Uploaded by Ruby Corazon Ediza

Expanded Program on Immunization

Launched in July 1976 by
the DOH in cooperation
with the WHO & UNICEF
• To reduce the morbidity &
mortality among infants and
children caused by 7
immunizable diseases
• The program is based on
epidemiological situation;
schedules are drawn on the
basis of the occurrence and
characteristic epidemiological
features of the disease
• The whole community rather
than just the individual is to be
protected , thus mass approach
is utilized
• Immunization is a basic health
services being provided for by
the Rural Health Unit
Elements of EPI
• Target setting
• Cold chain logistic management
• Information , education and
• Assessment and evaluation of the
program’s overall performance
Surveillance , studies and research
Legal Basis/Existing
• PD No. 996 (Sept. 16 ,1976)
• “Providing for compulsory basic
immunization for infants and
children below 8 yrs. Old”
Presidential Proclamation
No.6 (April 3 , 1986)
• “Implementing a United Nations
goal in Universal Child
Immunization by 1990
Presidential Proclamation
no.46(Sept.16 ,1992)
• “Reaffirming the commitment of
the Philippines to the Universal
Child and Mother Immunization
goal of the World Health
Presidential Proclamation
No. 147 (March 3 ,1993)
• “Declaring April 21 and May 19 ,
1993 and every 3rd Wednesday
of January and February
thereafter , for two years, as
National Immunization
Republic Act
7846(December 30 , 1994)
• “An act requiring compulsory
immunization against hepatitis
B for infants and children below
8 years old
Presidential Proclamation
No.773(march 28 , 1996)
• “Declaring April 17 and May 15 ,
1996 and every 3rd Wednesday
of April and May from 1996 to
2000 as “Knock out Polio Days”
Presidential Proclamation
No. 1066(august 26 ,1997)
• “Declaring a national neonatal
tetanus elimination campaign
starting 1997” Presidential
Proclamation No.1064 (August 27
,1997)”Enjoying all sectors of
society to participate in Acute
Flaccid Paralysis(AFP) surveillance
component of polio eradication
campaign of the Philippines
Presidential Proclamation
No.4 (July 29 ,1998)
• “Declaring the period from Sept.
16 to October 14 ,1998 as the
Ligtas Tigdas Month” and
launching the Philippines
Measles elimination campaign
• Process by which vaccines where
introduced into the body before
infection sets in.
• Vaccines are administered to induce
immunity thereby causing the
recipient’s immune system to react
to the vaccine that produces
antibodies to fight infection
• Is the resistance of a person
usually associated with the
presence of antibodies or all
having an action against a
particular infections diseases
on its toxin
• Is a suspended of attenuated or
killed microorganism of
viruses/bacteria capable of
stimulating the body to produce
antibodies against a specific
• No longer toxins
• Toxin treated in a way that is
poisoning ability is destroyed
but its ability to provoke
immunity is retain
Active immunity
• Stimulation with a specific
antigen to induce on immune
• Example
• If patient is having measles
Passive immunity
• The conferral of specific
immune reactivity on previously
non- immune individual by the
administration of the serum
from an immuned individual.
• Example
• immunization
Incubation Period
• The development of an
infectious disease from the
entrance of the pathogen to the
appearance of the clinical
• Time of exposure until the first
of signs and symptoms
3 Major ways to prevent
• 1. reducing exposure
• 2.using antimicrobial agents to
prevent colonization and
• 3.acquiring or inducing
Purpose of
• To provoke a specific immunologic
response to its antigen resulting to a cell
mediated immunity.
• 1.Standard Case definition –SC
• 2.Infectious agent
• 3.Incubation Period
• 4.Pathophysiology -pathway of disease
• 5.Clinical manifestation
• 6.Mode of transmission
• 7.Period of Communicability PC
Measles –
• Viral disease
• SC
• -highly communicable with the
history of the following:
• 1.generalized blotchy rash, lasting
for 3 or more days
• 2.fever 38 C
• 3.any of the following:
• -cough, runny nose , red eyes
• IA
• Measles Virus
• IP – about 10 days
• Ranges from 8 -13 days from
exposure to onset of fever
Duration of Natural ImmunityLifelong after attack
• infection sets – measles virus
multiplies in the lining of the
respiratory tract – dessiminated
by way of the blood to distant
-lymphoid tissue
-respiratory mucous membrane
• 1st sign of measles/pathognomonic sign:
• -whitish spots found at the inner side of
the cheeks
• Maculo papular rash appears from face
downwards associated with high grade
• Rashes fades in the same order as they
appeared leaving a dirty brown
pigmentation and desquamation which
maybe noted for several days
• CM- days 1-3
• Cold ,cough , fever , eyes are pink watery ,
sensitive to light
• Days 2-4
• Rash spreads over the face and body,after about a
week , the rash is self limiting
• MOT – droplet spread
• -direct contact with nasal/throat/urine secretions of
infected persons
• POC –
• -from 1-3 days before the beginning of fever &
• -decrease rapidly after the onset of rash
• -Viral disease
• SC
• Suspect case of polio is defined as any
patient below 15 yrs of age with AFP for
which no other cause can be immediately
• IA
• Poliovisur type I,II,III
• IP
• -7-12 days but can range from 3-21 days
• Poliovirus reaches the intestinal
tract through the mouth
• Enters the intestinal mucosa
where it lodges
&multiplies(Intestinal phase)
• Blood(uremia phase)
• CNS(neural Phase)
• CM
• Days 1-3 unwell, slight fever
3-5 headache , stiffness , muscle pain , high
5-7 paralysis , neck rigidity
Flaccid- soft
• Fecal – oral route
• Food , water , utensils ,objects
contaminated by human excreta
• Oral –through pharyngeal secretions
• POC – 7 – 16 days before onset of s/s
• First few days after onset of s/s
-whooping cough/100 days cough
Bacterial disease
SC- Hx of severe cough and hx of any
of the ff:
cough persisting for
2 or more weeks
cough followed by vomiting
Bordetella pertussis
usually 7 days but ranges 515(2 wks)
• Principal lessions are found in the bronchi
• Organism is found in large number entangled in the
bronchial epithelium
• CM -1st week catarrhal stage
– Child shows symptoms of cold , sneezing , and low
grade fever
– 2nd week paroxysmal stage
– Cough gets worse
– Child struggles to breath and “whoops” in a breath
– Whooping is a noisy inspiration associated with a high
pitched crowing sound
– Vomit and repeat the cycle
– Cough-whoops-vomit
– 3rd week convalescent stage
– Cough begins to deminished in frequency and severity
• Direct contact with discharges from
respiratory mucous membrane of
infected persons
• Indirect contact with articles freshly
soiled with the discharges of
infected persons
highly infectious in early
catarrhal stage
• BACTERIAL disease
• SC
NB w/ hx of all of ff:
• 1.normal suck & cry for the 1st 2
days of life
• 2. onset of illness between 3-28 days
• 3.inability to suck followed by
stiffness of the body
• IA
clostridium tetani
• IP
usually 6 days but
ranges from 3-21 days
• Patho.
Organism produces a
neuro toxins(tetanospasm)
• Toxin is brought by lymphatics
and bllod to the CNS w/c causes
• CM
• At birth-body appears healthy and
sucks well
• 5-7 days jaw muscle show stiffening
thus there is difficulty in opening the
mouth (trismus/lockjaw)
• Tension of facial muscle with spasm
• Gen.spasm – precipitated by slight
stimulus or none at all
Characteristics of
• Stiffening of the whole body
• Opisthotonus ,extension of the
extrimities , boardlike rigidity of the
abdomen , clenched hands , severe
pain and cyanosis lasting for 5-10
• Feeding difficulty or inability to suck
• Attempts to feed after results to
attacks of spasm and cyanosis
• 7-10 days –pt may die
unhygienic cutting of
umbilical cord
• Improper handling of cord
stump especially when tx with
contaminated substance
man to man
– Not directly transmitted from man to
• Bacterial disease
• SC
acute pharyngitis ,acute
nasopharyngitis ,or acute laryngitis
w/ pseudomembrane(looks like a
• IA
corynebacterium diptheriae
• IP
2-5 days or maybe longer
• Typical pseudomembrane is fromed
by microorganism w/c adherent to
the underlying tissue and leaves a
raw bleeding area when attached
• Pseudomembrane is found in the
nose , nasopharynx
• Formation of more toxin would
cause damage to the organs like the
heart , kidney , liver
• CM
-days 1-3
• Child complains of mild sore throat ,low
grade fever , headache , malaise and
slight and cervical lympadenopathy
• Days 4-6
-very ill,neck is swollen
• Pseudomembrane is obvious
• Dysphagia ,noisy breathing,
regurgitation of fluids through the nose
due to palatal weakness
• 2weeks –heart failure &paralysis of
droplets from
discharges of nose and throat
2-3 wks
• Shortened in pts w/antibiotics tx.