[03.21b] Principles of Immunization (Part 2) V2

Think actively about the vaccine and its purpose

What should be included in history taking and creating a plan of management regarding immunization?

Expanded Program on Immunization (EPI)

What is the immunization schedule recommended by the DOH as part of the National Immunization Program (NIP)?

Polio, HepB, DPT, Measles, Extrapulmonary TB

Name three vaccines covered by the Expanded Program on Immunization (EPI).

PPS, PIDSP, PFV

Which three organizations recommend the childhood immunization schedule besides the DOH?

First 12 hours of life

When is the 1st dose/birth dose of the Hepatitis B vaccine given?

At least 4 weeks apart

What should be the minimum interval between doses of the Hepatitis B vaccine primary series?

Hepatitis B

Which is the only mandatory vaccination in the Philippines, set by Senate Bill 1860?

Chronic HepB

Maternal-to-offspring infection of HepB leads to a higher chance for the infant to develop what condition?

4 doses

If the Hepatitis B vaccine is included in 5-in-one and 6-in-one vaccines, how many total doses may be administered instead of the primary 3-dose series?

Should NOT be administered

What is the general guideline for administering live vaccines to pregnant women?

Could have effects on the baby

Why should live vaccines not be administered to pregnant women?

Inactivated vaccines

Which type of vaccines may generally be administered to pregnant women if indicated?

HPV vaccines

Which non-live vaccine is deferred during pregnancy?

10-46 years old

What is the recommended age range for starting the HPV vaccine?

Sexually active

When is the recommended administration time for the HPV vaccine?

Quadrivalent (four strains) or Nonavalent (nine strains)

Which HPV vaccines are recommended for males?

Divalent (two strains), Quadrivalent, or Nonavalent

Which HPV vaccines are recommended for females?

TDAP (Tetanus, Diphtheria, acellular Pertussis)

Which vaccine is recommended for pregnant women during the 3rd or late 2nd trimester (after 20 weeks gestation)?

Protect newborns from pertussis

According to POGS, why should pregnant women receive a dose of TDAP during every pregnancy?

Neither inactivated nor live vaccines affect the safety of the mother or infant

How do vaccines administered to a lactating woman affect her or the infant?

Smallpox vaccine

Which vaccine is an exemption from the rule that breastfeeding is not a contraindication for any vaccine?

Live non-attenuated vaccine

What type of vaccine is the smallpox vaccine, which is contraindicated in lactating women?

Live vaccines

Which type of vaccine SHOULD NOT be administered to severely immunosuppressed persons?

Varicella vaccine

Which vaccine may individuals with isolated B-cell deficiencies receive?

Inactivated vaccines

Which type of vaccines are safe to use in immunosuppressed persons but may result in a decreased response?

Flu vaccines, pneumococcal vaccines

Name two vaccines against common infectious agents that are recommended for immunocompromised individuals.

Congenital Immunodeficiency, Leukemia or Lymphoma, Generalized malignancy

Name two examples of diseases considered immunocompromised conditions.

Alkylating agents, Antimetabolites, Radiation

Name two types of chemotherapy that lead to immunocompromise.

Corticosteroids

Which drug class, if given for 14 days or longer (e.g., Prednisone $\ge 20$ mg/day or $\ge 2$ mg/kg/day), leads to immunocompromise?

Aerosols, alternate day, short courses, topical

Which forms of corticosteroids do NOT lead to immunocompromise?

No live vaccines

What is the live vaccine guideline for symptomatic patients with HIV/AIDS?

Varicella and MMR

Which two live vaccines should be given to asymptomatic HIV/AIDS patients?

MMRV, Zoster, LAIV, Rotavirus

Which live vaccines should NOT be given to asymptomatic HIV/AIDS patients?

Yellow fever

Which live vaccine should be considered for asymptomatic HIV/AIDS patients, weighing pros and cons based on high prevalence/incidence?

MMR and Varicella separately

How should MMR and Varicella be given to HIV/AIDS patients instead of the combined MMRV?

1-4 years

How long after allogeneic or autologous HCT do antibody titers to Vaccine Preventable Diseases decline if the recipient is not vaccinated?

Pneumococcal disease

HCT recipients have an increased risk of some VPDs, particularly which disease?

6-12 months post-transplant

When is revaccination recommended for HCT recipients?

Inactivated flu (influenza) vaccine

Which vaccine should be given at least 6 months following transplant and annually thereafter for HSCT Recipients?

Tdap/Td, IPV, HepB, Hib, PCV, PPV

Name three inactivated vaccines given at 12 months post-transplant for HSCT Recipients.

MMR and Varicella

Which live vaccines should be given to HSCT recipients if they are already immunocompetent 2 years after stem cell treatment?

MMR and Varicella vaccines and annual influenza vaccinations

Which three vaccines should healthy individuals in the same household as an immunosuppressed person receive?

15 months old, booster dose at 4-5 years old

When is the MMR vaccine given to healthy children (household contacts)?

BCG and Hep B

Which two vaccines are given at birth according to the Childhood Immunization 2024 schedule?

1 dose

How many doses of BCG are given?

1st dose: at birth, 2nd dose: After 4 weeks, 3rd dose: After 6 weeks (10-16 weeks old)

What is the dose schedule for Hep B?

Hep B, DTaP, Hib, IPV1, DTP, and PCV

Which six vaccines are part of the 6-in-1 vaccine?

6th week, 10th week, 14th week

What are the scheduled weeks for the three doses of the 6-in-1 vaccine?

The vaccination would be voided, and the second dose should be repeated

If Hib is given at the 6th week and another Hib/5-in-one at the 9th week, what should happen?

6 weeks

When can Rotavirus vaccine administration start?

Beyond 1 year of age

When should the Rotavirus vaccine no longer be given?

1st dose: 6th week, 2nd dose: After 4 weeks (10th week), 3rd dose: After 4 weeks (14th week)

What is the dose schedule for Pneumococcal Conjugate Vaccine (PCV)?

OPV1 (oral polio vaccine)

What type of polio vaccine is given in the public setting?

IM Polio (IPV1)

Which type of polio vaccine is given in addition to the OPV3?

9 months old together with the measles vaccine

When is the second dose of the IPV given in the public setting?

IPV1, IPV2, and IPV3 (as part of the 5-in-1 or 6-in-1 vaccine)

Which polio vaccines are given in the private setting?

Influenza

Which vaccine, traditionally given at 12 months, can now be given at 6 months?

Measle vaccines (1st dose), Japan Encephalitis (1st dose), IPV2

Which vaccines can be given at the 9th month?

Booster dose/catch up dose for Hep B, 4th dose of DTaP, IPV, and Hib, MMR, Varicella, Inactivated Hep A

Name three vaccines that can be given at the 12th month.

15th month

When used the MMR vaccine typically given before the 12th month schedule became common?

Td/TDap

What is given instead of the DTaP vaccine in adolescence?

Intradermal (ID)

What is the route of administration for BCG?

Earliest possible age after birth within first 2 months of life (<12 months)

When is the BCG primary series given?

Extrapulmonary TB (Pott's Disease, TB of soft tissues)

What does the BCG vaccination prevent?

Congenital TB, History of close contact, Clinical findings suggestive of TB

Name two conditions that prevent healthy infants/children >2 months from receiving the BCG vaccination.

Diphtheria, Tetanus, Pertussis

What three infections does the DTP vaccine address?

Lockjaw

What condition is caused by Tetanus?

Whooping cough

What condition is caused by Pertussis?

Intramuscular (IM)

What is the route of administration for DTP?

12-18 months (DTP), 4-6 years (DTP), 9-18 years (Td/TDaP)

What are the ages for the three DTP booster doses?

Haemophilus influenzae Type B (HiB)

Which vaccine is for one of the most common causes of upper respiratory tract infection?

12-15 months (at least 6 months from 3rd dose)

When is the Hib booster dose given?

All newborns $\ge 2$ kgs within 24 hrs of life

When is the 1st dose of monovalent HBV given?

HBIG (Hepatitis Immunoglobulin)

What must be administered with the Hepatitis B vaccine for infants born to HBsAg positive mothers within the first 12 hours of life?

Inactivated Polio Vaccine (IPV)

Which Polio vaccine is administered via IM route?

Oral Polio Vaccine (OPV)

Which Polio vaccine is administered via PO route?

IPV: 3 doses (Week 6, 10, 14); OPV: 3 doses (Week 6, 10, 14)

What is the dose schedule for both IPV and OPV primary series?

Given with the 3rd dose of OPV

When is the 1st dose of IPV given in public health centers (where OPV is used)?

3 doses of IPVs following the DTP/HIB schedule (Week 6, 10, & 14)

How are polio vaccines administered in private institutions?

Cannot purchase OPVs

Why do private practitioners use IPVs for polio vaccination?

Human (RV1) and Human-Bovine Live Attenuated Rassortant (RV5)

What are the two types of Rotavirus vaccines mentioned?

2 doses

How many doses are required for RV1?

3 doses

How many doses are required for RV5?

NOT LATER than 24 weeks or 6 months of age

What is the maximum age limit for administering the last dose of RV1?

Intussusception (bowel blockage)

What condition may be caused if Rotavirus vaccine is given afterwards the maximum date?

Restart again on the first dose of RV5

What must happen if a patient has had a second dose of RV1 and decides to shift to RV5?

12 months

What is the minimum age for Inactivated Hepatitis A Vaccine (HAV)?

6 months minimum interval

What is the minimum interval between the 1st and 2nd dose of Inactivated HAV?

18 months

What is the minimum age for Live Attenuated HAV?

SC

What is the route of administration for Live Attenuated HAV?

PCV10: 1 dose at least 6 months after 3rd dose

What is the booster schedule for PCV10?

PCV 13/15: approximately 11-15 months of age, at least 2 months after 3rd dose

What is the booster schedule for PCV 13/15?

Annually

How often should the Influenza vaccine be given?

2 DOSES separated by at least 4 weeks

How many doses should children aged 6 months to 8 years receive if getting the influenza vaccine for the 1st time?

9 months

What is the minimum age for Japanese Encephalitis Live Attenuated Recombinant Vaccine?

4 weeks apart

How far apart must the Japanese Encephalitis vaccine and the Measles vaccine be given?

MMR/MR vaccine

What may be given as a substitute for the Measles vaccine if it is not available (in which case, the child should still receive 2 more doses of MMR)?

4-6 years old (or earlier, 3 months from 1st dose)

When is the 2nd dose of Varicella usually given?

4 weeks after the 1st dose

If the 2nd dose of Varicella is given at this interval, it is considered valid.

MMR (Measles-Mumps-Rubella)

Which vaccine is typically given at a minimum age of 12 months with the 2nd dose usually at 4-6 years old?