HANDOUT NO.

1  Focused on detailed orientation care of

OVERVIEW OF CHN individuals, families and communities in
Public Health attaining, maintain and recovering
optimal health and functioning.
 The science and practice of protecting  Nursing process
and improving health of the
community, as by preventive medicine, Important points in the definition of CHN
health education, control of
communicable diseases, application of
sanitary measures and monitoring of
The goal = promotion and preservation of the
environmental hazards.
health of population
 ‘’TO ENABLE EVERY CITIZEN TO REALIZE
HIS BIRTHRIGHT TO HEALTH AND
LONGEVITY’’.
 The art of applying science in the The nature = comprehensive, general, continual
context of politics so as to reduce and episodic
inequalities in health while ensuring the
best health for the greatest number.

Important terms: The knowledge = comes from nursing and public

health
1. Community (Recipient of care)
 Group of people sharing common
geographical boundaries, values,
CHN deals with different levels of clientele
interests and characteristics; common
rights and privileges, same laws and
regulation.
2. Health The practitioner’s recognition of the population
 A state of complete physical, mental as a whole
and social well-being and not merely
the absence of disease or infirmity 1947: DOH was divided into three bureaus:
(WHO)
 Hospital
 Multi-dimensional
 Quarantine
Determinants of Health:  Health

 Income and social status Strengths of CHN

 Education
 There is greater control for both the
 Physical Environment
client in making decisions
 Employment and working conditions
 There is equal collaboration of nurse
 Social support networks and politics
and client
 Culture
 Recognition of different factors that
 Genetics
affect the health of community
 Personal Behaviour
 The nurse has wide-range of awareness
 Health services
of their clients and situations
 Gender
3. Nursing (means to achieve the health Individual
product)
 Sick or well
  Seen in daily basis
 Seen in community-based activities
 Can be an entry point in working with
family.
Family
 Basic unit of care
 Composed of two or more persons who
are joined together by bonds of sharing
and emotional closeness (Friedman)
 Performs 2 major functions:
o Reproduction
o Socialization
 Can be contributions in health
development and nursing problems
 Can be source of support of each
members
 Social changes can affect the concept of
family
Population Group
 Group of people who shares common
characteristics, developmental stage
and health problem
Community
 Functions within a particular socio-
cultural context (no communities are
alike)
Republic Act 7160
 Transfer of power and authority from
national to local
 AIM: to build a self-government and
self-reliance in each community
 Creation of the local health board which
concerns budget proposals, operations
and maintenance of health facilities and
services.
Before RA7160
 DOH principal agency that has direct
authority over municipal city, provincial
health and hospital services.
The municipal and city health services and
hospitals were placed directly under the mayor.
Provincial health services and hospitals are
under the governor
Only regional officers and some hospitals
remained under control of DOH
HISTORY OF CHN IN PHILIPPINES
1901
 Act No.157 of the Philippines
Commission created a Bored of Health
of the Philippines.
1905
 Act No.1407 (Reorganization Act)
abolished the Board of Health and its
Function and activities were taken over
by the Bereau of Health under the
Department of interior.
1915
 The Bureau of Health was renamed
Philippine Health Service with a director
of Health as its Head. The office of
District Nursing was also created due to
increasing demands of nurses to work
outside the Hospital, in the homes and
the need for direction, supervision and
guidance of public health nurses.
1927
 Philippine Health Service was abolished
and supplanted by the section of Public
Health Nursing Mrs. Genara De Guzman
acted as consultant to the Director of
health on Nursing Matters.
December 08, 1941
 At the outbreak of World War II, Public
Health Nurses in Manila were assigned
to devastated areas to attend to the
sick and wounded.
June 1942
 A group of Public Health Nurses with
physicians and administrators of Manila
Health Department went to the
internment camp in Capas,Tarlac, to
receive sick prisoners of war released
by the Japanese army.
1948
 The first training center of the Bereau of
Health was organized. Physicians and
Nurses undergoing preservice and in-
service training in public health/public
health nursing as well as student nurses
on affiliation were assigned to the
above training center.
1950
 Organization of Rural Health
Demonstration and Training Center.
This was use a laboratory for the field of
experience of graduated and basic
students in medicine, nursing, health
education, nutrition and social work.
The first Supervising Training Nurse was
Miss Martha Obana.
1953
 Philippine Congress approved Republic
Act No. 1082 or the rural health law. It
created the first 81 rural health units.
1975
 The functions of the health team
members ( Municipal Health Officer
,Public Health Nurse, Rural Health
Midwife, Rural Sanitary Inspector) were
redefined. The roles of public health
nurse and the midwife were expanded.
1990-1992
 The Local Government Code (R.A. 7160)
was passed and implemented.
Devolution.
2002
 R.A.9173 or the Philippines Nursing Act
expanded the roles of nurses in both
hospital and community-based practice.
2009
 Commision on Higher Education (CHEd)
Memorandum Order (CMO) Number
14, Series of 2009. Policies and
standards for Bachelor of Science
Nursing Program.
Goal
 To raise the level of health of every
citizenry
 To help communities and families cope
with the discontinuities in health and
threats in such a way as to maximize
their potential for high level wellness
 To promote reciprocally supportive
relationship between people and their
physical and social environment
 To uplift the health of every Filipino
citizen
Concepts
 Primary focus is on HEALTH
PROMOTION
 Benefits not only the individual but the
WHOLE family and community
 Womb to tomb care
 Client contact may continue over long
period of time includes all ages and all
types of health care
 Requires current knowledge derived
from biological and social sciences,
clinical nursing and community health
organization be utilized
 Nursing process
PRINCIPLES OF CHN
 CHN practice must be based on needs
of client
 CHN must know the laws that governs
the practice
  Family is an important client
 Service for all
 Health teaching is the first responsibility
 CHN collaborates with other healthcare
team
 Evaluation of CHN service to improve
itself
 CHN must continue to pursue higher
level of education
 CHN must be resourceful
 CHN should make use of existing
community group
 CHN must provide educative
supervision
 CHN must have proper documentation
ROLES OF NURSE IN CHN
Planner/Programmer
 Identified needs, priorities and
problems of Individual, Families and
Community
 Formulates and implements nursing
plan, program policies and
memorandum
 Coordinates with Individual, Family and
Community and groups for health and
health-related services
 Coordinates nursing program with other
health program
Educator
 Identifies and interprets training needs
of RHMs, BHWs and hilots
 Formulates and conducts training
 Acts as resource speaker
 Development and distribution of
information material
 Pre-marital counselling
Evaluator
 Detects deviation from health
 Uses symptomatic and objective
observation to determine health status
of IFC
Role Model
 Example of healthy living
Change Agent

 Motivates modification in health

Provider of Nursing Care behaviour
 To sick and disabled Statistician
Manager/Supervisor  Prepares and submits required reports
and record
 Organizes, workforce, resources,
equipment, supplies and delivery of Researcher
health care
 Requisition, allocation and distribution  Participates in conduction of surveys,
of materials studies and research
 Regular visits and meeting to different  Coordinates with government
RHMs

Community Organizer

 Motivates and enhances community

participation

Coordinator of service
HANDOUT NO. 2
HEALTH CARE DELIVERY SYSTEM IN THE
PHILIPPINES
 A nation’s health care delivery system
has a tremendous impact not only on
the health of its people but also on their
total development, including their
socio-economic status.
WHO
 Founded in 1945 as a specialized agency
of the UN
 147 country offices
 6 world regional offices
OBJECTIVE:
 The attainment by all peoples of the
highest possible level of health
CORE FUNCTIONS:
 Providing leadership
 Shaping the research agenda and
stimulating the generation
 Setting norms and standards and
promoting and monitoring their
implementations
 Articulating ethical and evidence-based
policy options
 Providing technical support, catalysing
change and building sustainable
institutional capacity by offering
trainings in the field of MCH
2 SECTORS OF HEALTH CARE DELIVERY SYSTEM:
1. Public Sector – financed through a tax-
based budgeting system at national and
local levels, where health care is given
for FREE
e.g: ONA, JBL, Mabalacat
district
2. Private Sectors – largely market-
oriented and utilizes users fee to finance health
services.
2.1 Commercial or business –
profit-oriented such as private clinics,
laboratories and practitioners.
2.3 Non-commercial – service-
oriented such as socio-civic groups, religious
organizations or foundations.
30% - uses private health facilities
70% - health professionals employed in
this sector
Department of Health
 National agency mandated to lead the
health sector towards assuring quality
health of every Filipino.
 Over-all technical authority on health
 National health policy-maker and
regulatory institution.
VISION BY 2030:
Global leader for attaining
better health outcomes, competitive
and responsive health care system and
equitable health financing
MISSION:
To guarantee equitable,
sustainable and quality health for all
Filipinos, especially the poor and to lead
the quest for excellence in health.
3 MAJOR ROLES specified in EO 102
series 1999 (former president joseph
Estrada on may 24, 1999)
1. Leadership in health
2. Enabler and capacity
builder
3. Administrator of specific
services
Function in the Leadership role:
1. Planning and formulating policies of
health programs and services
2. Monitoring and evaluating the
implementation of health programs,
projects, research, training and services
3. Advocating for health promotion and
healthy lifestyle
 4. Serving as technical authority in disease
control and prevention
5. Providing administrative and technical
leadership in health care financing and
implementing the National Health
Insurance Law
Functions in the role as enabler and capacity
builder:
1. Providing logistical support to LGUs, the
private sector and other agencies in
implementing health programs and
services
2. Serving as the lead agency in health and
medical research
3. Protecting standards of excellence in
training and education of health care
providers at all levels of the health care
system
Functions in the role as administrator of specific
services:
1. Administrator of referral centers for
local health system such as tertiary and
special hospital, reference laboratories,
training centers, center for health
promotion, center for disease control
and prevention and regulatory offices.
2. Providing specific programs
components for conditions that affect
large segments of population, such as
tuberculosis, malaria, schistosomiasis,
HIV/AIDS, and micronutrient deficiency.
3. Developing of strategies for responding
to emerging health needs
4. Providing leadership in health
emergency preparedness and response
services, including referral and
networking system for trauma,injuries
and catastrophic events.
LEVELS OF HEALTH CARE FACILITIES AND
REFERRAL CENTERS:
1. General Hospital – provide services for
all kinds of illness, injuries or
deformities.
A. Primary Care Facility
 first contact facility that offers basic
services including emergency services
and provision for normal deliveries.
 Includes health centers, out-patient
clinics, dental clinics, short-stay facilities
like infirmaries and lying-in facilities
B. Custodial Care Facility
 Provides long-term care including basic
services like food and shelter to
patients with chronic conditions
requiring on-going health and nursing
care due to impairment and reduced
degree of independence in ADLs and
patients in need of rehabilitation.
 Custodial psychiatric facilities,
substance/drug abuse tx and
rehabilitation centers,
sanitaria/leprosaria and nursing homes.
C. Diagnostic/Therapeutic Facility
 A facility for the examination of the
human body, specimens from the
human body for the diagnosis,
sometimes tx of dse or water for
drinking water analysis.
Category classified into:
A. Laboratory facilities such as
clinical, HIV testing, Blood
service, drug testing,
newborn screening and
laboratory for water
analysis.
B. Radiologic facility providing
services such as X-ray, CT
scan, mammography, MRI
and ultrasonography.
C. Nuclear medicine facility is
regulated by the PNRI
utilizing applications of
radioactive materials in
diagnosis, tx or medical
research with the exception
of the use of sealed
radiation sources in
radiotherapy as in internal
radiation therapy.
 2. Specialty Hospitals – services for
specific disease or condition or type of
patient such as children and elderly.
e.g: dialysis clinic, ambulatory clinic,
cancer chemotherapeutic clinic, cancer
radiation facility and physical medicine
and rehabilitation center/clinic
Rural Health Unit
 Known as health center, primary care
facility
 Focuses on preventive and promotive
health services and supervision of BHSs
under its jurisdiction
 1 RHU:20,000 population
RHU PERSONNEL:
 Municipal Health officer
 Public Health Nurse
 Rural Sanitary Inspector
 Rural Health Midwife
 Barangay health worker
PHN functions:
A. Supervises and guides all RHMs in the
municipality
B. Prepares FHSIS quarterly/annual
reports of the municipality submission
to provincial health office
C. Utilizes the nursing process in
responding to health care needs,
including health education and
promotion of individuals, families and
communities
D. Collaborates with other members if the
health team, gov. agency, private
business, NGOs and people’s
organization to address the
community’s health problems.
The local health boards
RA 7160
 Local autonomy
 Enables LGU to attain their fullest
development as self-reliant
communities and make more effective
partners for achievement of national
goals
Devolution
 Refers to the act by which the LGU
confirms power and authority
 Health services transferred
from DOH to LGU
 All district, municipal, and
provincial hospitals are now
under the jurisdiction of the
provincial government
 All rural health units and
barangay health centers are
now under municipal
government
 Each LGU has local health board
which proposes annual
budgetary allocation
COMPOSITION OF LOCAL HEALTH BOARDS
Provincial
 Governor
 Prov. Health Officer
 Chairman of committee on health of SB
 DOH Representative
 NGO Representative
MUNICIPAL
 Mayor
 Municipal Health Officer
 Chairman of the committee on health of
SB
 DOH representative
 NGO representative
The Barangay Health Satellite
 First contact health care facility that
offers basic services
DOH MILESTONES
1991-1993
 Republic Act 7160 is fully implemented
1999-2004

 Through the executive order 102,

functions and operations of DOH were
aligned to provision of administrative
code 1987 and RA 7160

2005-2010

 FOURmula One was launched

2010-2016

 Universal Health care

Priority Health Policy Directions of
Aquino Administration:
1. Roadmap to UHC through refocused
Philhealth and NHIP coverage to
achieve financial risk protection
2. Construction, rehabilitation and
support of health facilities:
- LGU
- Rural health unit
- Barangay health stations

MILLENIUM DEVELOPMENT GOALS

MAJOR GOAL: LGUs to contribute to attainment

of MDG target by 2015

Goal 1: Eradicate extreme poverty and hunger

Goal 2: Achieve universal primary education

Goal 3: Promote gender equality and empower

women

Goal 4: Reduce child mortality

Goal 5: Improve maternal health

Goal 6: Combat HIV/AIDS, malaria and other dse

Goal 7: Ensure environmental sustainability

Goal 8: Develop a global partnership for

development
HANDOUT NO. 3  Immunisation should be given free for
infants and children up to 5 y/o.
DOH PROGRAMS  Infants born in health facilities should
be administered with Hepatitis B within
1. Expanded Program on Immunization
24 hours.
Antigen Age Dos Rout Site  Infants delivered by persons other than
e e the physician, nurse or midwife, must
BCG At 0.05 ID Right be brought to any available health care
Vaccine birth ml Deltoid facility so as to be immunised against
Hepatitis B At 0.5 IM Anterolate Hepatitis B within 24 hours after birth
birth ml ral thigh but not later than 7 days.
muscle R.A. 7846 – Compulsory Immunisation against
DPT- 6 0.5 IM Anterolate Hepatitis B for infants and children below 8 y/o.
HepB-Hib weeks ml ral thigh Goals of the EPI:
(Pentavale 10 muscle
nt weeks 1. To immunise all infants/children against
vaccine) 14 the most common vaccine-preventable
weeks diseases.
Oral Polio 6 2 Oral Mouth 2. To sustain the polio-free status of the
Vaccine weeks drop Philippines. (September 2000).
10 s 3. To eliminate measles infection
weeks (Presidential Proclamation No. 4 s.
14 1998).
weeks 4. To eliminate maternal and neonatal
Anti- 9-11 0.5 SQ Outer part tetanus elimination campaign starting
measles mont ml of the arm 1997.
vaccine hs 5. To control diphtheria, pertussis,
(AMV1) hepatitis B and German measles.
Measles- 12-15 0.5 SQ Outer part 6. To prevent extra pulmonary TB among
mumls- mont ml of the arm children.
rubella hs
vaccine A. Reminders on the EPI.
(AMV2)  Receiving antigens at earliest age
Rotavirus 6 1.5 Oral Mouth reduces possibility of child to get sick
vaccine weeks ml  Administration of the hepatitis B
10 vaccine at birth reduces of the chance
weeks of the child becoming a carrier.
Tetanus Grade 1.5 IM Deltoid  Rotavirus most common cause of
and 7& ml diarrhoea in infants and children
Diphtheria 10 between the ages of 6 and 24months
toxoid are at greatest risk for developing
severe rotavirus infection.
 Hib is a bacterium responsible for
LEGAL MANDATE serious illnesses, such as meningitis
and pneumonia, with almost cases
 R.A. 10152 – Mandatory Infants and younger than 5 years, with those
Children Health Immunisation Act of
2011.
 between 4 and 18 months of age
especially vulnerable.
Important considerations related to the
schedule and manner of administering infant
immunisations.
 Use only one sterile syringe and needle
per client.
 There is no need to restart a vaccination
regardless of the time that has elapsed
between doses.
 All the EPI antigens are safe and
effective when administered
simultaneously, that is, during the same
immunisation session but at different
sites. It is not recommended, however,
to mix different vaccines in one syringe
before injection, or to use a fluid
vaccine for reconstitution of a freeze-
dried vaccine. When a vaccine is
administered to an infant at the same
time with another injectable vaccine,
the vaccines should be administered on
different sites. However, if more than
one injection has to be given on the
same limb, the injection sites should be
2.2-5 cm apart to prevent overlapping
of local reactions.
 The recommended sequence of the co
administration of vaccines is OPV first
followed by Rotavirus vaccine then
other appropriate vaccines.
 OPV is administered by putting drops of
vaccine straight from the droplet onto
the child’s tongue. Do not let the
dropper touch the tongue.
 Only monovalent hepatitis B vaccine
must be used for the birth dose.
Pentavalent vaccine must not be used
for the birth dose because DPT and Hib
vaccine should not be given at birth. A
monovalent vaccine is one that contains
an antigen against a single disease.
Pentavalent vaccine contains antigens
against five diseases: diphtheria,
pertussis, tetanus, hepatitis and
haemophilus influenzae B.
 Children who have not received AMV1
as scheduled and whose parents or
caretakers do not know whether they
have received AMV1 shall be given
AMV1 as soon as possible, then AMV2
one month after the AMV1 dose.
 All children entering day care/preschool
and grade 1 shall be screened for
measles immunisation. Those without
the immunisation shall be referred to
the nearest health facility for
immunisation.
 The first dose of rotavirus vaccine is
administered only to infants aged 6
weeks to 15 weeks. The second dose is
given only to infants aged 10 weeks up
to a maximum 32 weeks.
 Administer the entire dose of the
vaccine slowly on one side of the mouth
(between cheek and gum) with the tip
of the applicator directed toward the
back of the infant’s mouth. To prevent
spitting or failed swallowing, stimulate
the rooting and sucking reflex of the
young infant. For infants aged 5 months
or older, lightly stroke the throat in a
downward motion to stimulate
swallowing.
B. Vaccines, their contents and form.
Vaccine Contents Form
BCG vaccine Live, Freeze-dried,
(Bacillus attenuated reconstituted
Calmette bacteria with a special
Guerin) diluent.
Hepatitis B RNA- Cloudy, liquid,
vaccine recombinant, in an auto-
 using disable Vaccines Side effects Management
Hepatitis B injection BCG  Koch’s  No
surface syringe if phenom manage
antigen (HBs available. enon: an ment is
Ag) acute needed.
DPT-HepB- Diphtheria Liquid, in an inflamm
Hib toxoid, auto-disable atory
(Pentavalent inactivated injection reaction
vaccine) pertussis syringe. within
bacteria, 24 days
tetanus toxoid after  Refer to
recombinant vaccinati the
DNA surface on, physicia
antigen, and usually n for
synthetic indicates incision
conjugate of previous and
Haemophilus exposure drainage
influenzae B to .
bacilli. tubercul
Oral Polio Live, Clear, pinkish osis.
Vaccine attenuated liquid.  Deep  Treat
virus abscess with INH
(trivalent) at powder.
Anti-measles Live, Freeze-dried, vaccinati
vaccine attenuated reconstituted on site;
(AMV1) virus with a special almost  If
diluent. invariabl suppurat
Measles- Live, Freeze-dried, y due to ion
mumps- attenuated reconstituted subcutan occurs,
rubella virus with a special eous or treat as
(AMV2) diluent. deeper deep
Rotavirus Live, Clear, injection abscess.
vaccine attenuated colourless . Refer to
virus liquid, in a  Indolent physicia
container with Ulceratio n for
an oral n: an I&D.
applicator, ulcer
Tetanus Weakened Clear, which
toxoid toxin colourless persists
liquid after 12
sometimes weeks
slightly turbid. from
vaccinati
on date.
D. Side effects of vaccinations and  Glandula
their management. r
enlarge
 ment: although .
enlarge very
ment of rare,
lymph may
glands occur in
draining children
the older
injection than 3
site. months.
Hepatiti  Local  No  Proper
sB soreness treatme manage
at the nt is ment of
injection necessar caused
site. y. by
DPT-  Fever  Advise pertussis
HepB- that parent vaccine
Hib usually to give OPV None
(Pentava lasts for antipyret Anti-  Fever 5-  Reassure
lent only 1 ic. measles 7 days parent
vaccine) day. vaccine after and
Fever (AMV1) vaccinati instruct
beyond on in them to
24 hours some give
is not  Reassure children, antipyret
due to parent sometim ic.
the that es there
vaccine soreness is a mild
but to will rash.
other disappea Measles  Local  Reassure
causes. r after 3- - soreness parent
 Abscess 4 days. mumps- , fever, and
after a rubella irritabilit instruct
week or vaccine y, and them to
more  I&D may (AMV2) malaise give
usually be in some antipyret
indicates necessar children. ic.
that the y. Rotaviru  Some  Reassure
injection s children parent
was not vaccine develop and
deep  Convulsi mild instruct
enough ons: vomiting them to
or the pertussis and give
needle vaccine diarrhoe antipyret
was not should a, fever ic.
sterile. not be and
 Convulsi given irritabilit
ons: anymore y.
Tetanus  Local  Apply 1.1 Storage of vaccines should not
toxoid soreness cold exceed:
at the compres  6 months at
injection s at the regional level.
site. site. No  3 months at
other provincial/district
treatme level.
nt is  1 month at the
needed. main health
centers/RHU (with
refrigerators).
BCG NORMAL COURSE.  Not more than 5
days at health
1. Wheal formation that disappears after centers.
30 minutes.
2. A small red tender swelling at the
injection site after 2 weeks. This 1.2 Transport of vaccines – use
develops into a small abscess, which transport boxes or vaccine carriers.
ulcerates.
3. The ulcer heals by itself and leaves a 1.3 Handling of vaccines – once opened
scar. or reconstituted, vaccines must be
4. The course from the vaccination to the placed in a special cold pack during
formation of the scar takes about 12 immunisation sessions.
weeks. 1.4 Discard: BCG vaccines after 4 hours.
DPT, Polio, Measles and
Tetanus Toxoid vaccines after 8
E. Target Setting. hours or at the end of a working
Vaccine requirement is calculated based on day.
eligible population by using the following
formula: Estimated # of infants = total The PHN is the Cold Chain Officer.
population X 2.7%  In charge of maintaining the cold chain
Estimated # of 12 to 59 month-old children = equipment and supplies, such as the
total population X 10% freeze/refrigerator, transport box, vaccine
bags/carriers, cold chain monitors,
Estimated # of pregnant women = total thermometers and cold packs.
population X 3.5%  Implements and emergency plan in the
event of an electrical breakdown or power
F. Maintaining the potency of the EPI failure.
vaccines.
Vaccines confer immunity only when they are
potent, and to retain their potency, vaccines 1.5 EPI vaccines and the special diluents
must be properly stored handled and have the following cold chain
transported. requirements:
 OPV: 15 to 25 C. OPV has to be stored in
1. Maintain the COLD CHAIN, the system the freezer. In the vaccine bag, OPV is
for ensuring the potency of a vaccine placed in contact with cold packs.
from the time of manufacture to the  All other vaccines (including measles,
time it is given to an eligible client. vaccine, MMR and Rotavirus vaccine)
 have to be stored in the refrigerator at
a temperature of +2 to +8 C. These
vaccines should be stocked neatly on
the shelves of the refrigerator. Do not
stock vaccines at the refrigerator door
shelves.
 Hepatitis B vaccine, Pentavalent
vaccine, Rotavirus vaccine, and TT are
damaged by freezing. Wrap the
containers of these vaccines with paper
before placing them in the vaccine bag
with cold packs.
2. Observe the first expiry-first out (FEFO)
policy.
3. Comply with recommended duration of
storage and transport.
 At the health center/RHU with a
refrigerator, the duration should not
exceed one month. Using transport
boxes, vaccine can be kept only up to a
maximum of 5 days.
 Take note if the vaccine container has a
vaccine vial monitor (VVM). The VVM is
a round disc of heat-sensitive material
placed on a vaccine vial to register
cumulative heat exposure.
4. Abide by the open-vial policy of the
DOH. A multi-dose vial may be opened
for one or two clients if the health
worker feels that a client cannot come
back for the scheduled immunisation
session. Multi-dose liquid vaccines, such
as OPV, Pentavalent vaccine, Hepatitis B
vaccine, and TT from which one or more
doses have been taken following
standard sterile procedures, may be
used in the next immunisation sessions
for up to a maximum of 4 weeks,
provided that all the following
conditions are met:
 The expiry date has not passed.
 The vaccine has not been
contaminated.
 The vials have been stored under
appropriate cold chain conditions.
 The VVM septum has not been
submerged in water.
 The VVM on the vial, if attached, has
not reached the discard point.
5. Reconstitute freeze-dried vaccines such
as BCG, AMV, and MMR only with the
diluents supplied with them.
6. Discard reconstituted freeze-dried
vaccines after 6 hours after
reconstitution or at the end of the
immunisation session, whichever comes
sooner.
7. Protect BCG from sunlight and rotavirus
from light.
G. Contraindications to Immunisation.
In general, there are no contraindications to up
immunisation of a sick child if the child is well
enough to go home. Sending children away and
telling mothers to bring them back for
immunisation when they are well enough is not
a good practice because it delays Immunisation.
ABSOLUTE CONTRAINDICATIONS to the EPI
vaccines. Do not give:
 Pentavalent vaccine/DPT to children
over 5 years of age.
 Pentavalent vaccine/DPT to a child with
a recurrent convulsions or another
active neurological disease of the CNS.
 Pentavalent vaccine 2 or 3/DPT 2 or 3 to
a child who has had convulsions or
shock within 3 days of the most recent
dose.
 Rotavirus vaccine when the child has a
history of hypersensitivity to a previous
dose of the vaccine, intussuceptions or
intestinal malformation or acute
gastroenteritis.
 BCG to a child who has signs and
symptoms of AIDS or other immune-
defiency conditions or who are immune
suppressed.
FALSE CONTRAINDICATIONS
 Malnutrition.
 Low grade fever.
 Mild respiratory infection.
  Diarrhoea – children with diarrhoea
who are due to OPV should receive a
dose of OPV during the visit. This dose,
is not counted. The child should return
when the next dose OPV is due.
 HPV shall be given to female children 9-
10 y/o. Quadrivalent HPV 2 doses are
given 0.6 months.

CHANGES IN THE CHILDHOOD IMMUNISATION

Scheduled 2016.

 EPI changed to NIP.

 JE vaccine included in the
recommended vaccine group.
 Quadrivalent influenza vaccine
included influenza vaccine
recommendation.
 Hib recommendation for high
risk children included in
vaccines for high risk/special
groups.
National Immunisation Program (NIP).

The National Immunisation Program consists of

the following antigens:

 BCG vaccine, single dose at brith.

 Monovalent Hepatitis B vaccine given at
birth.
 DPT-Hib-HepB vaccine, 3 doses given at
6-10-14 weeks of age.
 OPV, 3 doses given at 6-10-14 weeks of
age, a single dose or IPV is given with
the 3rd dose of OPV at 14th week.
 Pneumococcal conjugate vaccine, 3
doses given at 6-10-14 weeks of age.
 Rotavirus vaccine given at a minimum
age of 6 weeks with a minimum interval
of 4 weeks
between doses. The last dose should be
administered not later than 32 weeks or
age.
 Measles containing vaccine (either
mono measles vaccine or MMR) given
at 9 months of age.
 MMR vaccine given at 12 months of
age.
 MR and TD vaccines are administered to
Grade 1 and Grade 7 students enrolled
in public schools.
 JAPANESE  INFLUENZA VACCINE  HAEMOPHILUS
ENCEPHALITIS VACCINE (Trivalent/Quadrivalent) INFLUENZA TYPE B
CONJUGATE VACCINE
(Hib)
 Given subcutaneously.  Trivalent influenza  Given IM.
 Given at a minimum age vaccine given IM OR SC.  Children age 12-59
of 9 months.  Quadrivalent influenza months: Unimmunized
 9 months to 17 years of vaccine given IM. or with one dose of Hib
age (Primary dose; 0.5  Given at a minimum age vaccine received before
ml). 12-24 months of 6 months, age 12 months, give 2
(Booster dose; 0.5 ml).  0.25 ml for children 6 doses of Hib vaccine 8
18 years and older months to 35 months. weeks apart.
(Single dose; 1ml).  0.5 ml children 36 to 18  Given 2 doses of Hib
years. vaccine before age 12
 Children 6 to 8 years months give an
receiving influenza additional dose.
vaccine for the first  Children > 5 y/o who
time should receive 2 received a Hib booster
doses separated by at dose during or within
least 4 weeks. If only 14 days of starting
one dose was given chemotherapy/radiatio
during the previous n treatment should
influenza season, give 2 receive a repeat dose of
doses of the vaccine the vaccine at least 3
then 1 dose yearly months after
thereafter. completion of therapy.
 9 to 18 years (1 dose of
the vaccine yearly).  Children who are HSCT
 Annual vaccination recipients should be
should begin in reimmunized with 3
February. doses of Hib vaccine. 6-
12 months after
transplant regardless of
vaccination history:
doses should be given 8
weeks apart.

 Unimmunized children
aged 15 months and
older undergoing
elective splenectomy,
give one of Hib
containing vaccine at
least 14 days before the
procedure.

 Give on dose of Hib

vaccine to
 unimmunized children
5-18 y/o who have
anatomic/functional
asplenia (including
sickle cell disease) and
HIV infection.

UPDATES FOR NIP TO EPI

1976 1979 1982 1992- 2010 2012 2013 2014 2015 2015
1993 and
beyond
EPI was OPV, Measles Hep B MMR Rotavirus PCV IPV HPV Dengue
launched BCG, vaccine vaccine pentavalent Flu PPV MR/TD JE
DPT, Dip-HepB- senior Cholera
and Hib citizen
TT