Expanded Program On

Immunization
By Louise Opina & Khansa
Manzur
 Rationale
The Expanded Program on Immunization (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 months of age based on the EPI Comprehensive
Program review.
 Scenario
GLO
The burden BAL
SCE Weekly Epidemiological others (polio,
diptheria, tello
In 2002, WHO Record fever)

estimated that 1.4

NARI 13.00% tetanus

million of deaths O 1.00% 1.00%

(nonneonatal)

among children under 20.00% 38.00%

measles

5 years due to Hib

diseases that could 27.00%

pertussis
have been prevented
by routine neonatal tetanus

vaccination. This
represents 14% of
global total mortality
 Scenario
GLO
Chart Title BAL Burden of Diseases
100
SCE The immunization coverage of
90 all individual vaccines has
80
NARI improved as shown in Figure
70 O 1: (Demographic Health
60
Survey 2003 and 2008).  Fully
Immunized Child (FIC)
50
coverage improved by 10%
40
and the Child Protected at
30
Birth (CPAB) against Tetanus
20 improved by 13% compared
10 to any prior period.  Thus, the
0 Philippines has
DPT1 DPT3 AMV FIC CPAB
Series 1 Series 2
now historically the
highest coverage for these
two major indicators. 
 Interventions/Strategies
PROGRAM OBJECTIVES AND GOALS 
Over-all Goal:
To reduce the morbidity and mortality among children against the most
common vaccine-preventable diseases.
 
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, pertussis, hepatitis b and German measles.
6.   To prevent extra pulmonary tuberculosis among children.
 MANDATE
Republic Act No. 10152“MandatoryInfants and Children
Health Immunization Act of 2011Signed by President
Benigno Aquino III in July 26, 2010. The mandatory
includes basic immunization for children under 5
including other types that will be determined by the
Secretary of Health.
 Strategies
Conduct of Routine Immunization for Infants/Children/Women
through the Reaching Every Barangay (REB) strategy
REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was
introduced in 2004 aimed to improve the access to routine immunization and reduce drop-outs.
There are 5 components of the strategy, namely: data analysis for action, re-establish outreach
services, , strengthen links between the community and service, supportive supervision and
maximizing resources.
Supplemental Immunization Activity (SIA)
Supplementary immunization activities are used to reach children who have not been vaccinated or
have not developed sufficient immunity after previous vaccinations. It can be conducted either
national or sub-national –in selected areas.
Strengthening Vaccine-Preventable Diseases Surveillance
This is critical for the eradication/elimination efforts, especially in identifying true cases of
measles and indigenous wild polio virus
Procurement of adequate and potent vaccines and needles and syringes to all health facilities
nationwide
 Status of Implementation/
Accomplishment
All health facilities (health centers and barangay health
stations) have at least one (1) health staff trained on
REB.
Polio Eradication:
- The Philippines has sustained its polio-free status since October 2000.
- Declining Oral Polio Vaccine (OPV) third dose coverage since 2008 from 91%
to 83%. A least 95% OPV3 coverage need to be achieved to produce the
required herd immunity for protection.
- There is an on-going polio mass immunization to all children ages 6 weeks
up to 59 months old in the 10 highest risk areas for neonatal tetanus. These
areas are the following: Abra, Banguet, Isabela City and Basilan, Lanao Norte,
Cotabato City, Maguindanao, Lanao Sur, Marawi City and Sulu.
- 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
Measles Elimination
Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011.
Implemented the 2-dose measles-containing vaccine (MCV) in 2009
MCV1 (monovalent measles) at 9-11 months old
MCV2 (MMR) at 12-15 months old
Implemented and strengthened the laboratory surveillance for confirmation of measles. Blood samples are withdrawn
from all measles suspect to confirm the case as measles infection.
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.
Rapid coverage assessment (RCA) were conducted in selected areas to validate immunization coverage, assess high
quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of
72,353 9 months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494
barangays with a population of 1000 and above that were randomly selected. 97.6% of all eligible children were given
the MR vaccine during the immunization campaign
The Government of the Philippines spent PhP 635.7M for the successful conduct of the MR campaign.ss high quality
and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of 72,353
9 months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494 barangays with a
population of 1000 and above that were randomly selected. 97.6% of all eligible children were given the MR vaccine
during the immunization campaign.
As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were laboratory confirmed, 5 cases were
epidemiologically-linked and 27 clinically confirmed. This means we have at least 60 “true” measles at present.
Measles is said to be eliminated if we have 1 case per million or below 100 cases in a year
Maternal and Neonatal Tetanus
Elimination
10 areas were classified as highest risk for neonatal
tetanus (NT). Figure 3 shows the areas categorized as low
risk, at risk and highest risk based on the NT surveillance,
skilled birth attendants and facility based delivery and the
tetanus toxoid 2+ (TT 2+) vaccination.
Three (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
Hepatitis B Control
Republic Act No. 10152 has been signed. It is otherwise known as
the “Mandatory Infants and Children Health Immunization Act of
2011, which requires that all children under five years old be given
basic immunization against vaccine-preventable diseases.
Specifically, this bill provides for all infants to be given the birth dose
of the Hepatitis-B vaccine within 24 hours of birth.
One strategy to strengthen Hepatitis B coverage is to integrate
birth dose in the Essential Intrapartum and Newborn Care Package
(EINC). In 2011, 11 tertiary hospitals are already EINC compliant.
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-olds born after routine vaccination started 100% Hepatitis B
at birth vaccination.
Vaccines and cold chain management
Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16
regions since 2003.
An effective vaccine management assessment was conducted last
December 2011 and revealed cold chain capacity gaps from the national up to
the implementers level.
A total of PhP 267 million is required to address the gaps identified during
the assessment.

Introduction to New Vaccines

For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the
national immunization program. Immunization will be prioritized among the
infants of families listed in the National Housing and Targeting System (NHTS)
for Poverty Reduction nationwide.
The Government of the Philippines has allocated PhP 1.6 billion for the
procurement of these 2 vaccines.
 Future Plan/Action
 Strengthening the Cold Chain to support the
Immunization Program
 Capacity Building for Health Workers for the
Introduction of New Vaccines
 Advocacy for the financial sustainability for the newly
introduced vaccines for expansion.
 Development of the comprehensive multi-year plan for
immunization program.
Other Significant information worth
mentioning
One significant milestone is that the budget allocation for the
immunization program has continued to increase year by year
The Government of the Philippines allocated budget for the
immunization of all infants/children/women/older persons
nationwide. For 2012, the budget for EPI is PhP1.8 billion and
another P1.5 Billion for the immunization for senior citizen and
children for the NHTS families. This is great leap towards universal
access to quality vaccines for the prevention of the most common
vaccine-preventable diseases.
 Thank you!!
References:
https://www.doh.gov.ph/expanded-program-on-immunization
https://www.rappler.com/newsbreak/fast-facts/195478-doh-expanded-program-immunization-phi
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