Aimee A. Alvarico, MD Dept. of OB-Gyne.

Cotabato Regional and Medical Center

Active Immunity
process of exposing the body to an antigen to

generate an adaptive immune response response takes days/weeks to develop but may be long lastingeven lifelong Use of vaccine, antigen or immunogen Classification:
Natural-

example: Hepatitis A infection Acquired- example: Hepatitis A vaccination

Passive Immunity
process of providing IgG antibodies to protect against

infection it gives immediate, but short-lived protection several weeks to 3 or 4 months at most. Giving of gamma globulins Classification:
Natural- example: maternal transfer of tetanus antibody (IgG) Acquired- example: Hepatitis B Ig, Human Rabies Ig, Human Tetanus Ig, Human Varicella Zoster Ig

1. Live (Attenuated)

Measles, Mumps, Rubella, Chicken pox

Killed- generally refers to bacterial vaccines

2. Killed (Inactivated)
Pertussis Hepatitis A, Polio

Inactivated- generally refers to viral vaccines

3. Toxoid

Tetanus, Diphtheria, Botulism, Cholera

Hepatitis B, Haemophilus Influenzae (Hib), Pneumococcal

4. Subunit

 Target Population:
Adults ZERO, INCOMPLETE, UNKNOWN PRIMARY IMMUNIZATION SERIES COMPLETED PRIMARY SERIES OF TT IMMUNIZATION Pregnant Women ZERO, INCOMPLETE, UNKNOWN PRIMARY IMMUNIZATION SERIES > 1O YRS from last immunization Elderly > 65 years old > 65 yo with or without contact with infant < 12 months

 RECOMMENDATION:
1.
2.

ALL TARGET population= PRIMARY SERIES of Td except elderly Tdap vaccination. Td vaccine vs. TT vaccine

Td is PREFERRED over TT (additional protection to Diphtheria) as the PRIMARY IMMUNIZATION SERIES TT only be give as a BOOSTER dose, NOT PRIMARY IMMUNIZATION series. TT ONLY give if contraindicated to diphtheria component.

Td BOOSTER every 10 YEARS (completed primary series) 4. 1 dose of TETANUS- PERTUSSIS- DIPHTHERIA (Tdap) should substitute 1 BOOSTER
3.

RECOMMENDATION:
5. Pregnant women ZERO, UNKNOWN TT IMMUNIZATION

3 doses of Td= 1 month apart (2nd Trimester) 3rd dose as Tdap= Postpartum

> 10 YRS from last Td/Tdap Vaccination Td BOOSTER= 2nd and 3rd Trimester

DOSE REGIMEN:
PRIMARY IMMUNIZATION:
3

Td injections (0.5 ml IM, Deltoid) 1st 2 dose= 1 month apart For pregnant, start at 2nd Trimester 3rd dose= 6- 12 months apart as Tdap. For pregnant, give postpartum

BIVALENT HPV (CERVARIX) Target Virus TARGET POPULATION 16, 18

QUADRIVALENT HPV (GARDASIL) 6, 11, 16, 18

Women with abnormal Pap smears, history of genital warts, breastfeeding, immunocompromised 10 to 14 years old & 26 to 55 years old Women: 15-25 years old Persistent HPV infection CIN 2+ Vulvar intraepithelial lesion (VIN) Vaginal intraepithelial lesion (VAIN) CIN 2+ associated with the combined nonvaccine oncogenic HPV types 33, 45 9-45 years old Women: 16- 45 years old Persistent HPV infection CIN 2+ Anogenital wars Women: 9-45 years old Vulvar intraepithelial lesion (VIN) Vaginal intraepithelial lesion (VAIN) 0.5 ml IM @ 0, 2, 6 months

DOSE REGIMEN

0.5 ml IM @ 0, 1, 6 months

CONCOMITANT VACCINATION

Adolescents 11-17 years old Can be given concomitantly with dtap and polio vaccines

Can be give concomitantly with dtap, inactivated polio vaccine, HepA & HepB vaccines

HPV Infection status & Pap Smear NOT A PREREQUISITE to HPV VACCINATION.

 Contraindications/ Precautions/ Adverse Events:

CI: PREGNANT WOMEN, Hx of AR to any vaccine

component Can be given to women with MINOR ACUTE ILLNESSES Observer for SYNCOPE for 15 minutes post vaccination.

 TARGET POPULATION:
Routine Vaccination No evidence of immunity to varicella Persons > 13 years old School-aged children, college students & postsecondary education Other healthy adults:

Health care professionals Household contacts of immunocompromised patients Persons living/working in high risk transmission Persons living/working in a reported trasmission area Nonpregnant women of childbearing age Adolescents & adults living in households with children International travelers

Postpartum vaccination Upon delivery, 1st dose should be given prior to discharge 2nd dose, 4-8 weeks after Avoid conception for 1 month after each dose

 DOSE REGIMEN:
2 VZV injection (0.5 ml SQ) 4-8 weeks apart If > 8 weeks elapsed after 1st dose, administer 2nd dose without restarting the schedule

Storage Requirments:
Vaccine: Refrigerate immediately (35 to 46F or 2 to 8C) Diluent: refrigerated or room temp (68 to 77F or 20 to

25C) After reconstitution, store in 35 to 46F or 2 to 8C, protect from light and discard within 8 HOURS if not used.

 Target Population:
All non-pregnant women of childbearing age
Upon completion or termination of pregnancy, (-)

serologic evidence of rubella immunity/ documenation of rubella vaccination should be given 1st dose prior to discharge Routine PRENATAL serologic testing for rubella on ALL PREGNANT WOMEN who lack acceptable rubella immunity

 Dose Regimen:
1-2 doses MMR injection (0.5 ml, SQ) 1st dose given prior to discharge for postpartum women 2nd dose given after 4 weeks

(+) exposure to measles/mumps/ outbreak setting Vaccinated previously with killed measles vaccine Vaccinated in 1963-1967 (unknown type of measles vaccine) Students in postsecondary educational institutions Work in health-care facility International travel

 Contraindications/ Precautions/ Adverse Effects:

CI:
Severe allergic reaction Pregnancy

Precautions: Women should not get pregnant during the next 4 weeks post-vaccination Recent ( 11 months) receipt of antibody-containing blood products Hx of thrombocytopenia or thrombocytopenic purpura Need for tuberculin skin testing Moderate or severe acute illness with or without fever

 Target Population:
ALL PREGNANT & BREASTFEEDING WOMEN

should receive the INACTIVATED FLU VACCINE HIGH RISK GROUPS:

ALL

CHILDREN 6 months to 18 years old ELDERLY AGED 50 years old ALL HCP Other persons at risk for medical complications, their household contacts and close contacts

 Dosing Regimen:
Women > 19 years old 1 dose YEARLY (IM), as soon as newest/current WHOrecommended vaccine strains become available

CI/Precautions/AR:
CI

Severe allergic reactions from previous dose, component

Precautions GBS within 6 weeks of previous dose Moderate or severe acute illness with or without fever

Dose Regimen:
2 doses of HepA (IM) At 6-12 months apart for lasting protection

 Dose Regimen:
3 doses of HepB (20mcg/5 ml, IM) At 0, 1, 6-12 months
Accelerated Schedule
4 doses

at 0, 1, 2, 12 months

Rapid Schedule 4 doses at 0, 7, 21 days and 12 months

 Target Population:
High Risk Pregnant & Breastfeeding women 2nd and 3rd trimester

Dose Regimen:
Single dose 0.5ml IM or SQ q 5 years

1. Lynestrenol 500 mcg/tab (Exluton) , 28 tabs in 1 pill pack 2. Desogestrel 75 mcg/tab (Cerazette) , 28 tabs in 1 pill pack 3. Lynestrenol 500 mcg/tab (Daphne), 28 tabs in 1 pill pack

Cyproterone acetate 2 mg, ethinyl estradiol 35 mcg per tab (Althea), 21 tabs per 1 pill pack Ethinyl estradiol 30 mcg, levonorgestrel 125 mcg, Fe fumarate 75 mg (Trust Pill), 28 tabs per 1 pill pack Ethinyl estradiol 30 mcg, levonorgestrel 150 mcg, Fe fumarate 75 mg (Charlize), 28 tabs per 1 pill pack

Levonorgestrel 150 mcg, ethinylestradiol 30 mcg tab (Nordette), 21 tabs per 1 pill pack Ethinylestradiol 0.03 mg, gestodene 0.075 mg (Gynera), 21 tabs per 1 pill pack Drospirenone 3 mg, ethinylestradiol 0.03 mg tab ( Yasmin), 21 tabs per 1 pill pack Drospirenone 3 mg, ethinylestradiol 0.02 mg (Yaz), 28 tabs per 1 pill pack

7 blue tab each containing Desogestrel 25 mcg, ethinylestradiol 40 mcg, 15 white tab each containing Desogestrel 125 mcg, ethinylestradiol 30 mcg (Gracial), 22 tabs per 1 pill pack