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Championing Immunization (Dr. Gimenez)
Championing Immunization (Dr. Gimenez)
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PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
Measles prophylaxis as IG for people NOT 6 • Parenteral live vaccines (MMR, MMRV, varicella,
pregnant/severely immunocompromised zoster, and yellow fever) and LAIV are not believed
Measles prophylaxis as IG for pregnant 8 to have an effect on live vaccines given by the oral
and/or severely immunocompromised route (OPV, oral typhoid, and rotavirus). Live oral
Rabies prophylaxis as RIG 4 vaccines may be given at any time before or after
Replacement for immune deficiency as IVIG 8 live parenteral vaccines or LAIV.
RSV prophylaxis (palivizumab monoclonal None
antibody) Timing: 2 Live Vaccines
IVIG for ITP • The 4 day grace period should not be applied to the
400 mg/kg 8 4 week interval between 2 different live vaccines.
800 – 1000 mg/kg 10 • This is only applicable if either vaccine was given
IVIG for KD alone.
1600 – 2000 mg/kg 11 - MMR1 given < 4 days to second dose of MMR
Varicella prophylaxis is VALID
As IVIG 8 - MMR and Varicella < 4 days to second dose of
As VariZIG (IM) 5 MMR is NOT VALID
- MMRV < 4 days to second dose of MMRV is
Case Number 1: An 3 year old who was born preterm was NOT VALID
recently diagnosed for Kawasaki disease. Patient was given
IVIG and aspirin. Interval Between Doses of the Same Vaccine
Mother is worried that she will be unable to complete her • Doses should not be given earlier than the
immunization on time. She particularly asks you at what age minimum age
can the varicella vaccine be given? • Vaccine doses given 4 days before the minimum
Upon review of her immunization record, you find out that interval or age is counted as valid ( ACIP )
she has been given two doses of MMR and one Varicella at • Doses administered up to 4 days before the
2 years of age. minimum interval or age can be counted as valid*
She is currently on antibiotic for treatment of UTI. • Any vaccine administered ≥5 days earlier than the
Your plan of action. minimum interval or age should not be counted as
valid doses and should be repeated as age
Questions appropriate.
Can she receive vaccines? • The repeat dose should be spaced after the invalid
Considerations to be taken into account.. dose by the recommended minimum interval.
If so, what vaccine/vaccines may be given ? • It is not necessary to restart the series or add doses
Timing of the vaccine ? because of an extended interval between doses
*Exception: Rabies Vaccine
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PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
Page 3 of 12
PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
• Inactivated vaccines are safe to use in • LIVE VACCINES should be administered ≥4 weeks
immunosuppressed persons but the response to prior to immunosuppression and should be
the vaccine may be decreased avoided within 2 weeks of initiation of
immunosuppression.
Timing of Vaccinations • INACTIVATED VACCINES should be administered ≥2
• Vaccines should be administered prior to planned weeks prior to immunosuppression
immunosuppression if feasible. • Delay live vaccines for at least 1 month after
discontinuation of high-dose therapy of steroids
Case Number 5: A healthy 4 month old infant is brought to Refer to Vaccines for Special Groups for Hib
your clinic. Mother claims there was no BCG given at the recommendation in high risk children
health center at the time of birth. She recently learned that
the baby father tested positive on sputum smear. • Diphtheria and Tetanus Toxoid and Pertussis
What is your plan of action? Vaccine (DTP)
- Given intramuscularly (IM)
• Hepatitis B Vaccine (HBV) - Given at a minimum age of 6 weeks
- Given intramuscularly (IM) - The primary series consists of 3 doses with a
- Administer the first dose of monovalent HBV to minimum interval of 4 wks
all newborns >2kgs within 24 hours of life. - Booster series consist of 3 doses until
- A 2nd dose is given 1-2 months after the birth adolescence with the following schedule:
dose o 12-23 months (DTP)
- The final dose is administered not earlier than o 4-7 years (DTP)
24 weeks of age. Another dose is needed if the o 9-15 years (Td/Tdap)
last dose was given at age <24 weeks. - Ideally, the minimum interval between booster
- For infants born to HBsAg (+) mothers: doses should be at least 4 years
o Administer HBV and HBIG (0.5ml) - Full dose DTP should preferably be used only
within 12 hours of life. HBIG should be until age 7 years but package inserts should be
administered not later than 7 days of consulted for maximum age indications of
age, if not immediately available. specific products
- For infants born to mothers with unknown
• Inactivated Poliovirus Vaccine (IPV)
HBsAg status: - Given intramuscularly (IM), as a standalone IPV
o Birth weight ≥2 kgs: administer HBV or in combination with DTP containing vaccines
within 12 hours of birth and - The primary series consists of 3 doses
determine the mother’s hbsag as soon - Given at a minimum age of 6 weeks, at least of
as possible. 4 weeks apart in between doses
o Hbsag (+): administer also HBIG not - First booster at 12-18 months of age. The
later than 7 days of age. minimum interval between the third dose and
o Birth weight <2 kgs: administer HBIg in and the first booster is 6 months.
addition to HBV within 12 hours of - The second booster is given at 4-6 years of age
life. - If the 4th dose is given at age 4 years onward ,
o <2 kgs: the 1st dose received at birth is no further doses are necessary
not counted as part of the vaccine
series. Additional 3 HBV doses are • Oral Polio (LHC)
needed. - Only available as part of the government`s NIP
- Given per orem ( PO )
Case Number 6: A mother comes to you as she is set to - The primary series consists of 3 doses
deliver in 7 weeks. She found out that she was HBsAg beginning at age 6 weeks with a minimum
positive and negative for all STI`s including HIV. The child was interval of 4 weeks
born prematurely and weighed 1.8 grams
Your plan of action? How many doses will constitute the
primary series?
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PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
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PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
Page 8 of 12
PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
Incompletely
One dose Tdap then Td for
vaccinated 1-2
remaining dose
9-18 yrs old
Fully vaccinated
1 1 dose Tdap then Td every 10 yrs
9-18 yrs old
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PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
Page 10 of 12
PCMC 27th COMPREHENSIVE REVIEW Championing Immunization
Fatima Ignacio Gimenez, MD, FPPS, FPIDS
• Typhoid vaccine
- Given intramuscularly (IM)
- Given at a minimum age of 2 years old with
revaccination every 2—3 years
- Recommended for travellers to areas where
there is a risk for exposure and for outbreak
situations as declared by public health
authorities
• Cholera vaccine
- Given per orem (PO)
- Given at a minimum age of 12 months as a 2-
dose series two weeks apart.
- Recommended for outbreak situations and
natural disasters as declared by health
authorities
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