NLE Community Health Nursing — Communicable Disease Control & ImmunizationCheat Sheet

Common Values

Section Title

Immunity Concepts & Types

Important Facts

• Active immunity takes TIME to develop (lag phase) but is durable; passive immunity is IMMEDIATE but FADES.
• Vaccination harnesses active immunity; it does NOT provide instant protection.
• Herd immunity thresholds vary by disease (measles ~95%, polio ~80–85%, diphtheria ~85%).
• Maternal antibodies protect newborns initially but decline by 6–12 months (why EPI starts at birth/6 weeks).
• Live vaccines (BCG, OPV, measles, MMR) cannot be given to severely immunocompromised persons.
• Immunological memory: after initial exposure (natural or vaccine), subsequent encounters trigger faster, stronger response.

Key Definitions

Diagrams To Know

• The 'Immunity Spectrum' — active vs passive on one axis, natural vs artificial on the other (2×2 grid).
• Timeline of antibody levels in passively immunized vs actively immunized infant.
• Herd immunity threshold curve showing % immune vs disease transmission rate.

Common Values

Section Title

Expanded Program on Immunization (EPI) – Legal Foundation & Targets

Important Facts

• EPI targets: TB, diphtheria, pertussis, tetanus, poliomyelitis, measles (the classic 6).
• Program expanded to include Hepatitis B (birth dose), Hib, PCV, and MMR.
• Presidential Decree 996: compulsory basic immunisation for children <8 years.
• RA 10152 (Mandatory Infants and Children Health Immunization Act of 2011): mandates FREE routine immunisation for infants and children.
• Hepatitis B monovalent birth dose MUST be given within 24 hours of birth (RA 10152 requirement).
• FIC coverage is a KEY DOH performance indicator; low coverage signals outbreak risk.
• Vaccination must NOT be delayed for minor illnesses (low-grade fever, mild cough, mild diarrhea) — missed opportunities reduce herd immunity.
• Late vaccination is better than no vaccination; catch-up is allowed.

Key Definitions

Diagrams To Know

• EPI organizational structure (DOH → Regional → Provincial → RHU/health center).
• Timeline showing when children become FIC, CIC, and CPAB.
• Flow chart: Is the child eligible for catch-up vaccination?

Common Values

Section Title

EPI Routine Infant Vaccination Schedule (CRITICAL)

Important Facts

• SCHEDULE CORNERSTONE: **6–10–14 weeks** = pentavalent, OPV, PCV (3 doses each, minimum 4-week interval).
• **BCG & Hepatitis B at BIRTH** (HepB within 24 hours per RA 10152).
• **MCV1 (measles) at 9 MONTHS; MMR (MCV2) at 12 MONTHS** (NOT before 9 months; maternal Abs interfere).
• **OPV: 3 doses at 6–10–14 weeks + IPV at 14 weeks + IPV at 9 months** (current combined schedule).
• Minimum interval between doses is 4 weeks for primary series (pentavalent, OPV, PCV).
• Route specificity: **BCG = intradermal (0.05 mL); pentavalent/PCV/IPV = intramuscular (0.5 mL); OPV = oral (2–3 drops); measles/MMR = subcutaneous (0.5 mL)**.
• BCG successful take = wheal at injection site, later a small flat scar (~3–6 weeks); absence of scar may indicate vaccine failure.
• PPD/Koch's phenomenon = accelerated local reaction to BCG indicating prior TB exposure (do NOT revaccinate).
• Pentavalent = freeze-sensitive (do NOT freeze); DPT/Hep B/Td also freeze-sensitive.
• OPV = most heat-sensitive vaccine; store where coldest in cold chain.

Key Definitions

Diagrams To Know

• Vaccine schedule timeline from birth to 12 months showing all 8 vaccines and their ages.
• Route comparison chart: intradermal vs IM vs oral vs subcutaneous (site, needle angle, depth).
• Freeze-sensitive vs heat-sensitive vaccine classification.

Common Values

Section Title

Tetanus (Td) Immunization for Women of Childbearing Age & Pregnancy

Important Facts

• **Td1**: given as early as possible (even first antenatal care visit); provides NO protection yet.
• **Td2**: given ≥4 weeks after Td1; protects newborn from neonatal tetanus (~3 years' protection to mother).
• **Td3**: given ≥6 months after Td2; extends maternal protection to ~5 years.
• **Td4**: given ≥1 year after Td3; extends maternal protection to ~10 years.
• **Td5**: given ≥1 year after Td4; provides **LIFETIME** tetanus/diphtheria protection.
• **Two doses (Td1 + Td2) are the MINIMUM to protect the newborn; this is the definition of CPAB.**
• Tetanus toxoid is freeze-sensitive; must be stored at +2°C to +8°C (cold chain requirement).
• Neonatal tetanus is an immediately notifiable disease (within 24 hours).
• Clean, safe delivery practices (clean hands, clean cord, clean environment) + maternal Td vaccination = elimination of neonatal tetanus.
• Traditional cord practices (use of unsterile substances) increase neonatal tetanus risk if mother is unvaccinated.

Key Definitions

Diagrams To Know

• Td dosing schedule and protection timeline (Td1 → Td2 → Td3 → Td4 → Td5).
• Duration of protection curve: shows how long each Td dose protects (3, 5, 10, lifetime years).

Common Values

Section Title

Vaccine Cold Chain & Storage

Important Facts

• **Health center/RHU refrigerator: +2°C to +8°C** (standard cold room temp).
• **Regional/provincial level freezers: −15°C to −25°C** (for bulk OPV and measles stock).
• **HEAT-SENSITIVE (most vulnerable)**: OPV > measles/BCG > pentavalent/DPT.
• **FREEZE-SENSITIVE (must NOT be frozen)**: DPT, Hepatitis B, Td, pentavalent — freezing destroys potency.
• **Refrigerator monitoring**: thermometer checked twice daily (morning & evening); temperature log maintained.
• **VVM storage rule**: keep vaccines out of direct sunlight and UV light; VVM accelerates in UV.
• **Shake test positive (opaque/clumpy)** = vaccine frozen = potency destroyed = discard immediately.
• **Vaccine coolers for outreach**: use cool packs or ice; thermometer inside; ice should NOT touch vaccine vials directly (wrap in cloth).
• **Expired vaccines**: marked 'EXP' with thick marker, placed in 'discard box' for safe disposal.
• **Cold chain breakdown** (e.g., power outage, vaccine left in sun) = entire batch may be unusable — vaccine safety cannot be guaranteed.
• OPV most heat-sensitive because it's live attenuated; inactivated vaccines (IPV, Hep B) are more heat-stable but still sensitive.
• Storage order in RHU refrigerator: OPV/measles in coldest section; DPT/Hep B/Td in middle (not freezing).

Key Definitions

Diagrams To Know

• Cold chain flow diagram: vaccine manufacturer → freezer → RHU refrigerator → vaccine cooler → outreach → child (with temperatures).
• VVM color progression chart showing safe → unsafe transitions.
• Refrigerator layout showing temperature zones and vaccine placement.
• Shake test visual: clear liquid = safe; opaque/clumpy = frozen/unsafe.

Common Values

Section Title

Contraindications & Safe Vaccination Practice

Important Facts

• **LIVE vaccines (BCG, OPV, measles, MMR) are contraindicated in:**
• - Severely immunocompromised children (symptomatic HIV/AIDS, on immunosuppressive therapy, malignancy on chemo).
• - Do NOT give BCG to clinical AIDS; wait until CD4 recovery on ART.
• - Contraindicated during pregnancy (though accidental exposure is not an indication for termination).
• **INACTIVATED vaccines (IPV, Hep B, pentavalent, PCV, Td) are safe in immunocompromised — but response may be poor.**
• **Do NOT defer vaccination for:**
• - Mild febrile illness (low-grade fever <38.5°C).
• - Mild cough or upper respiratory infection.
• - Mild diarrhea.
• - Asymptomatic malnutrition.
• - Use of antibiotics.
• - Recent exposure to infectious disease (vaccination can still prevent).
• - Breast-feeding (live vaccines safe during lactation).
• **SEVERE REACTION to prior dose (convulsions, shock, encephalopathy within 3 days) → withhold subsequent doses of same vaccine; seek specialist advice.**
• **Relative contraindication (defer, don't withhold):**
• - Moderate-to-severe febrile illness (>38.5°C) → vaccinate when fever resolves.
• - Severe diarrhea → defer until resolved (vaccine may not be absorbed).
• - Recent blood transfusion or IG → defer measles/MMR by ≥3 months (passive Abs interfere).
• **Immunization errors are NOT contraindications to further vaccination — address the error and resume schedule (catch-up).**
• **If unsure, vaccinate! Missed vaccination opportunities > minimal risk of adverse event.**

Key Definitions

Diagrams To Know

• Decision tree: 'Should this child be vaccinated?' (YES for minor illness; NO for severe allergy/immunosuppression).
• Common misconceptions vs. true contraindications comparison chart.

Common Values

Section Title

Notifiable Diseases & Disease Surveillance (PIDSR)

Important Facts

• **RA 9173 (Philippine Nursing Practice Law) requires nurses to report notifiable diseases as a function of community health nursing.**
• **Immediately notifiable diseases (24-hour reporting requirement):**
• - Acute flaccid paralysis (polio surveillance).
• - Measles.
• - Neonatal tetanus.
• - Cholera.
• - Meningococcal disease.
• - Rabies (human).
• - Plague.
• - Yellow fever.
• **Weekly notifiable (aggregated reporting):**
• - Dengue fever.
• - Typhoid fever.
• - Dysentery (bacillary & amoebic).
• - TB (clinical diagnosis).
• **Reporting pathway**: frontline health worker (nurse/midwife/BHW) → RHU → City Health Office → Provincial Health Office → DOH.
• **Each case triggers investigation** (contacts, source, transmission) and appropriate control measures (isolation, quarantine, mass vaccination).
• **Confidentiality maintained** in reporting; patient identity protected per DOH guidelines.
• **Failure to report is a breach of duty** under RA 9173 and public health law.
• **Nursing documentation must include:** date of diagnosis, clinical signs, investigations, contacts, vaccination status, and isolation measures.

Key Definitions

Diagrams To Know

• Notifiable disease reporting pathway flowchart (case identification → RHU → CHO → PHO → DOH).
• Timeline of investigation and response (24 hours for urgent; 7 days for weekly).
• List of immediately notifiable vs. weekly notifiable diseases (two-column chart).

Common Values

Section Title

National TB Control Program (NTP) & DOTS Strategy

Important Facts

• **Five Elements of DOTS:**
• 1. Political commitment with sustained financing.
• 2. Case detection through quality-assured bacteriology (Xpert MTB/RIF or DSSM).
• 3. Standardized treatment regimen with direct observation (DOT).
• 4. Uninterrupted supply of quality-assured anti-TB drugs.
• 5. Standardized recording and reporting system.
• **First-line anti-TB drugs (HRZE):**
• - **H = Isoniazid**: hepatotoxic; monitor LFTs.
• - **R = Rifampicin**: turns urine/tears/sweat ORANGE-RED (normal, warn patient); hepatotoxic; monitor LFTs.
• - **Z = Pyrazinamide**: hyperuricemia (gout-like); hepatotoxic.
• - **E = Ethambutol**: optic neuritis (loss of color vision, especially red-green); monitor vision at baseline and monthly.
• - **S = Streptomycin**: ototoxicity (hearing loss, vertigo); nephrotoxicity; used in Category II.
• **Category I regimen (most common):**
• - Intensive: 2 months of HRZE daily (or 5 days/week with 2 days missed).
• - Continuation: 4 months of HR daily (or 5 days/week).
• - Total = 6 months treatment.
• - Sputum smear monitoring: end of month 2 (should convert to negative), month 5 (confirm cure).
• **Direct Observation is NON-NEGOTIABLE:**
• - Health worker or treatment partner WATCHES patient swallow EVERY dose (especially in intensive phase).
• - Directly observed = adherence → cure; non-observed = risk of default and drug resistance.
• **Drug-Resistant TB (MDR-TB, XDR-TB):**
• - Managed under Programmatic Management of Drug-Resistant TB (PMDT).
• - Requires longer regimen (18–24 months) with second-line drugs.
• - Resistance develops from incomplete/interrupted treatment.
• **Contact tracing & household screening:** all close contacts (especially children <5 yrs) must be screened for TB and TB infection.
• **Infection control:** TB patient should avoid crowded places, cover mouth when coughing, ensure ventilation at home; most infectious in first 2 weeks of treatment.
• **TB notifications:** presumptive TB cases (cough >3 weeks) and confirmed cases are notifiable; reported weekly.
• **Treatment success definition:** patient completes full regimen and is smear-negative at end of month 5.

Key Definitions

Diagrams To Know

• DOTS strategy 5-pillar flowchart showing feedback loops.
• TB treatment timeline: months 0–2 (intensive HRZE), months 2–6 (continuation HR), with sputum monitoring checkpoints.
• Category I vs. Category II regimen comparison.
• DSSM interpretation guide: 0 AFB, 1+ to 3+ grading.

Common Values

Section Title

Dengue & Vector-Borne Disease Control

Important Facts

• **Dengue 4 serotypes (DENV-1, DENV-2, DENV-3, DENV-4):** only one active at a time in a given area (monotypic circulation) or multiple (endemic in Philippines).
• **Vector characteristics:**
• - **Aedes aegypti**: anthropophilic (prefers human blood), endophilic (inside homes), DAY-ACTIVE.
• - **Aedes albopictus**: found in rural/highland areas, also day-active, less urban-adapted.
• **Breeding sites (source elimination):**
• - Clean stagnant water: flower pots, water storage containers, vases, discarded tires, bottles, coconut shells, bird feeders.
• - NOT in dirty/flowing water (unlike malaria Anopheles).
• **Transmission cycle:**
• - Viremic person (especially days 1–5) → mosquito bloodmeal → viral replication in mosquito (extrinsic incubation 8–12 days) → mosquito becomes infectious → bites another person.
• - Vertical transmission (mosquito → eggs) is possible but uncommon.
• **Clinical presentation:**
• - Fever (38–40°C), headache, myalgia, arthralgia, rash (maculopapular, appears after defervescence).
• - Leucopenia, thrombocytopenia common.
• - Dengue hemorrhagic fever (DHF): plasma leakage (hemoconcentration, pleural effusion, ascites), bleeding manifestations, thrombocytopenia (<100,000), shock.
• **Warning signs (must seek immediate care):**
• - Severe abdominal pain.
• - Persistent vomiting.
• - Bleeding (any manifestation).
• - Lethargy/restlessness.
• - Sudden drop in platelet count.
• - Hematocrit rise (≥20%).
• **DOH 4-S Strategy Implementation:**
• - **Search & Destroy**: community mobilization, house-to-house inspection, elimination of water containers, clean gutters.
• - **Self-Protection**: use of insect repellent (DEET), long sleeves/pants, window screens, bed nets (though dengue is day-biter, nets prevent early morning bites).
• - **Seek Early Consultation**: educate public on fever >3 days; early detection allows isolation (patient is infectious 1 day before to 5 days after fever onset).
• - **Support Fogging/Spraying**: only during outbreaks in hotspot barangays; space spraying targets adult mosquitoes; must be repeated every 2–3 days for ≥1 week.
• **Notification:** dengue is weekly notifiable; outbreak cases reported immediately to trigger response.
• **Immunity:** primary infection → immunity to that serotype for life; secondary infection with different serotype carries DHF risk.
• **No dengue vaccine widely available in Philippines yet** (Dengvaxia use restricted to prior-infected persons due to dengue-antibody-dependent enhancement risk).

Key Definitions

Diagrams To Know

• Aedes aegypti life cycle (egg → larva → pupa → adult) with timeline.
• Dengue transmission cycle: person → mosquito → person, with incubation periods.
• DOH 4-S strategy implementation flowchart.
• Dengue vs. malaria vector comparison (day/night, breeding site, biting behavior, control focus).

Common Values

Section Title

Other Endemic Communicable Diseases (Philippine Context)

Important Facts

• **MALARIA:**
• - Endemic in Mindanao and Visayas; not endemic in Metro Manila, Luzon.
• - Vector: **Anopheles mosquito (NIGHT-BITER)** — bites 8 PM–6 AM.
• - Transmission: blood transfusion, needle-sharing (rare in Philippines).
• - Control: insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), artemisinin-based combination therapy (ACT) for treatment.
• - Clinical: fever, chills, headache, myalgia; can progress to severe malaria (cerebral, renal failure, pulmonary edema).
• **SCHISTOSOMIASIS:**
• - Endemic in Leyte, Samar, and parts of Mindanao (Agusan del Sur).
• - Parasite: *Schistosoma japonicum*; intermediate host: **Oncomelania** snail.
• - Transmission: exposure to freshwater (swimming, wading, bathing) contaminated with cercariae.
• - Pathology: eggs deposit in organs → chronic inflammation, fibrosis, cirrhosis (if liver involved).
• - Control: snail control, water sanitation, mass treatment, health education (avoid infested water).
• **FILARIASIS:**
• - Endemic in parts of Mindanao, Visayas, and coastal regions.
• - Vectors: Anopheles, Culex, Aedes mosquitoes.
• - Causative agent: *Wuchereria bancrofti* (lymphatic filariasis).
• - Manifestations: asymptomatic microfilaremia, lymphangitis, lymphadenitis, elephantiasis of limbs/genitalia.
• - Control: **Mass Drug Administration (MDA)** with albendazole + diethylcarbamazine (DEC) for 5–6 years in endemic areas.
• **HANSEN'S DISEASE (LEPROSY):**
• - Causative agent: *Mycobacterium leprae*; chronic, slowly progressive; curable.
• - Transmission: respiratory droplets (prolonged close contact); NOT highly infectious (70–95% of exposed persons are immune).
• - Clinical forms: tuberculoid (few lesions, high immunity), lepromatous (many lesions, low immunity), borderline.
• - Diagnosis: slit-skin smear microscopy (acid-fast bacilli) or clinical features.
• - Treatment: **Multidrug Therapy (MDT)** for 6–12 months (paucibacillary = 6 months; multibacillary = 12 months).
• - Control: case detection, early treatment, contact screening, DOH Leprosy Program.
• - Complications: reversal reactions, Type 1 & Type 2 reaction (manage with corticosteroids).
• **RABIES:**
• - Viral disease; **ALWAYS FATAL if symptomatic** (99.9% fatality rate post-symptom onset).
• - Transmission: saliva of infected animal via bite, scratch, or mucous membrane exposure.
• - Incubation: variable (2 weeks–3 months, rarely up to 1 year); depends on wound location, viral load.
• - Prevention: **Post-Exposure Prophylaxis (PEP)** with rabies vaccine (PVRV or ERIG + PVRV) MUST be given within 24 hours, ideally within hours of exposure.
• - First aid: wash wound thoroughly with soap & water immediately (removes virus).
• - Animal control: suspect animal observation for 10 days; if animal dies/shows symptoms → confirm rabies.
• - DOH rabies program includes vaccination of high-risk groups (veterinarians, animal handlers).
• **DOH ELIMINATION/CONTROL PROGRAMS:**
• - Malaria: case management, vector control (ITNs, IRS), surveillance in endemic areas.
• - Schistosomiasis: snail survey & control, sanitation, mass treatment in endemic provinces.
• - Filariasis: MDA programs, surveillance, elimination targets.
• - Leprosy: case detection, MDT provision, disability prevention.
• - Rabies: PEP provision, animal control, vaccination of risk groups.

Key Definitions

Diagrams To Know

• Endemic areas map for malaria, schistosomiasis, filariasis in Philippines.
• Vector-parasite-host relationships for each disease (transmission cycle).
• Rabies post-exposure prophylaxis decision flowchart (animal type, observation status, PEP urgency).
• Hansen's disease classification (tuberculoid vs. lepromatous) based on bacillary load & immunity.

Section Title

Levels of Prevention in Communicable Disease Control

Important Facts

• **PRIMARY PREVENTION — specific examples:**
• - **Immunization** (vaccination) is the CLASSIC primary prevention-specific protection (active immunity induced).
• - Health education: hand-washing, food safety, sexual health, tobacco/alcohol cessation.
• - Environmental: clean water, sanitation, vector control (bed nets, IRS for malaria), food storage.
• - Nutrition: malnutrition ↑ TB risk; supplementation improves immunity.
• - Workplace safety: PPE for healthcare workers, needle-stick prevention.
• **SECONDARY PREVENTION — examples:**
• - **Case-finding**: sputum screening for TB (smear microscopy, Xpert), dengue surveillance, contact tracing.
• - **Screening**: TST (tuberculin skin test) for TB infection, blood smear for malaria, stool exam for schistosomiasis.
• - **Isolation/quarantine**: TB patient during infectious period (first 2 weeks of treatment); close contacts of measles/mumps watched.
• - **Contact tracing**: find and test contacts of TB, dengue, rabies-exposed persons.
• - **Early treatment**: DOTS initiation, dengue fluids/transfusion, rabies PEP.
• **TERTIARY PREVENTION — examples:**
• - TB: monitor treatment response, manage drug side effects (optic neuritis from ethambutol), prevent MDR-TB via adherence.
• - Dengue DHF: aggressive fluid resuscitation, transfusion for hemorrhage, prevent shock.
• - Hansen's disease: MDT adherence, eye care (blindness prevention), physiotherapy (contracture prevention).
• - Malaria: manage severe anemia, cerebral malaria, acute renal failure.
• - Rabies: supportive care only (palliative; always fatal post-symptom) — emphasis is on PEP (secondary prevention).
• **VACCINATION IS PRIMARY PREVENTION—SPECIFIC PROTECTION (active immunity).**
• **PRIMARY PREVENTION INTERRUPTS THE DISEASE CHAIN BEFORE PATHOGEN ENTERS HOST (e.g., immunization, vector control, sanitation).**
• **SECONDARY PREVENTION DETECTS & TREATS EARLY (e.g., DOTS, case-finding, contact tracing) TO PREVENT TRANSMISSION & PROGRESSION.**

Key Definitions

Diagrams To Know

• Three levels of prevention applied to one disease (e.g., TB: vaccination → case-finding via Xpert → DOTS/drug side effect monitoring).
• Disease progression timeline showing where each prevention level intervenes.
• Disease chain and prevention lever (agent, host, environment, prevention points).

Item

**EPI Legal Foundation:** RA 10152 (2011) mandates FREE routine immunization for all infants/children; Hepatitis B monovalent WITHIN 24 HOURS of birth; Presidential Decree 996 = compulsory immunization <8 years.

Why Critical

Exam repeatedly tests legal frameworks for immunization; recall specifics of timing and mandates.

Item

**The 6–10–14 Week Schedule is GOLDEN:** Pentavalent (DPT–HepB–Hib), OPV, and PCV are given at exactly 6 weeks, 10 weeks, 14 weeks (3 doses each, minimum 4-week interval between doses). This is the backbone of EPI.

Why Critical

This is asked in almost every NLE; know the ages, the vaccines, the routes, and the intervals perfectly.

Item

**Vaccine Routes & Sites (Non-negotiable):**

Why Critical

Incorrect route = vaccine failure; students commonly mix these up. BCG = 0.05 mL intradermal (right upper arm); Pentavalent/PCV/IPV = 0.5 mL IM (vastus lateralis); OPV = oral 2–3 drops; Measles/MMR = 0.5 mL SC (outer upper arm).

Item

**FIC (Fully Immunized Child) Definition:** 1 BCG + 3 OPV + 3 pentavalent (DPT–HepB–Hib) + ≥1 measles vaccine BEFORE 12 months of age. This is the DOH performance indicator; confuse with CIC (by 12–23 months) and you lose marks.

Why Critical

Definitions are staple exam questions; FIC vs. CIC vs. CPAB are frequently tested.

Item

**Cold Chain Temperatures:** RHU = +2°C to +8°C; Regional freezer = −15°C to −25°C. OPV is MOST heat-sensitive (store coldest); DPT/Hep B/Td are FREEZE-SENSITIVE (never freeze). Use the SHAKE TEST for freeze-sensitive vaccines (opaque/clumpy = frozen = discard).

Why Critical

Cold chain questions appear in almost every exam; incorrect temperature handling leads to vaccine failure and outbreaks; must know which vaccines freeze-sensitive vs. heat-sensitive.

Item

**DOTS = Directly Observed Treatment, Short-course for TB:** 5 elements: commitment, diagnosis (Xpert MTB/RIF), standardized regimen with DOT, drug supply, recording/reporting. Category I = 2HRZE/4HR (6 months). Observation is NON-NEGOTIABLE.

Why Critical

TB is heavily tested in NLE; DOTS is the cornerstone strategy; missing any element of DOTS or confusing regimens costs marks.

Item

**Dengue 4-S Strategy:** Search and destroy (breeding sites), Self-protection (repellent, long sleeves), Seek early consultation (fever), Support fogging (hotspots only). Aedes aegypti = day-biter, breeds in clean stagnant water (flower pots, containers, tires). Use repellent & source control, NOT just fogging.

Why Critical

Dengue is endemic in Philippines; 4-S is the DOH official strategy; distinguish from malaria control (Anopheles = night-biter, dirty water, ITNs/IRS).

Item

**Td for Pregnant Women:** Td1 ASAP, Td2 ≥4 weeks later (protects newborn from neonatal tetanus = CPAB status); Td2 also gives ~3 years maternal protection. Td5 = lifetime protection. Two doses minimum for CPAB.

Why Critical

Neonatal tetanus prevention is critical; Td scheduling for women is frequently tested; know the minimum (Td2) for CPAB status.

Item

**Immediately Notifiable Diseases (within 24 hours):** Acute flaccid paralysis (polio), measles, neonatal tetanus, cholera, meningococcal disease, rabies, plague, yellow fever. PIDSR is the reporting system. Failure to report violates RA 9173.

Why Critical

Notifiable diseases are exam staples; confusing immediately vs. weekly notifiable costs marks; RA 9173 compliance is tested.

Item

**Do NOT Withhold Vaccination for:** Mild fever (<38.5°C), mild cough/cold, mild diarrhea, breast-feeding, mild malnutrition, antibiotic use, or recent exposure to disease. Missed opportunities ↓ herd immunity & cause outbreaks. True contraindications are RARE; live vaccines contraindicated only in severe immunosuppression.

Why Critical

Students often incorrectly defer vaccination for minor illness; this is a major source of lost marks and real-world vaccine failure.

Tip

**Remember the 'Triple Check' for Cold Chain Violations:** If a vaccine was left in the sun, in a hot vehicle, or in a freezer (and it's freeze-sensitive), DO NOT USE IT. Use VVM for heat; shake test for freeze. When in doubt, throw it out — vaccine safety is non-negotiable.

When To Use

Any question about vaccine storage, handling, or vial condition.

Tip

**Pentavalent = 5-in-1 (DPT + Hep B + Hib) at 6–10–14 weeks** — NOT at birth. BCG and Hep B are separate birth doses. This confusion is a classic trap; Pentavalent is NOT the birth vaccine — HEP B monovalent is.

When To Use

Any EPI schedule question; look for the trick of 'when do you give pentavalent?'

Tip

**For DOTS & TB, Always Ask: 'Is the patient DIRECTLY OBSERVED?'** If no observer → NO credit for DOTS; observation is the CORE. Also: Rifampicin = ORANGE-RED urine (NORMAL); ethambutol = optic neuritis (vision loss); streptomycin = hearing loss. Match drug to side effect perfectly.

When To Use

Any TB case or DOTS strategy question.

Tip

**Dengue vs. Malaria Quick Rule:** Dengue = **DAY-BITER, CLEAN WATER, URBAN** (Aedes aegypti); Malaria = **NIGHT-BITER, DIRTY WATER, RURAL** (Anopheles). If the vector/water/time doesn't match, the disease doesn't match. Also, dengue has 4 serotypes (reinfection risk); malaria has Plasmodium species.

When To Use

Any vector-borne disease comparison or endemic disease question.

Tip

**For Neonatal Tetanus Prevention:** Mother with Td1 + Td2 = CPAB newborn (protected). Td2 requires ≥4 weeks after Td1. If mother has NO Td vaccination = newborn is NOT CPAB = neonatal tetanus risk → must give clean delivery, clean cord practices, and watch for signs (lockjaw, opisthotonus by day 3–7 of life).

When To Use

Any question about maternal immunization, newborn protection, or neonatal tetanus risk.

Rows

Columns

• Type
• Source of Antibodies
• Onset
• Duration
• Mechanism
• Example

Table Title

Immunity Types Comparison

Rows

Columns

• Age
• Vaccine(s)
• Route/Dose
• Number of Doses

Table Title

EPI Vaccine Schedule At-a-Glance

Rows

Columns

• Vaccine
• Route
• Depth
• Anatomical Site
• Needle Size (gauge)

Table Title

Vaccine Route, Site, and Depth of Injection

Rows

Columns

• Storage Level
• Temperature Range
• Storage Equipment
• Vaccines Stored Here
• Monitoring

Table Title

Cold Chain Temperature Requirements

Rows

Columns

• Vaccine Type
• Temperature Sensitivity
• Storage Constraint
• Detection Method
• Action if Compromised

Table Title

Freeze-Sensitive vs. Heat-Sensitive Vaccines

Rows

Columns

• Category
• Patient Type
• Regimen
• Intensive Phase
• Continuation Phase
• Total Duration

Table Title

TB Treatment Categories & Regimens

Rows

Columns

• Drug (Code)
• Generic Name
• Major Side Effect(s)
• Monitoring Required
• Patient Education

Table Title

Anti-TB Drugs: Mechanism, Side Effects, Monitoring

Rows

Columns

• Reporting Timeframe
• Example Diseases
• Trigger Action
• Reporting Route

Table Title

Immediately Notifiable vs. Weekly Notifiable Diseases

Rows

Columns

• Characteristic
• Anopheles (Malaria)
• Aedes aegypti (Dengue)

Table Title

Vector Comparison: Anopheles vs. Aedes aegypti