dr solis - midterms - preventive pediatrics 1&2 & handouts

8/17/2019 Dr Solis - Midterms - Preventive Pediatrics 1&2 & Handouts

1/12

CSU MD 2 18B [email protected]

SUBJECT : PEDIA

TOPIC : Preventive Pediatrics 1.2

LECTURER : DR. Pauline R. Solis, DPPS, DPIDSP

INFO

Source : PPT

OUTLINE

I. PRINCIPLES OF VACCINATION

A. ACTIVE IMMUNIZATION

B. PASSIVE IMMUNIZATION

A. ACTIVE IMMUNIZATION

Refers to stimulation of a person’s own immune system thru the

administration of ANTIGENS

Usually before natural exposure to an infectious agent.

Stimulation of the immune system to PRODUCE

Antigen-Specific Humoral (antibody)

Cell-Mediated Immunity

By active immunizing agents known as vaccines

VACCINE either CONTAIN 1 or more Antigen which will interact

With the immune system such that the response would be similar to a

Natural infection without subjecting the recipient to the

Disease & its Complications.

B. PASSIVE IMMUNIZATION

Refers to administration of preformed human or animal Antibodies to

Persons Before or soon after exposure to certain infectious agents.

III. CHARACTERISTICS OF AN IDEAL VACCINE

SAFE VACCINE : it will not induce the disease into the recipient

No serious reaction or adverse effect

____- recipient should be able to produce specific antibodies

EFFICACIOUS & EFFECTIVE

EFFICACY – How effective the vaccine in inducing protective

immunity under ideal circumstances, measured in RCTS.

EFFECTIVENESS – Measures how well a vaccine perform

DURING its actual routine use in community.

INDUCE Long-Lasting if not permanent immunity against disease.

Cost-Effective

IV. CLASSIFICATION OF VACCINES

A. LIVE ATTENUATED VACCINES

B. INACTIVATED VACCINES

A. LIVE ATTENUATED VACCINES

MODIFIED Virus or Bacteria that are WEAKENED BUT

Retain the ability to Replicate & Produce immunityWithout causing illness.

PRODUCE Immunologic memory

Similar to acquiring a Natural Infection

May have interference of antibody from any source

Exposure to Heat & Light MAY

Damage antigen

Prevent replication of vaccine organism


2/12

VACCINES FOR CHILDREN LOCALLY AVAILABLE IN THE PH

Vaccineclassification

Type Available vaccines Route

Inactivatedbacterial

Toxoids &

whole cell bacteriaDTwP IM

Toxoids & inactivated

bacterial components DTaP, Tdap IM

Toxoids Tetanus, Td IM

Polysaccharide

protein conjugate

Hib,PCV,

MCV4 IM

polysaccharidePPV, MPSV4

TyphoidIM,SC

Inactivated (“killed”)

whole bacteriaCholera Oral

Inactivated virusPoliovirus(IPV),

Rabies, Hepa A

IM

Recombinant subunit Hepa B IM

Recombinant viral Ag HPV IM

Inactivated viral

componentsInfluenza IM

Combinationinactivatedbacterial &

viral

Toxoids, inactivated

bacterial components,

Recombinant viral Ag,

Polysaccharide-

protein conjugate

DPT-based

combinations:

DTaP-IPV-Hib;

DTap-IPV-Hib-HepB;

DTaP-IPV;

DTwP-Hib-HepB

IM

Live viral Live attenuated virus

Measles, MMR,

Varicella, MMRV,

Yellow fever

SC

Live bacterial Live bacteria BCG ID

V. VACCINE SCHEDULING

VACCINE SCHEDULING, INTERVALS, SPACING

Recommended ages & intervals between doses of the same antigen/

are those that

Provide optimal protection

or have the Best evidence of efficacy

MULTIPLE-DOSE VACCINE should follow a schedule based on the

Minimum age & Minimum interval between doses

MINIMUM AGE

Age at which a significant risk for the disease exists

MINIMUM INTERVAL BETWEEN DOSES

Minimum interval recommended to ensure that a protective

immune response against the disease is achieved

VACCINE DOSES

Should NOT be administered at intervals less thanThe minimum interval or earlier than the minimal age

Vaccine doses Administered up to 4 days before

The minimum interval or minimum age can be counted as valid

E.g. Baby received 1st dose of DPT at

5 wks & 3 days old-valid

ROTAVIRUS VACCINE (RV1/RV5)

Maximum age of 1st dose

ACIP: 14weeks & 6daysRV5 : 12 weeks

Minimum interval between doses: 4weeks

Dose Maximum age for any dose

ACIP: 8months 0days

RV1: 24weeks

RV5: 32 weeks


3/12

Infants are exposed to many bacteria & viruses daily

Exposure to one bacterium from the environment can contain

Up to 6000 immunologic components

MISSED/ LAPSED IMMUNIZATIONS

Delayed doses or interruption of schedule does not reduce response to

The vaccine but immunization series must be completed

It is NOT necessary to restart series or give additional doses

Regardless of time elapsed between doses

Rabies Vaccination is an exception

CATCH- UP IMMUNIZATIONS

Recommended for patients who have misses out on previously

Scheduled vaccines or have been delayed in receiving subsequent

Doses of multi- dose vaccine

Ensures that these children receive protection quickly as possibleBy providing missing dose/s

Must be based on available, & preferably written documentation

of previous vaccination

When records are not available or immunization status is uncertain,

The schedule of vaccination appropriate for patient’s age

Must be administered

If more than one vaccine is overdue, all appropriate vaccines maybe

given at the same time following the general principles of simultaneous

administration of multiple vaccines.

VI. VACCINE INTERCHANGEABILITY

Ideally, vaccination series should be completed with the

SAME VACCINE BRAND

If a brand is not available or unknown, ANOTHER BRAND of the

SAME VACCINE type / dose can be used to complete the series

Rabies Vaccine are Exceptions

VIII. VACCINE PRECAUTION

A condition in a person that May

Increase the chance or severity of a serious adverse reaction

might compromise the ability of the vaccine to produce immunity

Vaccines should be deferred when precaution is present unless the

benefit of protection outweighs the risks for adverse events

PERMANENT PRECAUTIONS FOR FURTHER DOSES

OF PEDIATRIC PERTUSSIS CONTAINING VACCINES

TEMPERATURE

>= 40.5ᵒC within 48 hours of a dose

Collapse or shock - like state

(hypotonic hyporesponsive episode)

within 48 hours of a dose

Persistent inconsolable crying lasting 3 or more hours

occurring within 48 hours of a dose

Seizure with or without fever

occurring within 3 days of a dose

(Associated with whole cell pertussis containing vaccine)

TEMPORARY PRECAUTIONS

History of Guillain-Barre syndrome (GBS)

Tetanus containing

Influenza & Meningococcal conjugate vaccines

Unstable progressive neurological problem

Moderate or severe illness – all vaccines

Recent receipt of Ab -containing blood product –

live injectable vaccines

IX. INVALID CONTRAINDICATIONS TO VACCINE

1. Prematurity


4/12

Vaccine safety adverse reactions are commonly related to local

reactions such as pain on injection site.

Occasionally fever or rash & is usually mild.

Case series on 12 children where the investigators were not blinded.

MMR vaccines cause Autism through a gut reaction (Ileocecal

lymphoid nodular hyperplasia) that release brain damaging

peptides which increased ASD risk.Many studies thereafter which included thousands of subject

proved that there is really no link between MMR vaccines & ASD.

Lancet retracted the Wakefield study in 2010.

Wakefield was stripped of his medical license in 2010.

VACCINES & STEROIDS

Corticosteroid therapy usually is not a contraindication

to administering live-virus vaccine when :

Short term (


5/12

TABLE 1

ADMINISTERED FIRST ADMINISTERED SECOND RECOMMENDED MINIMUM INTERVAL BETWEEN DOSES

Antibody-containing products Inactivated antigens No interval necessary

Inactivated antigens Antibody-containing products No interval necessary

Antibody-containing products Live antigen Dose-related

Live antigen Antibody-containing products 2 weeks

TABLE 2

RECOMMENDED INTERVALS BETWEEN

ADMINISTRATION OF ANTIBODY-CONTAINING PRODUCTS & MEASLES OR VARICELLA-CONTAINING VACCONE

PRODUCT/ INDICATION DOSE (mg IgG/kg) Px ROUTE INTERVAL (MONTHS)

Tetanus Ig 250 units (10mg/kg) IM 3

HEPATITIS A Ig

Contact prophylaxis 0.02 ml/kg (3.3 mg/kg) IM 3

International travel 0.06 ml/kg (10 mg/kg) IM 3

Hepatitis B Ig 0.06 ml/kg (10 mg/kg) IM 3

Rabies Ig 20 IU/kg (22mg/kg) IM 4

BLOOD TRANSFUSION

RBC’s, washed 10 ml/kg, negligible IgG/kg IV None

RBC’s, adenine-saline added 10 ml/kg (10 mg/kg) IV 3

PRBCs 10 ml/kg (60 mg/kg) IV 6

Whole Blood 10 ml/kg (80-100 mg/kg) IV 6

Plasma/Platelet products 10 ml/kg (160 mg/kg) IV 7

IVIG


6/12

CSU MD 2 18B [email protected]

SUBJECT : PEDIA

TOPIC : Preventive Pediatrics 2.2

LECTURER : DR. Pauline R. Solis, DPPS, DPIDSP

INFO

Source : PPT

OUTLINE

I. IMMUNIZATION IN SPECIAL CLINICAL CIRCUMSTANCES

II. VACCINE SAFETY

III. FREQUENTLY ASKED QUESTIONS ON VACCINATION

I. IMMUNIZATION IN SPECIAL CLINICAL CIRCUMSTANCES

PRETERM AND LOW BIRTH WEIGHT INFANTS

Medically Stable* infants born


7/12

II. VACCINE SAFETY

ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI)

Any untoward medical occurrence which follows immunization &

which does not necessarily have a causal relationship with the

usage of vaccine.

The adverse event maybe an Unfavorable or Unattended signs,abnormal laboratory finding, symptom or disease.

Category Frequency Percentage

Very common ≥1/100 ≥10%

Common

(frequent) ≥1/100 and


8/12


9/12


10/12


11/12


12/12

dr solis - midterms - preventive pediatrics 1&2 & handouts

Documents