IMMUNIZATION

• VPDs initially targeted as part of routine basic vaccination in the early era of the EPI (1976-1982)


  • tuberculosis
  • poliomyelitis
  • diphtheria
  • whooping cough (PERTUSSIS)
  • tetanus
  • measles
• Hepatitis B was the seventh VPD included in 1992
• The Expanded Program on Immunization transitioned to become the National Immunization Program
• The National Immunization Program will include immunizations of other populations such as senior citizen immunization, school-age immunization, and adolescent immunizations
• Over-all Goal


  To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases
• Specific Goals


  • To immunize all infants/children against the most common vaccine-preventable diseases
  • To sustain polio-free status of the Philippines
  • To eliminate measles infection
  • To eliminate maternal and neonatal tetanus
  • To control diphtheria, pertussis, hepatitis b and German Measles
  • To prevent extra pulmonary tuberculosis among children
• Providing for compulsory basic immunization for infants and children below 8


  PD 996 (Sept 16, 1976)
• Hepa B immunization, 7 vaccines

  RA 7846 (December 30, 1994)
• The mandatory includes basic immunization for children under 5 including other types that will be determined by the Secretary of Health


  Republic Act No. 10152 "Mandatory Infants and Children Health Immunization Act of 2011" Signed by President Benigno Aquino III in July 26, 2010
• Implementing a united nations goal on Universal child immunization by 1990


  PP No. 6 (April 3, 1994)
• Wednesday- Immunization Day
• 2001-2020 Decade of Vaccines- envision a world of which all individuals and communities enjoy
• 5 components of the Reaching Every Barangay (REB) strategy

  • data analysis for action
  • re-establish outreach services
  • strengthen links between the community and service
  • supportive supervision
  • maximizing resources
• Vaccines


  • Bacillus Calmette Guerin (BCG)
  • Hepatitis B vaccine
  • Diphtheria Pertussis & Tetanus (DPT)
  • HAEMOPHILUS INFLUENZAE TYPE B CONJUGATE VACCINE (HIB)
  • Oral Polio vaccine
  • Inactivated Polio vaccine
  • Pentavalent vaccine
  • Tetanus Toxoid
  • Measles vaccine (MCV)
  • Mumps, Measles and Rubella vaccine
  • Pneumococcal Conjugate vaccine (PCV)
  • Pneumococcal Polysaccharide vaccine (PPSV)
  • Human Papillomavirus vaccine
  • Flu vaccine
  • Rotavirus vaccine
  • TETANUS AND DIPTHERIA TOXOID (Td)/ TETANUS AND DIPTHERIA TOXOID AND ACELLULAR PERTUSSIS (Tdap) VACCINE
  • INFLUENZA VACCINE (TRIVALENT/ QUADRIVALENT INFLUENZA VACCINE)
  • JAPANESE ENCEPHALITIS LIVE ATTENUATED RECOMBINANT VACCINE
• Cold Chain


  The system used to maintain and distribute vaccines in optimal condition
• Maintaining Cold Chain


  1. Transport vaccine safely

  2. Identify alternative space

  3. Have packing/ transporting supplies in stock

  4. Transport inside vehicles

  5. Take the quickest route

  6. Never leave vaccine unattended
• In 2016, the Expanded Program on Immunization transitioned to become the National Immunization Program. It will include immunizations of other populations such as senior citizen immunization, school-age immunization, and adolescent immunizations.
• Over-all Goal of the National Immunization Program

  To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases
• Specific Goals of the National Immunization Program

  • To immunize all infants/children against the most common vaccine-preventable diseases
  • To sustain polio-free status of the Philippines
  • To eliminate measles infection
  • To eliminate maternal and neonatal tetanus
  • To control diphtheria, pertussis, hepatitis b and German Measles
  • To prevent extra pulmonary tuberculosis among children
• Mandates for Immunization


  • PD 996 (Sept 16, 1976) - Providing for compulsory basic immunization for infants and children below 8
  • RA 7846 (December 30, 1994) - Hepatitis B immunization - 7 vaccines
  • Republic Act No. 10152 "Mandatory Infants and Children Health Immunization Act of 2011" - Mandatory basic immunization for children under 5 including other types that will be determined by the Secretary of Health
  • PP No. 6 (April 3, 1994) - Implementing a united nations goal on Universal child immunization by 1990
• Strategies for Immunization


  • Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every Barangay (REB) strategy
  • Supplemental Immunization Activity (SIA)
  • Procurement of adequate and potent vaccines and needles and syringes to all health facilities nationwide
  • Strengthening Vaccine-Preventable Diseases Surveillance
• Six Guiding Principles for Immunization

  • Country ownership - Countries have primary ownership and responsibility for establishing good governance and for providing effective and quality immunization services for all
  • Shared Responsibility and Partnership - Immunization against vaccine preventable diseases is an individual, community and governmental responsibility that transcends borders and sectors
  • Equity - Equitable access to immunization is a core component of the right to health
  • Integration - Strong immunization systems, as part of broader health systems and closely coordinated with other primary health care delivery programs, are essential for achieving immunization goals
  • Sustainability - Informed decisions and implementation strategies, appropriate levels of financial investment, and improved financial management and oversight are critical to ensuring the sustainability of immunization programs
  • Innovation - The full potential of immunization can only be realized through learning, continuous improvement and innovation in research and development, as well as innovation and quality improvement across all aspects of immunization
• BCG Vaccine


  Given intradermally (ID), 0.05 ml for children < 12 months and 0.1 ml for children ≥ 12 months after birth (preferably within the first 2 months of life), stored at 2-8C
• BCG Vaccine Adverse Events

  • Mild: A red, tender, and indurated papule usually is seen at the injection site. This papule may appear 2 or more weeks after vaccination, it can progress to an ulcer, and then form a crust that falls off after approximately 6 weeks and leaves the commonly known BCG scar
  • Severe: Should be reported
• When to do PPD test before BCG vaccination

  If mother is TB positive, history of close contact to known or suspected infectious cases, clinical findings suggestive of TB and/or chest x-ray suggestive of TB
• Hepatitis B Vaccine (HBV)

  • First dose given to newborns ≥2kgs within 24 hours of life, second dose 1-2 months after birth dose, final dose not earlier than 24 weeks of age
  • For infants born to HBsAg (+) mothers: Administer HBV* and HBIG (0.5ml) within 12 hours of life, HBIG should be administered not later than 7 days of age, if not immediately available
• Diphtheria, Tetanus, Pertussis Vaccine (DTP)

  • Given intramuscularly (IM), minimum age 6 weeks, primary series 3 doses with 4 week interval, booster series 3 doses until adolescence (12-23 months, 4-7 years, 9-15 years)
  • DTaP helps protect against diphtheria, tetanus, and pertussis (whooping cough)
  • DT helps protect against diphtheria and tetanus
  • Tdap helps protect against tetanus, diphtheria, and pertussis
  • Td helps protect against tetanus and diphtheria
• Haemophilus Influenzae Type B Conjugate Vaccine (HIB)


  Given intramuscularly (IM), 3-dose primary series with minimum age 6 weeks and 4 week interval, booster dose 12-15 months with 6 month interval from 3rd dose
• Pentavalent Vaccine


  5 in 1 vaccine containing DPT, HEP B, HIB, given intramuscularly to 1 and ½ months old infants, 3 doses
• Human Papillomavirus Vaccine (HPV)


  Given intramuscularly (IM), for ages 9-14 years 2-dose series at 0 and 6 months, for ages 15 years and older 3-dose series at 0, 2, and 6 months, for males age 9-18 years 4vHPV and 9vHPV can be given for prevention of anogenital warts and anal cancer
• Influenza Vaccine (Trivalent/Quadrivalent)


  Trivalent influenza vaccine (TIV) given intramuscularly (IM) or subcutaneously (SC), Quadrivalent influenza vaccine (QIV) given intramuscularly (IM), given at minimum age 6 months, children 6 months to 8 years receiving for the 1st time should receive 2 doses separated by at least 4 weeks, children 9 to 18 years should receive one dose yearly, annual vaccination should begin in February but may be given throughout the year
• Japanese Encephalitis Live Attenuated Recombinant Vaccine

  Given subcutaneously (SC), given at minimum age 9 months, children 9 months to 17 years should receive one primary dose followed by a booster dose
• 4vHPV and 9vHPV


  For the prevention of anogenital warts and anal cancer in males aged 9-18 years
• Influenza vaccine


  • Trivalent influenza vaccine (TIV) given intramuscularly (IM) or subcutaneously (SC)
  • Quadrivalent influenza vaccine (QIV) given intramuscularly (IM)
• Influenza vaccine


  Given at a minimum age of 6 months, follow manufacturer's recommendations for pediatric dose
• Influenza vaccine for children 6 months to 8 years


  1. If receiving for the 1st time, receive 2 doses separated by at least 4 weeks

  2. If only 1 dose given previous season, give 2 doses then 1 dose yearly thereafter
• Influenza vaccine for children 9 to 18 years


  Receive 1 dose yearly
• Influenza vaccination


  Begin in February but may be given throughout the year
• Japanese encephalitis live attenuated recombinant vaccine


  • Given subcutaneously (SC)
  • Given at a minimum age of 9 months
  • Children 9 months to 17 years receive 1 primary dose followed by 1 booster 12-24 months later
  • Individuals 18 years and older receive 1 dose only
• Measles vaccine


  • Given subcutaneously (SC)
  • Given at 9 months, may be given as early as 6 months in outbreaks
  • If monovalent measles vaccine unavailable, MMR/MR vaccine may be given to infants under 12 months, followed by 2 more MMR doses starting at 1 year