Expanded

program on
immunization
Tan, Ualat
 Expanded program immunization
● Established in 1976
● Ensures that infants/children and mothers have access to routinely
recommended infant/childhood vaccines
● In 1986, 21.3% “fully immunized” children less than fourteen
months of age based on the EPI Comprehensive Program review.
 Six vaccine-preventable diseases
initially included in the EPI:

01 02
Tuberculosis Poliomyelitis

03 04
Diphtheria Tetanus

05 06
Pertussis Measles
 SCENARIO

The burden
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.

Global Situation
BURDEN OF DISEASES
The immunization coverage
of all individual vaccines has
improved as shown in Figure
1: (Demographic Health
Survey 2003 and 2008).
Fully Immunized Child (FIC)
coverage improved by 10%
and the Child Protected at
Birth (CPAB) against Tetanus
improved by 13% compared
to any prior period. Thus, the
Philippines has now
historically the highest
coverage for these two major
indicators.
 INTERVENTIONS/STRATEGIES
PROGRAM OBJECTIVES/GOALS

OVER-ALL GOAL
To reduce the morbidity and mortality
among children against the most common
vaccine-preventable diseases.
 ● To immunize all infants/children against
the most common vaccine-preventable
diseases.
● To sustain the polio-free status of the
SPECIFIC Philippines.
● To eliminate measles infection.
GOALS ● To eliminate maternal and neonatal
tetanus
● To control diphtheria, pertussis, hepatitis b
and German measles.
● To prevent extra pulmonary tuberculosis
among children.
 MANDATES

Republic Act No. 10152

“Mandatory Infants and Children Health

Immunization Act of 2011”
strategies
 01
Conduct of Routine Immunization for Infants/Children/Women
through the Reaching Every Barangay (REB) strategy
 02
Supplemental Immunization Activity
(SIA)
 03
Strengthening Vaccine-Preventable
Diseases Surveillance
 04
Procurement of adequate and potent vaccines and
needles and syringes to all health facilities nationwide
 Status of
implementation/Accomplishment
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.

Declining Oral Polio Vaccine (OPV) third

dose coverage since 2008 from 91% to
83%.

A least 95% OPV3 coverage need to be

achieved to produce the required herd
Polio eradication
There is an on-going polio mass immunization to
all children ages 6 weeks up to 59 months old in
the 10 highest risk areas for neonatal tetanus.

Acute Flaccid Paralysis (AFP) reporting

rate has decreased from 1.44 in 2010 to
1.38 in 2011.

Only regions III, V and VIII have achieved

the AFP rate of 2/100,000 children below
15 years old.
 Measles elimination
● Conducted 4 rounds of mass measles campaign: 1998, 2004,
2007 and 2011.
● Implemented the 2-dose measles-containing vaccine (MCV) in
2009
a. MCV1 (monovalent measles) at 9-11 months old
b. MCV2 (MMR) at 12-15 months old.
● Implemented and strengthened the laboratory surveillance for
confirmation of measles. Blood samples are withdrawn from all
measles suspect to confirm the case as measles infection.
● A supplemental immunization campaign for measles and rubella
(German measles) was done in 2011. This was dubbed as “Iligtas
sa Tigdas ang Pinas” 15.6 million (84%) out of the 18.5 million
children ages 9 months to 8 years old were given 1 dose of the
measles-rubella (MR) vaccine between April and June 2011.
 Measles elimination
● The Government of the Philippines spent PhP 635.7M
for the successful conduct of the MR campaign.ss high
quality and that there are NO missed child in every
barangay.
● 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
MATERNAL AND NEONATAL TETANUS ELIMINATION

● 10 areas were classified as highest risk for

neonatal tetanus (NT).
● 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.
 HEPATITIS B CONTROL

Republic Act No. 10152. 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.
 Vaccines and Cold Chain Management

● Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16 regions
since 2003.
● An effective vaccine management assessment was conducted last December 2011
and revealed cold chain capacity gaps from the national up to the implementers
level.
● A total of PhP 267 million is required to address the gaps identified during the
assessment
 Introduction to New Vaccines

● For 2012, Rotavirus and Pneumococcal vaccines were introduced in the national
immunization program. Immunization were 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.
 DISEASE IT
VACCINE STORAGE SIDE EFFECT
PREVENTS

Malaise, fever, chills, and flu-like

BCG Tuberculosis 2°C-8°C (36°F-46°F ) symptoms

Drowsiness, dizziness, fever,

muscle or joint pain, vomiting,
HEP B Hepatitis B 2°C-8°C (36°F-46°F ) diarrhea, injection site reaction,
stomach pain or discomfort

Appetite loss; irritability, abnormal

crying,
Diphtheria, Tetanus, restlessness, inj site reactions
DPT 2°C-8°C (36°F-46°F ) fever ≥38°C, fatigue.
Pertussis
Nervousness, vomiting, diarrhea,
pruritus

Anaphylactoid/hypersensitivity
reactions, syncope, Inj site
HiB Meningitis 2°C-8°C (36°F-46°F ) reactions, fever, irritability, fatique,
URTI
 DISEASE IT
VACCINE STORAGE SIDE EFFECT
PREVENTS

Inj site pain, erythema, induration;

OPV Polio 2°C-8°C (36°F-46°F ) moderate
transient fever.

Inj site pain, erythema, induration;

IPV Polio 2°C-8°C (36°F-46°F ) moderate
transient fever.

drowsiness, loss of appetite, fever,

irritability and redness, pain,
PCV Pneumonia, Meningitis 2°C-8°C (36°F-46°F ) swelling, tenderness, and bruising
at the injection site.

fainting, fever, rash, irritability, loss

of appetite, headache, tiredness,
Measles, Mumps,
MMR -50°C-8°C (-58°F-46°F) nausea, vomiting, muscle pain and
German Measles redness, pain, swelling, and
bruising at the injection site.
 Bacille Calmette Guerin (BCG)
(Live attenuated)
Age Route: Dose: Notes:

At birth Intradermal Total Doses: 1 Given at the earliest

possible age after
Children < 12 months birth preferably within
= 0.05 mL the first 2 months of
Children ≥ 12 months life
= 0.1 mL
 Hepatitis B Vaccine
(Inactivated)
Age Route: Dose: Notes:

At birth Intramuscular Total Doses: 3 For infants born to HBsAg (+) mothers
(preterm or term infants):
1st = All newborns >2 kgs Administer HBV* and HBIG (0.5ml) within
within 24 hrs of life 12 hours of life.
2nd = 1-2 months after the
birth dose For infants born to mothers with unknown
3rd = not earlier than 24 HBsAg status:
weeks of age With birth weight ≥2 kgs, administer HBV
within 12 hours of birth and determine the
mother’s HBsAg as soon as possible. If
HBsAg (+), administer HBIG not later than 7
days of age.
With birth weight <2 kgs, administer HBIG in
addition to HBV* within 12 hours of life
 Pentavalent Vaccine
Tetanus and Diphtheria Toxoid and Acellular
Pertussis (Tdap)
(Inactivated)
Route: Dose:

Intramuscular For children who are fully immunized, Td /Tdap booster doses should be given every
10 years

For children age >7 years a single dose of Tdap can be given to replace due Td.

Give 1 dose of Tdap for every pregnancy

For fully immunized pregnant adolescents = 1 dose of Tdap vaccine at 27 to 36 weeks
AOG, regardless of previous Td or Tdap vaccination

For unimmunized pregnant adolescents = 5-dose tetanus-diphtheria (Td)-containing

vaccine following a 0-,1-, 6-,18-, and 30-month schedule. Use Tdap as one of the 5
doses, preferably given at 27-36 weeks AOG
 Pentavalent Vaccine
Haemophilus Influenzae Type B Conjugate
Vaccine (Inactivated)
Age Route: Dose: Notes:

6 weeks Intramuscular Total Doses: 3 Booster Dose = age 12-15 month;

interval of 6 months from 3rd dose
Minimum interval
of 4 weeks
e

Oral an Inactivated Polio Vaccine

Oral (Live Attenuated) / Inactivated (Inactivated)
Age Route: Dose: Notes:

6 weeks Intramuscular/ Primary series = 3 doses given
PO at 6, 10, and 14 weeks.
First booster = given at 12-18
months
● The minimum interval
between the third dose
and the first booster dose
is 6 months.
Second booster = given at age
4-6 years.
Oral Polio Vaccine (OPV)
Primary series consists of 3 doses
beginning at age 6 weeks with a
minimum interval of ≥4 weeks
IPV
The first dose of IPV is given
together with the third dose of OPV
The second dose of IPV is given
together with the measles vaccine at
9 months
 Pneumococcal Conjugate Vaccine (PCV)
(Inactivated)
Age Route: Dose: Notes:

6 weeks Intramuscular Total Doses: 3 Unvaccinated infants age 7-11 months = 3 doses
The first 2 doses are given 4 weeks apart.
Primary vaccination = The 3rd dose is given after 12 months of age, separated
3 doses with an from the 2nd dose by at least 8 weeks
interval of at least 4-8
For unvaccinated older children age 12 months to 5 years
weeks between doses.
PHID-CV (10-valent): 12 months - 5 years old: give 2
doses at least 8 weeks apart
Preterm infants (<37
weeks at birth) = PCV 10-SII : 12-24 months old: give 2 doses at least 8
receive a 4-dose weeks apart up to 2 years old only
regimen
PCV 13: 12-23 months old: give 2 doses at least 8 weeks
apart 2-5 years old: give 1 dose

PCV 15: 12-23 months old : give 2 doses at least 8 weeks

apart 2-5 years old: give 1 dose
 Measles-Mumps-Rubella (MMR) Vaccine
(Live Attenuated)

Age Route: Dose:

12 months Subcutaneously 2 doses of MMR vaccine are recommended

The second dose is usually given at 4-6 years of age but may
be given at an earlier age with a minimum of 4 weeks interval
between doses.
 Thank You For
Listening!

Sources:
● Expanded Program on Immunization | Department of Health (doh.gov.ph)
https://doh.gov.ph/uhc/health-programs/expanded-program-on-immunization/?fbclid
=IwAR3ttnESah46fD7bMfeOpxrFxUrzjEFsv6cclmXR9XZRu6AcOKGp9mffYcY
● Essential Programme on Immunization (who.int)
● https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-progra
mme-on-immunization?fbclid=IwAR2irLldZAqazSgdNGCRMbvc4qAUCnQKjmZlI8z5zIpF
2G_u1BofVbQAjF8