Expanded Program On Immunization: University of The Philippines Manila

University of the Philippines Manila
SCHOOL OF HEALTH SCIENCES

Palo, Leyte
EXPANDED
PROGRAM ON
IMMUNIZATION
Cedrick James Sabulao
Angela Kristia Solonia
Rationale:
- 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 moths of age based on the EPI
Comprehensive program.

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. This represents 14% of
global total mortality in children under 5 years
of age.

Scenario:
BURDEN OF DISEASES
- The immunization coverage of all individual
vaccines has improved. Fully Immunized Child
(FIC) coverage improved by 10% and the Child
Protected at Birth (CPAB) against tetanus has
improved by 13% to any prior period. Thus, the
Philippines has now historically the highest
coverage for these two major indicators.

Mandate:
- Republic Act No. 10152
- “Mandatory Infants and Children Health
Immunization Act of 2011”
- mandatory includes basic immunization for
children under 5 including other types that will
be determined by the Secretary of Health
- signed by Pres. Noynoy Aquino in July 26,
2010

STATUS
Status: Status of
Implementation/Accomplishment
- all health facilities have atleast one (1) health staff
trained on REB
- Polio Eradication
- Measles Elimination
- Maternal and Neonatal Tetanus Elimination
- Control of other common vaccine-preventable
diseases (diphtheria, pertussis, Hepatitis B, and
Meningitis/Encephalitis secondary to Hemophilus
Influenzae Type B.

Status: Polio Eradication
- The Philippines has sustained its polio-free status since
October 2000
- Declining OPV 3rd dose coverage since 2008 from 91% to
83%. Atleast 95% is needed to be achieved to produce the
required herd immunity for protection
- 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. (Source: NEC, DOH). A decreasing AFP rate
means we may not be able to find true cases of polio and
may experience resurgence of polio
cases
Status: Measles Elimination
- conducted 5 rounds of measles campaign: 1998, 2004, 2007,
2011 and 2018
- Implemented the 2-dose measles-containing vaccine (MCV)
in 2009
MCV1 (monovalent measles) at 9-11 months
MCV2 (MMR) at 12-15 months
- 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.

Status:
Maternal and Neonatal Tetanus Elimination
- there are (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.

Status: Control of other common vaccine-preventable
diseases (Diphtheria, Pertussis, Hep. B, and
Meningitis/Encephalitis secondary to H. Influenzae
type B
- 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: Hepatitis B Control
- 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-old born after routine vaccination
started 100% Hepatitis B at birth vaccination.
Timing of
administration/ 2009 2010* 2011*
dose
<24 hours 34% 38% 14%
>24 hours 62% 55% 24%
Hep B 3rd dose 86% 81% 30%
Hepatitis B Coverage. Philippines, 2001-2011
*both 2010 and 2011 data are as of October 2011

GOALS
Goals:
Specific Goal
- to reduce the morbidity and mortality among

children against the most common vaccine-
preventable diseases.

Goals:
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, hep. B, and German measles.
6. To prevent extra pulmonary tuberculosis among
children.

STRATEGIES
Strategies: 1. Conduct of Routine Immunization for
Infants/Children/Women through the Reaching
Every Barangay (REB) strategy
- Adaptation of WHO-UNICEF Reaching Every District
(RED)
- Introduced in 2004
- Aim: improve the access to routine immunization and
reduce dropouts
- 5 Strategy: data analysis for action, re-establish
outreach services, strengthen links between the
community and service, supportive supervision and
maximizing resources

Strategies:
2. Supplemental Immunization Activity (SIA)
- used to reach children who have not been vaccinated
or have not developed sufficient immunity after
previous vaccination
3. Strengthening Vaccine-Preventable Diseases

Surveillance
- critical for the eradication/elimination efforts
- involves procurement of adequate and potent
vaccines and needles and syringes to all health
facilities nationwide

VACCINES
Vaccines:
Bacille Calmetter Guerin (BCG)
- given intradermally (ID)
- a weakened (attenuated) version of a bacteria called
Mycobacterium bovis which is closely related to
Mycobacterium tuberculosis, the agent responsible for
tuberculosis
- given at the earliest possible age after birth preferably within
the first 2 months of life
- Dose is 0.05 mL for infants <12 mos. of age and 0.1 mL ≥ 12
months of age

Vaccines:
Hepatitis B (HBV)
- given Intramuscularly (IM)
- protects against hepatits B virus (HBV) infection, a
contagious disease that damages the liver
- 1st dose within the 1st 12 hours of life, and may be counted as
part of the 3-dose primary series. Subsequent doses are
given at least 4 weeks apart, with the 3rd dose preferably
given not earlier than 24 weeks of age
- dose: 0.5 mL

Vaccines:
Pentavalent Vaccines
- protects against 5 threatening diseases: Diphtheria, Tetanus,
Hepatitis B., Pertussis, Pneumonia and Meningitis
- given with 3 doses
- first dose is at 6 weeks after birth with 4 weeks of interval for
the next doses
- dose: 0.5 mL

Vaccines:
Oral Polio Vaccine (OPV)
- given orally (by drops)
- composed of live, weakened (attenuated) virus
- given in 3 doses at 1 ½ months (6 weeks), 2 ½ months (10
weeks) and 3 ½ months (14 weeks)
- passes immunity from person to person
- Old OPV: Trivalent (Type 1, 2, and 3)
- New OPV: Bivalent (Type 1 and 3)

Vaccines:
Inactivated Poliovirus Vaccine (IPV)
- composed of killed viruses
- given in a one dose a 3 ½ months (14 weeks) maximizes a
child’s immunity when given in addition to OPV
- provides immunity through the blood
- provides individual immunity only
- Dose: 0.5 mL

Vaccines:
Pneumococcal Conjugate Vaccine (PCV)
- given at 1 ½ months for first dose, 2 ½ dose for second dose
and 3 ½ for third dose (6 weeks, 10 weeks, 14, weeks)
- the vaccine protects the child against pneumococcal
diseases (pneumonia, bacteremia and meningitis)
- Dose: 0.5 mL

Vaccines:
Measles, Mumps, Rubella (MMR)
- given Subcutaneously
- given at 9 months (MCV) and 12 months (MMR)
- the vaccine protects the child against measles (Ordinary
Measles), mumps and rubella (German Measles)
- minimum age for MMR is 12 months
- Dose: 0.5 mL

Vaccines Disease/s Schedule Route Dosage Temperature
Prevented for Storage
Bacille Calmetter Tuberculosis at birth Intradermal (ID) 0.05 mL 3°C - 8°C
Guerin (BCG) (35°F – 46°F)
Hepatitis B Hepatitis B at birth Intramuscular (IM) 0.5 mL 3°C - 8°C

Vaccine (HBV) (35°F – 46°F)
Pentavalent Diphtheria, Tetanus, Hep. 6 weeks Intramuscular (IM) 0.5 mL 3°C - 8°C
Vaccine B, Pertussis, Pneumonia, 10 weeks (35°F – 46°F)
Meningitis 14 weeks
Oral Polio Vaccine Old (Trivalent): Poliomyelitis 6 weeks Intramuscular (IM) 0.5 mL 3°C - 8°C
(OPV) Type 1, 2, 3 10 weeks (35°F – 46°F)
New (Bivalent): Poliomyelitis 14 weeks
Type 1 and 3
Inactivated Polio Poliomyelitis Type 1, 2, 3 14 weeks Intramuscular (IM) 0.5 mL 3°C - 8°C
Vaccine (IPV) (35°F – 46°F)
Pneumococcal Pneumonia, Bacteremia, 6 weeks Intramuscular (IM) 0.5 mL 3°C - 8°C

Conjugate Vaccine Meningitis 10 weeks (35°F – 46°F)
(PCV) 14 weeks
Measles, Mumps, Measles, Mumps and 9 months Subcutaneous 0.5 mL -50°C - -15°C
Rubella (MMR) Rubella 1 year old (-58°F – 5°F)
COLD CHAIN
MANAGEMENT
Cold Chain Management:
Cold Chain Management

- The 'cold chain' is a system of storing and transporting
vaccines at recommended temperatures from the point of
manufacture to the point of use.
- the role of the cold chain is to maintain the potency of
vaccines

Vaccines and Cold Chain Management:

- upgraded the cold chain equipment in the 80 provinces, 38
cities and 16 regions since 2003
- effective vaccine management assessment was conducted
last December 2011 and revealed cold chain capacity gaps
from the national up to the implementers level

Temperature Monitoring
- store frozen vaccines (Varicella, MMR and Zoster) in a
freezer between -58°F and 5°F (-50°C and -15°C)
- store all routinely recommended vaccines in a refrigerator
between 35°F and 46°F (2°C and 8°C)
- desired average refrigerator vaccine storage is 40°F (5°C)

ROLE OF
MIDWIFE
Role of Midwife:
Assessment
- midwives assess the number of children in her catchment
area for recording and reporting
- assessment enables the midwife to ensure that all infants
that are to be vaccinated will be given the right vaccine at the
right time

Role of Midwife:
Planning
- midwives schedule “Immunization Day” to a certain barangay
that is under her catchment area
Implementation
- midwives carry out the vaccines from the RHU to BHS thru
cold chain management and immunized the infants as to the
right vaccine

Role of Midwife:
Monitoring
- midwives monitor the infants thru “Target Client List” (TCL)
- this allows the midwife to keep track the progress of the
infants with regards to vaccination
Target Client List
- midwives monitor the infants thru “Target Client
List” (TCL)
- this allows the midwife to keep track the
progress of the infants with regards to
vaccination

Role of Midwife:
Evaluation
- midwives evaluate the progress of the Immunization in their
catchment area with the use of TCL
- this enables the midwife to identify the infants who are not
vaccinated during his/her schedule

EPI :
THANK YOU! 


Expanded Program On Immunization: University of The Philippines Manila

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University of the Philippines Manila

SCHOOL OF HEALTH SCIENCES

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

- to reduce the morbidity and mortality among

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

3. Strengthening Vaccine-Preventable Diseases

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Hepatitis B Hepatitis B at birth Intramuscular (IM) 0.5 mL 3°C - 8°C

Pneumococcal Pneumonia, Bacteremia, 6 weeks Intramuscular (IM) 0.5 mL 3°C - 8°C

Cold Chain Management

Cedrick James Sabulao

Vaccines and Cold Chain Management:

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

Cedrick James Sabulao

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