Rotsen J.

Jambongana,
RN, MN, CICN-PHICNA
Professor II (Faculty) – Univ. of St. La Salle
National Lecturer – RGO Review Center
Former Supervisor, Infection Control Section, RMCI
IPC Lecturer, Province of Negros Occidental EEDD-HOD
 Expanded Program of Immunization
• The Expanded Program on Immunization (EPI)
~ established in 1976
~ ensure that infants/children and mothers have access to
routinely recommended infant/ childhood vaccines.

• National Immunization Program

- 14 vaccine preventable diseases (VPDs)
- expanded its population coverage beyond infants and pregnant
women to include:
➢ school children
➢ adolescents/youth
➢ senior citizens
 The Expanded Program on Immunization (EPI) in the Philippines made a response
to the Universal Child Immunization goal.
 Presidential Decree (PD) No. 996 (September 16, 1976) provides for compulsory
basic immunization for infants and children below eight years old
 R.A. 10152 “Mandatory Infants and Children Health Immunization Act” – mandates
basic immunization covering the vaccine preventable diseases to infants and children
up to 5 years of age.

 R.A. 7846 “Compulsory Immunization Against Hepatitis B for infants and children
below 8 years old. It also includes Hepa B immunization within 24 hours after
birth.

 P.D. No. 6 (1996) designates Wednesdays as Immunization Day (based on UN goal)

 Original 6 EPI vaccination in the 1970’s

• Diphtheria
• Pertussis
• Tuberculosis
• Polio
• Tetanus
• Measles
Types of Immunity
 General Principles in Vaccination:
 It is safe and immunologically effective to administer all
EPI vaccines on the same day at different sites of the body.

 Measles vaccine should be given as soon as the child is 9

months old, regardless of whether other vaccines will be
given on that day.

 The vaccination schedule should not be restarted from

the beginning even if the interval between doses have
exceeded the recommended interval by months or years.
 General Principles in Vaccination:
• Moderate fever, malnutrition , mild respiratory
infection, cough, diarrhea and vomiting are not
contraindications to vaccination.
• Generally, one should immunize unless the child
is so sick that he needs to be hospitalized.
• No extra doses must be given to children/mother
who missed a dose of DPT/HB/OPV/TT. The
vaccination must be continued as if no time had
elapsed between doses.
 2012: 2 new vaccines part of EPI
1. Rotavirus Vaccine
• infects the large intestines
• most common cause of severe diarrhea in infants and
children (6 – 24 months)
• 30% of diarrhea-related hospitalization is cause by
Rotavirus
2. HiB Vaccine (Haemophilus Influenza B)
• HiB is a bacterium responsible for serious illnesses :
meningitis, pneumonia
 MEASLES
• Causative Agent: Rubeola virus (or Morbilli
Paramyxoviridae for German Measles)
• MOT: Depending AB / Drop (Rubeola vs Rebella)
• Primary S/Sx: Rubella: spotty rash, low fever, headache,
pink eye, flu like symptoms
• Primary S/Sx: Rubeola: flat red spots, fevery, dry cough,
sore throat, Koplik’s spot (small spots with white centers)
• RX: symptom based (Benadryl, paracetamol, etc)
Rashes: Which is Rubella / Rubeola?
Establishing RR: for better prio assessment
 MALARIA
• Causative Agent: Plasmodium mosquito (parasite)
• MOT: vector mosquito (contact), by blood (humans)
• Primary S/Sx: fever and flu-like illness, including shaking
chills, headache, muscle aches, jaundice, marked increase in
ESR lab test can be seen (suggests inflammation)
• RX: artemether-lumefantrine (Coartem) as DOC; Other oral
options include atovaquone-proguanil (Malarone), quinine,
and mefloquine.
• Endemic in some areas of the world / country; Blood Smear as
diagnostic confirmation of malaria
Vaccine Minimum Percent Duration of
Age/Interval Protected Protection
TT1 As early as 80% protection for
possible the mother for
during the first delivery
pregnancy

TT2 At least 4 80% infants born to the

weeks later mother will be
protected from
neonatal tetanus
gives 3 years
protection for the
mother
TT3 At least 6 95% infants born to the mother
months will be protected from
neonatal tetanus
later
gives 5 years protection for
the mother

TT4 At least 1 99% infants born to the mother

year later will be protected from
neonatal tetanus
gives 10 years protection for
the mother

TT5 At least 1 99% gives lifetime protection for

year later the mother
all infants born to that
mother will be protected
 IDIOPATHIC THROMBOCYTOPENIC PURPURA

• Causative Agent: immune related (against platelets)

• MOT: N/A
• Primary S/Sx: Herman’s signs - erythematous
maculopapular or morbilliform eruptions that
develop three to six days from fever onset.
• RX: Steroids, symptom-based
 LEPROSY

• Causative Agent: mycobacterium leprae

• MOT: droplets
• Primary S/Sx: Discolored patches of skin, usually flat,
that may be numb and look faded, nodules on skin,
numbness of hands/limbs, painless ulcers, loss of
eyebrows, painless lumps, muscle weakness
• RX: Rifampicin, Dapsone, Lamprene
LEPROSY
 CHICKEN POX (VARICELLA)
• Causative Agent: varicella zoster virus (can also cause
shingles, a painful rash in certain circumstances)
• MOT: airborne
• Primary S/Sx: blisters, scabs after blister breaks, skin
rash, fever, headache, fatigue
• RX: Zovirax (asap within 24H post 1st S/Sx)
• Has incubation of 14-16 days (ave 2 weeks); most
infectious from 1 to 2 days before the rash appears, until
all the blisters have crusted over
 HEPATITIS-B
• Causative Agent: HBV
• MOT: contact (blood, sexual)
• Primary S/Sx: fever, fatigue, loss of appetite, abdominal
pain, vomiting, dark urine, clay colored bowel
movements
• RX: Antivirals including entecavir (Baraclude), tenofovir
(Viread), lamivudine (Epivir), adefovir (Hepsera) and
telbivudine (Tyzeka)
Review: Viral Hepatitis Strains

A B C D E G
 TETANUS
• Causative Agent: spore - Clostridium tetani
• MOT: contact (from soil to skin cuts)
• Primary S/Sx: involuntary muscle tightening, jaw
cramping, painful muscle stiffness, seizures, fever,
sweating, arching of the back
• RX: Penicillin G was long considered the drug of choice,
but metronidazole is now considered the antibiotic of
choice; also sedatives - diazepam
 TETANUS
• Risus sardonicus
– peculiar stiff
grin
• Trismus –
restriction of
jaw’s ROM;
results from
tetanospamin
release (toxin)
 CHOLERA
• Causative Agent: Vibrio cholerae bacteria
• MOT: contact (fecal-oral)
• Primary S/Sx: rice watery stools, foul smell stools, leg cramps,
thirst, vomiting
• RX: doxycycline is recommended as first-line treatment for
adults (including pregnant women) and children. If resistance
to doxycycline, may give azithromycin and ciprofloxacin are
alternative ; Nalidixic Acid is second line drug of choice
• Stages of cholera: evacuation -> collapse -> recovery
 TORNIQUET TEST
• Take the patient's blood pressure and record it, for
example, 100/70.
• Inflate the cuff to a point midway between SBP and DBP
and maintain for minutes. ( ...
• Reduce and wait 2 minutes.
• Count petechiae below antecubital fossa. ...
• A positive test is 10-20 or more petechiae per 1-2.5
square inch.
 LEPTOSIROSIS
• Causative Agent: Lesptospira interrogans
• MOT: contact, vector (contaminated food or fluid)
• Primary S/Sx: high fever, headache, chills, miscle pain,
vomiting, jaundice, calf pain, red eyes, abdominal pain
• RX: Intravenous penicillin (1.5 MU every 6 hours) is a
drug of choice for patients with severe leptospirosis, and
ceftriaxone was shown to be equally effective
• .Prophylaxis can include Doxycycline; disease is confiemd
by MAT (Microscopic Agglutination Test)
 FILARIASIS
• Causative Agent: Aedespoecillus mosquito-borne filarial
nematodes Wuchereria bancrofti, Brugia malayi, B.
timori
• MOT: vector; by infected mosquito bites
• Primary S/Sx: itchy skin (pruritis), abdominal pain, chest
pain, muscle pain (myalgias), and/or areas of swelling
under the skin
• RX: Diethyl carbamazine citrate (DEC) - Hetrazan
• Diagnosis thru Bentonite Flocculation test
 SCHISTOSOMIASIS
• Causative Agent: Schistosoma
• MOT: vecotr, from infected water
• Primary S/Sx: dermatitis, followed several weeks
later by fever, chills, nausea, abdominal pain,
diarrhea, malaise, and myalgia
• RX: Praziquantel
• .
THANKS FOR LISTENING!

Rotsen J. Jambongana, MN
0998 4299939 | rotsenRN@gmail.com
r.jambongana@usls.edu.ph
Rotsen.jambongana@concentrix.com