Midwife Licensure Exam The Midwife's Public Health Service Delivery — Immunization / EPI Delivery by the MidwifeCheat Sheet
A printable cheat sheet for Immunization / EPI Delivery by the Midwife, built for Midwife Licensure Exam reviewers who want one go-to reference in the final stretch. Covers formulas, key definitions, common question types, and the Professional Regulation Commission (PRC) — Board of Midwifery-specific twists you will see on Midwife Licensure Exam day.
Exam context
For the Midwife Licensure Examination, Professional Regulation Commission (PRC) — Board of Midwifery tests The Midwife's Public Health Service Delivery under a "Core" label, with Immunization / EPI Delivery by the Midwife in the 3rd slot across 4 chapters. Midwife Licensure Exam candidates must clear the 75% weighted average cut on the 2026 paper, which draws about a meaningful share of The Midwife's Public Health Service Delivery questions. Date to watch: April and November 2026 (expected).
Immunization / EPI Delivery by the Midwife - Cheat Sheet
Your last-minute revision companion for EPI mastery at the BHS. Cold chain, schedules, routes, sites, and the few true contraindications. This is exam-critical material—every detail counts.
Sections
Common Values
Value
+2°C to +8°C
Symbol
T(storage)
Quantity
Cold chain storage temperature (BHS/health center)
Value
-15°C to -25°C
Symbol
T(frozen)
Quantity
Frozen OPV storage (higher levels)
Value
4 hours
Symbol
t(BCG)
Quantity
BCG reconstitution time limit
Value
6 hours
Symbol
t(MCV)
Quantity
MCV/MMR reconstitution time limit
Section Title
Cold Chain: The Foundation
Important Facts
- Storage temperature at health center/BHS: **+2°C to +8°C** (THE critical number)
- Regional/provincial cold rooms may store OPV frozen at **-15°C to -25°C** (not BHS level)
- Temperature recorded **twice daily** (morning and afternoon) on monitoring chart
- Refrigerator holds **vaccines only**—no food, drinks, or non-vaccine items
- Heat-sensitive vaccines (heat-labile): **OPV > BCG > MCV** (most to least); store near cooling source (top shelf)
- Freeze-sensitive vaccines (freeze-labile): **Hepatitis B, Pentavalent, PCV, IPV, TT/Td**—never freeze; store middle/lower shelf
- FEFO rule: **First Expiry, First Out**—use vaccines with nearest expiry date first
- Reconstituted BCG: use within **4 hours**; discard remainder
- Reconstituted MCV/MMR: use within **6 hours**; discard remainder
- Both reconstituted live vaccines kept **on ice** during session
Key Definitions
Term
Cold Chain
Example
Refrigerator at BHS holds vaccines at +2°C to +8°C; ice packs in carriers maintain same temperature during outreach.
Definition
Unbroken system of storage and transport maintaining vaccine potency from manufacturer to child's arm via controlled temperature.
Term
VVM (Vaccine Vial Monitor)
Example
After vaccine exposure to heat, VVM inner square becomes dark gray; vaccine is no longer safe to use.
Definition
Heat-sensitive label on vaccine vial; inner square darkening to match outer ring signals heat damage—vaccine must be discarded.
Term
Shake Test
Example
Pentavalent suspected of freezing: shake gently—if flakes appear and do not resuspend, discard immediately.
Definition
Assessment for freeze damage in freeze-sensitive vaccines: if frozen-thawed vial shows flakes/sediment that settle quickly, vaccine is damaged.
Diagrams To Know
- Cold chain flow from manufacturer to child
- Refrigerator shelf arrangement (heat-sensitive vs. freeze-sensitive zones)
- VVM color interpretation chart
- Temperature monitoring chart template
Common Values
Value
Before 12 months (< 365 days)
Symbol
FIC_age
Quantity
Age for FIC completion
Value
12–23 months
Symbol
CIC_age
Quantity
Age range for CIC
Value
3 doses (6, 10, 14 weeks)
Symbol
Penta_doses
Quantity
Pentavalent doses in routine schedule
Value
2 doses (9, 12 months)
Symbol
MCV_doses
Quantity
Measles doses in routine schedule
Section Title
Routine EPI Schedule — DOH Childhood Immunization
Important Facts
- **At birth (within 24 hours):** BCG + Hepatitis B → Hepatitis B prevents mother-to-child transmission
- **6 weeks:** Pentavalent 1 + OPV 1 + PCV 1
- **10 weeks:** Pentavalent 2 + OPV 2 + PCV 2
- **14 weeks:** Pentavalent 3 + OPV 3 + PCV 3 + IPV 1 → IPV is inactivated polio vaccine
- **9 months:** MCV 1 (measles-containing/MMR) + IPV 2 → Two antigens at this visit
- **12 months:** MCV 2 (second measles dose) → Completes routine infant schedule
- **Pentavalent = DPT + Hep B + Hib** (five antigens in one shot, spares three separate injections)
- **IPV schedule:** 1st dose at 14 weeks (with OPV), 2nd dose at 9 months (with MCV1)
- **Measles requires two doses** (MCV1 at 9 mo, MCV2 at 12 mo)—one dose does not guarantee seroconversion in all children
- FIC is the program goal; it protects children during highest-risk period (6–12 months)
Key Definitions
Term
Fully Immunized Child (FIC)
Example
Baby completed all doses by 11 months 29 days = FIC; critical for DOH program targets.
Definition
Child who received all required antigens (BCG, 3× Pentavalent, 3× OPV, 3× Hepatitis B, 1× MCV) **before turning 12 months old**.
Term
Completely Immunized Child (CIC)
Example
Baby completed measles dose at 13 months = CIC; not ideal, but schedule is complete.
Definition
Child who completed all required doses **after turning 12 months** (aged 12–23 months).
Term
Defaulter
Example
Child missed 10-week Pentavalent 2 and has not returned by week 12; is a defaulter requiring home visit.
Definition
Child who missed a scheduled vaccination and did not return by the next appointment.
Diagrams To Know
- DOH EPI schedule timeline from birth to 12 months
- Pentavalent vaccine composition breakdown
- Comparison of OPV (oral live) vs. IPV (injectable inactivated)
Common Values
Value
0.05 mL
Symbol
D(BCG)
Quantity
BCG dose
Value
0.5 mL
Symbol
D(IM)
Quantity
HepB, Penta, PCV, IPV dose
Value
2 drops
Symbol
D(OPV)
Quantity
OPV dose
Value
0.5 mL
Symbol
D(SC)
Quantity
MCV/MMR dose
Section Title
Administration: Routes, Sites, Doses, and Technique
Important Facts
- **BCG:** 0.05 mL intradermal (ID), **right upper arm** (deltoid area)—only ID vaccine in routine EPI
- **Hepatitis B (birth):** 0.5 mL intramuscular (IM), **anterolateral thigh (vastus lateralis)**
- **Pentavalent (DPT-HepB-Hib):** 0.5 mL IM, **anterolateral thigh**
- **PCV (pneumococcal):** 0.5 mL IM, **anterolateral thigh**
- **IPV (inactivated polio):** 0.5 mL IM, **anterolateral thigh**
- **OPV (oral polio):** 2 drops oral (by mouth)
- **MCV/MMR (measles):** 0.5 mL subcutaneous (SC), **upper outer arm**
- **NEVER use buttock for infant IM injection** → risk of sciatic nerve damage and impaired absorption
- **Use new sterile auto-disable syringe for every dose** (one needle, one child); never recap
- **Give all vaccines due at one visit** in different sites; no benefit to splitting doses across visits
- **Never reduce or split a dose**—full dose required for immunity
- Used sharps go into safety collector box; never dispose in regular trash
Key Definitions
Term
Intradermal (ID)
Example
BCG 0.05 mL ID into right upper arm raises small wheal; later forms a scar (normal response, not infection).
Definition
Injection into the skin itself (superficial layer), forming a small wheal; used only for BCG.
Term
Intramuscular (IM)
Example
Pentavalent 0.5 mL IM into outer thigh of infant; provides good absorption and avoids nerve damage.
Definition
Injection into muscle; for infants, the **anterolateral thigh (vastus lateralis)** is the site (never buttock).
Term
Subcutaneous (SC)
Example
MCV 0.5 mL SC into upper outer arm of infant; standard site for live measles vaccine.
Definition
Injection into subcutaneous tissue (under skin, above muscle); used for measles/MMR vaccine.
Term
Oral (PO)
Example
OPV 2 drops placed in infant's mouth at each visit (6, 10, 14 weeks).
Definition
Vaccine administered by mouth; OPV (oral polio vaccine) is given as drops.
Diagrams To Know
- Infant thigh anatomy showing vastus lateralis and safe injection site
- Comparison of ID vs. IM vs. SC needle angles and depth
- Vaccine administration quick-reference card (route × site × dose)
Section Title
Contraindications — True vs. False
Important Facts
- **TRUE contraindications (DO NOT vaccinate):**
- - Anaphylaxis or severe allergic reaction to prior dose of **same vaccine** or **vaccine component**
- - Prior severe reaction to DPT/Pentavalent (e.g., encephalopathy) → do not give further pertussis-containing doses
- - BCG **not given** to child with clinical signs of AIDS (symptomatic HIV); live vaccine risk in severely immunocompromised
- - Live vaccines used with caution in known immunodeficiency states
- **FALSE contraindications (IMMUNIZE ANYWAY—do not miss opportunity):**
- - Mild illness (cough, cold, runny nose)
- - Low-grade fever (< 39°C)
- - Mild diarrhea
- - Malnutrition (undernourished child **needs** vaccines more)
- - On antibiotics
- - Recovering from illness
- - Prematurity or low birth weight (immunize by **chronological age**, not corrected age)
- - Breastfeeding (breastfeeding is not a contraindication to any vaccine)
- **The EPI principle:** Missed opportunities harm more children than rare adverse events.
- Every contact with a child ≤ 12 months is a chance to check and update the immunization card
Key Definitions
Term
True Contraindication
Example
History of anaphylaxis to previous dose of same vaccine = true contraindication; do not re-vaccinate.
Definition
Medical condition or prior reaction that means the vaccine should **not** be given.
Term
False Contraindication
Example
Low-grade fever, mild cough, or malnutrition = false contraindication; child should still be immunized.
Definition
Condition commonly mistaken as a reason to withhold vaccine but is **NOT** a reason to defer immunization.
Diagrams To Know
- Decision tree: Is this a true contraindication?
- Common false contraindications checklist
Common Values
Value
< 12 months (before first birthday)
Symbol
FIC_cutoff
Quantity
FIC age cutoff
Value
12–23 months
Symbol
CIC_range
Quantity
CIC age range
Value
> 95%
Symbol
FIC_target
Quantity
Target FIC coverage (DOH)
Section Title
Recording, Tracking, and Program Indicators
Important Facts
- **Every dose recorded on:** (1) child's **immunization card** (kept by mother) and (2) **TCL at BHS**
- TCL is the midwife's tool to see, at a glance, which children are due and which are overdue
- **FIC (Fully Immunized Child):** All antigens before **12 months**—the program target
- **CIC (Completely Immunized Child):** All antigens between 12–23 months—backup indicator
- Defaulter identification: TCL shows child missed last appointment and has not returned by next scheduled date
- **Defaulter management:** **Never restart the series**—continue from where the child left off (give the next due dose)
- Example: Baby missed 10-week dose but returns at 16 weeks → give Pentavalent 2 (not restart at Pentavalent 1)
- Home visit for defaulter includes: explain importance of immunization, reschedule, remove barriers (transport, work schedule)
- Barangay Health Workers (BHWs) assist with defaulter identification and home reminders
- Monthly reporting to RHU; RHU reports to provincial DOH office
- High FIC rate (> 95%) is indicator of strong BHS performance and effective midwife/BHW coordination
Key Definitions
Term
Target Client List (TCL)
Example
TCL shows 10-week Pentavalent 2 is due for baby Juan; midwife checks if he came on schedule.
Definition
BHS register of all infants in the barangay due for immunization; used to track schedule compliance and identify defaulters.
Term
Field Health Services Information System (FHSIS)
Example
BHS reports monthly FIC rate to FHSIS; DOH uses data to track provincial immunization coverage.
Definition
National health information system that receives immunization data from BHS (via TCL) for DOH monitoring and evaluation.
Term
Defaulter Tracking
Example
Baby Rosa missed 14-week appointment; midwife visits home to reschedule; Rosa completes Pentavalent 3 two weeks late.
Definition
Active follow-up by midwife of children who missed scheduled doses; uses home visits or reminders to bring child back and continue series.
Diagrams To Know
- Immunization record flow: from individual card to TCL to FHSIS
- Defaulter tracking workflow (identification → home visit → rescheduling → completion)
Common Values
Value
Within 24 hours of birth
Symbol
t(birth)
Quantity
BCG + Hep B birth dose window
Value
0.5 mL
Symbol
V(HepB_birth)
Quantity
Hepatitis B birth dose IM volume
Section Title
Special Situations and Midwife Responsibilities
Important Facts
- **BCG and Hepatitis B are birth doses** given within 24 hours of delivery
- Hepatitis B birth dose is **critical for prevention of vertical transmission** (mother → baby)
- Unang Yakap program mandates first immunization at point of delivery (home, BHS, hospital)
- Midwife must **counsel mother on importance of completing schedule** and explain return dates
- Immunization card given to mother at delivery; midwife explains how to read card and importance of keeping it safe
- Mother is educated on vaccine-preventable diseases and expected mild reactions (arm swelling after BCG)
- BHS midwife conducts post-natal check (6 weeks) and **verifies Unang Yakap was completed**; if not, gives BCG + Hep B immediately
- For low-birth-weight (LBW) infants: immunize by **chronological age, not corrected age** (same as any infant)
- Premature babies follow the same EPI schedule (by age from birth, not from due date)
- When vaccine is given late: **continue from where child left off**, not restart
- Catch-up immunization: if child comes at any age with incomplete record, give next due vaccine and plot remaining doses
Key Definitions
Term
Unang Yakap Program
Example
Midwife conducts home birth; within 24 hours, gives BCG ID and Hepatitis B IM to newborn; records on card.
Definition
DOH program ensuring newborn receives first immunization (BCG and Hepatitis B birth dose) within 24 hours of delivery, even at home or health center.
Term
Birth Dose Hepatitis B
Example
Newborn of HBsAg-positive mother receives Hep B within 24 hours to stop vertical transmission.
Definition
Single 0.5 mL IM dose of Hepatitis B vaccine given within 24 hours of birth to prevent mother-to-child (vertical) transmission.
Diagrams To Know
- Unang Yakap birth immunization workflow
- Hepatitis B vertical transmission prevention pathway
- Catch-up vaccination scheduling algorithm
Must Remember
- **Cold chain storage at BHS/health center: +2°C to +8°C**—record temperature twice daily (morning and afternoon); this is THE critical number for all EPI operations.
- **Heat-sensitive vaccines (OPV > BCG > MCV)** are stored on top shelf near cold source; **freeze-sensitive vaccines (HepB, Penta, PCV, IPV, TT/Td)** are stored on middle/lower shelf AWAY from freezer (use shake test if freezing suspected).
- **FEFO rule (First Expiry, First Out)** and **read the VVM**—if VVM inner square is as dark as or darker than outer ring, vaccine is heat-damaged and must be discarded.
- **Birth doses within 24 hours:** BCG (intradermal, right arm) + Hepatitis B (IM, thigh)—prevents vertical transmission of Hepatitis B.
- **Key schedule:** 6 weeks (Penta 1, OPV 1, PCV 1) → 10 weeks (Penta 2, OPV 2, PCV 2) → 14 weeks (Penta 3, OPV 3, PCV 3, IPV 1) → 9 months (MCV 1, IPV 2) → 12 months (MCV 2) = FIC.
- **Route and site are NOT interchangeable:** BCG is 0.05 mL intradermal (only ID vaccine); HepB/Penta/PCV/IPV are 0.5 mL IM into anterolateral thigh (NEVER buttock); OPV is 2 drops oral; MCV/MMR is 0.5 mL SC into upper arm.
- **True contraindications are rare:** Anaphylaxis to prior dose, prior encephalopathy from DPT, BCG not for symptomatic HIV/clinical AIDS. Mild fever, cough, diarrhea, malnutrition, prematurity, breastfeeding, antibiotics = **NOT** contraindications—vaccinate anyway.
- **Reconstituted live vaccines:** BCG use within 4 hours (discard remainder); MCV/MMR use within 6 hours (discard remainder); keep both on ice during session.
- **FIC = all antigens before 12 months** (program gold standard, > 95% target); **CIC = all antigens between 12–23 months** (backup if FIC missed). Defaulter = child who missed appointment and did not return; **never restart series—continue from where child left off (give next due dose)**.
- **Recording and tracking:** Every dose on immunization card (mother keeps) and TCL at BHS; use TCL to identify defaulters; conduct home visits to reschedule and remove barriers; report monthly to RHU for FHSIS entry.
Last Minute Tips
- **Know the critical numbers by heart:** +2°C to +8°C (cold chain), 0.05 mL (BCG intradermal), 0.5 mL (all IM/SC), 2 drops (OPV), 4 hours (BCG reconstitution), 6 hours (MCV/MMR reconstitution), < 12 months (FIC cutoff). MLE examiners test these relentlessly.
- **Heat-sensitive vs. freeze-sensitive is a trap question.** OPV/BCG/MCV are HEAT-sensitive (top shelf); HepB/Penta/PCV/IPV/TT are FREEZE-sensitive (never freeze, use shake test). Get this wrong and you fail the immunization scenario.
- **Contraindication questions are often about false contraindications.** If the question says 'fever, malnutrition, prematurity, or breastfeeding,' the answer is ALWAYS 'vaccinate anyway'—these are NOT true contraindications. Only anaphylaxis to prior dose and prior encephalopathy from DPT are real blocks.
- **Defaulter management is 'continue, not restart.'** If a child missed a dose, give the NEXT due dose whenever they return—do not go back to the first dose. This is a common MLE trick question.
- **The Unang Yakap program test: BCG + HepB within 24 hours of birth.** If asked about newborn immunization, the answer must include the 24-hour window and the Hepatitis B role in vertical transmission prevention. This ties to the midwife's role at delivery.
Comparison Tables
Rows
Values
- OPV (most sensitive) > BCG > MCV (measles)
- Hepatitis B, Pentavalent, PCV, IPV, TT/Td
Property
Vaccines (priority order)
Values
- Exposure to temperatures above +8°C
- Freezing (exposure to temperatures below +2°C)
Property
Damaged by
Values
- Top shelf (nearest freezer/cold source)
- Middle and lower shelves (away from freezer); NEVER in door
Property
Shelf placement in refrigerator
Values
- VVM (Vaccine Vial Monitor)—inner square darkens with heat
- Shake test—frozen-thawed vial shows flakes that settle quickly and do not resuspend
Property
Test for damage
Values
- Live-attenuated (BCG, OPV, MCV) — sensitive to heat degradation
- Mix of inactivated and live (varies by vaccine)
Property
Live or inactivated
Columns
- Characteristic
- Heat-Sensitive (Heat-Labile)
- Freeze-Sensitive (Freeze-Labile)
Table Title
Heat-Sensitive vs. Freeze-Sensitive Vaccines: Storage Rules
Rows
Values
- 0.05 mL
- Intradermal (ID)
- Right upper arm (deltoid)
- Only ID vaccine; forms wheal; later scars
Property
BCG
Values
- 0.5 mL
- Intramuscular (IM)
- Anterolateral thigh (vastus lateralis)
- Within 24 hours of birth; prevents vertical transmission
Property
Hepatitis B (birth)
Values
- 0.5 mL
- Intramuscular (IM)
- Anterolateral thigh (vastus lateralis)
- Never buttock; three doses at 6, 10, 14 weeks
Property
Pentavalent
Values
- 0.5 mL
- Intramuscular (IM)
- Anterolateral thigh (vastus lateralis)
- Three doses; protects against pneumococcus
Property
PCV
Values
- 0.5 mL
- Intramuscular (IM)
- Anterolateral thigh (vastus lateralis)
- Inactivated polio; 1st dose at 14 weeks, 2nd at 9 months
Property
IPV
Values
- 2 drops
- Oral (by mouth)
- Mouth (drops in)
- Live polio vaccine; three doses at 6, 10, 14 weeks
Property
OPV
Values
- 0.5 mL
- Subcutaneous (SC)
- Upper outer arm
- Two doses: MCV1 at 9 mo, MCV2 at 12 mo; live vaccine
Property
MCV/MMR
Columns
- Vaccine
- Dose (mL or drops)
- Route
- Site
- Key Point
Table Title
Vaccine Route, Site, and Dose Quick Reference
Rows
Values
- Anaphylaxis or severe allergic reaction to previous dose of same vaccine or component
- No contraindications; mild allergies are not barriers
Property
Allergic reactions
Values
- Encephalopathy after DPT/Pentavalent → do not give pertussis-containing doses
- N/A
Property
Prior severe vaccine reaction
Values
- BCG not given to child with clinical AIDS (symptomatic HIV); live vaccines avoided
- N/A
Property
Immunocompromise
Values
- N/A
- Mild fever (< 39°C), cough, cold, mild diarrhea—all safe to vaccinate
Property
Fever and illness
Values
- N/A
- Malnutrition—child should be vaccinated (needs protection more than well-nourished child)
Property
Nutritional status
Values
- N/A
- On antibiotics—no contraindication; still vaccinate
Property
Medication use
Values
- N/A
- Prematurity, low birth weight—vaccinate by chronological age, not corrected age
Property
Prematurity and birth weight
Values
- N/A
- Breastfeeding—no contraindication; vaccinate as scheduled
Property
Feeding status
Values
- N/A
- Recovering from acute illness—vaccinate (safe and effective)
Property
Recovering from illness
Columns
- Category
- True Contraindications (DO NOT vaccinate)
- False Contraindications (DO vaccinate—do not miss opportunity)
Table Title
True Contraindications vs. False Contraindications
Rows
Values
- Child received all required antigens (BCG, 3× Penta, 3× OPV, 3× HepB, 1× MCV)
- Child received all required antigens but after 12 months of age
Property
Definition
Values
- Before 12 months (< 365 days from birth)
- Between 12–23 months (365–730 days from birth)
Property
Age completion window
Values
- Primary target; FIC status ensures protection during highest-risk 6–12 month period
- Backup indicator; child is protected but vaccination delayed
Property
Program goal
Values
- > 95% FIC coverage is gold standard; indicates strong immunization program
- Used to calculate coverage if FIC not reached by deadline
Property
DOH coverage target
Values
- Baby received MCV2 at 11 months 28 days = FIC (on-time, within first year)
- Baby received MCV2 at 13 months = CIC (late; completed after 1st birthday)
Property
Example
Columns
- Indicator
- FIC (Fully Immunized Child)
- CIC (Completely Immunized Child)
Table Title
FIC vs. CIC: Program Indicators and Age Cutoffs
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Family Planning Provision by Midwives
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Prenatal Home-Based and Postnatal Home Care
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