Vaccine

Diptheria

Preparation
- Combined DPT - Diphtheria Toxoid - Diphther-Tetanus (DT)

Schedule, Site, Dose and Route

- In Philippine EPI: 0.5 mL, IM, at the upper outer thigh during 1, 2, and 3 mos. old - 3 doses of 0.5 mL, IM at 4-6 weeks interval - Must be less than 6 years old, cannot be given to adults 3 doses of 0.5 mL, IM at 4-6 weeks interval with a booster dose 1 year later - Required as a booster every 10 years after an initial TDAP (Tetanus, Diphteria and Acellular Pertussis vaccine) - Given as DTP - US only

Adverse Reactions
- High fever - Collapse followed by either recovery or shock like state of prostration - Thrombocytopenic purpura - Neurologic symptoms: common

Contraindications
- Severe febrile reaction - Any CNS symptom following perussis immunization

- Tetanus (Td) Adult

Pertussis

- Whole Cell Vaccine - Acellular vaccine

Tetanus

Polio

- Tetanus toxid, aluminum adsorbed - DPT - Td - DT: not available in the Philippines - DPT-Polio-HIV - TdAP - Salk vaccine or Inactivated/Killed Polio Vaccine (IPV)

Given as previously under diphtheria

- Local reactions: redness, tenderness, swelling - Systemic: Fever (100-102 F), crying, irritability - Uncommon: persistent crying, high pitched cry, convulsions, hypotonic episodes - Hypersensitivity reaction Rare, usually local erythema/tenderness

Rare, severe allergic rxns

- IM

Advantages: - No risk of contracting the disease - Simplicity of storage - Can be given to susceptible adults Disadvantages: - Wild polio virus can still grow in the GIT - Expensive - Reduction of antibody titer - IM injection inconvenient Advantages: - Limits growth of virus in GIT - Ease of administration - Cheap

- Altered immune status and immunosuppressive therapy - Siblings of children who are immunosuppressed - Pregnancy

- Sabin vaccine or Attenuated (live) oral vaccine (TOPV)

- minimum age: 2 mos. EPI: 1 mos, 2 mos, 3 mos oral

BCG (Bacillus of Calmette and Guerin) Measles

- Live attenuated strain from Mycobacterium bovis

- any age but must be atleast 3kg optimumly 6mos - EPI: Newborn to 12 mos, right deltoid, 0.5 mL, ID - 0.5 mL, IM or SC, ideally 15 mos. old - during outbreak immunize at 6 mos, then reimmunize at 9-15 mos - post-exposure immunization: within 3 days post-exposure Older children and adults: 0.5 mL, deltoid, IM Infants (<6 mos.): Anterolateral thigh

Disadvantages: - May cause polio in immunosuppressed - Freezing storage temp. inconvenient - No assurance that patient received the vaccine - Local reactions occur within 3-5 weeks. If papule appears early within days, then suspect TB (papule, lymphadenitis, osteomyelitis) - Systemic: minimal or slight, disseminated BCG in immunocompromised Mild - 10-20% low grade fever, malaise, skin rash 510days after - CNS: rare, encephalitis, Reye syndrome, cranial nerve palsy, Guillain-Barre syndrome - SSPE subacute sclerosing panencephalitis: rare

- Schwarz and Moraten strains in chick embryo tissue cultures

- Generalized malignancies - Skin infections - Immunosuppression - Burns - Prematurity - Severe malnutrition - Allergy to chicken or eggs - Immune deficiency states - Pregnancy - Recent injection of gamma globulin, whole blood derivatives or plasma

Hepatitis B

**please search and confirm..di ko magets un notes ng hepa

Rubella

- Prepared in duck embryo or human diploid cell culture - Singles or as MMR

Single dose, SC

- Transient joint manifestations (related to age of vaccine): arthralgia or arthritis 2-10 weeks after - Transient peripheral neuritis

Mumps Rabies Vaccine

**padouble check uli d ko gets notes

- Jeryl-Lynn Strain: live attenuated growth in chick embryo - Human Diploid cell vaccine Newest formulations: - Purified vercell rabies vaccine: less expensive - PCEC (Chiron) purified chicken: pre-exposure (3 doses at 0, 7, 21,0r 28 days); post exposure (5 doses at 0, 3, 7, 14, 28 days) Japanese Oka Strain

- Single dose, 0.5 mL, SC - Part of MMR 0, 3, 7, 14, 28 days after contact with rabid animal

- Side effects are few

- Pregnancy - Active PTB - Hypersensitivity to vaccine components (neomycin in package label) - Other general contraindications - General contraindications - Hypersensitivity to neomycin - Pregnancy is NOT a contraindication

Varicella

- SC, 9 mos- 12 yrs old with a recommended 2nd dose prefereably 1 year after

- acute febrile illness - pregnancy - immune globulin or plasma

- post exposure: 3-5 days after exposure, otherwise give acyclovir 80mg/kg/day in divided doses for 7 days

transfusion given 3 mos previously conditions associated with sever or fatal varicella: - immune deficiency states (prematurity, cancer, radiotherapy, burns, malnutrition etc) - pregnancy

Influenze Type B

PRP (polyribose ribitol phosphate capsule) Conjugated vaccines: - PRP-D (Prohibit): with Diphtheria Toxoid - PRP-T: Tetanus toxoid - HbOc: CRM (a diptheria toxin) - PRP-OMP: outer membrane protein complex of N. meningitis - Oral vaccine Live attenuated Salmonella typhi type 21 strain Injectible vaccines Vi capsular polysaccharide vaccine

<6 mos: 2,3,4 or 2,4,6 mos >6 mos: 6,7 or 6,8 mos booster: after 1 year

Shigellosis

Capsules given on day 1,3,5,7

- Not usually used because not that effective - Claimed to be effective for 3 years

Single dose, SC/IM, effective for 3 years 2-3 weeks after administration Minimum age: 1 y/o

Mild side effects - Local pain - Fever No serious adverse effects reported

- Mild GIT disturbance - <6 y/o or >10 y/o - pregnancy - progressive diseases - general contraindications - Hypersensitivity to vaccine components - Pregnancy - Fever - Severe infection

Hepatitis A Pneumococcal Vaccine

- 23 valent pneumococcal polysaccharide vaccine (PPV-23) - Pneumococcal conjugate vaccine (PCV7) - PCV10 - PCV13 Multivalent inactivated vaccine containing 3 virus strains (available now) Live attenuated intranasal vaccine (under development0

IM, 2 doses 6-12 mos apart Miminum age: 1 year old - Cheaper, given 2 years old and above - 2,4,6,12 mos

Influenza Vaccine

Annual vaccination Must be at least 6 mos or older

Meningococcus

Meningococcal polysaccharide vaccine (against group A and C): Type B is deadly but its not that infectious Prepared as duck embryo or human diploid cell culture

SC as single dose

- Transient joint manifestations - Transient peripheral neuritis

- Pregnancy - Active PTB - Known hypersensitivity (neomycin) - Other general C/I