Course

Packet
LM3-NRCM
LM01-NRCM

02 0104
117

Learning Module

NRCM0104
Related Learning
Experience
Clinical Duty
Course Packet 02
Expanded Program on
Immunization

Knowledge Area Code : NRCM

Course Code : NRCM01044
Learning Module Code : LM03-NRCM0104
Course Packet Code : LM03-NRCM.0104-02

Learning Module: Community Health

Nursing1(Individual
and Family)
3
 Course
Packet
LM03-NRCM

02 0104

Course Packet 02
Course Packet 02

Expanded Program on Immunization

Introduction

Welcome to the second course packet in this module! Here you will be learning about one of
the pioneering programs of the Department of Health (DOH) which is the expanded program
on immunization intended for infants and children.

The Philippine Expanded Program on Immunization (EPI) has been in existence for almost 40
years. It is one of the major programs of the Department of Health (DOH) launched on July
1976 in cooperation with WHO and UNICEF. The program has the critical objective of
providing Filipino children with access to safe and effective vaccines that will protect them
from diseases like measles, diphtheria, tetanus, and whooping cough (Ulep & Uy, 2021 ).

With the Philippine commitment to Universal Child Immunization (UCI) Goal of Expanded
Program on Immunization, our country was able to achieve ahead of the target date the Fully
Immunized Child. This was meeting because of the political will and strong support from
various international and local partners, and better performance of various levels of health
facilities. A clear guideline on EPI Manual Operation was develop for better planning, correct
targeting, correct immunization procedures and most importantly the improvement in cold
chain facilities for its safety and efficacy (DOH, 2012)

The following topics are arranged in a way that follows a natural pattern of how a nurse
would perform immunization to infants and children. Pay close attention on how the skills
are performed and the rationale for the actions done.

In this packet you will be provided with learning resources including PDF files (which you
can download and/or print for future reference), videos (files and/or links), activities, and
assessments which will help you in learning this concept. At the end of this packet, there will
be a requirement that you will have to accomplish. There will also be a scheduled
synchronous session (via Google Meet) to provide you with an avenue to ask questions and
have clarifications should there be anything that you are not immediately able to grasp on
your own

Objectives
At the end of this course packet, you will be able to:
1. Identify the different vaccines under the EPI program.
2. Acquire knowledge on the preparation, route, site of administration and side effect.
3. Define terminologies related to immunization
4. Identify the legal mandate of EPI
5. Discuss the concept and importance of vaccination.
6. Prepare and administer vaccines safely
7. Discuss cold chain management

Learning Module: Community Health Nursing1 (Individual and Family)

1
 Course
Packet
LM03-NRCM

02 0104

Learning Management System

Course Packet 02

Google Classroom Code: ahdv35x

Google Drive:
https://drive.google.com/drive/u/0/folders/1FHHkyiMJ4PCJ3PbFDFiktoB1uZF6j7XQslVNcnS
SJ4NQCWjKDgD11fglpXObc6RO2B6TmTiX

*Please take note that the class code will be locked 7 days after it was given to you. Please
make sure that you are able to join the classroom within this given period.
** Google meet link will be provided 3 days prior to the meeting date.

Duration
Course Packet 03: Expanded Program on Immunization 7 hours
• Topic 01: Legal Mandate and Goal of EPI 1
• Topic 02: National Immunization Program 1
• Topic 03: Routine Immunization Schedule for Infants and Women 2
• Topic 04: Recommended Storage Temperature for EPI Vaccines 1
• Topic 6 : Procedure for Immunization 2

Delivery Mode
This course packet will be delivered through flexible learning modalities with synchronous
and asynchronous learning.

Assessment with Rubrics

Assessment tool to be used will be specifically those that focuses in the development of
student’s competency in handling patients with maladaptive patterns of behavior. The
corresponding rubrics are also presented such as:

1.Student Activities (Assignment, Reflective Journal and Aesthetic Project)

2. Video Analysis

A nursing case/video analysis is a study of a particular patient situation/scenario by the

nursing student during the by-area discussion in the skills laboratory, as a part of the Related
Learning Experience (RLE). In the case analysis, the student will be able to apply the different
nursing concepts, theories, principles, and techniques in Psychiatric nursing utilizing the
nursing process

• Examination will be graded based on a 70% equivalent passing rate.

Requirement with Rubrics

• Skills Laboratory Portfolio
A nursing portfolio is a supporting document that categorizes and showcases the knowledge,
skills, and attitude (KSA); and professional development of a nursing student. It includes the

Learning Module: Community Health Nursing1 (Individual and Family)

2
 Course
Packet
LM03-NRCM

02 0104

chronological information and visual representation of the nursing student’s professional

goals, accomplishments, competencies, and skills.
Course Packet 02

See Annex ___ for Rubric for Grading Student’s Skills Laboratory Portfolio

Readings

1. DOH Expanded Program on Immunization

Link : https://www.doh.gov.ph/expanded-program-on-immunization

2. DOH Expanded Program on Immunization

Link : https://doh.gov.ph/node/6035

3.WHO Expanded Programme on Immunization District-Based Immunization Coverage

Cluster Survey
Link : https://reliefweb.int/sites/reliefweb.int/files/resources/63859.pdf

Note: You may read this for additional information. Make sure you
access and read them. If you have problems gaining access to
any or both, post it on the classroom stream so we can guide
you.

Learning Module: Community Health Nursing1 (Individual and Family)

3
 Course
Packet
LM03-NRCM

02 0104

Introduction Key Points:

• Key
ThePoints:
Course Packet 02

global EPI
In 1974, the World Health Organization (WHO) conceived of an
aimed to promote
idea for a global Expanded Program on Immunization •andTherapeutic
develop
(Expanded Program on Immunization – Philippines, 1988). The relationship is very
immunization
global EPI aimed to promote and develop immunization important in mental
programs in all countries, improve vaccination uptake, and • Saving
healththe lives of
establish monitoring systems. The Philippines was one of the •countless of Filipino
Therapeutic
first adopters of EPI. In 1976, the Philippines through a children.
relationship
presidential decree (PD 996) established the national EPI with a between nurses
• The program has
mission to promote universal access to safe and effective andthousands
saved patient ofin
vaccines for common vaccine-preventable diseases (VPDs). The Filipino
mentalchildren fromis a
health
country’s commitment to strengthen the implementation of EPI disabilities
helping and
was once again reinforced through Republic Act no. 10152 of premature death that's
relationship
2011 which mandates free routine vaccination for for 11 VPDs ( because of
based on vaccine-
mutual
preventable diseases
Ulep & Uy, 2021). trust and respect

The Expanded Program on Immunization (EPI) mission is also Definition

Definition of Terms
of Terms
to ensure that infants/children and mothers have access to
routinely recommended infant/childhood vaccines. Six vaccine- Psychiatric mental
Communication -A
Healthby– which
process is the appointed
preventable diseases were initially included in the EPI: position of a nurse that
information is
tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and
exchanged between
measles ( DOH,2012). Vaccines under the EPI are BCG birth individuals through a
dose, Hepatitis B birth dose, Oral Poliovirus Vaccine, common system of
Pentavalent Vaccine, Measles Containing Vaccines symbols, signs, or
(Antimeasles Vaccine, Measles, Mumps, Rubella) and Tetanus behavior.
Toxoid. In 2014, Pneumococcal Conjugate Vaccine 13 was
included in the routine immunization of EPI (DOH
CCHD,2016).

The Philippine EPI has achieved many milestones in this

regard. There is no doubt that mortality and morbidity due
VPDs have declined precipitously over the years, saving the
lives of countless of Filipino children. Moreover, polio was
certified eliminated in 2000 and maternal and neonatal tetanus
in 2017. Undoubtedly, the program has saved thousands of
Filipino children from disabilities and premature death because
of vaccine-preventable diseases (VPDs) like diphtheria,
pertussis, tetanus, and measles. Routine vaccination has
contributed to substantial improvements in childhood survival
and increased life expectancy in the Philippines and globally
(Ehreth, 2003 and Rodrigues, 2020).

According to McGovern & Canning (2015), perennial challenges

in the DOH EPI program remain. The Philippines has struggled
to maintain immunization coverage at par with global
recommendations for herd immunity as well as reach its target
to fully immunize at least 95% of all children.

Learning Module: Community Health Nursing1 (Individual and Family)

4
 Course
Packet
LM03-NRCM

02 0104

Pre-Assessment
Link to be posted
Course Packet 02

Lesson Proper

Review of Concepts

Before you proceed to the main topic, review the necessary

concepts you learned from the previous topic of bag technique.
As stated to your discussion that bag technique is a tool by
which the nurse, during her visit will enable her to perform a
nursing procedure with ease and deftness, to save time and
effort with the end view of rendering effective nursing care to
clients. This is an essential and indispensable equipment of a
public health nurse which she has to carry along during her
home visit. It contains basic medication and articles which are
necessary for giving care.

Let’s dig further! Take a look at the images below and try
to identify the materials that are included in a public health
bag. Kindle put an ( X ) on those materials that are included on
the list.

Learning Module: Community Health Nursing1 (Individual and Family)

5
 Course
Packet
LM03-NRCM

02 0104

Activity.
Key Points:
To help you prepare for the concept and understand
Course Packet 02

easier, here is a video you can watch and use as a guide. • Every child should be
fully immunized at
the age of 12
How Vaccines Work? | VACCINATION | Importance Of months.
Vaccine
• Cold chain
https://www.youtube.com/watch?v=OVcVSyjJkY4
management is
observe to maintain
potency of vaccine
Processing of the Activity and the public health
nurse is called the
cold chain manager

What part of the video triggers your interest to know more

about the immunization? Are you also afraid of having the shot? Definition of Terms
Will you please list down the advantages and disadvantages of the
Japanese Encephalitis -
vaccines? Let us discuss and share them during the forum and our It is the leading cause of
online meeting viral encephalitis in Asia.
Humans can get the
Brief Lesson disease a mosquito that
carries the virus bites
them. Japanese
Immunization or vaccination is a process of protecting every
encephalitis virus (JEV)
child through introduction of antibodies in the system. It is cannot transmit from one
therefore every child should be fully immunized at the age of 12 person to another.
months. Aside from the regular vaccines given the NIP introduce
additional protective vaccines like pentavalent, rotavirus, IPV, Measles Mumps
MMR, Japanese encephalitis. Cold chain management is observe Rubella -
vaccine protects people
to maintain potency of vaccine and the public health nurse is
from 3 serious viral
called the cold chain manager. She being the manager regularly diseases. The diseases
monitor the temperature of the storage vaccine. are spread from direct
contact with droplets
Immunization – is the process by which the vaccines are from sneezes or coughs
introduced into the body before infection sets in. of persons with the
viruses.
Vaccines – are the fluid administered to induced immunity
thereby causing the recipient’s immune system to react to the
vaccine that produces antibodies to fight infection.

Fully Immunized Child (FIC)– when a child receives one dose of

BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and one dose
of measles before a child’s first birthday.

First Expiry and First Out (FEFO) – vaccine is practiced to assure

that all vaccines are utilized before its expiry date

Cold Chain – a system for ensuring the potency of a vaccine from

the. time of manufacture to the time it is given to an eligible client

Learning Module: Community Health Nursing1 (Individual and Family)

6
 Course
Packet
LM03-NRCM

02 0104

Cold Chain Officer – person directly responsible for the cold

Key Points:
chain management
• Every child should
Course Packet 02

be fully immunized
Legal Mandate: at the age of 12
months.
• P.D 996 - Providing for compulsory basic immunization for
infants and children below 8 years old • Cold chain
management is
• R.A. 10152 – Mandatory Infants and Children Health observe to maintain
potency of vaccine
• Immunization Act of 2011
and the public
• R.A. 7846 – Compulsory immunization against Hepatis B for health nurse is
called the cold chain
infants and children below 8 years old manager
• P.D 996 - Providing for compulsory basic immunization for
infants and children below 8 years old” Definition of Terms

Tuberculosis - s a
Goal of EPI: bacterial infection spread
To reduce the morbidity and mortality among infants and through inhaling tiny
droplets from the coughs
children caused by the seven childhood immunizable diseases. or sneezes of an infected
Initially the Coverage of Vaccine-preventable diseases were person
only 6
Poliomyelitis- is a
1. TB disabling and life-
threatening disease
2. poliomyelitis
caused by the poliovirus.
3. diphtheria
4. pertussis Diphtheria - Diphtheria is
a serious infection caused
5. tetanus by strains of bacteria
6. measles called Corynebacterium
diphtheriae that make
R.A. 10152 –Mandatory Infants and Children Health toxin (poison).
Immunization Act of 2011 (Repealing for the purpose P.D. 996)
Pertussis - also known as
With the addition of: whooping cough, is a
7. Mumps highly contagious
respiratory disease.
8. Rubella/German Measles
9. Hepatitis B Tetanus - is an infection
caused by bacteria called
10. H. Influenza type B (HiB) Clostridium tetani.
Such other types as may be determined by the Secretary of
Measles- or rubeola, is a
Health. viral infection that starts in
Government Hospitals and health centers to provide free the respiratory system. It
still remains a significant
mandatory basic immunization to infants and children up to 5
cause of death worldwide,
years old. despite the availability of a
safe, effective vaccine.

EPI changed to NIP in 2016 which include a separate

annotation

Learning Module: Community Health Nursing1 (Individual and Family)

7
 Course
Packet
LM03-NRCM

02 0104

• JE vaccine included in the recommended vaccine group

Key Points:
• Quadrivalent influenzae vaccine included in influenza
• Measles-Rubella
vaccine recommendation
Course Packet 02

(MR) and Tetanus-

• Hib recommendation for high risk children included in Diphtheria (Td)
vaccines are
vaccines for high risk/special groups administered to
Grade 1 and Grade
7 students enrolled
National Immunization Program in public schools
• Human
A school-based immunization program to provide catch-up Papillomavirus
doses for school children and adolescents has been established. (HPV) shall be
given to female
Measles-Rubella (MR) and Tetanus-Diphtheria (Td) vaccines children 9-10
are administered to Grade 1 and Grade 7 students enrolled in years old at health
facilities in priority
public schools provinces

The National Immunization Program (NIP) consists of the Definition of Terms

following antigens:
Bacille Calmette Guerin
• BCG vaccine, single dose given at birth is a vaccine primarily used
• Monovalent Hepatitis B vaccine given at birth against tuberculosis.

• DPT-Hib-Hep B vaccine, 3 doses given at 6-10-14 weeks of Rotavirus vaccine- is a

age vaccine used to protect
against rotavirus
• Oral Polio vaccine (OPV), 3 doses given at 6-10-14 weeks of infections, which are the
age, a single dose of Inactivated Polio vaccine (IPV) is given leading cause of severe
diarrhea among young
with the 3rd dose of OPV at 14 weeks children
• Pneumococcal conjugate vaccine (PCV), 3 doses given at 6- .
10-14 weeks of age Human Papillomavirus
• Rotavirus vaccine given at a minimum age of 6 weeks with a (HPV) - are vaccines that
prevent infection by
minimum interval of 4 weeks between doses. The last dose certain types of human
should be administered not later than 32 weeks of age. papillomavirus.
• Measles –containing vaccine (either monovalent measles
vaccine or MMR) given at 9 months of age
• Measles-Mumps-Rubella (MMR) vaccine given at 12 months
of age
• Human Papillomavirus (HPV) shall be given to female
children 9-10 years old at health facilities in priority
provinces. Quadrivalent HPV 2 doses are given at 0, 6
months
- Given subcutaneously
- Given at a minimum age of 9 months

Learning Module: Community Health Nursing1 (Individual and Family)

8
 Course
Packet
LM03-NRCM

02 0104

- Children 9 months to 17 years of age should receive one

primary dose followed by a booster dose 12-24 months after
the primary dose
Course Packet 02

- Individuals 18 years and older should receive a single dose

only
• Japanese Encephalitis is endemic in the Philippines:
• JE is responsible for 7.4% to 40% of meningitis- encephalitis
syndrome, it affects children younger than 15 years old
- Given subcutaneously
- Given at a minimum age of 9 months
- Children 9 months to 17 years of age should receive one
primary dose followed by a booster dose 12-24 months after
the primary dose
- Individuals 18 years and older should receive a single dose
only

Minimum Age Number of Minimum Interval

Antigen/Vaccine Reason
at 1st dose Doses between doses

To protect the
possibility of TB
Birth or any time meningitis and other
BCG 1
after birth TB infectious in
which infants are
prone

Reduces the chance

DPT 6 weeks 3 4 weeks
of severe pertussis

Increased protection
against polio if given
OPV 6 weeks 3 4 weeks
earlier. Keeps the
Phil. polio free

An early start of
6 weeks interval Hepa B reduces the
from first dose to chance of being
second dose, and infected and
Hepa B At birth 3
8 weeks interval becoming carrier.
from second dose Prevent liver
to third dose cirrhosis and liver
cancer.

At least 85% of
Measles 9 months measles can be
prevented at this age.

Learning Module: Community Health Nursing1 (Individual and Family)

9
 Course
Packet
LM03-NRCM

02 0104

Concept and Importance of Vaccination

• Vaccines are administered to introduced immunity thereby causing the recipient’s immune
Course Packet 02

system to react to the vaccine that produces antibodies to fight infection.

• Vaccinations promote health and protect children from disease – causing agents.
• Infants and newborn need to be vaccinated at an early age since they belong to vulnerable
age group.

Routine Immunization Schedule for Infants

Schedule and Manner of Administration of Infants Immunization

Antigen Age Dose Route Site
Right deltoid region
BCG vaccine At birth 0.05 ml Intradermal
(arm)
Hepatitis B Anterolateral thigh
At birth 0.5 ml. Intramuscular
vaccine muscle
DPT-Hepa B- 6 weeks, 10
Anterolateral thigh
Hib weeks, 14 0.5 ml Intramuscular
muscle
(Pentavalent) weeks
6 weeks, 10
Oral Polio
weeks, 14 2 drops Oral Mouth
Vaccine
weeks
Anti-measles Outer part of the
9-11 months 0.5 ml Subcutaneous
vaccine (AMV) upper arm
Measles-
Mumps Rubella Outer part of the
12-15 months 0.5 ml Subcutaneous
Vaccines upper arm
(AMV2)
6 weeks, 10
Rotavirus
weeks

Vaccine, Contents and Form

Vaccine
BCG (Bacillus Calmette-
Guerin)
Hepatitis B vaccine
DPT-Hepa-Hib
(Pentavalent Vaccine)
Oral Polio Vaccine
Content Form
Freeze-dried. Reconstituted
Live attenuated bacteria
with a special diluent
RNA-recombinant using Cloudy, liquid, in an auto-
Hepatitis B surface antigen disable injection syringe if
(HBs Ag) available
Diptheria toxoid,
inactivated pertussis
bacteria, tetanus toxoid,
Liquid, in an auto-disable
recombinant DNA surface
injection syringe
antigen, and synthetic
conjugate of Haemophilus
influenzae B bacilli
Live, attenuated virus
Clear, pinkish liquid
(trivalent)

Learning Module: Community Health Nursing1 (Individual and Family)

10
 Course
Packet
LM03-NRCM

02 0104

Anti-measles vaccine
Measles-Mumps-Rubella
Course Packet 02
Freeze-dried reconstituted
Live, attenuated virus
with a special diluent
Freeze-dried reconstituted

Live, attenuated viruses

Vaccine with a special diluent
Clear, colorless liquid in a
Rotavirus Vaccine Live attenuated viruses container with an oral
applicator
Sometime slightly turbid in
appearance: Clear colorless
Tetanus Toxoid Weakened toxin
liquid sometimes slightly
turbid

Tetanus Toxoid Immunization Schedule Tetanus for Women

Minimum Age/
Vaccine Percent Protection Duration of Protection
Interval
As early as possible
TT1
during pregnancy
Infants born to mother will
be protected from neonatal
TT2 At least 4 weeks later 80% tetanus
Gives 3 years protection for
the mother
Infants born to the mother
will be protected from
At least 6 months
TT3 95% neonatal tetanus
later
Gives 5 years protection for
the mother
Infants born to the mother
will be protected from
At least one year
TT4 99% neonatal tetanus
later
Gives 10 years protection
for the mother
Gives life time protection
At least one year for the mother
TT5 99%
later All infants born to that
mother will be protected.

Recommended Storage Temperature for EPI Vaccines

Type of Vaccine
Oral Polio (live attenuated)
-15 C to -25 C (at the
Measles (freeze dried)
Most sensitive to heat freezer)

DPT/Hepatitis B
“D” toxoid which is a

Learning Module: Community Health Nursing1 (Individual and Family)

11
 Course
Packet
LM03-NRCM

02 0104

weakened toxin”
Least sensitive to heat “P” Killed bacteria + 2 C to +8 C (in the body of
“T” toxoid which is a the refrigerator)
Course Packet 02

weakened toxin
BCG (freeze dried)
Tetanus toxoid

Vaccines Side Effects Management

Kock’s phenomenon: an acute
inflammatory reaction within 2-4
days after vaccination; usually
No management is needed
indicates previous exposure to
tuberculosis
Deep abscess at vaccination site:
Refer to the physician for
almost invariably due to
incision and drainage
subcutaneous or deeper injection
Indolent ulceration: an ulcer which
BCG
persists after 12 weeks from
Treat with INH powder
vaccination date
Glandular enlargement:
If suppuration occurs, treat
enlargement of lymph glands
as deep abscess
draining the injection site
Hepatitis B vaccine Local soreness at the injection site No treatment is necessary
Fever that usually last for only 1
day. Advise parent to give
Fever beyond 24 hours is not due antipyretic
to the vaccine but other causes
Reassure parents that
Local soreness at the injection site soreness will disappear
after 3-4 days
DPT-Hepa B-Hib
Abscess after a week or more
(Pentavalent)
usually indicates that the injection Incision and drainage may
was not deep enough or the needle be necessary
was not sterile
Convulsions: although very rare, Proper management of
may occur in children older than 3 convulsion; pertussis
months, caused by pertussis vaccine should not be given
vaccine anymore
OPV None
Fever 5-7 days after vaccination in Reassure parents and
Anti-measles
some children; sometimes there is a instruct them to give
vaccine
mild rash antipyretic to the child
Reassure parents and
Local soreness, fever irritability,
MMR instruct them to give
and malaise in some children
antipyretic to the child
Some children develop mild Reassure parents and
Rotavirus vaccine
vomiting and diarrhea, fever, and instruct them to give

Learning Module: Community Health Nursing1 (Individual and Family)

12
 Course
Packet
LM03-NRCM

02 0104

irritability antipyretic and ORESOL to

the child
Apply cold compress at the
Course Packet 02

Tetanus toxoid Local soreness at the injection site site. No other treatment is
need

Sources: Expanded Program on Immunization Manual, revised

edition, 1995. DOH Republic of the Phil.; Dept. Memorandum
No. 2011-0157, Administration of Rotavirus vaccine for infants,
and Ligtas Tigdas ang Pinas Guide for Vaccination Team,
DOH, 2011d

Procedure for Immunization

BCG Vaccine
Reconstituting the Freeze-Dried BCG Vaccine
1. Always keep the diluent cold.
2. Using a 5 ml. syringe fitted with long needle, aspirate 2 ml.
of saline solution from the open ampule of diluent
3. Inject the 2 ml. saline into the ampule of freeze-dried BCG
4. Thoroughly mix the diluent and vaccine by drawing the
mixture back into the syringe and expel it slowly into
the ampule several times.
5. Return the reconstituted vaccine on the slit of the foam
provided in the vaccine

Giving BCG Vaccine:

1. Clean the skin with a cotton ball moistened with water
and let skin dry
2. Hold the child’s arm with your left hand so that your hand
is under and your thumb and finger come around the arm
and stretch the skin.
3. Hold the syringe in your right hand with the bevel and the
scale pointing up towards you
4. Lay the syringe and needle almost flat along the child’s arm
5. Insert the tip of the needle into skin – just above the bevel.
Keep the needle flat along the skin and the bevel facing
upwards, so the vaccine only goes into the upper layers of
the skin.
6. Put your left thumb over the needle end to hold it in
position. Hold the plunger between the index and middle

Learning Module: Community Health Nursing1 (Individual and Family)

13
 Course
Packet
LM03-NRCM

02 0104

finger of the right hand and press the plunger in with your
right thumb
7. If the vaccine is injected correctly into the skin, a flat wheal
Course Packet 02

with the surface fitted like an orange peel will appear on the
injection site
8. Withdraw the needle gently.
Note: Any remaining reconstituted vaccine must be discarded
after 6 hours or at the end of the day.

Administering the Freeze-Dried Measles Vaccine

1. Using 10 ml syringe pitted with a long needle, aspirate 5 ml.
of special diluent from the ampule.
2. Empty the diluent from the syringe into the vial with the
`vaccine
3. Thoroughly mix the diluent and vaccine by drawing the
`mixture back into the syringe and expelling it slowly into the
vial several times. Do not shake the vial.
4. Protect the reconstituted vaccine from sunlight. Wrap vial in
`foil.
5. Place the reconstituted vaccine in the slit of the foam
`provided in the vaccine carrier.

Giving Measles Vaccines

1. Ask the mother to hold the child firmly.
2. Clean the skin with a cotton ball, moistened with water and
let the skin dry.
3. With the finger of one hand, pinch up the skin on the outer
side of the upper arm
4. Without touching the needle, push the needle into the
pinched-up skin so that it is not pointing
5. Slightly pull the plunger back to make sure the vaccine is not
injected into a vein
6. Press the plunger gently and inject.
7. Withdraw the needle and press the injection spot quickly
with a piece of cotton.

Learning Module: Community Health Nursing1 (Individual and Family)

14
 Course
Packet
LM03-NRCM

02 0104

Giving Tetanus Toxoid (TeTox) Vaccine

1. Shake the vial.
2. Clean the skin with a cotton ball, moistened with water and
Course Packet 02

let skin dry.

3. Place your thumb and index finger on each side of the
injection site and grasp the muscles slightly. The best
injection site for a woman is outer side of the upper arm.
4. Quickly push the needle, going deep into the muscle.
5. Slightly pull the needle back to be sure it is not into a vein.
6. Inject a vaccine, withdraw the needle and press the injection
spot quickly with a piece of cotton.

Giving Oral Polio Vaccine (OPV)

1. Read instructions
2. Let mother hold the child
3. Open child’s mouth
4. Put drop of vaccine on the child’s tongue but don’t let
dropper touch the tongue
5. Make sure child swallows’ vaccine

EPI COLD CHAIN and LOGISTICS

The vaccine cold chain is a global network of cold rooms,
freezers, refrigerators, cold boxes, and carriers (like the one
shown above) that keep vaccines at just the right temperature
during each link on the long journey from the manufacturing
line to the syringe. Excess heat or cold will reduce the vaccine
potency (strength), increasing the risk that recipients will not
be protected against vaccine-preventable diseases.

The person directly responsible for cold chain management at

each level is called the Cold Chain Officer
Public Health Nurse is the Cold Chain Officer in the
RHU/health center

• Temperature monitoring of vaccines is done in all levels of

health facilities to monitor vaccine temperature.
• Temperature checking is done twice a day early in the
morning and in the afternoon before going home.

Learning Module: Community Health Nursing1 (Individual and Family)

15
 Course
Packet
LM03-NRCM

02 0104

• Temperature is plotted every day in monitoring chart to

monitor break in cold chain
Course Packet 02

Components of the cold chain

The cold chain has three main components, each
of which must combine to ensure safe vaccine
transport and storage:

a. transport and storage equipment

b. trained personnel
c. efficient management procedures.

This study session is about the first of these

components. You can see the cold chain equipment
in Figure 6.1, together with the storage temperatures
required at each storage place, from arrival in the
to the storage in your Health Post. Next we will
describe the common cold chain equipment you
will use when you collect vaccines from the health
centre and in your practice at the Health
Post and in the community.

Figure 6.1 The cold chain. (Adapted from: WHO, 2004,

Immunization in Practice, Module 3, The Cold Chain, Figure 3A,
p.2

Learning Module: Community Health Nursing1 (Individual and Family)

16
 Course
Packet
LM03-NRCM

02 0104

Importance of Cold Chain

The Cold Chain is standard practice for vaccines
throughout the pharmaceutical industry.
Course Packet 02

Maintaining the cold chain ensures that vaccines are transported

and stored according to the manufacturer’s recommended
temperature range + 2C to 8 C until point of administration.

Enhancement Activity
Direction: Click and watch following videos for your guidance
and reference.

Clinical Skills: Administering Vaccinations

Link :https://www.youtube.com/watch?v=hLXJ63bhuDE

How to Position Infants and Children for Vaccination

Link: https://www.youtube.com/watch?v=jMUIKYYxwqc

What is a Vaccine Cold Chain?

Link : https://www.youtube.com/watch?v=LqeP3zqMAuw

Generalization:
Please do the following:

1. Kindly give us a summary of what you had learned in this course packet. (3

paragraphs, minimum of 5 sentences for each paragraph)

Application
Actual demonstration of your learning in this module will be observed and
assessed during your scheduled limited face to face duty with your clinical instructors.

Course Packet Discussion Forum

After discussing various topics under Course Packet 3, Therapeutic

Relationship, what have you learned from the discussion? How will you apply
these learnings in the clinical practice as you provide nursing care to patients with
maladaptive patterns of behavior? What are the topics you think need focus to
further your learning and skills in communicating and interacting?

Group yourselves into two. Choose a moderator who will facilitate the
discussion. Prepare a five-slides PowerPoint presentation of the discussion
output to be presented next meeting.

Learning Module: Community Health Nursing1 (Individual and Family)

17
 Course
Packet
LM03-NRCM

02 0104

Post-Assessment
Link will be posted before the examination
Course Packet 02

Additional Activity

Since immunization is very controversial for the past

months, some people are having second thought of receiving it
for them and for their children despite the known effectivity of
the vaccine. As a nursing student, how would you educate the
people regarding the effectiveness and the safety of the vaccine?
Please make 2 educational materials a (pamphlet) that encourage
and educate the people the reason why they need to be
vaccinated. Be creative on how you are going to do your activity.

References

Ulep,V. and Uy,J (2021) An Assessment of the Expanded

Program on Immunization (EPI) in the Philippines: Challenges
and Ways Forward

Department of Health on Immunization

https://doh.gov.ph/expanded-program-on-immunization

Video Credits

1. Clinical Skills: Administering Vaccinations

Link :https://www.youtube.com/watch?v=hLXJ63bhuDE

2. How to Position Infants and Children for Vaccination

Link: https://www.youtube.com/watch?v=jMUIKYYxwqc

3. WHO: Expanded Programme on Immunization (EPI) 40th

anniversary
Link Lhttps://www.youtube.com/watch?v=LG7ikYLUAWQ

4. Immunization Techniques: Best Practices with Infants, Children, and Adults

Link : https://www.youtube.com/watch?v=WsZ6NEijlfI

5. What is a Vaccine Cold Chain?

Link : https://www.youtube.com/watch?v=LqeP3zqMAuw

Learning Module: Community Health Nursing1 (Individual and Family)

18
 Course
Packet
LM03-NRCM

02 0104

Activity Sheet
Activity Sheet

Learning Module: Community Health Nursing1 (Individual and Family)

19
 Course
Packet
LM03-NRCM

02 0104

Assignment
Assignment

Learning Module: Community Health Nursing1 (Individual and Family)

20
 Course
Packet
LM03-NRCM

02 0104

Learner’s Feedback Form

Learner’s Feedback Form

Name of Student: __________________________________________________________

Program : __________________________________________________________
Year Level : ______________ Section : __________________
Faculty : __________________________________________________________
Schedule : __________________________________________________________

Course Packet : Code : _________ Title : __________________________________

How do you feel about the topic or concept presented?

 I completely get it.  I’m struggling.
 I’ve almost got it.  I’m lost.

In what particular portion of this course packet, you feel that you are struggling or lost?
_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________

Did you raise your concern to you instructor?  Yes  No

If Yes, what did he/she do to help you?

_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________

If No, state your reason?

_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________

To further improve this course packet, what part do you think should be enhanced?
_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________

How do you want it to be enhanced?

_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________

Learning Module: Community Health Nursing1 (Individual and Family)

21