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EXPANDED PROGRAM ON IMMUNIZATION With the commitment of our country to Universal Child Immunization(UCI) Goal acceleration of EPI coverage

had began in 1986. The achievement of the fully immunized child (FIC) coverage of 80% was noted one year ahead of the target date of UCI in 1990. The development of the EPI manual of Operations with its clear guidelines, better planning, correct immunization practices and program implementation contributed to the success of the program. The conceptualization and introduction of the disease reduction initiative in early 90s contributed to the decline of numerous cases of the immunizable diseases. The four major strategies included: 1) Sustaining high routine 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 year 1992 was marked by the Presidential Proclamation #46 with the affirmation of the commitment to the Universal Child Immunization and the Mother Immunization Goal which was highlighted by the launching of the Polio Eradication Project, at the same year the high routine coverage of FIC of 92% was achieved nationwide. National Immunization days were conducted in 1993-1997 nationwide, this was the period of excitement where all concerned agencies public and private sector participated in the Oplan Alis Disis. From 1998 up to present our country is embarking on Measles Elimination. Mass measles vaccination among children ages 9 months to less than 15 years were given nationwide regardless of immunization status. In 2000 our country has been certified polio free in Kyoto Japan. The challenge is difficult to sustain since we are at risk of importing polio from endemic areas. The countrys neonatal tetanus (NT) rate is below 1/1,000 live births. There are few cities and provinces that still have high NT rates. A Maternal and Neonatal Tetanus Elimination Plan has been developed for the implementation of NT elimination.

The Concept and Importance of Vaccination

Immunization is the process by which vaccines are introduced into the body before infection sets in. Vaccines are administered to induce immunity thereby causing the recipients immune system to react to the vaccine that produces antibodies to fight infection. Vaccinations promote health and protect children from disease-causing agents. Infants and newborns need to be vaccinated at an early age since they belong to a vulnerable group. They are susceptible to childhood diseases.

There are several general principles which apply in vaccinating children: It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body. Measles vaccine should be given as soon as the child is 9 months old, regardless of whether other vaccines will be given on that day. Measles vaccines given at 9 months provide 85% protection against measles infection. When given at one year and older provides 95% protection. The vaccination schedule should not be restarted from the beginning even if the interval between doses exceed the recommended interval by months or years. Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindications to vaccination. Generally, one should immunize unless the child is so sick that he needs to be hospitalized. The absolute contraindications to immunization are: DPT2 or DPT 3 to a child who has had convulsions or shock within 3 days the previous dose. Vaccines containing the whole cell pertussis component should not be given to children with an evolving neurological disease(uncontrolled epilepsy of progressive encephalopathy) Live vaccines like BCG vaccine must not be given to individuals who are immunosuppressed due to malignant disease (child with clinical AIDS), therapy with immunosuppressive agents, or irradiation.

It is safe and effective with mild side effects after vaccination. Local reaction, fever and systemic symptoms can result as part of the normal immune response. Giving doses of vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccines leads to higher antibody levels. No extra doses must be given to the children/mother who missed a dose of DPT/HB/OPV/TT. The vaccination must be continued as if not time has elapsed between doses. Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other than the diluent supplied with them. False contraindications to immunizations are children with malnutrition, low grade fever, mild respiratory infections and other minor illnesses and diarrhea should not be considered a contraindication to OPV vaccination. Repeat BCG vaccination if the child does not develop a scar after 1st injection. Use one syringe one needle per child during vaccination.

The EPI Target Disease Vaccination among infants and newborns(0-12 months) against the seven vaccine preventable diseases. These include: tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles and hepatitis. (For the list of EPI disease with the corresponding WHO standard case definition, please refer to Table 1.)

The EPI Vaccines and its Characteristics Type/Form of Vaccines Most Sensitive to Heat Oral Polio (live attenuated) Measles (freeze dried) Least Sensitive to Heat DPT/Hep B D Toxoid which is a weakened toxin P killed bacteria T Toxoid which is a weakened toxin Hep B BCG (freeze dried) Tetanus Toxoid +2 C to +8 C (in the
body of the refrigerator)

Storage Temperature -15 C to -25 C (at the


freezer)

-15 C to -25 C (at the


freezer)

+2 C to +8 C (in the
body of the refrigerator)

+2 C to +8 C (in the
body of the refrigerator)

Administration of Vaccines Vaccine BCG DPT Dose Infants 0.05 ml 0.5 ml Route of Administration Intradermal Intramuscular Site of Administration Right deltoid region of the arm Upper outer portion of the thigh Mouth

OPV

2 drops or depending on manufacturers instructions 0.5 ml 0.5 ml

Oral

Measles Hep B

Subcutaneous Intramuscular

Outer part of the upper arm Upper outer portion of the thigh Deltoid region of the upper arm

Tetanus toxoid

0.5 ml

Intramuscular

Expanded Program on Immunization

Submitted By:

Buenacosa, Kristel Mae A. Patalinghug, Ellaine B. BSN3-A

Submitted To: Ms. Diane Mae V. Sudario, RN