Submitted by: Lumba, Chared Joy D. BSN II-2/ Group 8 Submitted to: Ms. Sarah S.

Nares, RN,MN

Expanded Program on Immunization Children who lack immunization are more susceptible to common childhood diseases. The EPI is one of the DOH programs that have been institutionalized and adopted by all LGUs in the country. OBJECTIVE: To reduce morbidity and mortality against 7 childhood immunizable diseases. (Tuberculosis/Primary Complex, Diphtheria, Pertussis, Tetanus, Poliomyelitis, Measles, and Hepatitis B) Immunization is a process by which vaccines are introduce to the body, before infection sets in. 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. PRINCIPLES: 1. The program is based on epidemiological situation; schedules are drawn on the basis of the occurrences and characteristics features of the said diseases. 2. The whole community rather than just an individual is to be protected, thus, mass approach is applied. 3. Immunization is a basic health service and as such, it is integrated into the health services provided for by Rural Health Unit.

ELEMENTS: 1. Target Setting 2. Cold chain logistic management 3. Information, education and communication 4. Assessment and evaluation of the programs overall performance 5. Surveillance studies and research EPI ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS VACCINE 1. BCG TARGET Anytime at Birth School Entrance 2. Hepa B Anytime at Birth DOSAGE 0.05ml 0.1ml INTERVAL Once ROUTE SITE

Intradermal (ID) Right Deltoid Assess for Wheal Left formation Deltoid Intramuscular (IM) Upper outer Portion of the thigh

0.5ml

6 wks. Interval from 1st dose to 2nd dose, then 8 weeks interval From 2nd to 3rd dose 4 weeks x 3 doses

3. DPT

6 wks. Up to 11 mos.

0.5ml

Intramuscular (IM)

Upper outer portion of the thigh

4. OPV

6 wks. Up to 11 mos.

2 drops

4 weeks x 3 doses

Oral (Child must be NPO for 30 mins.)

Mouth (side of the cheek)

5. Measles

9 months

0.5ml

Once

Subcutaneous (SQ)

Outer Part of the upper arm

Side Effects of BCG: 1. Kochs Phenomenon acute inflammatory process starting with in 24 hrs. and may last for 2 4 days. Wheal must disappear in about 30 minutes 1hr. 2. Abscess formation 1st week soreness and inflammation, 2nd week 11th week healing of abscess and ulceration. Abscess maybe invariable due to subcutaneous or deep injection and may be managed with Incision and Drainage. 3. Indolent ulceration an ulcer which, persists after 12 weeks from date of vaccination or an ulcer that is more than 10mm deep. This may be treated with INH powder. 4. Glandular Enlargement the glands draining the injection site may become enlarged. If suppuration occurs, treat as a deep abscess. Management: Physician may order, I and D, or Isoniazid. Side Effects of Hepatitis B: 1. Mild fever 1 -2 days, - a. Teach mother perform TSB refer to the Physician. 2. Mild Pain, swell and redness. a. Teach mother to do cold compress first before hot compress 1 3 times after injection then every 6 hours. Side Effects of DPT: 1. Fever within 24 hours 2. local soreness pain and swelling 3. Abscess appears after a week or more due to wrong technique, b. advice mother that she may give Paracetamol every 4 hours if fever not relapse. Fever more than 4 days,

4. Convulsions are very rare, but may occur more in children above 3 months of age. This is due to the Pertussis virus component of the vaccine. There are now available D and T only vaccines that may avoid convulsions of DPT. Side Effects of Measles Vaccine: 1. Fever and Rashes for rashes mother may give ANTIHISTAMINES (Benadryl) and for itchiness (Calamine Lotion). Side effects for OPV: NONE: But be aware of possible risk for aspiration once wrong site is used. Make sure also that the baby was NPO 30 minutes prior administration, for him not to vomit once drops were administered. TETANUS TOXIOD IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN VACCINE SCHEDULE % OF PROTECTION DURATION OF PROTECTION ROUTE AND SITE

TT1

As early as possible during pregnancy At least 4 weeks later

Not yet protected

none

IM , (Deltoid)

TT2

80%

Infant born from mother will be protected from neonatal tetanus. Gives 3 years protection for the mother

IM , (Deltoid)

TT3

At least 6 months later

95%

Infant born from mother will be protected from neonatal tetanus.

IM , (Deltoid)

Gives 5 years protection for the mother Infant born from mother will be protected from neonatal tetanus. Gives 10 years protection for the mother TT5 At least 1 year later 99% Gives Lifetime protection for the mother. All infants born to that mother will be protected IM , (Deltoid)

TT4

At least 1 year later

99%

IM , (Deltoid)

POINTERS ON IMMUNIZATION: 1. Every child deserves to be given the benefits of immunization protection based on PD 996 immunization law. September 16, 1976 Basic compulsory immunization of children below 8 years old is implemented. 2. No vaccine gives 100% protection. They go hand in hand with good hygiene and other measures for disease prevention. 3. Recommended series of immunization must be completed for adequate protection. 4. Booster doses are important to maintain continuous protection against the diseases. 5. Interruption of schedule does not interfere with final immunity nor does it necessitate contraindication to vaccination. 6. Malnutrition, minor respiratory infections, moderate fever, cough and diarrhea do not constitute contraindications to vaccinations. 7. the absolute contraindications to immunization are :

a. DPT2 or DPT3 to a child who has had convulsion or shock within 3 days the previous dose. b. Live weakened vaccine like BCG must not be given to individual who are immunocompromised due to malignant disease. 8. Measles and OPV vaccines are most sensitive to heat. They must be strictly maintained at -15 20 C. 9. Vaccines are safe and effective with mild side effects after vaccination. 10. No extra doses must be given to child/mother who missed a dose. 11. Giving doses of a vaccine at less than 4 weeks interval may lessen the anti-body response. Lengthening the interval leads to higher antibody levels. 12. Practice FEFO first expiry first out rule, and 1 syringe one needle one child policy must strictly implemented. A child is said to be Fully Immunized Child when he/she receives 1 dose of BCG, 3 doses of Hepatitis B, 3 doses of DPT, 3 doses of OPV, and 1 dose of Measles before his/her 1st Birthday.,.

Reference: Handout #13- Child Health Programs (Prepared by: Mr. Dean Michael D. Songco, RN, MAN)