Ob 1.05 Clinical Practice Guidelines On Immunization For Filipino Women

Transcribers: Angala, M.H., Javier, K.A.
Page 1 of 7
CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN

TOPIC OUTLINE
I. Introduction
II. General Consideration for Vaccination
III. General Contraindication to Vaccination
IV. Recommended Vaccines
a. Tetanus-Diphtheria [td] and Tetanus-
Diphtheria-Pertussis [tdap]
Immunization
b. Human Papilloma Virus [HPV]
c. Varicella Virus
d. Measles, Mumps, and Rubella Viruses
[MMR]
e. Influenza Virus
f. Pneumococcal Virus
g. Hepatitis A Virus [HAV]
h. Hepatitis B Virus [HBV]
V. Appendix
a. Levels of Evidence and Grades of
Recommendation

INTRODUCTION
Recognizing that immunization is one of the most
effective primary health care services, and that there
is a need to fill a gap in such service for adolescent
and adults, the Philippine Obstetrics and Gynecology
Society Foundation, Inc. POGS, through its
immunization for Filipino women IFW task Force,
has embarked in 2006 on an advocacy to incorporate
vaccination on the practice of obstetrics and
gynecology. Thus immunization has been
incorporated in the curriculum of accredited agency
training programs, and subsequently into the
certification examinations of the Philippine Board of
Obstetrics and Gynecology PBOG. The IFW task force
has published three editions 2006, 2009, 2010 of the
recommendation on Immunization for Filipino
Women.
The creation of the clinical Practice Guideline on
Immunization for Filipino Women represents the
continuing efforts of POGS to fulfill its advocacy in
improving the health not only of women, but also the
health of their children and other members of their
families.

GENERAL CONSIDERATIONS FOR VACCINATION
1. Never administer vaccines in the buttock
2. Confirm completion of childhood (or more recent)
primary vaccines series for measles, mumps, rubella
(MMR) and Tetanus-Diphtheria (Td) before
initiating adult recommended vaccine schedules
3. Maintain vaccine administration record in patients
chart, including date, site and route of
administration, manufacturer and lot number of
vaccine.
4. Knowing the route of vaccine administration,
needle size, and vaccine storage and handling are
critical components of a quality, office-based
vaccine program
5. Simultaneous use of any vaccines is not
contraindicated
6. Antibiotic therapy or breastfeeding are not
contraindications to vaccination. Likewise, the
presence of a pregnant woman or
immunosuppressed person in the household is not
a reason to withhold an indicated vaccine to a
family member.

GENERAL CONTRAINDICATION TO VACCINATION
1. Severe allergy to vaccine components
2. Pregnancy (or if planning pregnancy within four
weeks) for live attenuated vaccines
3. Severe immune attenuation (for live attenuated
vaccines only) consultation with an infectious
disease specialist is advised
4. Moderate or severe acute illness
5. If a live attenuated vaccine is given simultaneously
with another vaccine, a four week separation
interval should be used between vaccinations

RECOMMENDED VACCINES

A. TETANUS-DIPHTHERIA (Td) AND TETANUS-
DIPHTHERIA-PERTUSSIS (Tdap) IMMUNIZATION

TARGET POPULATION
General Adults
All persons with zero, incomplete or unknown primary
series of tetanus immunization should receive a
primary series of Tetanus-Diphtheria immunization
All persons who have completed the primary series of
tetanus immunization should have booster Td
injections every 10 yrs
One dose of Tdap should substitute one Td booster
Td vaccine preferred over Tetanus Toxoid (TT)
because of additional protection against diphtheria.
Tetanus Toxoid
o should only be given a booster dose and should
not be part of a primary immunization series
o is preferred to the diphtheria-containing vaccines
only if there is a contraindication to the diphtheria
component
*all of the above - (Level I, Grade A)

Pregnant Women
with no previous tetanus immunization or unknown
tetanus immunization history should receive 3 doses
of Td vaccine to be give 1 month apart, starting 2
nd

trimester. Third dose can be given postpartum as
Tdap
whose last Td/Tdap vaccination was >10 yrs ago
should receive Td booster in the 2
nd
/3
rd
trimester of
pregnancy

Persons more than 65 yrs old
Persons 65 yrs of age or older may be vaccinated with
Tdap
Persons 65 yrs of age or older who have close contact
with an infant <12 month old should be vaccinated
with Tdap (Level I, Grade A)
CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO
WOMEN
SPECIAL TOPIC
1.05
JUNE 16, 2014

Transcribers: Angala, M.H., Javier, K.A. Page 2 of 7

DOSE REGIMEN
The primary tetanus immunization series
o consists of 3 Td injections given IM
o first 2 doses : given one month apart
o 3
rd
dose ; given 6-12 months after 2
nd
dose
o 3
rd
dose may be given as Tdap
Tdap dose is 0.5 ml, administered IM, preferably into
deltoid muscle

CONTRAINDICATIONS/PRECAUTIONS/ADVERSE
EVENTS
Contraindication
Severe allergic reaction (e.g. anaphylaxis) after a
previous dose or to a vaccine component

Precaution
History of arthus-type hypersensitivity reactions
following a previous dose of TT-containing vaccine
Defer vaccination until at least 10 yrs have elapsed
since the last TT-containing vaccine

Adverse Events
Mild problems (noticeable, but did not interfere with
activities)
o Pain (up to about 8 in 10)
o Redness or swelling (up to about 1 in 3)
o Mild fever (up to about 1 in 15)
o Headache or tiredness (uncommon)

Moderate problems (interfered with activities, but did
not require medical attention)
o Fever over 102 F (rare)
o extensive swelling of the arm where the shot was
give (up to about 3 in 100)

Severe problem (unable to perform usual activities;
required medical attention)
o Swelling, severe pain, and redness in the arm
where the shot was given (rare)

AVAILABLE PREPARATIONS
Vaccine Formulation
Tetanus toxoid 0.5 ml/ampule
Tdap absorbed 0.5 ml/syringe
Tetanus-Diphtheria 0.5 ml/syringe

B. HUMAN PAPILLOMA VIRUS (HPV) IMMUNIZATION

TARGET POPULATION
Bivalent human papillomavirus (HPV) vaccination
o protect women aged 15-25 yrs from persistent
HPV infection and cervical intraepithelial
neoplasia (CIN) 2+;
o can be given to patients age 10-14 years and 26-55
years
o can protect target women from developing vulvar
intraepithelial neoplasia (VIN) & vaginal
intraepithelial neoplasia (VAIN);
o can protect target women from CIN 2+
associated with combined nonvaccine oncogenic
HPV types (HPV 33,45)

Quadrivalent HPV vaccination
o protect women 16-45 yrs from persistent HPV
infection and cervical intraepithelial neoplasia
(CIN) 2+
o can be given to patients age 9-45 yrs
o protect women aged 9-45 yrs from developing
vulvar intraepithelial neoplasia (VIN) & vaginal
intraepithelial neoplasia (VEIN)
o can protect women aged 16-45 yrs from
developing anogenital warts

HPV vaccination can be given in women with the
following special situations:
o Abnormal Papanicolaou (Pap) smear
o History of genital warts
o Breastfeeding
o Immunocompromised
*all of the above - (GPP)

Pap smear and HPV infection status are not a
prerequisite for HPV vaccination (GPP)

DOSE REGIMEN
Bivalent HPV vaccine
o Injected imtramuscularly at 0,1,6 months (Level I,
Grade A)
o Can be given concomitantly with diphtheria-
tetanus-acellular pertussis (dTpa), inactivated
poliovirus vaccine (IPV), Hepatitis A inactivated
caccine (HepA) and Hepatitis B inactivated vaccine
(HepB) (GPP)

Quadrivalent HPV vaccine
o Injected intramuscularly at 0,2,6 months
o Can be given concomitantly with diphtheria,
tetanus, pertussis, and poliomyelitis vaccine in
healthy adolescents 11-17 yrs of age

Bivalent and quadrivalent HPV vaccines are not
interchangeable to complete the 3 doses.

EVENTS
HPV vaccines
o cannot be given to pregnant women
o can be given to women with minor acute illnesses
o should not be given to patients with a history of
adverse reactions to any vaccine component
Women who receive HPV vaccination should be
observed for syncope in the clinic for 15 min.
*all of the above - (GPP)

Vaccine Formulation
Bivalent HPV vaccine 0.5 ml/syringe
Quadrivalent HPV vaccine 0.5 ml/syringe

C. VARICELLA ZOSTER VIRUS IMMUNIZATION

TARGET POPULATION
Routine Vaccination
The following population groups with no evidence of
immunity to Varicella (reliable clinical history of
disease, Physician-documented vaccination) should


routinely receive the Varicella vaccine (Level I, Grade
A):
o Persons aged > 13 yrs
o School-aged children, college students, and
students in other postsecondary educational
institutions
o Other healthy adults:
Health care professionals (HCP)
Household contacts of immunocompromised
persons
Persons who live or work in environments in
which transmission of Varicella zoster virus is
likely (e.g. teachers, day-care employees,
residents and staff in institutional settings)
Persons who live or work in environments in
which transmission has been reported (e.g.
college students, inmates, and staff members
of correctional institutions, and military
personnel)
Nonpregnant women of childbearing age
Adolescents and adults living in households
with children
International travelers

Postpartum Vaccination
Prenatal assessment of women for evidence of
Varicella immunity is recommended.
Upon completion or termination of their pregnancies,
women who do not have evidence of Varicella
immunity should receive the first dose of vaccine
before discharge from the health-care facility
Second dose should be administered 4-8 weeks later
Women should be counseled to avoid conception for
1 month after each dose of Varicella

DOSE REGIMEN
Eligible recipients should receive two 0.5 ml doses of
single-antigen Varicella vaccine administered
subcutaneously, 4-8 weeks apart
If >8 weeks elapsed after the 1
st
dose, the 2
nd
dose
may be administered without restarting the schedule
(Level I, Grade A)

EVENTS

Contraindications(Level I, Grade A)
who have a history of anaphylactic reaction to any
component of the vaccine
who have a history of anaphylactic reaction to
neomycin
who have any malignant condition, including blood
dyscrasias, leukemia, lymphomas of any type, or other
malignant neoplasms affecting the bone marrow or
lymphatic systems
who have a family history of congenital or hereditary
immunodeficiency in first-degree relatives (e.g.
parents and siblings) unless the immune competence
of the potential vaccine recipient has been clinically
substantiated or verified by a laboratory
persons receiving high-dose systemic
immunosuppressive therapy, including persons on
oral steroids >2mg/kg of body weight or a total
of >20mg/day of prednisone or equivalent for persons
who weigh >10kg, when administered for >2wks
pregnant women

Precautions
Vaccination of persons who have acute severe illness,
including untreated, active tuberculosis, should be
postponed until recovery. Tuberculin skin testing is
not a prerequisite for vaccination
Because of the potential inhibition of the response to
Varicella vaccination by passively transferred
antibodies, Varicella vaccines should not be
administered for the same intervals as measles
vaccine (3-11 months, depending on the dosage),
after administration of blood (except washed red
blood cells), plasma, or immunoglobulin (Ig).
Persons who received a Varicella vaccine should not
be administered an antibody-containing product for 2
weeks after vaccination unless the benefits exceed
those of vaccination
In such cases, the vaccine recipient should either be
revaccinated or tested for immunity at the
appropriate intervals, depending on the dose received,
and then revaccinated if seronegative

Vaccine Formulation
Varicella Virus Vaccine,
live-attenuated, freeze-
dried with separate
diluent, to be
reconstituted right before
administration
0.5 ml

D. MEASLES, MUMPS AND RUBELLA VIRUSES (MMR)

TARGET POPULATION
All non-pregnant women of childbearing age must be
offered measles, mumps, and rubella (MMR)
vaccination
Upon completion or termination of pregnancy,
women who do not have serologic evidence or rubella
immunity or documentation of rubella vaccination
should be vaccinated with MMR before discharge
from the hospital or birthing center
Routine prenatal serologic testing for rubella on all
pregnant women who lac acceptable evidence of
rubella immunity

DOSE REGIMEN
0.5 ml, administered subcutaneously, 1-2 doses
2
nd
dose of MMR vaccine
o Administered 4 weeks after the first dose is
recommended for adults
o Indicated for individuals who :
Have been recently exposed to
measles/mumps or are in an outbreak setting
Have been vaccinated previously with killed
measles vaccine
Have been vaccinated with an unknown type of
measles vaccine during 1963-1967
Are students in postsecondary educational
institutions
Work in a health-care facility
Plan to travel internationally


EVENTS
Contraindications
Severe allergic reaction after a previous dose of the
vaccine
Pregnancy
Severely immunocompromised patients
o Hematologic and solid tumors
o Receipt of chemotherapy
o Congenital immunodeficiency
o Long-term immunosuppressive therapy
o Patients with human immunodeficiency (HIV)
infection who are severely immunocompromised

Precaution
Women administered with MMR vaccine should be
advised not to get pregnant during the next 4 weeks
post-vaccination
Recent (11months) receipt of the antibody-
containing blood product (specific interval depends on
the product)
History of thrombocytopenia or thrombocytopenic
purpura
Need for tuberculin skin testing
Moderate or severe acute illness with or without
fever

STORAGE REQUIREMENTS
Vaccine
o Refrigerate immediately upon arrival
o Store at 35-46F (2-8C)
o Protect from light at all times, since such exposure
may inactivate the vaccine viruses
Diluent
o May be refrigerated or stored at room
temperature (68-77F [20-25C])
o Do not freeze or expose to freezing temperatures
After reconstitution, use immediately or store at 35-
46 F (2-8C) and protect from light. Discard if not
used within 8 hours of reconstitution

Vaccine Formulation
Measles, Mumps, Rubella
Virus Vaccine, live-
attenuated
0.5 ml

E. INFLUENZA VIRUS

TARGET POPULATION
All pregnant and breastfeeding women should receive
the inactivated flu vaccine. (Level I, Grade A).
Individuals belonging to the ff. high risk groups. (Level
I, Grade A).
o All children: 6-18y.o
o All persons: 50 years
o Other persons at risk for medical complications
from influenza, their household and close contacts.
o All health care professionals (HCP)

DOSE REGIMEN
Infants, children, adolescents: 6-18 years (refer to
Philippine Pediatric Society Guidelines)
Women 19 years old: IM, every year, as soon as the
newest/current WHO-recommended vaccine strains
become available. (Level III, GPP)

EVENTS
Contraindication
Severe allergic reactions (e.g anaphylaxis) after a
previous dose or to a vaccine component, including
egg protein.

Precaution
Guillan Barre Syndrome within 6 weeks of previous
dose of influenza vaccine.
Moderate or severe acute illness with or without
fever.

Vaccine Formulation
Inactivated Split-Influenza
Virus
0.5ml prefilled syringe
Inactivated Influenza Virus
Vaccine
0.25ml and 0.5ml prefilled
syringe

F. PNEUMOCOCCAL BACTERIA IMMUNIZATION

TARGET POPULATION
High-risk patients who have not received prior
immunization or whose prior vaccination status is
unknown.
o All persons >50 years old, particularly those living
in institutions
o Persons with certain underlying chronic medical
conditions
Chronic cardiovascular disease (e.g congestive
heart failure [CHF], cardiomyopathies)
Chronic pulmonary disease (e.g asthma,
chronic obstructive pulmonary disease [COPD],
bronchiectasis, pulmonary tuberculosis [PTB])
Sickle-cell disease
Diabetes mellitus
Alcoholism
Chronic liver disease
Cerebrospinal fluid or cochlear implants
Functional or anatomic asplenia

Immunocompromised persons 2yo:
o HIV infection or AIDS
o Leukemia, Hodgkins disease, lymphoma, multiple
myeloma, generalized malignancy
o Chronic renal failure
o Nephrotic syndrome
o Immunosuppressive chemotherapy, radiation
therapy
o Functional or anatomic asplenia
o Organ or bone marrow transplant recipients

Any adult 19-49 years old who is a smoker and has
asthma (Grade B)

Revaccination with pneumococcal polysaccharide
vaccine (PPSV) is recommended, at least 5 years after
the first dose particularly with ff population: (Grade A)
o 50-64 years old should be revaccinated if their
prior PPSV dose was given at least 5years prior


o >65years who had a prior dose with a lapse of at
least 5years
o 2-49 years old with/ on: (Grade B)
Damaged spleen or asplenia
Sickle-cell disease
HIV infections or AIDS
Generalized malignancy, leukemia, lymphoma,
multiple myeloma
Nephritic syndrome
Organ or bone marrow transplant
Long-term steroid therapy, chemotherapy and
radiation therapy

Pregnant and breastfeeding women who are at high-
risk for invasive pneumococcal disease.

Preferably administered during the 2
nd
or 3
rd
trimester
of pregnancy as a general safety precaution.

Women at high-risk should be offered vaccination
before becoming pregnant.
o High-risk women include those with: (Grade B)
Chronic cardiovascular disease (e.g congestive
heart failure [CHF], cardiomyopathies)
Chronic pulmonary disease (e.g asthma,
chronic obstructive pulmonary disease [COPD],
bronchiectasis, pulmonary tuberculosis [PTB])
Sickle-cell disease
Diabetes mellitus/ gestational DM
Chronic liver disease
Cerebrospinal fluid leaks or cochlear implants
Functional or anatomic asplenia
Immunocompromised persons:
HIV infections or AIDS
Leukemia, Hodgkins disease, lymphoma,
multiple myeloma, generalized malignancy
Chronic renal failure, Nephrotic syndrome
Organ or bone marrow transplant recipients

DOSE REGIMEN
Single 0.5ml dose, IM or SQ injection
EVENTS
Contraindications/Precautions
Hypersensitivity to any component of the vaccine.
Epinephrine injection (1:1000) must be available
immediately in case of anaphylaxis
Severely compromised cardiovascular and/ or
pulmonary function (since a system reaction incurs
significant risks)
Children < 2years as safety and efficacy have not been
established for this group

Adverse Events
PPSV and pneumococcal conjugate vaccine (PCV) are
relatively safe vaccines. About 30-50% of patients who
received the PPSV had mild side effect such as local
erythema.
Serious allergic reactions with the PPSV are
uncommon. Among children who received the PCV,
10-20% developed local erythema, tenderness or
swelling and 11% had low-grade fever

PPSV is licensed for persons aged 2 years and
recommended for persons with certain underlying
medical conditions (including immunocompromised
individuals) and for all persons aged 60 years.

Vaccine Formulation
Pneumococcal 23-Valent
Polysaccharide Vaccine,
PPSV23
0.5 ml prefilled syringe

G. HEPATITIS A VIRUS (HAV)

TARGET POPULATION
Women
o >18yo with close contact with persons with
Hepatitis A, must be vaccinated. (Level I, Grade A)
o Travelling to working in countries with high or
intermediate prevalence of hepatitis a should be
vaccinated. (Level I, Grade A)
o Use street drugs are candidates for vaccination.
(Level I, Grade A)
o With chronic liver disease (including Hepatitis B
and C) should receive Hepatitis A vaccination.
(Level I, Grade A)
o Previously treated with clotting factor
concentrated should avail of hepatitis A
vaccination. (Level I, Grade A)
o With occupational risk including laboratory staff
should be vaccinated. (Level I, Grade A)

Post-exposure Prophylaxis
For susceptible healthy women up to age 40yrs,
single-antigen hepatitis A vaccine should be
administered as soon as possible for exposure.
Beyond age 40yrs, immune globulin (Ig) is preferred.
Vaccine can be used if Ig cannot be obtained.

DOSE REGIMEN
IM for 2 doses, 6-12mos apart, for lasting protection

EVENTS
Severe or life-threatening allergic reaction to a
previous dose of hepatitis A vaccine is an absolute
contraindication.
Severe or life-threatening allergic reaction to any
vaccine component contraindicates the
administration of hepatitis A vaccine.
Moderate or severe illness at the time of vaccination
may defer the scheduled administration.
Safety of the hepatitis A vaccine for pregnant has not
been determined.
The most commonly reported adverse following
hepatitis A vaccination is local reaction at the site of
injection.

Several preparations of Hepatitis A vaccine that
contain inactivated whole-viruses are currently
available.

Vaccine Formulation
Inactivated Hepatitis A
Vaccine
1 ml / vial
Combined inactivated
Hepatitis A & B Vaccine
1 ml prefilled syringe


H. HEPATITIS B VIRUS (HBV) IMMUNIZATION

TARGET POPULATION
Given to the following target population. (Level I,
Grade A)
o Healthcare and public safety and security workers
who may have exposure to blood in the workplace
o Persons in training for allied health professions
o Hemodialysis patients and those receiving blood and
blood products including transplant candidates.
o Patients in early course of chronic liver diseases
o Sexually transmitted disease (STD) clinic clients
o Multiple sexual partners or prior STD
o Inmates in correctional facilities
o Clients and staff of institutions for developmental
disability
o Travelers to high endemic areas
o Overseas foreign workers
o Injection drug users
o Household contacts and sexual partners of Hepatitis
B virus carriers
Pregnant women who is otherwise eligible for it.
(Level III, Grade B)
All HBs-Ag negative pregnant women seeking STD
treatment who have not been previously vaccinated
should receive hepatitis B vaccination (Level III, Grade
B).

DOSE REGIMEN
IM in 3 doses at 0, 1, 6-12 months.
Accelerated schedule: 4 doses at 0, 1, 2, 12 months
Rapid schedule: 4 doses at 0, 7, 21 days and 12
months

EVENTS
severe allergic reaction to vaccine component or to a
prior dose of Hepatitis B vaccine is a contraindication
to further doses of the vaccine.
Persons with severe or moderate acute illness should
not be vaccinated until their condition improves.
Minor illnesses like upper respiratory tract infection
are not a contraindication to vaccination.

Vaccine Formulation
Recombinant Hepatitis B
Virus Vaccine
20 mcg / ml
5ml

APPENDIX

LEVELS OF EVIDENCE AND GRADES OF
RECOMMENDATION

LEVEL DEFINITION
I
Evidence obtained from at least one properly
randomized controlled trial
II-1
Evidence obtained from well-designated
controlled trials without randomization
II-2
Evidence obtained from well-designed cohort
or case-control analytic studies, preferably
from more than one center or research group.
II-3
Evidence obtained from multiple time series
with or without the intervention
III
Opinions of respected authorities, based on
clinical experience, descriptive studies and
case reports or reports of exter committees.

GRADE DEFINITION
A
There is good evidence to support the
recommendation of the practice in
immunization for Filipino women
B
There is a fair evidence to support the
recommendation of the practice in
C
There is insufficient evidence to recommend
for or against the inclusion of the practice in
D
There is a fair to support the
recommendation that the practice be
excluded in immunization for Filipino women.
E
There is a good office the recommendation
that the practice be excluded in immunization
for Filipino women
GPP
A good practice point (GPP) is a
recommendation for best practice based on
the experience of the Technical Working
Group.

Review Questions:

1. Vaccine administration record includes the
following except:
a. Date of purchase
b. site and route of administration,
c. manufacturer
d. Lot number of vaccine.
2. True regarding contraindications to Vaccines
includes the following except:
a. Pregnancy [for live attenuated vaccines]
b. Severe immune attenuation (for live
attenuated vaccines only)
c. Moderate acute illness
d. If a live attenuated vaccine is given
simultaneously with another vaccine, a five
week separation interval should be used
between vaccinations
3. Target population of pneumococcal vaccination
except:
a. adult smokers with asthma
b. All persons older than 50 yo.
c. Persons with sickle cell disease
d. Diabetic patients
4. Which of the following available preparations is
TRUE?
a. Inactivated influenza virus: 0.25ml and 0.5
ml prefilled syringe
b. Hepatitis A virus: 20mcg/ml, 5ml
c. Inactivated Split-influenza: 0.5ml prefilled
syringe
d. Inactivated Hepatitis B: 1ml/ vial
5. Given the following:
i. Bivalent HPV vaccination protects women aged
16-45 yrs from persistent HPV infection
j. HPV vaccination can be given to breastfeeding
women
k. Quadrivalent HPV vaccine can be given
intramuscularly at 0, 2, and 6 months
l. Bivalent HPV vaccine can be given with
Hepatitis A vaccine
m. HPV vaccines can be given to pregnant women


a. All of the statements are correct
b. Majority [3 out of 5] of the statements are
correct
c. All of the statements are incorrect
d. Majority [3 out of 5] of the statements are
incorrect

6. All of the following are injected intramuscularly
except:
a. MMR
b. Tdap
c. HAV
d. HBV
7. Level II-3 is defined as:
a. Evidence obtained from well-designated
controlled trials without randomization
b. Evidence obtained from at least one
properly randomized controlled trial
c. Evidence obtained from well-designed
cohort or case-control analytic studies
d. Evidence obtained from multiple time
series with the intervention
8. A grade given if there is good evidence to support
the recommendation of practice in immunization
for Filipino Women:
a. D
b. C
c. A
d. B
9. Women who received this vaccination should be
observed for syncope for 15 minutes:
a. HPV
b. HAV
c. HBV
d. MMR
10. Which of the following is TRUE?
a. Women administered with MMR vaccine
should be advised not to get pregnant
during the next 4 weeks pre-vaccination
b. Women administered with Influenza
vaccine should be advised not to get
pregnant during the next 4 weeks pre-
vaccination
c. Women administered with MMR should be
advised not to get pregnant during the
next 4 weeks post-vaccination
d. Women administered with Influenza
vaccine should be advised not to get
pregnant during the next 4 weeks post-
vaccination

Answers:
1. A
2. D
3. B
4. C
5. B [J, k and L are correct]
6. A
7. D
8. C
9. A
10. C

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