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Do not give more than one dose of The following are NOT
the same vaccine to a child in one contraindication. Infants with
session. Give doses of the same these conditions SHOULD be
vaccine at the correct intervals.
immunized:
Strictly follow the principle of
never, ever reconstituting the freeze Allergy or asthma ( except if there
dried vaccine in anything other than is a known allergy to a specific
the diluent supplied with them. component of vaccine mentioned
above )
If you are giving more than one Minor respiratory tract infection
vaccine, do not use the same syringe Diarrhea
and do not use the same arm or leg
Temp. below 38.5 C
for more than one injection.
Family history of adverse reaction
following immunization
Contraindication to Family history of convulsions,
Immunization seizures
Known or suspected HIV infection
with no signs and symptoms of
Anaphylaxis or severe
AIDS
hypersensitivity reaction to a
previous dose of vaccine is an Child being breastfed
absolute contraindication to Chronic illness such as diseases of
subsequent doses of vaccine heart, lung, kidney or liver
Stable neurological condition such
Person with a known allergy to a as cerebral palsy or Down’s
vaccine component should not be Syndrome
vaccinated. Premature or low birthweight
(vaccination should not be
DPT2 or DPT3 is not given to a postponed )
child who has convulsions or shock
Recent or imminent surgery
within 3 days after DPT1. Vaccines
containing the whole cell pertussis Malnutrition
component should not be given to a History of jaundice at birth
children with an evolving Note:
neurological disease. If parent strongly objects to
an immunization for a sick infant,
Do not give live vaccines like BCG do not give it. Ask the mother to
to a individuals who are comeback when child is well.
immunosuppressed due to malignant
disease ( child with AIDS) , going
therapy with immunosuppressive EPI Routine Schedule
agents or radiation. Every Wednesday is
designated as immunization day and is
A child with a sign and symptoms adopted in all part of the country
of severe dehydration
FIC “Fully Immunized Child” when
Fever of 38.5 C and above a child receives one dose of BCG, 3
doses of OPV, 3 doses of DPT, 3 doses
of HepB and one dose of measles
before a child’s first birthday.
Lecture Notes on EPI (Expanded Program on Immunization)
Prepared By: Mark Fredderick R Abejo R.N, MAN 3
Clinical Instructor
FEFO ( first expiry and first out ) vaccine is practiced to ensure that all
vaccines are utilized before its expiry date.
Proper arrangement of vaccines and labeling of vaccines expiry date are done to
identify those near to expire vaccines
Vaccine Wastage
Wastage is defined as loss by use, decay, erosion or leakage or through
wastefulness
Target Setting
Determine the EP = TP x 3%
Eligible Population (Infants/Children) 90 90 90 105
( EP )
EP = TP x 3.5 %
( Mothers )
Required number of
doses to immunize a 1 3 3 2
child/ mother
Determine the total
vaccine required TVR = EP x number 90 270 270 210
( TVR ) of doses
EPI VACCINES
Clean the skin with a cotton ball moistened with water and let skin dry.
Hold the child’s arm with your left hand so that your hand is under and your thumb
and finger come around the arm and stretch the skin.
Hold the syringe in your right hand with the bevel and the scale pointing up
towards you.
Lay the syringe and needle almost flat along the child’s arm.
Insert the tip of the needle into skin – just the bevel. Keep the needle flat along the
skin and the bevel facing upwards, so the vaccine only goes into the upper layers of
the skin.
Put your left thumb over the needle end to hold it in position. Hold the plunger e
between the index and middle fingers of the right hand and press the plunger in
with your right thumb.
If the vaccine is injected correctly into the skin, a flat wheal with the surface pitted
like an orange peel will appear at the injection site.
Withdraw needle gently.
Note:
Any remaining reconstituted vaccine must be discarded after 6 hours or at the end
of the immunization sessions, whichever comes first.
The small raised lump appears at the injection site, usually disappears within 30
minutes.
After 2 weeks, a red sore forms that is about the size of the end of an unsharpened
pencil.
The sore remains for another two weeks and then heals, a small scar, about 5mm
across remains. This is a sign that the child has been effectively immunized.
Repeat BCG vaccination if the child does not develop a scar after the 1st injection
Ask mother to hold the child across her knees so that her thigh is facing upwards.
Ask her to hold child’s leg.
Clean the skin with a cotton ball, moistened with water and let skin dry.
Grasp the injection site with your thumb and index finger.
Quickly push the needle, going deep in to the muscle.
Slightly pull the needle back to be sure it is not into a vein.
Inject the vaccine, withdraw the needle and press the injection spot quickly with a
piece of cotton.
Lecture Notes on EPI (Expanded Program on Immunization)
Prepared By: Mark Fredderick R Abejo R.N, MAN 9
Clinical Instructor
Hepatitis B Vaccine
Type of Vaccine “Monovalent vaccine” contain only one antigen
Form of Vaccine Cloudy liquid vaccine
Minimum Age at 1st Dose At birth
Number of Doses to 3
Complete the Immunization
Interval 6 weeks interval from 1st dose to 2nd dose
8 weeks interval from 2nd dose to 3rd dose
Reason An early start of Hep B vaccine reduces the chance of
being infected and becoming a carrier. Prevent liver
cirrhosis and liver cancer
Number of Doses per 1 for single dose vial
Ampule 10 for multi dose vial ( 10 children )
Dosage 0.5 ml
Route of Administration Intramuscular
Site of Administration Upper outer portion of the thigh ( Vastus lateralis ) in
infant ( with DPT: L – R – L )
Storage Temperature 2 C to 8 C ( in the body of refrigerator )
Note: Both heat and freezing damages the vaccine )
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 Mild fever that lasts one to two days after injection
Soreness, children may have pain, redness or
swelling at the injection site.
Contraindication Anaphylactic reaction such as severe rashes,
difficulty in breathing and choking to a previous
dose.
Health Teaching If the child has fever give paracetamol or any
appropriate antipyretic at the time and at four and
eight hours after immunization.
Alternating cold compress for 24 hours to warm
compress if there is pain and soreness .
Ask mother to hold the child across her knees so that her thigh is facing upwards.
Ask her to hold child’s leg.
Clean the skin with a cotton ball, moistened with water and let skin dry.
Grasp the injection site with your thumb and index finger.
Quickly push the needle, going deep in to the muscle.
Slightly pull the needle back to be sure it is not into a vein.
Inject the vaccine, withdraw the needle and press the injection spot quickly with a
piece of cotton.
Lecture Notes on EPI (Expanded Program on Immunization)
Prepared By: Mark Fredderick R Abejo R.N, MAN 11
Clinical Instructor
Measles Vaccine
Using a 10 ml. syringe fitted with a long needle, aspirate 5 ml of special diluent,
from the ampule.
Empty the diluent from the syringe into the vial with the vaccine.
Thoroughly mix the diluent and vaccine by drawing the mixture back into the
syringe and expelling it slowly into the vial several times. Do not shake the vial.
Protect reconstituted measles vaccine from sunlight. Wrap vial in foil.
Place the reconstituted vaccine in the slit of the foam provided in the vaccine
carrier.
AGE
BCG X
OPV X X X
DPT X X X
HepB Option B X X X
Option A X X X
Measles X
Lecture Notes on EPI (Expanded Program on Immunization)
Prepared By: Mark Fredderick R Abejo R.N, MAN 13
Clinical Instructor