Childhood Immunization Schedule 2023, Summaries of Pediatrics

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• Given intradermally (ID)
• The dose of BCG is 0.05 ml for children < 12 months and 0.1 ml for children ≥ 12 months
• 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. However, PPD is recommended prior to BCG vaccination if any of the following is present: o Congenital TB o History of close contact to known or suspected infectious cases o 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
• Given intramuscularly (IM)
• Given at a minimum age of 6 weeks.
• The primary series consists of 3 doses with a minimum interval of 4 weeks
• Booster series consists of 3 doses until adolescence with the following schedule: o 12-18 months (DTP) o 4-6 years (DTP) o 9-18 years (Td/Tdap) Ideally, the minimum interval between booster doses should be at least 4 years
• 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
• Given intramuscularly (IM)
• Given as a 3-dose primary series with a minimum age of 6 weeks and a minimum interval of 4 weeks
• 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

Inactivated Hepatitis A Vaccine

• Given intramuscularly (IM)
• Minimum age: 12 months
• 2 dose series: minimum interval between first and second dose is 6 months Live attenuated Hepatitis A Vaccine
• Given subcutaneously (SC)
• Minimum age: 18 months
• Given as single dose

BACILLE CALMETTE GUERIN (BCG)

DIPHTHERIA, TETANUS, PERTUSSIS VACCINE (DTP)

ANNOTATIONS

HAEMOPHILUS INFLUENZAE TYPE B CONJUGATE VACCINE

HEPATITIS A VACCINE (HAV)

• Given subcutaneously (SC)
• 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
• 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
• Given subcutaneously (SC)
• Given at a minimum age of 12 months
• 2 doses of MMR vaccine are recommended
• 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.
• Given subcutaneously (SC)
• Given at a minimum age of 12 months
• MMRV may be given as an alternative to separately administered MMR and Varicella vaccines
• The maximum age is 12 years
• The recommended minimum interval between doses is 3 months, but a second dose given 4 weeks from the first dose is considered valid
• Given intramuscularly (IM)
• Given at a minimum age of 6 weeks
• 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.
• 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
• For unvaccinated older children age 12 months to 5 years o PHID-CV (10-valent): 12 months - 5 years old: give 2 doses at least 8 weeks apart o PCV 10-SII : 12-24 months old: give 2 doses at least 8 weeks apart up to 2 years old only o PCV 13: 12-23 months old: give 2 doses at least 8 weeks apart 2-5 years old: give 1 dose o PCV 15: 12-23 months old : give 2 doses at least 8 weeks apart 2-5 years old: give 1 dose

MEASLES VACCINE

MEASLES-MUMPS-RUBELLA (MMR) VACCINE

MEASLES-MUMPS-RUBELLA-VARICELLA VACCINE (MMRV)

PNEUMOCOCCAL CONJUGATE VACCINE (PCV)

Inactivated Polio Vaccine (IPV)

• Given intramuscularly (IM), or in combination with DPT-containing vaccines
• Given at a minimum age of 6 weeks, at least 4 weeks apart
• The primary series consists of 3 doses given at 6, 10, and 14 weeks.
• The first booster is given at 12-18 months. The minimum interval between the third dose and the first booster dose is 6 months.
• The second booster is given at age 4-6 years.
• 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) Oral Polio Vaccine (OPV) o The Oral Polio Vaccine is available as part of the government’s National Immunization Program o The primary series consists of 3 doses beginning at age 6 weeks with a minimum interval of ≥4 weeks IPV o The first dose of IPV is given together with the third dose of OPV o The second dose of IPV is given together with the measles vaccine at 9 months

Human (RV 1 )

• Given per orem (PO) as oral liquid formulation
• Given as a 2-dose series
• 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. Human-Bovine live-attenuated reassortant (RV5) ( oral liquid formulation)
• Given per orem (PO)
• Given as a 3 - dose series
• First dose is given at age 6-12 weeks, with a minimum interval of 4-10 weeks between doses. The last dose should not be administered beyond 32 weeks of age. Human-Bovine live-attenuated reassortant (RV5) (oral freeze-dried / oral liquid formulation)
• Given per orem (PO)
• Given as a 3 - dose series, recommended at 2 , 4 and 6 months
• Given at minimum age 6 weeks with a minimum interval of 4 weeks between doses o The last dose should not be administered beyond 12 months of age.
• Given intramuscularly (IM)
• For children who are fully immunized, Td /Tdap booster doses should be given every 10 years
• For children age >7 years a single dose of Tdap can be given to replace due Td. Tdap can be administered regardless of the interval since the last tetanus and diphtheria-toxoid containing vaccine. Subsequent doses are given s Td/Tdap. Fully immunized is defined as 5 doses of DTP, or 4 doses of DTP if the 4 th dose was given on or after the 4 th birthday
• Give 1 dose of Tdap for every pregnancy o For fully immunized pregnant adolescents, administer 1 dose of Tdap vaccine at 27 to 36 weeks AOG, regardless of previous Td or Tdap vaccination o For unimmunized pregnant adolescents, administer a 5-dose tetanus-diphtheria (Td)-containing vaccine following a 0-,1-, 6-,18-, and 30-month schedule. Use Tdap as one of the 5 doses, preferably given at 27-36 weeks AOG

ROTAVIRUS VACCINE (RV)

TETANUS AND DIPHTHERIA TOXOID (Td)/ TETANUS AND DIPHTHERIA TOXOID AND ACELLULAR PERTUSSIS (Tdap) VACCINE

POLIOVIRUS VACCINE

• Given intramuscularly (IM)
• Immunocompromised children and those with high-risk medical conditions should receive both PCV and PPSV23. o The two vaccines should not be co-administered. The minimum interval between PCV and PPSV23 is 8 weeks. If a dose of PPSV23 is inadvertently given earlier than the recommended interval, this dose need not be repeated. o All recommended PCV doses should be given prior to PPSV23 if possible.
• The following tables summarize the indication and schedule of PCV/PPSV23 administration to children with high risk conditions according to age group:

VACCINES FOR HIGH RISK / SPECIAL GROUPS

PCV-PPSV23 VACCINATION SCHEDULE INDICATIONS FOR PNEUMOCOCCAL VACCINES

Age: 24 months to 5 years

**- Administer 1 dose of PCV if only 3 doses of PCV was received previously; give 1 * or 2 ** doses of PPSV 23 at least 8 weeks after the most recent dose of PCV

• Administer 2 doses of PCV at least 8 weeks apart if unvaccinated or less than 3 doses of PCV was received previously; give 1 or 2 * doses of PPSV 23 at least 8 weeks after the most recent dose of PCV**

ONE DOSE*

• Chronic heart disease, including congestive heart failure and cardiomyopathies
• Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
• Diabetes mellitus, Cerebrospinal fluid leaks, Cochlear implant(s), Alcoholism
• Chronic liver disease

TWO DOSES**

• Sickle cell disease and other hemaglobinopathies
• Congenital or acquired asplenia, or splenic dysfunction
• HIV infection
• Chronic renal failure and nephrotic syndrome
• Diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; or solid organ transplantation
• Congenita or acquiredl immunodeficiency (includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C 1 , C 2 , C 3 , and C 4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease)
• Leukemia or lymphoma
• Hodgkin disease
• Generalized malignancy
• Iatrogenic immunosuppression (diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy)
• Solid organ transplant
• Multiple myeloma

Any of the listed conditions is an indication for PCV () indicates need for ONE dose of PPSV23 (*) indicates need for TWO doses of PPSV

Age: 6 yrs to 18 years:

- Administer 1 dose of PCV13 if they have not previously received this vaccine; give 1 or 2 * doses of PPSV 23 at least 8 weeks after the most recent dose of PCV

PNEUMOCOCCAL CONJUGATE VACCINE (PCV)/ PNEUMOCOCCAL POLYSACCHARIDE VACCINE (PPSV23)

• Given intramuscularly (IM) or intradermally (ID)
• Recommended regimens for pre-exposure prophylaxis (PrEP): For immunocompetent individuals given WHO prequalified vaccines (Verorab ® or Rabipur®): o Intramuscular (IM) regimen: Purified Vero Cell Rabies vaccine (PVRV) 0.5 ml OR Purified Chick Embryo Cell vaccine (PCECV) 1 ml given on days 0 and 7 o Intradermal (ID) regimen: PVRV or PCECV 0.1 ml given on days 0 and 7 For immunocompromised individuals or those given non-WHO prequalified vaccines, give 3 doses on days 0 , 7 , 21 or 28 Other pre-qualified vaccines in the list (Rabivax-S & Vaxirab-N) are not available in the country
• A repeat dose should be given if the vaccine is inadvertently given subcutaneously
• Rabies vaccine should never be given in the gluteal area since absorption is unpredictable
• In the event of subsequent exposures: o High-risk* individuals who have completed PrEP require booster doses, regardless of the interval between exposure and last dose of the vaccine. Booster doses may be given through either: o 1-visit regimen: 0.1 ml ID (PVRV or PCECV) on each of the 4 sites on day 0 o 2-visit regimen: 0.1 ml ID (PVRV or PCECV) OR 0. 5 ml PVRV or 1. 0 ml PCECV IM at 1 site on days 0 and 3
  • for high risk individuals, pls. refer to : https://ais.doh.gov.ph/uploads/aopdf/ao2018-0013.pdf
• Given intramuscularly (IM) or subcutaneously (SC)
• Tetravalent meningococcal (ACYW-135) conjugate vaccine MCV4-D, MCV4-TT, given intramuscularly (IM)
• Indicated for those at high risk for invasive disease: o Persistent complement component deficiencies (including those with inherited or chronic deficiencies in C3, C5-9, properdin, factor D, factor H), anatomic/functional asplenia (including sickle cell disease), HIV, travelers to or resident of areas where meningococcal disease is hyperendemic or epidemic, including countries in the African meningitis belt or the Hajj, or belonging to a defined risk group during a community or institutional meningococcal outbreak

Conjugate vaccines

• MCV4-D: minimum age is 9 months o For children 9-23 months, give 2 doses 3 months apart o For children 2 years and above, give 2 doses 8 weeks apart  For outbreak or travel to endemic areas, give 1 dose o Except in cases of asplenia, HIV, persistent complement component deficiency where 2 doses given 8 weeks apart are recommended
• MCV4-TT (5 ug/0.5ml): minimum age is 6 weeks o For infants 6 to 12 weeks of age: give first 2 doses at least 2 months apart; the 3rd (booster) dose is at age 12 months o For children from 12 months of age to adolescence: 1 dose only
• MCV4-TT (10 ug/0.5ml): minimum age is 1 year o For children from 12 months of age to adolescence: 1 dose

RABIES VACCINE

MENINGOCOCCAL VACCINES

• Given per orem (PO)
• Given at a minimum age of 12 months as a 2-dose series two weeks apart.
• Recommended for outbreak situations and natural disasters as declared by health authorities
• Given intramuscularly (IM)
• Administer 2 doses of Hepatitis A vaccine, at least 6 months apart to unvaccinated individuals who are at increased risk for infection: o Travelers to or are working in countries with intermediate or high endemicity of infection o MSMs, Homelessness, Users of injection and non-injection illicit drugs, o Working with HAV infected primates or with HAV in research laboratories, o With clotting factor disorders, and chronic liver disease o HIV
• Bivalent HPV (2vHPV), quadrivalent HPV (4vHPV), or nonavalent HPV (9vHPV) given intramuscularly (IM)
• For ages 9-14 years:  2 doses given at 0, 6-12 months  Minimum interval: 5 months - If administered earlier than minimum interval: repeat dose
• Bivalent HPV (2vHPV), quadrivalent HPV (4vHPV), or nonavalent HPV (9vHPV) given intramuscularly (IM)  3 doses at 0, 1-2, 6 months  Minimum interval: Between dose 1 and dose 2 – 4 weeks; dose 2 and dose 3 – 12 weeks; dose 1 and dose 3 – 5 months - If administered earlier than minimum interval: repeat dose
• For males age 9-18 years, a 4vHPV and 9vHPV should be given for the prevention of anogenital warts and anal cancer.

CHOLERA VACCINE

INACTIVATED HEPATITIS A VACCINE (HAV)

HUMAN PAPILLOMAVIRUS VACCINE (HPV)

SUMMARY TABLE: Immunization of Pre-Adolescents and Adolescents (9 to 18 years old)

Vaccine Range Of Recommended Age

Dose(s) Needed Schedule Of Immunization Route Of Administration

Precautions And Contraindications

Hep B Vaccine Unvaccinated 9-18 years old

3 0, 1, 6 months IM •Severe allergic reaction to vaccine component •Moderate to severe illness

Inactivated Hepatitis A Vaccine

Unvaccinated 9-18 years old

2 Second dose given at least 6 months from first dose

IM •Severe allergic reaction to vaccine component •Moderate to severe illness

Live Hepatitis A Vaccine

Unvaccinated 9-18 years old

1 Anytime at this age group SQ •Severe allergic reaction to vaccine component •Moderate to severe illness

• Immunosuppression
• Pregnancy
• Recent receipt of blood products

MMR Unvaccinated 9-18 years old

2 4 weeks interval between doses SC •Severe allergic reaction to vaccine component •Pregnancy •Immunosuppression •Recent receipt of blood products •Moderate to severe illness

Incompletely vaccinated 9-18 years old

1 2nd dose given anytime but at least 4 weeks from 1st dose

Varicella Unvaccinated 9 -12 years old

2 Minimum interval between doses is 3 months

SC •Severe allergic reaction to vaccine component •Pregnancy •Immunosuppression •Recent receipt of blood products •Moderate to severe illness

Unvaccinated ≥ years old

2 Minimum interval between doses is 1 month Incompletely vaccinated 9-18 years old

1 Given anytime 9-12 years old: second dose at least 3 months from first dose ≥13 years old: second dose at least 1 month from first dose

Influenza Vaccine 9-18 Y years old 1 Give annually beginning February IM/SC •Severe allergic reaction to vaccine component •Moderate to severe illness •History of Guillain-Barre syndrome following a previous dose