EXPANDED PROGRAM ON IMMUNZATION

-In the Philippines began in July 1979. And, in 1986, made a response to the Universal Child Immunization
goal. The four major strategies include:

1. Sustaining high routine Full Immunized Child (FIC) coverage of at least 90% in all provinces and cities,
2. Sustaining the polio-free country for global certification
3. Eliminating measles by 2008,
4. Eliminating neonatal tetanus by 2008.
The development of National Plan of Action for Polo Eradication has been done in 1990 and Polio
Eradication Project has been created in 1992 where in this year, the Presidential Proclamation #46 with the
affirmation of the commitment to the Universal Child Immunization and the Mother Immunization Goal.
National Immunization Days were conducted in 1993-1997 nationwide and this was the period of excitement
for the Oplan Alis Disis.
As an initial phase of measles elimination by 2008, Measles Catch-up Campaign vaccinated 28 million
children that results to a drastic reduction of measles cases. In 2000, our country has been certified polio-
free in Kyoto Japan. This was the greatest achievement of the Philippines as one of the certified polio free in
Western Pacific Region.

The Concept and importance of Vaccination

Immunization is defined as the process by which vaccines are introduced into the body before infection
sets in. Vaccines are administered to induce immunity thereby causing the recipient’s immune system to
react to the vaccine that produces antibodies to fight infection. Thus, vaccinations promote health and
protect children from disease-causing agents.

The EPI Target Disease

1. Tuberculosis 5. Poliomyelitis
2. Diphtheria 6. Measles
3. Pertussis 7. Hepatitis
4. Tetanus

The EPI Routine Schedule

Wednesday is designated as immunization day and is adopted in all parts of the country.
A child is said to be Fully Immunized Child (FIC) when he/she receives one dose of BCG, 3 doses of OPV, 3
doses of DPT, 3 doses of HB and one dose of measles before the child’s first birthday.

Tetanus Toxoid Immunization Schedule for Women

Vaccine Minimum Percent Duration of Protection

Age/Interval Protected
 TT1 As early as possible
during pregnancy

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 95%  infants born to the mother will be protected from
later 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

Care for the Vaccines

Type/form of Vaccines Storage Temperature

Most Oral Polio Vaccine (live attenuated) -15c to -25c (at the freezer)
sensitive to heat Measles (freeze dried)
Least DPT (D-toxoid which is a weakened toxin, P-killed +2c to +8c (in the body of the refrigerator)
sensitive to heat
bacteria. T- toxoid which is a weakened toxin)
Hep B

BCG (freeze dried)

Tetanus Toxoid

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.
Temperature monitoring of vaccines is done in all levels of health facilities to monitor vaccine temperature. This is
done twice a day early in the morning and in the afternoon before going home. Temperature is plotted everyday in a
temperature monitoring chart to monitor break in the cold chain.

IMMUNIZATION TRENDS

IMMUNIZATION IS KEY TO ACHIEVING CHILD SURVIVAL GOALS

28/01/2011 from Hayatee Hasan, WHO/HQ

Member States ―meeting at the 128th session of the Executive Board on 18 January 2011 ― rally their
support for the WHO/ UNICEF Global Immunization Vision and Strategy (2006-2015) and its impact in guiding
national immunization strategies to reach the child survival goals.
Several countries shared their success stories including: Bangladesh with a near universal routine
coverage and documented successes in introducing new vaccines; Burkina Faso, the first country to
successfully introduce the new meningitis A conjugate vaccine; China successfully implemented the largest
ever measles vaccination campaign in 2010; and Rwanda, the first African nation to introduce pneumococcal
vaccine.
Mindful of the challenges ahead, Member States mentioned the need to: (1) ensure that introducing
newer vaccines is not done at the expense of basic immunization; (2) expand the use of rubella vaccines; (3)
maintain high measles vaccination coverage and not drop our guard against the disease, particularly in Africa
where large scale measles outbreaks have occurred; (4) strengthen linkages between polio eradication efforts
and routine immunization; (5) facilitate vaccine technology transfer to developing countries and promote
other strategies to bring down the prices of life-saving vaccines and replicating the success of MenAfrVac;
and (6) strengthen surveillance for vaccine preventable diseases.
The Board commends WHO's leadership on the Decade of Vaccines, a vision for using the next 10 years
to achieve immunization goals and reach important milestones in vaccine research, development and
financing. More details on the Decade of Vaccines strategic framework will be presented for discussion at the
64th World Health Assembly in May 2011.

Global immunization vision and strategy

Report by the Secretariat
1. Immunization averts an estimated 2.5 million deaths annually across all age groups. In 2009, an
estimated 107 million infants were vaccinated with three doses of diphtheria-tetanus-pertussis vaccine.
In spite of this unprecedented achievement, about 1.5 million children continue to die from vaccine
preventable diseases, nearly 20% of the current annual figure of about 8 million deaths in children under
five years.
2. In 2005, the Fifty-eighth World Health Assembly in resolution WHA58.15 welcomed the
Global Immunization Vision and Strategy. In 2008, having reviewed progress in implementing the
resolution, the Sixty-first World Health Assembly in resolution WHA61.15 urged Member States to
take further steps to put the global immunization strategy into practice and requested the Director-

General to report on progress. This report responds to that request.

ROUTINE IMMUNIZATION
3. Between 2000 and 2009, global immunization coverage increased from 74% to 82%, with
improvements in the African (+16%), Eastern Mediterranean (+12%), and Western Pacific (+10%)
regions, while rates have remained high in the Region of the Americas and the European Region.
4. One goal of the Global Immunization Vision and Strategy 2006–2015 is for countries to reach at
least 90% coverage nationally and 80% in every district or equivalent administrative unit by 2010.
In 2009, 122 Member States had reached national-level coverage of 90%. The slow progress, or even
lack thereof, in some countries with large birth cohorts affects global coverage. For 2009 it was
estimated that more than 23 million infants failed to receive three doses of diphtheria-tetanus-pertussis
vaccine by their first birthday; nearly two thirds (62%) of those children live in six countries
(Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria and Pakistan). In addition,
coverage was estimated to be less than 80% in 36 countries, and six countries (Chad, Equatorial
Guinea, Gabon, Nigeria, Palau and Somalia) failed to achieve 50% coverage. As not all countries
report coverage rates at the sub-national level, the second component of the goal is difficult to
measure. Only 48 of the 143 Member States that reported district-level rates had reached the goal of
80% coverage.
5. A review in 2009 found that parental attitudes and knowledge as well as family characteristics
were the primary influences on whether a child is fully vaccinated or remains incompletely vaccinated
or unvaccinated; in addition, the rate of 44% for incomplete childhood vaccination was attributable to
failures in the immunization system itself. These findings underline the need to further strengthen the
health-care delivery system and to address parental concerns about, and lack of awareness of the
benefits of, vaccination.
6. Increasingly, vaccination of other target groups than infants (e.g. pre-school children,
adolescents, health-care workers) has become important for expanding the benefits of vaccination.
Reaching those groups has necessitated the design of new strategies (e.g. school-based programmes)
and the expansion of existing services (e.g. hepatitis B vaccination of neonates).