COMMUNITY HEALTH NURSING
EXPANDED
PROGRAM
ON
IMMUNIZATION
INTRODUCTION
• The two public health interventions
that have had the greatest impact on
the world's health are clean water
and vaccines.
• Immunization is the most costeffective public
• health intervention, vaccines prevent
illness or death for millions of
individuals every year.
• Almost two million children still die
each disease for which are available
at low cost. year from
• Over 90,000 fall victims to paralytic
polio, which could also have been
prevented by immunization.
EXPANDED PROGRAM ON
IMMUNIZATION
• Established in 1976
• Ensure that infants/children and
mothers have access to routinely
recommended
infant/childhood
vaccines.
OVER-ALL GOAL
• To reduce the morbidity and mortality
among children against the most
common
vaccine-preventable
disease.
SIX VACCINE-PREVENTABLE
DISEASES
1. Tuberculosis
2. Poliomyelitis
3. Diphtheria
4. Tetanus
MIDTERMS
5. Pertussis
6. Measles
SPECIFIC GOALS
1. To immunize all infants/children
against the most common vaccinepreventable 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
diphtheriapertussishepatitis b and
German measles.
6. To
prevent
extra
pulmonary
tuberculosis among children
REPUBLIC ACT NO. 10152
- "Mandatory Infants and Children
Health Immunization Act of 2011"
- President Benigno Aquino III -July
26, 2010
- Basic immunization for children
under 5 including other types that
will be determined by the Secretary
of Health
LEGAL BASIS OF THE NATIONAL
IMMUNIZATION PROGRAM
RA No10152
(July 22011) otherwise known as the
Mandatory Infants and Children Health
Immunization Act of 2011 mandated the
adoption of a comprehensive, mandatory
and sustainable immunization program
against VPDs among all infants and children
under the age of five years These include
vaccines against:
(a) Tb;
(b) DPT;
(c) Poliomyelitis;
(d) Measles;
(e) Mumps;
(f) Rubella or German measles;
(g) Hepatitis B;
(h) H. Influenza Type B (HIB); and (h) other
types as may be determined by the
Secretary of Health
RA No. 7846
(An Act requiring compulsory immunization
against Hepatitis B for infants and children
below eight years old) listed down basic
immunization services to be provided.
These include vaccination against: (i)
tuberculosis (TB)(ii) dipththeria, pertussis
and
tetanus
(DPT)(iii)
poliomyelitis
(administered orally), (iv) measles(v)
rubella(vi) Hepatitis-B in newborns within 24
hours after birth, and (vii) provision of other
basic immunization services for infants and
children below eight years of age.
STRATEGIES
1. Conduct of Routine Immunization for
Infants/Children/Women through the
Reaching Every Barangay (REB)
strategy
2. Supplemental Immunization Activity
(SIA)
3. Strengthening Vaccine-Preventable
Diseases Surveillance
4. Procurement of adequate and potent
vaccines and needles and syringes
to all health facilities nationwide.
EXPANDED PROGRAM ON
IMMUNIZATION
GUIDELINES
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It is safe and immunologically
effective to administer all EPI
vaccines on the same day at
different sites of the body.
Moderate fever, malnutrition, mild
respiratory infection, cough, diarrhea
and vomiting are not contraindicated
to vaccinationDPT2 and DPT3 are
contraindicated to a child who has
had convulsion or shock within 3
days the previous dose.
Live vaccines like BCG must not be
given to individuals who are
immunosuppressed due to malignant
disease
therapy
with
immunosuppressive
agents
or
irradiation.
It is safe and effective with mild side
effects after vaccination. (Ex: Local
reaction, fever)
Repeat BCG vaccination if the child
does not develop a scar after the
first injection.
BCG immunization shall be given to
all school entrants both in private
and public schools regardless of the
presence or absence of BCG scar.
TUBERCULOSIS
Affects the lungs
Airborne
MYCOBACTERIUM
TUBERCULOSIS
BCG (Bacillus Calmette-Guerin)
At birth
1 dose (0.05 mL)
None
Intradermal
Right deltoid region of the arm
MIDTERMS
-
BCG given at earliest possible age
protects the possibility of TB
meningitis and other TB infections in
which infants are prone
DIPTHERIA
- bacterial infection -affects the nose
and
throat
-cause
breathing
problems and swallowing.
Causes,,,,
- Corynebacterium diphtheriae causes
diphtheria. Usually, the bacteria
multiply on or near the surface of the
mucous membranes of the throat,
where they cause inflammation.
SIGNS AND SYMPTOMS
- Symptoms
before
the
pseudomembrane appears include:
✓ Fever and weakness
✓ Enlarged lymph nodes on the neck
✓ Swelling of soft tissue on neck
✓ Nasal discharge ✓ High heart rate
PSEUDOMEMBRANE
PERTUSIS
whooping cough -"100-day cough"
Highly
contagious
respiratory
disease
Causative agent- Gram (-) bacteria
BORDETELLA PERTUSSIS
-
NEONATAL TETANUS
infection
occurs
at
unhealed
umbilical
stump
(non-sterile
equipment)
Tetanus. Infectious agent: Clostridium
tetani.
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DIPHTHERIA-PERTUSIS-TETANUS
- DPT
- 6 weeks old
- 3 doses (0.5 mL)
- 6 weeks (DPT 1)10 weeks (DPT 2),
14 weeks (DPT 3)
- Intramuscular
- Upper outer portion of the thigh
- An early start with DPT reduces the
chance of severe pertussis
POLIO
- Poliomyelitis
- Caused by poliovirus
- Crippling and potentially infectious
- Infects the person’s brain and spinal
cord causing paralysis
- POLIO VIRUS
- OPV (Oral Polio Vaccination)
- 6 weeks old
- 3 doses (2-3 drops)
- 4 weeks
- Oral
- The extent of protection against polio
is increased the earlier the OPV is
given
MEASLES
- Caused by a virus
- Airborne
- Infects the respiratory tract
- The causative agent, measles
virus (MV), is a member of the
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family Paramyxoviridae, genus
Morbillivirus
MCV
Measles-Containing Vaccine
9 months old
2 dose (0.5 mL)
Subcutaneous
Upper outer portion of the arms
At least 85% of measles can be
prevented by immunization at this
age
viral infection
attacks the liver
transmitted through blood or other
body fluids
causative is hepatitis B virus
At birth
3 doses (3 doses)
4 weeks interval
Intramuscular
Upper outer portion of the thigh
Prevents liver cirrhosis and liver
cancer
KOPLIK’S SPOTS
MIDTERMS
EXPANDED PROGRAM ON
IMMUNIZATION
THE COLD CHAIN AND VACCINE
HANDLING
COLD CHAIN
- The ‘cold chain’ is the system of
transporting and storing vaccines at
recommended temperature from the
point of manufacture to the point of
use.
Manufacture > Distributor > Vaccine Depots
> Provider office > client
IMPORTANCE OF COLD CHAIN
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Pathognomic of measles
- Typically involve the buccal and
labial mucosa. Irregular, patchy
erythema with tiny central white
specks
‘grains
of
salt’
appearance.
The cold chain is standard practice
for
vaccines
throughout
the
pharmaceutical industry
Maintaining the cold chain ensures
that vaccines are transported and
stored
according
to
the
manufacturer's recommended temp
range +2C +8C until point of
administration
TETANUS TOXOID
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MIDTERMS
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Responsibility not to waste
scarce NHS resources
Reduce wastage from errors
4. Compliance with SPC/Manufacturer
• Any vaccine that has not been
stored at a temperature of 2-8°C
as per its licensing conditions is
no longer a licensed product
Why is the cold chain important?
1. Vaccines are:
• Biological products
• lose potency with time
• Confident the vaccines you give
will be effective accelerated if
proper storage Public Health
responsibility
• Process
irreversible
and
conditions are not adhered to.
2. Assurance in potent product and
vaccine programmes
• Professional responsibility
o Confident the vaccines you
give will be effective
• Immunization programmes
o Public
confidence
in
immunization programmes
3. Ensuring maximum
immunizations
benefit
Maintenance of the cold chain requires
vaccine and diluent to be:
• Collected from an airport as soon
as it arrives
• Transported at the correct
temperature from the airport and
from one store to another
• Stored at the correct temperature
in central, regional and district
stores and in health centres.
• Transported at the correct
temperature to outreach sites.
• Kept cold during immunization
sessions
from
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MIDTERMS
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MIDTERMS
1. LIVE ATTENUATED VACCINES
(LAVs)
• LAVS are derived from (already
weakened)
disease-causing
pathogens (virus/bacteria).
• 5 vaccines (recommended by
WHO) using LAV technology
o Tuberculosis (BGC)
o Oral
Polio
Vaccine,
paralytic poliomyelitis
o Measles
o Rotavirus
o Yellow fever
2. INACTIVATED/KILLD
VACCINE
• Made from (Already killed via
physical/chemical
processes)
microorganism (virus/bacteria).
Therefore, non-disease causing.
• More stable than LAVs/
• Example:
inactivated
polio
vaccine (IPV), more expensive
than OPV-LAV
3. TOXOID VACCINE
• Bacterial toxins like tetanus &
diphtheria,
detoxified/purified
toxins are called toxoids, used in
vaccines.
• Examples: Tetanus Toxoid (TT),
Diphtheria Toxoid (DT and Td)
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