It includes the five most common immunization vaccines for the infant and these are the BCG, DPT, OPV, Hep B and Measles and also the Tetanus Toxoid for both infant and mother.

1. IMMUNIZATION
(Vaccines for the Infant)

2. WHAT IS IMMUNIZATION?
Vaccines train your immune
system to create antibodies,
just as it does when it’s
exposed to a disease.
However, because vaccines
contain only killed or
weakened forms of germs like
viruses or bacteria, they do
not cause the disease or put
you at risk of its
complications.
According to the World Health
Organization, immunization is a
global health and development
success story, saving millions of
lives every year. Vaccines
reduce risks of getting a disease
by working with your body’s
natural defences to build
protection. When you get a
vaccine, your immune system
responds.

3. Expanded Program on Immunization in the Philippines
• The Philippines Expanded Program on Immunization, begun in 1976, added polio, measles, and
tetanus toxoid for pregnant women, and also estimation of vaccine coverage and monitoring of
incidence and mortality of the 6 target diseases.
• Oral polio vaccine and tetanus were added in 1980 and measles in 1982.
• Twice yearly mass campaigns were held from 1977-1983, increased to 4 times yearly in 1984.
• Clinic-based year-round delivery has been expanded gradually. Reported coverage rates for
1986 are BCG-51%, DPT3-32%, OPV3-37% and measles-40%.
• In children under 5, incidence of all 6 diseases fell, especially polio, which was down 83%
compared to 1980. Measles is down 20% since 1982.

4. • To reduce the morbidity and mortality among children against
the most common vaccine-preventable diseases.
EPI Over-all Goal
by DOH
Specific Goals:
To immunize all infants/children against the most common vaccine-
preventable diseases.
To sustain the 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.

5. Republic Act No. 10152
“Mandatory Infants and Children Health
Immunization Act of 2011 Signed by President
Benigno Aquino III in July 26, 2010. The
mandatory includes basic immunization for children
under 5 including other types that will be
determined by the Secretary of Health.”

6. ？
Types of Immunization:
BCG
(Bacillus
Calmette–
Guérin Vaccine)
Hepatitis B
Vaccine
DPT
(Diphtheria,
Pertussis, and
Tetanus Vaccine)
OPV
(Oral Polio
Vaccine)
Measles Vaccine

7. The original BCG vaccine was developed by Albert Calmette and
Camille Guerin at the Pasteur Institute of Lille, France, between
1908 and 1921 after several hundred passages, and has been in
use since 1921
Other name: Bacille Calmette-Guérin (BCG) – a vaccine for
tuberculosis (TB) disease
Trade names TheraCys®, and TICE® BCG
BCG vaccine protects against serious TB disease for up to 15
years after vaccination.
Background

8. The most common side effects include fever, headache
and swollen glands. More serious complications, such as
abscesses or bone inflammation, are rare
BCG vaccine started in the Philippines in 1979 with the
Expanded Program on Immunization

9. BCG VACCINE
Minimum
Age at 1st
Dose
Number
of doses
Minimum
interval
between doses
Dose Route of
Administration
Site of
Administrati
on
Reason
Birth or
anytime after
birth
1 Infants
0.05 ml
Intradermal Right deltoid
region of the
arm
BCG given at
earliest
possible age
protects the
possibility of
TB, meningitis,
and other TB
infectious in
which infants
are prone

10. RECONSTITUTING THE FREEZE
DRIED BCG VACCINE:
A.Always keep the diluent cold by sustaining with BCG vaccine ampules
in refrigerator or vaccine carrier.
B. Using a 5 ml, syringe fitted with a long needle, aspirate 2 ml of
saline solution from the opened ampule of diluent.
C.Inject the 2ml saline into the ampule of free dried BCG.
D.Thoroughly mix the diluent and vaccine by drawing the mixture back
into the syringe and expel it slowly into the ampule several times
E.Return the reconstituted vaccine on the slit of
the foam provided in the vaccine carrier

11. a. Clean the skin with
a cotton ball
moistened with water
and let skin dry.
Procedures in the Giving BCG Vaccine:
b. Hold the child’s arm
with your left hand so
that your hand is under
the arm, and your thumb
and fingers come around
the arm and stretch the
skin
c. Hold the syringe in
your right hand with
the bevel and the
scale pointing up
towards you
d. Lay the syringe and
needle almost flat
along the child’s arm
e. Insert the tip of
the needle into skin –
just the bevel and a
little bit more. Keep
the needle flat along
the skin and the
bevel facing upwards,
so that the vaccine
only goes into the
upper layers of the
skin
f. Put your left thumb
over the needle end of
the syringe to hold in
it position. Hold the
plunger end of the
syringe between the
index and middle
fingers of your right
hand and press the
plunger in with your
right thumb
g. If the vaccine is
injected correctly into
the skin, flat wheal
with the surface
pitted like an orange
peel will appear at the
injection site
h. Withdraw the needle
gently

12. • 1914 - whole cell pertussis vaccine was first approved in the
United States and composed of a formaldehyde-treated B.
pertussis cells.
• 1921 - Diphtheria toxoid was developed and incorporated
with tetanus toxoid and extensively used in the 1940s.
• 1924 -Vaccines against tetanus were first introduced in in the
form of tetanus toxoid and were widely used during World
War II.
• Tetanus toxoid is administrated with diphtheria toxoid
because pediatric population needs both antigens. Single
antigen diphtheria toxoid is not available.
• 1948 - whole-cell pertussis vaccine combined with diphtheria
and tetanus toxoid (DTP) was developed.
Background

13. Common side effects of DTP include injection site
reactions (redness, warmth, swelling, tenderness,
itching, pain, hives, and rash), fever, drowsiness,
fretfulness, vomiting, weight loss (anorexia),
persistent crying, and rarely, convulsions.
An EPI program was established in the Philippines in
1976 with a primary vaccine course of 3 diphtheria,
pertussis and tetanus vaccine (DPT) doses given at 6,
10, and 14 weeks of age

14. Minimu
m Age
at 1st
Dose
Num
ber
of
dose
s
Minimu
m
interval
between
doses
Dose Route
of
Administ
ration
Site
of
Admini
stratio
n
Reason
6 weeks 3 4 weeks 0.5 ml intramusc
ular
Upper
outer
portion
of the
thigh
An
early
start
with
DPT
reduces
the
chance
of
severe
pertuss
is
DPT
VACCINE

15.  Trade name Recombivax HB or Engerix-B Pediatric
 Drs. Blumberg and Millman developed the first hepatitis B vaccine in 1969.
 In 1981, the FDA approved a more sophisticated plasma-derived hepatitis B vaccine
for human use in the United States.
 Hepatitis B vaccination in the Philippines was introduced in 1992 to reduce the high
burden of chronic hepatitis B virus (HBV) infection in the population.
 In 2007, a birth dose (HepB-BD) was introduced to decrease perinatal HBV
transmission. A first step in improving timely HepB-BD coverage is to ensure that all
newborns born in health facilities are vaccinated
 Most common side effects of the hepatitis B vaccine are mild and include Low fever
(less than 101 degrees) or, Sore arm
from the shot.
 The hepatitis B vaccine provides immunity for at least 10 years and likely for a
lifetime when completing the full series. There are
currently no recommendations for a healthy person
to receive a booster for this vaccine if they have
completed the full series.
Background

16. Minimum
Age at
1st Dose
Number
of doses
Minimum interval
between doses
Dose Route of
Administ
ration
Site of
Administratio
n
Reason
At birth 3 6 weeks interval
from 1st dose to 2nd
dose and 8 weeks
interval from 2nd
dose to 3rd dose
0.5 ml intramusc
ular
Upper outer
portion of the
thigh
An early start of heap b
reduces chance of being
infected and becoming a
carrier. Prevent liver
cirrhosis and liver
cancer. about 9000 die
of complications of HB.
10% of Filipinos have
chronic HB infection.
Eliminate HB before
2012 (a western
regional goal)
HEPATITIS B VACCINE

17. A. Ask the mother to hold the child across her knees so that his thigh is facing upwards.
Ask her to hold child’s legs.
Procedures in the Giving Hepatitis B/ DPT
B. Clean the skin with a cotton ball, moistened with water and let skin dry
C. Place your thumb and index finger on each side of the injection site and grasp the
muscles slightly. The best injection site is the outer part of the child’s mid-thigh
D. Quickly push the needle into the space between your fingers, going deep in the muscle
E. Slightly pull the plunger back before injecting to be sure that vaccine is not injected
into a vein (if using disposable syringes and needles)
F. Inject the vaccine. Withdraw the needle and press the injection spot quickly with piece
of cotton

18. Jonas Salk and first used in 1955, and. A live attenuated
(weakened) oral polio vaccine (OPV) developed by Dr. Albert Sabin
and first used in 1961.
The first inactivated polio vaccine (IPV) was produced by
Salk using virus grown on monkey kidney cells and inactivated with
formalin. In 1954, the inactivated vaccine was tested in a placebo-
controlled trial, which enrolled 1.6 million children in Canada,
Finland and the United States.
Pearl Kendrick, Grace Eldering and Loney Gordon
developed a highly effective, whole-cell inactivated vaccine (wP).
In the late 1940s the pertussis vaccine was combined with
diphtheria and tetanus toxoids to become DTP and was widely
adopted shortly afterwards.
Background

19. In the Philippines:
• The Philippines has sustained its polio-free status since
October 2000.
• Declining Oral Polio Vaccine (OPV) third dose coverage since
2008 from 91% to 83%. A least 95% OPV3 coverage need to
be achieved to produce the required herd immunity for
protection.
Common side effects of Orimune include fever, pinkeye
(conjunctivitis), severe fatigue, injection site reactions (hives,
itching, and skin redness), irritability, and loss of appetite.
The minimum interval between the next-to-last and last doses in
the polio vaccination series is 6 months and the last dose should
be at age 4 years or older.

20. Minimum
Age at
1st Dose
Number
of doses
Minimum
interval
between
doses
Dose Route
of
Administ
ration
Site of
Administratio
n
Reason
6 weeks 3 4 weeks 2 drops or
depending
on
manufacture
r’s
instructions
Oral Mouth The extent of
protection against polio
is increased the earlier
the OPV is given.
ORAL POLIO VACCINE

21. 需要给宝宝
接种哪些疫苗？
第一部分
A. Read the
manufacturer’s
instructions to
determine number
of drops to be given.
Use the dropper
provided for.
B. Let the mother
hold the child lying
firmly on his back.
C. If necessary
open the child’s
mouth by
squeezing the
cheeks gently
between your
fingers to make his
lips point upwards
D. Put drops of
vaccine straight
from the dropper
onto the child’s
tongue but do not
let the dropper
touch the child’s
tongue
E. Make sure
that the child
swallows the
vaccine. If he
spits it out, give
another dose
GIVING ORAL POLIO VACCINE

22. Hilleman was credited with creating the first measles and
mumps vaccine, and began researching ways to incorporate a
system of immunity for each virus. Using his previous research
and a rubella vaccine developed by Stanley Plotkin in 1969, he
created the first successful MMR vaccine in just two years.
Measles was declared eliminated from the United States in 2000
by the World Health Organization due to the success of
vaccination efforts. However, it continues to be reintroduced by
international travelers, and in recent years, anti-vaccination
sentiment has allowed for the reemergence of measles
outbreaks.
• If you got the standard two doses of the measles, mumps, and
rubella (MMR) vaccine, you should be protected against the
measles for life.
Background

23. In the Philippines:
• Conducted 4 rounds of mass measles campaign: 1998, 2004,
2007 and 2011.
• Implemented and strengthened the laboratory surveillance
for confirmation of measles. Blood samples are withdrawn
from all measles suspect to confirm the case as measles
infection.
• A supplemental immunization campaign for measles and rubella
(German measles) was done in 2011. This was dubbed as
“Iligtas sa Tigdas ang Pinas”
• 15.6 million (84%) out of the 18.5 million children ages 9
months to 8 years old were given 1 dose of the measles-
rubella (MR) vaccine between April and June 2011.
Side effects from MMR and MMRV vaccines that can occur
seven to 10 days after vaccination include fever (can be more
than 39.4 °C), lasting two to three days, faint red rash (not
infectious), head cold, runny nose, cough or puffy eyes,
drowsiness or tiredness, swelling of
salivary glands.

24. MEASLES VACCINE
Minimum
Age at
1st Dose
Number
of doses
Minimum
interval
between
doses
Dose Route of
Administratio
n
Site of
Administratio
n
Reason
9 months 3 0.5 ml Subcutaneous Outer part of
the arm
At least 85% of measles
can be prevented by
immunization at this age.
Prevents death (2% die),
malnutrition, pneumonia,
diarrhea get these
complications.

25. A. Using a 10 ml syringe fitted with a long needle, aspirate 5 ml of special diluent from the
ampule.
B. empty the diluent from the syringe into the vial with the vaccine.
C. thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and
expelling it slowly into the vial several times. Do not shake the vial
D. protect reconstituted measles vaccine from sunlight. Wrap vial in foil.
E. place the reconstituted vaccine in the slit of the foam provided in the vaccine carrier.
Reconstituting the Freeze Dried Measles Vaccine

26. A. Ask the mother to hold the child firmly.
B. Clean the skin with a cotton ball,
moistened with water and let the skin
dry.
C. With the fingers of one hand, pinch up
the skin on the outer side of the upper
arm
D. Without touching the needle, push the
needle into the pinched-up skin so that it is
not pointing.
E. Slightly pull the plunger back to make sure
that the vaccines is not injected into a vein.
F. Press the plunger gently and inject
PROCEDURES IN THE GIVING MEASLES VACCINE

27. THE EPI VACCINES AND ITS
CHARACTERISTICS
Type/Form of Vaccines Storage Temperature
Most sensitive to Heat Oral Polio (live attenuated) -15C to -25C (at the
freezer)
Measles (freeze dried) -15C to -25C (at the
freezer
Least Sensitive to Heat DPT/Hepa B
“D” Toxoid which is a
weakened toxin
“P” Killed Bacteria
“T” Toxoid which is a
weakened toxin
+2C to +8C (in the body of
the refrigerator)
Hepa B +2C to +8C (in the body of
the refrigerator)
BCG (freeze dried) +2C to +8C (in the body of
the refrigerator)

28. The Role of a Nurse Improving the Delivery of
Immunization Services in the Community
As a nurse you need to:
• Actively master list infant eligible for vaccination in the
community
• Immunize infants following the recommended immunization
schedule, route of administration, correct dosage and
following the proper cold chain storage of vaccines.
• Observe aseptic technique on immunization and use one
syringe and one needle per child. This reduces blood-borne
diseases and promote safety injection practices
• Disposable used syringes and needles properly by using
collector box and disposing it in the septic vault to prevent
health hazard

29. • Inform, educate and communicate with the parents.
• Conduct health visits in the community to asses other health
needs of the community and be able to provide package of health
services to targets.
• Identify case of EPI target diseases per standard case definition.
• Manage vaccines properly by following the recommended storage
of vaccines.
• Record the children given with vaccination in the target client list
GECD/GMC card or any standard recording utilized.
• Submit report and record of children vaccinated, cases and death
on EPI diseases, vaccine received and utilized and any other EPI
related reports.
• Identify and actively search cases and deaths of EPI target
disease following standard case definition.

30. TETANUS TOXOID FOR
MOTHER
Vaccine Minimum Age Percent Protected Duration of Protection
TT1 As early as possible during
pregnancy
TT2 At least 4 weeks later 80% Infants born to the mother will
be protected from neonatal
tetanus
Give 3 years protection for the
mother
TT3 At least 6 mos. later 95% Gives 5 years protection for the
mother
TT4 At least 1 year later 99% Gives 10 years protections for
the mother
TT5 At least 1 year later 99% Gives life time protection for
the mother
All infants born to the mother
will be protected

31. END