August 2, 2012

Adult Immunizations for

Filipinos
Dr. Solante

in the prevention of the common infectious diseases

in our country.
Outline:
1. Rationale for adult Vaccination
Objectives
2. Classification of Vaccines
3. Contraindications/Precautions
4. Hepatitis B Vaccine
5. Tetanus-Diptheria Vaccine
6. MMR Vaccine
7. Varicella Vaccine
8. Influenza Vaccine
Influenza
H1N1
9. Pneumococcal Vaccine
10. Thypoid Fever Vaccine
11. Rabies Vaccine
12. Role of Passive Immunization
13. Routine Immunizations for Filipino Health Care Workers
(HCW)
14.Summary

Note: Sir said we might not be able to find this topic in

books; also he focused on the handout for adult
immunization

RATIONALE FOR ADULT VACCINATION

Benefits of vaccination should be extended to adults
o Starting immunization (never too late)
o Updating immunization status
Adults are not invincible to vaccine preventable
diseases
o Increase exposure vs children
o Presence of special populations at risk:
High risk adults with underlying co
morbidities
Elderly
o Adults at risk for acquiring and transmitting
vaccine preventable diseases from other adults
and children
We have 2012 guidelines coming this month, Sir said
well settle first with the 2009, but sir included from
the 2012 guidelines, immunizations for health care
workers, which is unique bec were the only country
to give recommendations for individuals working in
the hospitals
The rationale here is we want to protect any individual
at risk of common infectious disease in our country.
Thats the reason why you cannot find this in other
articles because each country ahs specific
immunization guidelines depending on the common
infectious diseases in that particular country
You can decrease the transmission or vaccinepreventable diseases from other adults and children.
Especially, doctors, interns, nurses, theres a two
way mode of transmitting infections. Either from you
or the patient. So it is important to enumerate which
vaccine will protect you and your patient.

OBJECTIVES
To provide standards of care for the prevention of the
common infectious diseases in the Philippines, with
emphasis on the local epidemiology, vaccine dose,
route, schedule, preparations and indication.
To be a useful reference of the practicing physicians, so
as to be able to recommend the appropriate vaccines
(J-group) K.A, KIMPOY and MAGSIE

Edited by: Constantino

CLASSIFICATION OF VACCINES
Before we go into the specific vaccines, we do classify
vaccines as to its component, the ability to be
immunogenic, the ability to induce antibodies, ability
to protect, including the risk of complications,
indications and contraindications

LIVE ATTENUATED VACCINES

Attenuated form of the virus or bacteria
o What do you mean by live attenuated vaccine?
Youre giving a vaccine for a particular infection,
so you extract the microorganism causing the
infection and you reduce it into a form into a less
virulent form. This means you are mimicking an
infection when you give this vaccine. When you
give this vaccine, your immune system will
produce an antibody.
Must replicate to be effective
Immune response similar to natural infection
Usually effective with one dose
Severe reaction possible
Interference from circulating antibody, unstable
Examples: Varicella, MMR, Yellow fever, Oral Typhoid
-VoMYTting possible (severe reactions possible)

For this group of vaccines, there is a possibility

of sever on-site reactions; but the advantage of this
vaccine is taht it usually takes only one dose for you
to initiate antibody production
From 2014A trans
o
Examples: Trivalent Oral Polio, MMR (Measles, Mumps,
Rubella), Chickenpox, BCG, Typhoid oral vaccine
o
Whole, non-pathogenic virus
o
After administration, viral replication occurs with little or
no adverse host reaction
o
Replication of the virus in the vaccine is essential
o
Attenuated (weakened) form of the wild virus or
bacteria
o
Immune response similar to natural infection
o
Usually effective with one dose

INACTIVATED VACCINES

Not live and cannot replicate

Minimal interference from circulating antibody
Generally not as effective as live vaccines
Generally requires 3-5 doses
Immune response mostly humoral
Antibody titer falls over time
o Give additional doses when it falls to ineffective
levels
o Need to give boosters
These vaccines are not coming from live organisms
and cannot replicate.That is why you need to give
three doses. There is a cumulative antibody
response with the second and subsequent doses.
Because this vaccine is not live, immune response is
mainly humoral. So you rely on the titer of the
antibody. So you have to give additional doses, bec
there will come a time wherein the antibody titer will
not be in the protective titer. So that is why you need
1 of 7

to give another vaccine to boost the antibody

production.
Examples: Hepatitis A/B, Influenza,
Pneumococcal, Meningococcal, TetanusDiptheria
-HIP MDs inactivate infections
From 2014A:
o
o

o
o
o

Viral - influenza, polio SALK, rabies vaccine

Verocell, duck embryo vaccine
Bacterial pertussis, pneumococcal conjugate
and polysaccharide, H. Influenza, Hib,
meningococcal polysaccharide, yellow fever,
typhoid Vi capsular
Organisms cannot replicate
Requires sufficient amount of antigenic mass to
induce the desired immune response
Inactivated vaccines are not alive and cannot
replicate. The entire dose of antigen is
administered in the injection. These vaccines
cannot cause disease from infection, even in an
immunodeficient person. Inactivated antigens
are less affected by circulating antibody than are
live agents, so they may be given when antibody
is present in the blood (e.g. in infancy or
following receipt of antibody-containing blood
products).
Inactivated vaccines always require multiple
doses. In general, the first dose does not
produce protective immunity, but primes the
immune system. A protective immune response
develops after the second or third dose. In
contrast to live vaccines, in which the immune
response closely resembles natural infection, the
immune response to an inactivated vaccine is
mostly humoral. Little or no cellular immunity
results. Antibody titers against inactivated
antigens diminish with time. As a result, some
inactivated vaccines may require periodic
supplemental doses to increase, or boost,
antibody titers.

CONTRAINDICATIONS AND PRECAUTIONS

C- Contraindication

P-Precaution V-Vaccinate
if indicated

Do not give it to pregnant women bec it may

induce teratogenic effects and infections. Do not
give to immunocompromised hosts because it
can induce infections, you cannot give to
patients who are allergic to the vaccine.
Severe illness and recent blood product are the
most common misconceptions. Illness is not a
contraindication even in the presence of fever.
So is any transfusion of blood products.

Uncommonly known is the contraindication of

inactivated vaccines in patient with
encephalopathy

SCREENING QUESTIONS
Important to remember to ASK:

Feeling ill?

Allergies to food? Or medicines / vaccines?

Received vaccine within the past 4 wks?

Co-morbid problems?
o Cancer - immunosuppressive
treatment?

Other drugs taken now?

Previous illnesses?
o History of seizures?

Blood transfusion?

For women: Pregnant?

HEPATITIS B VACCINE
PREVALENCE

In 1997, the Philippines is included in the

geographic pattern of >8% for HBsAg carriers. A
law was then made in the Philippines that all
babies born should automatically receive
Hepatitis B vaccine. This is because infection
with Hepatitis B is a common cause of hepatic
carcinoma
HBsAg positivity prevalence : 2% to 16.5%, with
an average of 12% in a study of rural villagers
(Lansang, Gut 1996)
5-16%, with two age-specific incidences:
o 55-68% among 3-4 y.o.
More common among 3-4 y/o are
hepatitis carriers
comes from mothers that did not know
they were Hepatitis B carriers.
If you are pregnant, before you will
deliver you have to screen for HIV,
hepatitis B, hepatitis C and Syphilis
Screen all women for HepB along with
other TORCHS infections (e.g. HIV)
o 5-16% among 30-40 y.o.
(Guan, Sollano et al, J Gastro & Hepatol,
2000)

INDICATIONS
(J-group) K.A, KIMPOY and MAGSIE

Edited by: Constantino

2 of 7

Routine
Universal immunization of all:

Infants

Adolescents

Adults

Special Situations
Strongly recommended in subjects who are
at increased risk of exposure:

Health care personnel

Patients receiving frequent blood transfusions

or clotting factor concentrates (hemodialysis
and oncology units)

Organ transplant recipients

Thalassaemics, sickle-cell anemics, cirrhotic

and hemophiliacs

anemic, cirrhotic and hemophiliacs.

Personnel and residents of institutions

Persons at increased risk due to their sexual

practices (persons with multiple partners, STD
patients, prostitutes, homosexually active
males)

Illicit users of addictive injectable drugs

Travelers to high endemic areas

Infants born of mothers who are carriers

Police, brigade, and armed forces personnel

Household contacts of any of the above groups

College entrants to healthcare associated

courses

o Patients at high risk

o e.g. dialysis, immunodeficient
patients
o Certain health care workers
IMMUNOGENICITY, EFFICACCY,
REACTOGINICITY of HB Vaccine
In healthy persons, the duration of immunity after
primary immunization is at least 15-20 years
(the period since implementation of HB vaccine)
Currently no recommendation for routine booster
immunization
The vaccine is highly effective in preventing acute
and chronic HB disease, the vaccine is
considered
the
first
anti-cancer
vaccine
(prevention of primary liver cancer)

Management of Nonresponse to HepB

vaccine

SCHEDULE
Route: Intramuscular
A. Conventional: 3 doses:

0,1,6 months
or:
B. Rapid schedule of Administration :4
doses:

0,1,2,12 months
C. Very Rapid Schedule Of Administration

0; 7 ; 21 days + 12 months

The difference here is you will be giving 4

doses
Booster is not routinely recommended; once
you received any of these regimens,
booster is not recommended bec that will
be protective for a long period of time

POST IMMUNIZATION SEROLOGIC

TESTING
Because 95% of healthy persons will develop
protective anti-HBsAg titers, testing following
immunization is not recommended in case of
routine immunization of infants, children,
adolescents, or most adult
Testing following immunization is recommended
for
o Infants born to HBsAg+ mothers
o Why? Because if they dont develop
the antibodies that means they are
carriers of hepatitis B
(J-group) K.A, KIMPOY and MAGSIE

What about for those who you try to elicit

antibodies, but you dont get an antibody
response?
Complete a second series of three doses
Should be given on the usual 0,1 and 6 months
Test 1 to 2 months after completing the second
series
Persisten NonResponse to Hep B Vaccine
If patient was given the second series of three
doses and there is still no response: do not
repeat anymore.
o There may be a possibility that the
immune system is not adequate causing
the nonresponse.
< 5% of vaccinees do not develop anti-HBsAg after
6 valid doses
May be nonresponder or hyporesponder
o They may have the antibody but it is
detected based on threshold of detection
Check HBsAg status
o If and when you do not develop
antibodies, and you are in an endemic
country, chances are you may also be a
carrier of hepatitis B
If exposed, treat as nonresponder with
postexposure prophylaxis

[Notes from Dr. Dimlas lecture last year:]

Hepatitis B vaccine:
induces specific humoral response (anti-HBs antibodies)
antibody titre level of 10 IU correlates with protection to HBV
infection
PP: protective efficacy is at 96% for those who followed the
0,1,6 schedule

TETANUS-DIPTHERIA TOXOID
Inactivated vaccine, Intramascular (IM)
A vaccine with both tetanus and diptheria toxoid
Diptheria is commonly acquired among health
care workers in the hospital, through respiratory

Edited by: Constantino

3 of 7

route. So when you give your tetanus, you have

to combine it with your diptheria.

doses
>3 doses
No1
No
1
Yes, if >5 years since last booster
2
Yes, if >10 years since last booster

Target Individuals
Recommended
for
all
susceptible
adults
particularly:
a. pregnant women
b. healthcare workers
It is recommended for susceptible adults
especially
pregnant
womens
and
healthcare workers.

Schedule

Precautions/Contraindications
Severe allergic reactions to vaccine component or
following prior dose
Moderate to severe illness

Wound Classification

MMR (Measles, Mumps, Rubella) VACCINE

Live Attenuated Vaccine (LAV), Subcutaneous
(SQ)
Given to adults without documentation of previous
infection or those who were not previously
immunized.
o Rubella vaccine important for nonpregnant
susceptible women of childbearing age

Risk
Travelers who are not fully immunized against
measles are at risk when visiting countries or
areas where vaccine coverage is incomplete
All susceptible adolescents and adults without
documented evidence of immunity to any one of
the
components
(especially
non-pregnant
women of childbearing age)
Schedule
Given in 2 doses
0,1 month
Contraindications
Severe allergic reaction to a vaccine component or
to a previous dose

Moderate or severe acute illness

Pregnancy

Immunosuppression

Tetanus Prophylaxis in Routine Wound

Management

Uncertain or <3

Clean,
minor
wound
Td
TIG
Yes
No

(J-group) K.A, KIMPOY and MAGSIE

No

WHEN ARE YOU GOING TO GIVE TETANUS

PROHYLAXIS IN ROUTINE WOUND MANAGEMENT??

We have to consider two aspects here:

o
The type of wound
o
Dose of tetanus vaccine received in the past

For all clean and minor wound--- you only give

tetanus vaccine if you are not certain that
they were able to receive the tetanus vaccine.
If they are not able to receive it then you have to
give the vaccine. Since this is a CLEAN and MINOR
wound, you do not need to give your
Immunoglobulin (TIG) . But for all MAJOR and
BIGGER wound, you need to give both tetanus
vaccine (Td) and Immunoglobulins (TIG).

If patient was able to receive or complete 3 doses of

tetanus vaccine, and they acquire either minor or
other type of wound, you do not give your tetanus
vaccinebut, you need know if the dose of the 3
doses were given 5 years or more than 10 years,
because if more than 5 years, you need to give
booster.

Given in 3 doses
0,1,6,12 months
Booster every 10 years

There are certain specific wounds that you need to

give tetanus vaccine. If a patient had any of the
wound (Tetanus prone) described below, it is a
must that you give tetanus vaccine.
For example if you are injured by a sharp surface,
you dont need to give tetanus vaccine. But if it
is due to a burn injury, a motorcycle injury, even
with just an abrasion, we have a higher risk in
these patients
Most who develop tetanus are those who work in
construction facilities and those involved in
motorcycle accidents. Those who are involved in
this events, even just an abrasion, you need to
give tetanus vaccine because of the high rate of
development of tetanus among these
individuals.

No2

Measles Vaccine and HIV Infection

MMR
recommended
for
persons
with
asymptomatic HIV infection
All
other Not recommended for those with evidence of
severe immune-suppression
wounds
Td
TIG
Prevaccination HIV testing not recommended
Yes
Yes

Edited by: Constantino

4 of 7

VARICELLA VACCINE
Varicella is one of the most common hospital
acquired disease
Live Attenuated Vaccine (LAV), Subcutaneous
(SQ)

Transmission of Disease
Person to person
o Respiratory route
o Airborne spread in hospitals
o Mother to fetus
1st tri: 1:14 chance malformed infant
2nd & 3rd tri: postnatal zoster

Clinical Features
Incubation period 14-16 days (range 10-21 days)
Mild prodorme for 1-2 days
Rash generally appears first on head;most
concentrated on trunk
Successive crops over several days with lesions
present in several stages of development

Varicella Complications

This is the reason why the vaccine is

recommended; the older you get, the higher the
risk the complications.
Bacterial infection of skin lesions
Pneumonia (viral or bacterial)
o Most common and life-threatening
o Either due to varicella or superimposed
infection
Central nervous system manifestations
Reye syndrome
Hospitalization: 2-3 per 1,000 cases
Death: 1 per 60,000 cases
Postherpetic neuraligia (complication of zoster)
Varicella Encepalopathy
o Common in adult onset varicella

been exposed before to varicella, then you

have to get post-exposure prophylaxis

Schedule
12 months to 12 years old - 2 doses; at least 3
months apart
> 13 years - 2 doses 1 month apart

Contraindications
Severe allergic reaction to a vaccine component
(gelatin or neomycin) or to a previous dose
Moderate or severe acute illness
Pregnancy
Immunosuppression
Recently received a blood product
Untreated active tuberculosis
Adolescents in aspirin therapy

INFLUENZA VACCINE
One of the most common vaccine
Dependent on the strain available and common in
that country
Vaccine from one country is different from other
country
INACTIVATED VACCINE containing 3 strains (2
type A and 1 type B), Intramuscular (IM)

Indications

TARGET INDIVIDUALS:
Recommended for all adult particularly:

Persons >13 years of age without history of

varicella infection or vaccination

All health care workers

Teachers of young children

o For them not to transmit the disease to
their students
Non-pregnant women of childbearing age
o Because of complications of varicella
during pregnancy
International travelers
Military
\
POST EXPOSURE PROPHYLAXIS

Given within 72 hours after history of

previous varicella vaccination.
Especially to the healthcare workers who have
been taking care of patients positive for
varicella, and you have not been vaccine or
(J-group) K.A, KIMPOY and MAGSIE

Edited by: Constantino

INFLUENZA
ETIOLOGIC AGENT:

Influenza virus
o 3 virus strains in the Phils:
type A; moderate to severe
illness
type B: milder illness
type C: rare
In the phils, we have type a and
type b. And type a is the one
causing the severe type of flu
THE DISEASE:

incubation period: 1-3 days

causes fever, chills, myalgia, cough and sore

throat

complications: pneumonia, may lead to death

in immuno-compromised

EPIDEMIOLOGY

5 of 7

 Occurrence of flu is usually indicated and pacified

according to: a)Southern Hemisphere b)Tropical
c) Northern Hemisphere.
Eg: If you are in northern hemisphere there are
TWO occurrence of flu per year, on the first and
on the last quarter of the year.
If in tropical, it occurs in middle and last part of
the year.
If in the southern hemisphere, there is only one
peak season of flu and that is in the middle part
of the year.
Which among the hemisphere do Philippines
belong? Its not the tropical hemisphere but the
SOUTHERN
hemisphere
where
Philippines
belong, because every month RITM collects data
among patients with flu, and occurrence of flu
peaks on May, June, July, August and September.
If you want to receive your vaccine, you have to
receive it on the first quarter of the year, but it is
usually available during month of March and
April.

Influenza in the Philippines

One of the leading causes of morbidity
o Causes
of
consultation
and
hospitalization
4th in 2005, 5th in 2006
650 to 1220 per 100,000 cases
500, 000 to 700,000 cases every year
One out of 100 Filipinos gets sick of
influenza every year- DOH
Peak incidence: July October
INACTIVATED VACCINE containing 3 strains (2
type A and 1 type B)
o Current recommendation (in the
Philippines) is to use Southern
hemisphere formulation

Complications
Bacterial superinfections
o Bacterial pneumonia
o Respiratory disorders
Most common is viral etiology
Decompensation of chronic diseases
o Pulmonary disease
o Heart disease
o Renal insufficiency
o Metabolic disease

INFLUENZA VACCINE EFFICACY

One of the highly indicated, highly used vaccine in
our country
Vaccines benefit: preventing hospitalization and
death
o Reduces hospitalization: 50-70%
o Reduces death: 50-85%
(J-group) K.A, KIMPOY and MAGSIE

o
o

Reduces illness: 30-70%

Reduces
lower
respiratory
involvement: 70-90%

tract

Indications of Influenza Vaccine

Routine

Individuals > 50 years of age

Anyone who wants to reduce the chance of

falling ill

International travelers

Persons providing essential services

Students or other persons in institutional

settings
Special Situations
Persons at high risk for severe flu or complications
o Residents of chronic care facilities and
nursing home
o Those
with
chronic
cardiovascular
disorders (hemodynamically significant
cardiac disease)
o Those with chronic pulmonary diseases
(including asthma)
o Those with chronic disorders:
Diabetes mellitus
Renal dysfunction
Hemoglobinopathies
Other chronic metabolic disorders
o Those who are immunocompromised
HIV/AIDS
Immunosuppressed
due
to
medications
o Those pregnant in the 2nd or 3rd trimester
o Those who can transmit influenza to those
at risk for complications
Household members of persons in
high-risk group
Physicians, nurses and other healthcare workers who come in contact
with patients
Healthcare workers in nursing homes
and chronic care facilities who come
in contact with patients

Schedule and Dosing

Annually
o
Preferably from February June (local)
Peak season July to October
Formulation
for
the
Southern
Hemisphere
o Preferably from October November
(CDC)
Influenza season from December
March
Formulation
for
the
Northern
Hemisphere
1 dose given INTRAMUSCULARLY
o for Immunocompromised: 2 doses at least
4 weeks apart

Edited by: Constantino

6 of 7

 When given, mild local and/or systemic

reactions are common
o The reason why some people wouldnt
want to receive influenza vaccine

PNEUMOCOCCAL VACCINE
There are two types of pneumococcal vaccine:
o 23 valent polysaccharide vaccine
o 13 valent conjugate vaccine

THE DISEASE

types and brand names of influenza vaccine

Etiologic agent: Streptococcus pneumoniae

incubation period: 1-3 days
Pneumonia: cough, fever, pleuritic chest pain
Invasive disease includes bacteremia, meningitis,
endocarditis
o The vaccine is given not only for
pneumonia but also for invasive diseases
that can cause bacteremia and meningitis
Transmission: through droplet transmission
Epidemiology: worldwide

VACCINE

CONTRAINDICATIONS
Any prior anaphylactic reaction to vaccine or
components (e.g., egg)
History of GBS

H1N1 NOVEL INFLUENZA VIRUS VACCINE

Monovalent type, but the current flu vaccines
available now contains this H1N1, type A and
Type B.
If you received this vaccine, you will be protected
from the three stated above
*IN PPT but Not discussed:

Target groups:
o Pregnant women
o Persons who live with or provide care for
infants aged < 6 months (e.g., parents,
siblings, and daycare providers)
o Health-care and emergency medical
services personnel
o Persons aged 6 months - 24 years
o Persons aged 25 - 64 years who have
medical conditions that put them at
higher
risk
for
influenza-related
complications

Current formulation *H1N1 novel influenza

virus:
o Southern hemisphere (2010)
A/California/7/2009
(H1N1)-like
virus
A/Perth/16/2009 (H3N2)-like virus
B/Brisbane/60/2008-like virus
o Northern hemisphere (2009-2010)
A/Brisbane/59/2007
(H1N1)-like
virus
A/Brisbane/10/2007
(H3N2)-like
virus
B/Brisbane/60/2008-like virus
o Northern hemisphere (2010-11)
A/California/7/2009
(H1N1)-like
virus
A/Perth/16/2009 (H3N2)-like virus
B/Brisbane/60/2008-like virus
(J-group) K.A, KIMPOY and MAGSIE

Indication
Routine Use
o
Age > 50 years
o 23-valent NOT for routine use in children
o
13 valent conjugate: use in children less
than 2 years
Special Situations:
o
For Patients at High Risk of Invasive
disease (seen in):
1. Functional or anatomic asplenia
2. Patients with chronic illnesses:
a. chronic cardiovascular disease
b. chronic pulmonary disease
c. diabetes mellitus
d. alcoholism
e. chronic liver disease (including
cirrhosis)
3. Cerebrospinal fluid leaks
4. Immunocompromised persons
a. HIV/AIDS, lymphoma, leukemia,
multiple myeloma, malignancy
b. chronic renal failure or
nephrotic
c. those receiving chemotherapy,
including corticosteroids
d. solid organ or bone marrow
transplant
5. Those living in special environments
which put them at risk:
a. military recruits
b. nursing home residents
6. Smokers: latest addition to the
guidelines

Schedule
Single dose IM or SQ 0.5 ml dose

Booster Doses
Not routinely recommended
May be given to the following:
o Those > 65* years who received their first
dose > 5 yrs ago and before they reached
age 65

Edited by: Constantino

7 of 7

Persons < 64 years who received the

vaccine > 5 yrs ago and who have the
following:
Asplenia
HIV, leukemia, lymphoma,
malignancy, multiple myeloma
chronic renal failure or nephrotic
syndrome
receiving immunosuppressive
therapy
received solid organ or bone marrow
transplant

o immunocompromised
o pregnant women
Parenteral vaccine
o children below 2 years old
o persons with bleeding disorders
o immunocompromised persons
o pregnant women
o intradermally

Contraindications

An immediate anaphylactic reaction to a

previous dose of pneumococcal vaccine
Moderate or severe acute illness with or without
illness
Allergy to a vaccine component

TYPHOID FEVER
THE DISEASE
One of the common cause of infection in the
Philippines. There is a surge of typhoid
especially in children
Etiologic Agent: Salmonella typhi
Incubation period: 1-3 weeks
Insiduous onset, prolonged fever, headache in
70% of cases
diarrhea or constipation, abdominal discomfort,
malaise, anorexia, vomiting
Complications: intestinal perforation,
encephalitis,septicemia
Transmission: fecal oral route, ingestion of
contaminated food

Epidemiology

Endemic in the Philippines

morbidity 30.5/100,00 population
mortality 1.7/100,000
outbreak of Chloramphenicol, TMP/SMX resistance
in 1993-94

THYPOID FEVER VACCINE

Indications
Routine:
Hospital personnel involved in food handling:
most important
Microbiology lab technicians
Persons with intimate exposure to a documented
S. typhi carrier/patient
Any person who wants to get protected

Precautions and Contraindications

Oral vaccines: Should NOT be given to
o children below 6 years of ag
o patients with diarrhea or vomiting
o patients taking antibiotics within 7 days
o persons taking anti-malarial prophylaxis
(J-group) K.A, KIMPOY and MAGSIE

RABIES
High rate of Rabies in the country led to presence
of animal bite centers.
HDCV- Human diploid cell vaccine
PVRV- purified vero cell rabies vaccine
PDEV- purified duck embryo vaccine
PCECV purified chick embryo vaccine
Intramuscular / Intradermal
What were using now are the PVRV and HDCV.
The advantage of PVRV you only give a very low
amount f the vaccine,0 .5 ml, this is also costeffective

Schedule
Primary: series of 3 injections on days 0,7,21 or 28
Intramuscular: on the deltoid
o PVRV - 0.5 ml
o PCECV, HDCV, PDEV 1.0 ml.
Intradermal-on the deltoid
o PVRV, PDEV, PCECV 0.1 ml.
Some give intra-dermal because of the dose, you
only need 0.1 mL. That is why most people go to
San Lazaro or RITM, or East Ave because most of
the health care personnel there are trained to
give it intradermally. So the cost of the vaccine
is lower, because with one vial you can give the
vaccine to at least 5 patients, unlike in the IM
route.
Booster-single dose IM or ID every 2 years
For post-exposure prophylaxis- refer to Standard
guidelines

Edited by: Constantino

8 of 7

Routine: Pre-exposure vaccination

Healthcare workers in hospitals that handle dog
bites and rabies
Rabies research and diagnostic lab workers
Rabies biologic production workers
Veterinarians and vet students
Field workers (bill collectors, mailman, delivery
man)

It is recommended that all adults be immunized

against DPT, Hepatitis B, Varicella, MMR,
Influenza and Pneumococcal disease with
Typhoid and Rabies vaccines as additional
vaccines for HCWs
All HCWs should be included in these
recommendations
Susceptibility to serious infections increases as we
grow older, especially among those with
underlying problems or comorbidities.

Routine: Post-exposure vaccination

All persons exposed to rabid and or suspect rabid
animals categorized as follows:
o Category I : touching or feeding of animal ,
licks on broken skin
o Category II : nibbling of uncovered skin,
minor scratches or abrasion without
bleeding, licks on broken skin
o Category III: single or multiple transdermal
bites or scratches, contamination of
mucous membranes with saliva, all
category II exposures in the head, face or
neck

ROLE OF PASSIVE IMMUNIZATION

Immune globulins are administered to:

All patients with category III exposure

All category II exposure patients who are

immunocompromised

Recommended Immunizations for Filipino

Health Care Workers (HCW) 2012
Healthcare workers (HCW) are commonly
exposed to infectious agents and are
possible vectors for spread of infectious
disease to patients
Minimizing the risk of disease acquisition is
based on strict adherence to three key
recommended interventions:
1)
Appropriate hand hygiene
2)
Rapid institution of appropriate
isolation precautions for patients with
known on suspected communicable
diseases
3)
Appropriate immunizations

Vaccines Recommended for HCWs

General recommendations for Adults with
additional vaccines for health care workers have
been published by PSMID

(J-group) K.A, KIMPOY and MAGSIE

Edited by: Constantino

Explanation for the figure on the last page:

On the first row (white) are a list of
vaccines:
1st column: tetanus diphtheria accecular
pertussis vaccine (Tdap), 2nd column: HepB
vaccine,
3rd column: Influenza vaccine,
4th column: Varicella Vaccine
5th column: Measles Mumps Rubella Vaccine,
6th column: Pneumococcal Polysaccharide
Vaccine,
7th column: Rabies Vaccine,
2nd row (yellow) are a list of jobs requiring
first line vaccines:
Barangay health workers, Clinical
pharmacist, Doctors, Nurses,
Nursing aides, Phlebotomist,
Pulmonary therapist, Rad tech,
Students on clinical rotation
3rd row(yellow): Support Services (Hospital
Based)
Admitting, Ambulance driver, Dietary
nutritionists, Engineering, Info-tech
personnel, Janitorial services, Lab
personnel, Linen, Morgue, Office workers,
Pharmacist Public health specialist,
security, social workers, other med
personnel
Pink= strongly recommended
Green= Recommended if they want it
Blue= recommended (selected)
SUMMARY
Approprite
protection,
through
proper
vaccinations, could reduce the risk of infections,
lower down the likehood of hospitalization and
decrease antibiotics

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(J-group) K.A, KIMPOY and MAGSIE

Edited by: Constantino

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