Recommended Visits and Schedule of Immunization

The Expanded Program of Immunization (EPI) being administered in local health centers througout the country still covers the primary series consisting of 1 dose of BCG anytime from birth onwards, 3 doses of hepatitis B vaccine at 0,1,6 months and 3 doses each of whole cell DPT and OPV at 6, 10 and 14 weeks and 1 dose of measles at 9 months. This is the routine vaccines given at 0-12 months recommended by the Department of Health or DOH.

The BCG (Bacillus Calmette-Guerin (BCG) vaccine is ideally given at birth . If given beyond 12 months, do PPD (Protein Purified Derivative) or a Tuberculin skin test. If PPD is negative, give BCG. It is immunization against extrapulmonary Tuberculosis and is given as a single dose.

The first dose of Hepatitis B vaccine is ideally given within the 12th hour of life. This may be used as the first dose in a 3-dose primary series at least 4 weeks apart. A fourth dose is needed in the following instances, namely: the third dose is given at less than 6 months of age; no birth dose was given using the EPI schedule of 6, 10, 14 weeks amd for preterm infants less than 2 kgs., due to poor immunogenicity of the vaccine for these infants. For the third condition, the initial dose should not be counted in a 3-dose immunization schedule to complete the series. In infants born to a mother positive for hepatitis B via screening for HBS antigen, hepatitis B Immunoglobulin is ideally given within the first 12 hours of life together with the Hepatitis B vaccine at different injection sites or on alternate thighs intramuscularly.

For the Diptheria, Pertussis, Tetanus (DPT) vaccine, a first booster dose is given at 12-24 months or at least 1 year after the third dose. A second booster shot is administered between 4-6 years of age. For those who did not receive or complete the DPT three series by age 7-16 years, DT (Diptheria & Tetanus) vaccine is recommended at least 4 weeks apart. Booster shots are to be given every 5-10 years after completing the three series.

For the Oral Polio Virus (OPV)vaccine, the first booster is given at 12-24 months or 1 year after the third dose. While the second booster is given at 4-6 years of age.

In case of epidemics, the measles vaccine can be given as early as 6 months of age as a single dose instead of the EPI recommended schedule at 9-11 months.

The other recommended vaccines are Hib, IPV, MMR, Varicella, Hepatitis A, Pneumococcal, Rotavirus, Influenza and HPV.

The Haemophilus type b conjugate vaccine or Hib is indicated in infants from 2 months, for the prevention of invasive diseases such as meningitis, septicemia, epiglottitis caused by H. influenzae type b. In infants less than 6 months, it is given for 3 doses at intervals of 1 or 2 months followed by a booster injection one year after the third injecton. Between 6 and 12 months, 2 doses at an interval 1-2 months is given followed by a booster at 15-18 months of age. For children from 1 to 5 years, a single doses is given if no shot has been received earlier.

Another preparation of the polio vaccine is IPV which is an inactivated poliomyelitis virus vaccine. It is usually given with the other vaccines like Acellular DPT and Hib as combination vaccines so the interval between doses can be at least 1 or 2 months.

MMR (Measles, Mumps, Rubella) vaccine is given as early as 1 year of age with a booster shot between ages 5 - 12 years old. Although some authors recommend that the first dose be given at 15 months.

The first dose of Varicella vaccine is recommended at 12-15 months whereas the second dose may be given at 4-6 years but may be administered earlier provided the interval between the first and second is 3 months. The second dose is recommended for children, adolescents, and adults who received only 1 dose. All indiviuals aged 13 years and up, without previous evidence of immunity should receive 2 doses of varicella at least 4 weeks apart.

Hepatitis A vaccine can be given as early as 1 y/o with a second dose to be given within 6 - 24 months after the first dose or at 0, 1, 6 months schedule depending on the type of hepatitis A vaccine to be administered.

The pneumococcal vaccine or IPD can be given as early as 1 & 1/2 months or 6 weeks with a minimum interval of 4 weeks apart for 3 doses. The pneumococcal polysaccharide vaccine (PPV) is recommended for certain high risk groups in addition to PCV at 2-19 years of age. For healthy children, no additional doses needed if PCV series is completed.

The rotavirus vaccine (RV) is available in two preparations. One is a monovalent human Rotavirus vaccine which would require 2 doses: first dose at 6-14 weeks of age, and the second dose between 14-24 weeks of age. The interval should not be less than 4 weeks and the second dose should be given by age 24 weeks. Whereas the pentavalent human-bovine reassortant Rotavirus vaccine would need a 3 dose series: first dose between 6-12 weeks of age, subsequent doses should be administered at 4-10 weeks intervals and the final dose should not be given later than 32 weeks of age. The RV may be given with OPV or given 2 weeks apart. if give, concommitantly with OPV, 2 doses of monovalent human RV or 3 doses of pentavalent RV should be completed to overcome interference of OPV with RV immune response. This should be given at least 2 weeks apart from OPV.

Influenza vaccine is recommended in children 6 months to five years and those with high risk like congenital heart disease, vascular disease, chronic lung disease like asthma, chronic metabolic disorders, renal disorders and hemoglobinopathies and those children on long term (Aspirin) ASA therapy. Children aged 6 month to 8 years receiving influenza vaccine for the first time need 2 doses given at least 4 weeks apart. Those who received only 1 dose in the first year should receive 2 doses the following year. Children recommended for vaccination who are in their 3rd or more year of being vaccinated and who received only 1 dose in each of the first 2 years of being vaccinated should continue receiving a singlke annual dose. Vaccination should be given once a year preferably between February to June to cover the expected increase in influenza activity from June to October. Healthy children more than 5 years of age who wants to be protected against influenza can also be given the vaccine. Contraindications to vaccine administration are hypersensitivity to any constituent, acute febrile illness,prebious history of Guillen barresyndrome within the last 6 weeks.

Human papilloma virus (HPV) vaccine is available as a bivalent HPV vaccine and a quadrivalent HPV vaccine. The bivalent vaccine (cervarix) is recommended for ages 10-55 years at 0,1,6 months schedule. The second dose may be given 1 - 2.5 months after the first dose if flexibility is needed. Whereas the quadrivalent type (gardasil) is recommended for ages 10-26 years at 0,2,6 months schedule. If flexibility is needed, the second dose should be given at least 1 month after the first dose and the third dose at least 3 months after the second dose.

Other immunization schedule is recommended for the combination vaccine like 6-in-1 combinations (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Polio virus, H. influenzae type B, hepatitis B virus); 5-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus, H. influenzae type b) or 4-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus or H. influenzae type b virus). The age of administration may vary between brands but the first dose is usually given at least 2 months of age and the 3-dose series is completed at interval of 1-2 months.