The Expanded Program on Immunization

Benefits of Immunization

The first diseases targeted by the EPI were diphtheria, whooping cough, tetanus, measles, poliomyelitis and
tuberculosis. Global policies for immunization and establishment of the goal of providing universal
immunization for all children by 1990 were established in 1977, this goal was considered an essential
element of the WHO strategy to achieve health for all by 2000.
In 2010, an estimated 85% of children under one year of age globally had received at least three doses of
DTP vaccine (DTP3). Additional vaccines have now been added to the original six recommended in 1974.
Most countries, including the majority of low-income countries have added hepatitis B and Haemophilus
influenzae type b (Hib) to their routine infant immunization schedules and an increasing number are in the
process of adding pneumococcal conjugate vaccine and rotavirus vaccines to their schedules.
The Expanded Program on Immunization remains committed to its goal of universal access to all relevant
vaccines for all at risk. The program aims to expand the targeted groups to include older children,
adolescents and adults and work in synergy with other public health programs in order to control disease
and achieve better health for all populations, particularly the underserved populations.
Immunization is a proven tool for controlling and even eradicating infectious diseases. An immunization
campaign carried out by the World Health Organization (WHO) from 1967 to 1977 resulted in the
eradication of smallpox. When the program began, the disease still threatened 60% of the world's
population and killed every fourth victim. Eradication of poliomyelitis is now within reach. Since the launch
by WHO and its partners of the Global Polio Eradication Initiative in 1988, infections have fallen by 99%,
and some five million people have escaped paralysis. Between 2000 and 2008, measles deaths dropped
worldwide by over 78%, and some regions have set a target of eliminating the disease. Maternal and
neonatal tetanus has been eliminated in 20 of the 58 high-risk countries.

Immunization Supply Chain And Logistics

Successful immunization programs are built on functional, end-to-end supply chain and logistics systems.
The role of the supply chain is to ensure effective vaccine storage, handling, and stock management;
rigorous temperature control in the cold chain; and maintenance of adequate logistics management
information systems. The ultimate goal is to ensure the uninterrupted availability of quality vaccines from
manufacturer to service-delivery levels, so that opportunities to vaccinate are not missed because vaccines
are unavailable. This requires a system to achieve the six rights of supply-chain management:

 Right product
 Right quantity
 Right condition
 Right place
 Right time
 Right cost
Despite the success of routine immunization programs national vaccine supply chains are now strained to
effectively manage the surge of new vaccine introductions, adapt to the needs of new delivery strategies,
or benefit from new technological advances in cold chain equipment to increase their efficiency and
effectiveness.

Pressure to increase performance is pushing the limits of what can be achieved. It is for this reason that
WHO has prioritized this area of work as a key building block of the Global Vaccine Action Plan (GVAP).

https://www.who.int/immunization/programmes_systems/supply_chain/benefits_of_immunization/en/
 The 2019 Childhood Immunization Schedule for the Philippines, which indicates the recommended vaccines
for children and adolescents, has been released with a recommended indication for measles vaccine for infants
as young as 6months of age.

The annual schedule is developed by the Philippine Pediatric Society (PPS) and the Pediatric Infectious Disease
Society of the Philippines (PIDSP) together with the Philippine Foundation for Vaccination (PFV).

Given the measles outbreak nationwide, however, pediatricians now recommend that the first measles vaccine
be administered at six months old. Measles vaccines are usually given to infants at nine months old, but they
can be given as early as six months of age in cases of outbreaks.

Republic Act No. 10152

“Mandatory Infants and Children Health Immunization Act” of 2011 signed by President Aquino III in July 26,
2010. The mandatory includes basic immunization for children under 5 including other types of diseases
determined by the DOH.

PRESIDENTIAL DECREE No. 996 September 16, 1976

“Providing for compulsory basic immunization for infants and children below eight years of age”

Tetanus Toxoid Immunization

Tetanus vaccine is available as monovalent tetanus toxoid (TT), in bivalent combination with diphtheria
toxoid (DT) or low-dose diphtheria toxoid (Td), or as trivalent vaccine that also includes whole-cell (wP) or
acellular (aP) pertussis vaccine.

In some countries, combination vaccines with hepatitis B, Haemophilus influenzae type b and/or IPV exist.
Vaccines containing DT are used for children under 7 years of age and Td-containing vaccines for those aged 7
years and over. Vaccine combinations containing diphtheria toxoid (D or d) and tetanus toxoid, rather than
tetanus toxoid alone, should be used when immunization against tetanus is indicated.

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 Duration of Protection

Age/Interval Protected
TT1 At 20th weeks AOG 0%  protection for the mother for the
first delivery
 infants born to the mother will be
TT2 At least 4 weeks later 80%
protected from neonatal tetanus
  gives 3 years protection for the
mother
 infants born to the mother will be
protected from neonatal tetanus
TT3 At least 6 months 95%  gives 5 years protection for the
mother

 infants born to the mother will be

protected from neonatal tetanus
TT4 At least 1 year later 99%  gives 10 years protection for the
mother

 gives lifetime protection for the

mother
TT5 At least 1 year later 99%  all infants born to that mother will
be protected

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.

“Iligtas sa Tigdas ang Pinas ” A Door-to-Door Measles Follow-up Immunization Campaign

What is “Iligtas sa Tigdas ang Pinas”? “Iligtas sa Tigdas ang Pinas”

is a measles supplemental immunization activity (SIA) for a measles-free Philippines. This is a sequel to the
1998, 2004 and 2007 mass measles campaign

What are the “doors” referred to in this campaign?

• It includes all doors of houses, condominiums, apartments, tenements, orphanages and halfway homes as
well as non-conventional doors in the community.

• Non-conventional doors include the following:

a. Informal settlements such families/persons living under the bridge; inside the parks, cemeteries and open
spaces; in tents, carts, abandoned buildings, old vehicles/trains/motorboats, under the trees, in islands on the
middle of the street, etc.

b. All business/commercial establishments and market stalls where children may reside c. Institutions • Eligible
children of mobile and roaming families with no house or no permanent house shall be identified and given
immunization.

• All eligible children found in the parks, playgrounds, streets, markets, and other public places shall be directed
to go home to be vaccinated.

• Areas like day care centers, schools, malls, groceries, or churches shall not be visited anymore (if and only if
no family resides).
SCHOOL-BASED IMMUNIZATION

The Department of Health (DOH) today joins the School-based Immunization (SBI) campaign north of Manila
and continues to encourage mothers and caregivers to avail of the government’s free immunization services
to provide children, as well as adolescents, greater protection against vaccine preventable diseases.

The program aims to reach a total of 9,913,032 learners, under the school-based platform. For the 2019 school-
based immunization, school children from kindergarten to Grade 7 (K - 7) are the target population to be
vaccinated.

The DOH’s school-based immunization program aims to reach more children, especially with the yearly
increase in the number of enrollees. Piloted in 2013 in selected provinces and cities nationwide, in August
2015, the DOH, in collaboration with Department of Education and the Department of Interior and Local
Government, successfully conducted vaccinations in 38,688 public schools nationwide providing a second dose
for measles and booster doses for diphtheria and tetanus. Since then, August has been declared School-Based
Immunization month and the program has become an annual undertaking.

According to Secretary Duque, following the success of the Measles Outbreak Response (ORI) – which targeted
the most vulnerable population, or those 6 – 59 months old nationwide, reaching the last mile or the
Geographically Isolated and Disadvantaged Areas or GIDAs – the DOH will continue to provide MCV to school-
age children from kindergarten to Grade 7 using the school-based platform. The program will also provide
Grade 1 and 7 learners nationwide with booster doses of tetanus-diphtheria.

The health chief stressed that only learners with parental consent will be vaccinated after a quick health
assessment and evaluation of their immunization status against measles.

School-based immunization pre-implementation started June 2019 while actual vaccination using selective
strategy in the country's different regions will continue until September 2019.

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.

 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.
 Rapid coverage assessment (RCA) were conducted in selected areas to validate immunization
coverage, assess high quality and that there are NO missed child in every barangay. Overall RCA
results showed that 70,594 (97.6%) out of 72,353 9 months to 8 years old living in the randomly
selected barangays were vaccinated. There are 3,494 barangays with a population of 1000 and
above that were randomly selected. 97.6% of all eligible children were given the MR vaccine during
the immunization campaign.
 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. Overall RCA results
showed that 70,594 (97.6%) out of 72,353 9 months to 8 years old living in the randomly selected
barangays were vaccinated. There are 3,494 barangays with a population of 1000 and above that
were randomly selected. 97.6% of all eligible children were given the MR vaccine during the
immunization campaign.
 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

https://www.doh.gov.ph/expanded-program-on-immunization

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 immunity for protection.

On 19 September 2019, the Philippines declared an outbreak of polio.

Vaccine-derived polioviruses are rarely occurring forms of the poliovirus that have genetically changed from
the attenuated (weakened) virus contained in oral polio vaccine. They only occur when the vaccine virus is
allowed to pass from person to person for a long time, which can only happen in places with limited
immunization coverage and inadequate sanitation and hygiene. Over time, as it is passed between
unimmunized people, it can regain the ability to cause disease. When the population is fully immunized
with both oral polio vaccine and inactivated polio vaccine, this kind of transmission cannot take place. The
gut immunity in people immunized with oral polio vaccine stops the virus from being passed on. Full
immunization therefore protects against both vaccine-derived and wild polio viruses.
Public health response
1. Acute flaccid paralysis (AFP) and environmental surveillance are being enhanced to detect poliovirus.
2. Field investigation is currently underway in Lanao del Sur to define the geographic scope of the circulation
of the virus and inform planning for outbreak response including mass immunization campaigns.
3. The Department of Health (DOH) reinforced its recommendation that all children should be vaccinated
according to the routine immunization schedule.
4. WHO and other partners of the Global Polio Eradication Initiative (GPEI) are supporting the Department of
Health and local health authorities in their detailed investigations and supporting efforts to enhance
surveillance, strengthen routine immunization, communicate risk to the public and implement outbreak
response in line with internationally agreed polio outbreak response guidelines.

ADVISORY ON POLIO VACCINATION FOR TRAVELERS

 All travelers of all ages going to countries with ongoing poliovirus outbreaks should receive a dose
of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12
months prior to travel.
 Those undertaking urgent travel who have not received a dose of OPV or IPV in the previous four
weeks to 12 months, should receive a dose of polio vaccine at least by the time of departure as this
will still provide benefit, particularly for frequent travelers.
 Travelers must secure a Certificate of Vaccination that will serve as proof of vaccination prior to
departure.

SABAYANG PATAK KONTRA POLIO

The Department of Health (DOH) today reported an average of 95.58 percent coverage of children 0-59 months
old who were vaccinated against polio for the October 14-27 round of Sabayang Patay Kontra Polio in the
National Capital Region (NCR) and in identified areas of Mindanao (Lanao del Sur, Marawi City, Davao del Sur,
and Davao City).

The DOH Synchronized Polio Vaccination campaign started last October 14 in specific areas in Mindanao and
NCR. On November 24, the Sabayang Patak kontra Polio will commence its final round for NCR and its second
round for the whole of Mindanao. Third round for the whole of Mindanao will begin January 6, 2020.

https://www.doh.gov.ph/press-release/DOH-reports-96-percent-coverage-for-sabayang-patak-kontra-polio