National Immunization Program Overview

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Questions and Answers

What is the primary objective of the National Immunization Program?

To vaccinate every citizen over the age of 18.

To enhance the overall healthcare system in the nation.

To ensure vaccines are available only in urban areas.

To reduce mortality and morbidity in infants and children. (correct)

How does immunization function within public health?

It confers artificial immunity to specific population groups. (correct)

It requires multiple doses for every vaccine administered.

It relies solely on natural disease resistance.

It creates permanent immunity across all age groups.

Which statement correctly reflects the services provided by the National Immunization Program?

The program ensures that only certain vaccines are routinely recommended.

Immunization services are prioritized for wealthy individuals.

The program guarantees free immunization services to all populations. (correct)

Immunization services are only available in private facilities.

What is the definition of immunity in the context of immunization?

Resistance and protection from disease due to the presence of antibodies in the blood. Signup and view all the answers

Which population group is specifically targeted by the National Immunization Program?

Infants and children, particularly from poorer communities. Signup and view all the answers

What type of immunity is acquired through breastfeeding?

Passive immunity Signup and view all the answers

Which law mandates compulsory basic immunization for children under 8 years old?

PD No. 996 of 1976 Signup and view all the answers

What does the inclusion of Hepatitis B immunization in RA 7846 of 1994 specifically address?

Immunization for infants and children under 8 Signup and view all the answers

Which of the following is an example of active immunity?

Receiving an attenuated vaccine Signup and view all the answers

What is the main characteristic of passive immunity?

It is temporary and does not involve the host's immune response. Signup and view all the answers

What new vaccinations are included for infants and children up to 5 years of age under RA 10152 of 2011?

Hepatitis B, Mumps, and Rubella Signup and view all the answers

What is a critical consideration for caregivers when attending clinic visits for immunization?

Bring the immunization records of the child Signup and view all the answers

What does the law RA 10152 of 2011 specifically repeal?

PD 996 Signup and view all the answers

Up to what age are children eligible to receive pentavalent vaccines as per the guidelines?

Up to 5 years Signup and view all the answers

Which of the following statements regarding previous doses of vaccines is accurate?

Previous doses do not need to be repeated regardless of interval Signup and view all the answers

What is the correct procedure when administering multiple vaccines in the same leg?

Vaccines should be spaced at least 2.5 to 5 cm apart. Signup and view all the answers

Which of the following vaccines requires special diluents and has a specific discarding time after reconstitution?

BCG, AMV, MMR. Signup and view all the answers

What is the most important guideline regarding the storage of specific vaccines?

BCG should be kept away from sunlight and Rotavirus should be protected from light. Signup and view all the answers

What should be ensured when using alcohol to clean the injection site?

The area must be thoroughly dry before injecting the vaccine. Signup and view all the answers

Which statement about the utilization of vaccines is accurate?

Follow the 'first expiry and first out' principle when utilizing vaccines. Signup and view all the answers

Which condition is NOT required for reusable vaccines to last a maximum of 4 weeks?

The vaccine vial monitor has reached the discard portion Signup and view all the answers

What is the implication of the vaccine septum being submerged in water?

It can compromise the sterility of the vaccine Signup and view all the answers

Which factor directly influences the ability of vaccines like OPV and Pentavalent to remain usable for 4 weeks?

Observation of cold chain conditions Signup and view all the answers

Which of the following statements accurately reflects a requirement for the viability of reusable vaccines?

The vaccine has not passed its expiry date Signup and view all the answers

What ensures that a reusable vaccine's effectiveness is maintained until its maximum usability period?

Strict adherence to aseptic techniques during aspiration Signup and view all the answers

Which vaccine is administered at birth to protect against Tuberculosis?

Bacillus Calmette Guerin (BCG) Signup and view all the answers

At what age should the Inactivated Polio Vaccine (IPV) be administered?

14 weeks Signup and view all the answers

Which route of administration is used for the Pneumococcal Conjugate Vaccine (PCV)?

Intramuscular (IM) Signup and view all the answers

What is the dosage of the Measles Mumps Rubella (MMR) vaccine?

0.5 mL Signup and view all the answers

Which vaccine contains a plasma derivative or RNA recombinant as its component?

Hepatitis B Vaccine (Monovalent) Signup and view all the answers

Which vaccine is administered via the oral route and is designed for mucosal immunity?

Oral Polio Vaccine (OPV) Signup and view all the answers

At what age should the Pentavalent Vaccine be administered for the first dose?

6 weeks Signup and view all the answers

Which vaccine utilizes live-attenuated components and is primarily aimed at preventing multiple viral infections?

Measles Mumps Rubella (MMR) Signup and view all the answers

Which vaccine requires administration in the vastus lateralis site for intramuscular injections?

Hepatitis B Vaccine (Monovalent) Signup and view all the answers

What is the dosage and route of administration for the Pneumococcal Conjugate Vaccine for children aged 2 to 5 years?

0.5 mL, IM Signup and view all the answers

What is the expected management for a deep abscess resulting from a BCG vaccination?

Refer to the physician for incision and drainage Signup and view all the answers

Which of the following is a common side effect of the Pentavalent vaccine?

Local soreness at the injection site Signup and view all the answers

In the case of a child experiencing convulsions after receiving an OPV, what is the recommended course of action?

Give paracetamol for fever reduction Signup and view all the answers

What should be done if a child experiences local tenderness after receiving the IPV?

Apply ice to the injection site Signup and view all the answers

What additional treatment can be utilized for a child who develops an indolent ulcer after a BCG vaccination?

Observation without intervention Signup and view all the answers

What is considered a significant reaction indicating previous exposure to tuberculosis after BCG vaccination?

Koch's phenomenon Signup and view all the answers

Which vaccine may lead to an abscess if the injection was not administered deep enough?

OPV Signup and view all the answers

If a child is experiencing fever after the Pentavalent vaccine, what management step should NOT be taken?

Refer the child to a specialist Signup and view all the answers

What is the maximum duration for which vaccines can be transported with cold packs?

5 days Signup and view all the answers

What action should be taken if the vaccine vial monitor (VVM) square is darker than the circle?

Inform the supervisor and discard the vaccine Signup and view all the answers

Which storage location has the longest recommended duration for biologicals?

Regional Health Office Signup and view all the answers

For how long can the Pentavalent Hepatitis B vaccine remain stable at room temperature before it must be used?

4-6 hours Signup and view all the answers

What is the required storage temperature for the Diphtheria Tetanus Toxoid vaccine?

Body of refrigerator Signup and view all the answers

Which of the following conditions is considered an indication rather than a contraindication for immunization?

Malnutrition Signup and view all the answers

Which temperature threshold for fever is noted as acceptable for immunization?

38.5 °C Signup and view all the answers

Which of the following statements about minor illnesses during immunization is correct?

Mild acute respiratory infections permit vaccination. Signup and view all the answers

Which condition is explicitly mentioned as NOT being a contraindication for vaccines?

Mild acute respiratory infection Signup and view all the answers

Which of the following options correctly identifies an acceptable condition during immunization protocols?

Mild acute respiratory infection Signup and view all the answers

What is the age range for children that can be managed under the Integrated Management of Childhood Illness (IMCI) process?

1 week to 5 years Signup and view all the answers

Which type of facility is primarily designed to use the Integrated Management of Childhood Illness (IMCI) process?

First-level facilities Signup and view all the answers

Who is qualified to implement the Integrated Management of Childhood Illness (IMCI)?

Doctors, nurses, and other healthcare professionals Signup and view all the answers

In which settings can the IMCI process be effectively applied?

First-level healthcare facilities Signup and view all the answers

What is the primary focus of the IMCI process?

Case management for sick children Signup and view all the answers

What is the primary step in the IMCI case management process that involves evaluating a child's risk factors?

ASSESS Signup and view all the answers

Which color-coded classification indicates that a child's condition requires urgent prereferral treatment?

PINK Signup and view all the answers

During the TREATMENT step of the IMCI process, which aspect is emphasized for caregivers?

Teach how to administer oral medications. Signup and view all the answers

What is the primary purpose of the FOLLOW-UP CARE step in the IMCI process?

Assess new problems and reassess the child. Signup and view all the answers

What should be assessed during the COUNSEL step regarding the mother's health?

Feeding practices and her health. Signup and view all the answers

Study Notes

National Immunization Program (NIP)

The NIP works to guarantee free immunization services.
The program ensures that all Filipinos, especially the poor, have access to routine vaccines.
The NIP's ultimate goal is to reduce mortality and morbidity in children.
Immunization is essential to public health.
Immunization is the process of providing artificial immunity to a population group.
Immunity is the body's ability to resist disease.
The NIP aims to reduce the burden of vaccine-preventable diseases.
The NIP is a crucial part of the public health system in the Philippines.
The program helps to protect individuals and communities from preventable diseases.

Types of Immunity

Active immunity is acquired through exposure to a weakened or attenuated pathogen or vaccine, leading to the development of an immune response.
Passive immunity is obtained through receiving pre-made antibodies, often from breast milk, providing temporary protection.

Policies and Laws in the Philippines

Presidential Decree No. 996 (1976) mandated compulsory basic immunization for children below 8 years old.
Republic Act No. 7846 (1994) extended compulsory immunization to include Hepatitis B for infants and children below 8 years old.

RA 10152 of 2011

Mandates immunization for children up to 5 years old
Includes new vaccines: Hepatitis B, Mumps, Rubella, Haemophilus Influenza Type B (Hib)
Repealed PD 996, making it the legal basis of the National Immunization Program (NIP)

General Considerations

Caregivers should follow the prescribed immunization schedule
Children should bring their immunization records to every clinic visit
Previous doses should not be repeated regardless of the time between doses
Children up to 5 years old are eligible for pentavalent vaccines

Immunization Program Considerations

Booster doses may not be necessary in certain situations.
Vaccines can be administered on the same day at different injection sites.
When administering multiple vaccines on the same leg, maintain a distance of 2.5 to 5 centimeters between injection sites.
Follow a specific vaccine administration order: start with OPV, then Rotavirus, and lastly other vaccines.
Implement a "First Expiry, First Out" system for vaccine utilization.
Use cotton to clean the injection site. If using alcohol, ensure the area is completely dry before injecting.
Specific diluents are required for BCG, AMV, and MMR vaccines, and they should be discarded 6 hours after reconstitution or after clinic hours.
Protect BCG from sunlight and Rotavirus from light.
Inform caregivers about common vaccine side effects and how to manage them.

Reusable Vaccines - Conditions for Extended Use

Reusable vaccines such as OPV, Pentavalent, Hepatitis B, and Tetanus toxoid can be stored for up to four weeks under specific conditions.
Ensuring the expiry date has not passed is crucial for vaccine efficacy and safety.
Strict adherence to the cold chain, including proper refrigeration temperatures, is paramount to maintain vaccine potency.
Aseptic technique during vaccine aspiration prevents contamination.
The Vaccine Vial Monitor (VVM) is a critical indicator of vaccine stability, and its discard portion should not be reached.
The vaccine septum should not be submerged in water, as this can compromise the sterility of the vaccine.

### Bacillus Calmette Guerin (BCG) Vaccine

Protects against Tuberculosis
Administered at birth
Contains live-attenuated bacteria
Given as 0.05 mL dose
Administered intradermally
Injection site: Right upper arm/deltoid

Hepatitis B Vaccine (Monovalent)

Protects against Hepatitis B
Administered at birth
Contains plasma derivative or RNA recombinant, appears cloudy and liquid
Given as 0.5 mL dose
Administered intramuscularly
Injection site: Vastus lateralis

Pentavalent Vaccine (DPT-HepB-Haemophilus Influenza)

Protects against Diphtheria, Pertussis, Tetanus, Hepatitis B, Pneumonia, Meningitis
Contains D- weakened toxins, P- killed bacteria, T- weakened toxins, appears liquid and clear
Administered at 6, 10, 14 weeks
Given as 0.5 mL dose
Administered intramuscularly
Injection site: Vastus lateralis

Oral Polio Vaccine (OPV)

Protects against Poliomyelitis
Contains live-attenuated virus, appears clear and pinkish
Administered at 6, 10, 14 weeks
Given as 0.5 mL dose
Administered orally

Inactivated Polio Vaccine (IPV)

Protects against Poliomyelitis
Contains liquid, clear solution to provide serum immunity
Administered at 14 weeks
Given as 0.5 mL dose
Administered intramuscularly
Injection site: Vastus lateralis

Pneumococcal Conjugate Vaccine (PCV)

Protects against Pneumonia, Meningitis
Contains liquid, clear solution
Administered at 6, 10, 14 weeks
One dose given between 2–5 years old
Given as 0.5 mL dose
Administered intramuscularly
Injection site: Vastus lateralis

Measles Mumps Rubella (MMR) Vaccine

Protects against Mumps, Measles, German Measles
Contains live-attenuated virus
Administered at 9 months and 12–15 months
Given as 0.5 mL dose
Administered subcutaneously
Injection site: Outer arm

Bacillus Calmette Guerin (BCG) Vaccine

Administers the BCG vaccine at birth
Protects against tuberculosis
Consists of live attenuated bacteria
Utilizes a special diluent and is freeze-dried
Administers at birth with a dosage of 0.05 mL
Administered through the intradermal route
Administered at the right upper arm/deltoid region

Hepatitis B Vaccine (Monovalent)

Administered at birth
Protects against Hepatitis B
Utilizes either a plasma derivative or RNA recombinant
Has a cloudy, liquid appearance
Administers at birth with a dosage of 0.5 mL
Administered through the intramuscular route
Administered at the vastus lateralis region

Pentavalent Vaccine (DPT-HepB-Haemophilus Influenza)

Administers a 0.5 mL dosage at 6, 10, and 14 weeks of age
Provides protection against diphtheria, pertussis, tetanus, hepatitis B, pneumonia, and meningitis
Consists of weakened toxins, killed bacteria, and additional weakened toxins
It has a clear, liquid form
Administered via the intramuscular route at the vastus lateralis region

Oral Polio Vaccine (OPV)

Administered at 6, 10, and 14 weeks of age
Provides protection against Poliomyelitis
Consists of a live-attenuated virus
The virus targets the gastrointestinal tract (mouth and GI)
Utilizes a clear, pinkish liquid form and has a 0.5 mL dosage
Administered orally

Inactivated Polio Vaccine (IPV)

Administered at 14 weeks of age
Provides protection against Poliomyelitis
Utilizes a clear, liquid form and a 0.5 mL dosage
Administered via the intramuscular route at the vastus lateralis region

Pneumococcal Conjugate Vaccine (PCV)

Administered at 6, 10, and 14 weeks, with one additional dose for ages 2-5
Provides protection against pneumonia and meningitis
Utilizes a clear, liquid form and a 0.5 mL dosage
Administered via the intramuscular route at the vastus lateralis region

Measles Mumps Rubella (MMR)

The MMR vaccine provides protection against mumps, measles, and rubella
Administered at 9 months and 12-15 months of age
Utilizes live attenuated dried freeze-dried virus with a special diluent
Administered via subcutaneous injection
Administered at the outer arm
Utilizes a 0.5 mL dosage

BCG Vaccine

Side Effects:
- Wheal for 30 minutes followed by ulceration within 2 weeks, scarring within 3 months
- Koch's phenomenon: acute inflammation within 2-4 days after vaccination, indicating previous tuberculosis exposure
- Deep abscess at the vaccination site, often due to improper injection technique
- Indolent ulcer: persistent ulcer beyond 12 weeks from vaccination
- Glandular enlargement: enlarged lymph nodes draining the injection site
Management:
- Normal reactions require no treatment.
- Refer to a physician for incision and drainage for deep abscesses.

Hepatitis B Vaccine

Side Effects:
- Local soreness at the injection site
Management:
- Treat with Isoniazid (INH) powder.
- If suppuration occurs, treat as a deep abscess.

Pentavalent Vaccine

Side Effects:
- Fever, typically lasting one day. Fever beyond 24 hours suggests a different cause.
- Local soreness at the injection site
Management:
- No treatment needed for typical side effects.
- Cold compresses may be applied.
- Advise parents to administer an antipyretic.

Oral Polio Vaccine (OPV)

Side Effects:
- Abscess: often indicates improper injection technique
- Convulsions: rare in children over 3 months, may be caused by the pertussis component
Management:
- Reassure parents that soreness will subside within 3-4 days.
- Paracetamol can be given for pain.
- Incision and drainage may be necessary for abscesses.
- Proper management of convulsions.
- Provide the following instructions for subsequent doses if vomiting occurs:
  - No oral intake for 30 minutes to prevent vomiting and enhance absorption.
  - If vomiting occurs, administer another dose.
  - If simple diarrhea is present, administer OPV, but do not count the dose toward the vaccination schedule and instruct the child to return for their next scheduled dose.

Inactivated Polio Vaccine (IPV)

Side Effects:
- Local tenderness
Management:
- Apply cold compresses.

Measles, Mumps, Rubella (MMR) Vaccine

Side Effects:
- Local soreness, fever, irritability, and malaise in some children
Management:
- Reassure parents and advise them to administer an antipyretic.
- Give 200,000 IU of Vitamin A to promote epithelialization and enhance immunity.

Vaccine Storage Temperatures

Oral Polio Vaccine (OPV) should be stored between -15°C and -25°C
OPV can be stored at room temperature for up to 8 hours
Pentavalent Hepatitis B vaccine should be stored between 2-8°C
Pentavalent Hepatitis B vaccine can be stored outside of the refrigerator for 4-6 hours
Diptheria Tetanus Toxoid should be stored in the body of the refrigerator
Diptheria Tetanus Toxoid can be stored at room temperature for up to 8 hours

Vaccine Storage Duration

Vaccines stored at the Regional Health Office have a 6-month shelf life
Vaccines stored at the Provincial/District Health Office have a 3-month shelf life
Vaccines stored at the Rural Health Unit have a 1-month shelf life
Vaccines can be transported with cold packs for up to 5 days

Vaccine Vial Monitor (VVM)

If the VVM square is the same color or lighter than the circle, the vaccine is usable if its expiry date has not passed
If the VVM square is darker than the circle, the vaccine should not be used and the supervisor must be informed

National Immunization Program

Primary Objective: To protect Filipinos from vaccine-preventable diseases.
Public Health Function: Safeguards the health of the population by reducing the incidence and spread of diseases.

National Immunization Program Services

Provides a range of immunization services to the nation.

Immunity and Immunization

Immunity: Protection against diseases, acquired through exposure to a specific disease agent or through vaccination.

Target Population

Children Under 8 Years Old: Primary focus of the National Immunization Program.

Types of Immunity

Breastfeeding: Provides passive immunity, meaning antibodies are transferred from mother to child.

RA 7846 (1994)

This law mandates compulsory basic immunizations for children under 8 years old.
Hepatitis B immunization inclusion in RA 7846 (1994): Addresses the prevalence of Hepatitis B infection in the Philippines.

Active Immunity

Acquired through exposure to a disease or vaccination, stimulating the immune system to create antibodies.

Passive Immunity

Short-term protection obtained through receiving antibodies from another source, such as through breastfeeding or immunoglobulin injections.

RA 10152 (2011)

New vaccinations for infants and children up to 5 years old: Rotavirus (RV) and Pneumococcal Conjugate Vaccine (PCV).
Repeals: Republic Act 7846 of 1994.

Vaccination Guidelines

Pentavalent Vaccines: Eligible for children up to 5 years old.
Previous Vaccine Doses: If a child has already received some doses of a vaccine, they should continue the series based on the recommended schedule.

Administration Procedures

Multiple Vaccines in the Same Leg: Administered in separate injection sites.
Special Diluents and Discarding Time: Some vaccines like BCG require special diluents and must be discarded within a specific time after reconstitution.

Vaccine Storage Guidelines

Temperature: Crucial factor for vaccine efficacy.
Alcohol Cleaning: Ensure the injection site is clean and disinfected before administration.
Reusable Vaccines: Remain viable for up to 4 weeks under appropriate conditions.
Submerged Septum: Not permitted as it can compromise the vaccine's effectiveness.
Vaccine's Viability: Factors such as temperature and the absence of direct sunlight are essential.
Effectiveness Maintenance: Proper storage conditions ensure continued potency until the maximum usability period.

Vaccine Specifics

BCG: Administered at birth to protect against Tuberculosis.
IPV: Given at 2, 4, 6, and 18 months of age.
PCV: Administered through the intramuscular route.
MMR: 0.5 ml dose.
Plasma Derivative or RNA Recombinant: Hepatitis B Vaccine.
Oral Route for Mucosal Immunity: Rotavirus vaccine (RV).
Pentavalent Vaccine First Dose: Given at 6 weeks old.
Live-Attenuated Components: MMR, PCV, RV.
Vastus Lateralis Site: For intramuscular injections of Pentavalent vaccine.
PCV Dosage for Children Aged 2-5 Years: A single 0.5 ml intramuscular dose.

Vaccination Adverse Events

BCG Abscess: May occur due to improper injection depth. Requires observation, local wound care, and possibly oral antibiotics.
Pentavalent Vaccine Side Effects: Common side effects include fever, pain, swelling, and redness at the injection site.
OPV Convulsions: Observation and neurological evaluation might be necessary.
IPV Local Tenderness: Gentle massage and warm compresses can be applied.
BCG Indolent Ulcer: May require topical treatment.
Significant BCG Reaction: A large, indurated ulcer with necrotic center. Indicates previous exposure to tuberculosis.
Pentavalent Vaccine Abscess: Proper injection technique is crucial to prevent this complication.
Fever after Pentavalent Vaccine: Avoid using Aspirin or other salicylates.
Vaccine Transportation with Cold Packs: Maximum duration is 48 hours.
VVM Square Darker than Circle: Indicates the vaccine has been exposed to excessive heat and should not be used.

Vaccine Storage Recommendations

Biologicals: Stored in refrigerators for 4 weeks.
Pentavalent Hepatitis B Vaccine: Stable at room temperature for up to 8 hours.
Diphtheria Tetanus Toxoid: Stored at 2-8°C.

Vaccination Contraindications and Indications

Indications: Immune-compromised individuals may require booster doses.
Acceptable Fever Threshold: 37.5°C (99.5°F) or below.
Minor Illnesses: Not usually considered contraindications if the child is generally well.
Contraindication: A child who is allergic to a specific vaccine component.
Acceptable Condition During Immunization: Presence of a mild cold.

Integrated Management of Childhood Illnesses (IMCI)

IMCI is a case management process used by healthcare professionals to treat sick infants and children 1 week to 5 years old.
IMCI is used in first-level healthcare facilities.
IMCI processes are implemented in clinics, health centers, rural health units, and outpatient departments of the hospital.

Integrated Management of Childhood Illness (IMCI) Case Management Process

Assessment: Involves checking for danger signs, common conditions, examining the child, and reviewing nutrition and immunization status.
Classification: Categorizes child illness using a color-coded triage system.
- Pink: Urgent prereferral treatment and referral.
- Yellow: Specific medical treatment and advice.
- Green: Simple advice on home management.
Identification: Determines specific treatments after classifying all conditions.
Treatment: Provides practical management instructions, including oral drug administration, feeding and fluid management during illness, and home treatment for local infections.
Counseling: Assesses and addresses feeding problems, including breastfeeding practices. Also includes counseling mothers about their own health.
Follow-Up Care: Provides follow-up care and reassesses the child for new problems when they return to the clinic.

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Description

This quiz covers the essential aspects of the National Immunization Program (NIP) in the Philippines. It discusses the program's goals, the importance of immunization to public health, and how it benefits the community, especially the underprivileged. Test your knowledge on vaccine preventable diseases and the NIP's role in reducing mortality rates among children.