Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
COMMUNITY ORGANIZING PARTICIPATORY
ACTION RESEARCH
Definition
➔ COPAR is a process by which a
community identifies its needs and
objectives, develops confidence to act
in respect to them and in doing so,
extends and develops cooperative and
collaborative attitudes and practices in
the community.
➔ a collective, participatory,
transformative, liberate, sustained and
systematic process of building people's
organizations
➔ continuous and sustained process of
educating the people to understand
and develop their critical awareness of
their existing condition
Process
➔ sequence of steps whereby members of
a community come together to critically
assess to evaluate community
conditions and work together to
improve those conditions.
Structure
➔ Refers to a particular group of
community members that work
together for a common health and
health related goals.
Emphasis
1. Community working to solve its own
problem.
2. Direction is established internally and
externally.
3. Development and implementation of a
specific project that is important than
the development of the capacity of the
community to establish the project.
4. Consciousness raising involves
perceiving health and medical care
within the total structure of society.
Importance
1. COPAR is an important tool for
community development and people
empowerment as this helps the
community workers to generate
community participation in
development activities.
2. COPAR prepares people/clients to
eventually take over the management
of a development programs in the
future.
3. COPAR maximizes community
participation and involvement.
4. Community resources are mobilized for
community services.
5. It offers alternative solutions to health
problems that may not require modern
medical interventions.
Principles
1. People, especially the oppressed,
exploited and deprived sectors are
open to change, have the capacity to
change and are able to bring about
change.
2. COPAR should be based on the interests
of the poorest sectors of the society.
3. COPAR should lead to a self-reliant
community and society.
Methods Used
1. A progressive cycle of Action-Reflection-
Action-Session (ARAS)
2. Consciousness-Raising
3. COPAR is Participatory and Mass Based
4. COPAR is Group-Centered and Not
Leader-Oriented
CHARMEL FALCOTELO 1
Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
Functions of the Nurse as Community Organizer
1. Coordinates with the community and
organizes barangay units for health
clusters.
2. Coordinates with other health staff
members in planning and
implementing projects at the
community level.
3. Trains community researches and
community leaders regarding the
conduct of participatory action research
4. Ensures conducts of all identified
activities
5. Evaluates program implementation.
Critical Steps/ Activities in COPAR
1. Integration
➔ health care worker becomes one with
the people
2. Social Investigation
➔ Known as community study
➔ Systematic process of collecting,
collating, analyzing data to draw a clear
picture of the community
3. Tentative Program Planning
➔ CO to choose one issue to work on in
order to begin organizing the people
4. Groundwork
➔ going around and motivating the people
on a one-on-one basis to do something
on the issue that has been chosen
5. Meeting
➔ people collectively ratify what they
have already decided individually. The
meeting gives the people the collective
power and confidence. Problems and
issues are discussed.
6. Role Play
➔ means acting out the meeting that will
take place between the leaders of the
people and the government
representatives.
➔ It is a way of training the people to
anticipate what will happen and
prepare them for such eventuality
7. Mobilization or Action
➔ actual experience of the people in
confronting the powerful and actual
exercise of the people power
8. Evaluation
➔ the people reviewing the steps 1-7 to
determine whether they were
successfully or not in their objectives.
9. Reflection
➔ dealing with deeper on going concerns
to look at the positive values CO is
trying to build in the organization.
➔ It gives the people time to reflect on the
stark reality of life compared to the
ideal
10. Organization
➔ the people’s organization is the result of
many successive and similar actions of
the people. A final organizational
structure is set up with elected officers
and supporting members.
PHASES OF COPAR
1. Pre-Entry Phase
➔ initial phase of the organizing process
where the community organizer looks
for communities to serve and help
➔ Activities include:
1. Preparation of the Institution
2. Site Selection
3. Criteria for Initial Site Selection
4. Identifying Potential Municipalities
5. Identifying Potential Community
6. Choosing Final Community
7. Identifying Host Family
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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
2. Entry Phase
➔ Sometimes called the social
preparation phase.
➔ Is crucial in determining which
strategies for organizing would suit the
chosen community.
✓ Guidelines for Entry
✓ Activities in the Entry Phase
✓ Core Group Formation
3. Organization-building Phase
➔ formation of more formal structure and
the inclusion of more formal procedure
➔ given formal training to develop style
4. Sustenance and Strengthening Phase
➔ community organization has already
been established and the community
members are already actively
participating
MONITORING AND EVALUATING COMMUNITY
HEALTH PROGRAMS IMPLEMENTED
Designing and Implementing Evaluation Plan
➔ Monitoring and evaluation are closely
related.
➔ Monitoring which is done at the
implementation phase compares the
actual progress against what was
planned.
➔ The purpose is to identify deviations or
problems
➔ This implies reporting to appropriate
persons or offices at regular intervals.
What is Monitoring?
➔ Monitoring: defines as the continuous
or periodic review and surveillance by
management at every level of the
hierarchy of the implementation of an
activity to ensure that other required
actions are proceeding according to
plan
What is Evaluation?
➔ Evaluation: on the other hand is
analysis of the effectiveness, quality,
scope, and timeliness of services given.
Or simply, it is the collection and
analysis of information to determine
program performance.
Types of Evaluation
1. Formative
➔ Needs Assessment
➔ Determines who needs the
communication program/intervention,
➔ Involves audience research
➔ Process Evaluation
➔ Measures effort and the direct outputs
of programs/interventions
➔ Examines the process of implementing
the communication program/
intervention
➔ Results are used to
improve the program/intervention.
2. Summative
➔ Outcome Evaluation
➔ Measures effect and changes that result
from the campaign.
➔ Investigates to what extent the
communication program/intervention is
achieving its outcomes (short-term and
medium-term changes)
➔ Impact Evaluation
➔ Measures community-level change or
longer-term results.
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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
Reporting

Steps of Program Evaluation ➔ REPORTING takes place when two or

more people share information about
A. Decide what to evaluate
client care, either face to face or by
B. Design the evaluation Plan
telephone
C. Collect relevant data
➔ RECORDS
D. Analyze data
Health records refers to the forms on
E. Make decisions
which information about an individual
F. Report/Give Feedback
or family is recorded
➔ REPORTS
Documentation and Reporting these are account or statement
describing in detail an event, situation,
➔ These are all documents information, or like, usually as the result of
regardless of its characteristics, media, observation, inquiry, etc. a formal or
physical form and the manner it is official presentation of facts.
recorded or stored.
➔ Records function as evidence of Purpose of Records and Reports
activities.
1. Measure service/program directed to
➔ Express or presenting facts, data,
the clients
figures or other information in writing is
2. Provide basis for future planning
called records means written inf. of
3. Interpret the work to the public and
information.
other agencies, community
➔ Reporting and recording are the major
4. Aid in studying the conditions of the
communication techniques used by
community
health care providers.
5. Contributes to client care
Documentation
TYPES OF RECORDS
➔ DOCUMENTATION serves as a
permanent record of client information
1. Periodical A.) Permanent records
and care.
(cumulative)
➔ Documentation is defined as written
evidence of: B.) Temporary records
✓ The interactions between and (casual/daily records)
among health professionals, 2. Unit Based a.) individual
clients, their families, and Records (individual health
health care organizations. cards)
✓ The administration of tests,
procedures, treatments, and b.) related to family
client education. (family folders)
✓ The results or client’s response
to these diagnostic tests and c.) related to
community
interventions
(community folders)

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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
d.) National (national ✓ Stationary stock register
health program ✓ Daily diary, cumulative records
records)
3. Subject a.) economical 2. To be kept with the patient
Based (financial structure of - Kept under supervision of community
family, village) health nurse
✓ health record of school going
b.) social (records of
children
social structure)
✓ infant health card- maternal card
c.) Political ✓ tb patient card
✓ individual health card
d.) Medical and nursing ✓ Birth and death record
(treatment and ✓ Inpatient and outpatient record
medicine records) ✓ Eligible couple records
4. Collection a.) Collected at ✓ Movement register
Place Based institutions ✓ Medicine stock register
(records of
hospitals/ health
centers) IMPORTANT HEALTH RECORDS
3. Daily diary: daily activities of community
b) Records to be kept health nurse
with the individual 4. Village record: it consists of
(immunization cards, ✓ Name of village, distance from
disease cards) health center
✓ Total no of families
RECORDS RELATED TO COMMUNITY ✓ Total population
2 Categories: ✓ Religious beliefs
✓ No. of women under different
1. Records to be kept under health centers age group
✓ Family Folders ✓ No of trained dais
✓ MCH cards ✓ No of eligible couples
✓ Antenatal card/ postnatal cards ✓ Community health institutions
✓ Infant card anganwari etc
✓ Pre-school child card ✓ Schools, post offices, police
✓ Medicine distribution card stations, place of worship
✓ Family welfare records ✓ Means of transportation and
✓ Vital event records: birth and death communication
records ✓ Environment conditions
✓ General information records;
individual records, family, village,
map of community
✓ Other records: - antenatal records-
Medicine records- Monthly/ yearly
records- Consumable stock register

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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
Cumulative Records
➔ Cumulative means gradual increasing in
amount by one adding after another
➔ It is continuing record procedure
➔ Time saving, economical, review total
history of individual
➔ Evaluate progress for longer period
(nursing students clinical record)
Family Folder
➔ Condition and address of residence
➔ Name of head of family
➔ Religion and cast
➔ Name of family member
➔ Education, occupation, economic
status, diet, eligible couple,
environment.
Reports
➔ Account or statement describing in
detail an event, situation or like usually
as the result of observation, inquiry etc.
➔ A formal or official presentation of
facts
➔ Reports means fact findings
➔ Reports can be oral or written.
➔ Can be daily, monthly, quarterly, half
yearly and annual.
➔ Analytical aspect of a subject or services
is presented in a report.
TYPES OF RECORDS
1. Verbal Report
2. Written Report:
➔ In hospital important reports are;
24hrs reports
Night and day report
Supervision report
Patient census report
Accident report
➔ In Community:
Anecdotal reports
Monthly, quaterly, yearly or
annually reports
Evaluatory report
Importance of Records and Reports
➔ Assess health level of community.
➔ Helps in collecting data.
➔ Assessment and evaluation of work.
➔ Basis for formulating plans
➔ Tool or medium for health education.
➔ Determine needs of resources.
➔ Legal documentation
➔ Means of communication
➔ Provide information of good nursing
➔ Conduct training and research work
➔ Assess health problems.
Maintenance of Records and Reports
➔ Filling of records: Alphabetically,
numerically and geographically.
➔ Guidelines:
✓ Clear, appropriate and readable.
✓ Real or based on facts.
✓ Abbreviations and short forms
should be of standard.
✓ Sentences should be short and
clear.
✓ Signature of person filled records.
Precautions
1. Kept carefully.
2. Protected against termites and insects.
3. Good filling system
4. Easily available on time.
5. Kept at definite place.
6. Confidential
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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
protection, usually a few weeks or
months.
Community Profile
➔ Three ways of gaining passive
➔ Community (or stakeholder) profiles are immunity are either from:
a useful way of developing an 1. blood products
understanding of the people in a 2. through administration of
geographical area or a specific immune globulins
community of interest. 3. vertical transmission from
➔ This understanding can assist in the mother to newborn
development of a community
Active Immunity
engagement plan
➔ Profiles can illustrate the makeup of a ➔ Formed by stimulating the immune
community and could include system to produce cellular and
information about the diversity within antibody immunity.
the community. ➔ Ways of producing active immunity
➔ A community profile can also provide include:
information on the level of interest 1. Exposure to an infection or
community members may have in being disease, although infection
actively involved in a project and their does not lead to immunity
preferred method of engagement. in all cases.
2. Vaccination to produce
THE VACCINES IMMUNIZATION
immune responses similarly
What is Immunization?
evoked by natural infection
➔ Immunization is the process where a without the development of
person is made immune or resistant to the disease and its
an infectious disease, typically by the complications.
administration of a vaccine. Vaccines The immune response to
stimulate the body’s own immune vaccination is influenced by
system to protect the person against the:
subsequent infection or disease ✓ nature and dosage
of administered
➔ Immunity refers to protection from antigen
disease through the formation of ✓ route of
antibodies. There are two basic administration
mechanisms for acquiring immunity: ✓ adjuvants
✓ maternal antibodies
1. Passive Immunity ✓ age
2. Active Immunity ✓ nutritional status,
co-existing diseases
Passive Immunity ✓ other host factors
➔ Acquired through the administration of
products derived from human or
animals providing short-term

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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
Types of Vaccines
1. Live Attenuated Vaccines
➔ derived from wild viruses or bacteria
which are modified or weakened in
laboratories. Immunity is elicited by
replication of the attenuated organism
in the vaccinated person. The immune
response to a live attenuated vaccine is
identical to that induced by natural
infection.
➔ However, immuno-deficient or
immuno-compromised individuals may
only receive such vaccine with caution
as this may cause serious adverse
reactions as a result of uncontrolled
replications
➔ Currently available live attenuated
vaccines are those for TB (BCG), Oral
Polio, measles, mumps, rubella, and JE.
2. Inactivated Vaccines
➔ produced by growing the bacteria or
virus in culture media which are then
Consider the following:
subjected to heat or chemical agents.
In fractional or sub-unit form of these
vaccines, organisms are treated to be
able to derive those components
needed to produce the vaccines. Both
the inactivated or sub-unit preparations
must contain sufficient antigenic mass
to stimulate the desired response since
it is incapable of replicating inside the
host
➔ Forms of inactivated vaccines include:
✓ Whole viruses
✓ Whole bacteria
✓ Subunit or fractional vaccines
✓ Pure polysaccharides and
conjugates
✓ Toxoids
✓ Inactivated vaccines may not elicit
the range of immunologic response
provided by the live-attenuated
agents.
✓ Maintenance of long-lasting
immunity with inactivated viral or
bacterial vaccines often requires
periodic booster doses.
✓ Unlike live attenuated vaccines,
inactivated vaccines cannot
replicate in or be excreted by the
recipient as infectious agent.
Basic Principles in Immunization
Timing and Spacing of Vaccines
➔ Timing and spacing in administering
vaccines are the two most important
considerations in ensuring optimal
results
1. Multiple vaccines can be administered
at the recommended schedule and time
using different injection sites.
(i) the chance of clients coming back
for additional dose to prevent drop-
outs; and,
(ii) the capacity of the client to receive
multiple doses.
2. Two to three inactivated injectable
vaccines can be given in the same visit.
(i) Simultaneous administration of 2 live
vaccines can be given in same visit.
Example: Oral Polio and MMR
(ii) Two live parenteral vaccines can be
given together, with the 2nd dose of
the same vaccines usually administered
after 4 weeks.
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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
(iii) Longer interval between doses does not ➔ Take extra care not to trigger the gag-
reduce the effectiveness of the vaccine. reflex while administering the oral
It is not necessary to restart the series vaccine.
of any vaccine due to extended interval ➔ Do NOT administer or spray the vaccine
between doses. directly into the throat.
(iv) Vaccine doses should not be
administered at less than the 2. Subcutaneous Route (SC)
recommended minimum intervals or
earlier than the indicated minimum age.

Administration of Vaccines
➔ Appropriate method of vaccination is a
critical component of the NIP.
➔ Injections are administered into the
➔ As a vaccine provider, you must observe
fatty tissue underneath the dermis and
utmost professional care to ensure the
above the muscle tissue.
optimal immune response of the
➔ Recommended sites are the upper
recipient.
outer triceps of the arm.
1. Client Preparation and Care
3. Intramuscular Route (IM)
➔ Explain to the client how the vaccines
work, including safety and risk
➔ Make the vaccination least stressful to
the client and their parents or
guardians.

2. Infection Control
➔ Wash hands
➔ Wear gloves if necessary
➔ Proper disposal
Site and Route Administration
➔ There are four acceptable routes used
in the administration of vaccines.
1. Oral Route (Per Oral-PO)
➔ Administered into the muscle tissue
below the dermis and the subcutaneous
tissue.
➔ Mostly inactivated vaccines are
administered by intramuscular route.
➔ Administration through this site
depends on the individual’s age and
degree of muscle development.

4. Intradermal Route (ID)

➔ Administer the liquid agent slowly down

one side of the inside of the cheek
toward the back of the infant’s mouth.

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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
2. The following are reasons why specific
vaccines should NEVER be administered
➔ The vaccine is administered in between
and reasons why vaccines may be
the layers of the skin until a wheal
DELAYED for a short time.
appears.
➔ Reason for NEVER administering a
➔ This is the route of choice for only a
specific vaccine (Absolute
very limited number of vaccines such as
contraindications):
Bacille Calmette Guerin (BCG) against
an infant or person who has a history of
tuberculosis and post exposure rabies
anaphylaxis or a severe hypersensitivity
vaccination.
reaction during previous immunization
➔ For intradermal injection, insert a small
is an absolute contraindication to
thin needle (25 or 27 gauge) and 3/8 to
subsequent doses of a vaccine. Persons
3/4 inch (1-2 cm) underneath the skin
with a known allergy to a vaccine
to introduce the vaccine. The bevel
component should NOT be vaccinated.
should be facing upward

Administering multiple vaccines at the same time ➔ Reasons for DELAYING administering a
➔ If you are giving more than one vaccine: specific vaccine (Temporary
contraindications)
1. Do NOT use the same syringe for
more than one vaccine. 3. Report to supervisors IMMEDIATELY if a
2. As much as possible, do NOT inject reaction does occur upon vaccination.
the same arm or leg more than
once
3. Do NOT give more than one dose Vaccines Available in the Philippines and
of the same vaccine in one session. Recommended by DOH for use against VPDs
4. Give doses of the same vaccine at
the correct intervals.
5. Wait at least 4 weeks between
subsequent doses of OPV, DPT-
HepB-Hib (PENTA), and PCV.

Contraindications to Immunization
1. Contraindications and Precautions
➔ Contraindications: are conditions in the
recipient that greatly increase the
How safe?
chance of a serious adverse reaction.
➔ Precautions: are conditions in the
recipient that may increase the chance
of an adverse reaction or may impair
the ability of the vaccine to produce
immunity.
BCG (Tuberculosis Vaccine)
➔ BCG vaccine protects infants against
tuberculosis. The "BCG" stand for
Bacillus Calmette-Guérin.
➔ Safe vaccine with rare adverse events.
➔ Small raised lump appears at the
injection site, but usually disappears
within 30 minutes.
➔ After 2 weeks, The Vaccines 89 red sore
forms. The sore remains for another
two weeks and then heals.

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➔ Health workers look for this to
determine whether a child has been
vaccinated.
➔ Sometimes the glands in a child’s
armpit or near the elbow may swell or
develop an abscess.
➔ Swollen glands or abscesses occur
because an unsterile needle or syringe
was used, too much vaccine was
injected, or most commonly, the
vaccine was injected incorrectly under
the skin instead of on its top layer.
➔ Generalized infection due to BCG
vaccination occurs at a rate of 5 per
million doses of vaccine given.
How effective?
➔ Vaccination of uninfected children can
provide protection for more than 90%,
but the protective effect varies.
BCG (TUBERCULOSIS VACCINE)
Special ➔ Correct intradermal
Precautions administration is
essential.
➔ A special syringe and
needle is used to
administer BCG vaccine
Dosage 0.05 ml
Injection Outer upper arm or shoulder just
Site injection Site below the deltoid
Injection Intradermally
Type
Storage Store between +2°C to +8°C
(vaccine maybe frozen for
long-term storage but not the
diluent)
Hepatitis B Vaccine (HEP B)
➔ Hepatitis B vaccine protects against
Hepatitis B infection. The vaccine
contains only one antigen
(monovalent).
➔ Only monovalent HepB vaccine should
be used as a birth dose (within 24
hours). It is available in combination
and should not be used at birth, but
may be used in subsequent doses.
What are the forms and presentation of Hep B
vaccine?
➔ HepB vaccine is a cloudy liquid
provided in single or multi-dose vials or
in prefilled autodisable (AD) injection
devices.
➔ Hepatitis B vaccines are available in
single-dose and multidose glass vials.
➔ Multi-dose vials contain 2, 6, 10, or 20
doses.
How effective?
➔ Hep B is one of the safest and most
effective of vaccines.
➔ Studies show that it is 95% effective in
preventing chronic infection.
➔ For infants exposed through the mother
at birth, monovalent Hep B vaccine is
90% effective in preventing
transmission if the first dose is
administered within 24 hours and the
series completed at the recommended
intervals using the combination
vaccines.
HEPATITIS B
Type of Vaccine Recombinant DNA
No. of doses 1 dose
Schedule Give within 24 hours, ideally
90 minutes after birth.
Booster Not recommended
Contraindications No contraindications,
except if a very rare
anaphylactic
reaction has occurred. In
this case, Hep B should not
be given again.
Adverse Local soreness and redness,
Reactions rarely anaphylactic reaction
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Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
Special Birth dose must be given if 2. INACTIVATED POLIO VACCINE (IPV)
Precautions there is a risk of • Contains killed virus
perinatal transmission • Administered by injection
Dosage 0.05 ml • Highly effective
Injection Site ➔ For infants, Hep B • Used commonly in developed
vaccine is injected countries
usually into the • More expensive than OPV
outer part of the
• Requires trained health workers
mid-thigh.
• Provides immunity through blood
➔ For children and
adults, it is injected • Carries no risk of vaccine-associated
in the outer upper polio paralysis (VAPP) or vaccine-
arm. If more than derived poliovirus (VDPV)
one vaccine is
How effective?
injected at the
same time, ➔ In more than 95% of recipients, three
different sites doses of OPV produce immunity for all
should be used for of the poliovirus types in the vaccine.
each injection. ➔ IPV is also highly effective in preventing
Injection Type Intramuscular paralytic disease caused by all three
Storage Store between +2°C to
types of poliovirus but induces very low
+8°C.
levels of immunity in the intestine.
➔ As a result, when a person immunized
Polio Vaccine with IPV is infected with wild poliovirus,
➔ Polio vaccine protects against the the virus can still multiply inside the
poliovirus. intestines and be shed in the feces,
➔ 2 types of polio vaccines are used risking continued circulation.
throughout the world to provide
How safe?
immunity to poliovirus. One uses
inactivated (dead) poliovirus and the ➔ Both OPV and IPV are extremely safe.
other uses attenuated (weakened) ➔ With OPV, vaccine-associated paralytic
poliovirus polio (VAPP) can occur in approximately
1 in 2.7 million doses. VAPP usually
What are the forms and presentation of polio
occurs with the first dose of OPV, and
vaccine?
this small risk declines further with
1. ORAL POLIO VACCINE (OPV) subsequent doses.
• Contains live, attenuated (weakened) ➔ On rare occasions, over time, in areas of
virus low vaccination coverage, the live
• Administered by drops attenuated (weakened) viruses
• Inexpensive contained in OPV can begin to circulate
• Easy to administer and regain the ability to cause paralytic
• Provides mucosal/gut immunity cases. This is known as vaccine derived
• Protects close contacts who are poliovirus.
unvaccinated ➔ IPV is one of the safest vaccines in
routine use. No serious adverse events

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have been linked to it. Mild events
include injection site redness in less
than 1% of those vaccinated, swelling in
3%–11% and soreness in 14%–29%.
POLIO VACCINE
Type of Vaccine ➔ Live,attenuated
virus, oral (OPV)
➔ Inactivated virus,
injectable (IPV)
No. of doses 3-4 doses
Schedule (OPV ➔ 6, 10, 14 weeks
+IPV) Three OPV doses
initiated from six
weeks of age with
minimum interval
of four weeks;
➔ an IPV dose should
be given from 14
weeks of age (with
OPV dose).
Sequential (OPV ➔ 1–2 doses of IPV
& IPV) starting from two
months of age,
followed by at least
two doses of OPV;
➔ an interval of 4–8
weeks is required
between all doses
IPV Only Three doses beginning at
two months of age, with an
interval of 4–8
weeks between doses
Special Postpone vaccination if the
Precautions child has moderate to
severe illness (with
temperature ≥39 °C)
Booster Activities Supplementary doses given
during polio eradication
Contraindications Known hypersensitivity
(allergy) or anaphylaxis
Contraindications to a
previous dose
Adverse ➔ OPV – Rare vaccine-
Reactions associated paralytic
polio (VAPP)
➔ IPV – No known
serious reactions;
mild injection site
reactions do occur
Dosage ➔ OPV: two (2) drops
into the mouth;
➔ IPV: 0.5 ml
Injection Site ➔ For IPV left upper
thigh (outer part);
➔ OPV is given orally
through mouth
Injection Type For IPV - intramuscular
Storage ➔ OPV must be kept
frozen from -15°C
to -25°C.
➔ Do not freeze IPV. It
should be stored
from +2°C to +8°C
Pentavalent Vaccine (DPT+HepB+Hib)
➔ Protects against five diseases:
✓ Diphtheria
✓ Tetanus
✓ Pertussis
✓ Hepatitis B
✓ Haemophilus influenzae type b.
➔ The vaccine may come in single or multi
dose vials.
➔ Do not use DPT-HepB+Hib as a birth
dose.
➔ Available in liquid suspension for
injection which may be available in one
(1) -, two (2)- and 10-dose vials.
➔ Children who have a severe reaction
should NOT receive additional doses of
the vaccine.
➔ Mild reactions to the vaccine include:
(i) soreness, redness, or swelling
at the injection site, which
resolves within 1-3 days.
(ii) fever.
CHARMEL FALCOTELO 13
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Pentavalent Vaccine (DPT+HepB+Hib) ons (allergy) or anaphylaxis to a
Type of Pentavalent Vaccine previous dose
Vaccine Adverse Mild local and systemic
No. of doses Three doses (though Dipteria Reactions reactions are common
and Tetanus need booster Special Do not use as a birth dose
dose) consideration
Schedule 6, 10, 14 weeks of age (Penta1 Dosage 0.5 ml
with 6 wks minimum interval, Injection Site Right Outer Upper Thigh
while Injection type Intramuscular
Penta2 and Penta3 with 4 wks Storage Store between +2°C to +8°C.
interval after each dose) Never freeze the vaccine.
Booster ➔ For Tetanus vaccine:
Total childhood
schedule of five (5) Pneumococcal Vaccine
doses ➔ A pneumococcal vaccine is a vaccine
✓ 3 in infancy against Streptococcus pneumoniae.
✓ another (Td) ➔ Types include: (1) pneumococcal
in early conjugate vaccine and
childhood (1– (2) pneumococcal polysaccharide
6 years), vaccine.
✓ and another ➔ IPV is one of the safest vaccines in
(Td) during routine use. No serious adverse events
adolescence
have been linked to it. Mild events
(12–15 years)
include injection site redness in less
is required.
A further dose in than 1% of those vaccinated, swelling in
adulthood is likely to 3%–11% and soreness in 14%–29%.
provide lifelong
What are the forms and presentations of
protection.
Pneumococcal vaccine?
➔ For Diphtheria ➔ Pneumococcal Conjugate Vaccine
vaccine: (PCV13) – contains serotypes 1, 3, 4V, 5,
Total childhood 6A, 6B, 7, 9F, 14, 18, 18C, 19A, 19F and
schedule of 6 doses is 23F.
recently
➔ Pneumococcal Polysaccharide Vaccine
recommended by
(PPV) – contains serotypes 1, 2 , 3, 4, 5,
WHO.
✓ Three (3) 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14,
doses in 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F
infancy and 33F.
✓ 4th dose at 2
How safe?
years old
✓ two other ➔ Each pneumococcal vaccine protects
doses with Td against disease caused by the
vaccine at pneumococcal serotypes that it
school age. contains;
Contraindicati Known hypersensitivity

CHARMEL FALCOTELO 14
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➔ it is unlikely to protect against
serotypes that it does not contain. The
usage of these vaccines resulted in a
huge reduction in invasive
pneumococcal disease.
Pneumococcal Vaccine
Type of Vaccine ➔ Pneumococcal
Polysaccharide (PPV)
➔ Pneumococcal
Conjugate (PCV)
No. of doses PCV - three doses for infants.
PPV - one dose for adults.
Schedule ➔ PCV - 6, 10 and 14
weeks of age for
infants.
➔ PPV - At 60 and 65
years old for adults.
Contraindication Anaphylaxis or
hypersensitivity (allergy)
after a previous dose
Adverse Severe: none known
Reactions Mild: injection site reactions
and fever
Special Postpone vaccination if the
Consideration child has moderate to severe
illness (with temperature
≥39 °C)
Dosage 0.5 ml
Injection Site ➔ Anterolateral (outer)
part of the left thigh
(vastus lateralis) for
infants
➔ Upper arm (deltoid)
for adults
Injection type Intramuscular
Storage Store between +2°C to +8°C
Measles-Rubella (MR) and Measles-Mumps-
Rubella (MMR) Combination Vaccines
What are the MR and MMR vaccines?
➔ In the Philippines, the NIP uses
combination vaccines for measles,
rubella (MR) and for measles, mumps,
and rubella (MMR).
➔ MR and MMR vaccines are provided in
powder form with diluents and must be
reconstituted before they can be used.
➔ It is essential that only the diluent
supplied with the vaccine be used.
➔ MR and MMR vaccines should be kept
at +2ºC– +8°C after reconstitution. Any
remaining reconstituted vaccine must
be discarded after six hours or at the
end of the immunization session,
whichever comes first.
What are the forms and presentations of
Measles and Rubella containing vaccine?
➔ Measles and Rubella containing
vaccines are available as freeze dried
vaccine to be mixed with the diluent.
➔ Formerly these vaccines used to be
single antigen vaccines which contained
only Measles or Rubella vaccine,
however it is highly recommended to
use vaccines that contain both Measles
and Rubella with other antigen as per
the need and availability such as
Measles Rubella (MR), Measles Mumps
Rubella (MMR) or Measles Mumps
Rubella Varicella (MMRV).
How safe are MR and MMR vaccines and what
are their potential adverse effects?
Both MR and MMR vaccines are very safe to
use and may cause some rare adverse events as
described below:
➔ Mild events are more common and
include local injection site pain and
tenderness, (5%–15%), fever and rash
(in about 5%), which can occur 5 to 12
days after vaccination.
➔ Serious events are rare and include
anaphylaxis in 1–3.5 per one million
doses administered; severe allergic
reaction in one per 100 000 doses; and,
CHARMEL FALCOTELO 15
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RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
thrombocytopenia (decreased platelet
count) in one per 30,000 doses.
➔ Rubella-containing vaccine may cause a
temporary form of arthritis one to
three weeks after vaccination in up to
one in four post pubertal females (who
have already reached sexual maturity).
➔ Mumps containing vaccine may cause
parotid swelling (in 1%–2%).
Measles-Rubella (MR) and Measles-Mumps-
Rubella (MMR) Combination Vaccines
Type of Vaccine Live attenuated viral
No. of doses 2 doses
Schedule Childhood Dose of MMR: 9
months and 12 months
Booster In Philippines, booster dose
are given at school age
children at grade 1 and
grade 7.
Contraindication For Measles Containing
Vaccine (MCV)
• Known allergy to
vaccine components
• Pregnancy
• Severe congenital
or acquired immune
disorders, including
advanced HIV
infection/AIDS
Adverse Mild: fever, rash 5–12 days
Reactions following administration
Serious: Thrombocytopenia
(decreased platelets),
anaphylaxis, encephalitis.
Joint pain when rubella
containing vaccine (RCV) is
given to adult women;
parotitis with mumps
component.
Special None
Consideration
Dosage 0.5 ml
Injection site Upper arm
Injection type Subcutaneous
Storage Store between +2°C to +8°C
Rotavirus Vaccine
What is Rotavirus?
➔ usually found in stool
➔ rotavirus in intestine
➔ can cause vomiting and diarrhea in
children below 2 years old
➔ There's no specific treatment for a
rotavirus infection. Antibiotics and
antivirals won't help a rotavirus
infection. Usually, the infection resolves
within 3 to 7 days.
What is Rotavirus Vaccine?
➔ A rotavirus vaccine protects children
from rotaviruses, the leading cause of
severe diarrhea among infants and
young children.
➔ It contains genetically engineered live
attenuated human rotavirus strains or
hybrid human-bovine reassortment
rotavirus strains.
What are the forms and presentations of
Rotavirus vaccine?
➔ Rotarix™
Rotarix is a monovalent, human, live
attenuated rotavirus vaccine containing
one rotavirus strain of G1P[8]
specificity.
➔ RotaTeq™
RotaTeq is a live, oral pentavalent
vaccine containing five rotavirus strains
produced by reassortment.
How safe is Rotavirus vaccine and what are its
potential adverse effects?
➔ The available rotavirus vaccines are safe
and well tolerated.
➔ Mild adverse reactions include
irritability, runny nose, ear infection,
vomiting and diarrhea (in 5% or more of
children vaccinated).
CHARMEL FALCOTELO 16
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➔ There is a low risk of intussusception or
inversion of one portion of the intestine
within another portion (about one to
two per 100,000 infants vaccinated).
➔ Rotavirus vaccines are generally not
recommended for infants with a history
of intussusception.
Rotavirus Vaccine
Type of Vaccine Live attenuated virus, oral
No. of doses ➔ Two (2) doses
(Rotarix™);
➔ Three (3) doses
(Rotateq™)
Schedule Six (6) and 10 weeks of age
Contraindication ➔ Severe allergic reaction
to previous dose
➔ Severe
immunodeficiency (but
not HIV infection)
➔ History of uncorrected
congenital
malformation of
gastrointestinal (GI)
tract
Adverse Mild: irritability, runny nose,
Reaction ear infection, diarrhoea,
vomiting
Severe: intussusception
Special ➔ Should be postponed
Precaution for acute
gastroenteritis and/or
fever with moderate to
severe illness
➔ Not routinely
recommended if with a
history of
intussusception or
intestinal
malformations that
possibly predispose to
intussusception
Dosage 1 ml
Administration Oral
Storage Store between +2°C to +8°C
Japanese Encephalitis (JE) Vaccine
Japanese Encephalitis
➔ Cultex (vector)
➔ rapid onset/high fever, headache,
vomiting, convulsion, disorientation,
neck stiffness,spastic paralysis, coma,
death (rare to have severe symptoms)
➔ no treatment for viral infection but
treatment is supportive in relieving
symptoms
Japanese Encephalitis (JE) Vaccine
➔ Japanese Enchephalitis vaccine protects
people against viral enchepahilits
caused by Japanese Enchephaltis virus
(JEV).
➔ JEV is the leading cause of viral
encephalitis in Asia.
What are forms and presentations of JE
vaccine?
➔ Four vaccines for preventing JE are
currently available.
✓ Inactivated Vero cell derived
vaccine
✓ live attenuated vaccine,
✓ live recombinant vaccine
✓ Inactivated mouse brain
derived vaccine.
➔ The most commonly used one is live
attenuated powered vaccine mixed
with a diluent provided in a separate
vial by the manufacturer.
➔ Before it can be used, JE vaccine must
be reconstituted. The reconstituted
vaccine must be discarded after six
hours or at the end of the immunization
session, whichever comes first.
CHARMEL FALCOTELO 17
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RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
(brain disease),
uncontrolled
How safe is JE vaccine and what are its potential Adverse ➔ High fever
side effects? Reactions ➔ injection site
➔ JE vaccines are safe. reactions
➔ lowgrade fever
➔ Usual side effects.
➔ irritability
✓ High fever (in 5%–7% of those
➔ nausea
vaccinated) ➔ dizziness (rare)
✓ injection site reactions Special ➔ Medical history:
(redness, swelling: in less than Precaution caution needed for
1% with some types of vaccine) family or individual
✓ low-grade fever history of seizures or
✓ irritability other chronic
✓ nausea diseases, allergies
✓ dizziness (rare) and for women who
are lactating
Japanese Encephalitis (JE) Vaccine ➔ Postpone
Type of Vaccine Live attenuated virus vaccine vaccination for at
No. of doses 1 dose least three (3)
Schedule Single dose administered at months if the person
less than eight (8) months of has been given
age immunoglobulin
Booster The WHO states that the Dosage 0.5 ml
need for a booster in Injection Site & Upper arm/ Subcutaneous
endemic settings Type
has not been clearly Storage Store between +2°C to +8°C
established. However, most
of the countries
have adopted the one (1) Tetanus Diptheria (TD) Vaccine
dose schedule. ➔ Td is the tetanus diphtheria toxoid
Contraindication Known allergy to the vaccine vaccine.
or any of its components ➔ It is suitable for children older than five
➔ Pregnancy years old and adults, including pregnant
➔ Any condition that women. Td has the added advantage of
results in a protecting against diphtheria and
decreased or tetanus.
abnormal immune
system response, What are the forms and presentation of Td
➔ Acute diseases, vaccine?
severe chronic
diseases, and ➔ The vaccine can come in either as dT or
chronic diseases DT. The capital or small letter D
with acute signifies the amount of diphtheria
symptoms and/or toxoid in vaccine either high or low.
fever
➔ Encephalopathy

CHARMEL FALCOTELO 18
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Td should be given to
children 5-7 years old (Grade
How effective is the Td vaccine? 1) and 12-15 years old
➔ A three-dose course of Td provides (Grade 7).
protection against maternal and For pregnant women, Td
vaccine should be given as
neonatal tetanus for at least five years.
early as possible
➔ Five doses will protect women
upon onset of pregnancy.
throughout their childbearing years. For the prevention of
➔ When given to women of childbearing tetanus in women
age, vaccines that contain Td not only through their childbearing
protect women against tetanus, but years and in newborns,
also prevent neonatal tetanus in their women should receive five
newborn infants and act as booster for doses of tetanus toxoid. The
diphtheria. table below shows the
➔ When Td vaccine is given to a woman schedule by dose and the
who is or who becomes pregnant, the length of protection
antibodies that form in her body are provided.
Td can be used instead of TT
passed to her fetus. These antibodies
to protect against both
protect the baby against tetanus and
tetanus and diphtheria.
diphtheria during birth and for a few
months afterwards. ➔ Children (Grade 1
How safe is Td vaccine and what are its and Grade 7) who
had received three
potential side effects?
primary doses in the
➔ Mild reactions to Td vaccines include: form of PENTA
✓ Soreness should receive at
✓ Fever least two doses of Td
➔ Severe reactions, such as seizures, ➔ Pregnant women
neurological complications, and who had received
three childhood
anaphylaxis following Td vaccination are
DPT/PENTA doses
very rare.
should receive three
Tetanus Diptheria (TD) Vaccine doses of Td.
Type of Vaccine Toxoid ➔ Pregnant women
No. of doses 1 dose with no previous
Schedule Tetanus vaccine is given as DPT/PENTA
five (5)-dose schedule. immunization or
unreliable
Three (3) doses in infancy as immunization
Pentavalent and two (2) information should
doses in school age children receive 5 Td.
as Td. Contraindication There are no
After receiving primary contraindications to tetanus
doses during infancy (three toxoid. It is safe to give at
doses in the form of PENTA), any time, even in the first

CHARMEL FALCOTELO 19
Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
trimester of pregnancy.
However, PENTA, DT, and
Td should not be given to
individuals who have
suffered a severe
reaction to a previous dose.
Adverse Severe: rare anaphylaxis,
Reactions brachial neuritis
(inflammation
of the nerves that control
the shoulder, arm and hand)
Mild: injection site reactions
and fever
Dosage 0.5 ml
Injection Site & upper outer part of the arm/
Type Intramuscular
Storage Store between +2°C to +8°C.
Never freeze.
➔ When vaccines containing tetanus
toxoid are left standing for a long time,
the vaccine separates from the liquid
and looks like fine sand at the bottom
of the vial.
➔ Shake the vial to mix the vaccine and
liquid again before giving the vaccine.
➔ Td vaccine should never be frozen. The
“shake test” will determine if the
vaccine has been damaged by freezing.
➔ If the vaccine fails the shake test you
must discard it.
Human Papilloma Virus (HPV) Vaccine
➔ HPV vaccine is primarily used for
prevention of cervical cancer for
women.
➔ Other benefits are prevention of ano-
genital warts, vulvular, vaginal and
anal cancer and penile intraepithelial
neoplasia (precancerous disease of the
outer skin layer of the penis).
What are the forms and presentations of HPV
vaccine?
There are three available HPV vaccines:
1. Bivalent HPV vaccine
➔ contains types 16 and 18 L1 major
capsid protein, selfassembled as intact,
non-infectious virus-like particles
(VLP’s)
➔ manufactured in insect cells,
Baculovirus.
➔ adjuvanted with ASO4 (Aluminum
Hydroxide) plus monophosphoryl lipid A
derived from Salmonella minnesota.
2. Quadrivalent HPV vaccine
➔ Contains types 6, 11, 16, 18 L1 major
capsid protein, self-assembled as intact,
non-infectious virus-like particles
(VLP’s)
➔ manufactured in yeast, Saccharomyces
cereviseae
➔ adjuvanted with propriety amorphous
aluminium hydroxyphosphate sulphate.
3. Nonavalent HPV vaccine
➔ contains types 6,11,16,18,31,33,45,52
and 58 purified viral L1 protein
➔ manufactured in yeast, Saccharomyces
cereviseae
➔ adjuvanted with propriety amorphous
aluminium hydroxyphosphate sulphate.
How safe is HPV vaccine and what are its
potential side effects?
Potential side-effects and adverse events to the
vaccine include:
➔ Local reactions: 84% experience mostly
burning pain and swelling at the
injection site.
➔ Fever: 10% of vaccine recipients
CHARMEL FALCOTELO 20
Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
➔ Vasovagal syncope can occur among
adolescents and adults after receiving
the vaccine. If this happens:
✓ Clients should be observed for 15
minutes after receiving the vaccine.
✓ Recipients should always be seated
during vaccine administration.
Human Papilloma Virus (HPV) Vaccine
Type of Vaccine Recombinant
No. of doses 2 doses
Schedule Routinely given to females 9
to 10 years old.
Given in two (2) doses six
months apart
Contraindication Persons with history of
immediate hypersensitivity
to yeast or to any
vaccine component
Adverse ➔ Mild: injection site
Reactions reactions; fever,
dizziness, nausea
➔ Severe: rare anaphylaxis
Special ➔ Postpone vaccination for
Precaution pregnancy
➔ Adolescents should be
seated during injections
and for 15 minutes
afterwards since they
sometimes faint
Dosage 0.5 ml
Injection Site & Upper arm (deltoid) /
Type Intramuscular
Storage Store between +2°C to +8°C.
Protect from light
Seasonal Influenza Vaccine
➔ Most seasonal influenza vaccines are
trivalent, containing two strains of
influenza A and one strain of influenza
B, chosen based on known circulating
strains.
➔ The influenza vaccine, also known as flu
shot, is an annual vaccination using a
vaccine that is specific for a given year
to protect against the highly variable
influenza virus.
What are the forms and presentations of
Influenza vaccine?
There are two different types of flu vaccines,
trivalent and quadrivalent:
➔ Trivalent vaccines protect against two
influenza A viruses (an H1N1 and an
H3N2) and an influenza B virus.
➔ Quadrivalent vaccines protect against
two influenza A viruses and two
influenza B viruses.
How safe is Influenza vaccine and what are its
potential side effects?
➔ While there are side effects to the
vaccine, they are usually minor. The
safety is high.
➔ Side effects include runny nose and
sore throat, which can last for up to
several days.
➔ The flu vaccine in rare circumstances
may cause an allergic reaction which
needs immediate medical attention.
➔ Common side effects are mild and
temporary when compared to the
burden of hospitalization and deaths
during annual epidemics.
Seasonal Influenza Vaccine
Type of Vaccine Inactivated influenza virus
No. of doses Usually one dose to be given
annually
Schedule Adults 60 years of age or
older should get vaccine as it
becomes available in the
health center near you
ideally before flu season
Contraindication Known hypersensitivity
(allergy) or anaphylaxis to a
previous dose or to
a vaccine component such as
egg protein
CHARMEL FALCOTELO 21
Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
Adverse Mild: injection site reactions
Reaction and fever
Severe: rare anaphylaxis,
Guillain-Barré syndrome,
oculorespiratory
syndrome
Special May postpone vaccination in
Precaution case of moderate to
severe illness (with
temperature ≥39 °C)
Dosage 0.5 ml
Injection Site & Upper arm (deltoid) /
Type Intramuscular
Storage Store between +2°C to +8°C.

CHARMEL FALCOTELO 22
Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
➔ A person shall be considered as
engaged in the practice of medicine
Laws Affecting Practice of Public Health Nursing
who shall, for compensation, fee, salary
or reward in any form paid to him
Republic Act No. 7305 directly or through another, physically
examine any person, diagnose, treat,
➔ is known as Magna Carta for Public operate or prescribe any remedy for
Health Workers. any human disease, injury, deformity,
➔ This Act aims: physical, mental condition or ailment,
✓ to promote and improve the real or imaginary regardless of the
social and economic well-being remedy or treatment administered,
of health workers, their living prescribed or recommended.
and working conditions and
terms of employment; Republic Act 1082
✓ to develop their skills and
➔ the first Rural Health Act implemented
capabilities in order that they
in 1953
will be more responsive and
➔ It called for the employment of more
better equipped to deliver
physicians, dentists, nurses, midwives
health projects and programs;
and sanitary inspectors who will live in
✓ to encourage those with
rural areas where they are assigned to
proper qualifications and
help raise health condition of the barrio
excellent abilities to join and
people and thus help abate the still high
remain in government service.
incidence of preventable diseases in the
Republic Act No. 6713 country as a whole.

➔ March 25, 1983 known as the Code of Republic Act 9173

Conduct and Ethical Standards for
➔ "Philippine Nursing Act of 2002"
Public Officials and Employees.
➔ It is an act declaring the policy of the
➔ This code upholds a time honored
state to assure responsibilities for the
principle that public office is a public
protection and improvement of the
trust.
nursing profession instituting measures
➔ It is the policy of the state to promote
that will result in relevant nursing
high standards of ethics in public office.
education, humane working conditions,
Republic Act No. 6758 better career prospects and a dignified
existence for our nurses.
➔ standardized the salaries of
government employees which includes Republic Act 3573 in 1929
the nursing personnel.
➔ declared that all communicable
Republic Act 2382 diseases should be reported to the
nearest health station, and that any
➔ is known as the Philippine Medical Act. person may be inoculated,
➔ This Act defines the practice of administered, injected with
medicine in the country. prophylactic preparations.

CHARMEL FALCOTELO 23
Community Health Nursing
RLENCM104/ PPT-BASED/ MIDTERM REVIEWER
➔ These diseases include: actinomycosis,
acute anterior (adult or infant)
poliomyelitis, cerebro-spinal meningitis
(epidemic), diphtheria, food poising,
glanders, influenza, leprosy, malaria,
measles, plague, pneumonia, mumps,
opthalmia, neonatorum, tetanus,
trachoma, tuberculosis, typhoid,
paratyphoid fever, typhus fever, variola
or smallpox, varioloid, varicella,
viscount's angina, whooping cough and
yellow fever.
Republic Act 9211
➔ Tobacco Regulation Act. June 23, 2003
Republic Act 8976
➔ Philippine Food Fortification. November
7, 2000
Executive Order No. 2009.
➔ The Family Code of the Philippines.
➔ Presidential Decree No. 965 requires
applicants for marriage license to
receive instruction on family planning
and responsible parenthood.
Republic Act 7600
➔ Rooming-in and Breastfeeding.
➔ It provides that babies born in private
and government hospitals should be
roomed in with their mother to
promote breastfeeding and ensure
made and adequate nutrition to
children.
Organ Donation Act of 1991
Republic Act 7885
➔ Advance Corneal Transplantation in the
Philippines. Republic Act 7719 (May 5,
1994)- National Blood Service.
Republic Act 7875 (February 14, 1995)
➔ National Health insurance Act of 1995.
Presidential Decree No. 996
➔ requires the compulsory immunization
of all children below 8 years of age
against the six childhood immunizable
diseases.
Republic Act 6425
➔ known as the Dangerous Drug Act
➔ states that the sale, administration,
delivery, distribution and transportation
of prohibited drugs is punishable by
law.
Republic Act 8504
➔ Philippine AIDS Prevention and
Control.
➔ Ministry Circular No. 2's 1986 includes
Acquired Immune Deficiency Syndrome
(AIDS) as a notifiable disease.

Republic Act 9288

➔ Newborn Screening. April 4, 2004

Republic Act 9262 (March 8, 2004)

➔ Anti-Violence Against Women and the

Children. March 8, 2004

CHARMEL FALCOTELO 24