Angeles University Foundation

Angeles City

Expanded Program on Immunization

Submitted by: Cura, Lorelyn Jane P. Oballo, Neil Bryan BSN 2 6 Group 22 Submitted To: Mr. Gerard Vincent Aguas, RN, MN Clinical Instructor, OPD-DPMMH

OBJECTIVES:

To Reduce morbidity and Mortality against 7 childhood Immunizable diseases. (Tuberculosis, Diptheria, Pertusis, Tetanus, Poliomyelitis, Measles, and Hepatitis B.) Established here at Philippines by Pres. Marcos on the month of July, 1976 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. Immunization is a process by which vaccines are introduce to the Body, before infectious sets in. ELEMENTS :
1. Target Setting (0 12 mos.)

2. Cold chain Management (for vaccine life span and utilization) 3. Information, education and communication 3 Reasons: a. For parents, to be motivated to submit their child to immunization b. To provide health teachings on benefits and importance of immunization c. To inform the public about its availability and schedule (RHU q Weds. BHS q once a month, and remote area q Quarterly) 4. Assessment and evaluation of the programs over all performance 5. Surveillance, studies and research.

EPI ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS

1. BCG

Anytime at Birth School Entrance

0.05ml 0.1ml

Once

Intradermal (ID)
Assess for Wheal formation

Right Deltoid Left Deltoid

2. Hepa B Anytime at Birth

0.5ml

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

Intramuscular Upper (IM) outer Portion of the thigh

3. DPT

6 wks. Up to 11 mos.

0.5ml

4 weeks x 3 doses

Intramuscular Upper (IM) outer portion of the thigh

4. OPV

6 wks. Up to 11 mos.

2 drops

4 weeks x 3 doses

Oral
(Child must be PO for 30 mins.)

Mouth
(side of the cheek)

5. Measles

9 months (if epidemic crisis, 6 mos.)

0.5ml

Once

Subcutaneou s (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 mins 1hr. 2. Abscess formation 1st week soreness and inflammation, 2nd week 11th week healing of abscess and ulceration. If there is no scar developed, Repeat the procedure 3. indolent ulceration a. wrong technique, b. exposure of infant to Pt. c active TB. 4. Glandular Enlargement a. unsterile syringe or needle was used, b. too much vaccine was injected. C. the vaccine might be injected under the skin layer, and not instead in its superficial layer. Management: Physician may order, I and D, or Isoniazid.

Side Effects of Hepa B: 1. Mild fever 1 -2 days, - a. Teach mother perform TSB b. advice mother that she may give Paracetamol every 4 hours if fever not relapse. Fever more than 4 days, 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. 2. 3. 4. Fever within 24 hours local soreness pain and swelling Abscess appears after a week or more due to wrong technique, Convulsions is 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 mjay 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 mins. prior administration, for him not to vomit once drops were administered. TETANUS TOXIOD IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN VACCINE SCHEDULE % OF PROTECTIO N DURATION OF PROTECTIO N ROUTE AND SITE

TT1

As early as possible during pregnancy

Not yet protected

none

IM , (Deltoid)

TT2

At least 4 weeks later

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. Gives 5 years protection for the mother

IM , (Deltoid)

TT4

At least 1 year later

99%

Infant born from mother will be protected from neonatal tetanus. Gives 10 years protection for the mother

IM , (Deltoid)

TT5

At least 1 year later

99%

Gives Lifetime protection for the mother. All infants born to that mother will be protected

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 with in 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 Hepa B, 3 doses of DPT, 3 doses of OPV, and 1 dose of Measles before his/her 1st Birthday... EXPANDED PROGRAM ON IMMUNIZATION OBJECTIVES:

PRINCIPLES: The program is based on epidemiological situation; schedules are drawn on the basis of the occurrences and characteristics features of the said diseases. The whole community rather than just an individual is to be protected, thus, mass approach is applied. Immunization is a basic health service and as such, it is integrated into the health services provided for by Rural Health Unit. Immunization

ELEMENTS : Target Setting (0 12 mos.) Cold chain Management (for vaccine life span and utilization) information, education and communication 3 Reasons:

a. For parents, to be motivated to submit their child to immunization b. To provide health teachings on benefits and importance of immunization c. To inform the public about its availability and schedule (RHU q Weds. BHS q once a month, and remote area q Quarterly) Assessment and evaluation of the programs over all performance Surveillance, studies and research.

EPI ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS

1. BCG

2. Hepa B

3. DPT

4. OPV

5. Measles

Side Effects of BCG: Kochs Phenomenon Abscess formation indolent ulceration Glandular Enlargement Management: Physician may order, I and D, or Isoniazid.

Side Effects of Hepa B: 1. Mild fever 1 -2 days, 2. Mild Pain, swell and redness.

Side Effects of DPT:

5. 6. 7. 8.

Fever within 24 hours local soreness pain and swelling Abscess appears after a week or more due to wrong technique, Convulsions is 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: 2. Fever and Rashes

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 mins. prior administration, for him not to vomit once drops were administered. TETANUS TOXIOD IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN VACCINE SCHEDULE % OF PROTECTIO N DURATION OF PROTECTIO N ROUTE AND SITE

TT1

TT2

TT3

TT4

TT5

POINTERS ON IMMUNIZATION: Every child deserves to be given the benefits of immunization protection based on immunization law. No vaccine gives 100% protection. They go hand in hand with good hygiene and other measures for disease prevention. Recommended series of immunization must be completed for adequate protection. Booster doses are important to maintain continuous protection against the diseases. Interruption of schedule does not interfere with final immunity nor does it necessitate contraindication to vaccination. Malnutrition, minor respiratory infections, moderate fever, cough and diarrhea do not constitute contraindications to vaccinations. the absolute contraindications to immunization are :

Measles and OPV vaccines are most sensitive to heat. They must be strictly maintained at -15 20 C. Vaccines are safe and effective with mild side effects after vaccination.

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. Practice FEFO first expiry first out rule, and 1 syringe one needle one child policy must strictly implemented.