EXPANDED PROGRAM IMMUNIZATION & REPRODUCTIVE HEALTH

EXPANDED PROGRAM IMMUNIZATION

- is one of the DOH Programs that has already been institutionalized and adopted by all LGUs in the region.

Expanded Program on Immunization

OBJECTIVE: To reduce infant mortality & morbidity among infants & children caused by the seven childhood immunizable diseases. FOUR MAJOR STRATEGIES: 1.) Sustaining high routine FIC coverage of at least 90% in all provinces & cities. 2.) Sustaining the polio free country. 3.) Eliminating measles by 2008. 3.) Elimination neonatal tetanus by 2008.

ELEMENTS OF EPI: Target Setting (main element). Information, Education, & Communication. Cold chain logistic management. Assessment & Evaluation of overall performance. Surveillance, Studies & Research.

THE EPI TARGET DISEASES:

Vaccination among infants & newborns (0-12 mos) against the seven vaccine preventable diseases. Seven (7) Childhood Immunizable Diseases are the ff:

TB

MEASLES

DIPHTHERIA

HEPATITIS

POLIOMYLETIS

PERTUSSIS

NEONATAL TETANUS

CONCEPT & IMPORTANCE OF VACCINATION:

IMMUNIZATION - is the process by which vaccines are introduced into the body before infection sets in. Vaccines are administered to introduced immunity thereby causing the recipients immune system to react to the vaccine that produces antibodies to fight infection. Vaccination promote health & protect children from diseases- causing agents. Infants & newborn need to be vaccinated at an early age since they belong to vulnerable age group.

GENERAL PRINCIPLES IN VACCINATING CHILDREN:

1. IT IS SAFE & IMMUNOLOGICALLY EFFECTIVE TO ADMINISTER ALL EPI
VACCINES ON THE THE SAME DAY AT DIFFERENT SITES OF THE BODY.

2. THE VACCINATION SCHEDULE SHOULD NOT BE RESTARTED FROM THE

BEGINNING EVEN IF THE INTERVAL BETWEEN DOSES EXCEEDED THE
RECOMMENDED INTERVAL BY MONTHS OR YEAR.

3. GIVING DOSES OF A VACCINE AT LESS THAN THE RECOMMENDED 4 WEEKS INTERVAL MAY LESSEN THE ANTIBODY RESPONSE. LENGTHENING THE INTERVAL BETWEEN DOSES OF VACCINES LEADS TO HIGHER ANTIBODY LEVELS. 4. NO EXTRA DOSES MUST BE GIVEN TO CHILDREN WHO MISSED A DOSE OF DPT/HB/OPV. THE VACCINATION MUST BE CONTINUED AS IF NO TIME HAD ELAPSED BETWEEN DOSES.

GENERAL PRINCIPLES IN VACCINATING CHILDREN:

5. DO NOT GIVE MORE THAN ONE DOSE OF THE SAME VACCINE TO A CHILD IN ONE SESSION. GIVE DOSES OF THE SAME VACCINE AT THE CORRECT INTERVALS. 6. STRICTLY FOLLOW THE PRINCIPLE OF NEVER EVER RECONSTITUTING THE
FREEZE DRIED VACCINE IN ANYTHING OTHER THEN THE DILUENT SUPPLIED
WITH THEM.

7. IF YOU ARE GIVING MORE THEN ONE VACCINE, DO NOT USE THE SAME SYRINGE & DO NOT USE THE SAME ARM OR LEG FOR MORE THAN ONE INJECTION.

 CONTRAINDICATION TO IMMNUNIZATION:
Anaphylaxis or severe hypersensitivity reaction to a previous dose of vaccine is an previous dose of vaccine is an absolute contraindication to subsequent doses of vaccine. Person with a known allergy to a vaccine component should not be vaccinated. DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1. Vaccines containing the whole cell pertussis component should not be given to a children with an evolving neurological disease. Do not give live vaccines like BCG to a individuals who are immunosuppressed due to malignant disease (child w/ AIDS), going therapy w/ immunosuppressive agents or radiation. A child w/ a sign & symptoms of severe dehydration. Fever of 38.5 *C & above.

 The following are NOT contraindications. Infants with these conditions SHOULD be immunized:
Allergy or asthma (except if there is known allergy to a specific component of vaccine mentioned above.)

Minor respiratory tract infection

Diarrhea Temp. below 38.5 *C Family hx. of adverse reaction ff. immunization, convulsions, seizures. Known or suspected HIV infx with no s/s of AIDS. Child being breastfed Chronic illness such as diseases of heart, lung, kidney, or liver. Stable neurological condition such as cerebral palsy or DS.

 The following are NOT contraindications. Infants with these conditions SHOULD be immunized:
Premature or low birth weight (vaccination should not be postponed).

Recent or imminent surgery.

Malnutrition. History of jaundice at birth.

EPI ROUTINE SCHEDULE - Every WEDNESDAY is designated as immunization day & is adopted in all part of the country. FIC FULLY IMMUNIZED CHILD when a child receives 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of Hep B, & one dose of Measles before a childs first birthday.

Minimum Vaccine Age at 1st Dose Bacillus CalmetteGurin Diptheria-PertussisTyphoid Vaccine Birth or anytime after birth 6 weeks

Number of Doses Dose

Minimum Interval Between Doses Rt. deltoid region of the arm Upper outer portion of the thigh BCG given at earliest possible age protects the possibility of TB meningitis and other TB infections in which infants are prone Route Site Reason

0.5 mL

--

ID

0.5 mL

4 wks

IM

An early start with DPT reduces the chance of severe pertussis. The extent of protection against polio is increased the earlier

Oral Polio Vaccine

6 weeks

2 gtts

4 wks

Oral

Mouth

the OPV is given. Keeps the Philippines polio-free.

6 wks interval from 1st dose to 2nd Hepatitis B Vaccine At birth 3 0.5 mL dose, 8 weeks interval from 2nd dose to third dose. Measles Vaccine (not MMR) 9 months 1 0.5 mL -SQ Upper outer portion of the thigh At least 85% of measles can be prevented by immunization at this age. IM Upper outer portion of the thigh An early start of Hep B vaccine reduces the chance of being infected and becoming a carrier. Prevents liver cirrhosis and liver cancer w/c are more likely to develop if infected with Hepatitis B early in life. About 9,000 die of complications of Hepatits B. 10% of Filipinos have Hepatitis B infection

VACCINES

SPECIAL PRECAUTIONS

SIDE EFFECT

CONTRAINDICATION

HEALTH TEACHING

BCG (Bacille Calmette-Guerin - Live Bacterial - Freeze dried

Correct ID administration Is essential, A special syringe & needle is used for the administration of BCG Vaccine.

A wheal formation Koch phenomenon (inflammatory reaction 2-4 days).

Immunosuppressed Individual due to malignant disease, (child w/ clinical AIDS); Therapy w/ immunosuppresive agent or radiation

- Do not massage the area of injection. - A scar will formed 12 wks after injection - Repeat BCG vacci nation if the child does not develop a scar after 1st injection

DPT-Diphteria Pertussis-Tetanus Diphteria & Tetanus as toxiods w/c is weakened toxin Pertussis as killed whole-cell Bacterium. Liquid Vaccine

DPT not usually given over 6 years of age.

Fever in the evening after receiving the injection. Soreness, children may have pain, redness or swelling at the injection site.

DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1. Vaccines containing the whole cell pertussis component should not be given to a children with an evolving neurological disease.

If the child has fever give paracetamol or any appropriate antipyretic at the time & four & 8 hrs after immunization. Alternating cold compress for 24 hrs to warm compress if there is pain & soreness.

PRECAUTIONS OPV Oral Polio Vaccine Children known to have rare congenital immune deficiency syndrome should receive IPV (injectable Polio Vaccine) rather OPV. Causes almost no side-effects. Less than 1% of the people who receive the vaccine develop a HA, diarrhea or muscle pain. NONE (NPO) 30 minutes before & after OPV. Do not touch the tip dropper bottle to the tongue.

Live Attenuated Vaccine

Liquid Vaccine

Hepatitis B Vaccine Monovalent Vaccine contain only one antigen. Cloudy liquid vaccin

Birth dose must be given if there is a risk of perinatal transmission. NOTE: Combination vaccines should not be given at birth, only monovalent HepB vaccine.

-Mild fever that lasts one to two days after injection. - Soreness, children may have pain, redness or swelling at the injection site.

Anaphylactic reaction such as severe rashes, difficulty in breathing & choking to a previous dose.

If the child has fever give paracetamol or any appropriate antipyretic at the time & at 4 & 8 hrs after immunization. Alternating cold compress for 24 hrs to warm compress if there is pain & soreness.

VACCINES

SPECIAL
PRECAUTIONS Birth dose must be given if there is a risk of perinatal transmission. NOTE: Combination vaccines should not be given at birth, only monovalent HepB vaccine. -

SIDE EFFECT

CONTRAINDICATION

HEALTH TEACHING

Measles accine

ttenuated Measles Virus

reeze dried

Fever that lasts one to two days after injection. Soreness, children may have pain, redness or swelling at the injection site within 24 hrs of immunization. It usually resolve within 2 to 3 days.

Severe reaction to previous dose. Pregnancy Congenital or acquired immune disorder.

If the child has fever give paracetamol or any appropriate antipyretic at the time & at 4 & 8 hrs after immunization. Alternating cold compress for 24 hrs to warm compress if there is pain & soreness It also prevent diarrhea. NO MEDICATION FOR PREGNANT. For pain cold compress 24 hrs to warm compress

etanus Toxoid Tetox)Vaccine

Weakened toxin -

iquid Vaccine

Fever in the evening after receiving the injection. Soreness, woman may have pain, redness or swelling & warmth at the injection site.

Anaphylactic reaction to previous dose.

EPI COLD CHAIN & LOGISTICS:

COLD CHAIN MANAGER = PUBLIC HEALTH NURSE Temp. monitoring of vaccines is done in all levels of facilities to monitor vaccine temperature. Temp. checking is done twice a day early in the morning & in the afternoon before going home. Temp. is plotted every day in monitoring chart to monitor break in cold chain. Type Of Vaccine Storage Temp. Hours of Life after opening.

Most Sensitive to Heat

Most Sensitive to Cold Sensitive to Sunlight & Fluorescent Light

OPV Measles
Hep B DPT Tetox BCG

- 15 to 25 C At the freezer
2 to 8 *C Body of refrigerator 2 to 8 *C Body of refrigerator

8 hours

8 hours

4 hours

Tetanus Toxoid Immunization Schedule for Women

When given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not only protect women against tetanus, but also prevent neonatal tetanus in their newborn infants.

Role Of A Nurse In Improving The Delivery Of Immunization In The Community:

As a nurse you need to: Actively master list infants eligible for vaccination in the community.

Immunize infants following the recommended immunization schedule, route, of administration, correct dosage & following the proper cold chain storage of vaccines.
Observe aseptic technique on immunization & use one syringe & one needle per child. This reduces blood-borne diseases & promote safety injection practices. Dispose used syringes & needles properly. Inform, Educate & Communicate with parents.

 Conduct health visits in the community to assess other health needs of the community. Identify cases of EPI target diseases per standard case definition. Manage vaccines properly by following the recommended storage of vaccines. Record the children given with vaccination in the Target List.

Submit report & record of children vaccinated, cases & deaths on EPI diseases.

PHILIPPINE REPRODUCTIVE HEALTH

PHILIPPINE REPRODUCTIVE HEALTH

The Philippines is one of the signatory country to the International Conference Plan of Action of Reproductive Health in Cairo in 1994.
In 2004, harmonization & integration of the various approaches & different efforts in relation to women health & reproductive health, it came up with integrated Reproductive Health & Womens Health Framework w/ an overall goal of achieving Better Quality Life Among Filipinos.

ITS MAIN OBJECTIVES ARE:

Reducing maternal mortality rate. Reducing child mortality. Halting & reversing spread of HIV / AIDS. Increasing access to reproductive health information & services.

PHILIPPINE REPRODUCTIVE HEALTH

There are 10 elements very crucial on Reproductive Health. These are:

Family Planning Maternal & Child Health & Nutrition Prevention & Management of Reproductive Tract Infection including Sexually Transmitted Infections (STIs) & HIV/AIDS. Adolescent Reproductive Health (ARH). Prevention & Management of Abortion & its Complications Prevention & Management of Breast & Reproductive Tract Cancers & other Gynecological Conditions. Education Counseling on Sexuality & Sexual Health Mens Reproductive Health (MRH) & Involvement. Violence Against Women & Children. Prevention & Management of Infertility & Sexual Dysfucntion.