PREVENTIVE PEDIATRICS Flashcards
INACTIVATED VACCINES
- Hepatitis B vaccine
- DPT vaccine
- H. influenzae b vaccine
- Pneumococcal vaccine
- Hepatitis A vaccine
- Meningococcal vaccine
- Influenza trivalent vaccine
- Human papillomavirus vaccine
- Typhoid fever vaccine (IM)
- Rabies vaccine
- Inactivated polio vaccine (IPV)
LIVE VACCINES
- BCG vaccine
- Measles vaccine
- MMR vaccine
- Varicella vaccine
- Rotavirus vaccine
- Influenza attenuated vaccine (intranasal)
- Typhoid fever (oral) vaccine
- Oral polio vaccine
- Japanese Encephalitis
Vaccine spacing and intervals
Yellow fever vaccine (live) and Cholera vaccine (inactivated) – separate by at least ____ because of diminished Ab response if given simultaneously
3 weeks
Can two live vaccines be given together?
YES
Can live-inactivated be given together?
YES
Can I give a live vaccine today followed by an inactivated tomorrow?
YES
Can I give an inactivated today then inactivated tomorrow?
YES
Can I give inactivated today and live tomorrow?
YES
Can I give Live today and another live tomorrow?
NO
* If live + live vaccine, either give it SIMULTANEOUSLY, otherwise you have to wait 4 weeks.
BCG
- At birth, preferably within first 2mo
- Intradermal
- 0.05ml < 12months
- 0.1ml >12months
2 permanent contraindications to vaccination
- Anaphylactic reaction
- Encephalopathy not due to another identifiable cause occurring within 7 days after pertussis vaccination
2 temporary contraindications to live vaccines but not with inactivated vaccines:
- Pregnancy
- immunosuppression
What is the earliest time you can give the measles vaccine?
6 months
PPS RECOMMENDED VACCINES
Hep B
- At birth w/in 12hours of life
- 6-10-14weeks
DPT
- 6-10-14weeks
- Booster Usually at 1y/o and 4yo
- Interval between 3 rd and 4 th dose is 6months (4months is acceptable). 5 th dose not needed if 4 th dose given at 4y/o or older
Hib
- 6-10-14weeks
- 12-15mo booster
- Booster given 6mo from 3rd dose
- Not routinely given >5y/o
Polio
- 6-10-14weeks
- booster On or after 4th birthday
- Oral or IM
- Booster 6months from the previous dose
Pneumococcal
- 6-10-14weeks
- booster 6months after 3rd dose
- Healthy children 2-5y/o without previous vaccine may be given 1 dose PCV 13 or 2 doses PCV 10 8 weeks apart
- Not recommended for > 5y/
Rotavirus Vaccine
- 1 st dose: ALL infants 6 weeks up to 14 weeks and 6 days old
- 2nd dose: 10—32 weeks (final dose 8 months and 0 day)
- Should be strict with the schedule because of possible intussusception
- CUTOFF AGE: 14 weeks and 6 days old
- DO NOT give rotavirus vaccine beyond the cut-off age!
Influenza
- minimum 6months
- Initial of 2 doses 4 weeks apart for 6months to 8y/o
- 0.25ml for 6mo-35mo
- 0.5ml for 36mo-18y/o
Measles
- 9months
- Subcutaneous
- May be given at 6months if with outbreak
Japanese Encephalitis
- 9months
- Subcutaneous
- 9-17yo give 1 booster 12-24 months from primary series
- 18y/o and above total 1 dose
- <18y/o total of 2 doses
MMR
- 12months
- 2 doses at least 4 weeks apart
- 2 nd dose usually at 4-6y/o
- Subcutaneous
- Children <12mo given any measles containing vaccine should receive additional 2 doses of MMR
Varicella
- 12months
- 2 doses
- 2nd dose at 4-6y/o
- <13yo – interval between 2 doses at least 3months
- (*4 weeks is acceptable)
- 13 and above- 4 weeks interval
Hepatitis A
- 12months
- 2 doses 6 months apart
Tetanus and diphtheria toxoid (Td) / Tetanus and diphtheria toxoid and acellular pertussis (TDaP)
- Fully immunized children, defined as 5 doses of DTP or 4 doses if 4 th dose given on or after 4 th birthday, Td booster given every 10 years.
- Single Tdap can be given to replace due dose of Td
- Fully immunized pregnant adolescent give 1 dose Tdap any time after 20 weeks AOG
- Unimmunized pregnant adolescent give 3 dose td containing vaccine (Td/Tdap) following 0-1-6mo schedule.
Tdap should replace Td preferably after 20weeks AOG
Human Papilloma Virus
- 9y/o
- Bivalent 0-16months
- Quadrivalent 02-6months
- Interval between:
- 1st and 2nd dose is 1 month
- 2nd and 3rd dose is 3months
- 3rd and 1st dose is 6months
A male neonate was born from a HbsAg (+) mother, which among the ff. should be given to the neonate?
Hep B Vaccine and Hep B Immunoglobulin
Active anti-rabies vaccine
0.5 ml IM on days 0, 3, 7, 14, 28
Passive rabies vaccine
- HRIG – 20 U/kg (1/2 of the dose IM & ½ of the dose infiltrated around the wound), or;
- ERIG – 40 U/kg (needs skin testing)
Drug of choice for rabies prophylaxis?
Co-Amoxiclav at 40 mg/kg/day for 7 days
Simultaneous administration of Vaccines, no comtraindication except for
- MCV and DPT, and
- Yellow fever and Cholera
A 10-month-old infant had measles, what will you give in an exposed unvaccinated child to prevent measles?
Vaccinate immediately
POST EXPOSURE PROPHYLAXIS for varicella exposure
o VZIG within 96 hours 1 vial (125 U/1.25ml) per 10 kg IM (never IV!!) max of 5 vials
o Vaccine: healthy children within 3-5 days
o Newborn: give if onset of varicella <5 d pre delivery or within 48 hours
Meningococcemia prophylaxis
Rifampicin, Ceftriaxone or Ciprofloxacin (adults)
Diphtheria
o All close contact regardless of immune status
o Give booster if none within last 5 years
o Erythromycin 40-50mg/kg/d or Benzathine Pen G
In children younger than 1 year of age, what is the preferred site for IM injection?
anterolateral aspect of the thigh provides the largest muscle
In older children, what is the preferred site for IM?
deltoid muscle
This site should not be used for active immunization because the gluteal region is covered by a significant layer of subcutaneous fat and because of the possibility of damaging the sciatic nerve.
upper, outer aspect of the buttocks
DEWORMING
- Recommended for all children 1-12yo
-
Albendazole
- 12mos to 23mos – 200mg single dose Q6mo
- 24mos and up – 400mg single dose Q6mo
-
Mebendazole
- 12months and above – 500mg single dose Q6mo
IRON SUPPLEMENTATION
Contraindications to Deworming
o Severe malnutrition
o High grade fever
o Profuse diarrhea
o Abdominal Pain
o Serious illness
o Hypersensitivity to anti-helminthic drug
