The document summarizes key information about tuberculosis (TB) and the Philippines' National TB Control Program (NTP). It outlines the program's vision, mission, goals and objectives, which aim to reduce TB prevalence and mortality. It describes TB transmission, signs/symptoms, diagnosis, treatment regimens and dosages. It also covers management of childhood TB, including case finding, prevention through BCG vaccination, and treatment approaches like DOTS. Nursing responsibilities in childhood TB are also defined.

1. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 1
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
EPI TARGET DISEASES
Disease Causative Mode of Clinical Reservoir Diagnostic Treatment Nursing
Agent Transmission Manifestation Exam Implication
Tuberculosis Mycobacterium Droplet Infection
General weakness Man Sputum DOTS Pointers for
“Primary Tuberculosis ( inhalation of
And - patient is teaching on Anti-
Loss of weight, Exam
Complex” is less bacilli from
cough and wheeze Diseased 3 sample are required to take TB drugs:
than 3 years old patient who
which does not Cattle taken with 24 the Ant-Tb
coughs and
respond to antibiotic (Bovine TB) hrs: drugs in the Rifampicin: taken
- any child who sneeze)
therapy. - spot sample presence of a befor meals,
does not return to
Fever and night (1st visit) health care causes red urine
normal health after Degree of
sweat - early provider to urine
measles or Communicability
Abdominal swelling morning ensure Isoniazide: causes
whooping cough. Depends upon:
with a hard painless specimen compliance to peripheral neuritis,
- num.of bacilli
mass and free fluid - spot sample treatment given with Vit.B6
Most hazardous - virulence of
Hemoptysis and (2nd visit) regimen Pyrazinamide:
period: first 6-12 bacilli
chest pain Note: at least 2 cause
months after - environmental
Painful firm or soft sample are Anti-TB drugs: hyperurucemia
infection conditions
swelling in a group of positive (RIPES) Ethambutol:
Highest in risk Rifampicin causes optic
of developing: superficial lymph
nodes. Chest Xray Isoniazid neuritis/ blurring
under 3 years old of vision
Note: Mantoux Pyrazinamide
In young children the Test Ethambutol Streptomycin:
only sign of pulmonary - .1 cc Streptomycin cause tinnitus, loss
TB may be stunted injection of of hearing balance,
growth or failure to PDD and 48- damage to 8th
thrive 72 hours cranial nerve
reading
* 10 mm + Note: After 2-4
5 mm + (HIV weeks of
pt.) treatment, patient
is no longer
contagious

2. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 2
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
The National Tuberculosis Control Program Objective C:
Increase and sustain support and financing for TB
control activities
Vision: A country where Tb is no longer a public health problem
Mission: Ensure that TB DOTS services are available, accessible and
Strategies:
affordable to the communities in collaboration with the LGU’s
Facilitate implementation of TB-DOTS Center certification and
and other partners
accreditation
Goal: To reduce prevalence and mortality from TB by half the year
2015 ( Millennium Development Goal ) Build TB coalitions among different sectors
Targets: Advocate for counterpart input from local government units
1. Cure at least 85% of the sputum smear- positive TB patient discovered. Mobilize/extend other resources to address program limitations
2. Detect at least 70% of the estimated new sputum smear-positive TB cases.
Objective D:
NTP Objectives and Strategies Strengthen management (technical and operational) of TB
control services at all levels
Objective A:
Improve access to and quality of services provided to TB patients, TB Strategies:
symptomatics and communities by health care institutions and providers Enhance managerial capability of all NTP program managers at all
levels
Strategies: Establish an efficient data management system for both public and
Enhance quality of TB diagnosis. private sectors.
Ensure TN patient’s treatment compliance. Implement a standardized recording and reporting system.
Ensure public and private health care providers adherence to the Conduct regular monitoring and evaluation at all levels.
implementation of national standards of care for TB patients. Advocate for political support through effective local governance
Improve access to services through innovative service delivery mechanisms for
patients living in challenging areas. KEY POLICIES
Objective B: Case Finding
Enhance the health-seeking behavior on TB by communities, especially
the TB symptomatics 1. DSSM ( Direct Sputum Smear Microscopy ) shall be the
primary diagnostic tool in NTP case finding.
Strategies: Note: No TB diagnosis shall be made based on Xray result alone
Develop effective, appropriate and culturally-responsive IEC/communication likewise
materials. result of PDD skin test (Mantoux Test)
Organize barangay advocacy groups 2. All TB symptomatic identified shall undergo DSSM for diagnosis
before start of treatment
Note: Only contraindication for sputum collection is hemoptysis

3. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 3
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
3. After three sputum specimen yielding negative result X-ray and culture
are necessary RECOMMENDED CATEGORY OF TREATMENT REGIMEN
Note: Diagnosis based on Xray shall be made by the TB Diagnostic
Committee. Category Type of TB Treatment Regimen
4. Only trained medical technologist or microscopist shall perform DSSM. Patient
Intensive Continuation Total
Phase Phase Period
Patients with the following conditions shall be recommended for New smear
hospitalization: positive PTB
massive hemoptysis New smear
pleural effusion I positive PTB 2 RIPE 4 RI 6
military TB ( TB of the Spine “Pot’s Disease”) with extensive mos.
TB meningitis parenchymal
TB pneumonia lesion
and those requiring surgical intervention EPTB and
Severe
Anti-TB drugs: concomitant
(RIPES) HIV disease
Rifampicin Treatment
Isoniazid Failure
Pyrazinamide
II 2 RIPES 5 RIE 8
Relapse
Ethambutol Return after /1 RIPE mos.
Streptomycin default
Two Formulation of Anti-TB Drugs New smear-
1. Fixed-Dose Combination ( FDCs) – two or more first line anti-TB drugs negative PTB
are combined in one tablet. There are 2,3, or 4 drug fixed dose III 2 RIP 4 RI 6
With minimal
combinations. parenchymal mos.
2. Single Drug Formulation (SDF) – each drug is prepared individually. lession
Isoniazid, Pyrazinamide and Ethambuto are in tablet form while Chronic ( still Refer to Specialized facility
Rifampicin is in capsule form and streptomycin is injectable. smear-positive or DOTS Plus Center refer
IV after supervised to City Provincial NTP
re-treatment ) Coordinator

4. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 4
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
DOSAGE PER CATEGORY OF TRATMENT REGIMEN
B. Single Dose Formulation ( SDF )
A. Fixed-Dose Combination Formulation Simply add 1 tablet of Isoniazid ( 100mg) , Pyrazinamide
The number of tablets of FDCs per patient will depend on the body (500mg) and Ethambutol ( 400mg) each for the patient weighing more
weight. than 50kg before treatment initiation. Modify drug dosage within
acceptable limits according to patient’s body weight, particularly those
weighing less than 30 kg at the time of diagnosis.
Categories I and III : 2 RIPE / 4 RI ( FDC)
Categories I and III: 2 RIPE / 4 RI (SDF)
Body Weight No.of tablets per day No. of tablets per day
(kg) Intensive Phase Continuation Phase Anti-TB Drugs No. of tablets per day No. of tablets per day
( 2 months ) ( 4 months ) Intensive Phase Continuation Phase
FDC-A ( RIPE) FDC-B (RI) ( 2 months ) ( 4 months )
30 - 37 2 2 Rifampicin 1 1
38 – 54 3 3 Isoniazid 1 1
55 – 70 4 4 Pyrazinamide 2
More than 70 5 5 Ethambutol 2
Categories II : 2 RIPES / RIPE / 4RIE (FDC) Categories II: 2 RIPES / 1 RIPE / 5 RIE
Body Intensive Continuation Phase Anti-TB No. of Tablets / Vial per day No.of Tablets per
Weight Phase Drugs Intensive Phase day
First Months 3rd FDC-B E (3months ) Continuation Phase
Two (2) Month ( RI ) 400 ( 5 months )
mg First 2 months 3rd months
FDC-A Streptomycin FDC-A Rifampicin 1 1 1
(RIPE) (RIPE) Isoniazid 1 1 1
30 – 37 2 0.75 g 2 2 1 Pyrazinamide 2 2
38 – 54 3 0.75 g 3 3 2 Ethambutol 2 2 2
55 – 70 4 0.75 g 4 4 3 Streptomycin 1 vial per day
More 5 0.75 g 5 5 3
than 70 Note: 56 vials of Streptomycin for two months

5. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 5
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
Drug Dosage per Kg. Body Weight All TB symptomatic children 0-9 years old, except sputum positive
child shall subject to PDD testing
Anti-TB Drugs Dose per Kg Body Weight and Maximum Dose - Only trained nurse and midwife shall do the PDD test and recording
- Testing and reading shall be conducted once a week either on Monday
Rifampicin 5 ( 4 – 6 ) mg/kg and not to exceed 400 mg daily or
Isoniazid 10 ( 8 – 12 ) mg/kg and not to exceed 600 mg daily Tuesday.
Pyrazinamide 25 ( 20 – 30 ) mg/kg and not to exceed 2 mg daily Note: 10 children shall be gathered for testing to avoid wastage.
Ethambutol 15 ( 15 – 20 ) mg/kg and not to exceed 1.2 g daily
Streptomycin 15 ( 12 – 18 ) mg/kg and not to exceed 1 g daily A child shall be suspected as having TB and considered symptomatic
if with any three (3) of the following sign and symptoms:
D.O.T.S ( Directly-Observed Treatment Shortcourse ) “TuTok Gamutan” cough and wheezing for 2 weeks or more
unexplained fever for 2 weeks or more
5 Elements of D.O.T.S loss of appetite, loss of weight, failure to gain weight
Sustained political commitment failure to respond to a 2 weeks of appropriate antibiotic therapy
Access to quality-assured sputum microscopy failure to regain state of health 2 weeks after a viral infection or after
Standardized short-course chemotherapy for all cases of TB having measles.
Uninterrupted supply of essential drugs
Recording and reporting system enabling outcome assessment of all patients A child shall be clinically diagnosed or confirmed of having TB if he
and assessment of overall program performance. has any three (3) of the following condition:
positive history of exposure to an adult/ adolescent TB case
presence of sign and symptoms suggestive of TB
MANAGEMENT OF CHILDREN WITH TB positive Mantoux Test
abnormal chest radiograph suggestive of TB
Prevention
Management
BCG vaccination shall be given to all infants.
BCG vaccine is moderately effective. It has a protective efficacy of: For children with exposure to TB
50 % against any TB disease
64 % against TB meningitis Should undergo physical examination and PDD testing (Mantoux Test)
74 % against death from TB A child with productive cough shall be referred for DSSM, if found
positive, treatment shall be started immediately. PDD testing shall no
Case Finding longer needed.
Cases of TB in children are reported and identified in two instances: Children without sign/symptoms of TB but with positive Mantoux Test
- The patient sought consultation. and those with symptoms of TB but negative Mantoux Test shall
- The patient was reported to have been exposed to an adult with TB referred for chest x-ray examination.

6. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 6
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
For children with signs and symptoms of TB Continuation
Phase 10-15 mg/kg body weight
A child to have signs and symptoms of TB with either known or unknown 10-15 mg/kg body weight
4 months
Rifampicin
exposure shall be referred for Mantoux test. Isoniazid
For children with known contact but with negative Mantoux and those
unknown contact but with positive Mantoux shall be referred for chest x-ray
examination. B. Extra Pulmonary TB
For a negative x-ray report, Mantoux test shall be repeated after 3 months.
Chemoprophylaxis of Isoniazid for 3 months shall be given to children less Drugs Daily Dose (mg/kg per body weight ) Duration
than 5 years old with negative chest x-ray after which Mantoux test shall be Intensive Phase
repeated Rifampicin 10-15 mg/kg body weight
Isoniazid 10-15 mg/kg body weight
Treatment Pyrazinamide 20-30 mg/kg body weight
D.O.T.S will still be followed just like in adult 2
Short course regimen: Plus months
- at least 3 anti-TB drugs for 2 months ( intensive phase ) Ethambutol 15-25 mg/kg body weight
- 2 anti-TB drugs for 4 months ( continuation phase ) OR
Streptomycin 20-30 mg/kg body weight
* For Extra Pulmonary TB Cases:
- 4 anti-TB drugs for 2 months ( intensive phase ) Continuation
- 2 anti-TB drugs for 10 months ( continuation phase ) Phase 10-15 mg/kg body weight
10-15 mg/kg body weight
10
Rifampicin
Domiciliary treatment shall be the preferred mode of care Isoniazid months
No treatment shall be initiated unless the patient and health worker has agreed
upon a caseholding mechanism for treatment compliance. Public Health Nurse Responsibilities ( Childhood TB )
Treatment Regimen 1. Interview and open treatment cards for identified TB children.
2. Perform Mantoux testing and reading to eligible children
A. Pulmonary TB 3. Maintain NTP records
4. Manage requisition and distribution of drugs
Drugs Daily Dose (mg/kg per body Duration 5. Assist the physician in supervising the other health workers of the
weight ) RHU in the proper implementation of the policies and guidelines
Intensive Phase on TB in children.
Rifampicin 10-15 mg/kg body weight 6. Assist in the training of other health workers on Mantoux testing
10-15 mg/kg body weight
2 months and reading.
Isoniazid
Pyrazinamide 20-30 mg/kg body weight

7. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 7
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
EPI TARGET DISEASES
Disease Causative Mode of Clinical Reservoir Diagnostic Treatment Nursing
Agent Transmission Manifestation Exam Implication
Diphteria it is an Corynebacterium Respiratory Nasal Man
Schick’s Test Antibiotics Isolate patient
acute pharyngitis, diphtheriae Droplets dryness of the - test for the until 2-3 cultures
acute upper lip susceptibility to Pen G taken at least
nasopharyngitis serosanguinous Diptheria Potassium 24hrs apart are
or acute laryngitis secretion in the
Erythromycin negative
with Pseudo nose Moloney Test Small frequent
membrane – - for hyper-
grayish white in feeding
Pharyngeal sensitivity to
color with leathery Promote
“Bullneck” Diptheria toxin
consistency in the absolute rest
appearance
throat and on the Use ice collar to
because of the
tonsil relieve pain of
enlarge cervical
sore throat
lymph nodes.
May put on soft
diet
Laryngeal
sore throat
hoarseness
brassy metallic
cough
Pertussis Bordetella Airborne – At first, the
- 100 days cough Pertussis droplet infected child may
- Whooping cough Primarily by have a common
Erythromycin Place the patient
- “tuspirina” direct contact cold with runny Man Bordet-
Gengou Agar Ampicillin on NPO during
with he nose, sneezing
Plate paroxysmal stage
discharge from and mild cough
- used for - is given 5-7 days to prevent
respiratory Intermittent
culture medium aspiration
mucous episode of
membranes of Position prone
paroxysmal for infants and
infected person cough followed
upright for older
by a whoop
ending vomiting

8. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 8
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
Neonatal Tetanus Clostridium Unhygienic Assess the
Tetani cutting of NEWBORN for a
umbilical cord history of all 3 of the Blood Culture Penicillin Prevention
- which produces following: Erythromycin
the exotoxins: Improper CSF analysis Tetracycline Aseptic
Tetanolysin handling of cord Normal suck and handling of the
Tetanospasmin stump esp. when cry for the first 2 - administered neonatal
treated with days of life within 4 hours of umbilical cord
contaminated Onset of illness Soil injury Tetanus Toxiod
substance between 3 and 28 Intestinal immunization for
days canal of mothers
Inability to suck animal Active
followed by Man immunization of
stiffness of the DPT
body and
convulsion
In OLDER
CHILDREN, the
following may be
observed:
Trismus –
lockjaw
Opisthotonus –
arching of the
neck and back
Ridus
Sardonicus –
sardonic smile

9. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 9
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
Poliomyelitis 3 Types of Polio Fecal-oral route Abortive - did not Throat swab
Strict Isolation
“Infantile Virus progress to systemic Man
Hot moist
Paralysis” Type I Oral route infection Stool exam
through compress to
Brunhilde
pharyngeal Non-paralytic – Lumbar exam relieve spasm
Type II
Lansing secretion slight involvement
of the CNS Pandy’s test Use protective
Type III Leon
Contact with - for CSF devices:
infected person Poker spine or analysis - handroll to
stiffness of the prevent claw hand
spinal column
Spasms of the
- trochanter roll, to
hamstring
prevent outer
With paresis
rotation of femur
- footboard
Paralytic – severe
involvement of CNS
Hoyne’s Sign –
head falls back
when he is in
supine with
shoulder elevated
Paralysis
Head log/drop
Tripod position
– extend his arm
behind for support
when he sits up
Kernig’s sign
Brudzinski sign

10. Lecture Notes on EPI Diseases / National TB Control Program (DOTS) 10
Prepared By: Mark Fredderick R Abejo RR, MAN
Clinical Instructor
Hepatitis B Prodromal/pre-
- it is liver Hepa B Virus 3 P’s icteric
Liver
infection caused by Symptoms of Man Increase CHO
Function Test
the B type of Person to person URTI Moderate fat
hep.virus. Parenteral Weight loss Low CHON
It attacks livers the Placental Anorexia
liver often RUQ pain Observed universal
resulting in Malaise precaution
inflammation Icteric
Jaundice
Acholic stool
bile-colored
urine
3 C’s
Measles Paramyxo Virus Droplet Conjunctivitis Observe
Coryza Man respiratory
Cough isolation
Koplik’s spot – Should kept out
bluish gray spot on of school for at
the buccal mucosa. least 4 days after
Generalized blotch rash appear
rash For
Photophobic,
darkened room,
sunglasses