EPI

Expanded Program on Immunization (Philippines)

The Expanded Program on Immunization (EPI) 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.

Routine Schedule of Immunization

Every Wednesday is designated as immunization day and is adopted in all parts of the country. Immunization is done monthly in barangay health stations, quarterly in remote areas of the country.

Routine Immunization Schedule for Infants

The standard routine immunization schedule for infants in the Philippines is adopted to provide maximum immunity against the seven vaccine preventable diseases in the country before the child's first birthday. 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 measles vaccines before the child is 12 months of age.

Vaccine	Minimum Age at 1st Dose	Number of Doses	Dose	Minimum Interval Between Doses	Route	Site	Reason
Bacillus Calmette-Guérin	Birth or anytime after birth	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
Diphtheria-Pertussis-Tetanus Vaccine	3 weeks old	3 doses	0.5 mL	6 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.
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.
Hepatitis B Vaccine	birth or anytime after birth	3 doses	0.5 mL	4 weeks interval	Intramuscular	Upper 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. Prevents liver cirrhosis and liver cancer which are more likely to develop if infected with Hepatitis B early in life. About 9,000 die of complications of Hepatits B. 10% of Filipinos have Hepatitis B infection
Measles Vaccine (not MMR)	9 months old	1 dose	0.5 mL	none	Subcutaneous	Upper outer portion of the arms, Right deltiod	At least 85% of measles can be prevented by immunization at this age.

General Principles in Infants/Children Immunization

• Because measles kills, every infant needs to be vaccinated against measles at the age of 9 months or as soon as possible after 9 months as part of the routine infant vaccination schedule. It is safe to vaccinate a sick child who is suffering from a minor illness (cough, cold, diarrhea, fever or malnutrition) or who has already been vaccinated against measles.
• If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the schedule should be resumed using minimal intervals between doses to catch up as quickly as possible.
• Vaccine combinations (few exceptions), antibiotics, low-dose steroids (less than 20 mg per day), minor infections with low fever (below 38.5º Celsius), diarrhea, malnutrition, kidney or liver disease, heart or lung disease, non-progressive encephalopathy, well controlled epilepsy or advanced age, are not contraindications to vaccination. Contrary to what the majority of doctors may think, vaccines against hepatitis B and tetanus can be applied in any period of the pregnancy.
• There are very few true contraindication and precaution conditions. Only two of these conditions are generally considered to be permanent: severe (anaphylactic) allergic reaction to a vaccine component or following a prior dose of a vaccine, and encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination.
• Only the diluent supplied by the manufacturer should be used to reconstitute a freeze-dried vaccine. A sterile needle and sterile syringe must be used for each vial for adding the diluent to the powder in a single vial or ampoule of freeze-dried vaccine.
• The only way to be completely safe from exposure to blood-borne diseases from injections, particularly hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) is to use one sterile needle, one sterile syringe for each child.

vaccines: BCG

Since tuberculosis is common in the Philippines, the BCG (Bacillus Calmette-Guérin (or Bacille Calmette-Guérin)  is one of the immunizations given at birth or soon after birth among Filipino babies (and even to foreigners born on the Philippine shores at that).

This is also included in the government's EPI thus, is covered by the Philhealth on hospital deliveries.

Below is an information on this vaccine from the CDC.

Vaccines and Preventable Diseases:

Tuberculosis (TB) Vaccination

BCG is a vaccine for TB. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. BCG vaccine does not always protect people from getting TB. If you were vaccinated with BCG, you may have a positive reaction to a TB skin test.  This reaction may be due to the BCG vaccine itself or due to infection with the TB bacteria. Your positive reaction is more likely to mean you have been infected with TB bacteria...More

What You Should Know:

• About the Disease
 
• Vaccine Information
 
• Who Should Not be Vaccinated?

vaccines: DPT

DPT or DTaP includes three vaccine preventable diseases (diphtheria, pertussis, tetanus) that are much common in the Philippines. Fortunately, This comes free in government health centers with the DOH program on EPI (Expanded Program in Immunization).

I had my baby get his shits on the DPT at our local barangay.

The downside is that this type causes fever for about 24 hours. So, paracetamol drops is a must.

The combination vaccine which they mostly refer to as 5 in 1 which includes polio (IPV) and HiB aside from the three mentioned above, and 6 in 1 which adds hepatitis B, allows lesser shots for the baby also, there will be no fever after.

This doesn't come free though nor does it come cheap. But for those with the extra budget and little time, why not??!

Anyway, these succeeding information are again from CDC as with the other vaccine related posts I've made.

Vaccines and Preventable Diseases:

Diphtheria Vaccination
Pronounced (dif-THEER-ee-a)

Diphtheria causes a thick covering in the back of the throat. It can lead to breathing problems, paralysis, heart failure, and even death. There are several combination vaccines used to prevent diphtheria: DTaP, Tdap, DT, and Td.

What You Should Know:

• About the Disease
 
• Vaccine Information
 
• Beliefs & Concerns
 
• Vaccine Safety
• Who Should Not be Vaccinated?

Pertussis (Whooping Cough) Vaccination
Pronounced (per-TUS-iss)

Whooping cough — known medically as pertussis — is a highly contagious respiratory tract infection. Although it initially resembles an ordinary cold, whooping cough may eventually turn more serious, particularly in infants. Whooping cough is most contagious before the coughing starts. The best way to prevent it is through vaccinations. The childhood vaccine is called DTaP. The whooping cough booster vaccine for adolescents and adults is called Tdap. Both protect against whooping cough, tetanus, and diphtheria.

On This Page:

• About the Disease
 
• Vaccine Information
 
• Beliefs & Concerns
 
• Vaccine Safety
 
• Who Should Not be Vaccinated?

Tetanus (Lockjaw) Vaccination

Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases. Several vaccines are used to prevent tetanus among children, adolescents, and adults including DTaP, Tdap, DT, and Td.

What You Should Know:

• About the Disease
 
• Vaccine Information
 
• Vaccine Safety
• Who Should Not be Vaccinated?

vaccines: hepatitis B

This is a series of three shots. It is advisable to start it soion after birth due to the prevalence of undiagnosed hepa B cases in the Philippines.

As such, hospitals now give it and fortunately, it is also covered by the government's PhilHealth.

This is also included in the EPI. So, succeeding shots at 1 month (2nd dose) and 6 months are available at the local health centers.

Make sure that the third dose is after 6 months of age, else, a fourth dose is required.
Also, a fourth dose is required when the baby was born prematurely (born less than 37 weeks AOG).

Vaccines and Preventable Diseases:

Hepatitis B Vaccination
Pronounced (hep-ah-TY-tiss)

Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. 


Hepatitis B vaccine is available for all age groups to prevent HBV infection.

What You Should Know:

• About the Disease
 
• Vaccine Information
 
• Beliefs and Concerns
 
• Vaccine Safety
• Who Should Not be Vaccinated?

vaccines: polio

This is also included in the government's EPI.

The Philippines gives the oral polio vaccine (OPV) for free alongside the schedule for the DPT shots.

Vaccines and Preventable Diseases:

Polio Vaccination
Pronounced [PO-lee-oh]

Polio is an infectious disease caused by a virus that lives in the throat and intestinal tract. It is most often spread through person-to-person contact with the stool of an infected person and may also be spread through oral/nasal secretions. Polio used to be very common in the United States and caused severe illness in thousands of people each year before polio vaccine was introduced in 1955. Most people infected with the polio virus have no symptoms; however, for the less than 1% who develop paralysis it may result in permanent disability and even death.


There are two types of vaccine that protect against polio: inactivated polio vaccine (IPV) and oral polio vaccine (OPV). IPV, used in the United States since 2000, is given as an injection in the leg or arm, depending on patient's age. Polio vaccine may be given at the same time as other vaccines. Most people should get polio vaccine when they are children. Children get 4 doses of IPV, at these ages: 2 months, 4 months, 6-18 months, and booster dose at 4-6 years. OPV has not been used in the United States since 2000 but is still used in many parts of the world.

What You Should Know:

• About the Disease
 
• Vaccine Information
 
• Beliefs & Concerns
 
• Vaccine Safety
• Who Should Not be Vaccinated?

vaccines: pneumococcal conjugate vaccine

This is another vaccination that our baby will get by the end of this month.

There's a PCV10 and a PCV13 available in the market today. The latter has a greater coverage which is strongly advised by our pediatrician and costs a thousand more than the other.

I am due to research on those two soon, since we need to decide a week before our schedule.

Anyway, here is an overview of pneumococcal vaccination in general, still from CDC.

Vaccines and Preventable Diseases:

Pneumococcal Vaccination
Pronounced (NEU-mo-KOK-al)

Pneumococcal conjugate vaccine is recommended for all children less than 59 months old. In addition, children aged more than 24 months who are at high risk of pneumococcal disease and adults with risk factors may receive the pneumococcal polysaccaride vaccine.

What You Should Know:

• About the Disease
 
• Vaccine Information
 
• Beliefs & Concerns
 
• Vaccine Safety
• Who Should Not be Vaccinated?

vaccines: Hib Vaccination

This is one of the vaccines that Joram got today. This is also the vaccine that had long since been advised. Our little brother got this same vaccine 10 years back.

This is also the vaccine that my best friend's pediatrician had strongly advised her to get for her child aside from the ones in the EPI.

Anyway, this information is again from CDC.

Vaccines and Preventable Diseases:

Hib Vaccination
Haemophilus influenzae type b (Hib)

Haemophilus influenzae type b vaccine prevents meningitis (an infection of the covering of the brain and spinal cord), pneumonia (lung infection), epiglottitis (a severe throat infection), and other serious infections caused by a type of bacteria called Haemophilus influenzae type b. It is recommended for all children under 5 years old in the US, and it is usually given to infants starting at 2 months old. The Hib vaccine can be combined with other vaccines. Some brands of vaccine contain Hib along with other vaccines in a single shot. Hib vaccine can safely be combined with other vaccines to make these combination vaccines.

1st doses for two more vaccines

Joram and I went to his pediatrician this afternoon for his rotavirus vaccine and HiB shots.
It doesn't come cheap. But thinking about the possibility of our baby getting sick with those disease is enough to scare us into spending for the vaccines. We really don't want anymore hospital days for our baby.

Praying that God would use these vaccines to help baby Joram combat infections. Trusting...

Vaccines: Rotavirus Vaccination

I am researching on the vaccines that have been advised by our pediatrician.
This is one of the vaccines that my best friend had left out as she could very well prevent this with proper hygiene and good handling of food and etc.

Anyway, this one below is from the CDC. 

Vaccines and Preventable Diseases:

Rotavirus Vaccination
Pronounced "row-tuh-virus"

Rotavirus is the leading cause of severe acute gastroenteritis (vomiting and severe diarrhea) among children worldwide. Two different rotavirus vaccines are currently licensed for use in infants in the United States. The vaccines are RotaTeq® (RV5) and Rotarix® (RV1). Before being licensed, both vaccines were tested in clinical trials and shown to be safe and effective. In these studies, during approximately the first year of an infant's life, rotavirus vaccine was found to prevent almost all (85%-98%) rotavirus illness episodes that were severe and to prevent 74%-87% of all rotavirus illness episodes.

What You Should Know:

• About the Disease
 
• Vaccine Information
• Vaccine Safety
• Who Should Not Be Vaccinated?

vaccination prices

As I've posted previously, vaccination doesn't come cheap.. but the 80% (at least) protection that it provides for our baby would be worth it.

Anyway, I've researched on the prices of each vaccine that our pedia had advised us to get our child immunized with... I've found out that there is at least a 600Php difference on each vaccine that she priced.

That means, I need to haggle for a lower price on our next visit. After all, I could do the injection myself.

I do hope we could get a lower price though.