WEEK 8 6.

To prevent extra pulmonary tuberculosis among

Expanded Program On Immunization children.

 The Expanded Program on Immunization (EPI)

Goal
was established in 1976 to ensure that To reduce morbidity and mortality rates due to vaccine-
infants/children and mothers have access to preventable diseases
routinely recommended infant/childhood vaccines.
Six vaccine preventable diseases were initially
included in the EPI: tuberculosis, poliomyelitis,
Objective 1
diphtheria, tetanus, pertussis and measles. In Objective 2
Objective 3
1986, 21.3% “fully immunized” children less than To increase To provide additional
fourteen months of age based on the EPI coverage of protection to identified To achieve the
existing vaccines vulnerable groups country's
Comprehensive Program review. for targeted from other VPDs commitment to
population groups through evidenced- priority global
Background Of The National Immunization across the life- based new vaccines immunization goals
stage and technologies
Program (NIP)

 The last version of the Manual of Operations

(MOP) for the Expanded Program on Strategy 3 Strategy 4 Strategy 5
Strategy 2 Build-up
Immunization (EPI) was issued in 1995. As a Generate Strengthen
supervision,
Institute
surveillance supportive
reference, it guided health workers to deliver clients'
and response
monitoring
governance,
Strategy 1 demand and and
immunization services based on national protocols Expand the multi- sectoral evaluation
financing and
regulatory
and standards. It also helped EPI managers and package of support
immunization
for
measures
quality
supervisors coordinate different program immunization services
components at various levels of the health services and
scale up
system. coverage
Legal Basis Of The National Immunization Program
 EPI eventually became the National Immunization
Program (NIP), which covered wider segments of  The fundamental law of the land - the 1987
the population. To date, the NIP provides Philippine Constitution – says that "The State
immunity against 14 vaccine- preventable shall adopt a comprehensive approach to health
diseases (VPDs) from only six in 1976. It development which shall endeavor to make
expanded its population coverage beyond infants essential goods, health and other social services
and pregnant women to include school children, available to all people at affordable cost. There
adolescents/youth, senior citizens and those in shall be priority for the needs of the
special situations. Advances in immunization underprivileged, sick, elderly, disabled, women, and
technology resulted in safer vaccination children" (Article XIII, Section 11, 1987)
equipment and use of combined vaccines which  Presidential Decree (PD) No. 996 (September 16,
are easier to administer. The national government 1976) provides for compulsory basic immunization
budget for NIP increased from PhP 3 million in for infants and children below eight years old
early 2000 to almost Php 4 billion in 2016.  Presidential Proclamation No. 6, implementing
the Expanded Program on Immunization (EPI), in
National Immunization Program Goal, Objectives, response to the United Nation's goal of universal
Strategies child immunization by 1990.
 Proclamation No. 46 (September 16, 1992)
 The 2016-2021 comprehensive multi-year reaffirmed the Philippines' commitment to universal
strategic plan contains the following goal, goal of eradicating polio by 2000 through child and
objectives, strategies to be pursued by the mother immunization.
National Immunization Program.  RA No. 7846 (An Act requiring compulsory
immunization against Hepatitis B for infants and
Specific Goals: children below eight years old, amending for the
1. To immunize all infants/children against the most purpose Presidential Decree No. 996, December
common vaccine-preventable diseases. 30, 1994)) listed down basic immunization services
2. To sustain the polio-free status of the Philippines. to be provided. These include vaccination against:
3. To eliminate measles infection. (i) tuberculosis (TB), (i) dipththeria, pertussis and
4. To eliminate maternal and neonatal tetanus tetanus (DPT), (ii) poliomyelitis (administered
5. To control diphtheria, pertussis, hepatitis b and orally), (M) measles, (v) rubella, (v) Hepatitis-B in
German measles. newborns within 24 hours after birth, and (vii)
 provision of other basic immunization services for dried
Monovale
infants and children below eight years of age. -nt;
Measles-
duart
 DOH AO No. 39, s. 2003 (April 21, 2003) guided Rubella;
subcutaneo 10 should
Rubella attenuated and
the nationwide implementation of the EPI. Measles
us dose not be
from
(MR),
 RA No. 10152 (July 2, 2011) otherwise known as Mumps,
the Mandatory Infants and Children Health Rubella
(MMR)
Immunization Act of 2011 mandated the adoption Rotavir Liquid
of a comprehensive, mandatory and sustainable us
Vaccin
Rotavirus
Live
attenuated
oral
suspensi-
2 doses-
oral
1 dose No
immunization program against VPDs among all e on

infants and children under the age of five years. No but

These include vaccines against: (a) Tb; (b) DPT; JE
Vacci-
Japanese
Encephali-
Live
Lyophiliz-
ed
1 dose
subcutaneo- 1 dose
diluent
should
attenuated
(c) Poliomyelitis; (d) Measles; (e) Mumps; (f) ne tis powder us not be
frozen
Rubella or German measles; (g) Hepatitis B; (h) SBI [2
H. Influenza Type B (HIB); and (h) other types as doses] –
Intramuscul-
may be determined by the Secretary of Health. ar; WCBA [2
dose in 1st
 Republic Act No. 10152 “Mandatory Infants and TdVac Tetanus Inactivated:
Liquid
Multivale-
pregnancy
10
and 1 dose Yes
Children Health Immunization Act of 2011Signed cine Diphtheria toxoid nt
form: Td
in each
dose
subsequent
by President Benigno Aquino III in July 26, 2010. vaccine
pregnancy
The mandatory includes basic immunization for for 5 total
doses]–
children under 5 including other types that will be Intramuscul-
ar
determined by the Secretary of Health.
HPV Human 2 doses -
vaccin Papilloma Recombinant Liquid intramuscul 1 dose Yes
e Virus ar

Vaccines used in the NIP Influen

1 dose - 1 dose
-za
Influenza Inactivated Liquid intramuscul 10 Yes
Usual No. Vacci-
ar dose
of doses in ne
Co- Damag
Formulati primary
Vacci- Type of mmon -ed by
Disease -on (1st series and
ne Vaccine vial freezi-
column) route of
sizes ng!
administra-
tion Strategies:
Bacillus
Calmette-
 Conduct of Routine Immunization for
No, but
Tuberculos-
Guérin
Freeze- diluent Infants/Children/Women through the Reaching
BCG (BCG): live 1 dose- 20
is
attenuated
dried
intradermal dose
should
not be
Every Barangay (REB) strategy
mycobacteriu
m
frozen  Supplemental Immunization Activity (SIA)
Hepa-
bovis
 Strengthening Vaccine-Preventable Diseases
1 dose- 1 dose
B
Vacci-
Hepatitis B Liquid
Monovale
-nt
intramuscul 10 Yes Surveillance
ar dose
ne
Live
Polio (Oral
attenuated
2 drops per
10 Four vaccine
COPV dose
OPV Polio
contains 2
Liquid dose 3
20
No  BCG – TB for children
Vaccine) doses-oral
types of polio
virus
dose
 DPT – Diptheria; Pertusis; Tetanus
(Inactivated
Inactivated
whole-cell IPV 1 dose- 1 dose
 OPV – Oral Polio Vaccine
IPV Polio contains 3 Liquid Intramuscul 10 Yes  Measles vaccine
Vaccine) types of polio ar dose
virus.  1990 – introduce to the Philippines (Hepa B
Diphtheria,
Tetanus, vaccine)
PENTA
DPT-
Pertussis,
Hepatitis B,
Inactivated:
conjugate
Liquid 3 dose-
1 dose
2 dose
 PD 996 (Marcos) Compulsory Basic Immunization
lyophiliz- intramuscul Yes
HepB, Haemophilu polysaccharid
ed ar
10 to children below 8yrs old; Infant 0-12 mos old;
Hib s influenzae e vaccine dose
type b (Hib) School Entrants 6–7 yrs old
diseases
 PD 46 (Ramos) Universal Child and Mother
Inactivated
3 doses- 1 dose immunization
PCV Pneumonia Liquid intramuscul 10 Yes
conjugated
ar dose

Inactivated 1 dose- Route Of Administration, Dose, Type,

PPV Pneumonia polysacchari-
de
Liquid intramuscul
ar
1 dose Yes
And Appearance Of Vaccines
Freeze- Name
dried Vaccinati- How Appea-
Vacci- When given Dose Type
Monovale on site given rance
No but ne
nt, BCG Outer-upper At birth ID 0.05 ml Powd- White
diluent
Measles - measles- 1 dose- 1 dose arm er + cloudy
Live should
MMR Mumps- rubella subcutaneo 10 diluent liquid
attenuated not
Rubella (MR). and us dose with
be
measles- sedime
froze
mumps- -nt that
rubella Suspen
(MMR) -ds
MR Measles- Live Freeze 1 dose- 1 dose No but when
 shaken VACCINE
Hepa- (PCV)
White,
B Outer-upper Ready MEASLES, Measles,
At birth IM 0.5 ml cloudy
Vacci- thigh -to-use MUMPS, Mumps,
ne
liquid
RUBELLA German ü ü
Vial (MMR) Measles
Clear,
with
6, 10, 14 Oral pink or
OPV Oral 2 drops oral
weeks dropper orange
dropp-
er
liquid Immunization Schedule
Outer left  At Birth - BCG and HBV1
upper thigh
(with 2
Ready
Clear,
colorle
 6weeks old - DPT1, OPV1, Hib1, HBV2
IPV finger- 14 weeks IM 0.5 ml
breadth
-to-use ss
liquid
 10weeks old - DPT2, OPV2, Hib2
interval
from PCV)  14weeks old - DPT3, OPV3, Hib3, HBV3
White,
cloudy
 9mos old - Measles
liquid  12-15 mos old - MMR
PENTA with
DPT- Outer-right 6, 10, 14
IM 0.5 ml
Ready sedime  School entrants (6 – 7 years old) - 1 booster dose
HepB, upper arm weeks -to-use nt that
Hib suspen of BCG by ID in Left Deltoid -at 0.1ml.
ds
when - Indication: Scar
Outer left
shaken  Pregnant Mother – Tetanus Toxoid
upper thigh
Clear,
(with 2
PCV finger-
6, 10, 14
IM 0.5 ml
Ready colorle Tetanus Schedule % of Expected
weeks -to-use ss
breadth
liquid
protection duration of
interval protection
from ICV)
TT1 Anytime during 0% 0
Clear, pregnancy
Outer upper Ready colorle
PPV
arm
60-65 years IM 0.5 ml
-to-use ss TT2 After 1 month 80% 3
liquid TT3 After 6 months 95% 3
TT4 After 1 year 99% 10
Outer upper Powd-
Clear, TT5 After 1 year 99% For all
9 and 12 slightly
MMR arm (right
months
SC 0.5 ml er+
yellow
childbearing
arm) diluent age years and
liquid
possibly longer
Clear, (lifetime)
Powd-
Outer upper Grades 1 and slightly
MR SC 0.5 ml er+
arm 7 yellow
diluent
liquid

Rotavir Clear,
Contents Of Vaccine
Powd-
us
Vaccin
Oral
6 and 10
weeks
Oral
applicator
1 ml er+
colorle
ss
 LABOM – Live Attenuated Vaccine
e
diluent
liquid  BCG – Live attenuated Bacteria
Clear  OPV – Live attenuated Virus
or
JE Outer upper Powd-
slightly  Measles – Live attenuated Virus
Vacci- arm (left 9 months SC 0.5 ml er+
ne arm) diluent
whitish
turbid
 Diptheria/Tetanus – Bacterial inactived toxic/toxoid
liquid  Pertusis – Killed Bacteria
Td
White  Hepa B – RNA recombinants / Placing Derivatives
Vacci- Outer upper Grades 1 and Ready
ne arm 7
IM 0.5 ml
-to-use
cloudy
liquid
 TT – Bacterial inactivated toxoid/toxins
Clear
HPV or Preparations Of Vaccines
vaccin
e
Outer upper
arm
9-10 years old IM 0.5 ml
Ready
-to-use
slightly
whitish
 BCG
turbid
liquid
- Ampule
Influen - Freeze Dried
Clear,
-za
Vacci-
Outer upper 60 years old
IM 0.5 ml
Ready colorle - With special diluent
arm and above -to-use ss
ne
liquid  Measles
- Vial
NIREREKOMENDANG EDAD NG BATA
- Freeze Dried
BAKUNA
SAKIT NA
MAIIWASAN
PAGKA
PANGA
1 1/2
BUW-
2 1/2
BUW-
3 1/2
BUW-
9 BUW-
1 TAON
- With special diluent
AN
NAK AN AN AN
 Liquid Form Vaccines
BCG Tuberculosis ü - OPV
HEPATITIS B Hepatitis B ü - Hepa B
Diphteria,
PENTAVALE Tetanus, - TT
NT VACCINE Hepa B,
(DPT, Hep B, Pertusis, ü ü ü - DPT
Hib) Pneumonia,
Meningitis  Cold Chain System – to maintain potency of
ORAL POLIO vaccines
VACCINE Polio ü ü ü
(OPV)  Measle and OPV
INACTIVATE
D POLIO - (-15C to -25C)
VACCINE
Polio ü
(IPV) - 2 Most Sensitive to heat
PNEUMOCO
CCAL
Pneumonia,
Meningitis ü ü ü - Freezer
CONJUGATE  Body of the Ref (-2C - +8C)
 - DPT 3. Vomits everything
- Hepa B 4. Abnormally sleepy
 Least Sensitive to Heat  Check for malnutrition and anemia
- BCG  Check for immunization status
- TT  Check for vitamin A Status (Boost immune
system)
Four Contraindication To Vaccination  Symptoms:
 BCG – children with positive or symptoms to 1. Assess for cough or difficulty or breathing
AIDS/HIV 2. Assess for diarrhea
 DPT1 – to children with recurrent 3. Assess for fever
convulsion/neurologic disease 4. Assess for ear problem
 But child can receive DT
 Has neuro effect Summary Vitamin A Administration
 DP2, DPT3 – to children with 3 days convulsion or  Eight Condition:
shock after receiving DPT1  Severe pneumonia
 Do not immunized children before referral  Severe persistent diarrhea (SPD)
 Opened vaccines should be discarded after 4-6hrs  Persistent Diarrhea (PD)
 4-6hrs – BCG and Measles  Severe Complicated Measles
 Measles with Eye/Mouth Complication
 Measles
Week 9  Severe Malnutrition
Integrated Management and Childhood Illnesses  VLW/ Very Low Weight without feeding
(IMCI) problems
 An integrated approach to child health that  To prevent xerophthalmia, young children are given
focuses Retinol capsule every 6 months.
 on the well-being of the whole child  Preschoolers are given Retinol 200,000 IU every 6
 Holistic approach months.
 Aims to reduce death, illness and disability, and to  100,000 IU is given once to infants aged 6 to 12
 promote improved growth and development months.
among children under 5 years of age  The dose for pregnant women is 10,000 IU.
 Include bath preventive and curative
 Preventive prioritizes IMCI
Pink – Refer with preferred management
Global Partnership Yellow – specific Out-patient Management
 AHA Green – Home Management
 Kalusugang pangkalahatan
 Maternal/child/control and management Interventions
1. Assess other problems
ABC’s IMCI 2. Classifying conditions
 Active participation of the caregiver is encouraged 3. Treat the Child
 Based on a limited number of carefully selected 4. Give follow up Care
clinical signs 5. Follow up after
 Combination of clinical signs leads to a given  1 day - Jaundice
classification - Pathologic - Pink – Refer within 24hrs
 Decision making is based on: Integrated Care - Physiologic - Green – Follow up after 1day
Management Process  2 day (except for Ear Infection)
 Educate and counseling the caregiver to - Treatment for wheezing
recognize/assess sign can lead to effective and - Oral antibiotics
efficient management - Fever
 5 day - Cough and Cold /
The Process - Persistent Diarrhea - with feeding problem
 Identify the patient  14 day - Anemia when examine ( use palms)
 Ask fir the purpose of the visit/child problem  30 days – all children under 5 years old
 Ask for the patients age 6. Counsel the Mother
 Assess
 Check for the General Danger Signs The Client
before referral:  Remember: Only for under 5 years
1. Convulsion/seizure  Young infant: up to 2 months
2. Unable to drink or breast feed  Young Child: 2months to 12months
 Child: more than 12 months to before 5 years  Drug of Choice: Salbutamol (5days only)
 Route: Inhalation with a spacer
Fast Breathing
Young Infant: 60 bpm or more  To prevent Low Blood Sugar
Young Child: 50 bpm or more  Breast Feeding: 30-50ml
Child: 40 bpm or more  Sugar Water: 30-50ml
- if not able to swallow tube it only if the patient is
Cough or Difficulty Of Breathing conscious
 Chest Indrawing – Lower chest wall goes in  Before Departure:
when the child breath-in – Sugar Water
 Stridor – Harsh sound during inhalation 1. If Coughing for more than 3 weeks
 Wheeze – high pitched sound heard best during 2. Recurrent wheezing risk for Asthma
exhalation
 To prevent xerophthalmia
Severe Pneumonia  Young children are given Retinol capsule every
a. < 2months (Ventricular Septal Defect) 6 months.
 Management: – Preschoolers are given Retinol 200,000 IU
 Provide warmth due to risk for hypotension every 6 months.
b. CUVA, Chest indrawing, or stridor – 100,000 IU is given once to infants aged 6 to
 Management: 12 months.
 First dose of antibiotic – The dose for pregnant women is 10,000 IU.
 1st dose of Vitamin A, do not give if < 2mos
 Prevent hypoglycemia by means of Diarrhea
breastfeeding  3 or more loose stools in 24hrs
 Persistent – if 14 days or more
Pneumonia  Significant characteristic of stool
a. Fast Breathing
 Management: Agent Characteristi Drug of
 Give 3 days of oral antibiotic (1st line) c Choice
 Follow up after 2 days Amoebic E. hystolica Greenish Metronidazole
 Continue feeding mucoid
 Relieve the cough and soothe the throat Bacillary Shigella Bloody mucoid 1st line -
Ciprofloxacin
 Breast feeding
for 3 days
 TLC (Tamarind, Luya, Calamansi) 2nd line -
 IMCI: Nalidixic acid
1. Young Infant Violent Vibrio Rice watery Tetracycline
 Fast Breathing (60 bpm or more) Cholera stool
 Ventricular Septal Defect
 PINK Dehydration
2. Always not Pneumonia  DHN is a condition that can occur when the loss of
 YELLOW body fluids, mostly water, exceeds the amount that
is taken in.
NO Pnuemonia C-Test Severe Some No
a. Cough and Colds Dehydration Dehydration Dehydration
 Continue Feeding Condition Abnormal Restless and Well and
 Soothe Throat sleep pattern irritable alert
 Breast Milk and difficult
 TLC (Tamarind, Luya, Calamansi) to awake
Tongue Very dry Dry Moist
 Follow up after 5days
and Mouth
Eyes Sunken eyes Normal
Antibiotics Skin Pinch Goes back Goes back Goes back
a. Oral very slowly slowly (2 quickly (<2
 1st line – Amoxicillin (> 2 sec) sec) sec)
 2nd line – Cotrimoxazole Thirst Drinking Drinking Drinking
b. Parenteral (Early) poorly eagerly normally
 Intramuscular – Gentamycin & Benzyl Penicillin
 Intradermal– for Skin Test  IMCI:
1. Severe Dehydration
 To Treat Wheezing  <14 days
  PINK Amount 200-450 ml 450-800 ml 800-960 ml 960- 1600
ml
 >14 days
- Severe persistent diarrhea (with
signs of dehydration) Type C: IV Fluid Administration
 Blood  Type: Ringers Lactate (LRS), Normal Solution
- Dysentery (NSS)
2. Some Dehydration  PINK
 <14 days
 YELLOW Dengue
 >14 days  Affects the Platelet
- Persistent diarrhea (without signs  Causative Agent: Arbovirus
of dehydration)  Vector: Aedes Aegypti
3. No Dehydration  Day biter
 <14 days  Low flyer
 GREEN  Urban Area
 Dengue Hemorrhagic Fever
Oresol Re-hydration Therapy
 Extensive case management to diarrhea Malaria
 Oral Rehydration Solution  Affects the red blood cell
 Oresol Pocket (Hydrite)  Causative Agent: Plasmodium (Protozoa)
 Electrolytes within 2hrs  Vector: Anopheles Flavirostris
 Potassium Chloride  High biter
 Sodium Chloride  Flowing water
 Trisodium Phosphate  Rural area
 Glucose  Cerebral Malaria
 Home Made Oresol/ within 24hrs
Primary Treatment for Malaria
 Fluid resuscitation for severe hemorrhagic Fever
1 liter oresol 1 glass oresol
(PINK)
1 teaspoon of salt 1 pinch of salt
 Signs and symptoms:
8 teaspoon of sugar 2 teaspoon sugar
 Bleeding
1 liter water 1 glass of water  Cold and clammy extremities
 Sluggish capillary refill (>3 secs)
 RA 8172 – Asin Law  Abdominal Pain
 All human salt must be iodized salt  Persistent headache
 Tatak FIDEL  Persistent vomiting
 Fortification  Positive Tornique test
 Iodine - Inflating blood pressure cuff around the
 Deficiency upper arm to the point midway between the
 Elimination individual’s systolic and diastolic blood
pressure and leaving it inflated for 5 minutes.
Plan A: Home Management - Petechiae 20or more per 1 inch
 Give Extra Fluids  Laboratory:
 Breast Feeding or Breast Milk - Low Platelet count
 Oral Rehydration Solution - High Hematocrit
 Food Base - Blood Transfusion as needed
 Continue feeding
 Know when to return Fever
 Zinc Supplement  Dengue Hemorrhagic Fever unlikely (GREEN)
 GREEN
Malaria
Plan B: Reformulated Oral Rehydration Solution for  Malaria Risk Factor:
4 hours at the clinic 1. Overnight stay
 Give frequent small sips from cup if the child 2. Living near flowing stream
vomits 3. Blood Tranfusion within 6mos
 YELLOW 4. Trans-placental transmission
 IMCI:
Age Upto 4 4 months to 12 months 2 years to 5
months 12 months to 2 years years (Pink) – Severe Malaria
Weight Kg x 75ml Kg x 75ml Kg x 75ml Kg x 75ml (Yellow) – Malaria
(Green) – No malaria
  Home Management (Paracetamol, Anti-
No Malaria Unlikely histamine)
 IMCI:
(Pink) – Very Severe Febrile Disease (VSFD) Measles with Eyes and Mouth Complications
(Green) – Malaria Unlikely (Fever)  Signs and Symptoms:
 Mouth ulcer
Management:  Pus in the eyes
1. Pink
Severe Malaria Very Severe Febrile Management:
Disease  YELLOW
(+) Fever (+) Fever  Vitamin A
Stiff Neck Stiff Neck  Mouth – Gentian Violet
(+) CUVA (+) CUVA  Vitamin A
 Eye – Tetracycline eye ointment
 Give Quinine
 Give under medical supervision Severe Complicated Measles
 Risk for hypo-tension  Signs and Symptoms:
 Refer  Mouth ulcers (deep and extensive)
 Clouding of cornea
2. Yellow
(+) Malaria (-) Malaria Management:
(+) Malaria smear (-) Malaria smear  PINK
High fever No other symptoms  Vitamin A
 Gentian/Tetra
 Anti-malaria/schizonticides  Refer
a. 1st line (Arthemeter Lumefantrine)
 Requires 3 dose Dose of Vitamin A
 Advice high fat diet for proper absorption  6-11 months – 100,000 IU (Blue)
b. 2nd line (Chloroquine/Sulfadoxine)  12months-5years – 200,000 (Red)
 Give Chloroquine for 3 days
 Chloroquine is safe from pregnant Ear Problem
women  Ear Pain
 Give 1 dose of Sulfadoxine  Ear Discharge (<,> 14days)
c. If Falcifarum malaria (causative agent:  Tenderness behind the Ear (Mastoiditis)
Plasmodium falciparum)
 Give 1 dose of Primaquine Mastoiditis
Management:
3. Green  PINK
 Malaria Unlikely/No Malaria  1st dose of Antibiotic
 Give paracetamol for fever
Acute Ear Infection
Measles (Rubeola) Management:
 Results in viral exantem  YELLOW
 10 day measles  1 to 2 days or < 14days – oral antibiotics
 Signs and Symptoms: (Amoxicillin/Cotrimoxazole) for 5 days
 Fever  Follow up after 5days
 Cough
 Coryza Chronic Ear Infection
 Conjunctivitis  YELLOW
 Enanthem  2 ≥ 14days – otic antibiotics such as
- Inside quinolones/norefloxacin for 2 weeks
- Koplik Spots  Discharge: wicking 3 times a day
 Exanthem
- Outside No Ear Infection
- Rashes  GREEN

Management: Check for Malnutrition and Anemia

 GREEN  Parameters:
 Vitamin A  Palms of the Hands
 Severe Anemia  Sometimes referred to as “infectious” or
Paper white Severe
(Pink) “transmissible” diseases
Anemia
Pink tinged Some TYPES OF PATHOGENS
(Yellow)
No Anemia 1. Viruses - are tiny pathogens that contain genetic
Normal Normal material. Unlike other pathogens, they lack the
(Green)
complex structure of a cell.
Anemia 2. Bacteria are microscopic, single-celled organisms.
 Yellow They exist in almost every environment on earth,
 Management: including inside the human body.
 Iron supplementation (>3mos) 3. Fungi are a type of organism that includes yeasts,
 Albendazole (1yr old) every 6mos molds, and mushrooms. There are million trusted
 Mebendazole (1yr old) every 6mos sources of different fungi. However, only around
 14 days supplementation 300 cause harmful illnesses.
 Know when to return 4. Protozoa are microscopic organisms that typically
 Observe for visible severe wasting (Baggy Pants) consist of a single cell. Some protozoa are
 Weight for Age (Marasmus) parasitic.
 Edema of both feet (Kwashiorkor)
 Mid-upper arm circumference – 6mos above Contagious
110mm  Easily transmitted through direct or indirect mode
 Transmitted via:
Malnutrition a. Airborne - measles, pneumonia
1. Severe Malnutrition b. Droplet - Pulmonary Tuberculosis, Hepatitis A,
 PINK Diphtheria
 Parameters:
 Mid upper arm circumference – 110mm Infections
 Marasmus – both foot  Not easily transmitted
 Kwashiorkor – edema  Transmitted via:
2. Not Very Low Weight a. Blood Transfusion - AIDS, Hepatitis B.
 Home Management b. Sexual Intercourse (multiple sex partners)
 GREEN  Bacterial - gonorrhea, syphilis, STD
 Breast Feeding  Viral - AIDS, Hepatitis B
 Do not delay (within 60mins)  Fungal - Candidiasis
 Exclusive Breast Feeding (<6months, at  Protozoal - Trichomonas vaginalis
least 8-12 times a day, everyday for a c. Contaminated Article/Equipment - needles and
week, on demand with no water breaks syringes
 Dietary compliment (e.g. cereal based d. Placental Transfer
food)
6 months- 12 months- More than 2 Chain of Infection
12 months 2 years years
Breast
3 times 5 times 3 square
Feeding
meals +
Exclusive
nutritional
Breast 5 times 5 times
snacks
Feeding

Breastfeeding Act – RA 7600

Expanded Breastfeeding Act – RA 10028
Milk Code – EO 51

Week 10
Communicable Disease
 Communicable, or infectious diseases, are
caused by microorganisms such as bacteria,
viruses, parasites and fungi that can be
spread, directly or indirectly, from one person
to another. Some are transmitted through bites
from insects while others are caused by
ingesting contaminated food or water (WHO).
Causative/Infectious Agent
1. Pathogenicity - ability to cause disease
2. Virulence (disease severity) and Invasiveness
(ability to enter and move through tissue)
3. Infective dose - number of organisms needed to
initiate infection
4. Organisms specificity (host preference) D. Vector-borne Transmission (arthropods such as
antigenic variations flies, mosquitoes, ticks and others)
5. Elaboration of toxin
6. Viability - ability to survive outside the host Portal of entry
7. Invasiveness - ability to penetrate the cell 1. Respiratory tract (most common in man)
2. Gastrointestinal tract
Reservoir 3. Genito-urinary tract
 Natural habitat of the organism that is where 4. Direct infectious of mucus membrane/skin
resides and multiplies.
a. Human - man is the reservoir of the diseases Susceptible Host
that is more dangerous to humans than to  A person or animal or plant upon which parasite
other species. depends for its survival.
b. Animal - responsible for infestations with  Host Factors:
trophozoite, worms, etc. 1. Age, sex, genetic
c. Non-animal - street dust, garden soil, lint 2. Nutritional status, fitness, environment factors
from bedding. 3. General physical, mental and emotional health
4. Absent or abnormal Ig
Carrier 5. Status of hematopoetic system, efficacy of the
 Harbors the organism but w/o signs of infection Reticuloendothelial System (RES).
 Categories of Carrier: 6. Presence of underlying disease including Diabetes
1. Incubatory - no signs and symptoms Mellitus, lymphoma, leukemia, neoplasia,
2. Convalescent - disease subsided granulocytopenia, or uremia.
3. Intermittent - occasionally disseminate the 7. Patient treated with certain antimicrobials,
infectious organism corticosteroids, radiations, or immunosuppressive
4. Chronic - carrying the infectious organism for agents.
years.
I. GASTROINTESTINAL SYSTEM
Portal Of Exit 1. Amoebiasis
 Respiratory tract (most common in man)  Cause: Entamoeba Hystolitica – protozoan parasite
 Gastrointestinal tract  Mode of Transmission: fecal oral route, oralanal
 Genito-urinary tract sexual contact
 Open lesions  Incubation Period: 2-4 weeks
 Mechanical escape (includes bite of insects  Diagnostic Test: stool exam
 Blood  Treatment: Metronidazole (during date of
confinement)
Mode of Transmission  Signs and Symptoms:
 It indicates the potential of the disease;  Abdominal cramps
conveyance of the agent to the host, it can be by  Diarrhea,
common source transmission, contact source, air-  (+) tenderness at right iliac region
bome mansmission There are four main routes  Fatigue
of transmission:  Unintentional weight loss
A. By Contact Transmission  Nursing Management/Considerations:
1. Direct contact (person to person)  Adequate nutrition
2. Indirect contact (usually an inanimate object)  Fluid & Electrolyte balance
3. Droplet contact (from coughing, sneezing, or  Supportive management
talking, or talking by an infected person)  Preventive Measures:
B. By Vehicle Route (through contaminated items)  Immunization may be given (CDT– Cholera,
1. Food salmonellosis Diptheria, Typhoid fever)
2. Water shigellosis, legionellosis  Health teachings
3. Drugs - bacteremia resulting from infusion of a  Handwashing
contaminated infusion product  Proper sanitation
4. Blood - Hepatitis B
C. Airborne Transmission 2. Botulism
1. Droplet of nuclei
2. Dust particle in the air containing the infectious
agent
3. Organisms shed into environment from skin, hair,
wounds or perineal area.
 – Muscle Cramps
– Persistent vomiting
– Hypovolemia (if left untreated)
 Nursing Management/Considerations:
 Iv therapy & oresol (severe dehydration)
 Increased oral fluid intake
 Monitor input/output and vital signs
 Coconut water due to rich in
 Potassium
 Preventive Measures:
 Active immunization with CDT
A 14 year old with botulism. Note the weakness of his  Prevent unsanitary handling of food
eye muscle and the drooping eyelids in the image in  Boil water or treat with chlorine
the left, and the large an non- moving pupils in the right
image. 4. Typhoid Fever
 Cause: Salmonella typhosa (bacteria)
 Cause: Clostridium botulinum  Sources: fecal-oral route, direct/indirect
 Sources: Improperly processed /fermented food  Mode of Transmission: fecal oral route, oral-anal
 Mode of Transmission: ingestion, inhalation sexual contact
(rare)  Incubation Period: 1-2 weeks
 Incubation Period: 12-72 hours  Diagnostic Test: typhidot (confirmatory), rectal
 Diagnostic Test: stool exam swab
 Treatment: Botulinus antitoxin  Treatment: Chloramphenicol (upon date of
 Signs and Symptoms: confinement)
 Diplopia  Signs and Symptoms:
 Blurring of vision/Ptosis  Common:
 Dry mouth – Sustained ladder like fever
 Dysphagia – Headache
 Facial weakness – Loss of appetite
 Difficulty of breathing – Malaise
 Nursing Management/Considerations: – Diffuse abdominal pain
 Watch out for aspiration – Diarrhea or constipation
 Monitor respiratory & cardiac  Severe Symptoms:
 Functions – White coating on tongue
 Perform neurologic exam – Rose spots (macular leasions on abdomen,
 Ensure safety chest, limbs)
– Ulcers in intestine
3. Cholera – Enlarged liver, spleen, messenteric lymph
An infection of the small intestine nodes
It is spread mostly by unsafe food that has been – Microgranulomatous reaction (typhoid
contaminated with human feces containing the nodule) ileal wall
bacteria  Nursing Management/Considerations:
 Cause: Vibrio Eltor  Proper isolation
 Sources:contaminated food/water, feces  Standard precaution
 Mode of Transmission: ingestion of  Monitor Vital Signs
contaminated food/water  Watch out for internal bleeding/bowel
 Incubation Period: 12 hours – 5 days perforation
 Diagnostic Test: stool exam, rectal swab, blood
test (including BUN & creatinine) 5. Schistosomiasis (Snail Fever, Takayama)
 Treatment: Antibiotic (Tetracycline)  Cause: Schistosoma japonicum
 Signs and Symptoms:  Sources: Stool/urine of infected person
 Common:  Mode of Transmission: skin penetration, ingestion
– Watery diarrhea  Incubation Period: 2 weeks to 2 months
– Nausea and vomiting  Diagnostic Test: stool & urine test, circumoval
– Dehydration precipitation (COP test) as confirmatory
 Severe Symptoms:  Treatment: Praziquantel, wear boots
– Tachycardia- rapid heart rate  Signs and Symptoms:
– Hypotension- low blood pressure  Fever
– Washer woman hands  Swimmer’s itch
  Blood in stool
 Abdominal pain & diarrhea
 Liver enlargement (portal hypertension)
 Spleen enlargement

II. INTEGUMENTARY
1. Measles (Rubeola, 7 Day Measles)

 Pre-eruptive Stage
– Low grade fever
– Forcheimer’s spot-fine red spot on soft
palate
– Mild cough
 Erupted Stage
– Pink red maculopapules (smaller than
measles)
– Cephalocaudal
 Cause: Paramyxo virus – Rash covers within 24 hrs
 Sources: Ssecretion of infected person – Lymphadenopathy
 Mode of Transmission: direct contact  Post-eruptive Stage
(droplet/airborne), indirect contact (w/ – Rash disappears on the 3rd day
contaminated surfaces) – No peeling
 Incubation Period: 10-14 days – Large nodes will subside
 Diagnostic Test: Nose & throat swab, blood – May cause congenital deformities (if
exam pregnant)
 Signs and Symptoms:  Management:
 Pre-eruptive Stage  Isolation
– High fever for 4 days  Antipyretic for fever
– Coryza-Rhinitis  Bed rest
– Conjunctivitis- Stimson sign with Photophobia  Preventive Measures:
– Koplik’s spot (Pathognomonic sign)  Anti-Measles Vaccine
 Erupted Stage  Mmr (Measles, Mumps, Rubella)
– Maculopapular rash
 Post-eruptive Stage Measles Versus German Measles
– Rash would last from 5 to 6 days then fades Measles German Measles
 Management Caused by a virus which Caused by a virus which
 Isolation specifically infects the invades the lymph
 Antibiotics and antipyretic respiratory system nodes, skin and eyes
 IV fluids More severe and can e Benign or milder disease,
 Skin care life threatening but pregnant woman
 Rest should be cautious
 Preventive Measures: Results in red or reddish- Include red spots with a
 Anti-Measles Vaccine brown rash white center known as
 Mmr (Measles, Mumps, Rubella) Koplik spots, in oral
cavity
2. German Measles (Rubella, 3 Day Measles)
3. Herpes Zoster (Shingles)
Cause: Rubella Virus/Togavirus
Mode of Transmission: Droplet & airborne,
indirect/direct
Incubation Period: 2 to 3 weeks (most
infectious/contagious: 1 to 5 days)
Diagnostic Test: Blood exam
Treatment: Symptomatic approach
 Signs and Symptoms:
  Preventive Measures:
 Avoid skin to skin contact
 Clean surroundings
 Good personal hygiene

5. Leprosy (Hansen’s Disease)

 Cause: Varicella Zoster Virus

 Mode of Transmission: Direct contact to fluids of
blister, airborne/droplet
 Incubation Period: 2-3 weeks ( 13 to 17 days)
 Diagnostic Test: Direct fluorescent antibody test,
polymerase chain reaction
 Treatment: Acyclovir (upon date of confinement),
pain reliever & anti-inflammatory drugs
 Signs and Symptoms:  Cause: Mycobacterium leprae
 Fever & general weakness  Mode of Transmission: Unknown (possible: direct
 Pain, burning, & tingling sensation contact, airborne/droplet)
 Skin rash (localized on one side)  Incubation Period: Average is 5 yrs
 Fluid-filled blisters  Diagnostic Test: Slit skin smear, skin biopsy
 Preventive Measures:  Treatment/Management: Multi-drug therapy,
 Life attenuated zoster vaccine isolation, and skin care
 Avoid exposure to infected person  Signs and Symptoms:
 Skin lesion
4. Scabies  Sensory loss (classic characteristic)
 Thich & painful nerves
 Red & dry eyes
 Large ulceration, facial disfigurement, &
contractures (late stage)
 Preventive Measures:
 BCG vaccine

III. VECTOR BORNE DISEASE

1. Dengue Fever
 Cause: Flaviviridae family (dengue virus 1,2,3, & 4)
 Mode of Transmission: bite form am infected
female mosquito from the species of Aedes aegypti
 Incubation Period: 4-10 days
 Signs and Symptoms:
 Mild
 Cause: Human itch mite (Sarcoptes scabiei) – High grade fever (40C or 104F)
 Mode of Transmission: Direct contact – Severe Headache
 Source: Human skin – Muscle & joint pains
 Incubation Period: 2-6 weeks – Nausea & vomiting
 Diagnostic Test: Skin scraping – Swollen glands
 Treatment: Permethrin cream, benzyl benzoate – Skin rashes
lotion, sulfur ointment, antihistamine or steroid  Critical phase:
cream, ivermectin – Fever below 30C or 100F
 Signs and Symptoms: – Severe abdominal pain
 Relentless itching – Persistent vomiting
 Burrow raised lines in the skin – Blood in the vomitus
 Pimple like rashes – Bleeding gums
 – Fatigue  Antimalarial medicines as chemoprophylaxis:
– Rapid breathing – Sulfadoxine - pyrimethamine
– Restlessness
 Diagnostic Test: 3. Lymphatic Filariasis (elephantiasis)
– Virological method: RT-PCR test
– Serological method:  Cause:
– Enzyme-linked Immunosorbent Assay  Nematodes (roundworms) of family
(ELISA) IgM and IgG Filariodidea
– Torniquet test  Wuchereria Bancrift (common)
– Complete Blood Count (CBC)  Brugia malayi
 Management:  Brugia timori
 Acetaminophen or Paracetamol  Mode of Transmission: Mosquito bite (Culex,
 Increase hydration Anopheles, & Aedes)
 Blood transfusion (if necessary)  Incubation Period: as short as 4 weeks or as long
 If (+) epistaxis apply ice pack on the bridge of as 8-16 months
the nose  Signs and Symptoms:
 Diet: low fat, low fiber and No Dark Colored  Lypmhagitis
Foods  Lymphoedema
 Elephantiasis of limbs
2. Malaria  Hydrocele
 Cause:  Lymphadenopathy
 Plasmodium Falciparum (most common)  Diagnostic Test:
 Plasmodium vivax  Blood smear
 Plasmodium malariae  Physical Exam
 Plasmodium ovale  Treatment:
 Mode of Transmission:  Mass drug administration
 Bite form an infected female Anopheles – Albendazole
mosquito – Ivermectin
 Blood transfusion – Diethylcarbamazine citrate
 Transplacental transmission  Prevention:
 Incubation Period: 10-15 days  Vector control
 Signs and Symptoms:  Insecticide - treated mosquito nets
 Initial  Indoor residual spraying
– Fever  Persona protective measures
– Headache
– Chills 4.Leptospirosis
– Myalgia  Cause: Leptospira interrogans
– Profuse sweating  Mode of Transmission:
 Severe malaria  Direct contact with the urine of infected animals
– Severe anemia (rodents, dogs, pigs, horses, livestock or
– Respiratory distress wildlife)
– Cerebral malaria  Urine-infected environment
 In adults  Incubation Period: 7-10 days
– Multi-organ failure  Signs and Symptoms:
 Diagnostic Test:  First Phase
 Blood smear – Fever and chills
 Polymerase Chain Reaction test – Jaundice
 Complete Blood Count & Blood chemistry – Headache
 Prevention: – Myalgia
 Two forms of vector control: – Nausea & Vomiting
– Insecticide - treated mosquito nets  Second Phase
– Indoor residual spraying – Kidney or liver failure
– Respiratory distress
– Meningitis
 Diagnostic Test:
 Enzyme-linked Immunosorbent Assay (ELISA)
IgM
 Microscopic agglutination test (MAT)
 Polymerase chain reaction (PCR) test
 Prevention:
 Avoid exposure to floodwater
 Do not eat foods that exposed to rodents or
possibly contaminated with their urine
 Environmental sanitation and proper drainage
system
 Health education
 Treatment:
 Doxycycline
 Penicillin

IV. CNS DISEASES

1. Rabies
 Cause:
 Rabies virus  Cause: Clostridium tetani
– Rhabdovirus family  Mode of Transmission: Punctured wound
 Mode of Transmission: Saliva of infected  Incubation Period: 3-21 days
animals (bite/open wound or mucus membrane)  Signs and Symptoms:
 Incubation Period: 2-3 months  Jaw cramping
 Muscle spasms
Categories Of Bites  Painful muscle stiffness
 I – intact skin (lick)  Intermittent tonic seizures
 II – mucosal, non bleeding wound, abrasions  Difficulty swallowing
 III – bleeding bites, above neck, stray dogs,  Trismus – lock jaw
laceration, multiple bites  Risus sardonicus – distortion of the corners
of the mouth
 Signs and Symptoms:  Opisthotonus - arching of the back
 First Phase  Diagnostic Test:
– Irritability  Physical exam
– Excessive movement or agitation  Medical and immunization history
– Extreme sensitivity to light and sound  (+) Hallmark manifestations
– Confusion  Nursing Management:
– Muscle spasms  Maintain an adequate airway and ventilation
– Aerophobia & hydrophobia  Suction as needed and watch out for
 Paralytic Phase: respiratory distress
– Quiet & unconscious  Monitor for arrhythmias
– Cessation of spasm with progressive  Provide adequate fluid and nutrition
paralysis  Administer muscle relaxant, antibiotics, and
– Tachycardia tetanus immunoglobulin (TIG) as ordered
– Respiratory paralysis  Provide a safe, dim, and quiet room
– Heart failure  Aseptic wound care technique
 Diagnostic Test:  Medical Management:
 Direct fluorescent antibody (DFA) test  Epinephrine or corticosteroid
 Nursing Management:  Penicillin
 Isolate the patient and provide dark room with  Diazepam
a quiet environment  Prevention:
 Observe proper hand washing 1. Active immunization: DPT
 Should not be bathed & no running water 2. For pregnant: 2 doses given at 2nd trimester with
 Aseptic wound care technique one month interval
 Monitor cardiac and respiratory function 3. For non pregnant: 5 doses are given
 Medical Management:  1st dose - upon discharge
 Treat with post exposure prophylaxis  2nd dose - after 1 month
 Active immunization through anti-rabies  3rd dose - after 6 mos
vaccine (Hyperrab or Imogam)  4th dose - after 1 year
 Management of the Biting Animal:  5th dose - after 1 year
 If aggressive – kill and head goes to lab
 If calm - observe 4. Poliomyelitis (Infantile Paralysis)

2. TETANUS (LOCK JAW)

 1. Primary – presence of single or multiple sores
(chancre) at the site of infection
 Cause: 2. Secondary – it include skin rash, swollen lymph
 Poliovirus nodes, and fever
– Legio debilitans (happens below 10 y/o) 3. Tertiary – associated with severe medical
– Legio brunhilde (fatal) - permanent problems
– Legio lansing and Legio leon - temporary
 Mode of Transmission: direct contact with  Diagnostic Test:
infected oropharyngeal secretions or feces  Physical examination
 Incubation Period: 7-21 days  Lumbar puncture/Spinal tap
 Signs and Symptoms:  Darkfield microscopy
 Initial  Blood test: Nontreponemal and treponemal test
– Fever  Treatment:
– Fatigue  Penicillin
– Headache  Doxycylline
– Vomiting  Prevention:
– Stiffness of the neck & pain in the limbs  Abstain or practice safe sex
 Report cases
Note:  Health education
 1 in 200 infections, leads to irreversible  For pregnant women: should be tested for
paralysis. Usually in the legs. syphilis at the first prenatal visit
 Among those paralyzed, 5% to 10% die when
their breathing muscles become immobilized 2. Gonorrhea

 Diagnostic Test:
 (Specimen: throat, stool, & cerebrospinal
fluid)
– Cell culture
– Polymerase Chain Reaction (PCR)
 Nursing Management:
 Observe for paralysis and other neurologic
damage Maintain patent airway
 Good skin care and frequent repositioning
 Prevention: OPV (oral polio vaccine)
 Cause: Neisseria gonorrhoeae
V. SEXUALLY TRANSMITTED INFECTIONS  Mode of Transmission:
1. Syphilis  Sexual contact with the infected individual
 Cause: Treponema pallidum  Perinatally from mother to baby during
 Mode of Transmission: childbirth
 Direct contact with syphilis sore (chancre)  Incubation Period: 2-5 days
during vaginal, anal, or oral sex  Signs and Symptoms:
 From an infected mother to her unborn baby  Men
 Incubation Period: 10-90 days – Dysuria
– White, yellow, or green urethral discharge
Stages: – Testicular or scrotal pain
 Women
– Dysuria
– Vaginal discharge or bleeding
 Complications:
 Infertility
 Epididymitis
 Pelvic Inflammatory diseases
 Disseminated gonococcal infection
 Diagnostic Test:
 Urine test
 Swab
 Treatment:
 Ceftriaxone
 Azithromycin

3. Candidiasis
 Cause: Candida albicans
 Mode of Transmission:
 During childbirth
 Sexual contact
 Endogenous spread
 Signs and Symptoms:
 Burning sensation
 Itchy or painful feeling
 Redness, irritation, or swelling
 Abnormal white vaginal discharge
 Rashes
 Diagnostic Test:
 Blood culture
 Culture of a sample from the infected body
site
 Treatment:
 Fluconazole