COMMUNITY HEALTH NURSING MIDTERMS

EXPANDED PROGRAM ON 5. Pertussis (b) DPT;

IMMUNIZATION 6. Measles (c) Poliomyelitis;
SPECIFIC GOALS (d) Measles;
INTRODUCTION (e) Mumps;
1. To immunize all infants/children
• The two public health interventions (f) Rubella or German measles;
against the most common vaccine-
that have had the greatest impact on (g) Hepatitis B;
preventable diseases.
the world's health are clean water (h) H. Influenza Type B (HIB); and (h) other
2. To sustain the polio-free status of the
and vaccines. types as may be determined by the
Philippines.
• Immunization is the most cost- 3. To eliminate measles infection Secretary of Health
effective public 4. To eliminate maternal and neonatal RA No. 7846
• health intervention, vaccines prevent tetanus (An Act requiring compulsory immunization
illness or death for millions of 5. To control against Hepatitis B for infants and children
individuals every year. diphtheriapertussishepatitis b and below eight years old) listed down basic
• Almost two million children still die German measles. immunization services to be provided.
each disease for which are available 6. To prevent extra pulmonary These include vaccination against: (i)
at low cost. year from tuberculosis among children tuberculosis (TB)(ii) dipththeria, pertussis
• Over 90,000 fall victims to paralytic REPUBLIC ACT NO. 10152 and tetanus (DPT)(iii) poliomyelitis
polio, which could also have been (administered orally), (iv) measles(v)
- "Mandatory Infants and Children
prevented by immunization. rubella(vi) Hepatitis-B in newborns within 24
Health Immunization Act of 2011"
EXPANDED PROGRAM ON - President Benigno Aquino III -July
hours after birth, and (vii) provision of other
IMMUNIZATION basic immunization services for infants and
26, 2010
children below eight years of age.
• Established in 1976 - Basic immunization for children
• Ensure that infants/children and under 5 including other types that STRATEGIES
mothers have access to routinely will be determined by the Secretary 1. Conduct of Routine Immunization for
recommended infant/childhood of Health Infants/Children/Women through the
vaccines. LEGAL BASIS OF THE NATIONAL Reaching Every Barangay (REB)
strategy
OVER-ALL GOAL IMMUNIZATION PROGRAM 2. Supplemental Immunization Activity
• To reduce the morbidity and mortality RA No10152 (SIA)
among children against the most (July 22011) otherwise known as the 3. Strengthening Vaccine-Preventable
common vaccine-preventable Mandatory Infants and Children Health Diseases Surveillance
disease. Immunization Act of 2011 mandated the 4. Procurement of adequate and potent
SIX VACCINE-PREVENTABLE adoption of a comprehensive, mandatory vaccines and needles and syringes
DISEASES and sustainable immunization program to all health facilities nationwide.
against VPDs among all infants and children
1. Tuberculosis EXPANDED PROGRAM ON
under the age of five years These include
2. Poliomyelitis
vaccines against: IMMUNIZATION
3. Diphtheria GUIDELINES
4. Tetanus (a) Tb;
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• It is safe and immunologically - BCG given at earliest possible age NEONATAL TETANUS
effective to administer all EPI protects the possibility of TB - infection occurs at unhealed
vaccines on the same day at meningitis and other TB infections in umbilical stump (non-sterile
different sites of the body. which infants are prone equipment)
• Moderate fever, malnutrition, mild DIPTHERIA Tetanus. Infectious agent: Clostridium
respiratory infection, cough, diarrhea - bacterial infection -affects the nose tetani.
and vomiting are not contraindicated and throat -cause breathing
to vaccinationDPT2 and DPT3 are problems and swallowing. DIPHTHERIA-PERTUSIS-TETANUS
contraindicated to a child who has Causes,,,, - DPT
had convulsion or shock within 3 - Corynebacterium diphtheriae causes - 6 weeks old
days the previous dose. diphtheria. Usually, the bacteria - 3 doses (0.5 mL)
• Live vaccines like BCG must not be multiply on or near the surface of the - 6 weeks (DPT 1)10 weeks (DPT 2),
given to individuals who are mucous membranes of the throat, 14 weeks (DPT 3)
immunosuppressed due to malignant where they cause inflammation. - Intramuscular
disease therapy with SIGNS AND SYMPTOMS - Upper outer portion of the thigh
immunosuppressive agents or - Symptoms before the - An early start with DPT reduces the
irradiation. pseudomembrane appears include: chance of severe pertussis
• It is safe and effective with mild side ✓ Fever and weakness POLIO
effects after vaccination. (Ex: Local ✓ Enlarged lymph nodes on the neck - Poliomyelitis
- Caused by poliovirus
reaction, fever) ✓ Swelling of soft tissue on neck
• - Crippling and potentially infectious
Repeat BCG vaccination if the child ✓ Nasal discharge ✓ High heart rate - Infects the person’s brain and spinal
does not develop a scar after the PSEUDOMEMBRANE
first injection. cord causing paralysis
• BCG immunization shall be given to - POLIO VIRUS
all school entrants both in private - OPV (Oral Polio Vaccination)
and public schools regardless of the - 6 weeks old
presence or absence of BCG scar. - 3 doses (2-3 drops)
TUBERCULOSIS - 4 weeks
- Affects the lungs - Oral
- Airborne - The extent of protection against polio
- MYCOBACTERIUM is increased the earlier the OPV is
TUBERCULOSIS given
PERTUSIS
- BCG (Bacillus Calmette-Guerin) MEASLES
- whooping cough -"100-day cough"
- At birth - Caused by a virus
Highly contagious respiratory
- 1 dose (0.05 mL) - Airborne
disease
- None - Infects the respiratory tract
Causative agent- Gram (-) bacteria
- Intradermal - The causative agent, measles
BORDETELLA PERTUSSIS
- Right deltoid region of the arm virus (MV), is a member of the
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family Paramyxoviridae, genus EXPANDED PROGRAM ON
Morbillivirus IMMUNIZATION
- MCV
- Measles-Containing Vaccine
- 9 months old
- 2 dose (0.5 mL)
- Subcutaneous
- Upper outer portion of the arms
- At least 85% of measles can be
prevented by immunization at this
age
- viral infection
- attacks the liver
- transmitted through blood or other THE COLD CHAIN AND VACCINE
body fluids
HANDLING
- causative is hepatitis B virus
- At birth
- 3 doses (3 doses) COLD CHAIN
- 4 weeks interval - The ‘cold chain’ is the system of
- Intramuscular transporting and storing vaccines at
- Upper outer portion of the thigh recommended temperature from the
- Prevents liver cirrhosis and liver point of manufacture to the point of
cancer use.
KOPLIK’S SPOTS
Manufacture > Distributor > Vaccine Depots
> Provider office > client
IMPORTANCE OF COLD CHAIN

• The cold chain is standard practice

for vaccines throughout the
pharmaceutical industry
• Maintaining the cold chain ensures
Pathognomic of measles that vaccines are transported and
- Typically involve the buccal and stored according to the
labial mucosa. Irregular, patchy manufacturer's recommended temp
erythema with tiny central white range +2C +8C until point of
specks ‘grains of salt’ administration
appearance. TETANUS TOXOID
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• Responsibility not to waste
scarce NHS resources
• Reduce wastage from errors

4. Compliance with SPC/Manufacturer

• Any vaccine that has not been
stored at a temperature of 2-8°C
as per its licensing conditions is
no longer a licensed product

Why is the cold chain important? Maintenance of the cold chain requires
vaccine and diluent to be:
1. Vaccines are: • Collected from an airport as soon
• Biological products as it arrives
• lose potency with time • Transported at the correct
• Confident the vaccines you give temperature from the airport and
will be effective accelerated if from one store to another
proper storage Public Health • Stored at the correct temperature
responsibility in central, regional and district
• Process irreversible and stores and in health centres.
conditions are not adhered to. • Transported at the correct
temperature to outreach sites.
2. Assurance in potent product and • Kept cold during immunization
vaccine programmes sessions
• Professional responsibility
o Confident the vaccines you
give will be effective
• Immunization programmes
o Public confidence in
immunization programmes

3. Ensuring maximum benefit from

immunizations

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1. LIVE ATTENUATED VACCINES
(LAVs)
• LAVS are derived from (already
weakened) disease-causing
pathogens (virus/bacteria).
• 5 vaccines (recommended by
WHO) using LAV technology
o Tuberculosis (BGC)
o Oral Polio Vaccine,
paralytic poliomyelitis
o Measles
o Rotavirus
o Yellow fever
2. INACTIVATED/KILLD
VACCINE
• Made from (Already killed via
physical/chemical processes)
microorganism (virus/bacteria).
Therefore, non-disease causing.
• More stable than LAVs/
• Example: inactivated polio
vaccine (IPV), more expensive
than OPV-LAV
3. TOXOID VACCINE
• Bacterial toxins like tetanus &
diphtheria, detoxified/purified
toxins are called toxoids, used in
vaccines.
• Examples: Tetanus Toxoid (TT),
Diphtheria Toxoid (DT and Td)

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