EPI Teaching Demo

COMMUNITY HEALTH COMMUNITY HEALTH NURSINGNURSING

• 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

EXPANDED PROGRAM ON EXPANDED PROGRAM ON IMMUNIZATIONIMMUNIZATION

LEGAL BASISLEGAL 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 EPIFour 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 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, The EPI routine schedule of immunization is every Wednesday. In BHS, it is done monthly. In far flung areas, it is quarterly.it is done monthly. In far flung areas, it is quarterly.

VACCINE Minimum Age at 1st dose

Number of Doses

Interval between doses

Reason

BCG Birth or anytime after birth

1 BCG given at earliest possible time protects 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 between 1st & 2nd doses. 8 weeks

interval between 2nd & 3rd doses

Early start reduces the chance of being infected and becoming a carrier

Measles 9 months 85% protection against measles

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

Will be treated at home with antibioticsYES

Has a local skin infectionYES

Had convulsion immediately after DPT1 and needs DPT2 and OPV2 todayNO to DPT2 YES to OPV2

Has chronic heart problemYES


Will be referred for a severe health problemNO

Is exclusively breastfedYES

Older brother had convulsion last yearYES

Had jaundice at birthYES


Is very low weight for ageYES

Is known to have AIDS and has not received any immunizations at allYES to ALL except BCG

Has cough or coldYES

Absolute Contraindications to Absolute Contraindications to Immunization: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 Decide what vaccine/s each child needs TODAY: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:EPI Vaccines and its Characteristics:Type/Form of Vaccine Storage Temperature

Most Sensitive to Heat

Oral Polio (Live Attenuated) -15ºC to -25ºC (in freezer)

Measles (Freeze Dried) -15ºC to -25ºC (in freezer)

Least Sensitive to Heat

DPT/Hepa B

D – Toxoid

P – Killed Bacteria

T – Toxoid

+2ºC to +8ºC (in refrigerator)

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 vaccinesFEFO (First expiry, first out) is practiced to ensure that vaccines are used before expiration

STORAGE OF VACCINESSTORAGE OF VACCINES

FreezerFreezer

-15 ° C to -25 ° C-15 ° C to -25 ° C

OPV (most sensitive OPV (most sensitive to heat)to heat)

Measles vaccineMeasles vaccine

Body of the Body of the refrigeratorrefrigerator

2 ° C to 8 ° C2 ° C to 8 ° C

BCGBCG

DPTDPT

HBVHBV

TT (least sensitive to TT (least sensitive to heat)heat)

COLD CHAIN LOGISTIC MANAGEMENTCOLD 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: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 VACCINEAt birthDosage0.05 mlSiteRight deltoid

School entrantDosage0.1 mlSiteLeft deltoid

COMPLICATIONS OF BCG VACCINATIONCOMPLICATIONS 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 VACCINEBCG VACCINE

KOCH’S PHENOMENON

Acute inflammatory reaction

Appears within 2-4 days of vaccination

Not serious and disappears rapidly

Vaccine Minimum age at 1st

dose

No. of doses

Dose Route Site Interval Reason

DPT 1

DPT 2

DPT 3

6 weeks (1 ½ mo)

10 weeks (2 ½ mo)

14 weeks(3 ½ mo)

3 0.5 cc IM Thigh 4 weeks An early start with DPT reduces the chance of severe pertussis

•DPT 2 is contraindicated for a child who has had convulsions within 3 days of the 1st DPT dose

• Expected side-effect: fever

• Management: paracetamol RTC


dose

No. of doses


OPV 1

OPV 2

OPV 3

6 weeks (1 ½ mo)

10 weeks (2 ½ mo)

14 weeks(3 ½ mo)

3 2-3 gtts Per orem

mouth 4 weeks

The extent of protection is increased the earlier OPV is given

• OPV: only vaccine with no side-effects

• Instruct mother to keep the child on NPO for 30 minutes after OPV administration


dose

No. of doses


Hepa B 1

Hepa B 2

Hepa B 3

At birth

6 weeks (1 ½ mo)

14 weeks(3 ½ mo)

3 0.5 cc IM Thigh 4 weeks An early start of hepatitis vaccine reduces the chance of being infected and becoming a carrier

• Side-effect: Soreness and inflammation

• Management: Paracetamol RTC


dose

No. of doses


Measles 9-12 months

1 0.5 cc SQ Deltoid At least 80% of measles can be prevented

•Management:

•Paracetamol RTC

•Diphenhydramine or Calamine lotion

•Usual side-effects of measles vaccine are: FEVER AND MILD RASHES

Tetanus Toxoid Immunization Schedule for Tetanus Toxoid Immunization Schedule for Women:Women:

VACCINE Minimum Age/Interval

% Protected Duration of Protection

TT1 As early as possible during pregnancy

TT2 At least 4 weeks after TT1

80% Infant is protectedMother gets 3 years protection

TT3 At least 6 months after TT2


TT4 At least 1 year after TT3


TT5 At least 1 year after TT4

99% Infant is protectedMother gets lifetime protection

Let’s try this!Let’s try this!

The only vaccine given via The only vaccine given via the intradermal routethe intradermal route

BCGBCG

The vaccines given via the The vaccines given via the intramuscular routeintramuscular route

DPT, Hepa B and TTDPT, Hepa B and TT

The only vaccine given The only vaccine given subcutaneouslysubcutaneously


The only vaccine given per The only vaccine given per oremorem

OPVOPV

The vaccines injected in the The vaccines injected in the deltoid areadeltoid area

BCG, Measles vaccine, BCG, Measles vaccine, TTTT

The vaccines injected in the The vaccines injected in the thighthigh

DPT and Hepa BDPT and Hepa B

The vaccines given with a The vaccines given with a dosage of 0.5 mldosage of 0.5 ml

DPT, Hepa B, measlesDPT, Hepa B, measles

The dosage of BCG vaccine The dosage of BCG vaccine for school entrantsfor school entrants

0.1 ml0.1 ml

The only vaccine with no The only vaccine with no side effectside effect

OPVOPV

The expected side effect of The expected side effect of BCGBCG

Koch’s phenomenonKoch’s phenomenon

The vaccine with fever and The vaccine with fever and mild rashes as side effectsmild rashes as side effects


The vaccines that should be The vaccines that should be stored in the freezerstored in the freezer

OPV and measlesOPV and measles

The vaccine most sensitive The vaccine most sensitive to heatto heat

OPVOPV

The vaccine least sensitive to The vaccine least sensitive to heat heat

TTTT

The vaccine with deep The vaccine with deep abscess and glandular abscess and glandular enlargement as complicationenlargement as complication

BCGBCG

The dosage of BCG for The dosage of BCG for infantsinfants

0.05 ml0.05 ml

The vaccines given in the 6-The vaccines given in the 6-10-14 weeks schedule10-14 weeks schedule

DPT and OPVDPT and OPV

The vaccine given at 9 The vaccine given at 9 monthsmonths

MeaslesMeasles

Thank you!Thank you!

Documents

EPI Teaching Demo