Training Kit: Enhancing the Competence

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V. NATIONAL IMMUNIZATION PROGRAM

A. Immunization is the process where a person is made immune or resistant to an

infectious disease, typically by the administration of a vaccine. Vaccines stimulate the
body’s own immune system to protect the person against subsequent infection or
disease.

B. Immunity refers to protection from disease through the formation of antibodies.

There are two basic mechanisms for acquiring immunity:

2.1. Passive Immunity: Acquired through the administration of products derived

from human or animals providing short-term protection, usually a few weeks or months.
The three ways of gaining passive immunity are either from blood products, through
administration of immune globulins or vertical transmission from mother to newborn.

2.2. Active Immunity: Formed by stimulating the immune system to produce

cellular and antibody immunity. Ways of producing active immunity include:
• Exposure to an infection or disease, although infection does not lead to immunity in
all cases.

• Vaccination to produce immune responses similarly evoked by natural infection

without the development of the disease and its complications. The immune
response to vaccination is influenced by the:
› nature and dosage of administered antigen
› route of administration
› adjuvants
› maternal antibodies
› age
› nutritional status, co-existing diseases
› other host factors

C. Types of Vaccines

3.1. Live Attenuated Vaccines are derived from wild viruses or bacteria which
are modified or weakened in laboratories. Immunity is elicited by replication of the
attenuated organism in the vaccinated person. The immune response to a live attenuated
vaccine is identical to that induced by natural infection.

• However, immuno-deficient or immuno-compromised individuals may only receive

such vaccine with caution as this may cause serious adverse reactions as a result of
uncontrolled replications

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• Currently available live attenuated vaccines are those for TB (BCG), Oral
Polio, measles, mumps, rubella, and JE.

3.2. Inactivated Vaccines are produced by growing the bacteria or virus in culture
media which are then subjected to heat or chemical agents. In fractional or subunit form
of these vaccines, organisms are treated to be able to derive those components needed
to produce the vaccines. Both the inactivated or sub-unit preparations must contain
sufficient antigenic mass to stimulate the desired response since it is incapable of
replicating inside the host.

Forms of inactivated vaccines include:

• Whole viruses (e.g. influenza, IPV, rabies)
• Whole bacteria (e.g. pertussis, typhoid, cholera )
• Subunit or fractional vaccines (e.g. influenza, hepB, etc.)
• Pure polysaccharides and conjugates (e.g. Hib, PPV, PCV, etc.)
• Toxoids: diphtheria, tetanus.
• Inactivated vaccines may not elicit the range of immunologic response provided
by the live-attenuated agents.
• Maintenance of long-lasting immunity with inactivated viral or bacterial vaccines
often requires periodic booster doses.
• Unlike live attenuated vaccines, inactivated vaccines cannot replicate in or be
excreted by the recipient as infectious agent and thus cannot adversely affect
immunosuppressed hosts or their contacts.

D. Benefits of Immunization

VACCINES SAVE LIVES. The increase in life expectancy during the 20th century
was largely due to increased child survival and reduced deaths due to infectious diseases.
This was brought about largely by immunization.

• Immunization saves lives, prevents diseases and reduces direct and indirect
health costs.
• Vaccines are cost-effective and are a core component of any preventive services
package.
• Vaccines protect children from Vaccine Preventable Diseases (VPDs) that once
were top killers and disablers worldwide. These include diphtheria, whooping
cough, tuberculosis, small pox, polio and measles.
• Vaccines continue to give protection against more diseases among various age
groups as new vaccines are developed and tested.
• Vaccines also prevent the spread of these diseases among families, loved ones
and neighbours, resulting in healthier communities.
• Immunization prevents disease transmission from one generation to another,
freeing the next generation from the threat of disease.

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What happens when children are not vaccinated?

• Unvaccinated children can develop diseases resulting in prolonged or long-term

disabilities, affecting their full physical, emotional and social development and
wellbeing.
• Sick children are unable to go to school, which can hamper their becoming fully
productive individuals.
• Prolonged treatment and out-of-pocket spending burdens families with medical
expenses and lost time at work. This can eventually lead to a lower quality of
life for individuals and families.

This makes it important for various sectors to become involved in immunization

activities and services to achieve and sustain the desired herd immunity in the
population.

E. List of Vaccine Preventable Diseases (VPD)

 Tuberculosis (TB)
 Hepatitis B
 Poliomyelitis
 Diphtheria
 Pertussis (whooping cough)
 Tetanus
 Haemophilus Influenza B Disease
 Pneumococcal Diseases
 Measles
 Mumps
 Rubella and Congenital Rubella Syndrome
 Human Papilloma Virus (HPV)
 Influenza
 Rotavirus
 Japanese Encephalitis

F. Immunization Program

Goal: reduction of morbidity and mortality of children against the vaccine preventable
disease (VPD)

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1. BCG Vaccine
• Protects infants from tuberculosis
• Bacille Calmette Guerin (BCG)
– Bacilli described the shape of the bacteriumoute
– Calmette and Guerin developed the vaccine

Side Effects:
• Small raised lump appears at injection site, disappears after 30 minutes
• After 2 weeks – red sore forms
• Remains for another 2 weeks and heals
• A scar about 5mm in diameter remains
• Swelling or abscess
• Septicemia in HIV-infected persons or those with severe immune deficiencies

Administration Summary:

Type of vaccine Live bacteria

Number of doses One

Schedule At or as soon as possible after birth

Contraindications Symptomatic HIV infection

Adverse Reactions Local abscess, regional lymphadenitis, rarely

osteomyelitis, disseminated disease

Special Precautions Correct ID administration is essential. Special

syringe is used

Dosage 0.05ml

Injection Site Outer upper arm or shoulder

Injection Type Intradermal

Storage Between 2°C to 8°C

2. Hepatitis B Vaccine
• A cloudy liquid provided in single or multi-dose vials
• Monovalent
• Only monovalent vaccine must be used as a birth dose

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Administration Summary:

Type of vaccine Recombinant DNA or plasma-derived

Number of doses Three doses

Schedule Previous table
Contraindications Anaphylactic reaction to a previous dose
Adverse Reactions Local soreness and redness, rarely anaphylaxis
Special Precautions Birth dose must be given
Dosage 0.5ml
Injection Site Outer mid-thigh/outer upper arm
Injection Type Intramuscular
Storage Between 2°C to 8°C. Never freeze

3. Oral Polio Vaccine (OPV)

• Contains 3 serotypes of vaccine virus

• Grown on monkey kidney (Vero) cells
• Shed in stool for up to 6 weeks following vaccination
• Highly effective in producing immunity to polio virus
• 50% immune after 1 dose
• >95% immune after 3 doses
• Immunity probably lifelong

Supplementary Immunization with OPV

• Usually conducted in large scale campaigns where 2 doses of OPV, 2 months

apart are given to all children under 5 years regardless of previous dose
• There is no risk associated with multiple doses of OPV

Note: If a child has diarrhea when given OPV, administer an extra dose - a fourth dose;
at least 4 weeks after the last dose

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Administration Summary:

Type of vaccine Live oral polio vaccine

Number of doses Three doses

Schedule 6, 10, 14 weeks of age
Contraindications None
Adverse Reactions VAPP very rarely (2 to 4/million vaccinated
Special Precautions Children with rare congenital immune deficiency
syndrome must receive IPV
Dosage 2 drops
Storage Between -15°C to -25°C

Difference of OPV and IPV:

OPV IPV

Composed of live, weakened Composed of killed viruses

viruses
Given orally, by drops Given by injection
Given in 3 doses at 1 ½ months, 2 Given in one dose at 3 ½ months
½ months and 3 ½ months (6, (14 weeks) maximizes a child’s
10 and 14 weeks) immunity when given in addition to
OPV
Provides immunity through the Provides immunity through the
mucosa (mouth and blood
intestines)

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Passes immunity from person-to- Provides individual immunity

person only

4. Pentavalent Vaccine (DPT-HepB-Hib)

• For the active immunization of infants at 6 weeks or above the age of 6 weeks
• It is a protection against Diphtheria, Tetanus, Pertussis, Hepatitis B and
Haemophilus Influenza Type B
• It should NOT be used for birth dose

The new Pentavalent Vaccine 5 in 1

• One vial = 5 antigens – DPT, Hep B, Hib.
Now DPT, Hep B and Hib are all together
• But birth dose of Hep B is still needed
• One vial contains 10 doses just like DPT
• Same schedule as DPT-3 doses (6, 10 and 14 weeks of age)

Administration Summary:

Type of vaccine Pentavalent vaccine

Number of doses Three
Schedule 6, 10, 14 weeks of age
Booster None
Contraindications Do not use as a birth dose
Adverse reactions Mild local and systemic reactions are common
Do not use as a birth dose, usually not given over 6
Special precautions
years of age
Dosage 0.5ml
Injection site Outer mid-thigh
Injection Type Intramuscular

Storage Between 2°C to 8°C. Never freeze

5. Rotavirus Vaccine
• It is a vaccine to protect against rotavirus infections. These viruses are the leading
cause of severe diarrhea among young children

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• Do not protect against diarrhea caused by other agents than rotavirus

• Highly effective and safe
• Rotavirus vaccine is a ready-to-use, oral vaccine in a liquid formulation
• Specially designed tube for direct oral administration, 1 tube= 1 dose; 1 tube has
1.5ml liquid.
• Rotavirus vaccine is given in a 2-dose schedule at 6 and 10 weeks of age. It can
be given at the same time as first and second dose of Penta 1 and Penta 2, OPV
1 and OPV 2.
• Maintain an interval of 4 weeks between doses. First dose of vaccine should be
given before 15 weeks; second dose has to be given before 32 weeks. 16 weeks
is too late for the first dose and 33 weeks is too late for the second dose.

Administration Summary:

Type of vaccine oral vaccine in a liquid formulation

Number of doses Two doses

Schedule 2-dose schedule at 6 and 10 weeks of age
Contraindications Previous history of intussusception
Dosage 1 tube = 1 dose
1 tube has 1.5mL liquid
1st dose – 6 to 15 weeks
2nd dose – 10 to 32 weeks
Storage Between 2°C to 8°C.

6. Measles Vaccine
• Composition : Live virus
• Efficacy : 95% (range, 90%-98%)
• Duration of Immunity : Lifelong
• Any remaining reconstituted vaccine must be discarded after 6 hours or at the
end of the immunization session
• Vitamin A capsules given at the same time

Administration Summary:

Type of vaccine Live attenuated virus

Number of doses One dose

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Schedule At 9-11 months

Contraindications Anaphylactic reaction to a previous
dose,pregnancy,congenital or acquired immune
disorders (not HIV)
Adverse Reactions Malaise, fever, rash 5-12 days later, rarely
encephalitis, anaphylaxis
Special Precautions None
Dosage 0.5ml
Injection Site Outer mid-thigh (infants)/upper arm
Injection Type Subcutaneous
Storage Between -15°C to -25°C. Maybe frozen

Second Opportunity for Measles Immunization

• Increases the proportion of children who receive at least one dose
• Helps to assure measles immunity in previously vaccinated children who failed to
develop immunity
• May be derived through either routine immunization services or periodic mass
campaigns

7. Measles-Rubella (MR) and Measles-Mump-Rubella (MMR) Combination

Vaccines
• Composition: Live virus
• Any remaining reconstituted vaccine must be discarded after 6 hours or at the
end of the immunization session, whichever comes first.

Administration Summary:

Type of vaccine Live attenuated viral

Number of doses One dose
Schedule Generally 12–15 months
Booster A second opportunity for immunization is
recommended ( routine or campaign )
Contraindications Severe reaction to previous dose; pregnancy; congenital
or acquired immune disorders

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Adverse reactions Same as measles vaccine, plus cases of arthritis in

adolescent females for rubella-containing vaccine and
parotitis
Special precautions None
Dosage 0.5ml
Injection site Outer mid-thigh/upper arm
Injection type Subcutaneous
Storage Store between 2°C to 8°C

8. Tetanus Toxoid Vaccine

• Provided as liquid in vials
• Available in different formulations:
– TT vaccine protects only against tetanus and neonatal tetanus
– DPT
– DT
– Td or tetanus-diphtheria toxoids adult dose vaccine, the same as DT but
with lower diphtheria toxoid dose (suitable for children older than 6 and
adults including pregnant women

TT Immunization Schedule of Pregnant Women

Dose of Expected Duration of

When to Give
TT Protection
At first contact or as early as
1 None
possible in pregnancy

2 At least 4 weeks after TT1 1-3 years

At least 6 months after TT2 or during

3 At least 5 years
subsequent pregnancy
At least 1 year after TT3 or during
4 At least 10 years
subsequent pregnancy
At least 1 year after TT4 or during For all childbearing
5
subsequent pregnancy years and longer

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Immunization schedule for infants

AGE
Antigen
At birth 6W 10W 14W 9M 12M
BCG 
Hepa B-BD 
OPV 1 
Rota 1 
Penta 1 
PCV 1 
OPV 2 
Rota 2 
Penta 2 
PCV 2 
OPV 3 
Penta 3 
PCV3 
IPV 
MCV 1 
MCV 2 

Summary of administration / injection sites

Route of
Vaccine Administration / Injection site
administration
BCG Intradermal Upper left arm
Hepa B Intramuscular Outer mid-thigh
Pentavalent (DPT, Intramuscular Infants — Outer mid-thigh
Hepa B, Hib) Older children — Upper arm
OPV Oral Mouth
Rotavirus Oral Mouth
Measles Subcutaneous Upper left arm
Tetanus toxoid Intramuscular Outer, upper arm

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Note:
• Intradermal – into the skin
• Intramuscular – into a muscle
• Subcutaneous – under the skin

Indications to Immunization
• Allergy or asthma
• Minor illness with temp below 38.5
• Family history of AEFI
• Family history of convulsions, seizures, fits
• Treatment with antibiotics
• Child being breastfeed
• Chronic illness
• Prematurity or LBW
• Recent or imminent surgery
• Malnutrition
• History of jaundice at birth

Contraindications to Immunization
All infants should be immunized except in these 2 rare situations:
• Anaphylaxis or severe hypersensitivity reaction to subsequent doses of the
vaccine. Persons with known allergy to a vaccine component should not be
vaccinated
• Do not give BCG or yellow fever vaccine to an infant that exhibits signs and
symptoms of AIDS
– An infant with known or suspected HIV infection and/or signs and
symptoms of AIDS should receive measles vaccine at 6 months
then at 9 months
– If a parent strongly objects to an immunization do not give

C. Ways in Improving Immunization Coverage

1. making a master list of infants and pregnant women
2. motivating the mothers to have their children fully immunized and bring them on
scheduled dates
3. motivating pregnant women for prenatal check up and TT immunization
4. following-up on mothers and infants who failed to come for their scheduled
immunization
5. providing information to the community on scheduled immunization and stressing
its importance
6. doing routine/special immunization activities
7. mobilizing key leaders in the community during special immunization activities.

Reference: Maria Visitacion M. Taburnal. Enhancing the Competence of Barangay Health Workers.
2018. LAP Lambert Academic Publishing. OmniScriptum Publishing Group. ISBN 978-613-4-90740-1

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