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IMMUNIZATION

IMMUNIZATION

Provision of antibodies in order to


destroy or inactivate the diseaseproducing agent, or to neutralize toxins

PRINCIPLES ON
IMMUNIZATION

ACTIVE

PASSIVE

PRINCIPLES ON
IMMUNIZATION
ACTIVE
Expected responses

Complete protection for life


Partial protection
Readministration at intervals (Principle
of booster dose)

PRINCIPLES ON
IMMUNIZATION
ACTIVE
Types:
Live Attenuated
Contains wild or disease-causing
virus or bacteria that are markedly
weakened in the laboratory over
time
Immune response similar to natural
infection

PRINCIPLES ON
IMMUNIZATION
ACTIVE
Types:
Live Attenuated
Severe reactions possible (may cause
untoward effects to immunecompromised hosts)
Potential for reversal to pathogenic form
Viral: Measles, mumps, rubella, oral
polio, rotavirus, varicella
Bacterial: BCG, oral typhoid

PRINCIPLES ON
IMMUNIZATION
ACTIVE
Types:
Inactivated vaccines

Incapable

of replicating in the host


Contains killed microorganisms
Generally not as effective as live vaccines
Generally require 3-5 doses
Antibody titer falls over time
Should contain sufficient antigen mass to
stimulate response

PRINCIPLES ON
IMMUNIZATION
ACTIVE
Types:
Inactivated vaccines

Booster doses are essential since its


effects wanes over time
Viral: Influenza, Polio, Rabies, Hep A
Bacterial: Pertussis, typhoid, cholera

PRINCIPLES ON
IMMUNIZATION
ACTIVE
Types:
Combination vaccines

Multiple different antigens of an


organism mixed as a single product to
immunize against multiple serotype
(pneumococcal conjugate,
polysaccharide vaccines, polio vaccine)
Antigen from pathogen causing
different diseases (DPT, MMR)

PHILIPPINE EXPANDED PROGRAM ON


IMMUNIZATION

Pursued as a policy in 1976 in response


to UNs and WHOs goal of Universal
Child Immunization by 1990
Compulsory basic immunization for
infants and children, 8 years old (PD
996, 1976)
Inclusion of Hep B (1993)
National Immunization Days (3rd
Wednesday of January and February)

PHILIPPINE EXPANDED PROGRAM ON


IMMUNIZATION

National Immunization Days (3rd


Wednesday of January and February)
Rotavirus, HIB, MMR, PCV were
eventually included as of 2012
NO ABSOLUTE CONTRAINDICATION to
immunizations

Philippine Expanded Program on


Immunization Vaccines
BCG
DTwP-Hib-Hepatitis B
Oral Polio Vaccine (OPV)
Measles
MMR
Rotavirus (RV)
PCV
Td

Other Recommended Vaccines:


DTap
Tdap/Td
IPV
MMRV
Varicella
Hepatitis A
Influenza
Human Papillomavirus (HPV) vaccine

Vaccines for special groups:


Meningococcal
Rabies
Typhoid
Pneumococcal (PCV/PPV)

Philippine EPI Vaccine


BCG

Given intradermally
Live attenuated BCG should be given at
the earliest possible age after birth
(preferably within the first 2 months of
life)
The dosage of BGC is 0.05mL for
children < 12 months of age and 0.1mL
for children > 12 months of age

Philippine EPI Vaccine


BCG

What about healthy infants and children > 2


months who are not given the BCG at birth?

PPD prior to vaccination is not necessary


However PPD is recommended prior to BCG
vaccination if any of the following is present:
Suspected

congenital TB
History of closed contact to known or suspected
infectious cases of TB
Clinical findings suggestive of TB and/or Chest XRay suggestive of TB
An induration of > 5mm is considered positive

Philippine EPI Vaccine


DIPTHERIA AND TETANUS
TOXOIDS AND
ACELLULAR/WHOLE CELL
PERTUSSIS VACCINE
(DTaP/DTwP)

Philippine EPI Vaccine


DTaP/DTwP

The following DTP combination vaccines


are available in the Philippines:

DTwP-Hib
DTaP-IPV
DTwP-HepB
DTaP-IPV-Hib
DTwP-HepB-Hib
DTaP-IPV-Hib-HepB

Philippine EPI Vaccine


DTaP/DTwP

Given intramuscularly (IM)


Given at a minimum age of 6 weeks and
with a minimum interval of 4 weeks.
The 4th dose may be given as early as 12
months of age provided there is a minimum
interval of 6 months from the 3rd dose
The 5th dose may not be given if the 4th
dose was administered at age 4 years or
older

Philippine EPI Vaccine


HEPATITIS B VACCINE

Given intramuscularly (IM)


The 1st dose should be given within the
first 12 hours of life and may be counted
as a part of the 3-dose primary series
Subsequent doses are given at least 4
weeks apart with the 3rd preferably given
not earlier than 24 weeks of life

Philippine EPI Vaccine


HEPATITIS B VACCINE

Preterm infants born to HBsAg (-) who


are medically stable may be given the 1st
dose of HBV at 30 days of chronological
age regardless of weight and this can be
counted as part of the
3-dose primary series

Philippine EPI Vaccine


HEPATITIS B VACCINE

If the mother is HBsAg (+), administer


HBV and HBIG 0.5mL within 12 hours of
life.
If HBsAg status is unknown, administer
HBV within 12 hours of birth and
determine mothers HBsAg as soon as
possible.
If HBsAg (+), administer HBIG no later
than 7 days of age

Philippine EPI Vaccine


HEPATITIS B VACCINE

In the EPI schedule, Hepatitis B is given


as monovalent Hepatitis B vaccine at
birth then subsequent doses are given at
6,10,14 weeks of age as combination
vaccines containing
DTwP-HepB-Hib

Philippine EPI Vaccine


HAEMOPHILUS INFLUENZAE TYPE B
CONJUGATE VACCINE (HiB)

Given intramuscularly (IM)


Given at a minimum age of 6 weeks with
a minimum interval of 4 weeks
If the 1st dose was given between 7-11
months of age the 2nd dose should be
given at least 4 weeks later and the 3rd
dose at least 8 weeks from the 2nd dose

Philippine EPI Vaccine


HAEMOPHILUS INFLUENZAE TYPE B
CONJUGATE VACCINE (HiB)

A booster dose should be given between


12-15 months of age with an interval of
6 months from the 3rd dose
1 dose of HiB vaccine should be
considered for unimmunized children
aged 5 years or older who have sickle
cell disease, leukemia, HIV infection, or
who had splenectomy

Philippine EPI Vaccine


MEASLES VACCINE

Live attenuated
Given subcutaneously (SC) at the age of
9 months
May be given as early as 6 months of
age in cases of outbreaks as declared by
public health officials

Philippine EPI Vaccine


MEASLES, MUMPS, RUBELLA (MMR)

Given subcutaneously (SC)


Live attenuated
The minimum age for MMR is 12 months
Two doses of MMR are recommended
The 2nd dose is administered at ages 4-6
years but may be administered at an
earlier age provided the interval
between the 1st and 2nd dose is at least 4
weeks

Philippine EPI Vaccine


MEASLES, MUMPS, RUBELLA (MMR)

Children below 12 months of age given


any measles containing vaccine
(measles, MR,MMR) should be given 2
additional doses of MMR
Children 12 months or older given one
dose of any measles containing vaccine
(measles, MR, MMR) should be given a
second dose of MMR separated by at
least 4 weeks from the 1st measles
containing vaccine

Philippine EPI Vaccine


MEASLES, MUMPS, RUBELLA (MMR)

In the Philippine EPI, a second dose of


MMR is given to high school students
enrolled in public schools in selected
cities and provinces

Philippine EPI Vaccine


POLIOVIRUS VACCINE (OPV/IPV)

OPV given per orem (PO)


Live attenuated
Given at a minimum of 6 weeks with a
minimum interval of 4 weeks
In the Philippine EPI, OPV is administered
together with DwPT-HepB-HiB vaccines
at 6, 10 and 14 weeks of age

Philippine EPI Vaccine


POLIOVIRUS VACCINE (OPV/IPV)

Inactivated Polio Vaccine (IPV) given IM


Given at a minimum age of 6 weeks with
a minimum interval of 4 weeks
The final dose in the series should be on
or after the 4th birth date and at least 6
months from the previous dose
If 4 or more doses have been given prior
to age 4 years, an additional dose should
be given at age 4 through 6 years

Philippine EPI Vaccine


ROTAVIRUS VACCINE (RV)

Given per orem


The minimum interval between doses is
4 weeks
The monovalent human rotavirus
vaccine (RV1) is given as a 2-dose series
and a pentavalent human bovine
rotavirus vaccine (RV5) is given as a 3dose series
The first dose should be administered
beginning at 6 weeks of age and the last
dose should be administered not later

Philippine EPI Vaccine


PNEUMOCOCCAL VACCINE
(PCV/PPV)

Given IM
Minimum age for PCV: 6 weeks
Primary vaccination

3 doses interval of at least 4 weeks


between doses
Booster at 6 months after the 3rd dose

Children 2 and older who have no


previous PCV

May be given 1 dose of PCV-13 or 2 doses


of PCV-10 at least 8 weeks apart

Philippine EPI Vaccine


PNEUMOCOCCAL VACCINE
(PCV/PPV)

Routine use of PCV is not recommended


for healthy children aged > 5 years
High risk children > 2 years of age

PPV is recommended after completing PCV


Series

Recommended Vaccines

Influenza Vaccine
MMRV
Varicella
Tetanus and Diptheria Toxoid (Td) /
Tetanus and Diptheria Toxoid and
Acellularpertussis Vaccine (Tdap)

Recommended Vaccines
INFLUENZA VACCINE

Given IM or SC
All children 6 months 18 years should receive
influenza vaccine

6 months 8 years receiving influenza vaccine for


the 1st time
2

doses separated by at least 4 weeks


1 dose of vaccine yearly after

9 18 yrs should receive 1 dose of vaccine yearly

Annual vaccination should be given preferably


Feb to June, but may be given through out the
year

Recommended Vaccine
MEASLES, MUMPS, RUBELLA,
VARICELLA (MMRV)

Given SC
Live attenuated
May be given as an alternative to
separately administered MMR and
Varicella Vaccine for healthy children 12
months 12 years of age
Minimum interval between 1st and 2nd
dose: 3 mos

Recommended Vaccines
VARICELLA VACCINE

Given SC
Live attenuated
2 doses are recommended

1st dose: 12-15 months of age


2nd dose: 4-6 years or at an earlier age
provided the interval bet. 1st dose is at least
3 months

A 2nd dose is recommended for children,


adolescents, and adults who previously
received only 1 dose of vaccine

POINTERS TO
IMMUNIZATION

Long lasting immunity may require periodic


administration of booster doses
Effective antibody level in active immunization
takes some time (4 weeks - 1 month)
Minor febrile illness and malnutrition are not
contraindications to vaccination

Permanent contraindications

Anaphylactic reaction with previous shot


Encephalopathy related to DPT within 7 days
to shot

POINTERS TO
IMMUNIZATION

Interruption of schedule does not


interfere with the final immunity
achieved nor does it require repeating
the series again (regardless of the time
elapsed)
Shorter interval between doses will
diminish the efficacy of the second shot

POINTERS TO
IMMUNIZATION

No definite contraindication to giving


multiple vaccines simultaneously,
provided, they are given at different
sites
Use one sterile needle and one sterile
syringe for each child
Live oral vaccines maybe given at
anytime before or after the parenteral
vaccines

POINTERS TO
IMMUNIZATION

All vaccines must be properly stored at


recommended temperature to maintain
potency
Breastfeeding does not interfere with OPV
vaccination
Upper outer aspect of buttocks not
recommended in ordinary circumstances
Dont have to stop vaccinations on
patients on low dose steroids or antibiotics

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