PREVENTIVE PEDIATRICS

Question 1

INACTIVATED VACCINES

Answer 1

• Hepatitis B vaccine
• DPT vaccine
• H. influenzae b vaccine
• Pneumococcal vaccine
• Hepatitis A vaccine
• Meningococcal vaccine
• Influenza trivalent vaccine
• Human papillomavirus vaccine
• Typhoid fever vaccine (IM)
• Rabies vaccine
• Inactivated polio vaccine (IPV)

Question 2

LIVE VACCINES

Answer 2

• BCG vaccine
• Measles vaccine
• MMR vaccine
• Varicella vaccine
• Rotavirus vaccine
• Influenza attenuated vaccine (intranasal)
• Typhoid fever (oral) vaccine
• Oral polio vaccine
• Japanese Encephalitis

Question 3

Vaccine spacing and intervals

Answer 3

Question 4

Yellow fever vaccine (live) and Cholera vaccine (inactivated) – separate by at least ____ because of diminished Ab response if given simultaneously

Answer 4

3 weeks

Question 5

Can two live vaccines be given together?

Answer 5

YES

Question 6

Can live-inactivated be given together?

Answer 6

YES

Question 7

Can I give a live vaccine today followed by an inactivated tomorrow?

Answer 7

YES

Question 8

Can I give an inactivated today then inactivated tomorrow?

Answer 8

YES

Question 9

Can I give inactivated today and live tomorrow?

Answer 9

YES

Question 10

Can I give Live today and another live tomorrow?

Answer 10

NO

* If live + live vaccine, either give it SIMULTANEOUSLY, otherwise you have to wait 4 weeks.

Question 11

BCG

Answer 11

• At birth, preferably within first 2mo
• Intradermal
  • 0.05ml < 12months
  • 0.1ml >12months

Question 12

2 permanent contraindications to vaccination

Answer 12

1. Anaphylactic reaction
2. Encephalopathy not due to another identifiable cause occurring within 7 days after pertussis vaccination

Question 13

2 temporary contraindications to live vaccines but not with inactivated vaccines:

Answer 13

1. Pregnancy
2. immunosuppression

Question 14

What is the earliest time you can give the measles vaccine?

Answer 14

6 months

Question 15

PPS RECOMMENDED VACCINES

Answer 15

Question 17

Hep B

Answer 17

• At birth w/in 12hours of life
• 6-10-14weeks

Question 18

DPT

Answer 18

• 6-10-14weeks
• Booster Usually at 1y/o and 4yo
• Interval between 3 rd and 4 th dose is 6months (4months is acceptable). 5 th dose not needed if 4 th dose given at 4y/o or older

Question 19

Hib

Answer 19

• 6-10-14weeks
• 12-15mo booster
• Booster given 6mo from 3rd dose
• Not routinely given >5y/o

Question 20

Polio

Answer 20

• 6-10-14weeks
• booster On or after 4th birthday
• Oral or IM
• Booster 6months from the previous dose

Question 21

Pneumococcal

Answer 21

• 6-10-14weeks
• booster 6months after 3rd dose
• Healthy children 2-5y/o without previous vaccine may be given 1 dose PCV 13 or 2 doses PCV 10 8 weeks apart
• Not recommended for > 5y/

Question 22

Rotavirus Vaccine

Answer 22

• 1 st dose: ALL infants 6 weeks up to 14 weeks and 6 days old
• 2nd dose: 10—32 weeks (final dose 8 months and 0 day)
• Should be strict with the schedule because of possible intussusception
• CUTOFF AGE: 14 weeks and 6 days old
• DO NOT give rotavirus vaccine beyond the cut-off age!

Question 23

Influenza

Answer 23

• minimum 6months
• Initial of 2 doses 4 weeks apart for 6months to 8y/o
• 0.25ml for 6mo-35mo
• 0.5ml for 36mo-18y/o

Question 24

Measles

Answer 24

• 9months
• Subcutaneous
• May be given at 6months if with outbreak

Question 25

Japanese Encephalitis

Answer 25

* 9months * Subcutaneous * 9-17yo give 1 booster 12-24 months from primary series * 18y/o and above total 1 dose * \<18y/o total of 2 doses

Question 26

MMR

Answer 26

* 12months * 2 doses at least 4 weeks apart * 2 nd dose usually at 4-6y/o * Subcutaneous * Children \<12mo given any measles containing vaccine should receive additional 2 doses of MMR

Question 27

Varicella

Answer 27

* 12months * 2 doses * 2nd dose at 4-6y/o * \<13yo – interval between 2 doses at least 3months * (\*4 weeks is acceptable) * 13 and above- 4 weeks interval

Question 28

Hepatitis A

Answer 28

* 12months * 2 doses 6 months apart

Question 29

Tetanus and diphtheria toxoid (Td) / Tetanus and diphtheria toxoid and acellular pertussis (TDaP)

Answer 29

* Fully immunized children, defined as 5 doses of DTP or 4 doses if 4 th dose given on or after 4 th birthday, Td booster given every 10 years. * Single Tdap can be given to replace due dose of Td * Fully immunized pregnant adolescent give 1 dose Tdap any time after 20 weeks AOG * Unimmunized pregnant adolescent give 3 dose td containing vaccine (Td/Tdap) following 0-1-6mo schedule. Tdap should replace Td preferably after 20weeks AOG

Question 30

Human Papilloma Virus

Answer 30

* 9y/o * Bivalent 0-16months * Quadrivalent 02-6months * Interval between: * 1st and 2nd dose is 1 month * 2nd and 3rd dose is 3months * 3rd and 1st dose is 6months

Question 31

A male neonate was born from a HbsAg (+) mother, which among the ff. should be given to the neonate?

Answer 31

Hep B Vaccine and Hep B Immunoglobulin

Question 32

Active anti-rabies vaccine

Answer 32

0.5 ml IM on days 0, 3, 7, 14, 28

Question 33

Passive rabies vaccine

Answer 33

1. HRIG – 20 U/kg (1/2 of the dose IM & ½ of the dose infiltrated around the wound), or; 2. ERIG – 40 U/kg (needs skin testing)

Question 34

Drug of choice for rabies prophylaxis?

Answer 34

Co-Amoxiclav at 40 mg/kg/day for 7 days

Question 35

Simultaneous administration of Vaccines, no comtraindication except for

Answer 35

1. MCV and DPT, and 2. Yellow fever and Cholera

Question 36

A 10-month-old infant had measles, what will you give in an exposed unvaccinated child to prevent measles?

Answer 36

Vaccinate immediately

Question 37

POST EXPOSURE PROPHYLAXIS for varicella exposure

Answer 37

o VZIG within **96 hours** 1 vial (125 U/1.25ml) per 10 kg **IM** (never IV!!) max of 5 vials o Vaccine: healthy children within **3-5 days** o Newborn: give if onset of varicella \<5 d pre delivery or within 48 hours

Question 38

Meningococcemia prophylaxis

Answer 38

Rifampicin, Ceftriaxone or Ciprofloxacin (adults)

Question 39

Diphtheria

Answer 39

o All close contact regardless of immune status o Give booster if none within last 5 years o Erythromycin 40-50mg/kg/d or Benzathine Pen G

Question 40

In children younger than 1 year of age, what is the preferred site for IM injection?

Answer 40

anterolateral aspect of the thigh provides the largest muscle

Question 41

In older children, what is the preferred site for IM?

Answer 41

deltoid muscle

Question 42

This site should not be used for active immunization because the gluteal region is covered by a significant layer of subcutaneous fat and because of the possibility of damaging the sciatic nerve.

Answer 42

upper, outer aspect of the buttocks

Question 43

DEWORMING

Answer 43

* Recommended for all children 1-12yo * **Albendazole** * 12mos to 23mos – 200mg single dose Q6mo * 24mos and up – 400mg single dose Q6mo * **Mebendazole** * 12months and above – 500mg single dose Q6mo

Question 44

IRON SUPPLEMENTATION

Answer 44

Question 45

Contraindications to Deworming

Answer 45

o Severe malnutrition o High grade fever o Profuse diarrhea o Abdominal Pain o Serious illness o Hypersensitivity to anti-helminthic drug