St.

Paul College of Ilocos Sur

(Member, St. Paul University System )
St. Paul Avenue 2727, Bantay, Ilocos Sur

NCM 104: Community Health Nursing I:

Individual and Family

Module 5

Expanded Program Immunization

Melanio P. Rojas Jr, MAN

Clinical Instructor
 St. Paul College of
Ilocos Sur
(Member, St. Paul
University System)
St. Paul Avenue 2727, Bantay, Ilocos Sur

DEPARTMENT OF NURSING

PRE-LEARNING ACTIVITY

PRE-TEST EXAMINATION: MODULE 5

NCM 104: Community Health Nursing I- Individual and Families as Clients First
Semester A.Y. 2020-2021

Melanio P. Rojas Jr. MAN

(Clinical Instructor)

Name: _________________________________________Score: _______________________________

Section: ________________________________________Date: ________________________________

New Schedule
ANTIGEN AGE DOSE ROUTE SITE
BCG At birth 0.05 1. Right Deltoid ( arm)
Hepatitis B 2. 3. IM 4.
DPT- HepB-Hib 5. 6. 7. 8.
Oral Polio Vaccine 9. 2 gtts Oral 10.
Anti-Measles 10. 9-11 months 11. 12. 13.
vaccine
Measles- mump 14. 15. 16. 17.
vaccine
Rotavirus 18. 19. 20. 21.
II. Identification

__________________________22. What RA which mandate infants and children Health Immunization

Act of 2011 covering vaccine preventable diseases added the six
immunizable diseases?
__________________________23. Provided for compulsory immunization against hepatitis B for infants
and children below 8 years old
__________________________24. How many percent is eligible population in estimating number of
infants?
__________________________25. The first dose of Rotavirus vaccine is administered only as early for
how many weeks?
__________________________26. Is a bacterium responsible for illness such as meningitis and
pneumonia?
__________________________27. Is a system for ensuring the potency of a vaccine form the time of
manufacture to the time it is given to an eligible client
__________________________28. Where will you going to store the diluents of the vaccine?
__________________________29. It refers to children who completed their immunization scheduled age
of 12-13 months
__________________________30. Are those who were given the complete vaccine before reaching one
year of age?

Modified True or False. If false underline the phrase/word then write the correct answer.
_________________________31. The first sequence of co-administration of vaccine is the Rotavirus.
_________________________32. OPV is administered by putting drops of the vaccine touching the
tongue
_________________________33. There is need to restart a vaccination regardless of time that has been
elapsed.
_________________________34. Use only one sterile syringe and needle for client
_________________________35. Administer the entire dose of Rotavirus vaccine slowly on both side of
the mouth
_________________________36. Only pentavalent hepatitis b vaccine must be used for the birth dose
_________________________37. In 2012 two new vaccines were introduced a part of EPI
_________________________38. Tetanus Toxoid is a weakened toxin
_________________________39. Protect the BCG from the light
_________________________40. If the expiry date has not passed, use the vaccine

Essay: Situational

41-50. Gemina de Walay, a public health nurse is administering BCG vaccine to Baby chuby Kate as per
scheduled at the RHU unit. The mother of Baby chuby kate complained to Gemina de Walay that
her baby developed Koch’s phenomenon which is an acute inflammatory reaction within 2-4 days.
What will be the management this kind of phenomenon?

50-60. Nurse Susa de Ambsoya is a dedicated nurse in Barrio Alakdana de Mama, she was assigned to
vaccinate the infants like the Tetanus Toxoid. Deus, a nursing student of Pokakang University
asked a question regarding the side effects of TT like local soreness at the injection site? What will
be the best response and intervention of Nurse Susa de Ambosyoa to Baby Boy Gerich in
managing the side effects?

61-65. Mashella de Plantita is the next heir of the throne of Barangay Bokbok. She was scheduled for her
vaccination. Jeff, a pediatric nurse from Hawaii is assigned to administer the MMR. Upon giving the
vaccine, Mashella de Plantita, the princess of Barangay Bokbok developed local soreness, fever,
irritability and malaise. What will be the management of Nurse Jeff in this situation?
IMMUNIZATION
Immunizable Childhood Illnesses
1. Tuberculosis- considered as one of the deadliest disease;
highly infectious chronic disease caused by tubercle bacilli.
a. Causative agents- M. Tuberculosis, M. africanum
b. Mode of transmission- airborne droplet
c. Source of infection- coughing, singing, sneezing
d. Incubation period- 6 to 12 months
e. Period of communicability- as long as tubercle bacilli
are discharged in the sputum
2. Measles- an acute highly communicable infection; death
may be due to complications also known as rubeola.
a. Causative agents- Paramyxoviridae morbillivirus
measles
 b. Mode of transmission- droplet spread, direct contact with infected person
c. Source of infection- secretions from nose and throat
d. Incubation period- 10-12 days until appearance of fever and about 14 days until
rash appears
e. Period of communicability- 9 days ( 4 days before and 5 days after appearance of
rash
3. Chicken pox- varicella infection
a. Causative agents- varicella zoster virus
b. Mode of transmission- direct contact, droplet spread
c. Source of infection- secretions from respiratory tract of infected persons
d. Incubation period- 2-3 weeks, average 13-17 days
e. Period of communicability- <1 day before and > 6 days after appearance of first
crop of vesicles
4. Diptheria- acute febrile infection of the throat, tonsils, nose, larynx or a wound
a. Causative agents- cornebacterium diptheriae
b. Mode of transmission- contact with person, carrier soiled articles, contaminated
milk.
c. Source of infection- discharges and secretions from mucosal surface of nose and
nasopharynx, skin and other lesions
d. Incubation period- > 2-5 days
e. Period of communicability- 2 weeks; seldom > 4 weeks
5. Mumps- epidemic parotitis ; contagious disease occurring in an epidemic form
a. Causative agents- Paramyxoviridae mumps virus
b. Mode of transmission- direct contact with person, contaminated articles, soiled
linens
c. Source of infection- oral and nasal secretions
d. Incubation period- 12-26 days, usually 18 days
e. Period of communicability- before parotid glands become swollen and remains
infective as long as any glandular swelling is present.
6. Pertussis ( whooping cough)- acute respiratory tract infection
a. Causative agents- Bordetella pertussis, B parapertussis
b. Mode of transmission- direct spread through respiratory and salivary contacts
c. Source of infection- discharges from laryngeal and bronchial mucus membrane
d. Incubation period- 7-10 days, not exceeding 21 days
e. Period of communicability- 7 days after exposure to 2 weeks after onset of typical
paroxysms
7. Tetanus- contamination of an unhealed stump of the umbilical cord
a. Causative agents- clostridium tetani
b. Mode of transmission- contamination of an unhealed stump of the umbilical cord
c. Source of infection- soil, dust, animal and human feces
d. Incubation period- 3 days to 1 month, on average 7-14 days
Immunization should begin anytime after birth and continue with the recommended
schedule. It helps to reduce morbidity and mortality among infants and children caused by the
childhood immunizable diseases- tuberculosis, hepatitis B, diphtheria, pertussis/whooping
cough, tetanus, poliomyelitis and measles.
The community health as the team leader must advocate the importance of
immunization by coordinating the proper schedule of immunization and monitor the target
groups to be sure that they are fully immunized.
A fully immunized child is one who has received 1 dose of BCG, 3 doses of Hepa B,
DPT, OPV and 1 dose of AMV at the scheduled time before the child reaches his birthday.
ADMINISTRATION OF VACCINES (OLD SCHEDULE)
Vaccine Dose Route SITE SITE Interval Side Effects Management
BCG 0.05 ID Right Tuberculosi Anytime 1. Koch’s 1. No
Live cc deltoid s after birth phenomenon management
Attenuated of the Leprosy ( acute needed
bacterial arm inflammation) 2. Incision and
vaccine 2. Deep drainage,
abscess/ apply INH
glandular 3. Treat with INH
enlargement Powder
with
suppuration.
3.
Indolent
ulceration
Hepa B 0.5 cc IM Upper Upper outer Within 24 1. Local 1. Apply warm
Plasma portion portion of hours to soreness compress
Derived of the the thigh maximum
thigh of 7 days
after birth; 6
weeks
interval
from 1st to
2nd dose & 8
weeks
interval
from 2nd
dose to the
3rd dose.
DPT 0.5 cc IM Upper Diptheria 6 weeks, 1. 24 hours 1. Give
DT- toxoid outer Pertussis with one fever antipyretics
portion Tetanus month 2. Local 2. Apply warm
of the interval soreness compress
thigh 3. Abscess 3. Incision and
4. Convulsions drainage
4. Do not continue
course of DPT

OPV 2 gtts PO Mouth Poliomyelitis 6 weeks, Usually none

Live with one
attenuated month
virus interval
vaccine

AMV 0.5 cc SC Left Measles & 9th month 1. Fever after 5 to 1. Give
Live outer severe 7 days antipyretics
attenuated part of Diarrhea lasts from 1 to
virus the arm 3 days
vaccine 2. Mild rashes
GOALS OF THE EXPANDED PROGRAM ON IMMUNIZATION AND SUPPORTING LEGISLATION

- To achieve the over-all EPI goal of reducing the morbidity and mortality among children against the
common mortality among children against the most common vaccine-preventable diseases, the
following laws has given the mandate of protecting children through immunization to the DOH and
LGUs.
• RA 10152, also known as Mandatory and Children Health Immunization Act of 2011. It
mandates basic immunization covering the vaccine-preventable diseases. Added to the
six immunizable diseases previously mentioned are hepatitis B, mumps, rubella,
diseases caused by Haemophilus influenza type B ( Hib), and other diseases determined
by the Secretary of Health in a department circular.
• It gives directives to government hospitals and health centers to provide for free
mandatory basic immunization to infants and children up to 5 years of age. This law has
repealed PD 996.
• R.A. 7846 provided for compulsory immunization against hepatitis B for infants and
children below 8 years old. It also provided for hepatitis B immunization within 24 hours
after birth of babies of women with hepatitis B.

The following are the specific goals of the program:

1. To immunize all infants/children against the most common vaccine-preventable diseases.

2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection. Presidential Proclamation No. 4 s. 1998 launched the Philippine
Measles Elimination Campaign.
4. To eliminate maternal and neonatal tetanus. Presidential Proclamation No. 1066, s. 1997
declared a national neonatal tetanus elimination campaign.
5. To control diphtheria, pertussis, hepatitis B and German Measles.
6. To prevent extrapulmonary TB among children.

SCHEDULE and MANNER OF ADMINISTRATION OF INFANT IMMUNIZATION

(Expanded Program on Immunization, Philippines)
Antigen Age Dose Route Site
BCG vaccine At birth 0.05 ml Intradermal Right deltoid region
( arm)
Hepatitis B vaccine At birth 0.5 ml Intramuscular Anterolateral thigh
muscles
DPT-HepB-Hib 6 weeks, 10 weeks, 0.5 ml Intramuscular
( Pentavalent 14 weeks
vaccine)
Oral polio vaccine 6 weeks, 10 weeks, 2 drops Oral Mouth
14 weeks
Anti-measles 9-11 months 0.5 ml Subcutaneous Outer part of the
vaccine ( AMV1) upper arm

Measles-mumps- 12-15 months 0.5 ml Subcutaneous Outer part of the

rubella vaccine ( upper arm
AMV2)

Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml Oral Mouth

VACCINE, THEIR CONTENTS AND FORM

(EXPANDED PROGRAM ON IMMUNIZATION, PHILIPPINES)
 Vaccine
BCG ( Bacillus Calmette-
Guerin)
Hepatitis B vaccine
DPT-HepB-Hib
( Pentavalent vaccine)
Oral polio vaccine
Anti- measles vaccine
(AMV1)
Measles-mumps-rubella
Rotavirus vaccine
Tetanus Toxoid
IMMUNIZATION SCHEDULE FOR INFANTS AND YOUNG CHILDREN
Contents
Live, attenuated bacteria
RNA- recombinant, using
Hepatitis B surface antigen
( HBs Ag)
Diptheria toxoid, inactivated
pertussis bacteria, tetanus
toxioid, recombinant DNA
surface antigen, and synthesis
conjugate of Haemophilus
influenza B bacilli.
Live, attenuated virus ( trivalent)
Live, attenuated virus
Live, attenuated viruses
Live, attenuated virus
Weakened toxin
Form
Free-dried, reconstituted with a
special diluent
Cloudy, liquid in an auto-disable
injection syringe if available
Liquid in an auto-disable
injection syringe
Clear, pinkish liquid
Free-dried, reconstituted with a
special diluent
Free-dried, reconstituted with a
special diluent
Clear, colorless liquid in a
container with an oral applicator
Sometimes slightly turbid in
appearance, clear, colorless
liquid and sometimes slightly
turbid

Immunization is an essential health intervention for eligible children and women, and this
service is available in all health facilities and institutions providing health services for women
and children nationwide. Wednesday is the designated immunization day in government health
facilities, unless otherwise revised by local traditions, customs and other expectations.

Infants are given this service according to the schedule and manner prescribed by the
DOH. Receiving the antigens at the earliest possible age reduces the chance of the child
getting infected or sick of the immunizable diseases. Administration of the hepatitis B vaccine at
birth reduces the chance of the child becoming a carrier.

In 2012, two new vaccines were introduced of EPI: Rotavirus vaccine and Hib vaccine.
Rotavirus infects the large intestine. It is the most common cause of severe diarrhea in infants
and children. Children between the ages of 6 and 24 months are at greater risk for developing
severe Rotavirus infection.
Hib is a bacterium responsible for serious illness, such as meningitis and pneumonia with
almost cases younger than 5 years old with those age 4 and 19 months of age especially
vulnerable.

The following considerations related to the schedule and manner of administration infant
immunizations:

1. Use only one syringe and needle per client.

2. There is no need to restart a vaccination series regardless of the time that has elapsed
between doses.
3. All the EPI antigens are safe and effective when administered simultaneously, that is
during the same immunization session but at different sites. It is not recommended,
however, to mix different vaccines in one syringe before, or 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 vaccine should be administered on
different sites. However, if more than one injection has to be given on the same lib, the
injection site should be 2.5-5 cm apart to prevent overlapping of local reactions.
4. The recommended sequence of the coadministration of vaccines is OPV first followed by
Rotavirus vaccine, then other appropriate vaccines.
5. OPV is administered by putting drops of the vaccine straight from the dropper onto the
child’s tongue. Do not let the dropper touch the tongue.
6. 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
given at birth. A monovalent vaccine is one that contains antigen against a single
disease. Pentavalent vaccine contains antigens against fever diseases, diphtheria,
pertussis, tetanus, hepatitis B, and Hemophilus influenza B.
7. Children who have not received AMV1 as scheduled and children who parents or
caregivers do not know whether they have received AMV1 shall be given AMV1 as soon
as possible, then AMV2 one month after AMV1 dose.
8. All children entering day care centers/ preschool and grade I shall be screened for
measles immunization. Those without the immunization shall be referred to the nearest
health facility for immunization.
9. The first dose of Rotavirus vaccine is administered only to infants aged 6 weeks to 15
weeks. The second dose is given only infant aged 10 weeks up to maximum of 32
weeks.
10. Administer the entire dose of the Rotavirus vaccine slowly down one side of the mouth
(between the cheek and gum) with the tip of the applicator directed toward the neck 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, light stroke the
throat downward motion to stimulate swallowing
11. BCG vaccines shall be given to all school entrants regardless of the presence or
absence BCG scar. Booster dose at school entry ( Grade 1) 0.1 ml ID R/L deltoid given
to all grade school pupils regardless of the presence or absence of a BCG scar.

EPI VACCINES

Preparations used in EPI are either inactive (killed) microorganism, attenuated

microorganisms, fragment from microorganisms like hepatitis B vaccine, or toxoids.
Attenuated vaccines are live microorganism that has been altered so that they are no longer
pathogenic, but are still antigenic. Toxoids are inactivated or altered bacterial exotoxins.
TARGET SETTING AND VACCINE REQUIREMENTS

The first specific goal of EPI in the Philippines indicates a target of 100% immunization of
infants/children against the most common vaccine-preventable diseases. At the RHU/Health
center level, the public health is responsible for preparing for vaccine requirements and
overseeing vaccine allocation. Vaccine requirements is calculated based on eligible on
population. The nurse uses the following formulas to estimate eligible population
 Estimated number of infants
= total population x 2.7%
Estimated number of 12 to 59 month old children= total population x 10.8%
Estimated number of pregnant women = total population x 3.5%

COMPUTATION OF VACCINE REQUIREMENTS

To compute vaccine requirements, use the following formula:

Vaccine requirement for the year= eligible population X number of doses X wastage
multiplier

The following are the given wastage multipliers for some EPI vaccines:
• DPT, OPV and tetanus toxoid=1.67
• Hepatitis B vaccine= 1.20
• AMV=2.00
• BCG=2.50
The wastage multiplier may also be computed using the following formula:

Wastage multiplier = Total number of doses per unit ( ampule or vial Number
of doses used
To convert the vaccine requirement for the year to number of units ( ampules, vials or
bottles), divided by number of doses per unit.

Sample Computation
To determine OPV requirements for a municipality with a total population of 12,000.

Eligible population= 15,000 x .027

= 405 infants
OPV requirement for the year= 405 infants x 3 doses
Infant x 1.67
= 2, 029 doses

There are 20 doses/bottle of OPV. To convert doses to bottles

Requirement for the year in bottles= requirement for the year in doses
number of doses per bottle

= 2,029 doses
20 doses per bottle
= 101.45 bottles
If requisition of immunization supplies is done monthly divide the number of bottles by 12

Monthly OPV requirements = 101.45 bottles

12
= 8.45 or 9 bottles per month

Note: A reserve stock of 25% of the supply period should be maintained at the facility.
MAINTAINING THE POTENCY OF EPI VACCINES

Vaccines confer immunity only when they are potent and to retain their potency vaccines,
must be properly stored, handled, and transported.

Maintain the cold chain

The cold chain is a system for ensuring the potency of a vaccine from time to time if
manufacture to the time it is given to an eligible client.

The person directly responsible for cold chain management at each level is called the Cold
Chain Officer. At the RHU/health center, the public health nurse acts as a Cold Chain
Officer. At the RHU/health center, the public health nurse acts as the Cold Chain Officer.
This means that the nurse is in charge of maintaining the cold chain equipment and
supplies, such as freezer/refrigerator, transport box, vaccines bags/carriers, cold chain
monitors, thermometers, and cold packs. The nurse implements an emergency plan in the
event of an electrical breakdown or power failure.

Maximum Storage and Transport Considerations

1. RHO -> PHO-> DHO-> 3 months
2. RHU- 1 month
3. Maximum transport period if with cold packs- 5 days

Discarding Unused Biologicals

1. Unopened or exposed vaccines may be put back in the refrigerator or freezer 2 x only;
discard after the third time.
2. BCG; discard after 4 hours.
3. HBV, DPT, OPV, AMV, TT: discard after 8 hours.

The EPI vaccines and its characteristics

Vaccines are substances very sensitive at various temperature. To avoid spoilage and
maintain its potency, vaccines need to be stored at correct temperature. Below are
recommended storage temperatures of EPI vaccines.
Type/Form of Vaccines Storage of Temperature

Most Sensitive to Heat Oral Polio ( live attenuated-)
Measles ( free dried)
Least Sensitive to Heat DPT/B
“D” Toxoid which is a
weakened toxin
“P” Killed bacteria
“T” Toxoid which is
a weakened toxin
Hepa B
-15◦C to- 25 ◦C ( at the
freezer)
-15◦C to- 25◦ C ( at the
freezer)
+2◦C to + 8◦C ( in the body of
the refrigerator
+2◦C to + 8◦C ( in the body of
the refrigerator
 BCG ( free dried) +2◦C to + 8◦C ( in the body of
the refrigerator
Tetanus Toxoid +2◦C to + 8◦C ( in the body of
the refrigerator
When handling, transporting and storing vaccines, special care must be given to provide quality
potent vaccine among the targets.

A first expiry and first out (FEFO) vaccine is practiced to assure that all vaccines are utilized
before its expiry date are done to identify those near to expire vaccines.
Temperature monitoring of vaccines is done in all levels of health facilities to monitor vaccine
temperature. This is done twice a day early in the morning and in the afternoon before going
home. Temperature is plotted every in a temperature monitoring chart to monitor break in the
cold chain.

EPI vaccines and the special diluents have the following cold chain requirements:
• OPV: -15 to 25◦C OPV has to be stored in the freezer. In the vaccine bag, OPV has to
be stored in the freezer. In the vaccine bag. OPV is placed in contact with cold packs.
• All other vaccines, including measles 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 nearly 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 so they should not be stored in the freezer. Wrap the containers of these
vaccines with paper before putting them in the vaccine bag with cold packs.
• Keep diluents cold by storing them in the refrigerator in the lower or door shelves.

Other considerations to Maintain Potency

• Observe the first expiry-first out (FEFO) policy.

• Comply with the recommended duration of storage and transport. At the health
center/RHU with a refrigerator, the duration of storage should not exceed one month.
Using transport boxes, vaccines can be kept only up to maximum of 5 days
• Take note if the vaccine container has a vaccine vial monitor and act accordingly. The
VVM is a round disc of heat-sensitive material placed on a vaccine vial to register
cumulative heat exposure. A direct relationship exits between rate of color change and
temperature: the lower the temperature; the slower the color change, the higher
temperature the faster the color change.
• Abide by the open-vial policy of the DOH. A multidose vial may be opened for one or two
clients if the health worker feels that a client cannot come back for the scheduled
immunization session. Multidose 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 immunization sessions for up to a
maximum of 4 weeks, provided that the followings conditions are met:
1. The expiry date has not passed.
2. The vaccine has not been contaminated.
3. The vials have been stored under appropriate cold chain conditions
4. The vaccine vial septum has not been submerged in water
 5. The VVM on the vial, if attached, has not reached the discard point
• Reconstitute free-dried vaccines such as BCG, AMV and MMR only with the diluents
supplied them.
• Discard reconstituted free-dried vaccines 6 hours after reconstitution or at the end of the
immunization session, whichever comes sooner.
• Protect the BCG from sunlight and Rotavirus vaccine from light.
Side effects and adverse reactions of immunization

Vaccine recipients or their parents/guardians should be informed of side effects or adverse

reactions of the vaccine (s) to be given. Adverse events should be monitored closely.

BCG injection results in the formation of a wheal that disappears within 30 minutes. After about
2 weeks, a small red tender swelling appears at the injection site, which ulcerates. The ulcer
heals by itself and leaves a scar. The whole course from vaccination to the formation of a scare
about 12 weeks. This is an expected response and does not require management. The side
effects of EPI vaccination and their management:

SIDE EFFECTS OF VACCINATION AND THEIR MANAGEMENT

(EXPANDED PROGRAM ON IMMUNIZATION)
Vaccines Side Effects Management
BCG Koch’s phenomenon acute No management is needed
inflammatory reaction within 2-
4 days after vaccination;
usually indicates previous
exposure to tuberculosis.
Deep abscess at vaccination Refer to the physician for
site; almost invariably due to incision and drainage.
subcutenous or deeper
injection.
Indolent ulceration; an ulcer Treat with INH powder
which persists after 12 weeks
from vaccination date.
Glandular enlargement: If suppuration occurs; treat as
enlargement of lymph glands deep abscess
draining the injection site
Hepatitis B vaccine Local soreness at No treatment is necessary.
the injection site.
DPT-HeB-HiB ( Pentavalent Fever that usually last for only Advise parents to give
vaccine) 1 day. Fever beyond 24 hours antipyretic
is not due to the vaccine but to
other causes
Local soreness at Reassure parents
the injection site. that soreness will
disappear after 3-4 days
 Abscess after a week or Incision and drainage may be
more usually indicates that necessary
the injection was not deep
enough or the needle was
not sterile
Convulsions: although very Proper management of
rare, may occur in children convulsions; pertussis given
older than 3 months; caused vaccine should not be
by pertussis vaccine. anymore.

None
OPV
Anti-measles Fever 5-7 days after Reassure parents and
vaccination in some children; instruct them to give
sometimes; there is a mild antipyretic to the
rash. child.

MMR Local soreness, fever, Reassure parents and

irritability and malaise in instruct them to give
some children. antipyretic to the
child.
Rotavirus vaccine Some children developed Reassure parents and
mild vomiting and diarrhea, instruct them to give
fever and irritability. antipyretic and Oresol to the
child
Tetanus Toxoid Local soreness at Apply cold compress at the
the injection site. site. No other treatment is
needed.
CONTRAINDICATIONS

In general, there are no contraindication to immunization of a sick child if the child is well
enough to go home. Sending children away and telling the mothers to bring them back for
immunization when they are well enough is a bad practice because it delays immunization.
Bringing the child back to the RHU/health center for immunization at another time may not be
easy for the mother leaving the child at risk of getting sick of an immunizable disease.

There are few absolute contraindications to the EPI vaccines. Do not give:
1. Pentavalent vaccine/DPT to children over 5 years old.
2. Pentavalent vaccine/DPT to a child with recurrent convulsions or another active
neurological diseases of the central nervous system.
3. 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.
4. Rotavirus vaccine when the child has a history of hypersensitivity to a previous dosage
of the vaccine, intussusceptions or intestinal malformation, or acute gastroenteritis.
5. BCG to a child who has signs and symptoms of AIDS or other immune deficiency
conditions or who are immunosuppressed.
Some conditions are considered false considerations. If they are seen in children, the
health worker may continue with the appropriate immunizations. These are:
1. Malnutrition, which should be considered as an indication conferred by immunization.
2. Low grade fever
3. Mild respiratory infection
4. Diarrhea. Children with diarrhea who are due to OPV should receive a dose of OPV
during the visit. However, the dose is not counted. The child should return when the next
dose of OPV is due.

EPI recording and reporting

EPI recording and reporting are accomplished using the FHSIS.

Fully immunized children ( FIC) are those who were given BCG, three doses of OPV, three
doses of DPT and Hepatitis B vaccine or three doses of Pentavalent vaccine, and one dose of
anti-measles vaccine before reaching one year of age.

Completely immunized children refer to children who completed their immunization schedule
at the age 12-13 months.

A child protected at birth is a term used to describe a child whose mother has received (a)
two doses of TT during this pregnancy provided that the second dose was given at least a
month prior to delivery; or (b) at least three doses of TT anytime prior to pregnancy with this
child.

General Principles Which Apply When Screening for Vaccination

1. It is safe and immunologically effective to administer all EPI vaccines on the same day at
different sites of the body.
2. Measles vaccine should be given as soon as the child is 9 months old, regardless of
whether other vaccines will be given on that day.
3. The vaccination schedule should not be started from the beginning even if the interval
between doses exceeded the recommended interval by months or years.
4. Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea, and vomiting are
not contraindications to vaccination. Generally, one should be immune unless the child is
so sick the he needs to be hospitalized. The hospital needs to decide on when to
immunize the child.
5. The following conditions are contraindications to immunizations:
•DPT₂ or DPT₃ to a child who has convulsions or shock within 3 days of the
previous dose.
• BCG vaccine to a child with clinical AIDS.
6. Repeat BCG vaccination if the child does not develop a scar after the first injection.
DUTIES AND RESPONSIBILITES OF THE CHN IN EXPANDED PROGRAM ON
IMMUNIZATION
The duties and responsibilities of the CHN in EPI will vary according to the type of organization
where he works:
1. Preparation of the clinical area, the treatment cart, trays, vaccine carriers, Early
Childhood Care and Development Card.
2. Assessment/screening of the child by taking the temperature, history of the child.
3. Preparation before actual immunization such as handwashing, checking of labels, and
expiry dates of vaccines.
4. Actual immunizations.
5. Post immunizations activities:
1.1. Record in ECCDC/HBMR/target client list.
1.2. Giving of health teachings/instructions to mother on the kind of immunization, its
side effects and follow-up visits.
1.3. Proper disposal of unused vaccines, used syringes, needles and vials
6. Cold chain logistics and management:
1.4. On collecting and transporting vaccines
1.5. Temperature monitoring
Body of Vaccine Refrigerator: +2 to +8 degree Celsius
Freezer -15 to -25 degree Celsius
1.6. Maintaining cold chain equipment
7. Proper stocking of vaccines in the refrigerator, transport boxes and vaccine carrier.
8. Management for cold chain emergency.
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