Community Health Nursing 1 - Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 17

LESSON TITLE: Mandatory Infants and Children Materials:

Health Immunization Act of 2011 / Expanded Program
Pen, paper, index card, book, and class List
of Immunization
LEARNING OUTCOMES:
Reference:
Upon completion of this lesson, the nursing student can:
1. Apply management and leadership principles in providing
Famorca, Z. U., Nies, M. A., & McEwen, M.
direction to manage a community-based program;
(2013). Nursing Care of the Community.
2. Use appropriate strategies/approaches to plan Elsevier Gezondheidszorg.
community health programs and nursing service;
3. Evaluate specific components of health programs and
nursing services based on parameters/criteria; and,
4. Promote and maintain a positive practice environment.

LESSON PREVIEW/REVIEW (5 MINUTES)

Instruction: Why is breastfeeding important? Explain.
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MAIN LESSON (30 MINUTES)

MANDATORY INFANTS AND CHILDREN HEALTH IMMUNIZATION ACT OF 2011

Republic Act Number. 10152 - An act providing for mandatory basic immunization services for infants and children

The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children and mothers have
access to routinely recommended infant/childhood vaccines.

Over-all Goal: To reduce the morbidity and mortality among children against the most common vaccine-preventable
diseases.

Specific Goal:
 To immunize all infants/children against the most common vaccine-preventable diseases;
 To sustain polio-free status of the Philippines;
 To eliminate measles infection;
 To eliminate maternal and neonatal tetanus;
 To control diphtheria, pertussis, hepatitis b and German Measles;
 To prevent extra pulmonary tuberculosis among children.

Six preventable diseases were initially included in the EPI:

 Tuberculosis
 Poliomyelitis
 Diphtheria
 Tetanus
 Pertussis
 Measles

Vaccines under the EPI are:

 BCG birth dose

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 Hepatitis B birth dose
 Oral Poliovirus Vaccine
 Pentavalent Vaccine
 Measles Containing Vaccines (Anti-measles Vaccine, Measles, Mumps, Rubella)
 Tetanus Toxoid
 Pneumococcal Conjugate Vaccine 13

A. Bacillus Calmette–Guérin (BCG)

 Given intradermally (ID)
 The dose of BCG is 0.05 ml for children < 12 months of age and 0.1 ml for children > 12 months of age
 Given at the earliest possible age after birth preferably within the first 2 months of life
 For healthy infants and children > 2 months who were not given BCG at birth, PPD prior to BCG vaccination is
not necessary. However, PPD is recommended prior to BCG vaccination if any of the following is present:
 Congenital TB
 History of close contact to known or suspected infectious TB cases
 Clinical findings suggestive of TB and/or chest x-ray suggestive of TB

In the presence of any of these conditions, an induration of ≥ 5mm is considered positive and BCG is no
longer recommended.

B. Hepatitis B Vaccine (HBV)

 Given intramuscularly (IM)
 Administer the first dose of monovalent HBV to all newborns >2kgs within 24 hours of life.
 A 2nd dose is given 1-2 months after the birth dose

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 The final dose is administered not earlier than 24 weeks of age. Another dose is needed if the last dose was
given at age

a. For infants born to HBsAg (+) mothers:

 Administer HBV and HBIG (0.5ml) within 12 hours of life. HBIG should be administered not later than 7
days of age if not immediately available.
b. For infants born to mothers with unknown HBsAg status:
 with birth weight >2kgs, administer HBV within 12 hours of birth and determine the mother’s HBsAg as
soon as possible. If HBsAg (+), administer also HBIG not later than 7 days of age.
 with birth weight <2kgs, administer HBIG in addition to HBV within 12 hours of life.
c. For preterm infants:
 If born to HBsAg (-) mothers and medically stable, the 1st dose of HBV maybe given at 30 days of
chronological age regardless of weight, and this can be counted as part of the 3-dose primary series.
d. For those <2 kgs, the 1st dose received at birth is not counted as part of the vaccine series. Additional 3 HBV
doses are needed.

C. Hemophilus Influenzae Type B Conjugate Vaccine (Hib)

 Given intramuscularly (IM)
 Given as a 3-dose primary series with a minimum age of 6 weeks and a minimum interval of 4 weeks
 A booster dose is given between 12-15 months of age with an interval of 6 months from the 3rd dose.

D.
Diphtheria and Tetanus Toxoid and Pertussis Vaccine (DTP)
 Given intramuscularly (IM)
 Given at a minimum age of 6 weeks with a minimum interval of 4 weeks
 Complete a 5-dose series at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. The recommended
interval between the 3rd and 4th dose is 6 months, but a minimum interval of 4 months is valid
 The 5th dose of DTaP vaccine may not be given if the 4th dose was administered at age 4 years or older.

E. Inactivated Poliovirus Vaccine (IPV)

 Given intramuscularly (IM)
 Usually given in combination with DTaP and Hib, with or without Hep B
 Given at a minimum age of 6 weeks with a minimum interval of 4 weeks
 The primary series consists of 3 doses
 A booster dose should be given on or after the 4th birthday and at least 6 months from the previous dose

F. Rotavirus Vaccine (RV)

 Given per Orem (PO)
 Given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should
be administered not later than 32 weeks of age.
 The monovalent human rotavirus vaccine (RV1) is given as a 2-dose series and the pentavalent human
bovine rotavirus vaccine (RV5) is given as a 3-dose series.

G. Pneumococcal Conjugate Vaccines (PCV)

 Given intramuscularly (IM)
 Given at a minimum age of 6 weeks for PCV10 and PCV 13
 Primary vaccination consists of 3 doses with an interval of at least 4 weeks between doses plus a booster
dose given 6 months after the 3rd dose.
 Healthy children 2 to 5 years old who do not have previous PCV vaccination may be given 1 dose of PCV 13,
or 2 doses of PCV 10 at least 8 weeks apart Refer to Vaccines for Special Groups for Pneumococcal Vaccine
recommendation in high-risk children.

F. Influenza Vaccine (Trivalent/Quadrivalent Influenza Vaccine)

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 Trivalent influenza vaccine (TIV) given intramuscularly (IM) or subcutaneously (SC)
 Quadrivalent influenza vaccine (QIV) given intramuscularly (IM)
 Given at a minimum age of 6 months
 The dose of influenza vaccine is 0.25 ml for children 6 months to 35 months and 0.5 ml for children 36
months to 18 years
 Children 6 months to 8 years receiving influenza vaccine for the 1st time should receive 2 doses separated by
at least 4 weeks
 If only one dose was given during the previous influenza season, give 2 doses of the vaccine then one dose
yearly thereafter
 Children aged 9 to 18 years should receive one dose of the vaccine yearly
 Annual vaccination should begin in February but may be given throughout the year

H. Measles Vaccine
 Given subcutaneously (SC)
 Given at the age of 9 months, but may be given as early as 6 months of age in cases of outbreaks as
declared by public health authorities
 If monovalent measles is not available, MMR may be given

I. Japanese Encephalitis Vaccine (JE)

 Given subcutaneously (SC)
 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

J. Measles-Mumps-Rubella (MMR) Vaccine

 Given subcutaneously (SC)
 Given at a minimum age of 12 months
 2 doses of MMR vaccine are recommended
 The 2nd dose is usually given from 4-6 years of age but may be given at an earlier age with a minimum of 4
weeks interval between doses.

K.
Varicella Vaccine
 Given subcutaneously (SC)
 Given at a minimum age of 12 months
 2 doses of varicella vaccine are recommended
 The 2nd dose is usually given at 4-6 years of age, but may be given earlier at an interval of 3 months from the
first dose.
 If the 2nd dose was given 4 weeks from the first dose, it is considered valid.
 For children 13 years and above, the recommended minimum interval between doses is 4 weeks.

L. Hepatitis A Vaccine (HAV)

 Given intramuscularly (IM)
 Given at a minimum age of 12 months
 2 doses of the vaccine are recommended
 The 2nd dose is given at least 6 months from the 1st dose

M. Measles-Mumps-Rubella-Varicella Vaccine (MMRV)

 Given subcutaneously (SC)
 Given at a minimum age of 12 months
 MMRV may be given as an alternative to separately administered MMR and Varicella vaccines

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 The maximum age is 12 years
 The recommended minimum interval between doses is 3 months

N. Human Papillomavirus Vaccine (HPV)

 Given intramuscularly (IM)
 For ages 9-14 years, a 2-dose series is recommended
 Bivalent HPV (2vHPV), quadrivalent (4vHPV) or nonvalent (9vHPV) given at 0 and 6 months
 If the interval between the 1st and 2nd dose is less than 6 months a 3rd dose is needed. The minimum
interval between the 2nd and 3rd dose is 3 months.
 For ages 15 years and older, a 3-dose series is recommended.
 Bivalent HPV (2vHPV), quadrivalent (4vHPV) or nonvalent (9vHPV) at 0, 2 and 6 months.
 The minimum interval between the 1st and the 2nd dose is 1 month and the minimum interval between
the 2nd and 3rd dose is 3 months. The 3rd dose should be given at least 6months from the 1st dose.

For males 9-18 years of age, a 4vHPV and 9vHPV can be given for the prevention of anogenital warts and anal
cancer

O. Tetanus and Diphtheria Toxoid (Td) / Tetanus and Diphtheria Toxoid and Acellular Pertussis Vaccine
(TdaP)
 Given intramuscularly (IM)
 For children who are fully immunized, Td booster doses should be given every 10 years.
 For children aged > 7 years old, a single dose of Tdap can be given and can replace due Td. It can be
administered regardless of the interval since the last tetanus and diphtheria toxoid containing vaccine.
Subsequent doses are given as Td

Fully immunized is defined as 5 doses of DTP or 4 doses of DTP if the 4th dose was given on or after the 4th
birthday

For pregnant adolescents

 Fully immunized
 Administer 1 dose of Tdap vaccine during 27 to 36 wks. AOG regardless of previous Td or Tdap
vaccination

 Unimmunized: v
 administer a 3-dose tetanus-diphtheria containing vaccine (Td) following a 0- 1- 6-month schedule.
 Tdap should replace one dose of Td given during 27 to 36 wks. AOG

VACCINE STORAGE CHART

Vaccine Where to store Acceptable temperature Diluent Storage

range
All DTaP vaccines Refrigerator For those with Diluent,
(DTaP-Hep B-IPV – 2°C–8°C Refrigerator
Pediarix, DTaP-IPV – Do not freeze or expose
KINRIX, DTaP-Hib-IPV – to freezing temperatures
Pentacel)
Refrigerator 2°C–8°C For those with Diluent,
Hib Vaccines (PedvaxHIB, Refrigerator
Comvax, ActHIB, Hiberix) Do not freeze or expose
to freezing temperatures
Hep A: Havrix, VAQTA Refrigerator 2°C–8°C No diluent
Hep B: Engerix-B,
Recombivax HB HepA- Do not freeze or expose
Hep B: Twinrix to freezing temperatures
Refrigerator -50°C to +8°C Refrigerator or room
MMR or temperature
Freezer Do not freeze or expose

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 to freezing temperatures
Refrigerator 2°C–8°C For Rotarix, store diluent
RV1: ROTARIX or RV5: Do not freeze or expose separately at room
RotaTeq to freezing temperatures temperature

Td: DECAVAC DT: Refrigerator 2°C–8°C

Diphtheria and Tetanus Do not freeze or expose
Toxoid and Tdap: Tdap: to freezing temperatures
Adacel, Boostrix
Freezer Refrigerator or room
Vaccine should be stored -50°C to -15°C temperature
VAR: Varivax only in freezers or Store separately from
(chickenpox) refrigerator/freezer units vaccine.
zoster/shingles) with separate
compartments and
exterior doors
Freezer Refrigerator or room
Vaccine should be stored -50°C to -15°C temperature
only in freezers or Store separately from
MMRV: ProQuad refrigerator/freezer units vaccine.
with separate
compartments and
exterior doors
Freezer Refrigerator or room
Vaccine should be stored -50°C to -15°C temperature
VAR: Varivax(chickenpox) only in freezers or Store separately from
zoster/shingles) refrigerator/freezer units vaccine.
with separate
compartments and
exterior doors
Freezer -50° to -15°C Refrigerator or room
Vaccine should be stored temperature
Zostavax (herpes only in freezers or Store separately from
refrigerator/freezer units vaccine.
zoster/shingles)
with separate
compartments and
exterior doors

CHECK FOR UNDERSTANDING (20 MINUTES)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 20 minutes for this activity:

Multiple Choice

1. Which of the following vaccines are used in Expanded Program on Immunization (EPI) that must be stored in
the freezer?
A. DPT
B. Tetanus toxoid C.
Measles vaccine D.
Hepatitis B vaccine
ANSWER: ________
RATIO:__________________________________________________________________________________________
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2. Jimmy, a community nurse is aware that an unused BCG should be discarded how many hours after reconstitution?
A. 2
B. 4

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C. 6
D. At the end of the day
ANSWER: ________
RATIO:__________________________________________________________________________________________
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3. In immunizing children less than eight years of age with BCG, as a nurse, you are not obliged to secure parental
consent. This is because of which legal document?
A. P.D. 996
B. R.A. 7846
C. Presidential Proclamation No. 6
D. Presidential Proclamation No. 46
ANSWER: ________
RATIO:__________________________________________________________________________________________
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4. Holly, a senior nurse is aware that this type of immunization will produce a permanent scar.
A. DPT
B. BCG
C. Measles vaccination
D. Hepatitis B vaccination
ANSWER: ________
RATIO:__________________________________________________________________________________________
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5. A 4-week-old baby boy was brought to the health center for his first immunization. Which can be given to
him? A. DPT1
B. OPV1
C. Infant BCG
D. Hepatitis B vaccine 1
ANSWER: ________
RATIO:__________________________________________________________________________________________
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6. As a nurse, you will not give DPT 2 if the mother says that the infant had
A. Seizures a day after DPT 1.
B. Fever for 3 days after DPT 1.
C. Abscess formation after DPT 1.
D. Local tenderness for 3 days after DPT 1.
ANSWER: ________
RATIO:__________________________________________________________________________________________
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7. A 2-month-old baby girl was brought to the health center for immunization. During assessment, the infant’s temperature
registered at 38.1°C. Which is the best course of action that you will take?
A. Go on with the infant’s immunizations.
B. Give Paracetamol and wait for his fever to subside.
C. Refer the infant to the physician for further assessment.
D. Advise the infant’s mother to bring him back for immunization when he is well.
ANSWER: ________

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RATIO:__________________________________________________________________________________________
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8. Nora, a 28-year-old pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will
have protection against tetanus for how long?
A. 1 year
B. 3 years
C. 10 years
D. Lifetime
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

9. Juan, a 4-year-old boy is scheduled for routine immunizations. As the nurse, you know that the doctor will most
likely order what vaccinations? Select all that apply.
A. DTaP (diphtheria, Tetanus, Pertussis)
B. Polio
C. Hepatitis B
D. RV (Rotavirus)
E. MMR (Measles, Mumps, Rubella)
F. Hib (Hemophilus Influenzae Type B)
G. Varicella
ANSWER: ________
RATIO:__________________________________________________________________________________________
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10. Elrita, a mother of a 12-month-old baby girl calls the pediatric clinic to ask when her daughter will receive the
Varicella vaccine. As the nurse, your answer to her question is:
A. at 2, 4, and 6 months
B. at 12 months and 4-6 years
C. at 6 and 12 months
D. at 4 months and 4-6 years
ANSWER: ________
RATIO:__________________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)

The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________

RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (5 MINUTES)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

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AL Activity: Minute Paper:

1) What was the most useful or the most meaningful thing you have learned this session?
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2) What question(s) do you have as we end this session?
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