CHN Midterm Reviewer - Newborn Immunization Program PDF

CHN MIDTERM REVIEWER Wk7. NEWBORN IMMUNIZATION PROGRAM INACTIVATED VACCINES (Killed Antigen) (NIP) made from microorganisms (viruses, IMMUNIZATION bac...

CHN MIDTERM REVIEWER Wk7. NEWBORN IMMUNIZATION PROGRAM INACTIVATED VACCINES (Killed Antigen) (NIP) made from microorganisms (viruses, IMMUNIZATION bacteria, other) that have been killed process of conferring artificial immunity through physical or chemical processes. to population groups These killed organisms cannot cause process whereby a person is made immune disease or resistant to an infectious disease, SUBUNIT (Purified Antigen) typically by the administration of a Protein-based Subunit Vaccines vaccine present an antigen to the immune system proven tool for controlling and eliminating without viral particles, using a specific, life-threatening infectious diseases isolate protein of the pathogen. one of the most cost-effective health Polysaccharide Vaccines investments, with proven strategies that create a response against the molecules in make it accessible to even the most the pathogen’s capsule. These molecules hard-to-reach and vulnerable populations. are small, and often not very IMMUNITY immunogenic. resistance and protection from disease As a consequence, they tend to: condition of being secure against any ○ Not be effective in infants and particular disease. young children (under 18–24 months) ability of the human body to tolerate the ○ Induce only short-term immunity presence of material indigenous to the Conjugate Subunit Vaccines body, and to eliminate foreign material. also create a response against the 2 BASIC MECHANISMS FOR ACQUIRING IMMUNITY molecules in the pathogen’s capsule. In comparison to plain polysaccharide ACTIVE IMMUNITY PASSIVE IMMUNITY vaccines, they benefit from a technology protection that is produced protection by products that binds the polysaccharide to a carrier by the person’s own produced by an animal or protein that can induce a long-term immune system. human and transferred to another human, usually by protective response even in infants injection. TOXOID (Inactivated Toxins) based on the toxin produced by certain usually lasts for many wanes (disappears) with years, often during a time, usually within a few bacteria. lifetime. weeks or months. The toxin invades the bloodstream and is transfer of active humoral largely responsible for the symptoms of the Antibodies are immunity in the form of disease. created by the recipient and readymade antibodies, from may be stored permanently one individual to another. The protein-based toxin is rendered harmless (toxoid) and used as the antigen VACCINE in the vaccine to elicit immunity. helps the body’s immune system to recognize and fight pathogens like viruses or bacteria, which then keeps us safe from the diseases they cause. Vaccines protect against more than 25 debilitating or life-threatening diseases TYPES OF VACCINES LIVE-ATTENUATED VACCINES (LAV) derived from disease-causing pathogens (virus or bacteria) that have been weakened under laboratory conditions. NATIONAL IMMUNIZATION PROGRAM They will grow in a vaccinated individual, guarantee free immunization services and but because they are weak, they will cause ensures that Filipinos, especially the poor, no or very mild disease have access to routinely recommended vaccines EXPANDED PROGRAM ON IMMUNIZATION (EPI) Important Considerations related to the established in 1976 Schedule and Manner of Administering Infant Reducing the morbidity and mortality Immunizations: among children against the most common Use only sterile syringe and needle per vaccine-preventable diseases client Six vaccine preventable diseases were There is no need to restart a vaccination initially included in the EPI: series regardless of the time that has ○ TB, elapsed between doses. ○ poliomyelitis, All the EPI antigens are safe and effective ○ diphtheria, when administered simultaneously, that is, ○ tetanus, during the same immunization session but ○ pertussis, and at different sites. ○ measles. It is not recommended, however, to mix Supporting Legislation: different vaccines in one syringe before RA 10152 - Mandatory Infants and Children injection, or to use a fluid vaccine for Health Immunization Act (2011) reconstitution of a freeze-dried vaccine. mandates basic immunization covering the When a vaccine is administered to an infant vaccine-preventable diseases at the same time with another injectable gives the directive to government hospitals vaccine, the vaccines should be and health centers to provide for free administered on different sites. mandatory basic immunization to infants However, if more than one injection has to and children up to 5 years of age. be given on the same limb, the injection RA 7846 - An Act Requiring Compulsory sites should be 2.5-5 cm apart to prevent Immunization Against Hepatitis-B For Infants overlapping of local reactions. And Children Below Eight (8) Years Old The recommended sequence of the also provided for hepatitis B immunization coadministration of vaccines is OPV first within 24 hours after birth of babies of followed by Rotavirus vaccine, then other women with hepatitis B appropriate vaccines. Specific Goals: OPV is administered by putting drops of 1. To immunize all infants/children against the vaccine straight from the dropper onto the most common vaccine-preventable child’s tongue. (Do not let the dropper touch diseases. the tongue.) 2. To sustain the polio-free status of the Only monovalent hepatitis B vaccine must Philippines. be used for the birth dose. Pentavalent 3. To eliminate measles infection. vaccine must not be used for the birth dose 4. To eliminate maternal and neonatal because DPT and Hib vaccine should not tetanus. be given at birth. 5. To control diphtheria, pertussis, hepatitis ○ A Monovalent Vaccine is one that B, and German measles. contains an antigen against a single 6. To prevent extrapulmonary TB among disease. children. ○ Pentavalent Vaccines contain antigens against five diseases: IMMUNIZATION SCHEDULE FOR INFANTS AND diphtheria, pertussis, tetanus, YOUNG CHILDREN hepatitis B, and Hemophilus influenzae B. Children who have not received AMV1 as scheduled and children whose parents or caregivers do not know whether they have received AMV1 shall be given AMV1 as soon as possible, then AMV2 one month after the AMV1 dose. All children entering day care centers/ preschool and Grade I shall be screened for measles immunization. Those without the  immunization shall be referred to the cold chain monitors, nearest health facility for immunization. thermometers, and The first dose of Rotavirus vaccine is cold packs administered only to infants aged 6 weeks ○ Cold Chain Requirements: to 15 weeks. The second dose is given only OPV: -15 to 25⁰C. OPV has to to infants aged 10 weeks up to a be stored in the freezer. In maximum of 32 weeks. the vaccine bag, OPV is Administer the entire dose of the Rotavirus placed in contact with cold vaccine slowly down one side of the mouth packs. (between the cheek and gum) with the tip of All other vaccines, including the applicator directed toward the back of measles vaccine, MMR, and the infant’s mouth. To prevent spitting or Rotavirus vaccine, have to failed swallowing, stimulate the rooting or be stored in the refrigerator sucking reflex of the young infant. For at a temperature of +2 to infants aged 5 months or older, lightly +8⁰C. These vaccines should stroke the throat in a downward motion to be stocked neatly on the stimulate swallowing. shelves of the refrigerator. (Do not stock vaccines at the EPI VACCINES refrigerator door shelves.) Hepatitis B vaccine, Pentavalent vaccine, Rotavirus vaccine, and TT are damaged by freezing, so they should not be stored in the freezer. Wrap the containers of these vaccines with paper before putting them in the vaccine bag with cold packs. Keep diluents cold by TARGET SETTING AND VACCINE storing them in the REQUIREMENTS refrigerator in the lower or Vaccine requirement is calculated based on door shelves eligible population or targeted Observe the FIRST EXPIRY-FIRST OUT population size (FEFO) POLICY Comply with the recommended duration of storage and transport. ○ At the health center/RHU with a refrigerator, the duration of storage MAINTAINING THE POTENCY OF EPI VACCINES should not exceed one month. vaccines must be properly stored, handled, ○ Using transport boxes, vaccines can and transported be kept only up to max. of 5 days. Maintain the COLD CHAIN Take note if the vaccine container has a ○ The cold chain is a system for VACCINE VIAL MONITOR (VVM) and act ensuring the potency of a vaccine accordingly. from the time of manufacture to the ○ The VVM is a round disc of time it is given to an eligible client heat-sensitive material placed on a ○ At the RHU/health center, the Public vaccine vial to register cumulative Health Nurse acts as the COLD heat exposure. CHAIN OFFICER ○ A direct relationship exists between ○ Equipment/Supplies: rate of color change and freezer/refrigerator, temperature: transport box, the lower the temperature, vaccine bags/carriers, the slower the color change;  the higher the temperature, CONTRAINDICATIONS TO IMMUNIZATION the faster the color change There are few absolute contraindications to the EPI Abide by the OPEN-VIAL POLICY of the vaccines. Do not give: DOH. A multidose vial may be opened for Pentavalent vaccine/DPT to children over one or two clients if the health worker feels 5 years of age. that a client cannot come back for the Pentavalent vaccine/DPT to a child with scheduled immunization session. Multidose recurrent convulsions or another active liquid vaccines, such as OPV, Pentavalent neurological disease of the central nervous vaccine, hepatitis B vaccine, and TT from system. which one or more doses have been taken Pentavalent vaccine 2 or 3/DPT 2 or 3 to a following standard sterile procedures, may child who has had convulsions or shock be used in the next immunization sessions within 3 days of the most recent dose. for up to maximum of 4 weeks, provided Rotavirus vaccine when the child has a that all the following conditions are met: history of hypersensitivity to a previous ○ The expiry date has not passed. dose of the vaccine, intussusceptions or ○ The vaccine has not been intestinal malformation, or acute contaminated. gastroenteritis; and ○ The vials have been stored under BCG to a child who has signs and symptoms appropriate cold chain conditions. of AIDS or other immune deficiency ○ The vaccine vial septum has not conditions or who are immunosuppressed. been submerged in water. ○ The VVM on the vial, if attached, has EPI RECORDING AND REPORTING not reached the discard point. EPI recording and reporting are Reconstitute freeze-dried vaccines such as accomplished using the FHSIS. BCG, AMV, and MMR only with the diluents FULLY IMMUNIZED CHILDREN (FIC) supplied with them. are those who were given BCG, three doses Discard reconstituted freeze-dried of OPV, three doses of DPT and hepatitis B vaccines 6 hours after reconstitution of at vaccine or three doses of Pentavalent the end of the immunization session, vaccine, and one dose of anti-measles whichever comes sooner. vaccine before reaching one year of age. Protect BCG from sunlight and Rotavirus COMPLETELY IMMUNIZED CHILD vaccine from light. refers to children who completed their immunization schedule at the age of 12-23 SIDE EFFECTS OF VACCINATION AND THEIR months. MANAGEMENT CHILD PROTECTED AT BIRTH (CPAB) is a term used to describe a child whose mother has received ○ (a) two doses of TT during this pregnancy, provided that the second dose was given at least a month prior to delivery; or ○ (b) at least three doses of TT anytime prior to pregnancy with this child.  Wk9. ESSENTIAL INTRAPARTUM NEWBORN Arrange needed supplies in linear sequence CARE (EINC) Check resuscitation equipment INTRAPARTUM Double glove just before delivery The time period spanning childbirth, from TIME BAND: Within 1st 30 seconds: Immediate the onset of labor through delivery of the Thorough Drying placenta. Dry the newborn thoroughly for at least 30 EINC seconds. simple cost-effective newborn care Wipe the eyes, face, head, front and back, intervention that can improve neonatal as arms and legs. well as maternal care. It is an Remove the wet cloth evidence-based intervention that Do a quick check of breathing while drying ○ Emphasizes a core sequence of Notes: actions, performed methodically Do not wipe off vernix, bathe the newborn (step-by-step) Do not do foot printing ○ Is organized so that essential time No hanging upside-down, no slapping bound interventions are not No squeezing of chest interrupted; and TIME BAND: After 30 seconds of drying ○ Fills a gap for a package of Early Skin-to-skin Contact bundled interventions in a guide Position the newborn prone on the mother’s format abdomen or chest Cover the newborn’s back with dry blanket. EINC PRACTICES DURING INTRAPARTUM Cover the newborn’s head with bonnet Continuous maternal support, by a TIME BAND: 1-3 minutes companion of her choice, during labor and Properly- Timed Cord Clamping delivery Remove the first set of gloves Mobility during labor After umbilical pulsations stopped, clamp ○ Mother is still mobile, within reason the cord at 2 cm. from the umbilical base, during this stage clamp again at 5 cm. from the base. Position of choice during labor and delivery Cut the cord close to the plastic clamp Non-drug pain relief, before offering labor TIME BAND: Within 90 mins anesthesia Non-separation of newborn from Mother Early Spontaneous pushing in a semi-upright Breastfeeding position Leave the newborn in skin-to-skin contact Episiotomy will not be done, unless Observe for feeding cues (tonguing, licking, necessary rooting) Monitoring the progress of labor with the Encourage the mother to nudge the use of partograph newborn towards the breast Counsel on attachment and sucking 4 CORE STEPS OF ESSENTIAL NEWBORN CARE ○ Mouth wide open, lower lip turned 1. Immediate and thorough drying, outwards 2. Early skin-to-skin contact followed by, ○ Baby’s chin touching breast 3. Properly-timed clamping and cutting of the Weighing, bathing, eye care, examinations, cord after 1 to 3 minutes, and injections (hepatitis B, BCG, Vit. K) should 4. Non-separation of the newborn from the be done after the first full breastfeed is mother for early breastfeeding initiation completed and rooming-in. Postpone washing until 6 hours Take Anthropometric measurements UNANG YAKAP (FIRST EMBRACE) ○ Length = 48-54 cm TIME BAND: At Perineal Bulging, With ○ Head Circumference = 33-35 cm Presenting Part Visible ○ Chest/Abdomen = 31-33 cm Prepare for the Delivery ○ Weight = 2500-4000 grams/ 5-8 lbs Check temperature of the delivery room (25-28 ºC) Notify appropriate staff REMINDERS (Hospitals/Centers) Health workers should not tap the NB unless there is a medical indication Do not give sugar water, formula, or other pre-lacteals Do not give bottles or pacifiers Do not throw away colostrum  Wk10. NEWBORN SCREENING (NBS) GOAL To reduce preventable deaths of all Filipino RA 9288 - NEWBORN SCREENING ACT OF 2004 newborns due to more common and rare congenital disorders through timely screening Prior to delivery, any health practitioner and proper management who delivers or assists in the delivery of a newborn in the Philippines has the EXPANDED NEWBORN SCREENING (ENBS) obligation to inform the parents or legal The expanded newborn screening program guardian of the newborn of the increased the screening panel of disorders availability, nature, and benefits of newborn from six (6) to more than twenty-eight. screening IMPORTANCE OF NBS NEWBORN SCREENING REFERENCE CENTER Most babies with metabolic disorders look (NSRC) “normal” at birth. By doing ENBS, responsible for the national testing metabolic disorders may be detected database and case registries, training, even before clinical signs and symptoms are technical assistance, and continuing present. As a result of this, treatment can education for laboratory staff in all be given early to prevent consequences of Newborn Screening Centers untreated conditions. WHEN IS IT DONE? ENBS is ideally done immediately after 24 hours from birth until 72 hrs. HOW IS IT DONE? A few drops of blood are taken from the baby’s heel, blotted on a SPECIAL ABSORBENT FILTER CARD and then sent to Newborn Screening Center (NSC). NSC - NORTHERN LUZON ~ Ilocos Norte NSC - CENTRAL LUZON ~ Pampanga NSC - SOUTHERN LUZON ~ Batangas WHO WILL COLLECT THE SAMPLE FOR ENBS? NSC - NIH ~ Manila The blood sample for ENBS may be NSC - VISAYAS ~ Iloilo City NSC - CENTRAL VISAYAS ~ Cebu collected by any of the following: physician, NSC - MINDANAO ~ Davao del Sur nurse, medical technologist or trained midwife. NEWBORN SCREENING (NBS) simple procedure to find out if your baby WHERE IS ENBS AVAILABLE? has a congenital disorder that may lead to ENBS is available in hospitals, lying-ins, MENTAL RETARDATION or even DEATH if rural health units, health centers and left untreated. some private clinics. To know if the NB has a congenital disorder, the following were screened: HOW MUCH IS ENBS? ○ Blood Expanded newborn screening costs ₱1750 ○ Metabolic and is included in the Newborn Care ○ Hormone Package (NCP) for PhilHealth members. ○ Genetic VISION The National Comprehensive Newborn HOW CAN RESULTS BE CLAIMED? Screening System envisions all Filipino children Results can be claimed from the health will be born healthy and well, with an facility where ENBS was availed. inherent right to life, endowed with human dignity; and reaching their full potential with NORMAL ENBS RESULTS are available by the right opportunities and accessible 7-14 working days from the time samples resources are received at the NSC. MISSION To ensure that all Filipino children will have POSITIVE ENBS RESULTS are relayed to access to and avail of total quality care for the optimal growth and development of their full the parents immediately (