EXPANDED PROGRAM ON IMMUNIZATION

Question 1

The four major strategies of EPI includes:

Answer 1

-Sustaining high routine FIC coverage of at least 90% in all provinces and cities
-Sustaining the polio free country for global certification
- Eliminating measles by 2008
- Eliminating neonatal tetanus by
2008.

Question 2

The development of National Plan of Action for Polio Eradication has been
done when?

Answer 2

1990 which help a lot in the implementation of the eradication of polio.

Question 3

our country has been certified polio free?

Answer 3

2000, in kyoto Japan

Question 4

the process by which vaccines are introduced into the body
before infection sets in.

Answer 4

Immunization

Question 5

general principles which apply in vaccinating children:

Answer 5

-it is safe and effective to administer all EPI vaccines on the same day at different sites of the body.
-Measles vaccine should be given as soon as the child is 9 months old, regardless of whether vaccines will be given that day.
9 months: 85% protection.
1 y.o. & ↑: 95% protection.
-The vaccination schedule should not be restarted from the beginning, even if the interval between doses exceeds the recommended interval by months or years.
-Moderate fever; Malnutrition; Mild Respiratory Infection, Cough, Diarrhea and Vomiting: Not contraindicated for vaccination. unless so sick, that he needs to be hospitalized.
-It is safe and effective with mild side effects after vaccination. local reaction, fever, & systemic symptoms : Normal immune response.
-giving doses of vaccine <4 weeks interval may lessen antibody response. lengthening leads to higher antibody levels.
-No extra doses given to children/mother who missed a dose of DPT/HB/OPV/TT. Vaccination must be continued as if no time had elapsed between doses.
-Principle: Don’t reconstitute freeze-dried vaccines other than the diluent supplied with them.
-Repeat BCG
vaccination if the child does not develop a scar after the 1st injection.
- Use one syringe one needle per child during vaccination.

Question 6

Not Contraindicated to Vaccination:

Answer 6

Malnutrition; Mild Respiratory Infection, Cough, Diarrhea and Vomiting.

Question 7

The absolute contraindications to immunization are :

Answer 7

DPT 2 or DPT3: who has convulsion or shock within 3 days the previous dose.

Vaccines with Whole cell pertussis component: with evolving neurological disease (uncontrolled epilepsy of progressive encephalopathy)

Live Vaccines (BCG): Immunosuppresed due to malignant diseases (Child with clinical AIDS),
therapy with immunosuppressive agents, or irradiation (exposed to rad).

Question 8

The EPI Target Diseases:

Answer 8

***Vaccination among infants and newborns (0-12 months) against the seven vaccine preventable diseases.

Tuberculosis
Diphtheria
Pertussis
Tetanus
Poliomyelitis
Measles
Hepatitis

Question 9

the day which is designated as immunization day and is adopted in all parts of the country?

Answer 9

WEDNESDAY

BHS: Monthly
Far flung area: Quarterly
Some local areas: Everyday to cover all targets

Question 10

What do u call a child receives:
-one dose of BCG,
-3 doses of OPV,
-3 doses of DPT,
-3 doses of HB
-one dose of measles
before a child’s first birthday

11 vaccination: before 1st birthday

Answer 10

Fully Immunized Child

Question 11

BCG

Answer 11

Age at 1st dose:
Birth or anytime after birth

No. of doses:
1

Reason:
BCG given at earliest possible
to protects from
-TB,
-Menengitis
-other TB infectious
in which infants are prone.

Question 12

DPT & OPV

Answer 12

Age at 1st dose:
6 weeks

No. of doses:
3

Minimum Interval Best Doses:
4 weeks

Reason:
DPT: early start reduces chance of severe pertussis

OPV: protection against polio is ↑; earliest: keeps Philippines polio free.

Question 13

HEPATITIS B

Answer 13

Age at 1st dose:
At birth

No. of doses:
3

Minimum Interval Best Doses:
6 weeks
-From 1st dose to 2nd dose
8 weeks
-from 2nd dose to 3rd dose

Reason:
-prevent from being infected & carrier.
-prevent liver cirrhosis & liver cancer
-9000 die from HB; 10% Filipino has chronic HB infection
-eliminate HB before 2012 (Western Regional Goal)

Question 14

MEASLES

Answer 14

Age at 1st dose:
9 Months

No. of doses:
1

Reason:
-85% of measles can be prevented
-Prevent deaths (2% die),
-Malnutrition, pneumonia, diarrhea (at least 20%) get these complications from measles
-Eliminate measles by 2008

Question 15

What illness does the baby is being protected from TT injection?

Answer 15

neonatal tetanus

The baby will gain protection to the “2ND DOSE”

Question 16

TT 1

Answer 16

Minimum Age/ Interval:

As early as possible during pregnancy

Question 17

TT2

Answer 17

Minimum Age/ Interval:
At least 4 weeks later

Percent Protected:
80%

Duration of protection:
Infants: protected from neontal tetanus
Mother: 3 years protection

Question 18

TT3

Answer 18

Minimum Age/ Interval:
At least 6 months later

Percent Protected:
95%

Duration of protection:
Infants: protected from neontal tetanus
Mother: 5 years protection

Question 19

TT4

Answer 19

Minimum Age/ Interval:
1 year later

Percent Protected:
99%

Duration of protection:
Infants: protected from neontal tetanus
Mother: 10 years protection

Question 20

TT5

Answer 20

Minimum Age/ Interval:
1 Year

Percent Protected:
99%

Duration of protection:
Infants: all infants born to that mother will be protected
Mother: lifetime protection

Question 21

Reason why vaccines need to be stored at correct temperature?

Answer 21

-To avoid spoilage
-Maintain its potency

Question 22

Most Sensitive to Heat

Answer 22

“MOst sensitive to heat”

Measles (Freeze dried)
Oral Polio (Live attenuated)

Storage Temperature:
-15°C to -25°C (at the
freezer)

Question 23

Least sensitive to heat

Answer 23

“D-H-B-T”

-DPT/Hep B

“D” Toxoid; weakened toxin
“P” Killed bacteria
“T” Toxoid; weakened toxin

-Hep B
-BCG (freeze dried)
-Tetanus Toxoid

Question 24

-practiced to assure that all vaccines are utilized before its expiry date.
- Proper arrangement of vaccines and/or labelling
of vaccines expiry date are done to identify those near to expire vaccines.

Answer 24

“first expiry and first out” (FEFO)

Question 25

-Temperature monitoring of vaccines is done in all levels of health facilities to
monitor vaccine temperature.
-This is done twice a day early in the morning and in the afternoon before going home.
-Temperature is plotted every day in a temperature monitoring chart to monitor break in the cold chain.

Answer 25

Temperature Monitoring

Question 26

Cold chain equipment for use in the storage of vaccines:

Answer 26

-Cold room
-Freezer
-Refrigerator
-Transport box
-Vaccine carrier

Question 27

Other cold chain logistics supplies includes:

Answer 27

-Thermometers
-Cold chain monitor
-Ice packs
-Temperature monitoring chart
-Safety collector box

Question 28

Administration of vaccines:

BCG

Answer 28

DOSE:
Infants 0.05 ml

Route of Administration:
ID

Site of Administration
Right deltoid

Question 29

Administration of vaccines:

DPT

Answer 29

DOSE:
0.5ml

Route of Administration:
IM

Site of Administration:
Upper outer portion of
the thigh/ Vastus Lasteralis

Question 30

Administration of vaccines:

OPV

Answer 30

DOSE:
2 Drops or depending on manufacturer’s

Route of Administration:
ORAL

Site of Administration:
Mouth

Question 31

Administration of vaccines:

MEASLES

Answer 31

DOSE:
0.5 ml

Route of Administration:
Subcutaneous

Site of Administration:
Outer part of the upper arm/

Question 32

Administration of vaccines:

HEPATITIS B

Answer 32

DOSE:
0.5 ml

Route of Administration:
IM

Site of Administration:
Upper outer portion of
the thigh/ Vastus Lateralis

Question 33

Administration of vaccines:

TETANUS TOXOID

Answer 33

DOSE:
0.5 ml

Route of Administration:
IM

Site of Administration:
Deltoid

Question 34

Reconstituting the freeze dried BCG Vaccine:

Answer 34

a. Always keep the diluent cold by sustaining with BCG vaccine ampules in refrigerator or vaccine carrier.
b. Using a 5 ml syringe, aspirate 2 ml. of saline sollution from the opened ampule of diluent
c. Inject the 2 ml saline into the ampule of freeze dried BCG.
d. Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and expel it slowly into the ampule several times.
e. Return the reconstituted vaccine on the slit of the foam provided in the vaccine carrier

INTRADERMAL PRINCIPLE

Question 35

Giving Oral Polio Vaccine

Answer 35

A. Read the manufacturer’s instructions to determine number of drops to be given. Use the dropper provided.
b. Let the mother hold the child lying firmly on his back.
c. If necessary open the child’s mouth by squeezing the cheeks gently between your fingers to make his lips point upwards
d. Put drops of vaccine straight from the dropper, onto the child’s tongue. But do not let the dropper touch the child’s tongue.
e. Make sure that the child swallows the vaccine. If he spits it out, give another
dose.

Question 36

Hepatitis B and DPT
Giving Hepatitis B/DPT

Answer 36

a. Ask mother to hold the child across her knees so that his thigh is facing upwards. Ask her to hold child’s legs.
b. Clean the skin with a cotton ball, moistened with water and let skin dry.
c. Place your thumb and index finger on each side of the injection site and grasp the muscles slightly. The best injection site is the outer part of the child’s mid-thigh
d. Quickly push the needle into the space between your fingers, going deep in the muscle.
E. Withdraw to look for bloodflow, if injected into a vein.
f. Inject the vaccine.

Question 37

Reconstituting the Freeze Dried

Measles Vaccine

Answer 37

a. Using a 10 ml syringe aspirate 5 ml of special diluent, from the ampule.
b. Empty the diluent from the syringe into the vial with the vaccine.
c. Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and expelling it slowly into the vial several times. Do not shake the vial.
d. Protect reconstituted measles vaccine from sunlight. Wrap vial in foil.
e. Place the reconstituted vaccine in the slit of the foam provided in the vaccine carrier.

IM PRINCIPLES

Question 38

Note when giving EPI vaccines:

Answer 38

Note: Shake the vial before every injection.