RLE NCM 104- EXPANDED PROGRAM ON IMMUNIZATION

Immunization - process by which vaccines are introduced into the body to

induce immunity.

Vaccines- substance used to stimulate the production of antibodies and

provide immunity against one or several diseases, prepared from causative
agent of a disease, its products, or a synthetic substitute, treated to act as
an antigen without inducing the disease.

Cold chain- system of storing and transporting vaccines at recommended

temperatures from the point of manufacture to the point of use.

Site- specific area in the body where the vaccine is introduced.

Dosage- amount of vaccine in ml/drops to be administered.

Routes of vaccines administration:

1. Intradermal ID- vaccine is injected to the top layers of the skin

(dermis).
2. Subcutaneous- vaccine is injected into the fatty tissue below the
skin and above the muscle.
3. Intramuscular- vaccine is injected into the muscle
4. Oral- vaccine is given by drops into the mouth.

Introduction:

● The expanded program of immunization is a World Health

organization Program with the goal to make vaccines available to all
children throughout the world:
Expanded means:

- Expanding the number of diseases to be covered

- Expanding the number of children and population to be covered
 - Expanding coverage to all corners of the country and spreading
services to reach the less privileged sectors of the society.
Background:

● experience with the smallpox eradication program showed the world

that immunization was the most powerful and cost-effectiveweapon
against vaccine preventable diseases.

● In 1974, the WHO launched its "expanded program of immunization"

(EPI) against six most common preventable diseases (diphtheria,
pertussis, tetanus, polio, tuberculosis and measles).
EXPANDED PROGRAM ON IMMUNIZATION

- Established in 1976
- Ensure that infants/children and mothers have access to routinely
recommended infant/child vaccines.

RA 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''
Overall Goal

● To reduce the morbidity and mortality among children against the

most common vaccine-preventable disease.
○ Morbidity - being ill
○ Mortality - death
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.
10 diseases covered by EPI:

● Tuberculosis
● Polio
● Measles
● Diphtheria
● Pertussis
● Tetanus
● Hepa B
● Pneumococcal meningitis
● Influenza
● Diarrhea

Objectives of EPI:

1. To achieve 100% coverage for eligible children by an ongoing

integrated program
2. Eradication of polio to maintain polio-free status
3. Elimination of measles
4. Elimination of Neonatal Tetanus
5. Maintain zero level of diphtheria
6. Reducing pertussis incidence to a minimum level
7. Reducing childhood TB incidence
8. Reduce incidence of hepatitis B among under five children
9. To reduce the incidence of bacterial meningitis due to Haemophilus
influenza.
Contraindications of vaccines
Note: vaccine cannot be given if the child is immunocompromised

General

● Any acute illness

● Severe malnutrition
● In known case of immune deficiency

RELATED TO GROUP OF VACCINES

● During pregnancy
● During steroid therapy
● During radiation therapy
● During administration of antimetabolites

INDIVIDUAL VACCINES

● BCG- Extensive dermatitis

● Polio- diarrhea within 3 weeks of tonsillectomy
● Pertussis- febrile illness convulsion
● measles- convulsion

SOME COMMON VACCINES

● BCG
● DPT
● MEASLES
● TETANUS
● POLIO -IPV OPV
● MMR (MEASLES MUMPS RUBELLA

POLIO

● Short of poliomyelitis
● It is caused by poliovirus. Or as a carrier of virus without having the
symptoms of disease
● Crippling and potentially infectious
● It infects the person's brain and spinal cord causing paralysis
Poliomyelitis

Is given:

● OPV (ORAL POLIO VACCINATION)

● Is administered on the 6 or 14th week of life (6 weeks old)
● 3 doses (2-3 drops orally)
● The extent of protection against polio is increased the earlier the
OPV is given

DIPHTHERIA

● Is a bacterial infection that affects the nose and throat it causes

breathing problems and swallowing problems.
PERTUSSIS

● Is a whooping cough or also called 100-daycough it is highly

contagious respiratory disease
NEONATAL TETANUS

● Infection occurs at unhealed umbilical stump (non-sterile equipment)

DIPHTHERIA PERTUSSIS TETATNUS (DPT)is given:

● Is given at 6 weeks old having 3 doses (0.5ml) given in intramuscular

on the upper portion of the thigh
● An early start with DPT reduces the chance of severe PERTUSSIS
● 14 weeks (DPT 3)
● The mothers receive the vaccine it providesprotection to the child
born to her as well
TETANUS TOXOID IMMUNIZATION
 ● *Neonatal Tetanus is one of the public health concerns that we need
to address among newborns. To protect them from deadly disease,
tetanus toxoid immunization is important from pregnant women and
child bearing age women
● Both mother and child are protected against tetanus and neonatal
tetanus toxoid a series of 2 doses of tetanus toxoid vaccination must
be received by a women one month before delivery to protect baby
from neonatal tetanus and the 3 booster dose shots to complete the
5 doses following the recommended schedule provides full protection
for both mother and CHD the mother is then called as fully
immunized mother

Tuberculosis
Affects the lungs, this is an airborne disease.
BCG OR BACILLUS CALMI BUREN

- Is given at birth or any time at birth at 0.05ml intradermal at right

delted region of the arms
- it is used because it is effective in reducing the severity of tb
meningitis and miliary TB
HEPATITIS B- Viral infection that attacks the liver this transmitted through
blood or other body fluids

This given at birth 3 doses 4 weeks interval:

● Intramuscular
● Upper outer portions of the thigh starting from left then right
● Prevents liver cirrhosis and liver cancer

MEASLES

● Is caused by a airborne virus that infects the respiratory tract

MCV (MEASLES-CONTAINING VACCINE)

● 9 Months of life
● 2 dose(0.05ml)
● Subcutaneous (given subcutaneously)
● Upper outer portions of the arms
● At least 85% of measles can be prevented by immunization at this
age
Administration of the 2-dose measles- containingvaccine was implemented
in. 2009

MCV1(Monovalent measles) at 9–12-month-old

MV2 (MMR- MEASLES, MUMPS AND RUBELLA GERMA MEASLES AT

12-15 MONTHS OLD

This is the schedule of giving measles or MMR vaccines

● Vaccine: measles vaccine

● Minimum age: 9 months old
● Number of doses: 1 dose
● Doses: 0.5 mL

● Vaccine: measles Mumps-Rubella vaccines

● Minimum age: 12-15 months old
● Number of doses: 1 dose
● Doses: 0.5 mL

The components of pentavalent vaccines are DPT, HEPATITIS B and

HAEMOPHILUS INFLUENZA TYPE B vaccines

The pentavalent vaccine encompasses the DPT which is given under 6,10
and 14 weeks of life if pentavalent is available the DPT is no longer given.

Five-in-one Pentavalent (One vaccine against five diseases)

 ● diphtheria
● pertussis
● tetanus
● hepatitis b
● hip

In 2012, Rotavirus and Pneumococcal vaccineswere introduced in the

national immunization program

Rotavirus vaccines

● protects the variant children from acute diarrhea

● It is given at least 6 weeks of life with 3 doses
● One month interval between doses and 2 drops orally

Pneumococcal vaccine

● protects the young from pneumonia

○ pneumonia - a bacterial infection in the lungs that is a common
complication from the flu.
● In addition to a flu shot every fall, it's a good idea to get a
once-in-a-lifetime pneumococcal vaccine
PCV is given 6 weeks of life at 3 doses with one month interval between
doses of 0.5 mL that is given IM deltoid area.

This table summarize the vaccines discussed

● Vaccine: BCG (bacillus Calmette Guerin)

● Minimum age at 1st dose: at birth or any timeafter birth
● Number of doses: 1
● Minimum interval between doses:
● Reason: BCG protects the infant from possibility of TB meningitis
and other TB infections
● Vaccine: Hepatitis B vaccine
● Minimum age at 1st dose: at birth
● Number of doses: 1
● Minimum interval between doses:
● Reason: reduces the chance of being infected and becoming a
carrier of Hepatitis B
● Vaccine: Pentavalent Vaccine (DPT-HepB-Hib)
● Minimum age at 1st dose: 6 weeks
● Number of doses: 3
● Minimum interval between doses: 4 weeks / 1 month
● Reason: it is a protection against diphtheria, tetanus, pertussis,
hepatitis b and haemophilesinfluenza type
● Vaccine: Oral polio vaccine (OPV) and Inactivated Polio Vaccine
(IPV)
● Minimum age at 1st dose: 6 weeks
● Number of doses: OPV - 3 doses, IPV - 1 dose coexist with OPV 3
● Minimum interval between doses: 4 weeks / 1 month
● Reason: protection against polio diseases

● Vaccine: Rotavirus vaccine

● Minimum age at 1st dose: 6 weeks
● Number of doses: 2
● Minimum interval between doses: 4 weeks / 1 month
● Reason: protect against diarrhea caused by severe forms of rotavirus
disease
● Vaccine: measles
● Minimum age at 1st dose: 9 months
● Number of doses: 1
● Minimum interval between doses:
● Reason: prevents death, malnutrition and protection from measles

● Vaccine: MMR (measles, mumps, rubella) vaccine

● Minimum age at 1st dose: 1 year and 1 month
● Number of doses: 1
● Minimum interval between doses:
● Reason: protection against measles, mumps and rubella virus
When do we call a child fully immunized?

● WHO guideline: “COMPLETE OR FULL IMMUNIZATION” coverage

is defined as a child has received a BCG vaccination against
tuberculosis; three doses of DPT vaccine to prevent diphtheria,
pertussis and tetanus (DPT); at least three doses of polio vaccine
and one does of measles vaccine (jul 30, 2015)
This is the latest idea for A Fully Immunized Child:

● 1 dose BCG and Hepa B at birth

● 3 doses of POV
● 3 doses of pentavalent vaccine
● 1 dose measles vaccine before the child’s first birthday (DOH, 2017)

Remember: Every Wednesday is designated as immunization day and is

adopted in all parts of the country. Immunization is done monthly in
barangay health stations, and quarterly in remote areas of the country

Care of the Vaccines

1. Storage and transport of vaccines from the primary vaccine store

down to the end-user at the health facility and further down at the
outreach sites
2. A “first expiry and first out” (FEFO) vaccine system. It is practiced
that all vaccines are utilized for its expiry date, proper arrangement
of vaccines and or labeling of the expiry dates are done to identify
those close to expiry
3. Vaccine temperature is monitored twice a day (early in the morning
and in the afternoon) in all health facilities and plotted to monitor
break in cold chain
○ Cold chain is a system of transporting or storing vaccines within
the sage temperature range of 2 degrees Celsius to 8 degrees
Celsius (strive for 5 degrees Celsius - the midway out).
○ The role of cold chain is to maintain the potency of vaccines,
called chain bridges, which must be reported from the
department as soon as possible using the cold chain bridge
report form. This form is also use to report light exposure
bridges for light sensitive vaccines
○ Cold chain equipment
■ Cold room
■ Freezer
■ Refrigerator
■ Transport box
■ Vaccine carriers
■ Thermometers
■ Cold chain monitors
■ Ice packs
■ Temperature monitoring chart safety collector boxes