National Immunization Program PDF

CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-...

CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL Haemophilus Influenza type B (HIB) IMMUNIZATION PROGRAM OF THE PHILIPPINES ELIGIBLE POPULATION Committed to guarantee free immunization services and 0 – 12 MONTHS: newborns / infants ensures that Filipinos, especially the poor, have access to CONCEPT / IMPORTANCE routinely recommended vaccines The process by which vaccines are introduced into the Considered a means to achieve immunity of the body before infection sets in. population and contribute to public health Induce Immunity (immune system reacts) (antibodies) LEGAL BASIS Infants & newborns need to be vaccinated at early age EXPANDED PROGRAM ON IMMUNIZATION (EPI) (vulnerable age group) Presidential Decree 996 (PD 996) Susceptible to childhood disease. Marcos presidency PRINCIPLES 6 Diseases that can be prevented by vaccines (1976) Epidemiological Situation ○ Tuberculosis Mass Approach ○ Diphtheria Basic Health Service ○ Pertussis VACCINES TYPES, FORMS, CONTENTS ○ Tetanus TYPES OF VACCINE: 4 MAIN ANTIGENS ○ Poliomyelitis ○ Measles ATTENUATED VACCINE - LIVE BUT ALTERED (LAV) 4 Strategies Attenuated means “weakened.” ○ Sustain high routine Full Immunized Child ○ contains a small amount of weakened live coverage of at least 90% - all pathogen - doesn’t cause disease. It triggers provinces & cities. (In our survey we immune system asked if the child have complete Example vaccination) ○ MMR vaccine (measles, mumps & rubella) ○ Sustain polio-free country for global certification ○ Anti-Measles Vaccine / Measles Containing ○ Eliminate measles (2008) Vaccine ○ Eliminate neonatal tetanus ○ Rotavirus 2008 due to poliomyelitis infection ○ Smallpox COMPULSORY IMMUNIZATION AGAINST HEPATITIS B REPUBLIC ○ Chickenpox ACT 7846 Advantage 1995 ○ Very effective, provides lifelong protection in 1 Infants & children 8 y/o & below or 2 shots Within 24 hr after birth Hepa B immunization if mo. has Disadvantage Hepatitis B ○ Can’t give to weak immune system 7 Diseases can that be prevented by vaccines (1995) ○ Takes long time to manufacture ○ Tuberculosis Bacteria ○ Diphtheria ○ Tuberculosis (BCG) ○ Pertussis ○ Oral Polio Vax., measles, Rotavirus, Yellow fever ○ Tetanus INACTIVATED VACCINE - KILLED ○ Poliomyelitis Use killed or dead pathogen ○ Measles Example ○ Hepatitis B ○ wP – whole cell Pertussis NATIONAL IMMUNIZATION PROGRAM REPUBLIC ACT NO. 10152 ○ IPV – inactivated polio vaccine (NIP) Advantage 2011 ○ Doesn’t take time in manufacturing. Ninoy Aquino presidency ○ Safer than LAV Mumps Disadvantage Rubella or German measles ○ Less effective than LAV CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 1  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL ○ - Not lifetime protection. Needs multiple doses over time FORM Bacteria Liquid ○ Whole-cell pertussis (wP) Freeze-dried ○ Inactivated Poliovirus (IPV) TOXOID VACCINE - INACTIVATED OR ALTERED EXOTOXINS OF BACTERIA Inactivated or Altered exotoxins of bacteria ○ Inactivated toxin Example ○ Tetanus Toxoid ○ Diphtheria Toxoid ○ Td - tetanus and diphtheria toxoids vaccine. Advantage ○ Safe - can’t cause disease, no possibility of. reversion to virulence ANTI-MEASLES VACCINE (AMV1) Disadvantage Freeze-dried, reconstituted with special diluent ○ Require several doses, need adjuvant. MEASLES-MUMPS RUBELLA VACCINE (AMV2) ○ Not highly Immunogenic Bacteria Freeze-dried, reconstituted with special diluent ○ Tetanus (TT) BCG (BACILLE CALMETTE-GUERIN) ○ Diphtheria toxoid Freeze-dried, reconstituted with special diluent CONJUGATED SUBUNIT VACCINES HEPATITIS B VACCINE Create response against the molecules in the pathogen’s Cloudy, liquid capsule DPT -HEPB-HIB (PENTAVALENT VACCINE) (PENTAVALENT) 5-IN-1 Sample of a protein in their capsule VACCINE Example Liquid ○ Haemophilus influenzae type b conjugate (Hib) ORAL POLIO VACCINE ○ Pneumococcal conjugate ○ Hepatitis B (HepB) Clear, pinkish liquid ○ Acellular pertussis (aP) ROTAVIRUS VACCINE ○ Heralded new age for immunization against Clear, colorless liquid, in a container with an oral encapsulated m.o applicator Organisms TETANUS TOXOID ○ Meningococcus Sometimes slightly turbid in appearance: Clear, colorless ○ Haemophilus influenzae type b (Hib) liquid; ○ Pneumococcus ○ These are new vaccine produced by technology VACCINE STORAGE 2 degree C to 8 degree C Liquid formulations Vaccines containing diphtheria, pertussis, tetanus, hepatitis B, Haemophilus influenzae type b, IPV & their combinations should not be frozen OPV ○ kept frozen bet - 15oC to -25oC Freeze-dried vaccines ○ (i.e., BCG, measles, MMR & yellow fever) may also be kept frozen at -15oC to -25oC if cold CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 2  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL chain space permits but is neither essential nor ○ In injecting we have to: clean skin w/ cotton ball recommended moistened w/ water & let skin dry. HEAT SENSITIVITY ○ In injecting vaccine alcohol is not used ROUTINE IMMUNIZATION ROUTINE SCHEDULE OF IMMUNIZATION WED – Nationwide Immunization Day MONTHLY – Barangay Health Station QUARTERLY – Far Flung Area EVERY DAY – Some Areas, to cover all targets QUARTERLY – Far Flung Area BCG (Bacille Calmette-Guérin) PROCEDURES IN GIVING VACCINES At birth (after birth) RECONSTITUTING FREEZE-DRIED VACCINE ○ ID (Right Deltoid area) ○ 0.05ml BCG - Keep diluent cold ○ Given only once ○ Aspirate 2 ml Of saline solution from ampule of ○ earliest protects TB meningitis & other TB diluent infection ○ Use 5ml syringe w/ long needle EPI - Procedures in giving BCG ○ Inject the 2ml. Saline in the ampule of freeze ○ make a wheel dried BCG. MEASLES VACCINE HEPATITIS B VACCINE (HbV) ○ Aspirate 5ml. Of special diluent from the ampule At birth ○ Use 10 ml. Syringe fit w/ long needle ○ Intramuscular ○ Empty the diluent from the syringe into the vial ○ 0.5 mL with the vaccine. ○ Anterolateral of thigh RECONSTITUTING ○ infected/carrier ○ mix diluent & vaccine – draw mixture back into ○ Protects liver the syringe & expel it slowly in the ampule ○ cirrhosis/liver CA several times ○ Eliminate HB before 2012 ○ Return reconstituted vaccine on slit of foam ANTI MEASLES VACCINE/MEASLES CONTAINING VACCINE AMV / provided in vaccine MCV ○ carrier (vaccine needed are removed from the 9th month ref a day before vaccination) ○ Subcutaneous CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 3  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL ○ 0.5 mL ○ 12 mons IMMUNIZATION SCHEDULE FOR INFANTS AND YOUNG CHILDREN ○ outer part upper arm ○ 85% protection prevents death - 2 malnutrition, pneumonia, diarrhea 20% OPV / ORAL POLIO VACCINE 6 wks 10 wks 14 wks Per Orem 2 to 3 drops mouth UPDATES IN 2016: INACTIVATED POLIOMYELITIS VACCINE (IPV) CHILDHOOD IMMUNIZATION SCHEDULE 2016 tetravalent OPV (tOPV) was replaced by a bivalent OPV (bOPV) Reason: ○ Type 2 Polio Virus - eradicated - - Switch to IPV given once at 0.5mL via IM on last dose of OPV PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) Also part of immunization PROCEDURES 6th, 10th and 14th week – 0.5 mL MEASLES (SC) IM administration. Reconstitute (Freeze Dried Measles) Pentavalent Vaccines (Diphtheria, Pertussis, Tetanus, Hepatitis B ○ Use 10 ml. syringe (long needle) – Aspirate and Haemophilus Influenza Type B) ○ 5 ml diluent vial w/ vaccine At 6, 10, 14 weeks Mix 0.5 mL ○ Draw mixture in syringe IM route ○ Expel slowly in vial (Do NOT shake) ○ Protect against sunlight (slit of foam) Inject ○ Mother hold the baby ○ Clean cotton ball w/ water – dry ○ 1 hand (fingers) pinch UP SKIN outer side of upper arm ○ PUSH NEEDLE (w/o touching needle) ○ (chk.) pull plunger – PRESS plunger (Inject) BCG (ID) Reconstitute: ○ Always keep diluent cold (ref/vaccine carrier) ○ Use 5 ml. syringe, aspirate 2 ml saline soln (diluent) ○ Inject 2ml into vaccine Mix ○ (same w/ measles) CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 4  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL Inject In OPV do not let dropper touch the tongue. ○ Clean (same w/ measles) Use monovalent hepatitis B vaccine for birth dose Position Pentavalent vaccine is not for birth doses ○ (N) Lt. hand – Hold child arm Use monovalent vaccine ○ Hold under arm Pentavalent Vaccine ○ thumb & fingers come around arm STRETCH Rotavirus vaccine. Administered only to infants 6 weeks to SKIN 15 weeks. ○ (N) Rt. Hand – Hold syringe (bevel up) Given by mouth - Rotavirus 2nd dose, 10 wks up to a Injecting maximum of 32 wks ○ Almost FLAT along the child’s arm (skin) (Upper Rotavirus vaccine administer at 1 side of mouth with tip of layer of skin) Applicator directed toward back of infant’s mouth to ○ Once in position – prevent failed swallowing or spitting L Hand (thumb) hold syringe END in Coadministration of OPV & Rotavirus. position OPV first followed by Rotavirus vaccine R Hand (index & middle finger) hold plunger R Hand (thumb) press plunger ○ In injecting – FLAT WHEAL – withdraw needle DPT / HEPA B (IM) Mother Hold child across her thigh facing upwards Ask Mother To hold child’s legs CLEAN ○ Site (Outer part of midthigh) Cotton ball & water (N) HAND ○ Thumb, index finger grasp Muscle of site CONTRAINDICATIONS TO IMMUNIZATION ○ Inject needle ABSOLUTE CONTRAINDICATION ○ Aspirate to check PENTA - DPT 2 Or DPT3 ○ Inject vaccine ○ to a child who had convulsion or shock (w/in 3 ○ Withdraw needle days of PENTA - DPT ○ Press site w/ cotton balls ○ Ex: child w/ neurological disease, epilepsy TT (IM) LIVE BCG Shake Vial ○ immunosuppressed (malignant dse – AIDS) CLEAN SITE (Outer side of Left Upper Arm) ○ therapy w/ immunosuppressive agents PLACE thumb, index finger site,grasp MUSCLE ○ irradiation Inject needle False Contra Indication Aspirate to check Inject vaccine ○ low grade to moderate fever\ Withdraw needle ○ moderate infection Press site w/ cotton ball ○ (Minor illness) IMPORTANT CONSIDERATION Cough Use single syringe & needle per client diarrhea (opv) No need to restart vaccination regardless of the time Vomiting lapsed between doses malnourish All EPI/NPI antigens are safe & effective when COLD CHAIN administered simultaneously but at diff sites A system for ensuring potency of vaccine from time of - Auto-disable syringe for Fixed-dose Immunization (0.5ml manufacturer vaccine). Very Sensitive at various temp (correct temp) ○ to avoid spoilage, maintain potency CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 5  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL COLD CHAIN LOGISTICS When handling, transport & storing Cold Chain equipment ○ (cold room, freezer, ref, transport box, vaccine carrier) Other logistics ○ (thermometer, cold chain monitor, temp. monitoring chart, ice packs, safety collector box) Freezer / refrigerator Transport box Vaccine carrier/bags Cold chain monitors Thermometers Cold packs Cold chain officer Cold chain manager PHN REFRIGERATOR Freezer ○ Vaccine is stored at - 15 TO - 25 C ○ OPV Body of the ref ○ +2 TO +8 C ○ AMV ○ MMR ○ Rotavirus vaccine ○ HBV, 5-in-1, RV, TT damaged by freezing ○ Diluents –lower or door shelves Duration of storage & transport: health center/RHU ○ w/ refrigerator – storage should not exceed 1 month Duration of storage & transport: ○ Transport boxes -kept max. of 5 days VACCINE CARRIERS Smaller than cold boxes Easier to carry if walking Do not stay cold as long as cold box It is no longer necessary to ship and store freeze-dried Maximum for 48 hours with the lid closed. vaccines (measles, yellow fever and BCG) at –20°C. VACCINE VIAL MONITOR (VVM) Instead, they may be refrigerated at +2° to +8°C VVM OTHER CONSIDERATIONS TO MAINTAIN POTENCY ○ round dot of sensitive material placed on the Observe the first expiry-first out (FEFO) policy vaccine vial ○ register heat exposure CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 6  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL Direct relationship exists bet rate of Discard reconstituted freeze-dried vaccines 6 hrs after lower the temperature -slower color change reconstitution or at end of immunization session, higher the temperature, faster color change whichever comes sooner. OPEN-VIAL POLICY (DOH)/ MULTI – DOSE VIAL OPEN-VIAL POLICY (DOH) Any vial of applicable vaccines opened/used in session (fixed or outreach) - can be used at more than one immunization session up to 4 wk (28 days) provided MULTI DOSE LIQUID VACCINES OPV, 5-in-1, HBV, TT Re-used max. 4 wks if ff. standard sterile procedures all conditions are met Conditions are: ○ expiry date - not passed ○ vaccine - not contaminated. ○ vial-stored correct cold chain condition ○ vaccine vial septum- not submerged in ○ Water ○ VVM - not reached discard point Except: ○ Opened vials : measles, yellow fever, BCG and freeze-dried Hib vaccine Do Not Use after initial immunization session, (even if the VVM has not reached the discard point.). Discarded w/in 6 hrs of reconstitution or at end of session whichever comes first. Protect RECONSTITUTE FREEZE-DRIED VACCINES BCG protect from sunlight Rotavirus protect from light Dark brown glass BCG, measles, MR, MMR and rubella vaccines EXPOSURE TO UVL - LOSS OF POTENCY Protected against sunlight or fluorescent (neon) light. BCG, measles, MR, MMR and rubella vaccines Equally sensitive to light (as well as to heat) SHAKE TEST CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 7  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL 4. Tetanus 5. Poliomyelitis 6. Measles 7. Hepatitis Fully Immunized Child (FIC) ○ Should be Complete bef. 1 yr old: ○ BCG ○ hePbV ○ Penta Vaccine 1, 2, 3 ○ OPV 1, 2, 3 PROCEDURE ○ IPV Frozen control sample ○ PCV ○ vial - same type /batch of vaccine ○ AMV 1, AMV 2 (MCV1, MCV2) ○ vial - FREEZE until solid (10 hours at -10°C). Thaw Completely Immunized Child – CIC ○ Control sample - Mark vial clearly ○ Complete at 12 months Test sample ○ Aquina presidency ○ Vial (s) of vaccine from the batch (es) that you COMPUTATION : TARGET SETTING & VACCINE REQUIREMENTS suspect has been frozen. NIP TARGET SETTING Shake - control vial & test vial INFANTS = Total population x 2.7 % ○ Hold both in 1 hand. Shake vigorously (10–15 12 to 59 MON-OLD CHILDREN = Total population x 10.8 % secs) Pregnant = total population x 3.5 % Allow to rest both vials The following are given WASTAGE MULTIPLIER for some ○ Vials - put on table. Not moving further. EPI vaccines: Compare the vials ○ View both against light DPT, OPV, TT = 1.25 ○ Compare sedimentation rate HbV = 1.20 AMV = 2.00 RESULT - SHAKE TEST BCG = 2.50 SAMPLE COMPUTATION Determine OPV requirement for a municipality w/ a total population of 15,000 ○ Eligible population 15,000 x 0.027 = 405 infants OPV Requirement for the Year Test sample ○ FORMULA FOR VACCINE REQUIREMENT FOR ○ slower sedimentation rate than control sample, THE YEAR: test sample not frozen. Can be used. = eligible population x no. of doses x Sedimentation rate is same & with flakes wastage multiplier ○ Vial damaged by freezing. Should not be used = 405 infants x 3 doses x 1.67 RECORDING = 2,029 doses To Convert Doses to Bottles: EPI TARGET DSES ○ FORMULA 1. Tb Reqt for the Year in Bottles = 2. Diphtheria 𝑅𝑒𝑞𝑡 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟 𝑖𝑛 𝑑𝑜𝑠𝑒𝑠 # 𝑜𝑓 𝑑𝑜𝑠𝑒𝑠 𝑝𝑒𝑟 𝑏𝑜𝑡𝑡𝑙𝑒 3. Pertussis CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 8  CHN211 LESSON 11: NATIONAL IMMUNIZATION PROGRAM WEEK 7 I SECOND YEAR, FIRST SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF AIDA V. GARCIA, MAN, RN Transcribed by: MICAELLA RANE S. VALERIANO I BSN 2-Y1-4 I OLFU - VAL 2,029 𝑏𝑜𝑡𝑡𝑙𝑒𝑠 20 𝑑𝑜𝑠𝑒𝑠 𝑝𝑒𝑟 𝑏𝑜𝑡𝑡𝑙𝑒 = 101.45 bottles Monthly Vaccine Requirement ○ Monthly Vaccine Requirement = 𝑅𝑒𝑞𝑢𝑖𝑟𝑒𝑚𝑒𝑛𝑡 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑦𝑒𝑎𝑟 𝑖𝑛 𝑏𝑜𝑡𝑡𝑙𝑒𝑠 12 101.45 𝑏𝑜𝑡𝑡𝑙𝑒𝑠 = 12 = 8.45 or 9 bottles per month Wastage multiplier 𝑇𝑜𝑡𝑎𝑙 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑜𝑠𝑒𝑠 𝑝𝑒𝑟 𝑢𝑛𝑖𝑡(𝑎𝑚𝑝𝑢𝑙𝑒 𝑜𝑟 𝑣𝑖𝑎𝑙) ○ 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐷𝑜𝑠𝑒𝑠 𝑈𝑠𝑒𝑑 CHN211: COMMUNITY HEALTH NURSING LESSON 11: NATIONAL IMMUNIZATION PROGRAM 9