IMMUNIZ

ELAINE FRANCES M. ILLO, R.M., R.N.

ATION
Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

OBJECTIVES
To reduce the morbidity and
mortality among infants and
children caused by the seven
childhood immunizable
diseases.
 DEFINITION OF TERMS
IMMUNIZATION IMMUNITY 
– the ability of the body to fight off
 – The process of inducing
certain infections; immunity can
immunity to an infectious agent
result from natural (wild)
by administering a vaccine .
infection or from vaccination.

VACCINATION AEFI
 – any untoward medical occurrence
 – the administration of a
that follows immunization and does
vaccine; if vaccination is
not necessarily have a causal
successful, it results in relationship with the usage of the
immunity vaccine.
 WHAT IS IMMUNIZATION
CDC:
Immunization is a process by which a
person becomes protected against a disease
through vaccination.
WHO:
Immunization is the process wherein a
person is made immune or resistant to an
infectious disease, typically by the
administration of a vaccine.
WHAT IS VACCINATION
CDC:
Vaccination is the act of
introducinga vaccine into the body to
produce immunity to a specific disease.
WHO:
Vaccination employs vaccines to stimulate
the body’s own immune system to protect a
person against subsequent infection or
disease.
 LEGAL BASIS
PRESIDENTIAL REPUBLIC ACT
DECREE 996 No. 10152
Providing for compulsory “Mandatory Infants and Children
basic immunization for Health Immunization Act of 2011.
infants and children In which it requires that all
below 8 years old children under five years old be
given basic immunization against
vaccine-preventable diseases.
VACCINE
Vaccination (Latin; Vacca-Cow)
Edward Jenner used the term
Vaccination.
Vaccine is a immune-biological
substance designed to produce
specific protection against a given
disease.
 ACTIVE VS PASSIVE

ACTIVE PASSIVE
• Killed or live attenuated
• Transfer of antibodies
organism injected which can • Short Term
induce immune response • No role of immune
• Long Term
system
• Immune system plays role
• Ex: TT, Serum, Anti-
• Ex: Hepa B Vaccine, DPT,
Rabies, Immunoglobulin
IPV, MMR combined
Vaccine
 TYPE OF VACCINE
1. Live vaccine
2. Inactivated or killed vaccine
3. Combination
4. Subunit Vaccines
• Toxoids
• Protein vaccine
• RECOMBINANT protein vaccine
• Polysaccharide-based vaccines
• Conjugated vaccine
 LIVE VACCINE
Antigen in vaccine is live but
attenuated. Since antigen are
live, they multiply in body after
administration so stimulus is
more. Generally given in single
dose.
E.g.: BCG, OPV, MMR,
YELLOW FEVER
 KILLED VACCINE
Organism are
inactivated or killed by
heat or chemical. They
are given by multiple
doses. Immunity last
shorter than live
vaccine.
E.g., JE Vaccine, Antirabies Vaccine, Influenza Killed
Vaccine
 TOXOID
They are modified toxins.
Toxins are detoxicated. They
are required in multiple doses.
E.g.,
1. tetanus toxoid,
2. diphtheria toxoid
 PROTEIN VACCINE

Proteins can be
purified from in vitro
culture of a Pathogenic
micro-organism
RECOMBINANT PROTEIN
VACCINE
Recombinant vaccines are made using bacterial
or yeast cells to manufacture the vaccine. A
small piece of DNA is taken from the virus or
bacterium against which we want to protect and
inserted into the manufacturing cells. For
example, to make the hepatitis B vaccine, part of
the DNA from the hepatitis B virus is inserted
into the DNA of yeast cells. These yeast cells
are then able to produce one of the surface
proteins from the hepatitis B virus, and this is
purified and used as the active ingredient in the
vaccine. 
 CONJUGATED VACCINE
But in the early days
of polysaccharide
vaccines it was
found that they did
not work well in
babies and young
children.
 COMBINATION VACCINE
They are so called
because the preparation
contains more than one
antigen. They also called
mixed vaccine.
E.g.
Easy Five (pentavalent), DPT, MMR, Hep B & Hib
MAJOR CONSTITUENTS OF VACCINE
ACTIVE IMMUNIZING
SUSPENDING FLUID
ANTIGENS
Live virus, killed bacteria, Sterile water, saline or
toxoids tissue culture fluid
PRESERVATIVES,
STABILIZERS & ADJUVANTS
ANTIBIOTICS
Thiomersal, Neomycin,
Kanamycin
 THE EXPANDED
PROGRAM ON
IMMUNIZATION
EPI is a world Health Organization Program with the goal to make
vaccines available to all children throughout the world “Expanded”
means:
• Expanding the number of diseases to be covered
• Expanding the number of children and target population to be
covered
• Expanding coverage to all corners of the country and spreading
services to reach the less privileged sectors of the society
 TB
Diarrhea Polio

Influenza Measles
DISEASES
COVERED
Pneumoc BY EPI
occal Diphtheria
Meningitis

Hepatitis
Pertussis
B
Tetanus
 Women who are of
Other children who child bearing age (15-
have not fully 49 years) but not
immunized immunized against
tetanus

All children under 1 Every pregnant

year of age women for T.T.
TARGET GROUPS
FOR
IMMUNIZATION
 1798 1885 1897 1921 1923
Smallpox Rabies Cholera Diphtheria
BCG
Vaccine Vaccine Vaccine Toxoid

1926 1935 1937 1949

Pertussis
1927 Yellow
Influenza Mumps
TT Fever
Vaccine Vaccine Vaccine
Vaccine

1954 1957 1960 1962 1968

Salk’s Polio Sabin Live
Measles V Rubella V Type C MV
Vaccine OPV

1971
Type A MV
MILESTONE IN VACCINATION
 1980 1981 1982 1983
Smallpox declared Pneumococcal
Meningococcal Hepa B
eradicated from Vaccine 23
polysaccharide V Vaccine
the world valent

1988
Worldwide 1990 1991 1991
Polio The VAERS Hepa B Vac Acellular 1993
eradication was recommended pertussis JE Vaccine
initiative established for all infant vacc
launched

2003 2004 2006 2009

First adult CTaP, IPV &
Gardasil, the
2008 Influenza A-
immunization Hepa B V Rotarix H1N1 Vaccine
first HPV
sched into one shot was approved
 Milestones of the Immunization Program in the
Philippines: Vaccines Introduced by the Program

BCG first administered among school entrants

1976 DPT introduced in priority areas
BCG and DPT provided nationwide; OPV and tetanus toxoid
1979 (TT) for pregnant women provided in high risk areas

1980 OPV and TT provided nationwide

1982 MV provided among 35% of the eligible population
1983 MV provided nationwide
1992 Hepatitis B provided among 40% of eligible population
2005 Hepatitis B provided nationwide
MMR administered in selected areas PENTA: DTwP-HepB-Hib in
2010 three selected regions

PENTA administered Nationwide

Rotavirus vaccine provided among children in indigent families
2012
Anti-Influenza Vaccine and PPV 23 provided for indigent senior
citizens
Td and MR vaccines provided in high schools in selected high risk
2013 provinces and cities
MMR second dose provided for children 12 – 15 months of age

PCV 13 vaccine introduced in five selected regions

2014 HPV vaccine introduced in pilot areas in CAR and Region 7
 PV vaccine provided in the National Capital Region, Regions 3, 6
and 7
Td and MR vaccines provided in all public schools: Grades 1 (6-7
years) and Grade 7 (11-12 years)
2015
HPV vaccine provided in 20 priority provinces among females age
9 – 10 years
PCV 13 provision expanded to 14 regions (excluding NCR, 4 A and
4 B)
Switch from tOPV to bOPV IPV provision expanded to 6 regions
2016 Td and MR vaccines provided in all public schools HPV
vaccination expanded to 48 provinces
MV was replaced with MMR TT vaccine for CBAW was replaced
2017 with Td Anti-Influenza Vaccine and PPV 23 provided for all senior
citizen at ages 60 to 65 years
NATIONAL IMMUNIZATION
SCHEDULE
VACCINE/ANTIGEN DISEASE DOSES SCHEDULE
BCG Tuberculosis 1 Birth (within 24 hrs)
HepB Hepatitis B 1 Birth (within 24 hrs)
Pentavalent Diphtheria, tetanus 6 weeks
Vaccine & Pertussis 10 weeks
(DPT-HepB-HiB) Hepa B 14 weeks
Hemophilus 3
Influenzae Type B
Meningitis
VACCINE/ANTIGEN DISEASE DOSES SCHEDULE
6 weeks, 10 weeks
OPV 3
Poliomyelitis 14 weeks
IPV 1 14 weeks
Pneumococcal 6 weeks
PCV infections (e.g., 3 10 weeks
meningitis) 14 weeks

Measles, mumps & 9 months

MCV & MMR 2
rubella 1 year
 TETANUS TOXOID
• Type: Intramuscular
• Site: upper arm
• Dosage: 0.5 ml
• Doses: Pregnancy – 2 doses
• Schedule: Primary course of immunization
consists of 2 doses of tetanus toxoid at
intervals of 1-2 months.
• Storage: between 4⁰ and 10 ⁰ C.
TT IMMUNIZATION SCHEDULE OF
PREGNANT WOMEN
Dose of Expected Duration
When to Give
TT of Protection
At first contact or as early as possible in
1 pregnancy None

2 At least 4 weeks after TT1 1-3 years

At least 6 months after TT2 or during
3 subsequent pregnancy At least 5 years

At least 1 year after TT3 or during

4 subsequent pregnancy At least 10 years

At least 1 year after TT4 or during For all childbearing

5
subsequent pregnancy years and longer
 • Type Of Vaccine: Live
Bacteria
• Number of doses: One

B • Schedule: At or as soon as
possible after birth
C
• Contraindications:
G Symptomatic HIV Infection
• Adverse Reactions: Local
abscess, regional
lymphadenitis
 • Special Precautions: Correct ID
administration is essential. Special
syringe is used
• Dosage: 0.05 ml

• Injection Site: Outer upper arm or shoulder

• Injection Type: Intradermal
• Storage: Between 2⁰C - 8⁰C
 • Type of Vaccine: Recombinant
DNA or plasma-derived
• Number of doses: 3 doses, now
H
only birth dose
• Schedule: At Birth
E
• Contraindications:
P
Anaphylactic reaction to a A
previous dose
• Adverse Reactions: Local
soreness and redness,
rarely anaphylaxis B
 • Special Precautions:
Birth dose must be given
• Dosage: 0.5 ml
• Injection Site: Outer mid-
thigh/outer upper arm

• Injection Type: IM
• Storage: Between 2⁰C - 8⁰C.
Never freeze.
 ORAL POLIO VACCINE
• Type of Vaccine: Live
attenuated OPV
• Number of doses: 3 doses
• Sched: 6, 10, 14 wks of age
• Contraindications: None
• Adverse Reactions: VAPP; very
rarely (2-4/million vaccinated)
• Special Prec: Children with rare
congenital immune deficiency
syndrome must receive IPV
• Dosage: 2 drops
• Storage: Between -15 ⁰ C to -25 ⁰ C
PENTAVALENT
(DPT-HepB-
VACCINE
• TypeHib)
of Vaccine:
Pentavalent Vaccine
• Number of doses: 3
doses
• Schedule: 6, 10, 14
wks of age
• Booster: None
 • Contraindications: Do not use as a
birth dose
• Adverse Reactions: Mild Local and
systemic reactions are common
• Dosage: 0.5 ml
• Injection Site: Outer mid-thigh

• Special Precautions: Do not use as

birth dose, usually not given over 6
years of age
• Injection Type: IM
• Storage: Between 2 ⁰ C – 8 ⁰ C.
Never freeze.
 ROTAVIRAL VACCINE
• Type of Vaccine: Oral
Vaccine in a liquid
formulation
• Number of doses: 2 doses
• Schedule: 2 dose schedule
at 6 and 10 weeks of age
• Contraindications: Previous history of intussusception
• Dosage: 1 tube = 1 dose
1 tube has 1.5mL liquid
1st dose – 6 to 15 weeks
2nd dose – 10 to 32 weeks
• Storage: Between 2°C to 8°C.
• Route: Orally
• Dilution: Reconstitution in calcium carbonate buffer
contained in a single-dose, prefilled applicator given
promptly.
 • Type of Vaccine:
Inactivated Vaccine
• Number of Doses: 2
fractional doses
I • Schedule: given in 6th

P • Dosage: 0.1 ml
and 14th weeks.

V • Injection Type: Given

intradermally
• Injection Site: Right
upper arm
 • Type of Vaccine: Live
Attenuated Viral
• Number of doses: 1 dose
• Schedule: Generally 12-15
months
• Booster: A second opportunity for immunization is
recommended (routine or campaign).

MR AND MMR VACCINES

• Adverse Rx: Same as measles vaccine,
plus cases of arthritis in adolescents
females for rubella-containing vaccine
and parotitis.
• Booster: A second opportunity for
immunization is recommended (routine
or campaign).
• Special Prec: None
• Dosage: 0.5 ml
• Injection Site: Outer mid-thigh/upper arm
• Injection Type: Subcutaneous
• Storage: Store between 2 ⁰C–8⁰C
 ASSESSMENT
• Age and weight (if preterm infant)
• Current immunization record.
• Type of vaccine to be administered (inactivated or live,
attenuated) and route of administration.
• Informed consent, including discussion of risks of disease,
benefits of the vaccine, the expected vaccine side effects and
possible adverse events following immunization.
• Contraindications or precautions including:
 Current state of health, including any concerns with the immune system;
 Medications taken in past 3 months that may have caused
immunosuppression (e.g. high dose corticosteroids, cancer treatments, etc.);
 Previous adverse events following immunization;
 History of allergy, particularly anaphylactic reactions to any substance;
 Past health history;
 Pregnancy/lactation;
 Receipt of blood transfusions or antibody-containing blood products within the
past year;
 Receipt of vaccines within the previous four weeks (Exception: yellow fever
where there is a minimum 30 day interval recommended).
 EQUIPMENT
The equipment chosen will vary depending on whether the
vaccine is a reconstituted vaccine or a vaccine in a pre-filled
syringe. Equipment may include;

• Sharps container

• Vaccine, plus diluent if reconstitution

is required
• 19 gauge drawing up needle (to draw up
through rubber bung once vaccine
reconstituted)
• 23 gauge 25mm injecting needle (IM)
• 25 gauge 16mm injecting needle (SQ)
• 3mL
syringe
(unless
vaccine
is in pre-
filled • Clean cotton wool and micropore tape to
syringe) apply to injection site after vaccination
 PREPARING THE VACCINE
• Ensure that the correct vaccine is taken from the
refrigerator and that it is within the expiry date and cold
chain has been maintained
• Prepare the appropriate
injection equipment for the
vaccine to be
administered
PROCEDURE
1. Prior to performing the
procedure, introduce self and
verify the client’s identity using
agency protocol. Explain to the
client what you are going to do,
why it is necessary, and how
he or she can participate.
Discuss how the results will be
used in planning further care or
treatments.
2. Perform hand hygiene and
observe other appropriate
infection prevention
procedures.

3. Provide for client privacy.

IM Injection Technique
• Use 23 gauge 25
mm needle

• Depending on the injection site, position

the limb so as to the relax the muscle
into which the vaccine is to be injected
• Pierce the skin at an angle of
90 to the skin, so as the
needle can be safely inserted
to the hub.

• It is not necessary to draw

on the syringe plunger
before injecting the vaccine
 Subcutaneous Injection Technique
• For subcutaneous (SC)
injection, administer the
injection at a 45° angle to the
skin.

• The standard needle for

administering vaccines by SC
injection is a 25 or 26 gauge
needle, 16mm in length.
Oral Vaccine Technique
• The liquid formulation is
presented as a clear
liquid contained in a
squeezable plastic,
latex-free dosing tube
with a twist-off cap. 
Keep the cap – you need
this to pierce the tube
(see product information)
 • The current 1.5 ml dose of
vaccine should be
administered orally from the
oral applicator onto the inside
of the infant’s cheek in small
aliquots.

• If most of an oral rotavirus vaccine dose has been spat out or vomited
within minutes of administration, a single repeat dose can be
administered during the same visit.
• If an infant regurgitates or vomits only a small part of a vaccine dose, it
is not necessary to repeat the dose.
POST - VACCINATION
• Dispose of clinical and sharps
waste, including vaccine vials
• The live oral Rotavirus vaccine
squeezable plastic container
should also be discarded in
clinical waste or sharps
container
• Cover the injection site quickly with cotton
wool and tape as needed
• Gently apply pressure for 1-2 minutes (do
not rub the injection site, as may lead to
local irritation)

• Inform patient to remain on the ward for a

minimum of 15 minutes after the vaccination
(to observe for any immediate adverse
event, such as anaphylaxis)
Documentation requirements
• All vaccines administered to infants and
children should be documented in the MAR
on EPIC as well as in the parent held Child
Health record book
• Details which should be recorded include;
• Vaccine given, including brand name,
batch number, dose number
• Date and time of vaccination
• Site of administration
• Name of the person providing the
vaccination