cpm1st immunizations.pdf

8/14/2019 CPM1ST IMMUNIZATIONS.pdf

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IMMUNIZATION(1996)

PHILIPPINE PEDIATRIC SOCIETY


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IMMUNIZATIONS

249

CPM 1 ST EDITION

IMMUNIZATIONS

Philippine Pediatric Society, Inc.Committte on Handbook of Infectious Diseases,

1996-1998

Jose na C. Carlos, M.D., Chair Margaret L. Fong, M.D., Co-Chair Melba V. Masigan, M.D., Co-Chair


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IMMUNIZATIONS

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CPM 1 ST EDITION

Defnition

Prevention of infectious disease can be achieved intwo ways:

I. Active Immunization - entails the giving of an anti -gen usually prior to natural exposure to an infectiousagent to stimulate the individual to develop his ownantibody.

II. Passive Immunization - entails the giving of pre -formed human or animal antibody to temporarily

protect the recipient.

ACTIVE IMMUNIZATION

1. Involves the administration of all or part of a micro-

organism or a modi ed product of the microorganism(e.g. toxoid) to elicit an immunological responsesimulating that of natural infection but which

presents little or no danger to the recipient.

2. Types of protection induced:

Complete protection for life Partial protection so that booster doses are

administered at intervals.

3. Ef cacy is assessed by the evidence of protection

against the particular disease. Antibody formationis an indirect measure of protection, but in someinstance the immunologic response responsible for

protection is poorly understood and serum antibodyconcentration is not always predictive of protec-tion.

4. Characteristics of an ideal immunizing agent: Easy to produce Potency is durable and easily measured Easy to adminster Does not in itself produce disease in the

recipient or susceptible contacts Induce long-lasting (ideally permanent)

immunity that is measurable using commonand inexpensive technique.

Free of contaminating substances Adverse reactions should be minimal (ideally

absent). Except for the available immunizingagents, all of these objectives are rarely, if evermet, hence, incomplete immunization mayoccur, undesirable side effects or reactionsmay occur in small number of subjects, andinfrequently, morbid effects may beencountered.

5. Types of antigen for active immunization: Live attenuated virus or bacteria

Killed microorganisms

Inactivated exotoxins (toxoid) - incapable ofreplicating in the host, hence must containa suf cient antigenic mass to stimulate thedesired response provided by live attenuatedagents; maintenance of long- lasting immunityoften requires periodic administration of boosterdoses.

6. Fluid may contain proteins or other constituentsderived from the medium in which the vaccine was

produced, preservatives, stabilizers, antibiotics, andselective adjuvants (e.g. aluminum) to retain theantigen at the depot site to prolong its stimulatingeffect.

7. Timing: critical for the success of the procedure. In

general, vaccines are recommended for the young -est age group at risk for the natural infection and itscomplications that will demonstrate an acceptablelevel of immune response following vaccine admin -istration.

8. Recommended dose: derived from theoreticalconsiderations, experimental vaccine trials andsignificance; exceeding the recommended dosevolume may be hazardous because of excessive localor systemic concentrations of immunizing antigens;underdosage may result in an inadequate serologicresponse and protection.

9. Route of administration: may determine the type andduration of immunologic response; recommendedroutes are based on clinical trials demonstratingsafety and ef cacy. Injectable vaccines (intramus -cular and subcutaneous) should be administeredin areas unlikely to cause local neural, vascular ortissue injury e.g. anterolateral aspect of the upperthigh in infants and the deltoid muscle of the upperarm in older children.

Immunizations


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IMMUNIZATIONS CPM 1 ST EDITION

252

T A B

L E I . A C T I V E I M M U N I Z A T I O N O F I N F A N T S A N D C H I L D R E N

I m m u n

i z i n g

A g e n

t s

A g e

D o s e

R o u

t e

C o n

t r a i n d

i c a t

i o n s

A d v e r s e

R e a c t

i o n s

B C G

N e w

b o r n

0 . 0 5 m L

I n t r a d e r m a l

I m m u n e d e c i e n c y , p

r o g r e s s i v e

A b s c e s s o r u l c e r s a t

t h e s i t e o f

i n j e c t

i o n

> 1 m o n

t h

0 . 1 m

L

d e r m a t o s e s

a x i l l a r y

l y m p h a d e n o p a t

h y w h i c h m a y

c a s e a t e ,

d i s s e m

i n a t e d

B C G 0 . 1 / 1 0 0

, 0 0 0

v a c c

i n e e s ;

B C G o s

t e i t i s 0 . 1

- 0 . 3

/ 1 0 0

, 0 0 0

v a c c

i n e e s

D i p h t e r

i a - t e t a n u s

2 , 4 , 6 m o n

t h s

0 . 5 m L

I M

A c u

t e f e b r i l e i l l n e s s . C o n v u

l s i o n s

F e v e r ; a t

t i m e s a s s o c i a t e d w

i t h s o m n o

l e n c e

& /

a n d p e r t u s s i s v a c c i n e

1 8 m o n t h s

o r o t h e r s e v e r e r e a c t i o n s ( a n a p h y l a x i s

o r c o n v u l s i o n s a t t r i b u t e d t o p e r t u s s i s

( D T P )

4 - 6 y e a r s

o r c o l l a p s e ) t o p r e v i o u s d o s e o f D T P

v a c c i n e ; p r o l o n g e d c r y i n g

g i v e

D T i n s t e a

d

T r i v a l e n t O r a l

2 , 4 , 6 m o n t h s

0 . 5 m L

P O

A l t e r e d i m m u n e s t a t e s ( l e u k e m i a

,

P a r a l y s i s ( 0 . 0 6 m i l l i o n d o s e s a m o n g

P o l i o - V i r u s

1 8 m o n t h s

l y m p h o m a , m

a l i g n a n c y , t h e r a p y w i t h

r e c i p i e n t s 0 . 1 4 m i l l i o n d o s e s a m o n g

V a c c

i n e

( T O P V )

4 - 6 y e a r s

a l k y l a t i n g d r u g s , a n

t i m e t a b o l

i t e s ,

c o n t a c

t s o f r e c i p i e n

t s )

s t e r o i d s o r r a d i a t i o n ; p r e g n a n c y

D T P + I n a c t i v a t e d

2 , 4 , 6 a n d 1 8

0 . 5 m L

I M

A c u t e f e b r i l e i l l n e s s e s

F e v e r l o c a l r e a c t i o n e r y t h e m a , p a i n

,

P o l i o V i r u s

m o s , 4 - 6 y e a r s

e d e m a

( I P V ) V a c c i n e

A t t e n u a t e d m e a s l e s

6 m o n

t h s

0 . 5 m L

S C

A l t e r e

d i m m u n e s t a t e a s

l i s t e d a b o v e

L o c a

l r e a c t

i o n s i m u l a t

i n g a n

A r t h u s

v a c c

i n e

( E d m o n

d s t o n

A c u

t e f e b r i l e

i l l n e s s

p h e n o m e n o n ,

1 - 8 d a y s a f

t e r

v a c -

Z a g r e b s t r a

i n ) o r

U n t r e a t e d a c

t i v e

t u b e r c u l o s

i s

c i n a

t i o n ;

f e v e r w

i t h o r w

i t h o u

t

L i v e f u r t h e r a t t e n u a t e d

9 m o n t h s

S C

I m m u n o g l o b u l i n a d m i n i s t r a t i o n

m e a s l e s - l i k e m a n i f e s t a t i o n s a b o u t

( S c h w a r t z s t r a i n )

w i t h i n 3 m o n t h s

6 t h - 1 2 t h d a y s a f t e r v a c c i n a t i o n

m e a s l e s v i r u s v a c c i n e

M a r k e d h y p e r s e n s i t i v i t y t o v a c c i n e

M e a s l e s , M u m p s ,

c o m p o n e n t s ;

F e v e r , m a l a i s e , e n c e p h a l i t i s

, s k i n e r u p t i o n s ;

R u b e l l a v a c c i n e

A l l e r g y t o e g g s ;

F e v e r , h y p e r s e n s i t i v i t y r e a c t i o n s , r a s h ,

( M M R )

P r e g n a n c y

u n i l a t e r a l n e r v e d e a f n e s s ; t r a n s i e n t

a r t h r a l g i a a n d p e r i p h e r a l n e u r i t i s

L i v e m u m p s v i r u s

1 5 m o n t h s

0 . 5 m L

S C

v a c c

i n e *

1 1 - 1

2 y e a r s

L i v e r u b e l l a v i r u s

1 5 m o n t h s

0 . 5 m L

S C

v a c c

i n e *

D i p h t h e r i a -

1 4 - 1 6 y e a r s

0 . 5 m L

I M

A c u t e f e b r i l e i l l n e s s e s

F e v e r

t e t a n u s t o x o i

d s

& e v e r y

a d u l t t y p e ( T d )

1 0 y e a r s

t h e r e a

f t e r

* I f m e a s l e s v a c c i n e

i s n o t

i n d i c a

t e d

N O T E : I n t e r r u p t i o n a / s c h e d u l e

, w i t h a d e l a y b e t w e e n d o s e s , d o e s n o t i n t e r f e r e w i t h t h e n a l i m m u n i t y a c h i e v e d n o r d o e s i t n e c e s s i t a t e s t a r t i n g w

i t h t h e s e r i e s a f i n ,

r e g a r d l e s s o f t h e l e n g t h o f t i m e e l a p s e d .


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CPM 1 ST EDITION

T A B L E I . A C T I V E I M M U N I Z A T I O N O F I N F A N T S A N D C H I L D R E N

I m m u n

i z i n g

A g e n

t s

A g e

D o s e

R o u

t e

C o n

t r a i n d

i c a t

i o n s

A d v e r s e

R e a c t

i o n s

H e p a t

i t i s A

V a c c

i n e

> 2 y e a r s

F o l l o w

I M

H y p e r s e n s

i t i v i

t y t o a n y c o m p o n e n

t

L o c a

l r e a c t

i o n s

i n c l u d e e r y

t h e m a ,

m a n u f a c

t u r e r ' s

o f t h e v a c c

i n e s w e l

l i n g a n

d

r e c o m m e n

d a t

i o n

w a r m

t h .

H e p a t

i t i s B

V a c c

i n e

B i r t h

F o l l o w

I M

H y p e r s e n s

i t i v i

t y t o a n y c o m p o n e n

t

S y s t e m

i c c o m p l a i n t s i n c l u

d e f e v e r ,

m a n u f a c

t u r e r ' s

o f t h e v a c c

i n e m a l a i s e , f a t

i g u e , h e a

d a c h e ,

r e c o m m e n d a t i o n

d i z z i n e s s , m y a l g i a a n d n a u s e a .

H e m o p h i l u s i n u e n z a e

B v a c c i n e ( H i b )

a .

H B O C

2 , 4 , 6 m o n

t h s

I M

N o n e

N o n e

( c o n

j u g a

t e d w i t h

b o o s

t e r

D i p h t h e r i a t o x o i d ) *

1 5 m o n t h s

b . P R P - O M P

2 , 4 m o n

t h s

I M

N o n e

N o n e

( c o n

j u g a

t e d

w

i t h N

. m e m n y

t i d i s )

b o o s

t e r

F o l l o w

1 2 m o n

t h s

m a n u

f a c t u r e r

'

c . P R P - T ( c o n j u g a t e d

2 , 4 , 6 m o n t h s

I M

N o n e

N o n e

w i t h t e t a n u s t o x o i d )

b o o s t e r

i n s t r u c t i o n s

1 5 m o n

t h s

L i v e a t t e n u a t e d v a r i c e l l a

9 m o n t h s

1

S C

A l t e r e d i m m u n e s t a t e a s l i s t e d

L o c a l p a i n a n d e r y t h e m a

v a c c

i n e

a b o v e

A c u

t e f e b r i l e i l l n e s s

G e n e r a l r e a c

t i o n s : F e v e r , p a p u l o v e s

i c u l a r

U n t r e a t e d a c

t i v e

T B

r e a c

t i o n s n o

t e d 7 - 2 1 d a y s a f

t e r

I m m u n o g l o b u l i n a d m i n i s t r a t i o n

i m m u n i z a t i o n

w i t h i n 3 m o n

t h s

* 1 . W

h e n i m m u n i z a t i o n i s i n i t i a t e d a t 7 - 1 1 m o n t h s , r e c o m m e n d e d r e g i m e n s / o r t o t h H B O C a n d P R P - O M P a n d P R P - T a r e i d e n t i c a l v i z . 3 d o s e s - r s t 2

d o s e s y v e n a t 1 m o n t h s i n t e r v a l , 3 r d d o s e p v e n a t 1 5 - 1 8 m o n t h s o f a y . A n y c o n j u g a t e v a c c i n e f o r 3 r d d o s e .

2 . W

h e n i m m u n i z a t i o n i s i n i t i a t e d a t 1 1 - l i m o n t h s , t

h e r e c o m m e n d e d r e g i m e n s f o r t h e s e t h r e e v a c c i n e s a r e i d e n t i c a l v i z . 2 d o s e s

g i v e n a t 2 - 3 m o n t h s i n t e r v a l .

3 .

W h e n i m m u n i z a t i o n i s i n i t i a t e d a t 1 5 m o n t h s o r o l d e r , t

h e r e c o m m e n d e d r e g i m e n i s a s i n g l e d o s e o f a n y l i c e n s e d c o n j u g a t e v a c c i n e

( H B O C o r P R P - O M P , P R P - T ) .


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TABLE II.RECOMMENDED IMMUNIZATION SCHEDULE FOR CHILDREN

NOT IMMUNIZED IN THE FIRST YEAR OF LIFE

Recommended Time Immunizations Comments

Less than 7 years old

First visit DTP, TOPV or DTP MMR - if child 5 months old;IPV, MMR, Hib* HBV tuberculin testing (TT) should be

done; if TT negative, give BCG

Interval after rst visit

2 months DTP, TOPV or DTP Second dose of HIB is indicated IPV; HBV (Hib) only in infants whose 1st dose was received


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258

T A B L E I V

. E X P A N

D E D P R O G R A M

O N I M M U N I Z A T I O N ( E P I ) O F T H E D E P A R T M E N T O F H E A L T H

V a c c i n e

M i n i m u m

A g e

D o s e

N u m

b e r

R o u

t e o f

S i t e o f

M i n i m u m

I n t e r v a l

R e m a r

k s

o f D o s e

A d m i n i s t r a t i o n

A d m i n i s t r a t

i o n

b e t w e e n

d o s e s

B C G 1

B i r t h ; a n y

t i m e

0 . 0 5 m

L f o r

1


R i g h t d e l t o i d

V a c c

i n e

d e s t r o y e d

a f t e r o r 6 w e e

k s

n e w

b o r n s ; 0 . 1

r e g i o n o f

t h e a r m

b y h e a t a n

d s u n

m L f o r o

l d e r

l i g h t

i n f a n t s

D T P

6 w e e k s

0 . 5 m L

3

I M

u p p e r o u t e r

4 w e e k s

V a c c i n e d a m a g e d b y h e a t

p o r t i o n o f

t h i g h

a n d f r e e z i n g ;

D T P n o

t

g i v e n

t o > 6 y e a r s o l

d -

g i v e T d i f a v a i l a b l e

P o l i o

6 w e e k s

2 d r o p s o r 3

3

P O

M o u t h

4 w e e k s

V a c c i n e e a s i l y d a m a g e d

d e p e n d

i n g o n

b y h e a t

m a n u

f a c t u r e r ' s

i n s t r u c t

i o n s

H e p a t i t i s M i n i m u m a g e

F o l l o w

3

I M

A n t e r o - l a t e r a l

4 w e e k s

V a c c i n e d e s t r o y e d b y

B V a c c i n e B i r t h

m a n u f a c t u r e r ' s

a s p e c t , t

h i g h

f r e e z i n g a n d h e a t

i n s t r u c t

i o n s

( i n f a n t s )

M e a s l e s

M i n i m u m a g e

0 . 5 m

L

1

S C

O u t e r p a r t o f

V a c c

i n e e a s i l y

d a m a g e d

6 m o n

t h s

b y h e a

t

B C G 2

a t s c h o o l e n t r y

0 . 1 m L

1


l e f t d e l t o i d

V a c c i n e d e s t r o y e d b y h e a t

w h e t h e r o r n o t

a n d s u n l i g h t

c h i l d h a s

B C G

s c a r

T e t a n u s

W o m e n o f c h i l d

0 . 5 m L

5

I M

d e l t o i d r e g i o n

T T l a t 1 s t c o n t a c t ,

V a c c i n e d a m a g e d b y h e a t

t o x o i d

b e a r i n g a g e

T T 2 a t l e a s t 4 w k s

a n d s u n l i g h t

a f t e r

T T l

T T 3 a t

l e a s

t 6 w

k s

a f t e r

T T 2

,

T T 4 a t

l e a s

t 1 y e a r

F o r t

h o s e n o t g i v e n p r

i m a r y

a f t e r

T T 3

,

i m m u n

i z a t

i o n s

i n i n f a n c y

T T 5 a t

l e a s

t 1 y e a r

a n d c h

i l d h o o

d

a f t e r

T T 4


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CPM 1 ST EDITION

PASSIVE IMMUNIZATION

1. Indications for the administration of preformedantibody to provide temporary protection to anunimmune recipient.

Congenital or acquired 6-lymphocyte celldefects alone or in combination with other

immunode ciencies. When no vaccine for a given disease is avail

able and prevention or modi cation is possible by anti body.

When time does not permit adequate protection by active immunization alone (e.g. postexpo-

sure to measles, rabies, hepatitis B or tetanus prophylaxis).

When a speci c toxic effect of venom is bestmanaged by antibody administration (e.g.

poisonous snake bite). Therapeutically, when a disease is already

present, and antibody may ameliorate or aidin suppressing the toxin effects (e.g. botulism,diphtheria, tetanus).

N.B. Passive immunization must be given assoon as possible after exposure to be able to

prevent the infection.2. Types of products available for passive immuniza-

tion Normal (standard) human immunoglobulin for

general use (gamma globulin) a. Intramuscular immunoglobulin (IGIM) b. Intravenous immunoglobulin (IGIV) Speci c (special) human immunoglobulin

(for intramuscular use only) - e.g. Hepatitis B,Varicella-Zoster, Rabies, Tetanus immunoglobulins, etc.

Human plasma/blood Animal sera and antitoxins - Tetanus antitoxin,

Diphtheria antitoxin. Rabies immune serum,Botulism antiserum, Black widow spider anti

venin. Snake bite antivenin, etc.


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TABLE V. PASSIVE IMMUNIZATION IN INFANTS AND CHILDREN

Disease Preparation Goal and Dose Indications/Comments

Antibody IGIM Treatment: 0.7 mL/Kg Double dose at onset of therapy;Immunode ciency every 2-4 weeks give at multiple sites.

IGIV Treatment: 2 mL/Kg of Also for ITP& Kawasaki disease; 5% preparation; 3.3 mL/ more predictable blood levels Kg of 3% preparation but more frequent side effects and higher cost.

Diphtheria Diphtheria Prevention: 5,000 units For symptom-free, positiveAntitoxin culture and positive Schick test.

Treatment: See below* 40,000-120,000 units

Hepatitis A IGIM Prevention: Single Household contacts: higher dose exposure - 0.04 mL/Kg in adults with heavy exposure.

Continuous exposure: Repeat in 4-5 months if exposure 0.02 - 0.06 mL/Kg continues.

Hepatitis B IGIM Prevention: Use if HBIG is unavailable or 0.06 - 0.12 mL/Kg exposure is uncertain.

Hepatitis B Postexposure prophylaxis For newborns delivered from Immuno- in newborns: 0.5 mL at mothers with Hepatitis B

birth within 12 hours (HBsAg+globulin(HBIG)Others: 0.06 mL/Kg or 5 especially those with HBeAg+).

mL for adults within 24 Accidental puncture of skin by hours; repeat 4 weeks later contaminated needle. for those who choose not to Splashing of infected blood into receive Hepatitis B vaccine mucous membrane. Accidental injection of infected

blood.

Hepatitis C IGIM Prevention: 0.12 mL/Kg Use with transfusions under(non A, non B) special circumstances.

Measles IGIM Prevention: Susceptible normal infants & 0.25 - 0.50 mL/Kg children** Prevention: 0.50 mL/Kg Susceptible

(max 15 mL) immunocompromised patients Modi cation: 0.05 mL/Kg

Measles Prevention: 0.04 mL/Kg For susceptible normal infants

Immuno- and children

* Suggested doses: Mild nasal or pharyngeal -40,000units Moderately severe pharyngeal - 80,000 units Severe pharyngeal or laryngeal or extensive diseases > 48 hour duration,

or brawny swelling of the neck -120,000 units** If modi ed measles did not occur, vaccinate with live attenuated measles vaccine after 3 months.


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CPM 1 ST EDITION

* As antitoxin to neutralize circulating toxin: Tetanus Immune Globulin (TIG) is preferred, 3,000 - 6,000 units,intramuscularly, although some experts claim that 500 units is just as effective as a larger dose (part may bein ltrated around the wound); repeated doses are not reauired.

As control measure in Passive Immunization: TIG, 250 - 500 units, intramuscularly or Tetanus antitoxin,3,000 - 5,000 units, intramuscularly (after careful screening and testing for sensitivity to it.

** Alternative drug: Tetanus Antitoxin (ATS), 500 units/Kg BWor 5,000 units to newboms, 10,000 units to children,20,000 units to adults; 1/2 intravenously and the rest intramuscularly. Intradermal test must be done onehour before serum administration except in newborns in whom sensitivity testing can be dispensed with.

As control measure in Passive Immunization: TIG, 250 - 500 units, intramuscularly or Tetanus antitoxin,3,000 - 5,000 units, intramuscularly (after careful screening and testing for sensitivity to it).

Reference Handbook on Infectious Diseases, Philippine Pediatric Society, Inc., 1992 Edition, pp. 2-11

TABLE V. PASSIVE IMMUNIZATION IN INFANTS AND CHILDREN

Disease Preparation Goal and Dose Indications/Comments

Varicella VZIG Modi cation: 2-5 mL Newboms whose mother developed varicella prior to or soon after

delivery; patients on corticosteroids, altered immune status.

IGIM Modi cation: Use in high risk patients if VZIG is0.6 -1.2 mL/Kg unavailable or unaffordable.

Rabies Rabies human Prevention: 20.0 iu/Kg Multiple bites regardless of the immunoglobulin 1/2 IM 1/2 around presence or absence of signs of (RIG) wound rabies in animals; single bites in whom rabies cannot be ruled out.

Anti-rabies Prevention: 40.0 iu/Kg Use only if RIG is unavailable or equine serum unaffordable. (ARS)

Rubella IGIM Prevention: 0.55 mL/Kg Use only during pregnancy;or 20 mL ef cacy unreliable

Tetanus Tetanus human Prevention: 250 units Susceptible infants and children*

immunoglobulin Treatment: 500 units (TIG)

Tetanus antitoxin Prevention: 3,000-5,000 Use when TIG is unavailable or (ATS) units unaffordable** Treatment: 500 units/Kg

or 5,000 units to newborns, 10,000 units to children, 20,000 units to adults

Poliomyelitis IGIM Prevention: 0.15 mL/Kg Rarely indicated


12/13

FP

HIBTITER

WYETH


13/13

IMMUNIZATIONS

263

CPM 1 ST EDITION

Active Immunization BCG

Lyophilized BCG Vaccine...........................120Diphtheria, Tetanus,Pertussis, Polio Myelitis(DPTIOPV) Anatetall.............................113 Difpertetall.........................113 Diftetall Ped/Diftetall Adult Use........................113 Dite Anatoxal Berna

(Chldn)/DiteAnatoxal Bema (Adult)..................113 Diteper Anatoxal Bema...............................113 D.P.T.................................. 113 Pentact-HIB........................113 Polioral/Polio Vaccine............................113 Polio Sabin.........................113 Poliovirus Vaccine Live Oral Trivalent..................113 Te Anatoxal Bema..............114 Tetavax...............................114 Tetracoq..............................114 Tetract-HIB........................114 Tritanrix............................NP*

In uenza Act-Hib..............................120 Hibtiter................................120 In exal Berna ....................120 Vaxigrip..............................120

Measles, Mumps, Rubella(MMR) Biviraten Bema...................114

Ervevax .............................114 Gunevax.............................114 Lirugen...............................114 MMR II..............................114

Moraten Bema....................116 Morbilvax...........................116 Morupar..............................116 Mumaten Bema..................116 MumeruVax........................116 Rimevax ............................116 RubeatenBema...................116 Trimovax Merieux ............116

Drugs Mentioned in the Treatment GuidelineThis index lists drugs/drug classi cations mentioned in the treatment guideline. Prescribing Information of thesedrugs can be found in the Philippine Pharmaceutical Directory (PPD) 1997. Opposite the brand name is its pagenumber in the PPD 1997.

Triviraten Bema ................116

Hepatitis B Engerix-B...........................116 Tritanrix............................NP* H-B-Vax II..........................118 Hepavax-B..........................118 RecomvaxB........................118Passive Immunization

Diphtheria, Tetanus IG Tetano/Tetanus Immune Globulin (Human)..........................120

Puri ed Tetanus Antitoxin.........................120 Tetaglobuline......................121 Tetanus Antitoxin Bema...............................121 Tetuman Berna ..................121 Tosuman Bema...................121 Hepatitis A &B GlobumanBema..............121 Globuman Hepatitis Bema...............................121 Hepabig...............................121

Measles MorumanBema...................121

Rabies Imogam Rabies...................121 Pasteur Antirabies Serum..............................121

Rabies Antiserum Bema..................................121 Rabuman Berna..................121

Other Immunologicals GlobumanBema..................122 IG Gamma..........................122 Sandoglobulin.....................122

*NP - Product Information can be found in PPD 19971st Supplement

cpm1st immunizations.pdf

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