4. SCENARIO
Global Situation
The burden
In 2002, WHO estimated that 1.4 million of deaths among
children under 5 years due to diseases that could have
been prevented by routine vaccination. This represents
14% of global total mortality in children under 5 years of
age.
Source: Weekly Epidemiological Record, WHO:
No.46,2011,86.509-520)
6. INTERVENTIONS/ STRATEGIES
Program Objectives/Goals:
Specific Goals:
1. To immunize all infants/children against the
most common vaccine-preventable diseases.
2. To sustain the polio-free status of the
Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis b and
German measles.
6. To prevent extra pulmonary tuberculosis
among children.
7. INTERVENTIONS/
STRATEGIES
Mandates:
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.
8. INTERVENTIONS/
STRATEGIES
Strategies:
1. Conduct of Routine Immunization for
Infants/Children/Women through
the Reaching Every Purok (REP) strategy
2. Supplemental Immunization Activity (SIA)
3. Strengthening Vaccine-Preventable
Diseases Surveillance
4. Procurement of adequate and potent
vaccines and needles and syringes to all
health facilities nationwide
5. Catch-up Vaccinations
6. SBI
9. POLICIES
Administrative Order No. 39 s. 2003
SUBJECT: Policies on the Nationwide Implementation of the Expanded
Program on Immunization
10. POLICY STATEMENT
Immunization is a basic right of the child
and therefore no child shall be deprived
of this right. The State regards children
as one of the most important assest of
the nation and therefore every effort
should be exerted to promote their
welfare and full develpment of their
potentials for a useful nd quality life.
11. GENERAL GUIDELINES AND
PROCEDURES
A, Target Age Groups • All infants should recieved all the
immunization from BCG (at birth) to MMR ( 12
mons), and all women of child bearing age
(15-49y/o) should receive five doses of TT
fortheir lifetime Protection and infant
prevention on Neonatal Tetanus.
B. Immunization
Activities
• All immunization services rendered by the
government health workers must be free of
charge as prescribed by law
•Wednesday , National Day of Immunization.
• Only Skilled Health Worker and trained staff,
are allowed giving immunization authorized
by the DOH.
•Infants shall be vaccinated according to the
Immunization Schedule prescribed in the EPI
Manual.
•It is justified to open one multi-dose vial for
12. GENERAL GUIDELINES AND
PROCEDURES
B.
Immunization
Activities
• Patients or clients or their guardians shall be
informed of any side effects or adverse
reactions of any of the EPI Vaccines. The DOH
shall not directly give monetary compensation
for patients that may suffer any adverse
reaction due to the administered vaccine.
Instead, free treatment and services shall be
available in all government hospitals.
• Followup of defaulters and defaulters as well
as supplemental immunization activities and
outreach shall be regularly scheduled to catch
up on “missed” children.
13. GENERAL GUIDELINES AND
PROCEDURES
C.
Contraindicati
ons to
Immunization
• DPT vaccine should NOT be given to
children over 5 years of age or to children
who have suffered a severe reaction to a
previous dose of this vaccine
•BCG vaccine should NOT be given to
children who have signs and symptoms of
AIDS or other immune deficiency disease
or those who are immunosuppressed due
to malignant disease, therapy with
immunosuppressive agents.
14. GENERAL GUIDELINES AND
PROCEDURES
C.
Contraindications
to Immunization
• Both measles Vaccine and OPV can be given to
children with HIV and AIDS
• False Contraindications
- Children suffering from malnutrition should be
immunized
- Low grade fever, mild respiratory infections and
other minor illnesses should not be considered as
contraindications to immunization
- Diarrhrea should NOT be considered as
contraindication to OPV.
15. GENERAL GUIDELINES AND
PROCEDURES
D. Safe
Injection
Practices
•Use only One sterile syringe and
needle per child or mother.
•AUTO–DISABLE syringes must be
used.
•Proper Disposal of syringes in a
PUNCTURE –proof container or Safety
Collector BOX
17. COLD CHAIN
Cold Chain is a system for ensuring the
potency of a vaccine from the time it is
manufactured to the time it is
administered to a child or mother
21. TYPES OF VACCINES
LIVE ATTENUATED VACCINES
Are derived from wild viruses or bacteria which are
modified or weakened in laboratories
Ex: BCG, OPV, Measles, Mumps, Rubella, JE
INACTIVATED VACCINES
Are produced by growing bacteria or virus in culture
media which are then subjected to heat or chemical
agents
Ex: Influenza, IPV, rabies, pertussis, typhoid, cholera,
HepB, HiB, PPV, PCV, diphtheria, tetanus
22. BACILLUS CALMETTE-GUERIN
(BCG)
Type of Vaccine: Live Bacterial
Protects infants against Tuberculosis
Number of Doses: 1 (No Booster Dose)
Dosage: 0.05ml
Schedule: given preferably 90mins after birth but not
more than 3 mos of age
Route of Administration: Right Upper arm or shoulder,
ID
Storage: +2˚C to +8˚C
Adverse Rxn: Local abscess
*kapag nagsugat, hayaan lamang, BAWAL
LAGYAN NG BETADINE OR ALCOHOL, oki?
23. BCG
Contraindications: Known HIV infection and other
immune deficiency
PRECAUTION FOR HIV:
If the mother is HIV positive, the newborn must be
tested for HIV.
However, if HIV test is not available, BCG is NOT
given.
If the baby is HIV positive with HIV infection, DO NOT
GIVEN BCG
If the baby is Negative for HIV infection, GIVE BCG
vaccine
PRECAUTION FOR TB:
If the newborn baby is exposed to smear positive tb
clients (mother or 1st degree relative), it is
24. HEPATITIS B (HEPB) VACCINE
HepB vaccine should NEVER be Frozen
Type of Vaccine: Recombinant DNA
(Inactivated)
Protects against Hepatitis B
Number of Doses: 1
Dosage: 0.5ml
Schedule: Within 24hrs, ideally 90mins after
birth (can still be given within 7days)
Route of Administration: Outer part of mid-
thigh, IM
Storage: +2˚C to +8˚C
Adverse Rxn: Local soreness and redness
25. PENTAVALENT VACCINE
Type of Vaccine: Pentavalent Vaccine ,
Inactivated
Protects against five diseases: Diphtheria,
Tetanus, Pertussis, Hepatitis B,
Haemophilus influenzae type B
Number of Doses: 3
Dosage: 0.5ml
Schedule: 6, 10, 14 weeks
Route of Administration: Outer Upper thigh,
IM
Storage: +2˚C to +8˚C
Adverse Rxn: mild local and systemic
reaction
*Maaaring makalagnat, Mgt:
Paracetamol drops every 4 hrs
hanggang humupa ang lagnat
26. ORAL POLIO VACCINE (OPV)
Type of Vaccine: Live Attenuated
Protects against Poliovirus
Number of Doses: 3
Dosage: 2 drops
Schedule: 6, 10, 14 weeks
Route of Administration: PO
Storage: -15˚C to -25˚C
* hindi binibigay kapag super
nagtatae at nagsusuka ang
baby
**pagkatapos bigyan, bawal
muna pasusuhin ang baby,
27. INACTIVATED POLIO VACCINE
(IPV)
Type of Vaccine: Inactivated
Protects against Poliovirus
Number of Doses: 2
Dosage: 0.5ml
Schedule: 14weeks, 9mos
Route of Administration: Upper thigh
(outer part), IM
Storage: +2˚C to +8˚C
28. PNEUMOCOCCAL VACCINE
Type of Vaccine: Pneumococcal Conjugate
Vaccine (PCV), Pneumococcal
Polysaccharide Vaccine (PPV)
Protects against Streptococcus
pneumoniae
Number of Doses: PCV – 3 doses; PPV – 1
dose for adults
Dosage: 0.5ml
Schedule: PCV - 6, 10, 14 weeks; PPV -
PPV – at 60 and 65 y/o
Route of Administration: Outer Upper
thigh, IM; upper arm for adults, IM
Storage: +2˚C to +8˚C
29. MEASLES CONTAINING
VACCINE (MCV)
MEASLES, MUMPS, RUBELLA
VACCINE Type of Vaccine: Live attenuated
viral
Protects against Measles, Mumps,
Rubella
Number of Doses: 2
Dosage: 0.5ml
Schedule: 9 mos, 12mos
Route of Administration: Upper
arm, SQ
Storage: +2˚C to +8˚C
*ibilin sa magulang bawal i-
massage ang injection site
30. ROTAVIRUS VACCINE
Type of Vaccine: live attenuated
Protects against rotaviruses, leading
causes of severe diarrhea among infants
and young children
Number of Doses: 2
Dosage: 1ml
Schedule: 6 weeks, 10 weeks
Route of Administration: PO
Storage: +2˚C to +8˚C
* hindi binibigay kapag nagtatae
or nagsusuka ang baby
**pagkatapos bigyan, bawal
muna pasusuhin ang baby, 10-
31. JAPANESE ENCEPHALITIS (JE)
VACCINE
Type of Vaccine: live attenuated
Protects against viral encephalitis
caused by Japanese Encephalitis virus
Number of Doses: 1
Dosage: 0.5ml
Schedule: single dose administered at
<8mos of age
Route of Administration: Upper Arm,
SQ
Storage: +2˚C to +8˚C
WALA TAYO NETO :P
32. TETANUS DIPHTHERIA (TD)
VACCINE
Type of Vaccine: toxoid, inactivated
Protects against diphtheria and tetanus
Number of Doses: 3 – infancy, 2 – children (SBI), 5
for adult
Dosage: 0.5ml
Route of Administration: Upper Outer part of the
arm, IM
Storage: +2˚C to +8˚C, never freeze
Maybe very limited duration
protection
Gives 1
-
36. CAUSES OF VACCINES LOSS OF
POTENCY
Sensitivity to HEAT Most : OPV, Measles, MMR
Least: Penta, BCG,Hepa B and TT
Note: Freezed-dried vaccine become heat sensitive
after reconstitution
Sensitivity to
COLD
Most : Hepa B and Penta
Least: TT
Sensitivity to
LIGHT
BCG, Measles and MMR
Remember:
1. Expiry Date
- End of the month is the last date by which the vaccine can be
use (if not specified), and printed on all vials and packets during
manufacture’.
2. Diluents
- Diluents are not interchangeable.
- Diluents vials/ampules ust never be frozen or allowed to be in
contact with any frozen surface to avoid breakage and contamination.
37. MULTI-DOSE VIAL POLICY
(MDVP)
Multi – dose vials of OPV,DPT,Penta,Hepa B
vaccines from which one or more doses have
been removed during an immunization session
may be used in subsequent sessions for four
weeks provided the following conditions are
met:
1. Expiry date has not passed.
2. Vaccines are stored under appropriate cold chain
condition.
3. Vaccine vial septum has not been submerged in
water
4. Aseptic technique has been used to withdraw all
38. TYPES OF VACCINE WASTAGE
Vaccine Wastage in Unopened
Vials
Vaccine Wastage in Open Vials
-Expiry
- VVM indication
-Heat Exposure
- Freezing
- Breakage
- Missing Inventory
- Theft
- Discarding unused vials
returned from outreach session
-Discading remaining doses at end of
session
- Not being able to draw the number of
doses indicated on the label of the a
vial
- Poor reconstitution practices
- Submergence of opened vials in water
- Suspected contamination
- Patient reaction requiring more than
one dose.
39. WAYS TO REDUCE VACCINE
WASTAGE
1.Ensure compliance on MDVP
2.Use VVM
3.Ensure vital Information is recorded when vaccine are
recieved,stored and distributed
4.Monitor temperature of stored vaccines twice a daily including
weekends and holidays
5.Ensure the EARLIEST-EXPIRY-FIRST-OUT (FEFO) principle is
aintained except when vaccine is nearing its VVM dicard point.
6.Ensure vaccines are transported following the standard operating
procedures
7.Ensure a funtional contingery plan on cold chain failure
8.Monitor, maintain and routine repair cold chain exicts
9.Perform Shake Test
40. SHAKE TEST
The Shake Test determine whether DPT, Penta,
Hepa B or TT has been frozen. After freezing,
the vaccine is no longer a uniform cloudy
liquid. It forms flakes which gradually settle to
the bottom. Sedimentation occurs faster in
previously frozen vaccine vial than a never
frozen vaccine from the same manufacturer
41. TEST PROCEDURE : SHAKE
TEST
Step
1
Prepare a frozen control sample:
Take a vial of vaccine of the same type,batchno. And
manufacturer. Freeze the vial until the contents are solid
( at least 10 hrs at -10c ) Let it thaw. The vial is the
control sample.
Step
2
Choose a test sample:
Take avial of vaccine from the batch you suspected has
been frozen.This is the test sample.
Step
3
Shake the control and test samples:
Hold the control sample and test sample together in one
hand and shake vigorously for 10-15 seconds.
Step
4
Allow to rest:
Place the viald on a stable surface and do not move for
15-30minutes
Step
5
Compare the vials
-View both vials against the light to compare the
sediments rate.
45. AEFI
a medical incident thattakes place after an immunization,
causes concern, and is believed to be caused by immunization.
“medical incident” means any medical condition experienced by the
vaccine recipient
“ takes place” means experienced by the vaccine recipient
“after an immunization” means from day 0-4 weeks after the
immunization,unless otherwise specified ( Lymphadenitis caused by BCG
occurs 2 to 6 months after Immunization)
“causes concern means that the edical condition worries either the
patient, parent, vaccinator/health worker
“believed to be cause by immunization” means that the patient,
parent,vaccinator/health worker thinks that the vaccine is/could be the
cause of the medical condition or incident.
46. FULLY IMMUNIZED CHILD
(FIC)
- batang nakatanggap ng:
1 BCG
3 doses ng Penta
3 doses ng OPV
2 doses ng MCV hanggang 12mos and
30days
55. HERD IMMUNITY
(also called herd effect, community
immunity, population immunity, or mass
immunity)
Ay isang uri ng hindi direktang proteksyon
sa mga contagious diseases.
Ito ay nangyayari kapag ang sapat na
porsyento ng isang populasyon ay nagging
immune sa isang impeksyon, sa
pamamagitan man ng nakaraang impeksyon
o pagbabakuna, sa gayon ay binabawasan
ang posibilidan ng impeksyon para sa mga
indibidwal na walang kaligtasan sa sakit
