IMMUNIZATION PROGRAM

OF THE PHILIPPINES

Prepared by:
Aida V. Garcia, MAN, RN
LEGAL BASIS
LEGAL BASIS
 LEGAL BASIS

• In 1976
• Tuberculosis
EPI
• Diptheria
• Pertussis 6
• Tetanus
• Poliomyelitis
• Measles
 4 strategies:

1.sustain high routine

Full Immunized Child
coverage of -At least
90% - all provinces &
cities
 4 strategies:
• 2.sustain polio-free
country for global
certification
• 3.eliminate measles-2008
• 4.eliminate neonatal
tetanus - 2008
d/t poliomyelitis
infection
 LEGAL BASIS

• year 1995
• Infants & children 8 y/o & below
• w/in 24hr after birth Hepa B immunization if
mo. has Hepatitis B
• In 1995
• Tuberculosis
• Diptheria
• Pertussis
• Tetanus 7 Republic Act 7846

• Poliomyelitis
• Measles
• Hepatitis B
LEGAL BASIS

• In 2011
• Mumps
• Rubella or German measles
• H. Influenza type B (HIB)
0 – 12 MONTHS:
newborns / infants
 CONCEPT / IMPORTANCE
= The process by w/c vaccines are introduced
into the body before infection sets in.

= Induce Immunity (immune system reacts)

(antibodies)
- Infants & newborns need to be
vaccinated at early age (vulnerable age grp)

susceptible to childhood dses.

 PRINCIPLES

•1. Epidemiological Situation

•2. Mass Approach
•3. Basic Health Service
VACCINES TYPES,
FORMS,
CONTENTS
TYPES OF VACCINE:
4 main antigen
 ATTENUATED VACCINE- Live but altered
(LAV)
Attenuated means
ex.
“weakened.”
• contains small • MMR vaccine • Advantage – very
amount of weakened (measles, mumps & effective, provides
live pathogen - rubella) lifelong protection in 1
doesn’t cause • AMV / MCV or 2 shots.
disease. It trigger • rotavirus • Disadvantage – can’t
immune system.. give to weak immune
• smallpox
system. - takes long
• chickenpox.
time to manufacture.
 TYPES OF VACCINE: antigen
ATTENUATED VACCINE- Live but altered
 TYPES OF VACCINE: antigen
INACTIVATED VACCINE - Killed

• Advantage – doesn’t take

• use killed or • EX. time in manufacturing.

dead • wP - whole • - safer than LAV

• Disadvantage – less
pathogen cell Pertussis effective than LAV

• IPV - • Not lifetime protection.

Needs multiple doses
inactivated over time

polio vaccine
 TYPES OF VACCINE: antigen
INACTIVATED VACCINE - Killed
 TYPES OF VACCINE: antigen
TOXOID VACCINE - Inactivated or Altered exotoxins of bacteria

• ex. Tetanus • safe - can’t cause

• inactivated Toxoid disease, no possibility
toxin • Diptheria Toxoid
of
• reversion to virulence
• Td - tetanus and • Require several
diphtheria doses, need adjuvant.
toxoids vaccine • Not highly
immunogenic
 TYPES OF VACCINE: antigen
TOXOID VACCINE - Inactivated or Altered exotoxins of
bacteria
 TYPES OF VACCINE: antigen
Conjugate subunit vaccines

• ex. Haemophilus • heralded new age for

• create influenzae type b immunization against
response conjugate (Hib) encapsulated
against the • Pneumococcal organisms -
conjugate meningococcus,
molecules in Haemophilus
• Hepatis B (HepB)
the pathogen’s • accelular pertussis
influenzae type b
capsule (Hib) &
(aP)
pneumococcus.
 liquid
Freeze-dried
liquid Freeze-dried
Anti-measles Freeze-dried, reconstituted w/
vaccine (AMV1) special diluent

Measles-mumps- Freeze-dried, reconstituted w/

rubella vaccine special diluent
(AMV2)
BCG (Bacille Calmette- Freeze-dried, reconstituted w/ special
Guerin) diluent
Hepatitis B vaccine Cloudy, liquid
DPT-HepB-Hib Liquid
(Pentavalent vaccine)
(PETAVALENT) 5-in-1
vaccine
Oral polio vaccine Clear, pinkish liquid
Rotavirus vaccine Clear, colorless liquid, in a container with an
oral applicator
Tetanus toxoid Sometimes slightly turbid in appearance: Clear,
colorless liquid; sometimes slightly turbid…
VACCINE STORAGE
 VACCINE STORAGE

• 2 degreeC to 8degreeC
• Liquid formulations
• vaccines containing diphtheria, pertussis,
tetanus, hepatitis B, Haemophilus
influenzae type b, IPV & their
combinations should not be frozen.
VACCINE STORAGE
• 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 chain space permits,
but is neither essential nor recommended.
 ROUTINE SKED OF IMMU.
WED – Nationwide Immunization Day

MONTHLY – Barangay Health Station

QUARTERLY – Far Flung Area

EVERY DAY – Some Areas, to cover all targets

 ROUTINE SKED OF IMMU.

QUARTERLY
– Far Flung
Area
PROCEDURES
IN GIVING
VACCINES
 Reconstituting freeze dried
vaccine:BCG
Keep diluent cold

• Aspirate 2ml Of saline soln from ampule of diluent

• Use 5ml syringe w/ long needle

• Inject the 2ml. Saline in the ampule of freeze dried BCG.

Reconstituting freeze dried : measles vaccine
• aspirate 5ml. Of special diluent from the ampule
• Use 10 ml. Syringe fit w/ long needle

Empty the diluent from the syringe into the vial with the vaccine.
Reconstituting

• mix diluent &

vaccine - draw
mixture back into the
syringe &
expel it slowly in the
ampule several times
Return reconstituted vaccine on slit
of foam provided in vaccine carrier
Clean skin w/
cotton ball
moistened w/ water &
let skin dry
 ROUTINE
IMMUNIZATION
 ROUTINE IMMUNIZATION
BCG (Bacille Calmette-Guérin)
at birth (after birth) earliest protects
TB meningitis & other
ID (R Deltoid area)
TB infec.
.05ml
once
EPI | Procedures in giving BCG
BCG Vaccination
 ROUTINE IMMUNIZATION
Hep B Vaccine (HbV)
at birth infected/carrier
IM Protects liver
0.5 ml cirrhosis/liver CA
Anterolateral of thigh Eliminate HB before 2012
 ROUTINE IMMUNIZATION
Anti Measles Vaccine/Meales Containing Vaccine
AMV / MCV
9th mon 85% protection
SC 0.5 ml prevents death - 2 %
malnutrition, pneumonia,
12mons diarrhea 20%
outer part upper
arm
Giving Measles Vaccine
 ROUTINE IMMUNIZATION

OPV / ORAL POLIO VACCINE

6 wks
10 wks
14 wks
Per Orem
2 to 3 drops
mouth
 Updates In
2016: Inactivated Poliomyelitis Vaccine (IPV)
• 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
 Updates:

• Pneumococcal Conjugate Vaccine (PCV13)

• also part of immunization

– 6th, 10th and 14th week
– 0.5 mL
– IM administration.
 Updates:
Pentavalent Vaccines
(Diptheria, Pertussis, Tetanus, Hepatitis B
and Haemophilis Influenza Type B)

• at 6, 10, 14 weeks
0.5 mL
IM route
 Immunization Schedule for Infants and Young Children
Antigen Age Dose Route Site
BCG vaccine At birth 0.05 ml Intradermal Right deltoid region (arm)
Hepatitis B vaccine At birth 0.5 ml Intramuscular Anterolateral thigh muscle
DPT-HepB-Hib 0.5 ml Intramuscular Anterolateral thigh muscle
6 weeks, 10 weeks,
(Pentavalent vaccine)
14 weeks

Oral polio vaccine 2 drops Oral Mouth

6 weeks, 10 weeks,
14 weeks

Anti-measles vaccine 9-11 months 0.5 ml Subcutaneous Outer part of the upper arm
(AMV1)
Measles-mumps-rubella 12-15 months 0.5 ml Subcutaneous Outer part of the upper arm
vaccine (AMV2)
Rotavirus vaccine 1.5 ml Oral Mouth
6 weeks, 10 weeks
 Measles (sc)
- Reconstitute ( Freeze Dried Measles)
- Use 10 ml. syringe (long needle) – Aspirate
5 ml diluent vial w/ vaccine

MIX: Draw mixture in syringe

: Expel slowly in vial (Do NOT shake)
-Protect against sunlight (slit of foam)
 Measles (sc)
INJECT – Mo. Hold 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 2ml saline soln
(diluent)
- Inject 2ml into vaccine
- MIX well (same w/ measles)
 BCG (ID)
INJECT
Clean (same w/ measles)
POSITION
(N) Lt. hand – Hold child arm
:Hold under arm
:thumb & fingers come around
arm STRETCH SKIN
(N) Rt. Hand – Hold syringe (bevel up)
 BCG (ID)
INJECTING
: Almost FLAT along the child’s arm (skin)
(Upper layer of skin)
: Once in position –
: L Hand (thumb) hold syringe END in
position
: R Hand (index & middle finger) hold
plunger
:R Hand (thumb) press plunger
: In injecting – FLAT WHEAL – withdraw needle
 DPT / HEPA B (IM)
Mo. Hold child across her thigh facing upwards
Ask Mo. To hold child’s legs
CLEAN – Site (Outer part of midthigh)
- Cotton ball & water
 DPT / Hepa B (IM)
(N) HAND
: Thumb, index finger grasp Muscle of site
: Inject needle
: Aspirate to check
: Inject vaccine
: Withdraw needle
: Press site w/ cotton balls
 TT (IM)
Shake Vial
CLEAN SITE (Outer side of Left Upper Arm)
PLACE thumb, index finger site,grasp MUSCLE
- Inject needle
- Aspirate to check
- Inject vaccine
- Withdraw needle
- press site w/ cotton ball
IMPT. CONSIDERATIONS
Use single syringe & needle per client

No need to restart vaccination regardless of

the time lapsed between doses

All EPI/NPI antigens are safe & effective when

administered simultaneously but at diff sites
Auto-disable syringe for Fixed-dose
Immunization.
for single use
 IMPT. CONSIDERATIONS
In OPV..do not let dropper touch
the tongue.
Use monovalent hepatitis B vaccine
for birth dose
Pentavalent vaccine is not for birth
dose
 IMPT. CONSIDERATIONS

Use
monovalent
vaccine

combination
Pentavalent
vaccine
vaccine
IMPT. CONSIDERATIONS
 IMPT. CONSIDERATIONS
Rotavirus vaccine.. Administered
only to infants 6wks to 15 weeks

Rotavirus …2nd dose.. 10 wks up

to a maximum of 32 wks
 IMPT. CONSIDERATIONS

Rotavirus vaccine..adm. At 1
side of mouth with tip of
applicator directed toward
back of infant’s mouth to
prevent failed swallowing or
spitting
 IMPT. CONSIDERATIONS

Coadministration of OPV
& Rotavirus.
OPV first followed by
Rotavirus vaccine
CONTRAINDICATIONS TO
IMMUNIZATION
 ABSOLUTE CONTRAINDICATION
PENTA - DPT 2 or DPT3
: to a child who had convulsion or shock (w/in
3 days of PENTA - DPT 1
: x child w/ neurological dse, epilepsy

LIVE BCG
: immunosuppressed (malignant dse – AIDS)
: therapy w/ immunosuppressive agents
: irradiation
FALSE C/I
- low –grade to mod. Fever
- moderate infection
(minor illness)
: cough
: diarrhea (opv)
: vomiting
: malnourish
C/I - needs hosp.
 COLD CHAIN

A system for ensuring potency of

vaccine from time of manufacturer
 COLD CHAIN
- Very Sensitive at various temp (correct
temp)
: to avoid spoilage, maintain potency
- When handling, transport & storing
: Cold Chain equip.
(cold room, freezer, ref, transport box, vaccine carrier)

: Other logistics ( thermometer, cold chain

monitor, temp. monitoring chart, ice packs, safety collector box)
 COLD CHAIN LOGISTICS
• Freezer / refrigerator
• Transport box
• Vaccine carrier/bags
• Cold chain monitors
• Thermometers
• Cold packs
• Cold chain officer • Cold chain
manager
• PHN
 REFRIGERATOR
FREEZER -15 TO -
25 C BODY +2 TO +8 C
• OPV • AMV
• MMR
• Rotavirus vaccine
• HBV, 5-in-1,RV,TT damaged by
freezing
• Diluents –lower or door shelves
- Temperature monitoring – 2x
• It is no longer necessary to ship and store freeze-dried
vaccines (measles, yellow fever and BCG) at –20°C.
Instead, they may be refrigerated at +2° to +8°C
OTHER CONSIDERATIONS TO
MAINTAIN POTENCY
• 1. Observe
the first
expiry-first
out (FEFO)
policy.
 • 2. Duration of storage &
transport: health center/RHU

w/ refrigerator – storage should

not exceed 1 month
3. 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

• maximum for 48 hours

with the lid closed.\
• 3.VACCINE VIAL
MONITOR (VVM)

VVM – round dot of

sensitive material placed on
the vaccine vial
- register heat exposure
VVM
Direct relationship exists bet rate of
:

: lower the temperature -slower color change

: higher the temperature, faster color change
• 4. Reconstitute freeze-dried vaccines
• Discard reconstituted freeze-dried
vaccines
6 hrs after reconstitution
OR
at end of immunization session,
whichever comes sooner.
RECONSTITUTED FREEZE DRIED : BCG, AMV, MMR
•5. OPEN-VIAL
POLICY
(DOH)/ MULTI
– DOSE VIAL
 • OPEN-VIAL POLICY (DOH)
OPEN VIAL POLICY:
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

MULTI DOSE LIQUID VACCINES

Re-used max. 4 wks if ff. standard

sterile procedures

all conditions are met

conditions are:

üexpiry date - not passed

üvaccine - not contaminated.
üvial-stored correct cold chain condition
üvaccine vial septum- not submerged in
water
üVVM - not reached discard point
 except -
• Opened vials :
- measles, yellow fever, BCG and freeze-dried Hib
vaccine - Do Not Use after intial 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.
 4. Protect
• BCG protect from sunlight
• Rotavirus protect from light
qdark brown glass
qBCG, measles, MR, MMR and rubella vaccines
 EXPOSURE TO UVL - LOSS OF
POTENCY

qprotected against sunlight or fluorescent (neon)

light.

qBCG, measles, MR, MMR and rubella vaccines

qequally sensitive to light (as well as to heat)

Reference: cold chain. www.WHO

Procedure:
1. frozen control sample
vial - same type /batch of vaccine
vial - FREEZE until solid (10 hours at -10°C).
Thaw
Control sample - Mark vial clearly
Procedure:
2. Test sample
Vial (s) of vaccine from the batch (es) that
you suspect has been frozen.
Procedure:
3 Shake - control vial & test vial
Hold both in 1 hand.
Shake vigorously (10–15 secs)

4 Allow to rest both vials

Vials - put on table. Not moving further.
Procedure:

5. Compare the vials

View both against light
Compare sedimentation rate.
Result - Shake test

Test sample - slower sedimentation rate than

control sample, test sample not frozen. Can be
used.

Sedimentation rate is same & with flakes - vial

damaged by freezing. Should not be used
RECORDING
 EPI TARGET DSES

(1)TB
(2)DIPHTHERIA “FIC”
(3)PERTUSSIS
(4)TETANUS 7 -complete before 1y/o
(5)POLIOMYELITIS
(6)MEASLES
(7)HEPATITIS
 TARGET DSES

(1) BCG
(2) HEPbV • “CIC” -
(3) Pentavaccine 1, 2, 3
(4) OPV 1, 2, 3
(5) IPV
(6) AMV 1, AMV 2 (MCV1, MCV2)
7 -complete AT 12 MONTHS
COMPUTATION : TARGET SETTING &
VACCINE REQT
 NIP TARGET SETTING
• INFANTS = Total pop x 2.7 %

• 12 to 59 MON-OLD CHILDREN
• Total Pop x 10.8 %

• Pregnant
• total pop x 3.5 %
 COMPUTATION : TARGET SETTING &
VACCINE REQT
the following are given WASTAGE MULTIPLIER for some
EPI vaccines:
DPT, OPV, TT = 1.25
HbV = 1.20
AMV = 2.00
BCG = 2.50
 COMPUTATION : TARGET SETTING &
VACCINE REQT

Total number of doses per unit (ampulae or vial)

Wastage Multiplier x ____________________________________
• Number of Doses Needed
 SAMPLE COMPUTATION
• Determine OPV requirement for a municipality w/ a total
population of 15,000

Eligible = 15,000 x 0.27

= 405 infants
 SAMPLE COMPUTATION

OPV Requirement for the year

Vaccine Reqt for the yr
= eligible pop X # of doses X wastage multiplier

= 405 infants x 3 doses x 1.67

= 2,029 doses
 SAMPLE COMPUTATION
*20 doses / bottle of OPV.

To convert doses to bottles:

Reqt for the year in bottles = Reqt for the yr in doses

# of doses per bottle

= 2,029 doses / 20 doses per bottle

= 101.45 bottle
 SAMPLE COMPUTATION

Monthly Vaccine Reqt

Monthly Vaccine Reqt = Reqt 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
ABOUT VACCINE SAFETY
https://www.who.int/vaccine_safety/initiative/tech_support/Part-2.pdf

ABOUT VACCINE TEMPERATURE

https://www.cdc.gov/vaccines/hcp/admin/storage/downloads/D-
vax-temp-best-practices-frozen-C.pdf

ABOUT AUTO-DISABLED SYRINGE

https://ph.video.search.yahoo.com/search/video?fr=mcafee&ei=UTF-8&p=auto-
disable+injection+syringe#id=4&vid=19bfa01e17b971b37c867a397d3c49c2&action=view

ABOUT COLD CHAIN

https://www.slideshare.net/moliabdu/cold-chain-52969470

ABOUT COLD CHAIN

https://www.who.int/immunization/documents/IIP2015_Module2.pdf?ua=1