SPECIAL TOPIC CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN
CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO
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TOPIC OUTLINE
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Introduction General Consideration for Vaccination General Contraindication to Vaccination Recommended Vaccines a. Tetanus-Diphtheria [td] and TetanusDiphtheria-Pertussis [tdap] Immunization b. Human Papilloma Virus [HPV] c. Varicella Virus d. Measles, Mumps, and Rubella Viruses [MMR] e. Influenza Virus f. Pneumococcal Virus g. Hepatitis A Virus [HAV] h. Hepatitis B Virus [HBV] Appendix a. Levels of Evidence and Grades of Recommendation
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JUNE 16, 2014
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Simultaneous use of any vaccines is not contraindicated Antibiotic therapy or breastfeeding are not contraindications to vaccination. Likewise, the presence of a pregnant woman or immunosuppressed person in the household is not a reason to withhold an indicated vaccine to a family member.
GENERAL CONTRAINDICATION TO VACCINATION Severe allergy to vaccine components Pregnancy (or if planning pregnancy within four weeks) for live attenuated vaccines Severe immune attenuation (for live attenuated vaccines only) – consultation with an infectious disease specialist is advised Moderate or severe acute illness If a live attenuated vaccine is given simultaneously with another vaccine, a four week separation interval should be used between vaccinations
RECOMMENDED VACCINES INTRODUCTION Recognizing that immunization is one of the most effective primary health care services, and that there is a need to fill a gap in such service for adolescent and adults, the Philippine Obstetrics and Gynecology Society Foundation , Inc. POGS, through its immunization for Filipino women IFW task Force, has embarked in 2006 on an advocacy to incorporate vaccination on the practice of obstetrics and gynecology. Thus immunization has been incorporated in the curriculum of accredited agency training programs, and subsequently into the certification examinations of the Philippine Board of Obstetrics and Gynecology PBOG. The IFW task force has published three editions 2006, 2009, 2010 of the recommendation on Immunization for Filipino Women. The creation of the clinical Practice Guideline on Immunization for Filipino Women represents the continuing efforts of POGS to fulfill its advocacy in improving the health not only of women, but also the health of their children and other members of their families.
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GENERAL CONSIDERATIONS FOR VACCINATION Never administer vaccines in the buttock Confirm completion of childhood (or more recent) primary vaccines series for measles, mumps, rubella (MMR) and Tetanus-Diphtheria (Td) before initiating adult recommended vaccine schedules Maintain vaccine administration record in patient’s chart, including date, site and route of administration, manufacturer and lot number of vaccine. Knowing the route of vaccine administration, needle size, and vaccine storage and handling are critical components of a quality, office-based vaccine program
Transcribers: Angala, M.H., Javier, K.A.
A. TETANUS-DIPHTHERIA (Td) AND TETANUSDIPHTHERIA-PERTUSSIS DIPHTHERIA-PERTUSSIS (Tdap) IMMUNIZATION TARGET POPULATION General Adults All persons with zero, incomplete or unknown primary series of tetanus immunization should receive a primary series of Tetanus-Diphtheria immunization All persons who have completed the primary series of tetanus immunization should have booster Td injections every 10 yrs One dose of Tdap should substitute one Td booster Td vaccine preferred over Tetanus Toxoid (TT) because of additional protection against diphtheria. Tetanus Toxoid o should only be given a booster dose and should not be part of a primary immunization series o is preferred to the diphtheria-containing vaccines only if there is a contraindication to the diphtheria component *all of the above - (Level I, Grade A) Pregnant Women with no previous tetanus immunization or unknown tetanus immunization history should receive 3 doses nd of Td vaccine to be give 1 month apart, starting 2 trimester. Third dose dose can be given given postpartum as Tdap whose last Td/Tdap vaccination was >10 yrs ago nd rd should receive Td booster in the 2 /3 trimester of pregnancy *all of the above - (Level I, Grade A) Persons more than 65 yrs old Persons 65 yrs of age or older may be vaccinated with Tdap Persons 65 yrs of age or older who have close contact with an infant <12 month old should be vaccinated with Tdap (Level I, Grade A)
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CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN DOSE REGIMEN The primary tetanus immunization series o consists of 3 Td injections given IM o first 2 doses : given one month apart rd nd dose o 3 dose ; given 6-12 months after 2 rd o 3 dose may be given as Tdap Tdap dose is 0.5 ml, administered IM, preferably into deltoid muscle *all of the above - (Level I, G rade A) CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS Contraindication Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine component Precaution History of arthus-type hypersensitivity reactions following a previous dose of TT-containing vaccine – Defer vaccination until at least 10 yrs have elapsed since the last TT-containing vaccine Adverse Events Mild problems (noticeable, but did not interfere with activities) o Pain (up to about 8 in 10) o Redness or swelling (up to about 1 in 3) o Mild fever (up to about 1 in 15) o Headache or tiredness (uncommon) Moderate problems (interfered with activities, but did not require medical attention) o Fever over 102 °F (rare) o extensive swelling of the arm where the shot was give (up to about 3 in 100) Severe problem (unable to perform usual activities; required medical attention) o Swelling, severe pain, and redness in the arm where the shot was given (rare) AVAILABLE PREPARATIONS Vaccine Tetanus toxoid Tdap absorbed Tetanus-Diphtheria
Quadrivalent HPV vaccination o protect women 16- 45 yrs→ from persistent HPV infection and ≥ cervical intraepithelial neoplasia (CIN) 2+ o can be given to patients age 9-45 yrs o protect women aged 9- 45 yrs → from developing vulvar intraepithelial neoplasia (VIN) & vaginal intraepithelial neoplasia (VEIN) protect women aged 16-45 yrs from o can developing anogenital warts *all of the above - (Level I, G rade A) HPV vaccination can be given in women with the following special situations: o Abnormal Papanicolaou (Pap) smear o History of genital warts o Breastfeeding o Immunocompromised *all of the above - (GPP) Pap smear and HPV infection status are not a prerequisite for HPV vaccination (GPP) DOSE REGIMEN Bivalent HPV vaccine o Injected imtramuscularly at 0,1,6 months (Level I, Grade A) o Can be given concomitantly with diphtheriatetanus-acellular pertussis (dTpa), inactivated poliovirus vaccine (IPV), Hepatitis A inactivated caccine (HepA) and Hepatitis B inactivated vaccine (HepB) (GPP) Quadrivalent HPV vaccine o Injected intramuscularly at 0,2,6 months o Can be given concomitantly with diphtheria, tetanus, pertussis, and poliomyelitis vaccine in healthy adolescents 11-17 yrs of age *all of the above - (Level I, G rade A) Bivalent and quadrivalent HPV vaccines are not interchangeable to complete the 3 doses.
Formulation 0.5 ml/ampule 0.5 ml/syringe 0.5 ml/syringe
B. HUMAN PAPILLOMA VIRUS (HPV) IMMUNIZATION TARGET POPULATION Bivalent human papillomavirus (HPV) vaccination o protect women aged 15- 25 yrs → from persistent HPV infection and ≥ cervical intraepithelial neoplasia (CIN) 2+; o can be given to patients age 10-14 years and 26-55 years o can protect target women from developing vulvar intraepithelial neoplasia (VIN) & vaginal intraepithelial neoplasia (VAIN); o can protect target women from ≥ CIN 2+ associated with combined nonvaccine oncogenic HPV types (HPV 33,45) *all of the above - (Level I, Grade A)
Transcribers: Angala, M.H., Javier, K.A.
CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS HPV vaccines o cannot be given to pregnant women o can be given to women with minor a cute illnesses o should not be given to patients with a history of adverse reactions to any vaccine component Women who receive HPV vaccination should be observed for syncope in the clinic for 15 min. *all of the above - (GPP) AVAILABLE PREPARATIONS Vaccine Bivalent HPV vaccine Quadrivalent HPV vaccine
Formulation 0.5 ml/syringe 0.5 ml/syringe
C. VARICELLA ZOSTER VIRUS IMMUNIZATION TARGET POPULATION Routine Vaccination The following population groups with no evidence of immunity to Varicella (reliable clinical history of disease, Physician-documented vaccination) should
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CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN routinely receive the Varicella vaccine (Level I, Grade A): o Persons aged > 13 yrs o School-aged children, college students, and students in other postsecondary educational institutions o Other healthy adults: Health care professionals (HCP) Household contacts of immunocompromised persons Persons who live or work in environments in which transmission of Varicella zoster virus is likely (e.g. teachers, day-care employees, residents and staff in institutional settings) Persons who live or work in environments in which transmission has been reported (e.g. college students, inmates, and staff members of correctional institutions, and military personnel) Nonpregnant women of childbearing age Adolescents and adults living in households with children International travelers
Postpartum Vaccination Prenatal assessment of women for evidence of Varicella immunity is recommended. Upon completion or termination of their pregnancies, women who do not have evidence of Varicella immunity should receive the first dose of vaccine before discharge from the health-care facility Second dose should be administered 4-8 weeks later Women should be counseled to avoid conception for 1 month after each dose of Varicella DOSE REGIMEN Eligible recipients should receive two 0.5 ml doses of single-antigen Varicella vaccine administered subcutaneously, 4-8 weeks apart st nd If >8 weeks elapsed after the 1 dose, the 2 dose may be administered without restarting the schedule (Level I, Grade A) CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS Contraindications(Level I, Grade A) who have a history of anaphylactic reaction to any component of the vaccine who have a history of anaphylactic reaction to neomycin who have any malignant condition, including blood dyscrasias, leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic systems who have a family history of congenital or hereditary immunodeficiency in first-degree relatives (e.g. parents and siblings) unless the immune competence of the potential vaccine recipient has been clinically substantiated or verified by a laboratory receiving high-dose systemic persons immunosuppressive therapy, including persons on oral steroids >2mg/kg of body weight or a total of >20mg/day of prednisone or equivalent for persons who weigh >10kg, when administered for >2wks pregnant women
Transcribers: Angala, M.H., Javier, K.A.
Precautions Vaccination of persons who have acute severe illness, including untreated, active tuberculosis, should be postponed until recovery. Tuberculin skin testing is not a prerequisite for vaccination Because of the potential inhibition of the response to Varicella vaccination by passively transferred antibodies, Varicella vaccines should not be administered for the same intervals as measles vaccine (3-11 months, depending on the dosage), after administration of blood (except washed red blood cells), plasma, or immunoglobulin (Ig). Persons who received a Varicella vaccine should not be administered an antibody-containing product for 2 weeks after vaccination unless the benefits exceed those of vaccination In such cases, the vaccine recipient should either be revaccinated or tested for immunity at the appropriate intervals, depending on the dose received, and then revaccinated if seronegative AVAILABLE PREPARATIONS Vaccine Varicella Virus Vaccine, live-attenuated, freezedried with separate diluent, to be reconstituted right before administration
Formulation
0.5 ml
D. MEASLES, MUMPS AND RUBELLA VIRUSES (MMR) TARGET POPULATION All non-pregnant women of childbearing age must be offered measles, mumps, and rubella (MMR) vaccination Upon completion or termination of pregnancy, women who do not have serologic evidence or rubella immunity or documentation of rubella vaccination should be vaccinated with MMR before discharge from the hospital or birthing center Routine prenatal serologic testing for rubella on all pregnant women who lac acceptable evidence of rubella immunity *all of the above - (Level I, Grade A) DOSE REGIMEN 0.5 ml, administered subcutaneously, 1-2 doses nd 2 dose of MMR vaccine o Administered 4 weeks after the first dose is recommended for adults o Indicated for individuals who : Have been recently exposed to measles/mumps or are in an outbreak setting Have been vaccinated previously with killed measles vaccine Have been vaccinated with an unknown type of measles vaccine during 1963-1967 Are students in postsecondary educational institutions Work in a health-care facility Plan to travel internationally
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CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS Contraindications Severe allergic reaction after a previous dose of the vaccine Pregnancy Severely immunocompromised patients o Hematologic and solid tumors o Receipt of chemotherapy o Congenital immunodeficiency o Long-term immunosuppressive therapy o Patients with human immunodeficiency (HIV) infection who are severely immunocompromised Precaution Women administered with MMR vaccine should be advised not to get pregnant during the next 4 weeks post-vaccination Recent (≤11months) receipt of the antibody containing blood product (specific interval depends on the product) History of thrombocytopenia or thrombocytopenic purpura Need for tuberculin skin testing Moderate or severe acute illness with or without fever STORAGE REQUIREMENTS Vaccine o Refrigerate immediately upon arrival o Store at 35-46°F (2-8°C) o Protect from light at all times, since such exposure may inactivate the vaccine viruses Diluent o May be refrigerated or stored at room temperature (68-77°F [20-25°C]) o Do not freeze or expose to fr eezing temperatures After reconstitution, use immediately or store at 3546 °F (2-8°C) and protect from light. Discard if not used within 8 hours of reconstitution AVAILABLE PREPARATIONS Vaccine Measles, Mumps, Rubella Virus Vaccine, liveattenuated
Formulation 0.5 ml
E. INFLUENZA VIRUS TARGET POPULATION All pregnant and breastfeeding women should receive the inactivated flu vaccine. ( Level I, Grade A ). Individuals belonging to the ff. high risk groups. ( Level I, Grade A). o All children: 6-18y.o o All persons: ≥ 50 years o Other persons at risk for medical complications from influenza, their household and close contacts. o All health care professionals (HCP) DOSE REGIMEN Infants, children, adolescents: 6-18 years (refer to Philippine Pediatric Society Guidelines)
Transcribers: Angala, M.H., Javier, K.A.
Women ≥ 19 y ears old: IM, every year, as soon as the newest/current WHO-recommended vaccine strains become available. (Level III, GPP ) CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS Contraindication Severe allergic reactions (e.g anaphylaxis) after a previous dose or to a vaccine component, including egg protein. Precaution Guillan Barre Syndrome within 6 weeks of previous dose of influenza vaccine. Moderate or severe acute illness with or without fever. AVAILABLE PREPARATIONS Vaccine Inactivated Split-Influenza Virus Inactivated Influenza Virus Vaccine
Formulation 0.5ml prefilled syringe 0.25ml and 0.5ml prefilled syringe
F. PNEUMOCOCCAL BACTERIA IMMUNIZATION TARGET POPULATION High-risk patients who have not received prior immunization or whose prior vaccination status is unknown. o All persons >50 years old, particularly those living in institutions o Persons with certain underlying chronic medical conditions Chronic cardiovascular disease (e.g congestive heart failure [CHF], cardiomyopathies) Chronic pulmonary disease (e.g asthma, chronic obstructive pulmonary disease [COPD], bronchiectasis, pulmonary tuberculosis [PTB]) Sickle-cell disease Diabetes mellitus Alcoholism Chronic liver disease Cerebrospinal fluid or cochlear implants Functional or anatomic asplenia Immunocompromised persons ≥ 2yo: o HIV infection or AIDS o Leukemia, Hodgkin’ s disease, lymphoma, multiple myeloma, generalized malignancy o Chronic renal failure o Nephrotic syndrome o Immunosuppressive chemotherapy, radiation therapy o Functional or anatomic asplenia o Organ or bone marrow transplant recipients Any adult 19-49 years old who is a smoker and has asthma (Grade B) Revaccination with pneumococcal polysaccharide vaccine (PPSV) is recommended, at least 5 years after the first dose particularly with ff population: ( Grade A) o 50-64 years old should be revaccinated if their prior PPSV dose was given at least 5years prior
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CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN o
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>65years who had a prior dose with a lapse of at least 5years 2-49 years old with/ on: (Grade B) Damaged spleen or asplenia Sickle-cell disease HIV infections or AIDS Generalized malignancy, leukemia, lymphoma, multiple myeloma Nephritic syndrome Organ or bone marrow transplant Long-term steroid therapy, chemotherapy and radiation therapy
Pregnant and breastfeeding women who are at highrisk for invasive pneumococcal disease. nd
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Preferably administered during the 2 or 3 trimester of pregnancy as a general safety precaution. Women at high-risk should be offered vaccination before becoming pregnant. o High-risk women include those with: ( Grade B) Chronic cardiovascular disease (e.g congestive heart failure [CHF], cardiomyopathies) Chronic pulmonary disease (e.g asthma, chronic obstructive pulmonary disease [COPD], bronchiectasis, pulmonary tuberculosis [PTB]) Sickle-cell disease Diabetes mellitus/ gestational DM Chronic liver disease Cerebrospinal fluid leaks or cochlear implants Functional or anatomic asplenia Immunocompromised persons: HIV infections or AIDS Leukemia, Hodgkin’ s disease, lymphoma, multiple myeloma, generalized malignancy Chronic renal failure, Nephrotic syndrome Organ or bone marrow transplant recipients DOSE REGIMEN Single 0.5ml dose, IM or SQ injection CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS Contraindications/Precautions Hypersensitivity to any component of the vaccine. Epinephrine injection (1:1000) must be available immediately in case of anaphylaxis Severely compromised cardiovascular and/ or pulmonary function (since a system reaction incurs significant risks) Children < 2years as safety and efficacy have not been established for this group Adverse Events PPSV and pneumococcal conjugate vaccine (PCV) are relatively safe vaccines. About 30-50% of patients who received the PPSV had mild side effect such as local erythema. Serious allergic reactions with the PPSV are uncommon. Among children who received the PCV, 10-20% developed local erythema, tenderness or swelling and 11% had low-grade fever AVAILABLE PREPARATIONS PPSV is licensed for persons aged ≥2 y ears and recommended for persons with certain underlying
Transcribers: Angala, M.H., Javier, K.A.
medical conditions (including immunocompromised individuals) and for all persons aged ≥60 years.
Vaccine Pneumococcal 23-Valent Polysaccharide Vaccine, PPSV23
Formulation 0.5 ml prefilled syringe
G. HEPATITIS A VIRUS (HAV) TARGET POPULATION Women o >18yo with close contact with persons with Hepatitis A, must be vaccinated. ( Level I, Grade A ) o Travelling to working in countries with high or intermediate prevalence of hepatitis a should be vaccinated. (Level I, Grade A ) o Use street drugs are candidates for vaccination. (Level I, Grade A ) o With chronic liver disease (including Hepatitis B and C) should receive Hepatitis A vaccination. (Level I, Grade A ) treated with clotting factor o Previously concentrated should avail of hepatitis A vaccination. ( Level I, Grade A ) o With occupational risk including laboratory staff should be vaccinated. ( Level I, Grade A ) Post-exposure Prophylaxis For susceptible healthy women up to age 40yrs, single-antigen hepatitis A vaccine should be administered as soon as possible for exposure. Beyond age 40yrs, immune globulin (Ig) is preferred. Vaccine can be used if Ig cannot be obtained. DOSE REGIMEN IM for 2 doses, 6-12mos apart, for lasting protection CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS Severe or life-threatening allergic reaction to a previous dose of hepatitis A vaccine is an absolute contraindication. Severe or life-threatening allergic reaction to any vaccine component contraindicates the administration of hepatitis A vaccine. Moderate or severe illness at the time of vaccination may defer the scheduled administration. Safety of the hepatitis A vaccine for pregnant has not been determined. The most commonly reported adverse following hepatitis A vaccination is local reaction at the site of injection. AVAILABLE PREPARATIONS Several preparations of Hepatitis A vaccine that contain inactivated whole-viruses are currently available. Vaccine Inactivated Hepatitis A Vaccine Combined inactivated Hepatitis A & B Vaccine
Formulation 1 ml / vial 1 ml prefilled syringe
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CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN H. HEPATITIS B VIRUS (HBV) I MMUNIZATION III TARGET POPULATION Given to the following target population. ( Level I, Grade A) o Healthcare and public safety and security workers who may have exposure to blood in the workplace o Persons in training for allied health professions o Hemodialysis patients and those receiving blood and blood products including transplant candidates. o Patients in early course of chronic liver diseases o Sexually transmitted disease (STD) clinic clients o Multiple sexual partners or prior STD o Inmates in correctional facilities o Clients and staff of institutions for developmental disability o Travelers to high endemic areas o Overseas foreign workers o Injection drug users o Household contacts and sexual partners of Hepatitis B virus carriers Pregnant women who is otherwise eligible for it. (Level III, Grade B ) All HBs-Ag negative pregnant women seeking STD treatment who have not been previously vaccinated should receive hepatitis B vaccination ( Level III, Grade B).
GRADE A
B
C
D
E
GPP
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CONTRAINDICATIONS/PRECAUTIONS/ADVERSE EVENTS severe allergic reaction to vaccine component or to a prior dose of Hepatitis B vaccine is a contraindication to further doses of the vaccine. Persons with severe or moderate acute illness should not be vaccinated until their condition improves. Minor illnesses like upper respiratory tract infection are not a contraindication to vaccination. 3.
Formulation 20 mcg / ml 5ml 4.
APPENDIX LEVELS OF EVIDENCE AND GRADES OF RECOMMENDATION
LEVEL I II-1 II-2 II-3
DEFINITION Evidence obtained from at least one properly randomized controlled trial Evidence obtained from well- designated controlled trials without randomization Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Evidence obtained from multiple time series with or without the intervention
Transcribers: Angala, M.H., Javier, K.A.
DEFINITION There is good evidence to support the recommendation of the practice in immunization for Filipino women There is a fair evidence to support the recommendation of the practice in immunization for Filipino women There is insufficient evidence to recommend for or against the inclusion of the practice in immunization for Filipino women There is a fair to support the recommendation that the practice be excluded in immunization for Filipino women. There is a good office the recommendation that the practice be excluded in immunization for Filipino women A good practice point (GPP) is a recommendation for best practice based on the experience of the Technical Working Group.
Review Questions:
DOSE REGIMEN IM in 3 doses 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
AVAILABLE PREPARATIONS Vaccine Recombinant Hepatitis B Virus Vaccine
Opinions of respected authorities, based on clinical experience, descriptive studies and case reports or reports of exter committees.
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Vaccine administration record includes the following except: a. Date of purchase b. site and route of administration, c. manufacturer d. Lot number of vaccine. True regarding contraindications to Vaccines includes the following except: a. Pregnancy [for live attenuated vaccines] b. Severe immune attenuation (for live attenuated vaccines only) c. Moderate acute illness d. If a live attenuated vaccine is given simultaneously with another vaccine, a five week separation interval should be used between vaccinations Target population of pneumococcal vaccination except: a. adult smokers with asthma b. All persons older than 50 yo. c. Persons with sickle cell disease d. Diabetic patients Which of the following available preparations is TRUE? a. Inactivated influenza virus: 0.25ml and 0.5 ml prefilled syringe b. Hepatitis A virus: 20mcg/ml, 5ml c. Inactivated Split-influenza: 0.5ml prefilled syringe d. Inactivated Hepatitis B: 1ml/ vial Given the following: i. Bivalent HPV vaccination protects women aged 16-45 yrs from persistent HPV infection j. HPV vaccination can be given to breastfeeding women k. Quadrivalent HPV vaccine can be given intramuscularly at 0, 2, and 6 months l. Bivalent HPV vaccine can be given with Hepatitis A vaccine m. HPV vaccines can be given to pregnant women
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CLINICAL PRACTICE GUIDELINES ON IMMUNIZATION FOR FILIPINO WOMEN
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All of the statements are correct Majority [3 out of 5] of the statements are correct All of the statements are incorrect Majority [3 out of 5] of the statements are incorrect
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All of the following are injected intramuscularly except: a. MMR b. Tdap c. HAV d. HBV 7. Level II-3 is defined as: a. Evidence obtained from well-designated controlled trials without randomization b. Evidence obtained from at least one properly randomized controlled trial c. Evidence obtained from well-designed cohort or case-control analytic studies d. Evidence obtained from multiple time series with the intervention 8. A grade given if there is good evidence to support the recommendation of practice in immunization for Filipino Women: a. D b. C c. A d. B 9. Women who received this vaccination should be observed for syncope for 15 minutes: a. HPV b. HAV c. HBV d. MMR 10. Which of the following is TRUE? a. Women administered with MMR vaccine should be advised not to get pregnant during the next 4 weeks pre-vaccination b. Women administered with Influenza vaccine should be advised not to get pregnant during the next 4 weeks prevaccination c. Women administered with MMR should be advised not to get pregnant during the next 4 weeks post-vaccination d. Women administered with Influenza vaccine should be advised not to get pregnant during the next 4 weeks postvaccination
Transcribers: Angala, M.H., Javier, K.A.
Answers: 1. A 2. D 3. B 4. C 5. B [J, k and L are correct] 6. A 7. D 8. C 9. A 10. C
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