FAMED

SECOND SEMESTER PRELIMS (AY 2024-2025)

Doctor/Lecturer: Dr. Mabasa

NATIONAL IMMUNIZATION PROGRAM

Specific Goals of NIP
I. Benefits of Immunization 1.​ To immunize all infants/children against the most
1.​ Saves lives, prevents diseases and reduces direct common vaccine-preventable diseases (Target
and indirect health costs 95%).
2.​ Vaccines are cost-effective and are a core 2.​ To sustain the polio-free status of the Phils.
component of any preventive services package. 3.​ To eliminate measles infection.
3.​ Vaccines protect children from VPDs 4.​ To eliminate maternal and neonatal tetanus
(vaccine-preventable diseases) that once were top 5.​ To control diphtheria, pertussis, hepatitis B and
killers and disablers worldwide (diphtheria, German measles.
whooping cough, tuberculosis, smallpox, polio and 6.​ To prevent extra pulmonary tuberculosis among
measles). children.
4.​ Vaccines continue to give protection against Services Provided:
more diseases among various age groups as new 1.​ PhilHealth Benefit Package
vaccines are developed and tested. a.​ provision of birth dose of BCG and
5.​ Vaccines also prevent the spread of these Hepatitis B immunization to the newborn
diseases among families, loved ones and (under the PhilHealth Newborn Service
neighbors, resulting in healthier communities. Package)
6.​ Immunization prevents disease transmission b.​ provision of at least 2 doses of Tetanus
from one generation to another, freeing the next Toxoid (part of the Maternity Care
generation from the threat of disease. Package) reimbursed by PhilHealth
7.​ Vaccination not only benefits the health and welfare 2.​ Trainings – includes online Mid-level Management
of the whole population but is also a source of high Training, EPI Basic Skills Training
investment return to the government. 3.​ Implementation Support Materials
a a.​ NIP Manual of Procedures – provide
A. Consequences of Non-vaccination guidance for implementers
●​ Unvaccinated children can develop diseases b.​ Philippine Immunization Strategic Plan,
resulting in prolonged or long-term disabilities, 2016-2022 - provides the roadmap for
affecting their full physical, emotional and social scaling up the current Expanded Program
development and well being. of Immunization into a National
●​ Sick children are unable to go to school, which can Immunization Program over the next 5
hamper their becoming fully productive individuals. years.
●​ Prolonged treatment and out-of-pocket spending Policies and Laws
burdens families with medical expenses and lost * summarized definition of policies and laws
time at work. This can eventually lead to a lower
quality of life for individuals and families.
RA 10152 of 2011 Mandatory Infants and
●​ VPDs are re-emerging and new infectious diseases
Children Immunization Act
are affecting the country.
of 2011
II. National Immunization Program
PD 996 of 1976 Providing for Compulsory
●​ initially launched as EXPANDED PROGRAM ON
Basic Immunization for
IMMUNIZATION (EPI) on July 12, 1976
Infants and Children below
○​ after WHO established the program in
8yo
1974 through a World Health Assembly
resolution to build on the success of the
global smallpox eradication program, and RA 9994 An act granting additional
to ensure that all children in all countries benefits and privileges to
benefited from life-saving vaccines seniors (grant of twenty
○​ EPI primarily aims to reduce the morbidity percent
and mortality among children against the (20%) discount and
most common VPDs which includes exemption from the
tuberculosis, poliomyelitis, diphtheria, value-added tax on the
tetanus, pertussis and measles purchase of medicines

Dept. Memo No. interim guidelines for

EPI (1976) NIP (current) 2020-0150 immunization services in
Coverage: 6 VPDs Coverage: 14 VPDs the context of COVID-19
Target Pop: infants and ●​ TB, Hep B, Polio, outbreak
pregnant women DPT, HiB,
Pneumococcal Proclamation No . 46 reaffirming the commitment
Dse, MMR, HPV, (1992) to the universal child and
influenza, mother immunization
rotavirus + JE goal by launching the Polio
Target Pop: Infants, Eradication Project
pregnant women, school
children, adolescents/ Dept. Memo No. OP guide for the
youths, senior citizens, and 2019-0018 introduction of Japanese
those in special situations Encephalitis vaccine in

Transcriber/s and Editor/s: Lamboso, J.​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 1

References:
 the NIP

Dept. Memo No. Amendment to DM

2019-0018 A 2019-0018:
“the JE vaccine can be
administered with other
vaccines at the same time.
However, if the child
received a live vaccine in
the past four (4) weeks,
delay JE vaccination for 28
days from the
administration of the live
vaccine.

Definition of Terms
Access terms here:
https://quizlet.com/ph/1022554940/famed-nip-definition-of-ter
ms-flash-cards/?i=5ytra0&x=1qqt

Fully Immunized Child (FIC)

●​ someone who has received:
○​ 1 dose of bacille Calmette-Guérin (BCG)
vaccine for tuberculosis;
○​ 3 doses of oral polio vaccine (OPV);
○​ 3 doses of diphtheria, tetanus, pertussis,
Hib, and Hepatitis B (pentavalent) vaccine;
and
○​ 2 doses of the measles, mumps, and
rubella (MMR) vaccine.
●​ WHO FIC:
○​ An infant who received 1 dose of BCG, 3
doses each of OPV, 3 doses of
pentavalent vaccines and 1 dose of
Measles-containing vaccine before
reaching year old. It is an overall program
indicator to assess the proportion of full
complement of immunization during the 1st
year of life.
●​ High Risk Purok - <90% of children with cards
have complete immunization OR >80% have no
card
●​ Low Risk Purok - >90% of children with cards
have complete immunization.

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 Common VPDs in the Philippines

Disease Agent Reservoir Spread Duration of Immunity Risk factors for infection Prevention
Induced by Infection

Tuberculosis Mycobacterium Human Airborne Not known, ●​ Crowding ●​ Routine immunization-BCG

tuberculosis droplets reactivation of old ●​ Immunodeficiency protects infants infected with
infection commonly ●​ Malnutrition in adults TB from progressing to more
causes diseases ●​ Alcoholism dangerous forms of the
●​ Diabetes disease (miliary or meningeal
●​ HIV TB) and gives them some
protection against recurrence
at a later age.
●​ TB preventive treatment
(TPT)-oral medication

Hepatitis B Virus Humans Mother to newborn, child to If infection resolves, ●​ Infected mother ●​ Hepa B Vaccine
child, blood, sexual. In life-long immunity ●​ Unsafe injections
developing countries, ●​ Unsafe blood transfusions
transmission at birth or Multiple sexual partners
early childhood is dominant.

Poliomyelitis Poliomyelitis Humans Fecal-oral Lifelong type-specific ●​ Poor environmental ●​ OPV

virus-serotypes 1, immunity hygiene ●​ IPV
2, 3

Diphtheria Corynebacterium Humans Close respiratory contact or Usually lifelong ●​ Crowding ●​ Immunization of children in
diphtheriae contact with infectious their first year of life with three
(toxin-producing material doses of diphtheria vaccine
bacterium) and appropriate booster
doses

Pertussis Bordetella Humans Close respiratory contact No concrete evidence ●​ Crowding ●​ Timely delivery of three doses
pertussis of vaccine at proper intervals
during child’s first year of life

Tetanus Soil animal Spores enter through None ●​ Exposure to animal feces
intestines wounds ●​ Infections with rusty
metals
Clostridium tetani ●​ Untreated wounds
(toxin-producing
Maternal-Neona bacterium) Infected Infection through the None ●​ Inadequately trained birth
tal Tetanus Mother umbilical cord of newborns attendants
●​ Lack of supplies for clean
and safe deliveries

Meningitis and Haemophilus HUmans Close respiratory contact Usually lifelong ●​ Overcrowding leading to ●​ Hib vaccination in the first
pneumonia influenzae type b exposure to the infections 6mos of life

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Disease Agent Reservoir Spread Duration of Immunity Risk factors for infection Prevention
Induced by Infection

caused by HiB (bacterium) ●​ Hib vaccine will not prevent

meningitis and pneumonia
causde by other types of
Haemophilus influenzae or
other agents

Rotavirus Virus Humans Fecal-oral Unknown ●​ Globally circulating virus ●​ Improved nutrition
strain ●​ Good hygiene (handwashing)
●​ Poor environmental and sanitation
hygiene ●​ Oral live weakened rotavirus
vaccines

Measles ●​ Vaccination
○​ MCV1 (monovalent
measles) at 9-11
months old
○​ MCV2 (MMR) at 12-15
months old

Mumps ●​ Vaccination

Rubella ●​ Vaccination
○​ For infant immunization,
these are usually given
in combination with
measles-rubella (MR)
Close respiratory contact and/or measles, mumps
Virus Humans Lifelong ●​ Crowding​
and aerosolized droplets and rubella (MMR).
○​ For prevention of
congenital rubella
syndrome (CRS),
women of childbearing
age are the primary
target group for rubella
immunization.
○​ Immunizing women
between 15-49 years
old will rapidly reduce
the incidence of CRS
without affecting
childhood transmission
of the virus.

Japanese Virus Mosquitoes Bite by infected mosquito Lifelong ●​ Presence of HIgh burden ●​ Immunization
Encephalitis of disease-causing vector ○​ 4 types of JE vaccines

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Disease Agent Reservoir Spread Duration of Immunity Risk factors for infection Prevention
Induced by Infection

Human Virus Humans Sexual Intercourse Not known ●​ Unsafe sexual practices ●​ Comprehensive cervical
Papilloma Virus cancer prevention and control
○​ Primary prevention by
HPV vaccination for girls
nine to 13 years of age
and, for both girls and
boys, health education
warning against tobacco
use, sexuality education
and promotion of
condom use, and male
circumcision;
○​ Secondary prevention in
women aged 30–49
years with a screen and
treat approach, since
vaccination does not
protect against all
cancer-causing HPV
types
○​ Tertiary prevention by
treatment of invasive
cancer at any age.

Influenza Virus HUmans Close respiratory contact Unknown or weak ●​ Crowding ●​ Annual Vaccination esp for
and airborne droplets immunity high-risk individuals
●​ Good personal health and
hygiene
●​ Proper coughing and
sneezing
●​ Avoiding close contact with
sick people

Pneumococcal Bacteria Humans Close respiratory contact Some type-specific ●​ Crowding​ ●​ Vaccination
Dse and airborne droplets immunity ○​ Children: Pneumococcal
Conjugate Vaccine
○​ Elderly: Pneumococcal
Polysaccharide Vaccine
●​ Improved living conditions
and nutrition

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 VPD Surveillance ○​ at least one of the following: cough, coryza
●​ refers to the intensive case-based surveillance for (runny nose) or conjunctivitis (red eyes).
VPDs targeted for eradication and elimination: ●​ The clinical diagnosis of measles is supported by
cases of acute flaccid paralysis (AFP) or the presence of Koplik's spots and if the rash
suspected polio, measles and neonatal tetanus progresses from the head to the trunk and to the
(NT) extremities.
●​ also includes the surveillance of adverse events Rubella
following immunization (AEFI) cases discussed in ●​ Suspected case: Any individual regardless of age
the AEFI section under Injection Safety measures with the following signs and symptoms:
●​ process of systematic collection, consolidation, ○​ fever (38°C or more) or hot to touch; and
analysis, interpretation and dissemination of data on ○​ maculopapular rash (non vesicular); and/or
VPDs for policy development, guidelines ○​ one of the following: post auricular or
formulation, decision making, planning for public axillary lymphadenopathy and/or joint pain
health intervention, advocacy and health promotion, and/or conjunctivitis
program implementation and program monitoring,
assessment and evaluation. NEONATAL TETANUS (NNT)
●​ 3 Components: *definition in quizlet* ●​ Suspected case:
○​ Control ○​ any neonatal death from 3 to 28 days of
○​ Elimination age in which the cause of death is
○​ Eradication unknown, OR
Purpose of Surveillance Activities of Selected VPDs ○​ any neonate reported as having suffered
●​ Varies depending on the level or stage of goals set from neonatal tetanus from 3 to 28 days of
for each VPD & criteria age and not investigated.
●​ Eg: ●​ Confirmed case
○​ Eradicate polio ○​ any neonate that sucks and cries normally
■​ Maintain certification standards in during the first two days of life, and
polio-free countries becomes ill from three to 28 days of age
■​ No cases of clinical poliomyelitis and develops both an inability to suck and
associated with wild poliovirus diffuse muscle rigidity (stiffness), which
■​ No wild poliovirus found may include trismus, clenched fists or feet,
worldwide despite intensive continuously pursed lips, and/or curved
surveillance back (opisthotonus), OR
○​ Eliminate maternal-neonatal tetanus ○​ a neonate from three to 28 days of age
■​ Achieve and maintain <1NT diagnosed as a case of tetanus by a
case/1,000 LB in every physician.
province/city/municipality every
year ACUTE MENINGITIS ENCEPHALITIS SYNDROME
○​ Eliminate measles and rubella ●​ A case of suspected AMES is any person who at
■​ Absence of endemic measles any time of the year had sudden onset of fever and
virus transmission for a period of one of the following:
12 months or more,in the ○​ Change in mental status (including
presence of adequate symptoms such as altered consciousness,
surveillance,and confusion, disorientation, coma, or inability
■​ Reduced incidence of measles to talk)
to<1/1,000,000 pop so that it is ○​ New onset of seizures (excluding simple
no longer a health threat febrile seizures)
○​ Control other VPDs (e.g., diphtheria, ○​ Neck stiffness of other meningeal signs
pertussis) ○​ Case diagnosed by physician either as
encephalitis or meningitis
ACUTE FLACCID PARALYSIS
●​ Any child under 15 years of age with acute onset of
floppy paralysis, OR a person of any age in whom
poliomyelitis is suspected by a physician.
●​ Acute: sudden onset of paralysis. Usually the
interval from the first sign of muscle weakness to
inability to move the affected limb(s) takes 3–4 days
but may extend to two weeks
●​ Flaccid: loss of muscle tone of the affected limb(s)
giving it a floppy appearance (as opposed to spastic
or rigid)
●​ Paralysis: reduced or lost ability to move the
affected limb(s)
●​ If an AFP case is less than 5 years of age with less
than 3 OPV doses and had fever at onset of
asymmetrical paralysis OR if the client has L20B+
isolate, the case is considered a "Hot Case"

MEASLES-RUBELLA
Measles
●​ Suspected case: Any individual, regardless of age,
with the following signs and symptoms:
○​ fever (38°C or more) or hot to touch; and
○​ maculopapular rash (non-vesicular); and

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 VACCINES USED IN THE NIP
Vaccine Disease Type of Vaccine Formulation Usual No. of doses Common Damaged by
in primary series Vial Sizes freezing?
and route of
administration

BCG TB Bacillus Freeze-dried 1 dose - ID 20 doses No, but diluent

Calmette - should not be
Guerin (BCG): frozen
live attenuated
mycobacterium
bovis

Hepa B Hepatitis B Liquid Monovalent 1 dose - IM 1 dose Yes

10 doses

OPV Polio Live Liquid 2 drops per dose 10 doses No

attenuated; 3 doses 20 doses
contains 2
types of polio
virus

IPV Inactivated, Liquid 1 dose - iM 1 dose Yes

whole-cell IPV; 10 doses
contains 3
types of polio
virus

Pentavalent: Diphtheria, Inactivated: Liquid 3 doses - IM 1 dose Yes

DPT, Hep B, Pertussis, conjugate lyophilized 2 doses
Hib Tetanus, Hep polysaccharide 10 doses
B, Hib vaccine

PCV Pneumonia Inactivated Liquid 3 doses - iM 1 dose Yes

(Pneumococcal conjugated 10 doses
conjugate
vaccine)

PPV Pneumonia Inactivated Liquid 1 dose - IM 1 dose Yes

(Pneumococcal conjugated 10 doses
polysaccharide
vaccine)

MMR Measles, Live attenuated Freeze-dried, 1 dose - subq 1 dose No, but diluent
Mumps, monovalent 10 doses should not be
Rubella frozen

MR Measles - Live attenuated Freeze-dried, 1 dose - subq 1 dose No, but diluent
Rubella monovalent 10 doses should not be
frozen

Rotavirus Vacc Rotavirus Live attenuated Liquid oral 2 doses - oral 1 dose No
suspension

JE Vaccine Japanese Live attenuated Lyophilized 1 dose - subq 1 dose No, but diluent
Encephalitis powder should not be
frozen

Td Vaccine Tetanus, Inactivated: Liquid SBI: 2 doses - IM 10 doses Yes

diphtheria toxoid Multivalent WCBA: 2 doses in
form: Td 1st preg then 1
vaccine dose in subsequent
pregnancies for 5
total doses - IM

HPV Vaccine Human Recombinant Liquid 2 doses - IM 1 dose Yes

Papilloma Virus

Influenza Influenza Inactivated Liquid 1 dose - IM 1 dose Yes

Vaccine 10 doses

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 SUMMARY OF VACCINES

Vaccine Route Injection Site Dose Schedule Type Appearance

BCG ID Upper right arm 0.05mL At birth Powder + diluent White, cloudy liquid with
sediment that suspense
when shaken

HepB IM Outer mid-thigh 0.5mL At birth Ready-to-use White, cloudy liquid

OPV Oral Mouth 2 drops 6-10-14 wks VIal with oral Clear, pink, or orange liquid
dropper

IPV IM Outer left upper thigh 0.5mL 14 wks Ready-to-use Clear, colorless liquid
with 2 finger-breadth
interval from PCV

PENTA IM Outer right upper thigh 0.5mL 6-10-14 wks Ready-to-use White, cloudy liquid with
sediment that suspense
when shaken

PCV IM Outer left upper thigh 0.5mL 6-10-14 wks Ready-to-use Clear, colorless liquid
with 2 finger-breadth
interval from PCV

PPV IM Upper right arm 0.5mL Adults, 60 and 65 yo Ready-to-use Clear, colorless liquid

Rotaviru IM Mouth 1mL 6-10 weeks Powder + diluent Clear, colorless liquid
s
Vaccine

MMR SC Upper right arm 0.5mL 9mos, 12mos Powder + diluent Clear, slightly yellow liquid

MR SC Upper right arm 0.5mL Grade 1 and 7 Powder + diluent Clear, slightly yellow liquid

Td IM Outer, left upper arm 0.5mL Children: Grade 1 and 7 Powder + diluent White cloudy liquid
WCBA:
Td1: As early as possible
in pregnancy
Td2: 4 weeks after Td1
Td3: 6 months after Td2
Td4: 1 year after Td3
Td5: 1 year after Td4

JE SC Upper arm 0.5mL 9mos Powder + diluent Clear or slightly whitish

turbid liquid

HPV IM Outer upper arm 0.5mL Female: 9-10yo Ready-to-use Clear or slightly whitish
turbid liquid

Influenza IM Outer upper arm 0.5mL 60yo and above, annually Ready-to-use Clear, colorless liquid
Vaccine

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 Conditions which are NOT CONTRAINDICATIONS to Vaccines’ Sensitivity to Various Temperature
Immunization MORE Heat Light Freezing
●​ Minor illnesses such as upper respiratory infection or SENSITIVE
diarrhea with fever < 38.5°C
●​ Allergy, asthma, or other atopic manifestations such
BCG Hep B
as hay fever or runny nose
●​ Prematurity, low birth weight
●​ Malnutrition JE IPV
●​ Breastfeeding
●​ Family history of convulsions MCV Penta
●​ Treatment with antibiotics, low dose corticosteroids
or locally acting (e.g. topical or inhaled) steroids OPV Rubella HPV
●​ Dermatoses, eczema or localized skin infection
●​ Stable neurological conditions such as cerebral palsy IPV Flu
and Down syndrome
●​ History of jaundice after birth PCV PCV

Policy on Immunizing Sick Children and Hospitalized HPV Rota

Children
●​ IT IS SAFE TO IMMUNIZE INFANTS EVEN IF THEY Flu Td
ARE MILDLY ILL.
●​ Child with a mild illness: Rota TT
○​ Immunize them following the guidelines.
○​ Check the immunization status of every Penta
child regardless of the service being sought.
○​ Immunization should be provided to all Hep B
eligible children.
●​ Children with fever: Td
○​ Children can be immunized if suffering from
mild fever. However if a child has a high LESS TT
fever and under medication, it is BETTER Sensitive
TO WAIT until his/her course of medication
is completed.
●​ Very ill infants who need to go to hospital: Cold Chain
○​ Immunize them if possible. A senior health ●​ Elements:
worker must decide for each individual ○​ Personnel: organize and manage vaccine
infant. distribution
○​ Remember that sick infants need protection ○​ Equipment: for storage and transport of
against vaccine-preventable diseases. vaccines
○​ All children admitted to the hospital and ○​ Procedures: manage the program and control
those that are brought to outpatient health distribution and use of vaccines
facilities must be screened and - if they are ●​ Temperature Monitoring
eligible for immunization - should receive it ○​ Done in all levels of health facilities to monitor
upon admission. vaccine temperature.
●​ Malnourished infants: ○​ It is done twice a day
○​ Immunization should be encouraged. ○​ Temperature is plotted everyday in a chart to
○​ The child can develop good immunity monitor the break of the cold chain.
although they are malnourished. ●​ Correct Storage Temperatures
○​ Malnourished children are more likely than
other infants to suffer from VPDs.
○​ Parents should thus be encouraged to bring
their children for immunization despite
illness.
Recommendations for Immunization of HIV-infected
Children and WCBA
●​
○​
○​
✅
For either asymptomatic or symptomatic

❌ : PENTA, OPV, Measles, Hep B, Td

: BCG

STORAGE OF VACCINES ●​ Control and Monitoring of Temperature

●​ All vaccines are sensitive biological substances. ○​ Should be a routine activity.
Potency reduced if exposed to temperature outside ○​ At the start and end of each working day.
the recommended range. ○​ Monitoring devices include:
●​ Some vaccines lose potency when exposed to ■​ Thermometers.
freezing temperatures. ■​ Temperature record sheets.
●​ Once potency is lost, it is irreversible. ■​ Refrigerator or freezer thermostat.
■​ Cold chain monitor card (CCM).
■​ Vaccine vial monitor (VVM).
■​ Freeze watch indicator
First Expiry, First Out (FEFO) Principle
●​ The expiry date of the vaccines and diluent is printed
on the vaccine viol or ampoule.

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 ●​ Each vaccine vial has an expiration date. Vaccines WHO Policy on Use of Opened Vials
must not be used beyond the expiration date, even if ●​ Opened vials can be used in subsequent
the VVM has not reached the discard point. If the immunization sessions and should be discarded at
exact date of expiration is not indicated, the vaccine the end of each day.
can still be used until the end of the expiration month. ●​ Measles, yellow fever and BCG vaccines
○​ For example, if the expiration is “Jun 2019”, discarded after 6 hrs.
the vaccine may still be used until 30 June ●​ Opened vials discarded immediately if there is any
2019. suspicion of contamination.
●​ When deciding which vaccine viol to use/ deliver first,
always apply the First Expiry First Out (FEFO) Single-Dose Vials
principle.
●​ Expired vaccine vials should be properly recorded in ●​ A single-dose vial (SDV) contains one dose and
the vaccine stock card and disposed of immediately should be used one time for one patient.
(after accounting and auditing procedures have been ●​ SDVs do not contain preservatives to help prevent
completed), labelled and stored outside the cold microorganism growth.
chain to avoid being mixed with unexpired vaccines. ●​ Never combine leftover vaccine from one SDV with
●​ Practiced to assure that all vaccines are utilized another to obtain a dose.
before the expiry date. Multidose Vials
●​ Proper arrangement of vaccines and labelling ●​ A multidose vial (MDV) contains more than one dose
vaccines expiry date are done to identify those of vaccine.
near to expire vaccines. ●​ They can be entered or punctured more than once.
The Vaccine Vial Monitor ●​ Only the number of doses indicated in the
●​ is a label on a manufacturer’s package insert should be withdrawn
vaccine vial from the vial.
which serves as ●​ After the maximum number of doses have been
an indicator if the withdrawn, the vial should be discarded.
vaccine were Manufacturer-Filled Syringes
exposed to heat ●​ A manufacturer- filled syringe (MFS) is prepared and
●​ VVM sticker is sealed under sterile conditions by the manufacturer.
found either on ●​ Activate an MFS (i.e., remove the syringe cap or
the vial label or attach the needle) only when ready to use.
cap ●​ Once the sterile seal has been broken, the vaccine
●​ Looks like a should be used or discarded by the end of the
white square workday.
inside a light
violet circle Reconstitution of Vaccine
●​ VVM changes ●​ Lyophilized (freeze-dried) vaccines are in either
color when the vial has been exposed to heat over a powder or pellet form and must be mixed with a liquid
period of time (diluent) in a process known as “reconstitution”
●​ The square becomes darker in color as the vial is before being administered.
exposed to heat. ●​ Diluents vary in volume and composition and are
●​ VVMs do not measure exposure to freezing specifically designed to meet volume, pH balance,
temperatures (for freeze-sensitive vaccines). and the chemical requirements of their corresponding
●​ A VVM still at start point does not exclude the vaccines.
possibility that the vaccine has been frozen. ●​ Diluents are not interchangeable unless specified by
●​ If a freeze-sensitive vaccine with VVM still at start the manufacturer.
point is suspected to have been frozen, perform a ●​ Never use a stock vial of sterile water or normal
shake test. saline to reconstitute vaccines.
●​ Never administer a vaccine reconstituted with the
wrong diluent.
●​ Draw up vaccines only at the time of administration.

CONDUCTING IMMUNIZATION SESSION

Rationale
●​ Must safely administer potent vaccines to all eligible
children and women before they are exposed to
vaccine-preventable diseases.
●​ Conduct immunization sessions that meet quality
standards and follow recommended procedures -
whether this is done in a fixed site, through outreach
or in special campaigns.
●​ Good quality immunization sessions will ensure that
targeted clients will receive optimum immune
response and are encouraged to come back for
follow-up vaccination.
Setting Up an Immunization Session
1.​ Take the vaccines and diluents out of the refrigerator.
2.​ Check if the vaccines are safe to use.
○​ Take note of the VVM (Vaccine Vial Monitor).
3.​ Prepare the vaccine carrier with ice packs.
4.​ Prepare the Workplace

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 ○​ The arrangement of the space in the health ○​ Determine which vaccines the infant has
facility will affect how we work and efficiently received.
complete the immunization process. ○​ Determine all vaccines for which the infant is
○​ The space for immunization should be: eligible.
■​ Easily accessible to target children and
women, but arranged so that they are not Ensure the Safety and Viability of the Vaccines
crowding the immunization area. ●​ Use opened vials of OPV, Td, hepatitis B vaccines in
■​ In a clean area not directly exposed to the subsequent immunization sessions. This is
sunlight, rain, or dust. referred to under the multi-dose vial policy.
■​ Convenient for health staff who are ●​ DISCARD opened vials of measles and BCG
preparing and giving doses of vaccines. vaccines at the end of each immunization session, or
■​ Quiet enough so we can explain and give after 6 hours, whichever comes first.
advice. ●​ Keep the opened vials that can be used for the
○​ The space for immunization should be: following session in the refrigerator – in a box
■​ Put up a sign saying “immunization clinic” to marked “USE FIRST” so they can be used first in the
show people where to come in and wait. next session.
○​ The fixed health facility should have:
■​ Space in the shade where women and Dispose of Used Equipment
infants can sit before being vaccinated. ●​ Dispose of used needles and syringes safely.
■​ Space and equipment for screening, ●​ Wrap vials and rubbish in paper. If the local
registration, vaccination, and recording. government does not collect them, bury them for
■​ A table for vaccines and injection proper disposal.
equipment. ●​ Standard safety boxes
■​ A chair for the mother to sit on while ○​ These puncture-proof boxes are specifically
holding a child for vaccination. designed to receive syringes with the needles
■​ A chair for the health worker. attached.
○​ These should not be reused. Different safety
●​ For other services during the immunization session, boxes have different nominal capacities.
space and equipment must be provided as well. Set ●​ Puncture-resistant plastic safety boxes
up a separate station for each of these services, ○​ These are more expensive and might be more
which may include: difficult to find for small and medium health-care
○​ Weighing babies and charting their growth. facilities in some areas.
○​ General health check-up and treatment. ○​ Capacity: 100 syringes. These should not be
○​ Antenatal care. reused.
○​ Health education. ●​ Locally available puncture-resistant cardboard
●​ List of Equipment and Supplies boxes, plastic bottles
○​ Needed for Fixed and Outreach Sessions ○​ In cases of supply shortages of standard safety
○​ Soap or hand sanitizer for hand washing. boxes in small health-care facilities, alternative
○​ Metal file to open ampules. solutions can be implemented, such as
○​ Immunization register. puncture- and leak-proof boxes, or thick plastic
○​ New immunization cards for women and infants. containers.
○​ Safety box. ○​ These should be labeled as containing
○​ Cotton. hazardous sharps waste.
○​ Waste container. ○​ Open boxes, bleach bottles, and thin plastic
○​ Immunization tally sheets or forms. containers should NOT be used
○​ Paper, pencils, and pens.
○​ Table(s). CALCULATING VACCINE NEEDS
○​ Stool / chair(s) for health providers and clients.
●​ Plan for client movement through the immunization
facility to ensure safety. This involves planning client
flow to reduce the risk of accidental needle stick
injury to the health worker or clients.
●​ Prepare the Equipment for the Immunization
Session.
○​ The amount of equipment needed for the
session depends on the estimated number of
women and infants to be immunized.
COMPUTING VACCINE WASTAGE RATE
WASTAGE RATE = (Number of doses supplied – number of
Outreach Site
doses administered) / number of doses supplied x 100
●​ The physical space during outreach immunization
sessions may be in a building or in the open air.
DOSES SUPPLIED = (Starting balance of viable doses + new
●​ The building should be well-lit and well-ventilated.
doses received) – ending balance
●​ If in the open air, activities should be done in the
shade.
COMPUTING VACCINE WASTAGE FACTOR
Assessing Clients for Immunization WASTAGE FACTOR = 100 / (100 - wastage rate)
●​ Assess whether the client is eligible for vaccines.
●​ Whenever infants, children are brought and women ESTIMATING ANNUAL VACCINE REQUIREMENT
visit the health center, we should screen if they have Calculate the target population / eligible population.
been immunized and give them the vaccines they are Eligible population (EP) = Total population (TP) x Multiplication
eligible to receive. Factor (MF)
○​ Determine the infant’s age. *** Standard multiplication factor of 2.7% for estimating the
number of eligible population under 1 year old.

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ESTIMATING ANNUAL VACCINE REQUIREMENT
Calculate the number of vials required annually per vaccine.
Annual Requirement = (Eligible population (TP) x Required #
of doses) / (# of doses per vial x Wastage factor) +
Recommended buffer stock

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