TECHNICAL INSTITUTE OF MOZAMBIQUE

Course:

Chair

Group:

Labor

Students:

Maputo, January 2023

Extended Vaccination Program

Research work to be submitted to the

Technical Institute of Mozambique, how
partial fulfillment of the necessary requirements
for evaluation. This work was guided
by the Teacher: ........

Teacher:

Maputo, January 2023

Index
1.0 Introduction
2.0 Objectives
2.1 General Objective...............................................................................................................2
2.3 Specific Objectives
3.0 Vaccination
3.1 Target diseases of the PAV............................................................4
3.1.1 Target Diseases do PAV, disorders due to Vitamin A deficiency............................4
3.1.2 Measles..................................................................................................................4
3.1.3 Case definition....................................................................................................4
3.1.5 Frame Clinical......................................................................................................5
3.1.6 Treatment
4.1 Definition of suspected polio or acute flaccid paralysis case................................7
4.1.2 Epidemiology
4.2 neonatal tetanus
4.2.1 Case definition....................................................................................................8
4.2.2 Epidemiology.........................................................................................................8
4.2.3 Clinical picture........................................................................................................9
4.2 4 Prevention................................................................................................................9
5.0 vaccination and vaccination schedule
5.1 Child Vaccination
5.2 Simultaneous administration of vaccines.........................................................................12
5..2.1 Recovery vaccination...................................................................................12
5.2.2 Contraindications for vaccination.......................................................................12
5.3 Pregnant woman and woman of childbearing age (mif)............................................................14
6.0 Special vaccination activities..................................................................................16
6.1 Elimination of Measles.................................................................17
6.2 Eradication of Polio....................................................................................................17
6.3 Elimination of neonatal tetanus.................................................................18
7.0 Conclusão........................................................................................................................19
8.0 Bibliography...22
1.0 Introdução
Recognizing the complexity of the topic, the Expanded Vaccination Program (PAV),
has shown notable health gains over the years, such as the reduction of morbidity and of
mortality from infectious diseases targeted by vaccination.
these were addressed in the national system of health, considering the safety of
patient first
As vacinas permitem salvar mais vidas e prevenir mais casos de doença do que qualquer
medical treatment.
It is natural that, at one point or another, the work may be insufficient in solving some
doubts and concerns. In general, however, it brings together fundamental knowledge
to the guiding and clarifying role that it holds and, deserves, thus, the privileged position
from
"permanent" companion of the daily life of those who bear the heavy responsibility of
ensure the proper implementation of the extended vaccination program.

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2.0 Objectives

2.1 General Objective

Learn about the expanded vaccination program

2.3 Specific Objectives

Mention Target Diseases of the PAV

Knowing the types of vaccination
Know the vaccination period and its schedule

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 3.0 Vaccination
Vaccination is the act of inoculating or administering biological substances into the body in such a way as to

create, artificially and without risk, a state of protection against certain diseases
transmissible.
In a very simple way, we can describe the process as follows:
Vaccines are biological substances prepared from microorganisms.
causative agents of diseases - bacteria or viruses.

These microorganisms, after undergoing laboratory treatment,

they lose the power to cause disease, therefore they no longer pose a danger when
they enter into the constitution of the vaccine and, through it, they are inoculated into the organism

human.

For example:
The BCG vaccine contains bacteria that cause Tuberculosis. However, these bacteria,
modified by a laboratory process, are so weakened that they cannot cause
disease.
The vaccine against measles contains the respective viruses. However, these viruses are also
modified and cannot develop disease.
These preparations of bacteria or viruses (vaccines), when introduced into the body,
They stimulate, after some time, the creation of antibodies against that bacteria or virus.
Antibodies are the defenders of our organism and have the ability to eliminate the action of
virus and bacteria that, without this defense, would be able to cause the disease.
Antibodies are, thus, the elements responsible for the defense of the organism against the
diseases. When the body of a vaccinated person comes into contact with the virus or
bacteria from another sick person, the body reacts and defends itself through antibodies
produced by the vaccine, eliminating the action of invading viruses or bacteria.
Specific antibodies, that is, they protect against a certain disease for which it is
vaccination done.
For example: the antibodies against the measles virus protect only against this disease.
Yes, the vaccine should be administered to the child before their contact with the measles virus.
to allow time for the formation of antibodies.
 3.1 Target diseases of the PAV

3.1.1 Target diseases of the PAV, disorders due to Vitamin A deficiency

The target diseases of the PAV are those that can be prevented with the application of specific vaccines.

included in the Program. Once each country has its own policy regarding the vaccines to be
used in their respective programs, the target diseases of the PAV must be well defined
to facilitate its detection and monitoring at all levels, through the surveillance system
epidemiological. The following are detailed enumerations of diseases preventable by
vaccination in the country.

3.1.2 Measles

Measles is a highly infectious disease caused by a virus. The disease is common.

in some populations and often occurs in epidemic proportions. The epidemic measles
is particularly common in conditions of overcrowding and poverty, where a high number of
unvaccinated people live in close contact. Measles is a disease of
mandatory notification, and it is the one that kills the most children among the diseases preventable by vaccination.

3.1.3 Case definition

Presence or history of generalized skin rash and fever, and any of the following signs:
constipation, nasal discharge or redness in the eyes.
3.1.4 Epidemiology
The epidemiology of Measles is dynamic, changing over time as services
vaccination alters the pool of susceptible individuals (WHO, 1996). The epidemics continue to
still occur even when vaccination coverage is above 90%. However, they are of
very small magnitude and are separated by very long intervals. This is due to the accumulation
of susceptible individuals (those who are unvaccinated and those who fail to do the
seroconversion) associated with the fact that Measles is a highly infectious disease.
In conditions of high population density, it is very likely that Measles will occur throughout
Throughout the year, sometimes with seasonal peaks. In areas of low population density, every

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two or three years. In cases where a large population pool of children is susceptible, a
A single case of measles can cause epidemics.
People who recover from measles are immune for life, and children born from
Mothers who had measles are generally immune for 6 to 8 months. Vaccination is the intervention.
the most effective one that exists in public health, to protect a child against Measles.
Preventing measles through vaccination will have profound impacts on morbidity and
mortality from the disease and will bring other benefits through the prevention of other conditions
such as dehydration, respiratory infections, blindness, severe malnutrition, and deficiency
of Vitamin A.
The Measles virus is transmitted through respiratory droplets released by people.
infected when they cough or sneeze. Cases are infectious one to three days before the
appearance of the skin rash up to 7 days later.
The incubation period ranges from 7 to 18 days.
The disease spreads rapidly in places where children and adolescents gather, such as
like hospitals, houses, schools, markets, refugee centers, and gathering places.
Children between 9 and 12 months old, if not vaccinated, are very likely to be.
infected with the measles virus. Severe measles is also very likely to occur.
in the following cases:
Malnourished children, especially those with Vitamin A deficiency.
Children living in overcrowded environments.
Children with weak immune systems due to, for example, HIV/AIDS.

3.1.5 Clinical Framework

The characteristic eruption that is accompanied by inflammation of the mucosa occurs at the moment

in which immunity to the virus develops. Fever, cold, and diarrhea precede the
eruption. There may be an eruption in the mouth that appears as 'Koplik spots'. The
A rash usually appears first behind the ears and spreads across the face and
the upper part of the trunk and then extends to the rest of the body. The rash is macular or
but more often maculopapular and darker in color than normal skin.
The following complications can occur especially in children under 5.
years:
 Acute respiratory infections, mainly pneumonia, which is the most common disease.
common associated with mortality from measles.
Ear infections (otitis)
Diarrhea
Corneal lesions (Keratomalacia) that can cause blindness.
Encephalitis, among other complications.

3.1.6 Treatment

Since it is a viral infection, there is no specific treatment. However, the

symptomatic treatment is important and should be done by the mother at home in mild cases. The
home remedy should include:
Treatment of fever (aspirin, paracetamol, body cooling), feeding and
eye care (cleaning with warm water, without using traditional medications).
Recognition of complication signs, especially dyspnea, dehydration and
seizures, which require that the patient be referred urgently to the
nearest health unit.

Hospital care includes:

Give vitamin A, (100,000 units for children between 6 and 12 months, and 200,000
units for children over 1 year old) in all cases and a second dose on the day
next. If there is xerophthalmia or keratomalacia, give a third dose one
a week later.
Antibiotic treatment for infections (pneumonia, otitis, etc.).
Treatment of dehydration with ORS or intravenous fluids.
Extra feeding if there is weight loss.

4.0 Poliomyelitis
It is an acute viral infection that spreads through the fecal-oral route. Consequently, the

transmission is higher in areas of poor sanitation and contaminated water. Paralysis

acute flaccid paralysis (AFP) which is the clinical condition to suspect poliomyelitis, is a
notifiable disease.

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4.1 Definition of a suspected case of polio or acute flaccid paralysis

Any case of sudden onset of flaccid paralysis in one or more limbs in children
under 15 years of age.

4.1.2 Epidemiology

The virus spreads through the fecal-oral route. Almost all children who live in a house where
someone is infected by the virus, they will be infected. Infected people are very
susceptible to spreading the virus 7 to 10 days after showing the first symptoms of the
disease. Asymptomatic infected people can also spread the infection.
During an epidemic, only a small proportion of individuals manifest the disease.
(Philips J et. al, 1998). However, although this is the case, severe disability (which is
preventable) makes polio a very serious disease. It is the most important cause of
physical disability in children.
Poliomyelitis is caused by one of the three strains of poliovirus (1, 2, or 3), and has a
incubation period until the onset of paralysis is 2 - 3 weeks.
The infection can be asymptomatic or cause a febrile illness with malaise, headaches,
nausea, vomiting, and muscle pain. After a few days, paralysis begins in the
members, usually of asymmetric distribution. Sometimes there is involvement of the muscles
respiratory (in these cases the patient may die from breathing difficulties) and of the
swallowing. Complete spontaneous recovery is possible, but more often
residual paralysis occurs, which if not properly treated with physiotherapy, can lead to
marked deformity of the limb and physical incapacity.

4.1.3 Treatment
There is no treatment for this disease. However, the symptoms can be relieved with
symptomatic treatment. Sometimes the patient needs assisted breathing, when
there is paralysis of the respiratory muscles.

4.2 neonatal tetanus

Tetanus is an acute neurological disease caused by the exotoxin (toxin) of the bacillus of
tetanus (Clostridium Tetani), which grows in dead tissues in the absence of oxygen, such as
for example, in deep and dirty wounds, or on the stump of the baby's umbilical cord. The
spore-forming bacteria that can survive in the environment, particularly on the surface of
rusty metals. A toxin they produce intoxicates the nerves that control the muscles
and causes stiffness.

Newborns can suffer from neonatal tetanus (NT), which occurs through the umbilical cord.
if the delivery or postnatal care was not aseptic (clean). Infection occurs
as a result of using contaminated instruments. Anyone can catch it.
tetanus.
Neonatal tetanus is a reportable disease.

4.2.1 Case definition

Disease characterized by onset between the 3oand the 28oday of age and history of disability of
sugar, followed by stiffness and/or muscle spasms, and often, death.

4.2.2 Epidemiologia

The reservoir for the bacillus is the environment in places with dust and garbage. It is a disease.

common with a very high mortality rate. They are particularly at risk of catching the
illness of those who work in the fields, newborns or anyone with a wound
dirty. It is also associated with living with animals, lack of vaccination or vaccination
incomplete, and application of traditional remedies with ash or other types of dirt on the
wounds.
The magnitude of neonatal tetanus is not known because many of the deaths occur in
The house is poorly reported by the community.

Newborns become infected if:

the knife, blade or other instrument used to cut the umbilical cord is
dirty.
the feces or ash are used to rub on the cord, or if the sand gets into the cord
baby's umbilical cord.

if the hands of the person delivering the baby are not clean

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Babies and children can also contract tetanus when dirty instruments are used.
for circumcision, to pierce the skin, or when charcoal, dirt, or other substances
little clear ones are used to rub on the wound.

4.2.3 Clinical picture

it is an acute disease caused by the toxin produced by the tetanus bacillus and characterized by

painful and involuntary spasm of voluntary muscles

The newborn is born normal, but stops sucking 3 to 10 days later. The baby becomes
irritable and cries a lot. Then there is generalized stiffness, seizures, and spasms.
severe muscle spasms, particularly following stimuli such as touching the child, noise or
light, and death follows in many cases.
The jaw muscles are often the first to be affected by
spastic contraction, giving the characteristic 'sardonic smile'. Later they become more and more
involving other muscle groups resulting in the characteristic stiffness of
nuchal rigidity (opisthotonos) and difficulties in breathing and swallowing.

4.2 4 Prevention

Individuals immunized with TT (tetanus toxoid) develop antibodies against tetanus.

Pregnant women with their tetanus vaccination up to date pass the antibodies to their
babies, thus ensuring their protection against tetanus at birth, but for a period
limited. Therefore, the correct VAT for women of childbearing age (including pregnant women) protects-

to them and their babies against tetanus.

Neonatal tetanus can also be prevented if aseptic conditions are observed.
at all times during labor.
Additionally, proper wound management also prevents tetanus. Wounds must
be completely clean and all dead tissue removed. People with dirty wounds and that
if they are not completely protected against tetanus, they should receive immunoglobulin
tetanus antitoxin to neutralize the effects of the tetanus toxin.
5.0 vaccination and vaccination schedule
The objective of vaccination in the country is to ensure that all children receive all doses of
all antigens before their first birthday, although children up to 23 months
remain eligible for routine vaccination. A fully vaccinated child is
those who have received the BCG, Measles, VAP3, and DPT/Hepatitis B3 by their first
year of life. The children who abandon - that is, those who do not complete the vaccination cycle -

they must be identified and followed.

The MINISTRY OF HEALTH adopted the policy of providing routine vaccination services to children and

women of a specific age to meet the needs of the country. Thus, the
the target group for routine vaccination includes children under 1 year of age,
pregnant women and women of childbearing age (from 15 to 49 years old). The services of
vaccination should be integrated with other aspects of health promotion, such as,
health education and counseling, micronutrient supplementation, planning
familiar, prenatal and postnatal care. In addition to the routine schedule, in case of
when needed, special vaccination campaigns are also organized.

5.1 Child vaccination

Vaccination calendar
Each child should receive one dose of BCG, four of VAP, three of DPT/Hepatitis B, and
a dose of Measles before their first birthday. If the child is seen at the unit
sanitary or if she presents herself at the vaccination post of the mobile brigade in the first two
Weeks of life (up to 13 days of age) should receive the VAP0 at the same time as the BCG.

For multi-dose vaccines like the DTP and Hepatitis B, it is emphasized that the
the interval between doses must be at least 4 (four) weeks. Give doses of one
vaccine with an interval shorter than the recommended 4 weeks may reduce the response
from the production of antibodies. However, an interval between doses greater than the
recommended, does not reduce the final concentration of antibodies.

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When a child is late, start the doses as early as possible. If a dose of
DPT/Hepatitis B or VAP is missed (missed opportunity), vaccination at the next occasion
it should continue as if the usual interval has passed, and it is not necessary to give a dose
extra.

Table 1. Childhood Vaccination Calendar

Schedule: vaccination calendar, routes and doses of vaccine administration.

VACCINE AGE AGE IDADE DOSE BY WAY OF

IDEAL MINIMUM MAXIMUM APPLICATION
BCG at birth at birth 23 months < 1 year 0.05
ml
Intradermal
Polio VAP 1 2 months 6 weeks 23 months one five zero, one low

ml Oral Polio VAP 2 3 months 10 weeks the same The same

Same
Polio VAP 3 4 months 14 weeks same Same Same
IPV 1 4 months 14 weeks the same The same Same
DPT / Hep B 1 2 months 6 weeks 23 months 0.5 ml
intramuscular
DPT / Hep B 2 3 months 10 weeks same Same Same
DPT / Hep B 3 4 months 14 weeks same Same Same

Rotavirus 2 months 6 weeks 23 months 1.5 ml Oral

Rotavirus 3 months 10 weeks Same Same The same
PCV 13 2 months 6 weeks The same 0.5 ml
Intramuscular
PCV 13 3 months 10 weeks Same Same Same
PCV 13 4 months 14 weeks The same The same Same

Measles 9 months 8.5 months 23 months 0.5 ml

4 years
in the displaced subcutaneous population

Measles 18 months 17 months 23 months 0.5 ml (booster)

(4 years in the displaced subcutaneous population)

Rubella 18 months 17 months 23 months 0.5 ml

 (4 years in the displaced subcutaneous population)

5.2 Simultaneous administration of vaccines

Multiple vaccines can be given at the same time. For example, BCG, VAP0, or the
VAP1 and DPT/Hepatitis B1 should be given at the same time if the child is eligible.
for this. This reduces the number of contacts needed to complete the vaccination schedule.

It is important for the child to receive vaccinations before being exposed to diseases, but after the
sufficient loss of maternal antibodies, given that they influence the effectiveness of vaccines.
In some cases, vaccination before the recommended ages may be effective. However,
younger children than the recommended age should not be vaccinated, except in
exceptional circumstances authorized by health authorities at the national level.
Children vaccinated at an early age than recommended may not maintain protection.
necessary against diseases without booster doses.

5.2.1 Recovery vaccination

Older children who are not fully vaccinated should receive the doses.
losses. All other missing doses should be given at normal intervals, of
in accordance with the calendar.

5.2.2 Contraindications for vaccination

There are few absolute contraindications for vaccination. The risk of delaying a
vaccination due to an intercurrent illness, is that the child may not return and lose
seize the opportunity. Around the world, opportunities lost due to false
contraindications are the main cause of the delay in completing vaccination or of not
vaccination.

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In general, the PAV recommends that all healthcare workers should use all the
opportunities to vaccinate eligible children; the vaccine should be given to all children
eligible individuals who attend all healthcare facilities, even on a regime
outpatient. Hospitalized children should be vaccinated as soon as their clinical condition allows.
improve, at least before being discharged from the hospital. The measles vaccine should,
preferably, to be administered upon admission, due to the risk of transmission
nosocomial of measles.

[Link] contraindication
Individuals with immunodeficiency diseases, or undergoing therapy with immunosuppressive agents,
Individuals undergoing radiation therapy generally should not receive live vaccines. However, all antigens

except for BCG, should be given to all children with symptomatic HIV/AIDS.
A severe adverse event following the administration of a vaccine dose (anaphylaxis, collapse
seizures or non-febrile convulsions) constitutes a true contraindication to vaccination.
The mother and the healthcare worker can easily recognize such events. A second or
the third dose of DPT/Hepatitis B should not be administered to a child who has suffered
such adverse reactions to a previous dose.

B. False contraindications
It is particularly important to vaccinate children suffering from malnutrition. Low fever,
mild respiratory infections and other minor illnesses should not be considered as
a contraindication for vaccination. Diarrhea should not be considered a contraindication
for the VAP. Some conditions that are not contraindications for vaccination are like if
therefore:
Minor illnesses such as upper respiratory infections or diarrhea, fever <
38.5oC.
Allergy, asthma or another atypical manifestation, hay fever Malnutrition.
Breastfeeding
Family history of seizures.
Treatment with antibiotics, low dose of corticosteroids.
 Dermatoses, eczema or localized infection on the skin.
Chronic disease of the heart, lungs, or liver.
History of jaundice shortly after birth
Mothers or other caregivers of children should be encouraged to keep the card.
of weight and vaccination records for your children even after childhood for reference
future.
5.3 Pregnant woman and woman of childbearing age (mif)

All contacts with women of childbearing age should be used to verify if their
vaccination is up to date and giving the appropriate advice. This should lead to a reduction in

missed opportunities to vaccinate with VAT and improve coverage with this vaccine.
Each dose of VAT must be recorded on the woman's VAT card. Doses received during
The pregnancy must be registered both in the prenatal record as well as in the VAT card.
Doses received before the current pregnancy should be transferred from the VAT card to the
prenatal form.
The policy in Mozambique is that every pregnant woman must be protected against neonatal tetanus.
aderindo ao esquema da tabela 2 abaixo. As doses de tétano recebidas durante a infância
they can count for the VAT scheme and the DPT3 counts as VAT2. If a woman has
a documented history of five (5) VAT injections, she does not need to take doses
additional VAT, given that five (5) doses provide complete protection during the years
of childbearing age as shown in the table below.

Table 2. Vaccination Calendar for Pregnant Women/MIF

VAT DOSE CONTACT
VAT 1 At the first contact or as soon as possible during pregnancy,
including the first quarter

VAT 2 At least four (4) weeks after VAT 1

VAT 3 At least 6 months after VAT 2 or during pregnancy
subsequent

VAT 4 At least 1 year after VAT 3 or during pregnancy

subsequent

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 VAT 5 At least 1 year after VAT 4 or during pregnancy
subsequent

This is the ideal calendar. If it is not possible to follow it exactly, it should be adapted to the

local conditions.

Table 3: Expected duration of immunity after the administration of different doses of VAT
in Women of Fertile Age (15 - 49 years)
Doses Minimum interval Protection Duration of Protection

VAT1 1o contacto 0 0
VAT2 4 weeks 80% 3 years
VAT3 6 months 95% 5 years
VAT4 1 year 99% 10 years
VAT5 1 year 99% all life

In the vaccination scheme of the routine PAV, the target groups for VAT include the
pregnant women, women of childbearing age, first-year students, and workers.

It is necessary, however, to keep in mind that the previously received tetanus vaccines,
that is, in childhood, school age, are counted towards the fulfillment of the calendar, as long as
among them the minimum intervals must have been respected. There is no maximum interval between the
doses.
The verification of previous vaccinations requires the presentation of a valid document from
Health Units where the following were performed (Child's Health Card, Consultation Record)
Prenatal
In the absence of evidence under the mentioned conditions, the woman must start and complete the

5-dose schedule. In this case, if the woman is pregnant, she should take 2 doses during the
pregnancy (Prenatal Consultation), a 3rd dose when the child is vaccinated against Measles,
leaving the 4th dose beyond a year and the 5th dose, after another year as well.
The following table indicates the behavior to follow in some situations that may arise
verified.

Table. Situations to consider in the tetanus vaccine (MIF's)

DOSES ALREADY RECEIVED DOSES TO BE RECEIVED

In childhood At school In adulthood

VACCINE- Doses VACCINE - DOSES Vaccine Doses - Doses

DOSES valid valid valid

DPT0ou 0 VAT0 or 1 Dose 0 Start calendar 5

1 Dose
DPT0ou 0 VAT - 2 Doses 2 take 3rd, 4th, and 5th doses 3

1 Dose
DPT2ou 2 VAT - 0 Doses 0 give 3rd, 4th, and 5th doses 3

3 Doses
DPT2ou 2 2 doses with a 2 Complete the 5 Dose 1
3 Doses minimum interval of 1
Yes

The last hypothesis - 2 doses in childhood and 2 doses in school - is only valid if the interval between
if the two doses received at school are more than a year apart (1st and 2nd grades).
If the interval is less than (4 weeks for example), only one dose should be counted.
canceling the second for not corresponding to the interval between the 3rd and 4th doses of the schedule.

6.0 Special vaccination activities

Mozambique has also adopted the WHO's policies and principles regarding elimination of
measles, elimination of neonatal tetanus and eradication of poliomyelitis. These policies

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they include special vaccination campaigns aimed at different age groups
of those from routine vaccination.

6.1 Elimination of Measles

The strategies for the elimination of measles include:

Atingircoberturas de vacinação de rotina iguais ou superiores a 95% com uma
measles vaccine dose given at 9 months of age.
Carry out a nationwide campaign for an attack vaccination.
interrupt the transmission.
It will conduct national periodic follow-up campaigns to maintain the
interruption of measles transmission.
Establish case-based surveillance with laboratory confirmation.
The elimination of measles requires intensive surveillance at all levels. Any case
Suspicion of measles must be investigated. This involves filling out the investigation form.
in case, collect blood sample between 0 - 30 days after the onset of the rash and samples of
urine from cases detected only during 0 - 7 days after the onset.

6.2 Eradication of Polio

The following 4 activities are necessary in the process of eradicating Polio:

Routine vaccination: achieve and maintain high levels of coverage with VAP3 (by
less than 80% in all districts.
Epidemiological Surveillance: focus on the surveillance of acute flaccid paralysis (AFP),
a system to detect all cases of acute flaccid paralysis and confirm if they are
or not polio.
 DNV's (National Vaccination Days): give supplemental doses of VAP to everyone
children from 0 to 59 months.
Cleaning activities: sub-national polio vaccination campaigns, only
in a focal area, when there is suspicion of the circulation of the polio virus.

6.3 Elimination of neonatal tetanus

To reduce the incidence of neonatal tetanus to less than 1 case in every 1000 live births
Vivo, Mozambique aims to increase VAT coverage among women of childbearing age.
through the reduction of missed opportunities, intensification of social mobilization and
information, education, and communication (IEC) to all contacts and improvement of surveillance
epidemiological. Emphasis should be placed on special activities in high-risk areas.

Another strategy to support vaccination in the elimination of neonatal tetanus is adherence.

two "five aspects" of asepsis during childbirth: clean the delivery area, wash well the
hands, use clean threads to tie the umbilical cord, use a clean blade or scissors to
cut the cord and clean the umbilical stump well.

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7.0 Conclusion

Towards the end of the work, it was noted that discussing the vaccination expansion program is important.

which in turn the vaccine is biological substances prepared from micro-

disease-causing organisms where microorganisms, after being subjected to a
laboratory treatment, lose their ability to cause disease, so they no longer represent
danger when they enter the constitution of the vaccine and, through the vaccine against any

disease, also these are modified and cannot develop illness.

These preparations of bacteria or viruses (vaccines), when introduced into the body,
they stimulate it, after some time, to create antibodies against that bacteria or
virus. Antibodies are the defenders of our organism and have the ability to eliminate the
action of viruses and bacteria that, without this defense, would be capable of causing the disease. The

vaccines can be given at the same time. For example, the BCG, VAP0, or VAP1 and the
DPT/Hepatitis B1 should be given at the same time if the child is eligible for it.

For multiple dose vaccines such as the BCG and DPT/Hepatitis B, it is emphasized that the
the interval between doses should be at least 4 (four) weeks. Give doses of a
vaccine with an interval shorter than the recommended 4 weeks may reduce the response
yes
production of antibodies.
8.0 Bibliografia

Ministry of Health. Expanded Vaccination Plan Manual. Republic of Mozambique.

Maputo. 2006.
World Health Organization. International travel and health. Research Center in
Community Health, Faculty of Medical Sciences at Nova University Lisbon.
Lisbon.2000.
G. Pereira. A introdução da vacina contra o rotavírus em Moçambique. UNICEF. Maputo.
[Link]://[Link]/introduction-of-the-rotavirus-vaccine-in-mozambique/

Bio-Manguinhos. Inactivated Polio Vaccine. Institute of Technology in

Immunobiologicals. Fiocruz. Rio de Janeiro. 2014.
[Link]