Definition of primary health care nursing

APNA's definition of primary health care nursing has a number of components, outlined below.
What is health?
is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity .
Essential Health Services in Primary Health Care (ELEMENTS)
1. E: Education for Health2.
2. L: Locally endemic disease control3.
3. E: Expanded program for immunization4.
4. M: Maternal and Child Health including responsible parenthood5.
5. E: Essential drugs6.
6. N: Nutrition7.
7. T: Treatment of communicable and non-communicable diseases8.
8. S: Safe water and sanitation
Goal:
 The global goal as stated in the Alma Ata Declaration is Health for All by the year 2000 through self-reliance. Y
 Health begins at home, in schools and in the workplace because it is there where people live and work that
health is made or broken.
 It also means that people will use better approaches than they do now for preventing disease sand
alleviating unavoidable disease and disability and have better ways of growing up, growingold and dying
gracefully. Y
 It also means that here will be even distribution among the population of whatever resources for health are
available.
 It means that essential health services will be accessible to all individuals and families in an acceptable and
affordable wa
OBJECTIVE OF PHC POSTING:
At the end of the posting in PHC the group will be able to
1. Know about the organization set up of the PHC
2. Understand about policies and protocols of the PHC
3. Orient with the PHC regarding physical setup, staffing pattern, and facilities related to health
4. Know about various training programme conducted in PHC
5. Know and participate in daily activities of PHC
6. Gather the information about the various national health programme and state government
health programs undertaken by PHC
7. Know about the MCH services conducted under the training centre
8. Collect the information about AYUSH in PHC
9. Know and identify the records and reports maintained in the centre
What is primary health care?
Primary health care is the first level of contact that individuals, families and communities have with the health care
system.
What are the roles of a primary health care nurse?
A model of the roles of nurses is that their work may cover:
 health promotion
 illness prevention
 midwifery, antenatal and postnatal care
 treatment and care of sick people
 rehabilitation and palliation
 community development
 population and public health
 education and research
 policy development and advocacy.
Functions and responsibilities
Health activities
 Assessment of the health situation in a community
 Support and supervision of local health-care facilities
 Training of national staff
 Management and treatment of Communicable and Non-Communicable Diseases
 Set-up and implementation of immunization programmes
 Detection and treatment of acute malnutrition
 Response to health emergencies
 Clinical management for victims of rape
 Implementation and supervision of various aspects of the reproductive health package
 If necessary prescribe relevant treatment based on ICRC and national guidelines and protocols
 Ensure quality medical follow-up and if necessary refer to other health facilities
 Apply hygiene standards in all health activities
Principles and Strategies:
1. Accessibility, Availability, Affordability and Acceptability of Health Services
o Strategies:
 Health services delivered where the people are
 Use of indigenous/resident volunteer health worker as a health care
provider with a ratio of one community health worker per 10-20
households
 Use of traditional (herbal medicine) with essential drugs.
2. Provision of quality, basic and essential health services
o Strategies:
 Training design and curriculum based on community needs and priorities.
 Attitudes, knowledge and skills developed are on promotive, preventive,
curative and rehabilitative health care.
 Regular monitoring and periodic evaluation of community health workers
performance by the community and health staff.
3. Community Participation
o Strategies:
 Awareness, building and consciousness raising on health and health-
related issues.
 Planning, implementation, monitoring and evaluation done through small
group meetings (10-20 households cluster)
 Selection of community health workers by the community.
 Formation of health committees.
 Establishment of a community health organization at the parish or
municipal level.
 Mass health campaigns and mobilization to combat health problems.
4. Self-reliance
o Strategies
 Community generates support (cash, labor) for health programs.
 Use of local resources (human, financial, material)
 Training of community in leadership and management skills.
 Incorporation of income generating projects, cooperatives and small scale
industries.
5. Recognition of interrelationship of health and development
 o Strategies:
 Convergence of health, food, nutrition, water, sanitation and population
services.
 Integration of PHC into national, regional, provincial, municipal and
barangay development plans.
 Coordination of activities with economic planning, education, agriculture,
industry, housing, public works, communication and social services.
 Establishment of an effective health referral system.
6. Social Mobilization
o Strategies
 Establishment of an effective health referral system.
 Multi-sectoral and interdisciplinary linkage.
 Information, education, communication support using multi-media.
 Collaboration between government and non-governmental organizations.
7. Decentralization
o Strategies
 Reallocation of budgetary resources.
 Reorientation of health professional and PHC.
 Advocacy for political and support from the national leadership down to
the barangay level.
What is a Health Information System?
• This is a routine integrated system of collection, collation, analysis, presentation,
dissemination and utilization of relevant health‐related information. It is specially
designed to assist in the management and planning of health programmes.
Functions of HMIS:
 Data generation
 Data Compilation
 Analysis and synthesis
 Communication and use
 Effective utilization of hospital facilities and improves inventory control
 Makes data collected available for research purposes
 Generates MIS reports, which help the management in making policy decisions.
 Provides information required to support patient care
 Maintains records necessary for statutory requirements
 Data security, integrity and accessibility
 Efficient tracking of critical public health related data
Major benefits of our HMIS:
The most important benefits that a hospital gains out of a HMIS implementation are:
 Least manpower requirements
 Instant information retrieval
 Timely treatment decisions
 Information sharing between the healthcare specialists across the world
 Access to DICOM images online if HMIS is web based
 Saves lot of money to the promoters if HMIS is web based
 Allows remote access to all stake holders including patients
 Web based HMIS can also provide services such as online appointment scheduling
 Accepting payment online becomes possible with Ecommerce for payment gateways
 Online claims processing for cashless patients become far too easy
Path of data flow

Data Collection

Data analysis, Data entry into facility

interpretation and use register

Regional Monthly Data Health facility Monthly

aggregation report form

District Monthly report

form

Types of data collection tools

Quantitative data can be collected using four main types of surveys:

Census data collection about every unit in a group or population, e.g. if a VET provider
collects data about the age of trainees in a class, that would be considered a “class
census”
Sample Survey: only part of population is approached for data, e.g. if a VET provider collects data
about the age of female trainees in a programme, that would be considered a “sample
survey of the programme”
Administrative collected as a result of an organisation's day-to-day operations, e.g. data on enrolment
data:
Tracer studies: usage of a) a regular survey as the core tool b) combining it with in-depth discussions
with a sample of those surveyed and c) interviewing key informants on particular key
issues

Qualitative data can be gathered in a variety of ways, for example:

Questionnaires: Series of questions and other prompts for the purpose of gathering information from
respondents, i.e. VET stakeholders
Interviews: Conversation between two or more people where questions are asked by the
interviewer to obtain information from the interviewee(s)
Focus groups: A group of people are asked about their attitude towards a product, service, concept,
an idea
Observation: A group or single learners are asked to perform a specific task or action. Observations
are then made of behaviours, processes, workflows etc, in a real-life situation (e.g. the
workplace)
Case study: Often used to provide context to other data (such as outcome data), offering a more
complete picture of what happened and why
Abbreviation
ARICP Acute Respiratory Infection Control Programme
BCG Bacille-Calmette Guérin
CDSS Communicable Disease Surveillance System
CHC Commune Health Centre
DHC District Health Centre
DHS Department of Hospital Services
DOF Department of Finance
DMCH Department of Maternal and Child Health
DP Department of Planning
DPT Diphteria-Pertussis-Tetanus
DSS Disease Surveillance System
EH Environmental Health
EPI Expanded Programme of Immunization
FPSF Family Planning Service Facilities
H Hospital
HACP HIV/AIDS Control Programme
HMIS Health Management Information Systems
MCH Maternal and Child Health
MOE Ministry of Education
MOH Ministry of Health
NIN National Institute of Nutrition
NMCP National Malaria Control Programme
NSO National Statistics Office
NTCP National Tuberculosis Control Programme
OPV Oral Polio Vaccine
ORS Oral Rehydration Salts
PHC Primary Health Centre
PHO Provincial Health Office
PMC Preventive Medical Centre
TT Tetanus Toxoid
VARIOUS DATA COLLECTION TECHNIQUES CAN BE USED
Using available information
Observing
Interviewing (face-to-face)
Administering written questionnaires
Focus group discussions
Types of data and data collection methods
Basic sampling methods
Describing data sets numerically
Aggregation of statistical information
Quiz
Causes of Malnutrition
1. Immediate Causes of Malnutrition
Inadequate dietary intake and disease are immediate causes of malnutrition and create a vicious cycle.
2. Underlying Causes of Malnutrition
Three major underlying causes of malnutrition include:
A. Food: Inadequate household food security (limited access or availability of food).
B. Care: Inadequate social and care environment in the household and local
community, especially with regard to women and children.
C. Health: Limited access to adequate health services and/or inadequate
environmental health conditions (including access to safe water and sanitation
facilities).
Types of Malnutrition:
1. Stunting / Chronic malnutrition: Stunting is a retardation of linear growth and is indicated by a low
height-for-age. It can occur when a child suffers from chronic (long-term)
2. Acute Malnutrition occurs when a person suffers from a severe nutritional restriction. It can present in the
form of wasting or kwashiorkor. Acute malnutrition is measured as either moderate (MAM) or severe
(SAM)2.
3. Wasting as a clinical sign means visible loss of subcutaneous fat and skeletal muscles (severe thinness). It
is also known as Marasmus. Anthropometric wasting refers strictly to low weight-for-height, which is
usually observed in cases of clinical wasting.
4. Kwashiorkor is a form of severe acute malnutrition characterized by the accumulation of liquid (swelling
or oedema) in the legs and sometimes arms and face. It may be accompanied by wasting, in which cases it
is called Marasmaic Kwashiorkor
5. Underweight refers to a child who has a low weight-for-age. This concept does not distinguish between
wasting and stunting as it does not indicate if the deficit is in weight (with normal height) or in height itself.
Weight-for-age is used in health programmes for growth monitoring.

Acute malnutrition: types and classification

The term acute malnutrition makes reference to two different medical entities with different clinical and
pathological characteristics: Marasmus (or wasting) and Kwashiorkor. Each of them is the consequence of
different metabolic disturbances. Despite these differences, the standard protocols to treat them are similar, with
small – but important differences.
Acute malnutrition is also categorised into Moderate acute malnutrition (MAM) and severe acute malnutrition
(SAM), depending on the patient’s degree of wasting and/or the presence of kwashiorkor.
Severe acute malnutrition is often the result of Moderate acute malnutrition that has not been treated. All cases of
kwashiorkor are categorized as SAM. Moderate acute malnutrition and severe acute malnutrition are treated in
different programmes, reflecting their different level of severity and their different nutritional and medical needs.
These programmes are most often based in the community.
Diagnosis of acute malnutrition
The diagnosis of acute malnutrition can be done in different ways:
1. Weight for height (W/H): Calculated from patient’s weight, height and sex, using WHO Growth
Standards (Z-scores). The weight and the height of the child are compared to those of a standard population
of the same sex.
2. Middle Upper Arm Circumference (MUAC): Using a band around the mid-point of the upper left arm of
the patient.
3. Bilateral Oedema: bilateral pitting oedema, for identification of Kwashiorkor and Marasmic kwashiorkor.
4. Severe Wasting and other clinical signs of SAM and its complications.
Diagnosing Bilateral Oedema
1. Oedema is the swelling of the body or one of its parts.
2. Oedema is an indication of Kwashiorkor.
3. Kwashiorkor oedema should be in both feet (bilateral). It is noticed when the bilateral oedema is pitting on
both feet after pressing for a few seconds. “Pitting” means that when you press on the top of the feet or the
leg the finger leaves a pit in the skin for some seconds.
4. Any oedemas which appear only in one foot or leg are not Kwashiorkor.

Steps of diagnosing oedema

A. Oedema is evaluated first on the top of the feet.
B. Press gently with your thumbs on each foot, while you count: 121, 122, 123 (approx 3 seconds).
C. After removing the thumb, there is kwashiorkor oedema if a pit stays for some seconds.
D. Do the same thing for the leg (above the knee) and for the back of the hands and the face (around the
eyes).
 Oedema is coded in the following way:
 Oedema in both feet: +
 Oedema in both feet plus legs: + +
 Oedema in both feet, legs and hands or face: + + +
The groups of weight for height are:
< -3 -----------------> Severe acute malnutrition.
< -2 -----------------> Moderate acute malnutrition

These are the main clinical characteristics of Marasmus and Kwashiorkor, the two manifestations of SAM.

Marasmus

Severe weight loss and wasting

Ribs prominent
Limbs emaciated
Muscle wasting
May have good appetite
With correct treatment, good prognosis

Kwashiorkor

 Bilateral pitting oedema

 Loss of appetite
 Brittle thinning hair
 Hair colour change
 Apathetic and irritable
 Face may seem swollen
 High risk of death

This table summarizes the criteria for admission for SC, OTP and TSFP.

SC OTP TSFP
SAM with complications SAM no complications MAM
W/H (z-score) < -3 < -3 < -2
MUAC (mm) < 115 < 115 < 125
Oedema Bilateral oedema +++ No oedema, or Bilateral
Marasmus with any oedema +, ++
Oedema No oedema

Appetite NO APPETITE Pass appetite test N?A

 Uncontrollable vomiting No Complications No Complications
 Fever > 39°C
Complications  Hypothermia <35°C
  Lower respiratory tract infection
 Severe anaemia
 Extensive skin infection
 Very weak, apathetic
 Unconscious, convulsions
Components of Management of Acute Malnutrition programmes:
The objectives of programmes for the Management of Acute Malnutrition are:
1. to save the lives of individuals that have developed severe acute malnutrition
2. to prevent the development of severe acute malnutrition.
3. Well run programmes can obtain this through the combination of their different components,
particularly when they are well coordinated and integrated.
Community mobilisation:
A. Objective: To sensitize the population to the problem of malnutrition and how to identify it, in
order to reach more children and at an earlier stage in their development of acute malnutrition,
therefore increasing programme coverage and recovery.
B. Intervention: Screening of children through assessment of MUAC and nutritional oedema;
mobilisation of key leaders and associations; education and sensitization; promotion of
acceptance of the programme by the community; follow up of patients in programmes that default
or present a problem.
Targeted Supplementary Feeding Programme - SFP:
A. Objective: To treat patients with Moderate Acute Malnutrition (MAM) and prevent the
development of Severe Acute Malnutrition (SAM).
B. Intervention: Weekly, biweekly, or monthly distributions of take home rations in the form of
Fortified Blended Flours (e.g. CSB or UNIMIX) or Ready to Use Supplementary Foods
(RUSFs) (e.g. Supplementary Plumpy) and routine medicines; nutritional monitoring of the
patient; programmes implemented as stand alone by fixed or mobile teams, or from Health
Centres.
Outpatient Therapeutic Programme (Outpatient care) - OTP:
A. Objective: To treat patients with SAM who have a good appetite and no medical complications.
B. Intervention: Weekly or biweekly distributions of Ready to Use Therapeutic Foods (RUTFs)
and routine medicines; medical and nutritional monitoring of the patient; programmes
implemented as stand alone by fix or mobile teams, or in Health Centres. After recovery and
discharge he/she can be admitted in SFP to prevent relapse through supplementary food.
Stabilisation Centre (Inpatient care) - SC:
A. Objective: To treat patients with SAM who have poor appetite or medical complications.
B. Intervention: Daily therapeutic milk and medical treatment in inpatient care centre (Hospital or
stand alone centre, run as daycare or as a 24h care centre). A child with complicated SAM will
start treatment at SC (inpatient), when the child improves he/she can continue treatment as an
outpatient at the OTP. After recovery and discharge he/she can be admitted in SFP to prevent
relapse through supplementary food. A referral system must be in place to transfer patients from
one component to the next (when the patient condition worsens), or to return to the previous one
if the evolution of treatment is satisfactory. Refer to respective chapters for more information on
each of the programme components presented here.
C. When body measurements are compared with a reference value they are called nutrition
indices. Three commonly used nutrition indices are weight-forheight (WFH), height-for-age
(HFA) and weight-for-age (WFA). The mid-upper arm circumference (MUAC) is also used
in assessing malnutrition in emergencies.
Weight-for-height reflects recent weight loss or gain. It is the best indicator of wasting and so is
the indicator used for determining acute malnutrition. Height-for-age reflects skeletal growth, and
is the best indicator of stunting. This is the indicator used for determining chronic malnutrition.
Weight-for-age is a composite index, which reflects either wasting or stunting, or a combination
of both. Rapidly changing WFA can be assumed to be the result of changing WFH, while low
WFA among older children is more likely to be the result of low HFA. Hence, this is the indicator
used for determining if a child is underweight.
 Anthropometric measurements and indices
MUAC reflects recent weight loss or gain. It is used as an indicator of wasting and acute
malnutrition.

A vaccination is the injection of a killed or weakened organism that produces immunity in the body
against that organism. An
immunization is the process by which a person or animal becomes protected from a disease

Types of Vaccines
Scientists take many approaches to designing vaccines against a microbe. These choices are
typically based on fundamental information about the microbe, such as how it infects cells and
how the immune system responds to it, as well as practical considerations, such as regions of the
world where the vaccine would be used. The following are some of the options that researchers
might pursue:

 Live, attenuated vaccines

 Inactivated vaccines
 Subunit vaccines
 Toxoid vaccines
 Conjugate vaccines
 DNA vaccines
 Recombinant vector vaccines

Recommended vaccinations:

 Chickenpox (varicella) vaccine.

 Diphtheria, tetanus, and pertussis vaccine (DTaP)
 Hepatitis A vaccine (HepA)
 Hepatitis B vaccine (HepB)
 Hib vaccine.
 Human papillomavirus (HPV) vaccine.
 Influenza vaccine.
 Measles, mumps, and rubella vaccine (MMR)

Oral polio vaccine (OPV)

The oral polio vaccine (OPV) was developed in 1961 by Albert Sabin. Also called “trivalent oral
polio vaccine” or “Sabin vaccine”, OPV consists of a mixture of live, attenuated (weakened)
poliovirus strains of all three poliovirus types.
The oral polio vaccine is simple to administer. A few drops, given multiple times, can protect a
child for life.
WHO/Rod Curtis

OPV produces antibodies in the blood to all three types of poliovirus. In the event of infection,
these antibodies protect against paralysis by preventing the spread of wild poliovirus to the
nervous system.

OPV also produces a local, mucosal immune response in the mucous membrane of the intestines.
In the event of infection, these mucosal antibodies limit the replication of the wild poliovirus
inside the intestine. This intestinal immune response to OPV is thought to be the main reason
why mass campaigns with OPV can rapidly stop person-to-person transmission of wild
poliovirus.

Advantages
 OPV is administered orally. It can be given by volunteers and does not require trained
health workers or sterile injection equipment.
 The vaccine is relatively inexpensive. In 2011, the cost of a single dose for public health
programmes in developing countries was between 11 and 14 US cents.
 OPV is safe, effective, and induces long-lasting immunity to all three types of poliovirus.
 For several weeks after vaccination, the vaccine virus replicates in the intestine, is
excreted in the faeces, and can be spread to others in close contact. This means that in
areas where hygiene and sanitation are poor, immunization with OPV can result in the
“passive” immunization of people who have not been directly vaccinated.

Disadvantages
Although OPV is safe and effective, in extremely rare cases (approx. 1 in every 2.7 million first
doses of the vaccine) the live attenuated vaccine virus in OPV can cause paralysis. In some cases
it is believed that this vaccine-associated paralytic polio (VAPP) may be triggered by immune
deficiency.

The extremely low risk of VAPP is well known and accepted by most public health programmes
in the world because without OPV, hundreds of thousands of children would be crippled every
year.
A second disadvantage is that very rarely the virus in the vaccine may genetically change and
start to circulate among a population. These viruses are known as circulating vaccine-derived
polioviruses (cVDPV).

Safety
OPV is an extremely safe vaccine. All OPV used in supplementary immunization activities for
the Global Polio Eradication Initiative is pre-qualified by WHO and procured through UNICEF.
In 2006, WHO issued a statement to affirm the quality and safety of OPV.

Oral polio vaccine is usually provided in vials containing 10–20 doses of vaccine. A single dose
is usually two drops

Efficacy
OPV is highly effective against all three types of wild poliovirus. When this vaccine is used
however, there is competition among the three viruses to cause immunity, which results in
protection but not with equal efficiency for each type: it is most effective against type 2.

One dose of OPV produces immunity to all three poliovirus serotypes in approximately 50% of
recipients. Three doses produce immunity in more than 95% of recipients. Immunity is long-
lasting and probably life-long.

Recommended use
In most countries, OPV remains the vaccine of choice in routine immunization schedules and
supplementary immunization activities.

Where more than one type of wild poliovirus is circulating, OPV is epidemiologically and
operationally the best vaccine to use because protection develops to each of the three types of
polio virus
Bacille Calmette Guerin
Definition of BCG. BCG: An effective immunization against tuberculosis. BCG stands for
Bacille Calmette Guerin. BCG is a weakened (attenuated) version of a bacteria called
Mycobacterium bovis which is closely related to Mycobacterium tuberculosis, the agent
responsible for tuberculosi
*Abbreviations used on U.S. immunization records.
AVA Anthrax Vaccine Adsorbed
IPV Inactivated Poliovirus Vaccine
IIV Inactivated Influenza Vaccine (formerly called TIV)
IIV3 Inactivated Influenza Vaccine, Trivalent
IIV4 Inactivated Influenza Vaccine, Quadrivalent

Vaccine Acronyms & Abbreviations*

*Abbreviations used on U.S. immunization records.
This vaccine abbreviations page lists abbreviations used for vaccines, including some "old" or
non-standard abbreviations used on immunization records.
See also:
 Translating Foreign Immunization Records [2 pages]
Immunization Action Coalition
 General acronyms and abbreviations used throughout this site
 Glossary
 U.S. Vaccine abbreviations (standardized list from ACIP)

AVA Anthrax Vaccine Adsorbed

BCG Bacille Calmette-Guérin (Tuberculosis) Vaccine
ccIIV3 Cell-Culture Inactivated Influenza Vaccine, Trivalent (Flucelvax®)
DPT Replaced by the term DTP (see DTP for description)
DT Diphtheria and tetanus toxoids, pediatric formulation
Diphtheria and tetanus toxoids and acellular pertussis vaccine, pediatric
DTaP
formulation (replaced DTP)
Diphtheria and tetanus toxoids and whole-cell pertussis vaccine, pediatric
DTP or (DTwP)
formulation (no longer available)
eIPV Enhanced inactivated polio vaccine
HAV Hepatitis A Virus
Haemophilus b Oligosaccharide Conjugate (Hib) Vaccine (no longer
HbOC
available)
HBV Hepatitis B Virus
HepA Hepatitis A Vaccine
 HepB Hepatitis B Vaccine
Hib Haemophilus influenzae type b
Hib-MenCY-
Hib-Meningococcal (Bivalent) Conjugate Vaccine (MenHibrix®)
TT
HPV Human Papillomavirus
HPV2 Human Papillomavirus vaccine, bivalent (Cervarix®)
2vHPV Bivalent HPV vaccine (Cervarix®)
HPV4 Human Papillomavirus vaccine, quadrivalent (Gardasil®)
4vHPV Quadrivalent HPV vaccine (Gardasil®)
9vHPV 9-valent HPV vaccine (Gardasil®)
HZV Herpes Zoster (Shingles) Vaccine (formerly called ZOS)
IPV Inactivated Poliovirus Vaccine
IIV Inactivated Influenza Vaccine (formerly called TIV)
IIV3 Inactivated Influenza Vaccine, Trivalent
IIV4 Inactivated Influenza Vaccine, Quadrivalent
JE Japanese Encephalitis
Inactivated, mouse brain-derived Japanese encephalitis vaccine (JE-Vax®)
JE-MB
(no longer available)
Inactivated, Vero cell culture-derived Japanese encephalitis vaccine
JE-VC
(Ixiaro®)
LAIV Live, Attenuated Influenza Vaccine (Nasal Spray)
LAIV4 Live, Attenuated Influenza Vaccine (Quadrivalent)
MCV Measles antigen-containing vaccines
MCV4 Meningococcal Conjugate Vaccine (Quadravalent)
MenACWY-
Meningococcal Conjugate Vaccine, Quadrivalent (Menveo®)
CRM
MenACWY-D Meningococcal Conjugate Vaccine, Quadrivalent (Menactra®)
MenB Serogroup B meningococcal vaccine
MenB-FHbp Serogroup B meningococcal vaccine (Trumenba®)
MenB-4C Serogroup B meningococcal vaccine (Bexsero®)
MMR Measles, Mumps & Rubella Vaccine
MMRV Measles, Mumps, Rubella & Varicella Vaccine
MPSV4 Meningococcal Polysaccharide Vaccine (Quadravalent)
MR Measles-rubella Vaccine
OPV Oral Polio Vaccine (no longer available)
PCV7 (or PCV) Pneumococcal Conjugate Vaccine (7-valent) (no longer available)
PCV13 Pneumococcal Conjugate Vaccine (13-valent) (replaced PCV7)
Pneumococcal Polysaccharide Vaccine (23-valent) (replaced by the term
PPV23 (or PPV)
PPSV23)
Pneumococcal Polysaccharide Vaccine (23-valent) (formerly called PPV or
PPSV23
PPV23)
Polyribosylribitol Phosphate Polysaccharide (Hib) Vaccine (no longer
PRP
available)
Polyribosylribitol Phosphate-Diphtheria Conjugate (Hib) Vaccine (no longer
PRP-D
available)
 Polyribosylribitol Phosphate-Outer Membrane Protein Conjugate (Hib)
PRP-OMP
Vaccine
PRP-T Polyribosylribitol Phosphate-Tetanus Conjugate (Hib) Vaccine
Pentavalent Rotavirus Vaccine (i.e., RotaTeq®) (replaced by the term
PRV
ROTA, then by RV5)
RIV3 Recombinant Influenza Vaccine, Trivalent (Flublok®)
ROTA Rotavirus Vaccine (replaced by the terms RV1 and RV5)
RRV-TV Live, tetravalent rotavirus vaccine (RotaShield™) (no longer available)
RV1 Rotavirus Vaccine, monovalent (Rotarix®) (formerly called ROTA)
RV5 Rotavirus Vaccine, pentavalent (RotaTeq®) (formerly called ROTA)
Td Tetanus & diphtheria Vaccine, adult/adolescent formulation
Tetanus, diphtheria & acellular pertussis vaccine, adult/adolescent
Tdap
formulation
TIV Trivalent (Inactivated) Influenza Vaccine (replaced by the term IIV)
TT Tetanus Toxoid (no longer available)
Ty21a Live Oral Typhoid Vaccine
VAR Varicella Vaccine
ViCPS Vi Capsular Polysaccharide (Inactivated Typhoid) Vaccine
VZV Varicella Zoster Virus
YF Yellow Fever
ZOS Zoster (Shingles) Vaccine (replaced by the term HZV)
The Diseases Vaccines Prevent
 Haemophilus influenzae type b (Hib)
 Diphtheria
 Hepatitis A
 Hepatitis B
 Influenza
 Measles
 Mumps
 Pertussis (whooping cough)
 Pneumococcal disease
 Polio
 Rubella (German measles)
 Tetanus (lockjaw)
 Rotavirus
 Varicella (chickenpox)

Birth to 15 Months
Vaccine 2 mos 4 mos
Diphtheria, tetanus, & acellular pertussis3 (DTaP: <7 yrs) 1st dose 2nd dose
Haemophilus influenzae type b4 (Hib) 1st dose 2nd dose
Pneumococcal conjugate5 (PCV13) 1st dose 2nd dose
Inactivated poliovirus6 (IPV:<18 yrs) 1st dose 2nd dose
Anemia also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale
skin, chest pain, weakness, and fatigue (tiredness). If you don't have enough hemoglobin-carrying red
blood cells, your heart has to work harder to move oxygen-rich blood through your body

What Are the Symptoms of Anemia?

The symptoms of anemia vary according to the type of anemia, the underlying cause, the severity
and any underlying health problems, such as hemorrhaging, ulcers, menstrual problems, or
cancer. Specific symptoms of those problems may be noticed first.

The body also has a remarkable ability to compensate for early anemia. If your anemia is mild or
has developed over a long period of time, you may not notice any symptoms.

Symptoms common to many types of anemia include the following:

 Easy fatigue and loss of energy

 Unusually rapid heart beat, particularly with exercise
 Shortness of breath and headache, particularly with exercise
 Difficulty concentrating
 Dizziness
 Pale skin
 Leg cramps
 Insomnia