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TheExpanded Programon Immunization(EPI)
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TheExpanded Program onImmunization(EPI)
in the Philippines began in
July 1979. And, in 1986,
made a response to the
Universal Child
Immunization goal.
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The four major strategies
include:
Sustaining high routine Full
Immunized Child (FIC) coverage of at
least 90% in all provinces and cities, Sustaining the polio-free country for
global certification
Eliminating measles by 2008,
Eliminating neonatal tetanus by 2008.
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Routine Immunization
Schedule for Infants
The standard routine immunization
schedule for infants in the
Philippinesis adopted to provide maximum
immunity against the seven vaccine
preventable diseases in the countrybefore the child's first birthday
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The fully immunized child
must have;
completed BCG 1
DPT 1, DPT 2, DPT 3
OPV 1, OPV 2, OPV 3 HB 1, HB 2, HB 3
and ANTI- measles vaccinesbefore the child is 12 months ofage.
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Vaccine Minimum Ageat 1st Dose
Number
of Doses DoseMinimum Interval
Between Doses Route Site Reason
Bacillus Calmette-Gurin Birth or anytime afterbirth 1 dose 0.05 mL none Intradermal
Right deltoid region of the
arm
BCG given at earliest
possible age protects the
possibility of TB
meningitis and other TB
infections in which infants
are prone[3
Diphtheria-Pertussis-
Tetanus Vaccine 6 weeks old 3 doses 0.5 mL6 weeks(DPT 1), 10
weeks (DPT 2), 14 weeks
(DPT 3)Intramuscular
Upper outer portion of the
thigh, Vastus Lateralis (L-
R-L)An early start with DPT
reduces the chance of
severe pertussis.[4
Oral Polio Vaccine 6 weeks old 3 doses 2-3 drops 4 weeks Oral Mouth
The extent of protection
against polio is increased
the earlier the OPV is
given.
Keeps the Philippines
polio-free.[5
Hepatitis B Vaccine At birth 3 doses 0.5 mL 4 weeks interval IntramuscularUpper outer portion of the
thigh, Vastus Lateralis (R-
L-R)
An early start of Hepatitis
B vaccine reduces the
chance of being infected
and becoming a carrier.[6]
Prevents liver cirrhosis
and liver cancer which are
more likely to develop if
infected with Hepatitis B
early in life.[7][8]About 9,000 die of
complications of Hepatitis
B. 10% of Filipinos have
Hepatitis B infection[9]
Measles Vaccine
(not MMR)9 months old 1 dose 0.5 mL none Subcutaneous Upper outer portion of the
arms, Right deltiodAt least 85% of measles
can be prevented by
immunization at this
age.[10]
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General Principles in
Infants/Children Immunization
Because measles kills, every infant needsto be vaccinated against measles at theage of 9 months or as soon as possible
after 9 months as part of the routine infantvaccination schedule.
It is safe to vaccinate a sick child who issuffering from a minor illness (cough, cold,diarrhea, fever or malnutrition) or who hasalready been vaccinated against measles.
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General Principles in
Infants/Children Immunization
If the vaccination schedule is interrupted,it is not necessary to restart. Instead, theschedule should be resumed using
minimal intervals between doses to catchup as quickly as possible.
Vaccine combinations (few exceptions),
antibiotics, low-dose steroids (less than20 mg per day), minor infections with lowfever (below 38.5 Celsius)
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General Principles in
Infants/Children Immunization
diarrhea, malnutrition, kidney or liverdisease, heart or lung disease, non-
progressive encephalopathy, well
controlled epilepsy or advanced age, arenot contraindications to vaccination.
Contrary to what the majority of doctors
may think, vaccines against hepatitis Band tetanus can be applied in any period
of the pregnancy.
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General Principles in
Infants/Children Immunization
There are very few true contraindication and
precaution conditions.
Only two of these conditions are generallyconsidered to be permanent:
severe (anaphylactic) allergic reaction to a
vaccine component or following a prior doseof a vaccine, and encephalopathy not due to
another identifiable cause occurring within 7
days of pertussis vaccination.
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General Principles in
Infants/Children Immunization
Only the diluents supplied by themanufacturer should be used to
reconstitute a freeze-dried vaccine. A sterile needle and sterile syringe
must be used for each vial for adding
the diluents to the powder in a singlevial or ampoule of freeze-driedvaccine.
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General Principles in
Infants/Children Immunization
The only way to be completely safe
from exposure to blood-borne
diseases from injections, particularlyhepatitis B virus (HBV), hepatitis C
virus (HCV), and human
immunodeficiency virus (HIV) is touse one sterile needle, one sterile
syringe for each child.
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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
Mi i P t
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Vaccine MinimumAge/Interval
Percent
Protected Duration of Protection
TT1 As early as possibleduring pregnancy 80%
protection for the mother for
the first delivery
TT2 At least 4 weeks later 80% infants born to the mother will
be protected from neonatal
tetanus gives 3 years protection for
the mother
TT3 At least 6 months later 95% infants born to the mother will
be protected from neonatal
tetanus gives 5 years protection for
the mother
TT4 At least 1 year later 99%
infants born to the mother will
be protected from neonatal
tetanus gives 10 years protection for
the mother
TT5 At least 1 year later 99% gives lifetime protection for
the mother all infants born to that mother
will be protected
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a classification for countriesclose to maternal and neonatal
tetanus elimination.
In June 2000, the 57 countries
that have not yet achievedelimination of neonatal tetanus
were ranked and the Philippines
was listed together with 22 other
countries in Class A,
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Care for the Vaccines
To ensure the optimal potency ofvaccines
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
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Care for the Vaccines
and further down at the outreach
sites Inappropriate storage,
handling and transport of vaccineswont protect patients and may lead to
needless vaccine wastage.
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(FEFO)
A "first expiry and first out"
vaccine system is practiced to
assure that all vaccines areutilized before its expiry date.
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Proper arrangement of
vaccines
Proper arrangement of vaccines and/or
labelling 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.
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cold chain equipment
Each level of health facilities has foruse in the storage vaccines whichincluded
cold room, freezer, refrigerator, transport box, vaccine carriers,
thermometers, ice packs,
cold chain monitors
temperature monitoring chart
and safety collector boxes
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References
^Public Health Nursing in the Philippines. Manila,
Philippines: National League of Philippine
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^"Six Out of Ten Children 12 to 23 Months Are Fully
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2003-06-02. Retrieved 2007-05-11.
^ Puvacic, S.; Dizdarevi, J; Santi, Z; Mulaomerovi,
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9. PMID15628980.
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^"Immunisation". Dialogue on Diarrhoea Online (30): 16. 1987.
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^ Centers for Disease Control and Prevention (2001-10-12). "Public
Health Dispatch: Acute Flaccid Paralysis Associated with Circulating
Vaccine-Derived Poliovirus --- Philippines, 2001". Morbidity and
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^ Ni, Y. H.; M.H. Chang, L.M. Huang, H.L. Chen, H.Y. Hsu, T.Y. Chiu,
K.S. Tsai, and D.S. Chen (2001-11-06). "Effects of Universal
Vaccination for Hepatitis B".Annals of Internal Medicine135 (9): 796
800. PMID11694104. Retrieved 2007-05-12.
^"A Look at Each Vaccine: Hepatitis B Vaccine". Vaccine Education
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^ Chang, MH; C.J. Chen, M.S. Lai, H.M. Hsu, T.C.
Wu, M.S. Kong, D.C. Liang, W.Y. Shau, D.S. Chen
(1997-06-26). "Universal hepatitis B vaccination in
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in children. Taiwan Childhood Hepatoma StudyGroup". The New England Journal of
Medicine336 (26): 1855
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97213. ^ Salazar, Tessa R. (2004-05-24). "Cancer
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^ Orenstein, WA; L.E. Markowitz, W.L.
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^ Zimmerman, Richard Kent (2000-01-
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^"Management of the Traveler: Vaccination". Travel Medicine.
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^"General Recommendations on
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^ Department of Vaccines and Biologicals (2000-12). "WHO
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^ Hoekstra, Edward. "Immunization: Injection Safety". UNICEF
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^"Tetanus - The Disease". Immunization, Vaccines and
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^"Maternal and Neonatal Tetanus" (PDF). UNICEF. 2000-11.
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^"Handle Vaccines with Care". British Columbia Center for
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Philippines: Department of Health, Philippines. 1995.
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