Expanded Program on Immunization (EPI) 

Diseases

TUBERCULOSIS
Other names:
Koch’s Disease
Consumption
Phthisis
Weak lungs
 Mycobacterium tuberculosis
 TB bacillus
 Causative agent  Koch’s bacillus
 Mycobacterium bovis
 (rod-shaped)
 Airborne-droplet

 Direct invasion through mucous

 Mode of transmission
membranes and breaks in the skin (very
rare)

 Usually asymptomatic
 Low-grade afternoon fever
 Night sweating
 Loss of appetite
 Weight loss
 Pathognomonic sign  Easy fatigability – due to increased oxygen
demand
 Temporary amenorrhea
 Productive dry cough
 Hemoptysis

 Incubation period  4 – 6 weeks

 Diagnostic test Diagnostic test:
 Sputum examination or the Acid-fast bacilli
(AFB) / sputum microscopy
1. Confirmatory test
2. Early morning sputum about 3-5 cc
3. Maintain NPO before collecting sputum
4. Give oral care after the procedure
5. Label and immediately send to laboratory
6. If the time of the collection of the sputum is
unknown, discard
 Chest X-ray is used to:
1. Determine the clinical activity of TB,
whether it is inactive (in control) or active
(ongoing)
2. To determine the size of the lesion:
a. Minimal – very small
b. Moderately advance – lesion is < 4 cm
c. Far advance – lesion is > 4 cm
 Tuberculin Test – purpose is to determine the
history of exposure to tuberculosis
 Other names:
Mantoux Test – used for single screening, result
interpreted after 72 hours
Tine test – used for mass screening read after 48
hours

 SCC/Short Course Chemotherapy

 Direct –observed treatment short
course/DOTS;

o Rifampicin (R)
 Medical management o Isoniazid (H)
o Pyrazinamide (Z)
o Ethambutol (E)
o Streptomycin (S)

 B – CG vaccination of newborn, infants

and on grade school entrants.
 A – rrange for examination & prophylactic
mgt. of contracts
 C – onditions need to be improved like
overcrowding in order to decrease the risk
of acquiring the infection.
 T – xt facilities should be provided for
those who need treatment.
 Nursing management
 E – early detection & examination
 R – e-emphasize public education &
adequate information dissemination about
MOT
 I – n clients with (+) lab tests, the Directly
Observed Short Course (DOTS) is
comprehensively monitored.
 A – lert for signs of drug reaction.

 Respiratory precautions
 Cover the mouth and nose when sneezing
to avoid mode of transmission
 Give BCG
 Type of Isolation
*BCG is ideally given at birth, then at school
entrance. If given at 12 months, perform
tuberculin testing (PPD), give BCG if negative.
 Improve social conditions

DIPTHTHERIA
Strangling angel of children

Types:
nasal
 pharyngeal – most common
laryngeal – most fatal due to proximity to epiglottis
 Corynebacterium diphtheria
 Causative agent
 Klebbs-loffler

 Droplet especially secretions from mucous

membranes of the nose and nasopharynx
and from skin and other lesions
 Mode of transmission

Milk has served as a vehicle

Pseudomembrane – mycelia of the oral mucosa

causing formation of white membrane on the
oropharynx
 Pathognomonic sign  Bull neck
 Dysphagia
 Dyspnea

 Incubation period  2 – 5 days

 Nose/throat swab
 Moloney’s test – a test for hypersensitivity to
diphtheria toxin
 Schick’s test – determines susceptibility to
 Diagnostic test
bacteria

Complication: MYOCARDITIS (Encourage bed

rest)

Drug-of-Choice:
 Medical management Erythromycin 20,000 - 100,000 units IM once only

 Isolation: 14 days (until 2-3 cultures, 24

hours apart)
 Bedrest for 2 weeks
 Care for nose and throat (gentle
 Nursing management
swabbing)
 Ice collar (decrease pain of sore throat)
 Diet (soft food, small frequent feedings)

 Type of Isolation DPT immunization

Pasteurization of milk
Education of parents

***Infants born to immune mothers maybe

protected up to 6-9 months. Recovery from clinical
attack is always followed by a lasting immunity to
 the disease.

PERTUSSIS
Whooping cough
Tusperina
No day cough
 Bordetella pertussis
 Hemophilus pertussis
 Causative agent
 Bordet-gengou bacillus
 Pertussis bacillus
 Droplet especially from laryngeal and
 Mode of transmission bronchial secretions

 Catarrhal period: 7 days paroxysmal cough

followed by continuous nonstop
 Pathognomonic sign accompanied by vomiting

Complication: abdominal hernia

 Incubation period
 Diagnostic test
 Medical management
 Nursing management
 7 – 10 days but not exceeding 21 days
 Bordet-gengou agar test
 DOC: Erythromycin or Penicillin 20,000 -
100,000 units
 Complete bed rest
 Avoid pollutants
 Abdominal binder to prevent abdominal
hernia
 Isolation: 4-6 weeks from onset of illness
 Supportive measures (bedrest, avoid
excitement, dust, smoke and warm
baths)
 Safety (during paroxysms, patient
should not be left alone)
 Suctioning (kept at bedside for
emergency use)

 Type of Isolation
 DPT immunization
 Booster: 2 years and 4-5 years
 Patient should be segregated until after 3
weeks from the appearance of paroxysmal
cough

TETANUS
Other names:
Lock jaw
 Causative agent  Clostridium tetani – anaerobic spore-
forming heat-resistant and lives in soil or
intestine

 Mode of transmission
For newborn:
 Pathognomonic sign
1.
2.
3.
4.
 Incubation period
 Diagnostic test
 Medical management
Note: The nurse can give fluid provided that the
patient is able to swallow. There is risk of
aspiration. Check first for the gag reflex
 Nursing management
 Type of Isolation
 Neonate: umbilical cord
 Children: dental caries
 Adult: punctured wound; after septic
abortion
 Indirect contact – inanimate objects, soil,
street dust, animal and human feces,
punctured wound
 Risus sardonicus (Latin: “devil smile”) –
facial spasm; sardonic grin
 Opisthotonus – arching of back
Difficulty of sucking
Excessive crying
Stiffness of jaw
Body malaise
 Varies from 3 days to 1 month, falling
between 7 – 14 days
 No specific test, only a history of
punctured wound
 Antitoxin ant tetanus serum (ATS)
 Tetanus immunoglobulin (TIG) (if the
patient has allergy, should be administered
in fractional doses)
 Pen G
 Diazepam – for muscle spasms
 Adequate airway
 Quiet, semi-dark environment
 Avoid sudden stimuli and light
 DPT immunization
 Tetanus toxoid (artificial active)
immunization among pregnant women
 Training and Licensing of
midwives/”hilots”
 Health education of mothers
 Puncture wounds are best cleaned by
thorough washing with soap and water.
 POLIOMYELITIS
Other name:
Infantile paralysis
 Legio debilitans
 Polio virus
 Enterovirus
 Causative agent
 Attacks the anterior horn of the neuron,
motor is affected
 Man is the only reservoir
 Fecal – oral route
 Mode of transmission
 Paralysis
 Muscular weakness
 Pathognomonic sign  Uncoordinated body movement
 Hoyne’s sign – head lag after 4 months

 Incubation period  7 – 21 days

 CSF analysis / lumbar tap
 Diagnostic test  Pandy’s test

 Rehabilitation involves ROM exercises

 Medical management
 Nursing management
 Type of Isolation
 Enteric isolation
 Proper disposal of secretions
 Moist hot packs
 Firm / non sagging bed
 Suitable body alignment
 Comfort and safety
 OPV vaccination
 Frequent hand washing

HEPATITIS B
Other names:
Serum Hepatitis
 Causative agent  Hepatitis B virus
 Blood and body fluids
 Mode of transmission
 Placenta
 Pathognomonic sign  Right-sided Abdominal pain
 Jaundice
 Yellow-colored sclera
 Anorexia
 Nausea and vomiting
 Joint and Muscle pain
 Steatorrhea
 Dark-colored urine

 Incubation period
 Diagnostic test
 Medical management
 Nursing management
 Type of Isolation
MEASLES
RUBEOLA
MORBILLI
Other names:
Morbilli
Rubeola
 Causative agent
 Mode of transmission
 Pathognomonic sign
Period of Communicability:
 Incubation period Incubation period:
 Diagnostic test
 Medical management
 Nursing management
 Low grade fever
 45 – 100 days
 Hepatitis B surface agglutination (HBSAg)
test
 Hepatitis B Immunoglobulin
 Diet: high in carbohydrates
 Hepatitis B immunization
 Wear protected clothing
 Hand washing
 Observe safe-sex
 Sterilize instruments used in minor
surgical-dental procedures
 Screening of blood products for transfusion
 RNA containing paramyxovirus
 Droplet secretions from nose and throat
 Koplik’s spots – whitish/bluish pinpoint
patches on the buccal cavity
 Cephalocaudal appearance of
maculopapular rashes
 Stimson’s line – bilateral red line on the
lower conjunctiva
 4 days before and 5 days after the
appearance of rash
 10 days – fever
 14 days – rashes appear (8-13 days)
 No specific diagnostic test
 Supportive and symptomatic
 Darkened room to relieve photophobia
 Diet: should be liquid but nourishing
 Warm saline solution for eyes to relieve
eye irritation
 For fever: tepid sponge bath and anti-

 Type of Isolation
DISEASES TRANSMITTED THROUGH FOOD AND WATER
CHOLERA
Other names:
El tor
 Causative agent
 Mode of transmission
 Pathognomonic sign
Period of Communicability:
 Incubation period
 Diagnostic test
 Medical management
 Nursing management
 Type of Isolation
pyretics
 Skin care: during eruptive stage, soap is
omitted; bicarbonate of soda in water or
lotion to relieve itchiness
 Prevent spread of infection: respiratory
isolation
 Measles vaccine
 Disinfection of soiled articles
 Isolation of cased from diagnosis until
about 5-7 days after onset of rash
 Vibrio cholera
 Vibrio coma
 Ogawa and Inaba bacteria
 Fecal-oral route
 5 Fs
 Rice watery stool
 Few hours to 5 days; usually 3 days
 7-14 days after onset, occasionally 2-3
months
 Stool culture
 Oral rehydration solution (ORESOL)
 IVF
 Drug-of-Choice: tetracycline (use straw;
can cause staining of teeth).
 Oral tetracycline should be administered
with meals or after milk.
 Maintain and restore the fluid and
electrolyte balance
 Enteric isolation
 Sanitary disposal of excreta
 Adequate provision of safe drinking
water
 Good personal hygiene
 Proper handwashing
 Proper food and water sanitation
 Immunization of Chole-vac
 AMOEBIASIS
Amoebic Dysentery
 Causative agent
 Mode of transmission
 Pathognomonic sign
 Incubation period
 Diagnostic test
 Medical management
 Nursing management
 Type of Isolation
TYPHOID FEVER
 Causative agent
 Mode of transmission
 Pathognomonic sign
 Incubation period
 Diagnostic test
 Medical management
 Nursing management
 Entamoeba histolytica
 Protozoan (slipper-shaped body)
 Abdominal cramping
 Bloody mucoid stool
Tenesmus - feeling of incomplete
defecation
N/A
N/A
 Metronidazole (Flagyl)
* Avoid alcohol because of its Antabuse
effect can cause vomiting
 Enteric isolation
 Boil water for drinking
 Handwashing
 Sexual activity
 Avoid eating uncooked leafy vegetables
 Diet
 Proper handwashing
 Proper food and water sanitation
 Salmonella typhosa (plural, typhi)
 Fecal-oral route
 Rose Spots in the abdomen – due to
bleeding caused by perforation of the
Peyer’s patches
 Ladderlike fever
 Usual range 1 to 3 weeks, average 2 weeks
 Typhi dot – confirmatory test; specimen is
feces
 Widal’s test – agglutination of the patient’s
serum
 Chloramphenicol
 Maintain and restore the fluid and
electrolyte balance
 Enteric isolation
 Sanitary disposal of excreta
  Adequate provision of safe drinking
water
 Good personal hygiene

 Proper handwashing
 Type of Isolation
 Proper food and water sanitation

HEPATITIS A
Other names:
Infectious Hepatitis /
Epidemic Hepatitis /
Catarrhal Jaundice
 Causative agent  Hepatitis A Virus
 Mode of transmission  Fecal-oral route
 Fever
 Anorexia (early sign)
 Headache
 Pathognomonic sign
 Jaundice (late sign)
 Clay-colored stool
 Lymphadenopathy
 15-50 days, depending on dose, average
 Incubation period
20-30 days
 Diagnostic test
 Prophylaxis: “IM” injection of gamma
globulin
 Hepatitis A vaccine
 Hepatitis immunoglobulin
 Avoid alcohol
 Complete bed rest – to reduce the
 Medical management breakdown of fats for metabolic needs of
liver
 Low-fat diet; increase carbohydrates (high
in sugar)

 In convalescent period, patient may have

difficulty with maintaining a sense of well-
being.
 Nursing management
 Proper handwashing
 Proper food and water sanitation
 Type of Isolation  Proper disposal of urine and feces
 Separate and proper cleaning of articles
used by patient

SEXUALLY TRANSMITTED DISEASES

SYPHILIS
 Other names:
Sy
Bad Blood
The pox
Lues venereal
Morbus gallicus
 Causative agent
 Mode of transmission
 Pathognomonic sign
 Incubation period
 Diagnostic test
 Medical management
 Nursing management
 Type of Isolation
GONORRHEA
Other names:
 Treponema pallidum (a spirochete)
 Direct contact
 Transplacental (after 16th week AOG)
 Through blood transfusion
 Indirect contact with contaminated articles
 Primary stage (4-6 weeks): painless
chancre at site of entry of germ with serous
exudates
 Secondary syphilis (6-8 weeks: generalized
rashes, generalized tender discrete
lymphadenopathy, mucus patches, flu-like
symptoms, condylomata, patchy alopecia
 Latent stage (one to two to 50 years): non-
infectious
 Tertiary stage (one to 35 years) : Gumma,
syphilitic endocarditis and meningitis
 10 to 90 days (3 months); average of 21
days
 Dark field illumination test
 Fluorescent treponemal antibody
absorption test – most reliable and sensitive
diagnostic test for Syphilis; serologic test
for syphilis which involves antibody
detection by microscopic flocculation of
the antigen suspension
 VDRL slide test, CSF analysis, Kalm test,
 Wasseman test
 Drug of Choice: Penicillin (Tetracycline if
resistant to Penicillin)
 Abstinence
 Be faithful
 Condom
 GC, Clap, Drip,
Stain, Gleet,
Flores Blancas
 Causative agent  Neiserria gonorrheae
 Mode of transmission  Direct contact – genitals, anus, mouth
 Thick purulent yellowish discharge
 Pathognomonic sign
 Burning sensation upon urination / dysuria
 Incubation period  2 – 10 days
 Culture of urethral and cervical smear
 Diagnostic test
 Gram staining
 Medical management  Penicillin
 Nursing management
 Abstinence, Be faithful
 Condom

 Type of Isolation  Prevention of gonococcal ophthalmia is

done through the prophylactic use of
ophthalmic preparations with erythromycin
or tetracycline