DEPARTMENT OF HEALTH PROGRAMS AND SERVICES

Departnemtn of Health (DOH) Programs Related to Family Health

1. Expanded Program of Immunization (EPI)
2. Integrated Management of Childhood Illnesses (IMCI)
3. Essential Intrapartal and Newborn Care (EINC)
4. Newborn Screening
5. BEmONC/CEM
NATIONAL Immunization Program/Expanded Program on Immunization (EPI)
 In the Philippines began in July 1979a
 Every Wednesday is designated as immunization day
To achieve the over-all goal of reducing the morbidity and mortality among children against the most common vaccine-preventable diseases
Mandates:
 PD 996 - is 1976 Providing for compulsory basic immunization for infants and children below eight years of age.
 RA 10152 – known as Mandatory Infants and Children Health Immunization Act of 2011 requires all children under 5 years old to be given basic
immunization against vaccine preventable diseases
 RA 7846 – Provides for compulsory immunization against Hepatitis B for infants and children below 8 years old. It also provided for Hepatitis B
immunization within 24 hours of birth.
IMMUNIZATION: Concepts
 Immunization is the process
 Vaccines stimulates the body’s own immune system to protect the person against subsequent infection or disease
 Six vaccine – preventable disease was initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles
 Vaccinations promote health and protect children from disease – causing agents.
 Infants and newborns need to be vaccinated at an early age since they belong to vulnerable age group. They are susceptible to childhood disease
 The fully immunized child (FIC) – must have completed one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of Hepatitis B or 3 doses of
Pentavalent and one dose of measles vaccines before the child reaches 12 months of age.
 COMPLETELY IMMUNIZED CHILDREN (CIC) – refers to children who completed their immunization schedule at the age of 12-23 months
 CHILD PROTECTED AT BIRTH (CPAB) - a term used to describe a child whose mother has received:
 2 doses of TT during this pregnancy provided that the second dose was given at least a month prior to delivery
 At least 3 doses of TT any time prior to pregnancy with this child
VACCINE REASON
Bacullus Calmette – Guerin Protects the possibility of TB meningitis and other
TB infections in which infants are prone
Diphtheria- Pertussis- Tetanus Vaccine An early start with DPT reduces the chance of
severe pertussis
Oral Polio Vaccine The extent of protection against polio is increased
the earlier the OPV is given
Hepatitis B Vaccine An early start of Hepatitis B vaccine reduces the
chance of being infected and becoming a carrier.
Prevents liver cirrhosis and liver cancer which are
more likely to develop if infected with Hepatitis B
early in life
Measles Vaccine At least 85% of measles can be prevented by
(not MMR) immunization at this age
OPV and IPV must be administered together, if it can’t be given together with OPV do not give IPV.
Minimum Minimum
Vaccine age at 1st Number of Dose Interval Route Site
dose doses Between
Dose
Bacillus Birth or any Intradermal Right
Calmette-Guerin time after 1 0.05 ----- ----- deltoid
birth mL region of
the arms
PENTABALENT;

Diphtheria/
Pertussis/ Tetanus/ 6 weeks 3 0.5 mL 4 weeks Intramuscular Vastus
Hepatitis B/ Lateralis
Haemophilus
influenza B
PCV 6 weeks 3 0.5 mL 4 weeks Intramuscular Vastus
Oral Polio Vaccine 6 weeks 3 2 gtts PO Mouth

IPV 4 weeks Vastus

14 weeks 1 0.5 mL Intramuscular Lateralis
Measles Vaccine Upper
AMV 1 9 months 1 outer
0.5 mL ---- ---- Subcutaneous portion of
12-15 1 the arms
AMV 2 (MMR) months
SIDE EFFECTS OF VACCINATION AND THEIR MANAGEMENT
Vaccine Side Effects Management
BCG Koch’s phenomenon: an acute inflammatory No management is needed
reaction 2-4 days after vaccination, usually
indicates previous exposure to tuberculosis
Deep abscess at vaccination site; almost Refer to physician for incision and drainage
invariably due to subcutaneous or deeper
injection
Indolent ulceration: an ulcer which persist Treat… with-INH powder
after 12 weeks from vaccination
Hepatitis B Local soreness at the injection site No treatment is needed
Vaccine
Pentavalent Fever that last for 1 day but fever beyond 24 Advise parent to give antipyretic
hours is not due to the vaccine but to other
causes
Local soreness of the injection site Reassure parents that soreness will disappear
after 3-4 days
Convulsions: although very rare may occur in Proper management of convulsions; pertussis
children older than 3 months cause by vaccine should not be given anymore
pertussis vaccine
OPV None
AMV Fever 5-7 days after vaccination in some Reassure parent and instruct to give
children; sometimes there is a mild rash antipyretic to the child
MMR Local soreness, fever, irritability, and malaise Reassure parent and instruct to give
in some children antipyretic
Rotavirus Some children develop mild vomiting and Reassure parents and instruct them to give
diarrhea, fever and irritability antipyretic and ore sol to the child
Tetanus Toxoid Local soreness at the injection site Apply cold compress at the site no other
treatment
Concept…
 Maintain a master list of eligible children for immunization.
 Administer immunization following the protocols
o Right administration of vaccines
 Right dose
 Right route
 Right schedule
 Right interval
 Proper utilization of cold chain
Concept…
 Infuse proper aseptic technique and infection control
o One syringe: one child
o Proper disposal of syringes
 Provide health teachings to enhance the awareness of community
 Conduct visits in the community to assess their needs and to identify cases of EPI disease
 Have an updated record of children who had received immunization and the like and report case if there is.
PRINCIPLES IN HANDLING, TRANSPORTING & STORING VACCINES
 COLD CHAIN
Equipment:
o Cold room
o Freezer/Refrigerator
o Transport box
o Vaccine carrier
o Thermometer
o Cool Dog
Temperature monitoring
VVM (vaccine vial monitor)
 FIRST EXPIRARY FIRST OUT
 “Cold Chain” refers to the process used to maintain optimal conditions during the transport, storage, and handling of vaccines, starting at the
manufacturer and ending with the administration of the vaccine to the client.
 A “first expiry and first out” (FEFO) vaccine system is practiced to assure that all vaccines are utilized before its expiry date
 Temperature monitoring of vaccines is done in all levels of health facilities to monitor vaccine temperature
 Temperature checking is done twice a day in the morning and in the afternoon before going home
 Temperature is plotted every day in monitoring chart to monitor breaking in cold chain
TYPE OF STORAGE HOURS OF LIFE
VACCINE TEMPERATURE AFTER OPENING
Most Sensitive to OPV, Measles -15 to -25 C @ 8 hours
Heat the freezer
Most Sensitive to Hepatitis B, DPT, 2 to 8 C Body of Can be used
Cold Tetanus toxoid the refrigerator check VVM
Sensitive to BCG 2 to 8 C Body of the 6 hours
 sunlight and refrigerator
Fluorescent Light

OTHER CONSIDERATION TO MAINTAIN POTENCY

1. Multidose liquid vaccine
(PENTA, TT, Hepatitis B) may be used to a maximum of 4 weeks
2. Reconstituted freeze dried vaccine
(BCG, AMV, MMR) will be discarded within 6 hours
3. Use designated diluents for reconstitution
4. Protect BCG from sunlight and Rotavirus from light
Important Considerations Related to the schedule and manner of administering infant immunization
1. There is no need to restart a vaccination regardless of the time that has elapsed between doses
2. All the EPI antigens are safe and effective when administered simultaneously
3. It is not recommended to mix different vaccines in one syringe
4. Vaccine should be administered in different sites
5. If more than vaccine has to be given on the same limb injection site must be 2.5 – 5 cm apart
6. OPV first followed by Rotavirus
7. First dose of Rotavirus is administered only to infants aged 6-15 weeks 2 nd dose is given to aged 10 weeks – 32 weeks only
CONTRAINDICATIONS
1. Anaphylaxis or severe hypersensitivity reaction to a previous dose
2. Person with a known allergy to a vaccine component SHOULD NOT be vaccinated
3. Pentavalent vaccine/ DPT to a child with recurrent convulsions or another active neurological disease
4. Pentavalent 2 or 3 to a child who has had convulsions within 3 days of the most recent dose (WHO, 2005)
5. Rotavirus vaccine when the child has a history of previous dose of the vaccine, intussusception or intestinal malformation or AGE (DOH,2012)
6. Do not give live vaccines like BCG to an immunosuppressed client
7. A child with signs and /symptoms of severe dehydration
8. Fever of 38.5C and above