Karla May C. Gentapan, M.D.

Post-Graduate Medical Intern DMSFI Department of Pediatrics

Designed to protect infants and children early in life, when they are most vulnerable and before they are exposed to potentially lifethreatening diseases.

A vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans by being specially subcultured in bile.

Route: Intradermal (ID) No. of doses: 1 Time of administration:

Earliest possible time after birth Within first 2 mos If > 2 mos old: no need for PPD prior to BCG vaccination Indications for PPD test prior to BCG shot:

Suspected congenital TB History of close contact to known/ suspected case of TB Clinical findings suggestive of TB CXR findings of TB

Positive PPD:
Induration > 5mm

BCG Dosage:
Age < 12 mos = 0.05 ml Age > 12 mos = 0.1 ml

a class of combination vaccines against three infectious diseases in humans:

diphtheria, pertussis (whooping cough) and tetanus. The vaccine components include diphtheria and tetanus toxoids, and killed whole cells of the organism that causes pertussis (wP).

Route: Intramuscular (IM) No. of doses: 4-5 Time of administration:

Minimum age of 6 weeks Minimum interval of 4 weeks If 12 mos old: 4th dose may be given provided minimum interval of 6 mos from 3rd dose If > 4 yo : if 4th dose is given at this age, 5th dose may not be given

Hepatitis B vaccine can prevent hepatitis B, and the serious consequences of hepatitis B infection, including liver cancer and cirrhosis. Hepatitis B vaccine may be given by itself or in the same shot with other vaccines. Vaccination gives long-term protection from hepatitis B infection, possibly lifelong.

In the EPI schedule, Hepatitis B is given as monovalthen subsequent doses are given at 6, 10 andent Hepatitis B vaccine at birth then subsequent doses are given at 6, 10 and 14 weeks of age as combination vaccines DTwP/HepB/Hib.

Route: Intramuscular (IM) No. of doses: 3-4 Timing of administration:

1st dose = 1st 12 hours of life (counted part of 3-dose primary series) Subsequent doses: 4 weeks apart 3rd dose: not earlier than 24 weeks of age

Indications for 4th dose: (given not earlier than 24 weeks of

age) If the 3rd dose is given at age <24 weeks For preterms <2kg whose 1st dose was given at birth

Special Cases:

Preterm infants with HBsAg(-) mothers, stable: If with HBsAg (+) mother:
3)

Give HBV at 30 days of chronological age regardless of weight (1 of give HBV and HBIG (0.5 ml) within 12 hours of life Give HBV within 12 hours of life and determine mothers HBsAg

If unknown HBsAg status of mother: If baby is HBsAg (+):

ASAP

give HBIG no later than 7 days of life

a conjugate vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae type b bacteria. The Centers for Disease Control and Prevention (CDC) has recommended the use of the Hib vaccine.

Unimmunized children aged 5 years or older who have sickle cell disease, leukemia, HIV infection Children who had splenectomy

Route: Intramuscular (IM) No. of doses: 3 + 1 booster Timing of administration:

Given at minimum age of 6 weeks Minimum interval of 4 weeks If 1st dose is given between 7-11 mos:
2nd dose 4 weeks later 3rd dose 8 weeks later from 2nd dose

Booster dosing:
Given bet 12-15 mos Interval of 6 mos from 3rd dose

Route: Subcutaneous (SC) No. of doses: 1 Timing of administration:

9 mos preferably Given as early as 6 mos in cases of outbreaks

an immunization vaccine against measles, mumps, and rubella (also called German measles). It is a mixture of live attenuated viruses of the three diseases, administered via injection.

Route: Subcutaneous (SC) No. of doses: 2 Timing of administration:

Given at minimum age of 12 months 15 months 2nd dose at 4-6 yo but can be given earlier as long as minimum interval of 4 weeks If <12 mos and given any measles containing vaccine (Measles, MR, MMR):

Give additional 2 doses of MMR

If >12 mos and given any measles containing vaccine (Measles, MR, MMR):
Give a second doses of MMR separated 4 weeks from 1st measles

containing vaccine

Route: Subcutaneous (SC) No. of doses: 2 Timing of administration:

Given as alternative to separately administered MMR and Varicella Vaccines for healthy children 12 mos to 12 years of age Minimum interval between 1st and 2nd dose is 3 mos

Oral polio vaccine (OPV) is a live-attenuated vaccine, produced by the passage of the virus through non-human cells at a sub-physiological temperature, which produces spontaneous mutations in the viral genome. OPV reported to cause vaccine-derived poliovirus (VDPV) which lead to vaccine-associated paralytic poliomyelitis (VAPP). IPV or Injectable Polio Virus Vaccine was used because reversion is not possible but there remains a small risk of clinical infection upon exposure to reverted OPV or wild polio virus.

Route: IPV Intamuscularly (IM)

OPV Per Orem(PO)

No. of doses: 4-5 Timing of administration:

Given at a minimum age of 6 weeks Minimum interval of 4 weeks Final dose at the 4th bday or 6 mos from previous dose If >4 doses were given before 4 yo:
Add 1 more dose at age 4-6 yo

Route: Intamuscularly (IM) No. of doses: Timing of administration:

Fully immunized child :

5 DTaP doses or 4 DtaP (4th dose at 4yo)

If fully immunized: 1 Td booster every 10 years 1 dose Tdap can be given in place of Td regardless of interval from last tetanus and diphteria containing vaccine

Timing of administration:

7-18 yo not fully immunized with DPT:

Give a single dose of Tdap Succeding doses are Td

7-18 yo NEVER immunized with DPT:

Give 3-dose series of tetanus containing vaccines with 0-1-6

months schedule Tdap as 1st dose Remaining doses Td

The vaccine protects against the virus in more than 95% of cases and provides protection from the virus for at least fifteen years. There are two types of vaccines: inactivated Hepatitis A virus live but attenuated virus Both types stimulate active immunity against a future infection

Route: Intamuscularly (IM) No. of doses: 2 Timing of administration:

Age > 12 months 2nd dose 6 months after 1st dose

protects children from rotaviruses, which are the leading cause of severe diarrhea among infants and young children Rotavirus is highly contagious and resistant and, regardless of water quality and available sanitation nearly every child in the world is at risk of infection Available vaccines:

Rotarix by GlaxoSmithKline RotaTeq by Merck

Route: Per Orem (PO) No. of doses: 2 Timing of administration:

1st dose at 6 weeks Last dose not later than 32 weeks Minimal interval between doses - 4 weeks

Monovalent human rotavirus vaccine(RV1)

2-dose series, 3rd dose not recommended

Pentavalent human rotavirus vaccine (RV5)

3-dose series

a live (attenuated) virus administered to protect against the viral disease commonly known as chickenpox caused by the varicella zoster virus (VZV) Available vaccines:

Varivax by Merck Varilrix by GlaxoSmithKline

Route: Subcutaneously (SC) No. of doses: 2 Timing of administration:

1st dose at 12-15 months 2nd dose at 4-6 yo or earlier as long as interval is 3 months If <13 yo, recommended interval is 3 months If interval is about 4 weeks still valid If >13 yo and without immunity:
Give 2 doses 4 weeks apart

prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers Available vaccines:

Gardasil Cervarix

protect against the two HPV types (HPV-16 and HPV18)

70% of cervical cancers 80% of anal cancers 60% of vaginal cancers 40% of vulvar cancers

Route: Intramuscular (IM) No. of doses: 3-dose series Timing of administration:

Given to women 10-18 yo Bivalent vaccine: 0,1,6 months Quadrivalent vaccine: 0,2,6 months

can be given to males 10-18 yo for prevention of anogenital warts

Minimum interval:
1st 2nd dose: 1 month 2nd-3rd dose: 3 months

3rd dose given atleast 6 months after 1st dose

an annual vaccination using a vaccine specific for a given year to protect against the highly variable influenza virus Influenza vaccines may be administered as an injection, also known as a flu shot, or as a nasal spray

Route: Intramuscular (IM) Subcutaneous (SC) No. of doses: 2 Timing of administration:

All children from 6 months 18 yo If 6mos -8 yo and receiving flu vaccine for the 1st time: 2 doses 4 weeks apart If 6mos -8 yo and received >2 doses since 2010: give only 1 vaccine annually If 6mos -8 yo and received only 1 dose since 2010: Give 2 doses for the current year and 1 dose yearly thereafter

Timing of administration:

Age 9-18 yo: 1 dose yearly February to June preferred vaccination time

Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae, which is sometimes referred to as the pneumococcus bacterium. Pneumococcal infections can lead to pneumonia, septicaemia and meningitis.

Route: Intramuscular (IM) No. of doses: 1 Timing of administration:

PCV minimum age of 6 weeks PPV minimum age 2 yo No additional PPV needed if PCV series is completed

Vaccines not included in Philippine EPI or Other recommended vaccines Meningococcal Vaccine Rabies Vaccine Typhoid Vaccine Pneumococcal Vaccine (PCV/PPV)

Tetravalent Meningococcal (ACYW-135) Conjugate Vaccine (MCV4)

Route: Intramuscular (IM)

Tetravalent Meningococcal Polysaccharide Vaccine (MPSV4)

Route: Subcutaneous (SC)

Bivalent Meningococcal Polysaccharide A and C Vaccine

Route: Intramuscular (IM) / Subcutaneous (SC)

Who should be given?

Children > 9 mos at high risk for invasive disease

Persistent complementary component deficiency Anatomic or Functional asplenia HIV Travelers or Residents where meningococcal disease is

hyperendemic or epidemic Belong to a defined risk group is a menigococcal outbreak

How?

Give 2 doses MCV4 2 months apart

If with persistent increased risk

Initial booster dose of MCV4 given 3 yrs after completing the primary series Continue booster dose at 5 yrs interval after initial booster dose

If first dose used was MPSV4 or Bivalent Meningococcal Polysaccharide A and C

A second dose of MCV4 should be given 2 mos later No more booster doses needed

Route: Intramuscular (IM) Who will be given?

Travelers to areas where there is risk to exposure to S. typhi Outbreak situations

How?

1st dose as early as 2 yo Revaccination every 2-3 yrs with continued exposure

Anti-Rabies Act (2007)

Routine rabies pre-exposure prophylaxis (PrEP) For children 5-14 yo In areas with high incidence of rabies and animal bites (>2x the national ave.)
IM regimen: PVRV 0.5ml or PCECV 1 ml given on days 0,7,21 or 28 ID regimen: PVRV or PCECV 0.1 ml given on days 0,7,21 or 28

2 recommended regimens for PrEP:

When to repeat dose?

If inadvertently given SC If given at gluteal area (unpredictable absorption)

Booster doses: not needed if no exposure For subsequent exposures:

If completed 3 doses of PrEP, regardless of interval between re-exposure and last dose, give only booster doses on day 0 and 3 Booster doses: IM (0.5 ml PVRV) or (1ml PCECV) ID (0.1ml PVRV or PCECV) No need for Rabies Immune globulin

Route: Intramuscular (IM) For children >2 yo with medical conditions

Anatomic/functional asplenia HIV infection Immunocompromising conditions Chronic lung, heart and renal disease Cochlear implant CSF leak

Who should be given and how?

Children 24-71 months old

Give 1 dose PCV if 3 doses already given previously or Give 2 doses of PCV at least 8 weeks apart if less than 3

doses previously given

Children 6-18 years old w/o previous PCV doses

give 1 dose of PCV 13

Give PPV at least 8 weeks after last dose of PCV to children 2-8 yo with underlying medical condition 2nd dose is needed 5 yrs after 1st dose No more than 2 doses recommended

Thank you!