NATIONAL
IMMUNIZATION
PROGRAM
Goals
◦To immunize all infants against vaccine
preventable diseases
◦To sustain polio-free status of the Philippines
◦To eliminate measles infections
Goals
◦To eliminate maternal and neonatal tetanus
◦To control Diphtheria, Pertussis, Hepatitis B
infection and German Measles
◦To prevent extrapulmonary tuberculosis among
children
Related Policies and Laws
◦PD 996 (1976) – Compulsory basic immunization
for infants and children below 8 years old
◦RA 7846 (1994) – Inclusion of Hepatitis B
immunization for infants and children below 8
years old
◦PP 6 (1996) – Implementing a United Nations
Goal on Universal Immunity and designating
Wednesday as Immunization Day
Related Policies and Laws
◦ RA 10152 (2011) – Mandatory Infants and Children
Health Immunization Act
◦ For children up to 5 years of age and inclusion of new
vaccines: Hepatitis B, Mumps, Rubella, Haemophilus
Influenza type B (Hib).
◦ This repealed PD 996 and is considered as the legal
basis of the NIP
General Considerations
◦Remind caregivers of children to comply with the
prescribed schedule of routine immunization
◦Previous doses do not have to be repeated
regardless of interval
◦Eligible for Pentavalent vaccines – up to 5 years
old
◦Booster doses are not really necessary
General Considerations
◦Vaccines may be given on the same day at
different sites
◦When administering several vaccines on the
same leg. It should be at least 2.5 – 5 cm apart
◦If several vaccines will be administered, start with
OPV, Rotavirus then other vaccines
General Considerations
◦Use cotton in cleaning the injection site. If with
alcohol, area should be thoroughly dry before
injecting the vaccine
◦BCG, AMV, MMR have special diluents and
should be discarded 6 hours after reconstitution
or after clinic hours
General Considerations
◦Protect BCG from sunlight and Rotavirus from
light
◦Inform caregivers of children for immunization
about common side effects and how to deal
with it
General Considerations
◦ Reusable vaccines such as OPV, Pentavalent, Hepa B
and TT may last for a maximum of 4 weeks provided the ff
conditions are met:
◦ Has not passed the expiry date
◦ Appropriate cold chain conditions have been observed
◦ Aseptic technique was observed during aspiration of the
vaccine
◦ The vaccine vial monitor (VVM) has not reached its
discard portion
◦ The vaccine septum was not submerged in water
General Considerations
◦ In case of a measles epidemic, a supplemental
measles vaccine is administered depending on the
age group:
◦ For under 9 months – give MR (measles rubella)
vaccine
◦ For 9 months to 5 years old – give MMR
Absolute Contraindications
◦Any serious condition that needs hospitalization
◦Immunocompromised condition such as AIDS
Non Contraindications
◦Fever up to 38.5 C
◦Mild acute respiratory infection
◦Simple diarrhea
◦Malnutrition – considered an indication
Vaccine Disease/s Components Age Dose Route Site
Bacillus Calmette Tuberculosis Live attenuated At birth 0.05mL ID Right upper
Guerin (BCG) bacteria arm/deltoid
Freeze dried
Hepatitis B Hepatitis B Plasma derivative At birth 0.5mL IM Vastus
Vaccine or RNA lateralis
(Monovalent) recombinant
Cloudy, Liquid
Pentavalent Diphtheria D-weakened toxin 6,10,14 0.5mL IM Vastus
Vaccine Pertussis P- killed bacteria weeks lateralis
(DPT-Hepa B-Hib) Tetanus T- weakened toxin
Hepatitis B Liquid, clear
Pneumonia
Meningitis
Oral Polio Vaccine Poliomyelitis Live attenuated 6,10,14 2 gtts PO mouth
(OPV) virus weeks
(For GI immunity)
Clear, Pinkish
Vaccine Disease/s Components Age Dose Route Site
Inactivated Polio Poliomyelitis Liquid, clear 14 weeks 0.5mL IM Vastus
Vaccine For serum immunity lateralis
(blood)
Pneumococcal Pneumonia Liquid, clear 6,10,14 0.5mL IM Vastus
Conjugate Meningitis weeks lateralis
Vaccine For 2-5
years old
give 1
dose
Measles Mumps Mumps Live attenuated 9 months 0.5mL SC Outer arm
Rubella (MMR) Measles virus and 12-15
German Freeze dried months
Measles
Rotavirus vaccine Severe Weakened virus 6 weeks, 1.5 mL PO Mouth
Diarrhea 10 weeks
Vaccine Side effects Management
BCG • Wheal for 30 minutes followed by ulceration • Normal reaction
within 2 weeks then scar formation within 12
weeks or 3 months
• Koch’s phenomenon: an acute inflammatory • No management is needed
reaction within 2-4 days after vaccination
usually indicates previous exposure to TB
• Deep (subcutaneous) abscess at vaccination • Refer to the physician for incision
site and drainage
• Indolent ulcer – an ulcer that persists after 12 • Treat with Isoniazid (INH) powder
weeks from vaccination date
• Glandular enlargement – enlargement of the • If suppuration occurs, treat as
lymph glands draining the injection site deep abscess
Hepatitis B Local Soreness at the injection site • No treatment necessary
• May apply cold compress
Vaccine Side effects Management
Pentavalent • Fever that usually lasts for only one day. Fever • Advise parents to give antipyretic
beyond 24 hours is not due to the vaccine but
other causes
• Local soreness at the injection site • Reassure parents that soreness will
disappear after 3 – 4 days
• May give paracetamol for pain
• Abscess after a week or more usually • Incision and drainage may be
indicates that the injection was not deep necessary
enough or the needle was not sterile
• Convulsions, although very rare may occur in • Proper management of
children older than 3 months caused by convulsions; may give DT next
pertussis component vaccination
Vaccine Side effects Management
OPV None • Nothing per orem for 30 minutes
to prevent the child from vomiting
and enhance absorption
• If child vomits, administer another
dose
• If the child has simple diarrhea
may give OPV but dose not
counted and should be instructed
to return for next due dose
IPV Local soreness • Cold compress
MMR Local soreness, fever, irritability and malaise in • Reassure parents and instruct
some children them to give antipyretic to the
child
• Give 200,000 Vitamin A to
promote epithelialization and
increase immunity
Ensuring Potency
◦ Cold chain – proper storage, handling and transport of
vaccines in prescribed temperature
◦ The nurse serves as cold chain manager and needs to
check proper temperature at least twice a day in the
RHU
◦ Special diluents should be stored in the lower
compartment or door shelves
◦ Polio vaccine should be placed near or adjacent to the
cold pack/box while the rest is placed in the middle
Recommended temperature for vaccine storage
Vaccine Temperature Stability
Most sensitive to heat OPV -15 to - 25 C
Least sensitive to Pentavalent 2 to 8 C 8 hours if in room
heat/Most sensitive to Hepa B temperature
cold Diptheria
Tetanus Toxoid
Most sensitive to light Rotavirus 2 to 8 C 4 to 6 hours
Recommended duration of storage for vaccines
Facility Duration
Regional Health Office 6 months
Provincial/District Office 3 months
RHU 1 month
Transport box 5 days
DOH recommendations
◦Proper vaccine storage
◦FEFO Principle – “First Expiry, First Out
◦Vaccine Vial Monitor – round disc of heat
sensitive material to register cumulative heat
exposure
◦Shake test
Recording in the NIP
◦ A fully immunized child (FIC) is a child who has received
all immunizations that should be given before reaching
1st year of life
◦ A completely immunized child (CIC) is a child who has
completed all immunizations scheduled at the age of
12-23 months
◦ A Child Protected At Birth (CPAB) is a child whose
mother has received 2 doses of Td during pregnancy
Computation of vaccine
requirements
◦ Estimated number of infants = total population x 2.7%
◦ Estimated number of pregnant women = total
population x 3.5%
◦ A reserve stock of 25% of the supply period should be
maintained at the facility
