | | | tetanus. | | | | | | | | | | | | | | Gives 3 | | | | | | | years | | | | | | | protectio | | | | | | | n | | | | | | | for the | | | | | | | mother. | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | TT3 | At least | 95% | Infants | Intramusc | Deltoid | | | 6 months | | born to | ular | | | | later | | the | | | | | | | mother | | | | | | | will be | | | | | | | protected | | | | | | | from | | | | | | | neonatal | | | | | | | tetanus. | | | | | | | | | | | | | | Gives 5 | | | | | | | years | | | | | | | protectio | | | | | | | n | | | | | | | for the | | | | | | | mother. | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | TT4 | At least | 99% | Infants | Intramusc | Deltoid | | | 1 year | | born to | ular | | | | later | | the | | | | | | | mother | | | | | | | will be | | | | | | | protected | | | | | | | from | | | | | | | neonatal | | | | | | | tetanus. | | | | | | | Gives 10 | | | | | | | years | | | | | | | protectio | | | | | | | n | | | | | | | for the | | | | | | | mother | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | TT5 | At least | 99% | Gives | Intramusc | Deltoid | | | 1 year | | lifetime | ular | | | | later | | protectio | | | | | | | n | | | | | | | for the | | | | | | | mother. | | | | | | | | | | | | | | All | | | | | | | infants | | | | | | | born to | | | | | | | that | | | | | | | mother | | | | | | | will be | | | | | | | protected | | | +-----------+-----------+-----------+-----------+-----------+-----------+ **POINTERS ON IMMUNIZATION:** 1. Every child deserves to be given the benefits of immunization protection based on PD 996 immunization law. September 16, 1976 -- Basic compulsory immunization of children below 8 years old is implemented. 2. No vaccine gives 100% protection. They go hand in hand with good hygiene and other measures for disease prevention. 3. Recommended series of immunization must be completed for adequate protection. 4. Booster doses are important to maintain continuous protection against the diseases. 5. Interruption of schedule does not interfere with final immunity nor does it necessitate contraindication to vaccination. 6. Malnutrition, minor respiratory infections, moderate fever, cough and diarrhea do not constitute contraindications to vaccinations. 7. The absolute contraindications to immunization are : - DPT2 or DPT3 to a child who has had convulsion or shock within 3 days the previous dose. - Live weakened vaccine like BCG must not be given to individual who are immunocompromised due to malignant disease. 8. Measles and OPV vaccines are most sensitive to heat. They must be strictly maintained at -15 -- 20 C. 9. Vaccines are safe and effective with mild side effects after vaccination. 10. No extra doses must be given to child/mother who missed a dose. 11. Giving doses of a vaccine at less than 4 weeks interval may lessen the anti-body response. Lengthening the interval leads to higher antibody levels. 12. Practice FEFO first expiry first out rule, and 1 syringe one needle one child policy must strictly implemented. **CARE FOR THE VACCINES** To ensure the optimal potency of vaccines, a 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. Inappropriate storage, handling and transport of vaccines won't protect patients and may lead to needless vaccine wastage. 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.