[12] MIDTERMS | NATIONAL IMMUNIZATION PROGRAM (NIP)

Question 1

An organizational component of DOH charged with preventing disease, disability, and death from vaccine-preventable diseases in children and adults.

Answer 1

National Immunization Program

Question 2

How long does it take for the body to produce antibodies after vaccine administration?

Answer 2

28 DAYS

Question 3

Launch of EPI

Answer 3

1976

Question 4

EPI

Orginal objectives, decrease morbidity and mortality among infants and children caused by ____

Answer 4

Orginal objectives, decrease morbidity and mortality among infants and children caused by 6 immunizable diseases

Question 5

EPI PRINCIPLES

• The program is based on ____ situation; schedules are drawn on the basis of the ____ and ____ of epidemiological features of the disease
• The whole community rather than just the individual is to be protected, thus ____ approach is utilized
• ____ is a basic health service and integrated into the health services being provided by the RHU

Answer 5

• The program is based on epidemiological situation; schedules are drawn on the basis of the occurence and characteristics of epidemiological features of the disease
• The whole community rather than just the individual is to be protected, thus mass approach is utilized
• Immunization is a basic health service and integrated into the health services being provided by the RHU

Question 6

STRATEGIES

• Conduct routine immunization for infants/children/women through the ____ strategy
• ____ (SIA)

Answer 6

• Conduct routine immunization for infants/children/women through the Reaching Every Barangay (REB) strategy
• Supplemental Immunization Activity (SIA)

Question 7

STRATEGIES

• Strengthening Vaccine-Preventable ____
• Procurement of adequate and potent ____ to all health facilities nationwide

Answer 7

• Strengthening Vaccine-Preventable Diseases Surveillance
• Procurement of adequate and potent vaccines and needles and syringes to all health facilities nationwide

Question 8

TARGET SETTING

• Essential for effective planning and implementation
• Includes infants, children ____ y/o, and women

Answer 8

• Essential for effective planning and implementation
• Includes infants, children < 5 y/o, and women

Question 9

Mandatory Infants and Children Health Immunization Act of 2011

Answer 9

Republic Health Act No. 10152

Question 10

R.A. 10152

Basic immunization for children under ____ including other types that will be determined by the Secretary of Health

Answer 10

Basic immunization for children under 5 including other types that will be determined by the Secretary of Health

Question 11

GUIDELINES OF COLD CHAIN MANAGEMENT

• All vaccines refrigerators or freezeers shall be ____
• Vaccines are stored according to the ____ for each antigen
• Regular temp. monitoring
• ____ for emergency measures

Answer 11

• All vaccines refrigerators or freezeers shall be used exclusively for EPI vaccines
• Vaccines are stored according to the temp. requirement for each antigen
• Regular temp. monitoring
• Contingency plan for emergency measures

Question 12

COLD CHAIN LOGISTUC MANAGEMENT

Provided to each midwife for temporary storage and transport of the vaccines to their catchment areas

Answer 12

VACCINE CARRIERS

Question 13

COLD CHAIN MANAGEMENT

COMBINATION REFRIGERATOR / FREEZER UNIT

• No vaccines on ____. Fill the space with frozen packs and water bottles
• No vaccine in ____ or on the ____ of the refrigerator. Fill the space with cold packs or water jugs
• No vaccine near cold ____
• No vaccine on the ____ shelf

Answer 13

COMBINATION REFRIGERATOR / FREEZER UNIT

• No vaccines on doors. Fill the space with frozen packs and water bottles
• No vaccine in drawers or on the floor of the refrigerator. Fill the space with cold packs or water jugs
• No vaccine near cold air vents
• No vaccine on the top shelf

Question 14

COLD CHAIN MANAGEMENT

FOR ALL UNITS

• Keep vaccines ____ inches away from walls and other boxes
• Post ____ stickers on electrical outlets. Plug in only 1 unit per outlet
• Place the thermometer probe in the ____ of the unit. Post a temperature log on the door

Answer 14

FOR ALL UNITS

• Keep vaccines 2-3 inches away from walls and other boxes
• Post Do Not Unplug stickers on electrical outlets. Plug in only 1 unit per outlet
• Place the thermometer probe in the center of the unit. Post a temperature log on the door

Question 15

VACCINES MOST SENSITIVE TO HEAT (3)

Answer 15

ORAL POLIO, MEASLES, MMR (-15C TO -25C)

Question 16

VACCINES LEAST SENSITIVE TO HEAT (6)

Answer 16

PENTAVALENT, BCG, TETANUS TOXOID, PCV-10, IPV, ROTAVIRUS, HPV (+2C TO +8C)

Question 17

OPEN VIAL POLICY

• Multi-dose liquid vaccines (OPV, DPT, TT, and Hepa B) may be used in the next immunization sessions for up to a max of ____ weeks provided that all the proper conditions are met

Answer 17

• Multi-dose liquid vaccines (OPV, DPT, TT, and Hepa B) may be used in the next immunization sessions for up to a max of 4 weeks provided that all the proper conditions are met

Question 18

OPEN VIAL POLICY

FOR MULTI-DOSE LIQUID VACCINES

• Expiry date has not passed
• The vaccine has not been contaminated
• The vials have been stored under appropriate cold chain conditions
• The vaccine vial septum has not been ____
• The ____ on the vial, if attached, has not reached the discard point

Answer 18

FOR MULTI-DOSE LIQUID VACCINES

• Expiry date has not passed
• The vaccine has not been contaminated
• The vials have been stored under appropriate cold chain conditions
• The vaccine vial septum has not been submerged in water
• The vaccine vial monitor on the vial, if attached, has not reached the discard point

Question 19

looks like a square inside a circle

Answer 19

VACCINE VIAL MONITOR (VVM)

Question 20

VACCINE VIAL MONITOR (VVM)

• As the vaccine vial is exposed to more heat, the ____ becomes darker
• Use only vials with inner square that are ____ in color than the outside circle
• Inner squares that have begun to ____ should be used before vials with lighter inner square
• VVMs do not measure exposure to ____ for freeze-sensitive vaccines
• A VVM not at the discard point does not exclude the possibility that the vaccine was frozen. Before use, make sure that the freeze-sensitive vaccine with good VVM has not been frozen

Answer 20

• As the vaccine vial is exposed to more heat, the square becomes darker
• Use only vials with inner square that are lighter in color than the outside circle
• Inner squares that have begun to darken but still lighter than outer circle should be used before vials with lighter inner square
• VVMs do not measure exposure to freezing temperatures for freeze-sensitive vaccines
• A VVM not at the discard point does not exclude the possibility that the vaccine was frozen. Before use, make sure that the freeze-sensitive vaccine with good VVM has not been frozen

Question 21

• Freeze-dried vaccines (AMV and BCG) should be discarde ____ hours after reconstitution or at the end of the immunization session

Answer 21

• Freeze-dried vaccines (AMV and BCG) should be discarde 6 hours after reconstitution or at the end of the immunization session

Question 22

LEGAL BASIS

Compulsory Basic Immunization for Infants and Children below 8 y/o

Answer 22

PRESIDENTIAL DECREE NO. 996

Question 23

LEGAL BASIS

Implementing a UN goal on Universal Child Immunization by 1990

Answer 23

PRESIDENTIAL PROCLAMATION NO. 6

Question 24

LEGAL BASIS

Reaffirming the commitment of the Philippines to the Universal Child and Mother Immunization goal of the WHA

Answer 24

PRESIDENTIAL PROCLAMATION NO. 46

Question 25

# **LEGAL BASIS** Compulsory Immunization against Hepa B for Infants and Children below 8 y/o

Answer 25

**REPUBLIC ACT 7846**

Question 26

# **LEGAL BASIS** Providing for Mandatory Basic Immunization Services for Infants and Children up to 5 y/o

Answer 26

**REPUBLIC ACT 10152**

Question 27

# **LEGAL BASIS** Policies on the Nationwide Implementation of EPI

Answer 27

**DOH ADMINISTRATIVE ORDER NO. 39 S. 2003**

Question 28

# **LEGAL BASIS** Implementing Guidelines on Hepa B Immunization for Infants

Answer 28

**DOH ADMINISTRATIVE ORDER NO. 2006-0015**

Question 29

# **LEGAL BASIS** Administration of Rotavirus Vaccine for Infants

Answer 29

**DOH MEMORANDUM NO. 2012-0153**

Question 30

# **LEGAL BASIS** Administration of Pneumococcal Conjugate Vaccine-13 (PCV 13)

Answer 30

**DOH MEMORANDUM NO. 2014-0155**

Question 31

# **LEGAL BASIS** Administration of Inactivated Poliomyelitis Vaccine

Answer 31

**DOH MEMORANDUM NO. 2015-164**

Question 32

# **LEGAL BASIS** Guidelines in the Implementation of School-Based Immunization

Answer 32

**DOH MEMORANDUM NO. 2015-0146**

Question 33

# **LEGAL BASIS** Guidelines in the Implementation of School-Based Immunization

Answer 33

**DOH MEMORANDUM NO. 2015-0238**

Question 34

Designated as Immunization Day

Answer 34

**WEDNESDAY**

Question 35

# **GENERAL PRINCIPLES OF IMMUNIZATION** * Safe & immunologically effective to administer all EPI vaccines on the ____ at ____. * **Measles vaccine** should be given as soon as the child is ____ months old. * Vaccination schedule should not be ____.

Answer 35

* Safe & immunologically 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**. * Vaccination schedule should not be **restarted from the beginning**.

Question 36

# **GENERAL PRINCIPLES OF IMMUNIZATION** * Vaccine should be given with the recommended ____ weeks interval * Strictly follow principle of never, ever reconstituting the freeze dried vaccine in anything other than the ____ supplied with them.

Answer 36

* Vaccine should be given with the recommended **4 weeks interval** * Strictly follow principle of never, ever reconstituting the freeze dried vaccine in anything other than the **diluent** supplied with them.

Question 37

# **GENERAL PRINCIPLES OF IMMUNIZATION** * False contraindications to immunization: ____ grade fever m____ mild ____ infections d____ other minor illnesses * Repeat BCG vaccination if the child does not develop a ____ after the first injection.

Answer 37

* False contraindications to immunization: **low grade fever** **malnutrition** **mild respiratory infections** **diarrhea** **other minor illnesses** * Repeat BCG vaccination if the child does not develop a **scar** after the first injection.

Question 38

# **GENERAL PRINCIPLES OF IMMUNIZATION** * Generally, one should immunize unless the child is so sick that he needs to be hospitalized. Absolute contraindications to immunization : * Severe ____ reaction to previous dose of vaccine * With known ____ to vaccine component * A child with a sign and symptoms of severe ____ * Fever of ____ C and above

Answer 38

* Generally, one should immunize unless the child is so sick that he needs to be hospitalized. Absolute contraindications to immunization : * **Severe hypersensitivity** reaction to previous dose of vaccine * With known **allergy** to vaccine component * A child with a sign and symptoms of **severe dehydration** * Fever of **38.5 C** and above

Question 39

# **GENERAL PRINCIPLES OF IMMUNIZATION** Absolute contraindications to immunization: a. **DPT vaccine**: * over ____ years of age * suffered a severe reaction to previous dose (convulsion or shock w/in 3 days of the most recent dose) * recurrent ____ * active ____ disease

Answer 39

Absolute contraindications to immunization: a. **DPT vaccine**: * over **5 years** of age * suffered a severe reaction to previous dose (convulsion or shock w/in 3 days of the most recent dose ) * recurrent **convulsions** * active **neurological disease**

Question 40

# **GENERAL PRINCIPLES OF IMMUNIZATION** Absolute contraindications to immunization: b. **BCG vaccine**: * with ____ or other immune deficiency diseases * i____ * therapy with immunosuppressive agents or ____ * after ____ y/o

Answer 40

Absolute contraindications to immunization: b. **BCG vaccine**: * with **AIDS** or other immune deficiency diseases * **immunosuppressed** * therapy with immunosuppressive agents or **irradiation** * after **1 y/o**

Question 41

# **GENERAL PRINCIPLES OF IMMUNIZATION** Absolute contraindications to immunization : c. **IPV**: * severe allergic reaction (anaphylaxis) to a previous dose or to any component of the vaccine. * Infants w/ moderate or severe illness temp.  ≥ ____°C should not be vaccinated until they have improved.

Answer 41

Absolute contraindications to immunization : c. **IPV**: * severe allergic reaction (anaphylaxis) to a previous dose or to any component of the vaccine. * Infants w/ moderate or severe illness temp.  ≥ **39°C** should not be vaccinated until they have improved.

Question 42

# **GENERAL PRINCIPLES OF IMMUNIZATION** Absolute contraindications to immunization : d. **PCV 13**: * severe allergic reactions to a prior dose or to any component of the vaccine, including ____ * Infants with moderate or severe illness (temp. ____ °C) should not be vaccinated until they improved.

Answer 42

Absolute contraindications to immunization : d. **PCV 13**: * severe allergic reactions to a prior dose or to any component of the vaccine, including **diphtheria toxoid** * Infants with moderate or severe illness (temp. **39 °C**) should not be vaccinated until they improved.

Question 43

# **GENERAL PRINCIPLES OF IMMUNIZATION** Absolute contraindications to immunization : e. **Rotavirus vaccine**: * Hypersensitivity to any of their components * History of ____ or intestinal malformations, predisposition to ____. * Vaccination should be postponed in case of ongoing acute ____ or serious febrile illness.

Answer 43

Absolute contraindications to immunization : e. **Rotavirus vaccine**: * Hypersensitivity to any of their components * History of **intussusceptions** or intestinal malformations, predisposition to **intussusceptions**. * Vaccination should be postponed in case of ongoing acute **gastroenteritis** or serious febrile illness.

Question 44

# **GENERAL PRINCIPLES OF IMMUNIZATION** * Low birth wt. or prematurity are NOT contraindications to hepatitis B vaccination (wt. less than ____ gm.: birth dose, & 3 additional doses) * Safe & effective with mild side effects after vaccination * Doses of a vaccine less than the recommended ____ weeks interval may lessen the antibody response.

Answer 44

* Low birth wt. or prematurity are NOT contraindications to hepatitis B vaccination (wt. less than **2000 gm**.: birth dose, & 3 additional doses) * Safe & effective with mild side effects after vaccination * Doses of a vaccine less than the recommended **4 weeks** interval may lessen the antibody response.

Question 45

# **GENERAL PRINCIPLES OF IMMUNIZATION** * ____ must be given to children/mother who missed a dose of DPT/OPV/TT/ Hepatitis B. * Use ____ syringe one needle per child during vaccination.

Answer 45

* **No extra doses** must be given to children/mother who missed a dose of DPT/OPV/TT/ Hepatitis B. * Use **one syringe** one needle per child during vaccination.

Question 46

# **TETANUS TOXOID IMMUNIZATION** TT1

Answer 46

**Time**: Anytime during pregnancy

Question 47

# **TETANUS TOXOID IMMUNIZATION** TT2

Answer 47

**Time**: 1 month after dose 1 **Duration of Protecion**: 3 years

Question 48

# **TETANUS TOXOID IMMUNIZATION** TT3

Answer 48

**Time**: 6 months after dose 2 **Duration of Protecion**: 5 years

Question 49

# **TETANUS TOXOID IMMUNIZATION** TT4

Answer 49

**Time**: 1 year after dose 3 **Duration of Protecion**: 10 years

Question 50

# **TETANUS TOXOID IMMUNIZATION** TT5

Answer 50

**Time**: 1 year after dose 4 **Duration of Protecion**: lifetime

Question 51

# TETANUS DIPTHERIA IMMUNIZATION SCHEDULE Number of Doses * Pregnant women who had received ____ childhood DPT/Pentavalent doses should receive ____ doses of Td * Pregnant women w/ no previous DPT/Pentavalent immunization or unreliable immunization information should receive ____ Td * Dosage: ____ ml * Site: upper outer part of the arm * Method of Administration: IM

Answer 51

Number of Doses * Pregnant women who had received **3 childhood DPT/Pentavalent doses** should receive **3 doses of Td** * Pregnant women w/ no previous DPT/Pentavalent immunization or unreliable immunization information should receive **5 Td** * Dosage: **0.5 ml** * Site: upper outer part of the arm * Method of Administration: IM

Question 52

# **SCHOOL-BASED IMMUNIZATION** **1.MCV (Measles-containing vaccine), Td (Tetanus-diphtheria), and MR (Measles-Rubella) vaccines** * All school children enrolled in Grade ____ shall be vaccinated w/ the appropriate vaccines as specified * Screened for their measles vaccination history at the time of school entry and vaccinate if evidences show either zero or only ____ dose to ensure that these students received at least ____ MCV by school entry. * Administered w/ 1 dose of ____ vaccines. * Students enrolled in grade 7 regardless of age shall be vaccinated w/ ____ dose each of measles-rubella (MR) and Td vaccines on the same immunization session.

Answer 52

**1.MCV (Measles-containing vaccine), Td (Tetanus-diphtheria), and MR (Measles-Rubella) vaccines** * All school children enrolled in **Grade 1 & 7** shall be vaccinated w/ the appropriate vaccines as specified * Screened for their measles vaccination history at the time of school entry and vaccinate if evidences show either zero or only **1 dose** to ensure that these students received at least **2 MCV** by school entry. * Administered w/ 1 dose of **Tetanus-diphtheria (Td) vaccines.** * Students enrolled in grade 7 regardless of age shall be vaccinated w/ **1 dose each of measles-rubella (MR) and Td vaccines** on the same immunization session.

Question 52

# **SCHOOL-BASED IMMUNIZATION** **2.Human Pappilomavirus (HPV) Vaccine** * A component strategy in the prevention of cervical cancer. * All ____ years old female school children enrolled in Grade 4 shall be vaccinated w/ two doses of quadrivalent HPV vaccine following the DOH recommended immunization schedule. * Dosage: HPV ____ ml, IM, ____ deltoid arm * All students who received the first dose of HPV shall be given the second dose after ____ months

Answer 52

**2.Human Pappilomavirus (HPV) Vaccine** * A component strategy in the prevention of cervical cancer. * All **9 to 13 years old female school children** enrolled in Grade 4 shall be vaccinated w/ two doses of quadrivalent HPV vaccine following the DOH recommended immunization schedule. * Dosage: HPV **0.5 ml**, IM, **left deltoid arm** * All students who received the first dose of HPV shall be given the second dose after **6 months**

Question 53

# **HEALTH TEACHINGS** **BCG** * Deep ____ at vaccination - refer to the physician for incision and drainage. * Do not ____ the area of injection. * A scar will form ____ weeks after injection

Answer 53

**BCG** * **Deep abscess** at vaccination - refer to the physician for incision and drainage. * Do not **massage** the area of injection. * A scar will form **12 weeks** after injection

Question 54

# **HEALTH TEACHINGS** **MMR** * If the child has fever give ____ or any appropriate antipyretic every four hours after immunization. **Rotavirus** * Reassure parents and instruct them to give ____ to the child

Answer 54

**MMR** * If the child has fever give **paracetamol** or any appropriate antipyretic every four hours after immunization. **Rotavirus** * Reassure parents and instruct them to give **antipyretic** to the child

Question 55

# **HEALTH TEACHINGS** **Measles Vaccine** * If the child has fever give paracetamol or any appropriate antipyretic every four hours after immunization * Alternating ____ for 24 hours for pain and soreness **Tetanus Toxoid** * No medication for ____ * For pain ____ compress 24 hours

Answer 55

**Measles Vaccine** * If the child has fever give paracetamol or any appropriate antipyretic every four hours after immunization * Alternating **cold and warm compress** for 24 hours for pain and soreness **Tetanus Toxoid** * No medication for **pregnant** * For pain **cold compress** 24 hours