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Child Health Program Orientation
VINCENT SUMERGIDO
Senior Health Program Officer
National Immunization Program
Module 1:
Basic of the Immuniza6on Program
Essential Package for Child Survival

The Vaccines Introduction in the Philippines (1)
2010
1992
Hepatitis B MMR,
1982 vaccines Pentavalent
Anti- (DPT-HepB-
1979 measles HiB) vaccines
OPV & vaccine
Tetanus
1976 Toxoid
EPI was
launched

The Vaccines Introduction in the Philippines (2)
*2016
2015 Dengue
HPV Japanese
2014
Encephalitis
IPV
Cholera
Dt schoolchildren
2013
PCV
2012 MR & Td
Rotavirus adolescents
vaccine
Flu &PPV
Senior Citizen

Policies / Laws in Immunization
Presiden6al Decree 996 (1976)
Compulsory Basic Immuniza2on For Infants and Children Below 8 years of Age
Basic Imzn Services : BCG,DPT,OPV,Measles,Rubella,others
Viola@ons : Imprisonment not exceeding 1 month
Fine not exceeding Php200
AO No. 25-A s 1997

Updated Guidelines on Neonatal Tetanus Elimina2on
Elimina6on : below 1 case per 1,000 livebirths

Schedule of Immuniza6on
NT Surveillance
• All neonatal deaths shall be inves6gated w/in 2 weeks
• Monthly Ac6ve search in the HF
Ac6ons to be taken if there is NT

• Immuniza6on of the mother and other eligibles
• Search for other NT cases
• Promote TT immuniza6on and clean delivery prac6ces
• Implement correc6ve ac6ons to prevent further cases

AO 39s 2003
Policies on the Na2onwide Implementa2on of EPI
• Program Goals
• General Guidelines - Target, Schedule,Contraindica9on
• Safety Injec9on Prac9ces, Open Vial Policy
• Cold Chain Management,
• Recording and Repor9ng, Surveillance
• Implemen9ng Mechanism - Supervision and M/E

AO 2006-0015
Implemen2ng Guidelines on Hepa22s B Immuniza2on Policies on the Na2onwide
Implementa2on of EPI
Ra2onale :
Mother (+) HBsAg/HBeAg Baby :70-90% risk of infec@on
Hep B BD – decrease the risk 70-95%

Program Goal :
To reduce chronic Heb B rate to <1% (HBsAg) among <5yo aYer rou@ne HepB BD (within
24H)

REPUBLIC ACT 10152
• An act providing for MANDATORY BASIC IMMUNIZATON
services for infants and children, repealing for the purpose
Presiden9al Decree No 996, as amended
• The act shall be known as “Mandatory Infants and Children
Immuniza6on Act of 2011”
• The mandatory basic immuniza9on shall be given for FREE at
any government hospital or health center to infants and
children up to five (5) years of age

AO 2010- 17; 17-A; AO 2016-006

Guidelines in Surveillance and Response to AEFI and its amendments
AEFI surveillance shall be integrated into the Philippine Integrated Disease Surveillance
and Response (PIDSR) system
The MHO/CHO shall immediately be no@fied of all types of AEFI that occur in the field or
health facili@es and conduct immediate preliminary inves@ga@on
All serious AEFI, severe and unusual events occurring within 4 weeks of immuniza@on
shall be reported to next level

AO 2012-0003
Guidelines on the Strengthening of Laboratory Confirma2on of Suspected Measles Cases

AO 2012-0003
Guidelines on the Strengthening of Laboratory Confirma2on of Suspected Measles Cases

Immunization Response: Post National Mass Measles Immunization
Scenario Immunization Response Target Age Area to be covered
Selective Catch Non-selective Group*
Up Immunization
Immunization
Suspect measles No No Not Look for other
case in a barangay applicable cases in the
affected barangay
1 confirmed measles MCV1 or MCV2 No 9-23 months All barangays in the
case in a barangay for all missed old health center
children catchment area
2-9 confirmed MCV1 or MCV2 No 9-23 months City / municipality
measles cases in a for all missed old wide
barangay children
10 confirmed No 1 dose of MCV 9-59 months City / municipality
measles cases in one regardless of old wide
city / municipality immunization status
10 confirmed No 1 dose MCV regardless 9-59 months Province / region
measles cases in of immunization status old wide **
multiple cities /
municipalities
* Target age can be adjusted locally based on epidemiological evidence. For example, the lowest age can be adjusted to 6 months and upper
age limit up to 59 months. If target age is lowered to 6 months, children immunized between 6-8 months should get their routine MCV dose at
age 9 months.
** This approach requires consultation with national level first and should only be considered if initial strategies are proven ineffective to
control outbreak.

DM 2014 – 0155 (Administration of PCV13)
DM 2015 -0238 (Implementation of School-based Immunization)
DM 2015 – 0316 (HPV Implementation)
2015-0164 (Administration of IPV)

Regional Level Policies in Immunization




National Immunization Program Goals
1. Maintenance of Polio Eradication
2. Elimination of Measles
3. Elimination of Maternal and Neonatal Tetanus
4. Control of Diphtheria,Pertusis, Hepatitis B infection,

Tuberculous Meningitis and other disseminated
forms of TB
5. Maintenance of at least 95% FIC coverage

Program Indicator
Fully Immunized Child (FIC)

A child before reaching 1 year old should receive all of the
following:
• 1 dose of BCG
• 3 doses of DPT (PentaHib)
• 3 doses of Hep B (PentaHib)
• 3 doses of OPV
• 1 dose of AMV

EPI Target Diseases
• Poliomyeli6s • Mumps
• Measles • Rubella
• Diphtheria • Rotavirus
• Pertussis (whooping cough) • Congenital Rubella Syndrome
• Tetanus • Pneumococcal Disease
• Disseminated Tuberculosis (TB) • Human Papillomavirus
• Hepa66s B Infec6on

National Immunization Program Vaccines
BCG (Bacillus of Calmette Guerin)
Type of Vaccines Live Attenuated
No. of doses One (1) dose only
Schedule At birth (before 1 year of age)
Dose 0.05mL
Injection Site Upper Arm
Injection Type Intradermal
Side Effects Local reaction
Storage +2 to +8 °C
• BCG is freeze-dried.
• Before you can use BCG, you must recons@tute the dry vaccine with an accompanying diluent.
• Maximum of 6 hours only aYer recons@tu@on
• BCG is damaged most easily by sunlight.

Hepatitis B (birth-dose)
Type of Vaccines Inactivated vaccine
Schedule Within 24Hours
Dose 0.5mL
Injection Site Outer-mid thigh
Injection Type Intramuscular
Side Effects Local soreness
• Gold Standard: WITHIN 24 Hours

• If not given within 24 hours, given immediately a]er 24 hours before 2 weeks of age.

Pentavalent Hib
Component D, P, T, HepaB, H. Influenza type B
No. of doses Three (3) doses (one month apart)
Schedule 6, 10, 14 weeks
Dose 0.5mL
Injection Site Outer-mid thigh
Side Effects Local reaction, fever
• Shake the vial before aspira9on of the vaccine.
• Do not massage injec9on site.
• Apply pressure to the site.
• Instruct mothers for side effects management:
FEVER: Increase fluids; Paracetamol; TSB
LOCAL REACTION: Cold Compress

Oral Polio Vaccine

Type of Vaccines Live Attenuated Vaccine
Dose 2 drops
Injection Site -------
Injection Type Oral
Side Effects Usually none
Storage -15 to -25 °C
• Oral polio vaccine (OPV) is damaged very quickly by heat.

• If the child has diarrhea, give the dose now, un@l comple@on of the series.
Then give an extra dose one month aYer the last dose in the series.

Inactivated Polio Vaccine (IPV)

No. of doses One (1)
Schedule 14 weeks (given together with OPV3)
Dose 0.5mL
Injection Site Outer-mid thigh (Left Thigh)
Side Effects Local Reaction
• Given only before 1year of age CONCURRENTLY with OPV3

Pneumococcal Conjugate Vaccine

Dose 0.5mL
Injection Site Outer-mid thigh (Left Thigh)
• Three doses should be completed BEFORE 1year of age.

Measles
Schedule 9 months
Dose 0.5mL
Injection Type Subcutaneous
Side Effects Local reaction, fever, rash
• Measles is freeze-dried.
• You must recons@tute the dry vaccine with an accompanying diluent.
• Maximum of 6 hours only aYer recons@tu@on
• Management of side effects:
Fever (develops 5-12days aYer, lasts for 2 days) – Increase OFI
Rash (develops 5-12days aYer, lasts for 2 days) – No ac@on needed
Soreness (may occur in 24H) – resolves within 2-3 days

Measles-Mumps-Rubella (MMR)
Schedule 12-15 months
Dose 0.5mL
Injection Type Subcutaneous
Side Effects Local reaction, fever, rash

Human Papillomavirus (HPV)

Type of Vaccines Inactivated (Sub-unit) vaccines
No. of doses Two (2) dose (Six months apart)
Schedule/Age 9-10y Female (Iloilo/Negros ONLY)
Dose 0.5mL

Pneumococcal Polysaccharide (PPSV)

Type of Vaccines Inactivated (purified) vaccines
No. of doses One (1) dose, once in his/her lifetime
Schedule/Age 60 yo & up
Dose 0.5mL

Td MR 2.5mL diluent 5mL diluent

Vaccine Birth 6 weeks 10 weeks 14 weeks 9 months 12 months
BCG
HEPA B Included Included Included
in Penta in Penta in Penta
OPV 1
Rotavirus1 Oral
PENTA 1 Right
Thigh
PCV 1 Left Thigh
OPV 2
Rotavirus2 Oral
PENTA 2 Right Thigh
PCV 2 Left Thigh
OPV3
PENTA3 Right
Thigh
PCV3 Left Thigh
IPV Left Thigh
MEASLES
MMR
Vaccinations to Pregnant Women
TT Dose When to Give
TT 1 As early as possible during pregnancy
TT 2 4 weeks after TT1
TT3 6 months after TT 2

TT4 1 year after TT3
TT5 1 year after TT4

CORRECT MISCONCEPTION
Remember: VACCINES ARE ONE OF THE MOST SAFEST

PUBLIC HEALTH COMMODITY
There are not much contraindica9on to vaccina9on.
All infants should be immunized EXCEPT for these
situa9ons:
• Anaphylaxis/Severe allergic reac9on to a previous dose.
Persons known to have an allergy to a component of a
vaccine
• Do not give BCG to a person exhibi9ng signs &
symptoms of AIDS

General Rules on simultaneous administration
Simultaneous administration is defined as administering more than one

vaccine on the same clinic day, at different anatomic sites, and not
combined in the same syringe.
Simultaneous administration of vaccines for which a person is eligible

at the time of visit increases the probability that a child, adolescent/
adult will be vaccinated fully by appropriate age.
Example: Penta, OPV, PCV13 administered simultaneously at 6, 10, 14 weeks

of age

What is a defaulter?
All children who have not received their vaccines at the
recommended AGE are considered as DEFAULTER
Who are our PRIORITY target age groups in defaulter tracking?

All under two (2) year old children. They should complete their
primary series before they turn two years old
How to look for defaulters? (to be discussed on Module 2)

• TCL Tracking
• House to House

FHSIS Recording & Reporting
TARGET CLIENT LIST FOR NUTRITION AND EPI PROGRAM PART I
CHILD
LENGTH/HEIGHT
DATE OF DATE FAMILY DATE PROTECTED
WEIGHT
REGISTR COMPLETE COMPLETE AT BIRTH
OF BIRTH SERIAL NHTS * NAME OF CHILD SEX NEWBORN
A- NAME ADDRESS (CPAB)**
NUMBE
TION (mm/dd/yy) (M/F) OF MOTHER SCREENING (12)
R
(mm/dd/yy) (11) TT Status DATE
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) REFERRAL DONE Date ASSESS

DATE CHILD WAS EXCLUSIVELY COMPLEMENTARY
DATE IMMUNIZATION RECEIVED
FULLY ROTA PNEUMOCOCCA BREASTFED**** FEEDING*****
IMMUNI VIRUS L CONJUGATE
(13) (15) (16) REMAR
ZED VACCINE VACCINES (PCV)
KS
HEPA B1 PENTAVALENT OPV MCV CHILD Put a (√) check Put a Put a (√) check
More (FIC) Date
w/in MCV1 MCV2 1st 2nd 3rd 4th 5th 6th 7th 8th
BCG than *** for
1 2 3 1 2 3 1 2 1 2 3
24 6th
24 hrs. (AMV) (MMR) (14) MO MO MO MO MO MO MO MO (17)
hrs. mo.


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
DATE OF REGISTRATION – write in this column the month, day, and year an infant was SEEN at
the clinic for health services

CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
DATE OF BIRTH – write in this column the month, day, and year of birth.
This is important for determining the immunization schedule


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
FAMILY SERIAL NUMBER– Indicate in this column the number that corresponds to
the number of the family folder or envelope or individual treatment record.
This column will help you facilitate retrieval of the client’s record.


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
NHTS – Write the symbol (*) to indicate that the infant is from the NHTS list
provided by the DSWD


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
NAME OF CHILD – Write the complete name of the child.


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
WEIGHT – Write the weight of the child in kilograms.


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
LENGHT/HEIGHT – Write the length of children under 2 years, and write

the height of children 2 years and over in centimeters


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
SEX – Write the sex of infant; “M” for male and “F” for female


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
COMPLETE NAME OF MOTHER – Write in this column the name of the mother
(Family Name, First Name, and Middle Initial)


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
COMPLETE ADDRESS – Record the client’s permanent place of residence.

This column will help you to monitor or follow-up the client


CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
DATE OF NEWBORN SCREENING – This is divided into two sub-columns.
The first subcolumn refers to those given with referral only.
The second sub-column refers to newborn screening done in the health center.
Write the date only.

CHILD
LENGTH/HEIGHT
WEIGHT
NUMBE
R
CHILD PROTECTED AT BIRTH (CPAB) – Write the Tetanus Toxoid Status of the mother in the sub-column TT STATUS -
TT1, TT2, TT3, TT4, TT5 or Fully immunized mother (FIM) and if the mother received TT2 only, write the month and year TT2
was given. Write the month and year the child was classified as CPAB.
CPAB – child born to a mother who has received at least 2 doses of Tetanus toxoid, provided that the 2nd dose was given at least a month
prior to delivery
–(column1) Indicate TT status. If TT2 only, indicate the date below.

–(column2) Indicate the Date the Child was assessed CPAB

DATE IMMUNIZATION RECEIVED DATE FULLY
PNEUMOCOCCAL
ROTA VIRUS
CONJUGATE VACCINES
(13) IMMUNIZED VACCINE
(PCV)
HEPA B1 PENTAVALENT OPV MCV CHILD
BCG w/in More than MCV1 MCV2 (FIC) ***
1 2 3 1 2 3 1 2 1 2 3
24 hrs. 24 hrs. (AMV) (MMR) (14)
Indicate the dates of the vaccine administration.
For IPV - make a “slash” on the OPV3 column and indicate in the lower box the IPV accomplishment
For the individual antigens, Do NOT count Hospital Reports or those given at other Health Centers.

PNEUMOCOCCAL
ROTA VIRUS
CONJUGATE VACCINES
(PCV)
1 2 3 1 2 3 1 2 1 2 3
24 hrs. 24 hrs. (AMV) (MMR) (14)
MCV2 – If the child is less than 2 years old, and given MCV2, still count as accomplishment. (for Old TCL, MMR is indicated in the Remarks
column)
FIC – received ALL of the following:

BCG, 3-DPT, 3-OPV, 3-Hepa B, Measles, BEFORE 1 Year of age


PNEUMOCOCCAL
ROTA VIRUS
CONJUGATE VACCINES
(PCV)
1 2 3 1 2 3 1 2 1 2 3
24 hrs. 24 hrs. (AMV) (MMR) (14)
FIC – received ALL of the following:

BCG, 3-DPT, 3-OPV, 3-Hepa B, Measles, BEFORE 1 Year of age

Summary Table
The Summary Tables is a form with 12-month columns
retained at the facility (BHS) where the midwife records all
monthly data.
Composed of:
• Health Program Accomplishment – the midwife records a
summary of all the data from TCL or registries
• Morbidity Diseases – the midwife accomplished this table

on a monthly basis. This summary table can also be the
source of ten leading causes of morbidity and reportable
disease
Recording & Reporting


Program Report (M1)

The Monthly Form contains selected indicators categorized
as maternal care, child care, family planning and disease
control.
The indicators found in the TCL and Summary Tables are also
recorded in M1.
The midwife should copy the data from the Summary Table
to the Monthly Form which she regularly submits monthly
to the public health nurse.



FHSIS Reporting Flow
PHN
PHN accomplishes
consolidates Q1 and submits
M1 in MCT to higher level
Individua Monthly
Provision l Target Monthly Consolid Quarterly
Treatmen Summary ation
of Health Client List Report Reports
Table (ST)
Services t Record (TCL) (M1) Table (Q1)
(ITR) (MCT)
Midwife Midwife Midwife Midwife fills
records in records in TCL fills up ST up M1 and
ITR GIVES to PHN
Data Validation by NDPs

The Cold Chain System
The cold chain is a system for ensuring the potency
of vaccines from the time of manufacturing to the
time they are given to an eligible child/woman.

Most heat sensitive Most freeze sensitive
OPV HepB
MMR PCV Penta TT
Measles
Rota
Penta
BCG
TT PCV HepB
Least heat sensitive

Proper Stocking of Vaccines
In the Refrigerator:
• DO NOT stock on the door of the refrigerator
• Keep diluents in the lower shelves. DO not freeze
• Segregate different types of vaccines, arrange them
neatly in a tray or in their boxes.
• Stock vaccines in the refrigerator so that those that re
due to expire first can be identified and used first.
(use VVM as guide)
• CONTINUE to use opened vial vaccines in subsequent
sessions if MDVP conditions are met.



Always Remember!
Conditions for MDVP
C –proper Cold Chain is maintained at all times
A – Aseptic /sterile technique has been used to withdraw all doses
V – Vaccine Vial Monitor (VVM) has not reached the discard point
E – Expiry date has not passed
S – septum/vial has not been submerged in water
D – Date of opening is indicated

• Discard an opened vial immediately if any of the

following conditions apply:
• Sterile procedure have not been observed
• There is even a suspicion that opened vials has been

contaminated
• There is visible evidence of contamination

In the Transport Box or Vaccine Carrier:
• Make sure you have enough icepacks.

• Place OPV in contact with ice packs.
• Wrap other vaccines in a plastic to prevent them in
coming into contact with icepacks.
• REMEMBER, leave ice packs out of the freezer for a few
minutes before packing.



TRANSPORT BOX VACCINE CARRIER

Important Points in Storing
• Never Freeze DPT, TT and HepB
• Keep Polio in the freezer
• If vaccines are stored or below its safe temperature, it

will lose its potency. It cannot be restored by being
cooled/thawed again.
• Keep diluents in the lower shelves. DO NOT freeze

diluents
• Never keep vaccines in the door of the refrigerator

Temperature Monitoring Chart
Temperature of the refrigerators must be monitored

once during the FIRST working hour of the morning
and again during the LAST working hour in the
afternoon.
Temperature should be recorded and posted outside

the door of the refrigerator.

Temperature Monitoring Devices
Dial Thermometer
Fridge Tag
Example of
continuous
monitoring

How to use Fridge-Tag
WHAT TO RECORD
Twice a day record the temperature in the temperature log as you would for a
regular thermometer. If there is an alarm record the type of alarm and the day it
occurred.
WHERE TO PLACE IN REFRIGERATOR
Place with freeze-sensitive vaccines, as the detection of freeze events is vital. Also
consider safety (avoiding door to minimize likelihood of FT falling out) and ease of
reading without removing from the fridge.
WHAT TO DO IF THERE IS AN ALARM

.
Check electricity, electrical connection and the refrigerator’s
ability to remain closed.
Heat Alarm
Check all vaccine vial VVMs and discard any vaccines with VVMs
3 or 4.
Conduct a shake test on any freeze-sensitive vaccines (eg, DPT,

Freeze Alarm penta, HepB) stored in the refrigerator. Use at least 3 vials from
different locations in the fridge
An alarm indicates a serious problem with the fridge or with electricity. Contact your
supervisor or refrigeration expert for help in case of recurring alarms.

Vaccine Vial Monitor (VVM)
Vaccine Vial Monitor is a label of heat-sensitive material which
is placed on a vaccine vial or ampule to register cumulative
heat exposure over time.
The lower the temperature, the slower change in color

The higher the temperature, the faster change in color

Different stages of VVM colour change

Stock Card Monitoring
Province : _________________
Municipality : _________________
Barangay/BHS : _________________
Name of Vaccine : _________________
No. of
Expiry
Date No. of Vials Vials Balance Lot No. Remarks
Date
Received Utilized

Vaccine Inventory
Conducted at the Last working day of the Month
One RHU Inventory
NDPs who have Vaccine Refrigerators in their BHS

should conduct vaccine inventory if the Refrigerator is
storing vaccines
Child Focal Person shall do analysis and relay results to

PHN and DMO

Vaccine Inventory

Vaccine Inventory
1. See vaccine computation Worksheet
2. Report Summary of Stock-level Analysis
Summary of Vaccine Inventory/Stock Level

___________________
Province/City : __________
___________________
Month : __________
___________________
Year : __________
Fill up stocks in Months
Vaccine expiring within 6

Municipality/ AD Mixing months
PentaH Tetanus ECCD/MC
City/ District BCG MeaslesMMR Hep B PCV OPV Syringe Syringe SCB Remarks
ib Toxoid B
Health Center s s
Name of No. of Expiry
Vaccine Vials Date

Vaccine Inventory
Ideal RHU storage capacity is 1month stock level PLUS 1month

buffer stock
Ensure ideal stock level at ALL TIMES especially for vaccines with
adequate supplies
More than the 2 months vaccine stock capacity may be ok, but may
place the storage at full levels unecessarily
Ensure vaccines expiring within 6months are utilized immediately

The PIDSR Notifiable Cases
Category I Category II
(Immediately No6fiable) (Weekly No6fiable)

1. Acute Flaccid Paralysis 1. Acute Bloody Diarrhea
2. Adverse Event Following Immuniza9on (AEFI) 2. Acute Encephali9s Syndrome
3. Anthrax 3. Acute Hemorrhagic Fever Syndrome
4. Human Avian Influenza 4. Acute Viral Hepa99s
5. Measles 5. Bacterial Meningi9s
6. Meningococcal Disease 6. Cholera
7. Neonatal Tetanus 7. Dengue
8. Paraly9c Shellfish Poisoning 8. Diphtheria
9. Rabies 9. Influenza-like Illness
10. Severe Acute Respiratory Syndrome (SARS) 10. Leptospirosis
11. Malaria
12. Non-neonatal Tetanus
13. Pertussis
Typhoid and Paratyphoid Fever

The PIDSR Notifiable Cases
Category I:
No9fy simultaneously the PHO, RO6 and NEC within 24 hours
of detec9on and send advance copy of the Case Inves9ga9on
Form (CIF) as soon as possible.
Category II:
Report all cases of No9fiable diseases/syndromes every
Tuesday of the week to the next higher level (CESRU) using the
Case Report Form (CRF).

Standard AFP Case Definition
Any child less than 15 years of age with acute flaccid paralysis,
OR
A person of any age in whom poliomyeli9s is suspected by a
physician.
Acute: rapid onset of paralysis, < 3-4 days usually to reach

the maximum but may extend to two weeks
Flaccid: loss of muscle tone, “floppy” (as opposed to spas2c
or rigid)
Paralysis: loss of motor func2on, loss or diminu2on of mo2on

Standard Measles Case Definition
Suspected Case
Any individual, regardless of age, with the following
signs and symptoms:
history of fever (38°C of more, or hot to touch); and
generalized non-vesicular rash of 3 or more days
dura9on; and
at least one of the following: cough, coryza or
conjunc9vi9s.

Definition of AEFI
An AEFI is any untoward medical occurrence which

follows immunization and which does not necessarily
have a causal relationship with the usage of the vaccine.
The adverse event may be any unfavorable or

unintended sign, abnormal laboratory finding, symptom
or disease.

CIOMS/ WHO cause specific definition of AEFIs
1 4 5
2 3
Vaccine Immunization
Vaccine quality Immunization
product- anxiety-
defect-related error-related Coincidental
related related
reaction reaction event
reaction reaction
An AEFI that is
caused or
precipitated by
An AEFI that is An AEFI that is
a vaccine that
caused or caused by
is due to one An AEFI that is
precipitated by An AEFI arising something
or more caused by
a vaccine due from anxiety other than the
quality defects Inappropriate
to one or about the vaccine
of the vaccine vaccine
more of the immunization. product,
product handling,
inherent immunization
including its prescribing or
properties of error or
administration administration.
the vaccine immunization
device as
product. anxiety
provided by
the
manufacturer.

CIOMS/ WHO cause specific definition of AEFIs
1 4 5
2 3
Vaccine Immunization
Vaccine quality Immunization
product- anxiety-
defect-related error-related Coincidental
related related
reaction reaction event
reaction reaction
EXAMPLE
Failure by the EXAMPLE
manufacturer EXAMPLE A fever after
EXAMPLE to completely EXAMPLE vaccination
Extensive Vasovagal (temporal
inactivate a Transmission
limb swelling syncope in an association)
lot of of infection by
following DTP adolescent and malarial
inactivated contaminated
vaccination. following parasite
polio vaccine multidose vial.
vaccination. isolated from
leads to cases
of paralytic blood.
polio.

Vaccine reactions 1 2
Vaccine Vaccine quality
product-related defect-related
reaction reaction
MINOR REACTIONS SEVERE REACTIONS
÷Usually occur within a few hours of injection.

÷Resolve after short period of time and pose little danger.
÷Local (includes pain, swelling or redness at the site of
injection).
÷Systemic (includes fever, malaise, muscle pain, headache or
loss of appetite).

Minor vaccine reactions, treatments and rates associated with childhood vaccines
Local reactions Systemic reactions
Vaccine Irritability, malaise and
(pain, swelling, redness) Fever > 38 C
systemic symptoms
BCG1 90% – 95% – –
Adults up to 15%, Children up to

Hepatitis B 1 – 6% –
5%
Hib 5 – 15% 2% – 10%
Measles/MR/MMR ~ 10% 5% – 15% 5% (Rash)
OPV None Less than 1% Less than 1%2
Pertussis (DTwP) 3 up to 50% up to 50% up to 55%
Pnemucoccal
~ 20% ~ 20% ~ 20%
conjugate5
Tetanus/DT/aTd ~ 10%4 ~ 10% ~ 25
Treatment • Cold cloth at injection site • Give extra oral fluids • Give extra oral fluids
• Paracetamol6 • Wear cool clothing • Paracetamol6
• Tepid sponge or bath
• Paracetamol6

reaction reaction
÷Usually do not result in long-term problems.

÷Can be disabling.
÷Are rarely life threatening.
÷Include seizures and allergic reactions caused by the
body's reaction to a particular component in a
vaccine.

reaction reaction

Severe vaccine reactions, treatments and rates associated with childhood vaccines
Frequency per
Vaccine Reaction* Onset interval
doses given
BCG Fatal dissemination of BCG infection 1 – 12 months 0.19 – 1.56/1.000.000
Vaccine associated paralytic
OPV 4 – 30 days 2 – 4/1.000.000
poliomyelitis (VAPP)**
Prolonged crying and seizures*** 0 – 24 hours < 1/100
DTwP
HHE 0 – 24 hours < 1/1.000 – 2/1.000
Febrile seizures 6 – 12 days 1/3.000
Measles Thrombocytopenia 15 – 35 days 1/30.000
Anaphylaxis 1 hour 1/100.000
* Reactions
* Reactions
(except
(except
anaphylaxis)
anaphylaxis)
do notdooccur
not occur
if already
if already
immune
immune
(90% (90%
of those
of those
receiving
receiving
a second
a second
dose);dose);
children
children
>6 years
>6 years
unlikely
unlikely
to have
to have
febrilefebrile
seizures.
seizures.
** VAPP
** VAPP
risk higher
risk higher
for first
for dose
first dose
(1 in (1
750in000
750compared
000 comparedwith 1with
in 5.1
1 inmillion
5.1 million
for subsequent
for subsequent
doses),
doses),
and for
andadults
for adults
and immunocompromised
and immunocompromised clients.
clients.
*** Seizures
*** Seizures
are mostly
are mostly
febrile.
febrile.
The risk
Theofrisk
having
of having
a seizure
a seizure
depends
depends
on theonpersons
the persons
age. The
age. risk
Theisrisk
much
is much
lowerlower
in infants
in infants
<4 months
<4 months
of age.
of age.

AEFI CASE SELECTION FOR REPORTING*
Serious Potential
AEFI immunization
error
Cluster
Reporter
should NOT
assess causality
Parental
concern
Community
Unexpected
Unexpected relationship
concern
frequency with
vaccination
* Events to be reported according to context - Routine surveillance,

new vaccine, mass campaign etc

Module 2:
Conduct of Immuniza6on Sessions &
Defaulter Tracking
Defaulter Tracking Framework
COMMUNITY MASTERLISTING
is an EFFECTIVE type of target
identification in a barangay
PROs:
• Thorough identification of Children in the community (door
to door)
• Those not seen by the RHMs can be detected by BHWs
CONs:
• May take time to do masterlist
• Inappropriate master listing process will defeat the workers
efforts
BHW Midwife
Masterlist TCL
Comprehensive
Defaulters Evaluation
List Process
Vaccination
Step1: Masterlisting (Active)
BHWs will conduct a monthly

Door to Door Masterlisting of ALL
0-15 months old children
Masterlist will include ONLY the following:

• Household Number/Purok
• Name of Child & Mother
• Date of Birth
The BHW ensures that ALL household in her catchment

are covered monthly by checking/enlisting all
0-15months old children residing in the house.
BHW also increases demand of services through

advocacy.
The BHW submits to the NDP the list

of the 0-15month old children seen in
their community/households covered
Form 3: BHW Masterlisting Form
Department of Health
Regional Office VI
Form 3: BHW Masterlist of 0-15 Months Old
Month: _____________
Household No.
Name of Child Birthdate Name of Mother
Sitio / Purok / Street
Note:
For 0-15months old children covered by Private

Physicians and not availing health services in the
RHU:
- Include their names in the BHW Masterlist
- NDP will gather the immunization data from these
private-covered children for inclusion in the TCL
- Vaccines administered by Private Physician will be
counted by the NDP as RHU accomplished
Step2: Compare TCL vs MList
Compare the BHW’s Masterlist vs Midwife’s TCL
BHW vs TCL
A. For Children Found in the TCL:
• DO NOT enlist in the Defaulter Tracking Form

Step2: Compare TCL vs MList
Compare the BHW’s Masterlist vs Midwife’s TCL

B. For children not found in the TCL:
1. Get the immunization Card.
2. Identify the immunization status using the Immunization Card:

2.a.If fully immunized, NO further action.
2.b.If with missed vaccines, enlist in the defaulter tracking
form
3. If without Immunization Card, interview the mother re the

vaccines received. If there is doubt in the immunization status,
enlist in the defaulter tracking form
Step3: TCL Defaulter Tracking
• Using the Updated TCL of your catchment

barangay, identify the date of the last immunization
session.
• Enlist in the Defaulter Tracking Form the children

who did not receive their vaccines in the last
immunization session
Defaulters
Comprehensive Defaulter Tracking Form

includes:
1. Children in the Masterlist not found in the

TCL with missed vaccines
+
2. Children found in the TCL with missed
vaccines
Defaulters
Department of Health
Regional Office VI
National Program on Immunization
FORM 1: 0-15 Months DEFAULTER TRACKING LIST (per barangay, MONTHLY)
Reporting Month: _____________________ Total No. of 0-15mo defaulters for the month:
______________
Name of Municipality : _____________________________
Name of Barangay : __________________ Total No. of 0-15mo children vaccinated for the month:
Name of BHW/CHT Partner: _____________________________ ______________
Date of Masterlisting Started: _________________
Ended : _________________
Note: Defaulters/Missed children identified for the month that have not
completed the needed vaccines by the end of the month SHOULD be carried over
in the NEXT month's defaulter list
House Hold Age of baby in Remarks

No. Name of Child Mother's Name NEEDED vaccines
No. Months/years (Name & Date of Vaccine given)
EXERCISE
STEP1: BHW Conduct Door to Door Master listing
BHW Masterlist
Form 3: BHW Masterlist of 0-15 Months Old
Month: August 2016
Household No.
Name of Child Birthdate Name of Mother/Parent
HH9 / PurokB Inday Duterte January 10, 2016 Rody Duterte

HH28/PurokC Zandro Marcos October 20, 2015 Ferdie Marcos
EXERCISE
STEP2 - Compare Masterlist and TCL.
- Identify those who are not found in the TCL.
BHW Masterlist Midwife TCL
Form 3: BHW Masterlist of 0-15 Months Old Last Session:

August 3, 2016 (1st Wed)
Month: August 2016
Household No.
Name of Child Birthdate Name of Mother/Parent Children Vaccinated:
HH9 / PurokB Inday Duterte January 10, 2016 Rody Duterte
Paolo Roxas - MMR
HH28/PurokC Zandro Marcos October 20, 2015 Ferdie Marcos
Did not arrive:
Zandro Marcos - Measles
EXERCISE
STEP2 - Enlist in the Defaulter Tracking Form

those who are not found in the TCL
House Age of baby in Remarks

No. Name of Child Hold No.
Mother's Name Months/years
NEEDED vaccines
(Name & Date of Vaccine given)
Penta1,2,3
1 Inday Duterte 9 Rody Duterte 7 months OPV1,2,3
PCV1,2,3
EXERCISE
STEP3 - Using the updated TCL, enlist also

those children who did not receive their
vaccines in the last immunization session
House Age of baby in Remarks
No. Name of Child Hold No.
Mother's Name Months/years
NEEDED vaccines
(Name & Date of Vaccine given)
Penta1,2,3
1 Inday Duterte 9 Rody Duterte 7 months OPV1,2,3
PCV1,2,3
2 Zandro Marcos 28 Ferdie Marcos 10 months Measles
For the Month of August 2016, you have now

Two (0-15months old) defaulter
Conduct of Vaccination
Ensure that all children enlisted in the

Defaulter Tracking Form will be vaccinated in
the NEXT immunization session.
1. Mobilize BHWs to bring the

children in the RHU (Fixed Site)
2. Conduct Outreach
Immunization
(mobile/door-to-door)
Conduct of Vaccination
When to decide if Outreach

Immunization is warranted?
“If there is an increasing defaulters (more than 25

identified defaulters) in a barangay”
Remember: Defaulters are are always having problems in

accessing immunization services. HW should EXERT effort in
ensuring they will be vaccinated
Evaluation of the Catch-up
Record all accomplishments in the TCL immediately

after the immunization session
A. Those who missed the immunization session &

lacking vaccines shall remain/enlisted again in
the Defaulter Tracking Form
B. Include those NEW 0-15months old children

identified by the BHW in their succeeding
Masterlist
Step 1
BHW Step 2 Midwife
Masterlist TCL
Comprehensive
Step 3 Defaulters Evaluation
List Process
Vaccination
Consolidation of Report
FORM 2: Consolidation Matrix for 0-15 Months Catch-up Immunization (MONTHLY)
MUNICIPAL
PROVINCE: _________________________________________ TOTAL
Name of Total Number of 0-15mo defaulters for
Municipality: _________________________________________ the month: __________
Reporting Total Number of 0-15mo children
Month : _________________________________________ vaccinated: ___________
* indicate here the breakdown of the missed vaccines of the identified defaulters
Number of Defaulters/Missed Children
Total No. of 0- Vaccinated
Name of Total Total No. of 0-
15mo defaulters
15mo defaulters
Population PentaHib OPV PentaHib OPV
Barangay for the month
vaccinated for the
BCG
Measle
MMR BCG Measles MMR
month s
1 2 3 1 2 3 1 2 3 1 2 3
Consolidation of Report
FORM 2: Consolidation Matrix for 0-15 Months Catch-up Immunization (MONTHLY)
MUNICIPAL
PROVINCE: _____Iloilo ______________________________ TOTAL
Name of Total Number of 0-15mo defaulters for
Municipality:___Ajuy__________________________________ the month: ____2____
Reporting Total Number of 0-15mo children
Month : ___August________________________________ vaccinated: ____2_____
* indicate here the breakdown of the missed vaccines of the identified defaulters
Total No. of 0- Vaccinated
Name of Total Total No. of 0-
15mo defaulters
15mo defaulters
Population PentaHib OPV PentaHib OPV
Barangay for the month
vaccinated for the
BCG
Measle
MMR BCG Measles MMR
month s
1 2 3 1 2 3 1 2 3 1 2 3
Abra 150 2 2 / / / / / / / / /
Module 3:
Evalua6ng the Immuniza6on Program
DATA VALIDATION
• Part of the NDP deliverable to ensure correct repor9ng
• Done regularly on a monthly basis, together with the RHM
• Scheduled within 1st week of the following month
• Use the standard Data Valida9on Sheet provided by RO6
• Data Valida9on Sheet shall be the basis of DMOs in ensuring

NDPs are valida9ng reports

Barangay Validation of EPI Accomplishment
Name of Barangay : ___________________ Municipality of : ______________
Month : ______________ Year : ______________
Note: Once there are under/over reporting noted during validation, ensure to reconcile
data and reflect the final validated accomplishment Report to the M1 of the Brgy.
Remarks
Indicators TCL ST M1 (Over/Under
Reporting)
CPAB
BCG
PentaHib 1
PentaHib 2
PentaHib 3
PCV1
PCV2
PCV3
Prepared by:
_________________________ ______________________
NDP Assigned in Brgy RHM/PHN

Barangay Validation of EPI Accomplishment
Name of Barangay : ___________________ Municipality of : ______________
Month : ______________ Year : ______________
Note: Once there are under/over reporting noted during validation, ensure to reconcile
data and reflect the final validated accomplishment Report to the M1 of the Brgy.
Remarks
Indicators TCL ST M1 (Over/Under
Reporting)
CPAB
BCG 20 20 15 Under Reporting
PentaHib 1
PentaHib 2
PentaHib 3
PCV1 30 35 35 Over Reporting
PCV2
PCV3
Prepared by:
_________________________ ______________________
NDP Assigned in Brgy RHM/PHN

Afer the Data Valida6on and Reconcilia6on, reflect the Final/
Corrected EPI Report to the M1. This will be used by the PHN
as their final report. TARGET POP January
(2.7% OF TOTAL
POP) Male Female TOTAL TOTAL %
BCG
HepaB in 24H
HepaB after 24H
PentaHib1
PentaHib2
PentaHib3
PCV1
PCV2
PCV3
NDPs shall be submikng Rota1
Rota2
validated PI Reports to OPV1
OPV2
DOH6 using this matrix: OPV3
IPV
Measles
MMR
TT2+
CPAB
FIC
LIVEBIRTHS
Pneumo (Senior)
Influenza (Senior)
HPV (9-10yo females)

(NEW) EPI Monitoring Chart

Workshop on
Filling up of EPI Monitoring Chart

EPI MONITORING CHART
• Used to assess/plot monthly

accomplishments of FIC
• Should be posted in ALL Health

Facilities
2013 Jaro I
28,608 773 Total Population for
2013: 28,608
773
704
Eligible Population?
640
576
773
512
448
384
320
256
192
128
64
33 35 31 32 38 40
33 68 99 131 169 209
38 70 110 135 180 252

39 75 105 135 177 225
-1 -5 5 0 3 27
-3% -7% 5% 0% 2% 11%
Jan Feb Mar Apr May June

FIC 33 35 31 32 38 40
Penta
Hib 1 38 32 40 25 45 72
Penta
Hib 3 39 36 30 30 42 48
2013 Ivisan
28,608 773
773
704
640 Jan Feb Mar Apr Ma Jun
il y e
576
FIC 33 35 31 32 38 40
512 Cum 33 68 99 131 169 209
448 FIC
384 P1 38 70 110 135 180 252
320 P3 39 75 105 135 177 225

256 Drop -1 -5 5 0 3 27
192 Drop -3% -7% 5% 0% 2% 11%
Out
128 %
64
REB Analysis Workshop

Analyze problems
Highes
t
Drop-out
Doses of Vaccines Unimmunized Immun
FIC Rates
Immunization Measle Identity ized
2012 REB Covera DPT3
Targ Coverage (%) s Cases Problems
Analysis Total et ge
Pop Prioriti
Pop Administered (No.) (%)
ze area
PENTA PENTA Measle PENTA PENTA Measle PENTA Measle P1-P3 P1-MV Utilizat Priority
% No. Access
1 3 s 1 3 s 3 s /P1 /P1 ion 1,2,3…
a b c d e f g h i j k l m n o p q r
Mambusao
Barangay A 1,500 41 35 28 30
Barangay B 3,500 95 85 82 80
Barangay C 1,750 47 40 35 35
Barangay D 2,800 76 68 65 65
Analyze problems
Highes
t
Drop-out
Doses of Vaccines Unimmunized Immun
FIC Rates
Immunization Measle Identity ized
2012 REB Covera DPT3
Targ Coverage (%) s Cases Problems
Analysis Total ge
et Prioriti
Pop Administered (No.) (%)
Pop ze area
PENTA PENTA Measle PENTA PENTA Measle PENTA Measle P1-P3 P1-MV Utilizat Priority
% No. Access
1 3 s 1 3 s 3 s /P1 /P1 ion 1,2,3…
a b c d e f g h i j k l m n o p q r
Mambusao
Barangay A 1,500 41 35 28 30 85% 68% 73% 74% 13 11 None 20% 14% P P 2

Barangay B 3,500 95 85 82 80 89% 86% 84% 85% 13 15 None 4% 6% P G 1
Barangay C 1,750 47 40 35 35 85% 74% 74% 74% 12 12 None 13% 13% P P 3
Barangay D 2,800 76 68 65 65 89% 86% 86% 86% 11 11 None 4% 4% P G 4
For Workshop Purposes, the Penta3 Unimmunized was used to

prioritize. However since we look into the completeness of the
vaccination of the child, prioritization can be based on the MCV2
Unimmunized
Vaccine Inventory & Analysis
Vaccine Inventory & Analysis

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Child Health Program Orientation

National Immunization Program

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AO No. 25-A s 1997

Elimina6on : below 1 case per 1,000 livebirths

Ac6ons to be taken if there is NT

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AO 2010- 17; 17-A; AO 2016-006

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2015-0164 (Administration of IPV)

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1. Maintenance of Polio Eradication

3. Elimination of Maternal and Neonatal Tetanus

4. Control of Diphtheria,Pertusis, Hepatitis B infection,

5. Maintenance of at least 95% FIC coverage

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Fully Immunized Child (FIC)

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• Gold Standard: WITHIN 24 Hours

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Oral Polio Vaccine

• Oral polio vaccine (OPV) is damaged very quickly by heat.

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Inactivated Polio Vaccine (IPV)

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Pneumococcal Conjugate Vaccine

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Human Papillomavirus (HPV)

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Pneumococcal Polysaccharide (PPSV)

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Td MR 2.5mL diluent 5mL diluent

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TT 2 4 weeks after TT1

TT3 6 months after TT 2

TT5 1 year after TT4

Remember: VACCINES ARE ONE OF THE MOST SAFEST

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