EXPANDED PROGRAM ON IMMUNIZATION Launched in July 1976 by the DOH in cooperation with the WHO & UNICEF Objective • To reduce the morbidity & mortality among infants and children caused by 7 immunizable diseases Principles • 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 communication • Assessment and evaluation of the program’s overall performance Surveillance , studies and research Legal Basis/Existing policies • 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 Assembly” 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 Days(NID) 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 Immunization • 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 Immunity • 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 Vaccine • Is a suspended of attenuated or killed microorganism of viruses/bacteria capable of stimulating the body to produce antibodies against a specific agent Toxoids • 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 response • 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 symptom. • Time of exposure until the first of signs and symptoms 3 Major ways to prevent infections • 1. reducing exposure • 2.using antimicrobial agents to prevent colonization and infection • 3.acquiring or inducing immunization Purpose of immunization • To provoke a specific immunologic response to its antigen resulting to a cell mediated immunity. • 1.Standard Case definition –SC • 2.Infectious agent -IA • 3.Incubation Period -IP • 4.Pathophysiology -pathway of disease • 5.Clinical manifestation CM • 6.Mode of transmission MOT • 7.Period of Communicability PC Measles – Rubeola(Scientific) • 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 (conjunctivitis) • IA • Measles Virus • IP – about 10 days • Ranges from 8 -13 days from exposure to onset of fever Duration of Natural ImmunityLifelong after attack Pathophysiology • infection sets – measles virus multiplies in the lining of the respiratory tract – dessiminated by way of the blood to distant sites: -conjunctiva -lymphoid tissue -respiratory mucous membrane • 1st sign of measles/pathognomonic sign: • KOPLICK’S SPOTS • -whitish spots found at the inner side of the cheeks • Maculo papular rash appears from face downwards associated with high grade fever • 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 & cough • -decrease rapidly after the onset of rash POLIOMYELITIS • -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 identified • IA • Poliovisur type I,II,III • IP • -7-12 days but can range from 3-21 days Pathophysiology • 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 fever 5-7 paralysis , neck rigidity Flaccid- soft Spasm-hard Spastic-paralysis • MOT • 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 PERTUSSIS -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 IA Bordetella pertussis IP usually 7 days but ranges 515(2 wks) Pathophysiology • 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 • MOT airborne/droplet • Direct contact with discharges from respiratory mucous membrane of infected persons • Indirect contact with articles freshly soiled with the discharges of infected persons • POC highly infectious in early catarrhal stage NEONTAL TETANUS • 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 convulsion • 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 spasm • 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 sec. • Feeding difficulty or inability to suck • Attempts to feed after results to attacks of spasm and cyanosis • 7-10 days –pt may die • MOT unhygienic cutting of umbilical cord • Improper handling of cord stump especially when tx with contaminated substance • POC man to man – Not directly transmitted from man to man Diptheria • Bacterial disease • SC acute pharyngitis ,acute nasopharyngitis ,or acute laryngitis w/ pseudomembrane(looks like a cauliflower) • IA corynebacterium diptheriae • IP 2-5 days or maybe longer pathophysiology • 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 breathing • MOT droplets from discharges of nose and throat • POC 2-3 wks • Shortened in pts w/antibiotics tx.