IMMUNIZATION

• BCG


  Bacille Calmette Guerin
• BCG administration


  1. Given intradermally (ID)

  2. Dose for children < 12 months: 0.05 ml

  3. Dose for children ≥ 12 months: 0.1 ml

  4. Given at the earliest possible age after birth preferably within the first 2 months of life

  
• For healthy infants and children > 2 months who are not given BCG at birth


  PPD prior to BCG vaccination is not necessary

  
• If any of the following is present


  PPD is recommended prior to BCG vaccination

  
• Conditions where PPD is recommended prior to BCG vaccination


  • Congenital TB
  • History of close contact to known or suspected infectious cases
  • Clinical findings suggestive of TB and/or chest x-ray suggestive of TB

  
• In the presence of any of these conditions, an induration of 5 mm is considered positive and BCG is no longer recommended
• DTP


  Diphtheria, Tetanus, Pertussis Vaccine
• DTP administration


  1. Given intramuscularly (IM)

  2. Given at a minimum age of 6 weeks

  3. Primary series consists of 3 doses with a minimum interval of 4 weeks

  4. Booster series consists of 3 doses until adolescence with the following schedule: 12-18 months (DTP), 4-6 years (DTP), 9-18 years (Td/Tdap)

  5. Ideally, the minimum interval between booster doses should be at least 4 years

  6. Full-dose DTP should preferably be used only until age 7 years, but package inserts should be consulted for maximum age indications of specific products
• Hib


  Haemophilus Influenzae Type B Conjugate Vaccine
• Hib administration


  1. Given intramuscularly (IM)

  2. Given as a 3-dose primary series with a minimum age of 6 weeks and a minimum interval of 4 weeks

  3. A booster dose is given between age 12-15 months with an interval of 6 months from the third dose
• Refer to Vaccines for Special Groups for Hib recommendation in high risk children

  
• Hepatitis A Vaccine (HAV)


  • Inactivated Hepatitis A Vaccine
  • Live attenuated Hepatitis A Vaccine
• Inactivated Hepatitis A Vaccine administration


  1. Given intramuscularly (IM)

  2. Minimum age: 12 months

  3. 2 dose series: minimum interval between first and second dose is 6 months
• Live attenuated Hepatitis A Vaccine administration


  1. Given subcutaneously (SC)

  2. Minimum age: 18 months

  3. Given as single dose
• Hepatitis B Vaccine (HBV)


  Monovalent Hepatitis B Vaccine
• Hepatitis B Vaccine administration


  1. Given intramuscularly (IM)

  2. Administer the first dose to all newborns ≥2kgs within 24 hours of life

  3. A second dose is given 1-2 months after the birth dose

  4. The final dose is administered not earlier than 24 weeks of age

  5. Another dose is needed if the last dose was given at age <24 weeks

  
• Hepatitis B Vaccine administration for infants born to HBsAg (+) mothers


  1. Administer HBV and HBIG (0.5ml) within 12 hours of life

  2. HBIG should be administered not later than 7 days of age, if not immediately available

  
• Hepatitis B Vaccine administration for infants born to mothers with unknown HBsAg status


  1. With birth weight ≥2 kgs, administer HBV within 12 hours of birth and determine the mother's HBsAg as soon as possible. If HBsAg (+), administer HBIG not later than 7 days of age.

  2. With birth weight <2 kgs, administer HBIG in addition to HBV within 12 hours of life

  
• For infants born <2 kgs, the 1st dose received at birth is not counted as part of the vaccine series. Additional 3 HBV doses are needed

  
• Human Papillomavirus Vaccine (HPV)


  Bivalent HPV (2vHPV), quadrivalent (4vHPV) or nonavalent (9vHPV)
• HPV administration for ages 9-14 years


  1. 2-dose series recommended at 0 and 6 months

  2. If the interval between the first and second dose is less than 6 months, a third dose is needed, the minimum interval between the second and third dose is 3 months
• HPV administration for ages 15 years and older


  1. 3-dose series recommended at 0, 2 and 6 months

  2. The minimum interval between the first and the second dose is 1 month and the minimum interval between the second and third dose is 3 months, the third dose should be given at least 6 months from the first dose
• For males age 9-18 years, a 4vHPV and 9vHPV can be given for the prevention of anogenital warts and anal cancer
• Influenza Vaccine


  • Trivalent influenza vaccine (TIV)
  • Quadrivalent influenza vaccine (QIV)
• Influenza Vaccine administration


  1. Given intramuscularly (IM) or subcutaneously (SC)

  2. Given at a minimum age of 6 months

  3. For pediatric dose, follow the manufacturer's recommendations

  4. Children age 6 months to 8 years receiving influenza vaccine for the 1st time should receive 2 doses separated by at least 4 weeks

  5. If only one dose was given during the previous influenza season, give 2 doses of the vaccine then one dose yearly thereafter

  6. Children age 9 to 18 years should receive one dose of the vaccine yearly

  7. Annual vaccination should begin in February but may be given throughout the year

  
• Japanese Encephalitis Live Attenuated Recombinant Vaccine


  Live attenuated recombinant vaccine
• Japanese Encephalitis Vaccine administration


  1. Given subcutaneously (SC)

  2. Given at a minimum age of 9 months

  3. Children age 9 months to 17 years should receive one primary dose followed by a booster dose 12-24 months after the primary dose

  4. Individuals 18 years and older should receive a single dose only

  
• Measles Vaccine


  Monovalent measles vaccine
• Measles Vaccine administration


  1. Given subcutaneously (SC)

  2. Given at the age of 9 months, but may be given as early as age 6 months in cases of outbreaks as declared by public health authorities

  3. If monovalent measles vaccine is not available, then MMR/MR vaccine may be given as substitute for infants below 12 months of age. In such cases, the recipient should receive 2 more MMR vaccines starting at 1 year of age, following recommended schedules

  
• Measles-Mumps-Rubella (MMR) Vaccine


  MMR vaccine
• MMR Vaccine administration


  1. Given subcutaneously (SC)

  2. Given at a minimum age of 12 months

  3. 2 doses of MMR vaccine are recommended

  4. The second dose is usually given at 4-6 years of age but may be given at an earlier age with a minimum of 4 weeks interval between doses

  
• Measles-Mumps-Rubella-Varicella (MMRV) Vaccine


  MMRV vaccine
• MMRV Vaccine administration


  1. Given subcutaneously (SC)

  2. Given at a minimum age of 12 months

  3. MMRV may be given as an alternative to separately administered MMR and Varicella vaccines

  4. The maximum age is 12 years

  5. The recommended minimum interval between doses is 3 months, but a second dose given 4 weeks from the first dose is considered valid

  
• Pneumococcal Conjugate Vaccine (PCV)


  PCV 10, PCV 13, PCV 15
• PCV administration


  1. Given intramuscularly (IM)

  2. Given at a minimum age of 6 weeks

  3. Primary vaccination consists of 3 doses with an interval of at least 4-8 weeks between doses. A booster (4th) dose for PCV 10 is given at least 6 months after the third dose. A booster (4th) dose for PCV 13/15 should be administered at approximately 11 through 15 months of age and at least 2 months after the third dose and for preterm infants (<37 weeks at birth) should receive a 4-dose regimen, with the fourth dose to be administered at approximately 11 through 15 months of age.

  4. For unvaccinated infants age 7-11 months, give a total of 3 doses. The first 2 doses are given 4 weeks apart. The 3rd dose is given after 12 months of age, separated from the 2nd dose by at least 8 weeks

  5. For unvaccinated older children age 12 months to 5 years: PHID-CV (10-valent): 12 months - 5 years old: give 2 doses at least 8 weeks apart, PCV 10-SII: 12-24 months old: give 2 doses at least 8 weeks apart up to 2 years old only, PCV 13: 12-23 months old: give 2 doses at least 8 weeks apart, 2-5 years old: give 1 dose, PCV 15: 12-23 months old: give 2 doses at least 8 weeks apart, 2-5 years old: give 1 dose

  
• Poliovirus Vaccine


  • Inactivated Polio Vaccine (IPV)
  • Oral Polio Vaccine (OPV)
• IPV administration


  1. Given intramuscularly (IM), or in combination with DPT-containing vaccines

  2. Given at a minimum age of 6 weeks, at least 4 weeks apart

  3. The primary series consists of 3 doses given at 6, 10, and 14 weeks.

  4. The first booster is given at 12-18 months. The minimum interval between the third dose and the first booster dose is 6 months.

  5. The second booster is given at age 4-6 years.

  6. If the fourth dose is given at age 4 years onward, no further doses are necessary

  
• OPV/IPV as part of the National Immunization Program (DOH)


  1. The Oral Polio Vaccine is available as part of the government's National Immunization Program

  2. The primary series consists of 3 doses beginning at age 6 weeks with a minimum interval of ≥4 weeks

  3. The first dose of IPV is given together with the third dose of OPV

  4. The second dose of IPV is given together with the measles vaccine at 9 months

  
• Rotavirus Vaccine (RV)


  • RV1 (2-dose series)
  • RV5 (3-dose series)
• RV1 administration


  1. Given per orem (PO) as oral liquid formulation

  2. Given as a 2-dose series

  3. Given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should be administered not later than 24 weeks of age