Community Health Nursing

 Meningitis/Encephalitis

IMMUNIZATION – process by which a person becomes protected against a disease through

vaccination. Causative Agent: Mycobacterium Tuberculosis
VACCINATION – the act of introducing a vaccine into the body to produce immunity to a MOT: Airborne
specific disease. Clinical Manifestations:
VACCINE – a product that stimulates a person’s immune system to produce immunity to a  Weight loss
specific disease, protecting the person from that disease.  Cough for 2 weeks/more
EXPANDED POGAM ON IMMUNIZATION (EPI) – established in 1976 to ensure that infants/children  Fever
and mothers have access to routinely recommended vaccines.  Hemoptysis
Legal Basis:  Night sweats (Pathognomonic Sign)
 P.D. 996
- “Providing for Compulsory Basic Immunization fo Infants & Children below 8
years old”  “Infantile flaccid paralysis”
 R.A. 10152  Causative Agent: Legio debilitans ??
- “Mandatory Infant & Children Immunization Act of 2011” o Brunhilde
- The mandate includes basic immunization for children under 5 including o Lansing
other types that will be determined by the secretary of Health. o Leon
- Signed by Benigno Aquino III  MOT: Early – Droplet Spray
Late – Fecal - Oral
GOALS OF EPI:  Clinical Manifestations:
 To reduce the morbidity & mortality among children against the most common o Hoyhe’s sign – head drop
vaccine-preventable diseases o Tripod position
 Specific Goal: o Paralysis
1. To immunize all infants/children against the most common vaccine-
preventable diseases.
2. To sustain the polio-free status of the Philippines.  Causative agent: Corehybacterium diptheriae
3. To eliminate the measles infection.  MOT: Droplet
4. To eliminate maternal & neonatal tetanus.  Pathognomonic sign: Pseudomembrane Pertussis
5. To control diphtheria, pertussis, heap b, & German Measles.  “whooping cough”
6. To prevent extra-pulmonary tuberculosis among children.  Causative agent: Bordetella Pertussis
 MOT: Droplet
VACCINE PREVENTABLE DISEASES:  Clinical Manifestations:
o Spasmodic Coughing (15-20 coughs) followed by vomiting Tetanus
 Tuberculosis
 Causative agent: Clostridium tetani
 Poliomyelitis
 MOT: Direct contact via OPEN WOUND
 Diphteria
 Clinical Manifestations:
 Tetanus
o Painful muscular spasms
 Pertussis
o Opisthotomos posture
 Measles
o Risus sardonicus (Pathognomonic sign)
RECENTLY ADDED:
 Hepatitis B
 Mumps
 Rubella  Causative Agent: Hepa B virus
 Pneumonia  MOT: Direct, Indirect, Vertical
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 Clinical Manifestations: o Productive cough

o Fever o Sputum production
o Abdominal pain
o Anorexia
o Jaundice  “Cerebrospinal Fever”
 Causative Agent: varies
o N. meningitis
 “Rubeola” o M. tuberculosis
 Causative Agent: Paramyxovirus o S. aureus
 MOT: Airborne o HiB
 Period of Communicability: 4 days before & 5 days after ash appearance  MOT: Droplet
 Clinical Manifestations:  Incubation period: 2 to 10 days
o Fever  Clinical Manifestations:
o Cough, coryza (rhinitis/sipon), conjunctivitis o Projectile vomiting
o Cephalocaudal rash o Nuchal Rigidity
o Koplik’s spot (Pathognomonic sign) o (+) Kernig
o (+) Brudzinski
Kernig Sign:
 “Beke’”, “Bayook” 1. Knee is flexed to 90 degress
 Causative Agent: Paamyxovirus 2. Hip is flexed to 90 degress
 MOT: Droplet 3. Externsion of the knees is painful or limited in extension
 Period of Communicability: Up to 5 days after onset of signs & symptoms Brudzinski Sign:
 Clinical Manifestations: 1. Passive flexion of neck
o Fever
o Painful, enlarge parotid gland/s PRINCIPLES OF EPI:
o In boys, painful & swollen testicles 1. It is safe and immunologically effective to administer all EPI vaccines on the same day
at different sites of the body
2. Measles vaccines should be given as soon as the child is 9 months old regardless of
 “German Measles” whether other vaccines will be given on that day.
 Causative Agent: Pseudo-paramyxovirus 3. The vaccination schedule should not be restarted from the beginning even if the
 MOT: Droplet/ Direct intervals between doses exceed the recommended interval by months or years.
 Period of Communicability: Entire course of the disease 4. Moderate fever, malnutrition, mild respiratory infection, cough, diarrhoea, & vomiting
 Clinical Manifestations: are not contraindications to vaccination.
o Fever 5. The absolute contraindications to immunization are:
o Forchheimer’s spot (Pathognomonic Sign) a. DPT 2 or DPT 2 (or DPT – containing vaccines) to a child who has had
o Non-itchy, pink, cephalocaudal, macullopapular rash convulsions or shock within 3 days the previous dose.
o Enlarged lymph nodes b. Vaccines containing whole-cell pertussis component should not be given to
children with evolving neurological disease (uncontrolled epilepsy)
c. Live vaccines like BCG should never be given to individuals who are
 Inflammation in the lungs characterized by pus/fluid production immunosuppressed due to a malignant disease, therapy with
 Causative agent: Haemaphilus Influenzae Type B (HiB) S. Pneumoniae immunosuppressive agents, or irradiation.
 MOT: Droplet d. It is not safe to give IPV to the following:
 Clinical Manifestations: i. Children allergic to streptomycin, neomycin, Polymyxin B, or a
o Fever previous IPV dose.
 Community Health Nursing

ii. Children with known bleeding disorders as bleeding may occur h. Freeze dried vaccines MUST ONLY be reconstituted by the diluent supplied by
after injection. the manufacturer.
e. It is safe & expected to have mild side effects after vaccination. Local i. Use one syringe, one needle one child principle during vaccinations.
reaction, fever, & mild systemic symptoms can result as part of the normal
immune response.
f. Giving doses of a vaccine at less than the recommended interval may lessen
the antibody response.
g. No extra doses must be given to a child/mother who missed a dose of
DPT/HB/OPV/TT. The vaccination must be continued as if no time had
elapsed between doses.

EPI VACCINES
MINIMUM AGE AT NO. OF
VACCINE DISEASE PREVENTED DOSAGE ROUTE SITE
FIRST DOSE DOSES

Within 24 hours after

BCG (Bacillus Calmette-Guerin) Tuberculosis 1 0.05 mL Intradermal Right deltoid region of the upper arm
birth

Within 24 hrs after Upper outer portion of thigh/ anterolateral

Hepatitis B Vaccine Hepa B 1 0.5 mL Intramuscular
birth aspect of the thigh (Vastus Lateralis)

Pentavalent Vaccine
1. Diptheria
Components: 2. Pertussis
Upper outer portion of the thigh or
1. Diptheria 3. Tetanus 6 weeks (4 weeks
3 0.5 mL Intramuscular anterolateral aspect of the thigh (Vastus
2. Whole-cell pertussis vaccine 4. Hepatitis interval)
Lateralis)
3. Tetanus vaccine 5. Pneumonia
4. Hepatitis B vaccine 6. Meningitis
5. HiB conjugate vaccine

Oral Polio Vaccine (OPV) 2 drops (or

6 weeks (4 weeks depending on
Poliomyelitis 3 Oral Mouth
-“sabin” vaccine interval) manufacturer’s
- composed of live, attenuated viruses rec.)

Inactivated Polio Vaccine (IPV)

-“salk” vaccines
Poliomyelitis 14 weeks 1 0.5 mL Intramuscular Upper outer left thigh or Upper left deltoid
- composed of killed viruses
-strenghtens the protection given by OPV

1. Pneumonia 6 weeks (4 weeks

Pneumococcal Conjugate Vaccine (PCV) 3 0.5 Ml Intramuscular Upper outer left thigh or Vastus Lateralis
2. Meningitis interval)
 Community Health Nursing

1. Measles 9 months
MMR Vaccine 2. Mumps Next: 1 year & 29 2 0.5 mL Subcutaneous Upper outer left thigh or Vastus Lateralis
3. Rubella days
Note: It only takes FIVE visits to fully immunize your baby
Note: Mother will be given an immunization record that they need to bring every visit.

FAQs:
1. It is safe for the child to receive 3 (or more) injections in one visit?  Two doses of TT injection given a one-month interval between each dose
Answer: Yes, it is safe for the child to be given 3 (or more injections) at one during pregnancy or even before pregnancy period protects the baby from
visit. Many countries have been doing this & have been proven that it is neonatal tetanus.
generally safe for the child to receive multiple injections during the same visit. MINIMUM AGE/ PERCENT OF DURATION OF
VACCINE
INTERVAL POTECTION PROTECTION
2. Will there be cross-reactions between the IPV & the other 3 vaccines given at
the same time? As early as possible
TT1 None None
Answer: IPV will not interfere with the other vaccines. In fact, giving these during pregnancy
vaccines on the same day will not overwhelm the child’s immune system. > Infant born will be
SEQUENCE OF ADMINISTRATION: protected from
Step 1: OPV neonatal tetanus
Step 2: PCV (Left) TT2 4 weeks after TT1 80%
> 3 years protection to
Step 3: Penta (Right) the mother
Step 4: IPV (Left)
FULLY IMMUNIZED CHILD (FIC) > Infant born will be
 A child who has received all recommended basic vaccines before his/her protected from
birthday. TT3 6 months after TT2 95% neonatal tetanus
 BCG at birth > 5 years protection to
 Polio doses at 6 – 10 – 14 weeks of age. the mother
 Pentavalent doses at 6-10 14 weeks of age. > Infant born will be
 PCV doses at 6 – 10 – 14 weeks of age. protected from
 Measles dose at 9 months of age. TT4 One year after TT3 99% neonatal tetanus
COMPLETELY IMMUNIZED CHILD (CIC) > 10 years protection to
 A child who has received all recommended basic vaccines after his/her first the mother.
birthday.
>Lifetime protection to
TETANUS TOXOID IMMUNIZATION FOR WOMEN
mother.
 Prevents tetanus in both mother & baby
TT5 One year after TT4 99% > All neonate born to
 Completing five doses of the prescribed schedule will give lifetime immunity.
the mother will be
TETANUS TOXOID (TT)
protected
 Dosage: 0.5 mL
 Route: Intramuscular
 Site: Delt
Community Health Nursing
 Community Health Nursing

STORING, HANDLING, TRANSPORTING VACCINES

COLD CHAIN REMEMBER: “Oh My Baby (Darling) Please Help Tita Ingrid”
 A system of storing & transporting vaccines at recommended temperatures
from point of manufacture to point of use (WHO). MAXIMUM STORAGE & TRANSPORT CONSIDERATIONS
 Maintains the potency of vaccines.  RHO -> PHO -> DHO – 3 months
COLD CHAIN EQUIPMENT  RHU – 1 month
 Cold room  Maximum transport period if with cold packs – 5 days
 Freezer
 Refrigerator HANDLING & TRANSPORTING VACCINES
 Transport Box  “First expiry, First out” (FEFO)
 Vaccine carrier o To assure that all vaccines are utilized before its expiry date.
 Thermometer  Temperature Monitoring
 Cold chain monitors o Done BID: Early in the morning & in the afternoon before going
 Ice packs home
 Temperature monitoring chart o Plot temperature every day in a temperature monitoring chart.
 Safety collector box DISCARDING UNUSED BIOLOGICALS
 Unopened/exposed vaccines may be put back in the refrigerator/ freezer 2x
STORAGE OF VACCINES only; discard after third exposure.
 BCG: discard after 4 hours
TYPE/FORM OF
CHARACTERISTICS STORAGE TEMPRERATURE  HBV, DPT, OPV, AMV, TT: discard after 8 hours
VACCINE
 IPV: discard multi-dose vials after 28 days
OPV -15°C to -25°C (Stored at
Most sensitive to heat
Measles freezer)
NURSING MANAGEMENT
BCG (freeze dried)  Clean the skin with cotton ball moistened with cool boiled water or sterile
DPT (If still existing) water & hot with alcohol and let the skin dry before injecting vaccines.
Pentavalent =2°C to +8°C (in the body of  If fever occurs to child, explain to mother that this is normal and needs no
Least sensitive to heat
Hep. B the refrigerator) aggressive treatment. Advise her to give TSB or antipyretic drops, as ordered.
Tetanus Toxoid  Swelling of the injection site is a very common side effect. Advise mother to
IPV apply cold compress over
 The site for the first 24 hrs. then hot compress after 24 hours.