COMMUNITY HEALTH

NURSING
 EXPANDED PROGRAM ON
IMMUNIZATION
• This was launched in July 1976 by the
Department of Health in cooperation with
the World Health Organization and the
UNICEF
OBJECTIVE:
• To reduce the morbidity and mortality
among infants and children caused by the
seven immunizable diseases
 LEGAL BASIS
• PD No. 996 (September 16, 1976)
• Providing for compulsory basic immunization
for infants and children below eight years old

• RA 7846 (December 30, 1994)

• An Act requiring for the compulsory
immunization against hepatitis B for infants and
children below eight years old
• Acceleration of EPI coverage had begun in 1986
• 1987-1992 was the period of EPI Acceleration
• 1990 – development of the National Plan of
Action for Polio Eradication
• 1992 – Hepa B Vaccine was integrated in EPI 1992
– high routine coverage of 92% nationwide
• 1993-1996 – National Immunization days were
conducted
• 1993-1997 – Oplan Alis Disis by both private and
public sectors
• 1998 – Philippines embarked on Measles
Elimination
• 2000 – Philippines was certified as Polio Free in
Kyoto, Japan
• 2004 – drastic reduction of Measles cases due
to Measles Catch-Up Campaign
• Country’s National Tetanus Rate is below
1/1,000 live births
 Four Major Strategies in EPI
• Sustaining high routine FIC coverage of
at least 90% in all provinces and cities
• Sustaining the Polio-free country for
global certification
• Eliminating measles
• Eliminating neonatal tetanus
 EPI TARGET DISEASES
• Vaccinate all children aged 0-12 months against:
– Tuberculosis
– Diphtheria
– Pertussis
– Tetanus
– Poliomyelitis
– Measles
– Hepatitis B
The EPI routine schedule of immunization is every Wednesday. In BHS,
it is done monthly. In far flung areas, it is quarterly.

VACCINE Minimum Age Number Interval Reason

at 1st dose of Doses between doses

BCG Birth or 1 BCG given at earliest

anytime after possible time protects
birth against TB Meningitis and
other TB infections
DPT 6 weeks 3 4 weeks Early start of DPT reduces
the chance of Pertussis

OPV 6 weeks 3 4 weeks Protection against Polio is

increased when OPV is
started early
Hepa B At birth 3 6 wks. interval Early start reduces the
between 1st & 2nd chance of being infected
doses. 8 weeks and becoming a carrier
interval between
2nd & 3rd doses

Measles 9 months 85% protection against

measles
 Decide if it is safe to immunize if the child:

Will be treated at home with antibiotics

YES
Has a local skin infection
YES
Had convulsion immediately after DPT1 and
needs DPT2 and OPV2 today
NO to DPT2 YES to OPV2
Has chronic heart problem
YES
 Decide if it is safe to immunize if the child:

Will be referred for a severe health problem

NO
Is exclusively breastfed
YES
Older brother had convulsion last year
YES
Had jaundice at birth
YES
 Decide if it is safe to immunize if the child:

Is very low weight for age

YES
Is known to have AIDS and has not received
any immunizations at all
YES to ALL except BCG
Has cough or cold
YES
 Absolute Contraindications to
Immunization:
• DPT2 or DPT3 should not be given to a
child who had convulsions within three
days after the previous dose
• DPT1 should not be given to a child who
had convulsions prior to immunization
• BCG should not be given to a child who
has HIV/AIDS
 Decide what vaccine/s each child needs
TODAY:
Dingdong is 10-month-old and has received
BCG and HepB1 only.

Baby Marianne is 8-week-old and has not

received any immunization.

Noymar is 2-month-old and has received BCG,

DPT1, OPV1 and HepB1 5 weeks ago.
 EPI Vaccines and its Characteristics:
Type/Form of Vaccine Storage Temperature
Most Sensitive Oral Polio (Live Attenuated) -15ºC to -25ºC (in freezer)
to Heat Measles (Freeze Dried) -15ºC to -25ºC (in freezer)
DPT/Hepa B +2ºC to +8ºC (in
Least Sensitive D – Toxoid refrigerator)
to Heat P – Killed Bacteria
T – Toxoid
Hepa B +2ºC to +8ºC (in
refrigerator
BCG (Freeze dried) +2ºC to +8ºC (in
refrigerator
Tetanus Toxoid +2ºC to +8ºC (in
refrigerator)
Cold chain must be maintained in handling vaccines
FEFO (First expiry, first out) is practiced to ensure that vaccines are used

before expiration
 STORAGE OF VACCINES

Freezer OPV (most sensitive

-15 ° C to -25 ° C to heat)
Measles vaccine

Body of the BCG

refrigerator DPT
2 ° C to 8 ° C HBV
TT (least sensitive to
heat)
COLD CHAIN LOGISTIC MANAGEMENT

A system for
ensuring the potency
of a vaccine from the
time of manufacture
to the time it is given
 Administration of Vaccines:
Vaccine Dosage Route Site of
Administration
BCG 0.05 ml Intradermal Right upper
deltoid region of
the arm
DPT 0.5 ml IM Upper outer
portion of the
thigh
OPV 2 drops Oral Mouth
Measles 0.5 ml Subcutaneous Outer part of the
upper arm
Hepa B 0.5 IM Upper outer
portion of the
thigh
Tetanus toxoid 0.5 IM Deltoid region of
the upper arm
 BCG VACCINE
At birth School entrant
Dosage Dosage
0.05 ml 0.1 ml
Site Site
Right deltoid Left deltoid
 COMPLICATIONS OF BCG VACCINATION
DEEP ABSCESS – due to injecting
the vaccine too deeply
EXCESSIVE ULCERATION – ulcer
present for more than 12 weeks
and more than 10 mm in
diameter
GLANDULAR ENLARGEMENT –
glands draining at injection site
may enlarge
KELOID – thickened protruding
scar
 BCG VACCINE
KOCH’S
PHENOMENON
Acute inflammatory
reaction
Appears within 2-4
days of vaccination
Not serious and
disappears rapidly
Vaccine Minimum No. of Dose Route Site Interval Reason
age at 1st doses
dose
DPT 1 6 weeks 3 0.5 cc IM Thigh 4 weeks An early
(1 ½ mo) start with
DPT
DPT 2 10 weeks reduces
(2 ½ mo) the chance
of severe
DPT 3 14 weeks pertussis
(3 ½ mo)

• Expected side- •DPT 2 is contraindicated

effect: fever for a child who has had
• Management: convulsions within 3 days
of the 1st DPT dose
paracetamol
RTC
Vaccine Minimum No. of Dose Route Site Interval Reason
age at 1st doses
dose
OPV 1 6 weeks 3 2-3 gtts Per mouth 4 The
(1 ½ mo) orem weeks extent of
protection
OPV 2 10 weeks is
(2 ½ mo) increased
the earlier
OPV 3 14 weeks OPV is
(3 ½ mo) given

• OPV: only vaccine with no

side-effects
• Instruct mother to keep the
child on NPO for 30 minutes
after OPV administration
 Vaccine Minimum No. of Dose Route Site Interval Reason
age at 1st doses
dose
Hepa B 1 At birth 3 0.5 cc IM Thigh 4 weeks An early
start of
hepatitis
Hepa B 2 6 weeks vaccine
(1 ½ mo) reduces
the chance
Hepa B 3 14 weeks of being
(3 ½ mo) infected
and
becoming
a carrier

• Side-effect: Soreness and

inflammation
• Management: Paracetamol RTC
 Vaccine Minimum No. of Dose Route Site Interval Reason
age at 1st doses
dose
Measles 9-12 1 0.5 cc SQ Deltoid At least
months 80% of
measles
can be
prevented

•Usual side- •Management:

effects of measles •Paracetamol RTC
vaccine are: •Diphenhydramine
FEVER AND or Calamine lotion
MILD RASHES
Tetanus Toxoid Immunization Schedule for
Women:
VACCINE Minimum % Protected Duration of Protection
Age/Interval
TT1 As early as
possible during
pregnancy

TT2 At least 4 weeks 80% Infantis protected

after TT1 Mother gets 3 years

protection

TT3 At least 6 months 95% Infantis protected

after TT2 Mother gets 5 years

protection

TT4 At least 1 year after 99% Infantis protected

TT3 Mother gets 10 years

protection

TT5 At least 1 year after 99% Infantis protected

TT4 Mother gets lifetime

protection
Let’s try this!
The only vaccine given via BCG
the intradermal route
The vaccines given via the DPT, Hepa B and TT
intramuscular route
The only vaccine given Measles vaccine
subcutaneously
The only vaccine given per OPV
orem
The vaccines injected in the BCG, Measles vaccine,
deltoid area TT
The vaccines injected in the DPT and Hepa B
thigh
The vaccines given with a DPT, Hepa B, measles
dosage of 0.5 ml
The dosage of BCG vaccine 0.1 ml
for school entrants
The only vaccine with no OPV
side effect
The expected side effect of Koch’s phenomenon
BCG
The vaccine with fever and Measles vaccine
mild rashes as side effects
The vaccines that should be OPV and measles
stored in the freezer
The vaccine most sensitive OPV
to heat
The vaccine least sensitive to TT
heat
The vaccine with deep BCG
abscess and glandular
enlargement as complication
The dosage of BCG for 0.05 ml
infants
The vaccines given in the 6- DPT and OPV
10-14 weeks schedule
The vaccine given at 9 Measles
months
Thank you!