Angeles University Foundation Angeles City
“Expanded Program on Immunization”
Presented By: Jefferson Baladhay Dungca BSN IV - 4 Group 13 Submitted To: Mr. Dennis S. Cortez, R.N. MN Clinical Instructor, CHN Marcos Village
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
VACCINE
1. BCG
TARGET
DOSAGE
INTERVA L
Anytime at Birth
0.05ml
Once
School Entrance
0.1ml
ROUTE
SITE
Intradermal (ID)
Right Deltoid
Assess for Wheal formation
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
Mouth
(Child must be PO for 30 mins.)
(side of the cheek)
9 months
0.5ml
Once
Subcutaneou s (SQ)
Outer Part of the upper arm
5. Measles
(if epidemic crisis, 6 mos.)
Side Effects of BCG:
1. Koch’s 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
TT1
As early as possible during pregnancy
TT2
At least 4 weeks later
% OF PROTECTIO N
Not yet protected
80%
DURATION OF PROTECTIO N
ROUTE AND SITE
none
IM , (Deltoid)
Infant born from mother will be protected from neonatal tetanus.
IM , (Deltoid)
Gives 3 years protection for the mother TT3
TT4
At least 6 months later
At least 1 year later
95%
99%
Infant born from mother will be protected from neonatal tetanus. Gives 5 years protection for the mother Infant born from mother will be protected from neonatal tetanus. Gives 10 years
IM , (Deltoid)
IM , (Deltoid)
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)
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.,.”
Jef7
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 VACCINE
TARGET
DOSAGE
INTERVA
ROUTE
SITE
L
1. BCG
2. Hepa B
3. DPT
4. OPV
5. Measles
Side Effects of BCG: Koch’s 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.
