CHAPTER 1 The National Immunization Program

1 National Immunization PROGRAMMANUAL OF OPERATIONSBOOKLET 1 IntroductionThe National Immunization ProgramCHAPTER 1 Cover Photo from DOH Regional Office IDepartment of HealthIn collaboration with theWorld Health OrganizationManual of OperationsNATIONAL Immunization PROGRAMN ational Immunization Program Manual of Operations2 ForewordThe Expanded Programme on Immunization (EPI) is one of the pioneering programs of the Department of Health (DOH). Just two years after the World Health Organization established the Program in 1974, the Philippines followed, establishing free vaccination against six common diseases. Through the Program , we have protected millions of Filipino children from deaths and disability from vaccine-preventable diseases.

2 Immunization has also been crucial in achieving public health milestones, such as sustaining our polio-free status since year 2000 and eliminating maternal and neonatal tetanus in the country in was then the EPI is now the National Immunization Program (NIP). Now, we have almost doubled the number of vaccines in routine childhood Immunization . We have expanded vaccination to the adolescent and adult age groups. More vaccines are also set to be offered. Challenges come along with the expansion; foremost of which is ensuring that our health workers remain equipped with knowledge and standard procedures in carrying out Immunization activities. As the NIP continues to expand, it is an opportune time that we are releasing an updated version of its Manual of Operations.

3 I urge all our health workers to make the best use of this Manual as your guide in delivering Immunization quality services. Your confidence in carrying out your duties contributes immensely to the building of public trust in the Immunization Program and in our health system. Building and maintenance of public trust is of utmost importance for Immunization , where distrust results to hesitancy, and increasing hesitancy also increases the risk for spread of diseases and the deaths and disabilities which otherwise could have been gives the Filipino children a good start at life and maintains good health as they progress to productive adults. With competence and compassion, let us continue delivering excellent health services such as Immunization to Francisco T.

4 Duque III, MD, MScSecretary of HealthDepartment of Health, PhilippinesIntroduction3 AcknowledgementsThe National Immunization Program (NIP) Manual of Operations comprehensively covers updates in the 20 years since the last publication of a similar reference material. The Manual is a result of successful collaboration of the Department of Health with its partners. The DOH NIP wishes to ackhowledge the contribution of the following for this Manual: EPI Units at the DOH Regional Offices for their technical input, World Health Organization Philippines for its technical support in content generation, review, and initial printing, The National Vaccine Storage at the Research Institute for Tropical Medicine - DOH for documentation of vaccines and cold chain processes, Technical consultants, editors, and artists involved in the preparation of this Immunization Program Manual of Operations4 Table of ContentsAbbreviations and AcronymsDefinition of TermsReferencesBOOKLET 1 BOOKLET 2 BOOKLET 39121927272727282929303234636363636468 Introduction20 CHAPTER 1.

5 The National Immunization ProgramA. RationaleB. ObjectivesC. Scope and CoverageD. The Benefits of ImmunizationE. Consequences of Non-VaccinationF. Legal Framework of the National Immunization ProgramG. Brief History of the Immunization Program in the PhilippinesH. Implementation Status of the National Immunization Program I. National Immunization Program Goal, Objectives, and Strategies3939393940 CHAPTER 2. Vaccine-Preventable Diseases (VPDs)A. RationaleB. ObjectivesC. Scope and CoverageD. Common Vaccine Preventable Diseases in the Philippines7979 7979808287108 CHAPTER 4. The VaccinesA. RationaleB. ObjectivesC. Scope and CoverageD. What is Immunization ?E. Basic Principles in ImmunizationF.

6 Vaccines Available in the Philippines and Recommended by DOH for Use Against VPDsG. Summary of Route of Administration, Injection Sites and ScheduleChapter 3. Vaccine-Preventable Disease SurveillanceA. RationaleB. ObjectivesC. Scope and CoverageD. VPD SurveillanceE. VPD Surveillance ActivitiesIntroduction5 BOOKLET 4111111111111112117121130132135 CHAPTER 5. Holding an Immunization SessionA. RationaleB. ObjectivesC. Scope and CoverageD. Setting Up An Immunization SessionE. Assessing Clients for ImmunizationF. Giving the Right Vaccine SafelyG. Communication with Parents During and After Immunization SessionH. Ending the SessionI. Reaching Every Purok StrategyBOOKLET 5139139139139140152 CHAPTER 6.

7 Injection SafetyA. RationaleB. ObjectivesC. Scope and CoverageD. Vaccine Safety and QualityE. Adverse Events Following Immunization (AEFI) SurveillanceBOOKLET 6157157157157158162172 CHAPTER 7. Immunization Program Management A. RationaleB. ObjectivesC. Scope and CoverageD. Immunization Service Delivery System in the PhilippinesE. Approaches in the Delivery of Immunization ServicesF. Making a Comprehensive Immunization PlanBOOKLET 7177177177177178180182187194196198198 CHAPTER 8. Monitoring, Supervision and EvaluationA. RationaleB. ObjectivesC. Scope and CoverageD. Monitoring, Evaluation and Supportive Supervision for the NIPE. Data and Report ManagementF. Monitoring Through Routine Data Collection in a Health-FacilityG.

8 Data Collection-Consolidation at Various Levels of AdministrationH. Monitoring Immunization PerformanceI. Field Monitoring VisitsJ. Program Implementation Review K. Supportive Supervision VisitsNational Immunization Program Manual of Operations6 BOOKLET 8205205205205206211217217217217218219220 223 CHAPTER 9. Health PromotionA. RationaleB. ObjectivesC. Scope and CoverageD. The Role of Behavior ChangeE. Tools and Channels for Communicating Information on ImmunizationChapter 10. Mobilizing Community SupportA. RationaleB. ObjectivesC. Scope and CoverageD. Building Community Support for ImmunizationE. plan with the CommunityF. Implement and Monitor Immunization Services with the CommunityG.

9 Effective Communication for Community InvolvementTitleCommon VPDs in the PhilippinesCase Definitions of AFP, MR, NT and AMESV accines Used in the NIPOPV and IPV Immunization Schedule of Children Under One year of AgePCV and PPV ImmunizationMMR and MR ImmunizationTetanus Diphtheria Immunization ScheduleSummary of Vaccines by Route of Administration, Injection Site and ScheduleRecommendations for Immunization of HIV-infected Children and Women of Childbearing AgeVaccines that Require ReconstitutionRoute of Administration, Dose, Type, and Appearance of VaccinesDifferent Equipment Used to Administer Injectable VaccinesFive Types of AEFIF unctions of the NIP CommitteesDOH National Immunization ScheduleCommon Problems Associated with High Drop-Out and Poor Access and their SolutionsComprehensive Approach to Reduce Drop-OutsTechniques in Effectively Communicating with Community MembersGuide in Addressing Questions and Concerns about ImmunizationRoles and Responsibilities of Key Stakeholders in the NIPN umber 123456789 10111213141516171819 List of TablesIntroduction7 List of FiguresTitleMorbidity Rates Due to Selected VPDs 1997-2016 Flow of Information Feedback for VPD SurveillanceHow to Read the VVMP acking a Vaccine CarrierSet-Up of an

10 Immunization Session at a Fixed SiteLayout of the Immunization WorkspaceDifferent Needle PositionsInjection Sites for PENTA, PCV and IPVL ocating the Site to Give IM Injection to InfantsLocating the DeltoidSubcutaneous InjectionAdministering OPVI ntramuscular Injection of the Td VaccineHow to Read the VVMHow to Perform Shake TestParts of a Syringe and Needle that Must Not Be TouchedParts of a Syringe and Needle that May Be TouchedCorrect Position for Child Receiving InjectionSafety BoxSafety Box Assembly and UseSafety PitDisposal PitImmunization CardTemperature Monitoring ChartImmunization Monitoring ChartSample Materials for Communication for ImmunizationNumber 1234567891011121314151617181920212223242 526 List of FormsTitleSample Form for Recording Timeliness and Completeness of Monthly Reporting from Health Facility to