LASCANO (Vaccinology)

LASCANO, Joanne Alyssa H.
September 3, 2021
Section 3J Pediatrics 3B
SGD 5: Vaccinology
Clinical Vignette 1
Didi was born to a G3P3 mom at a government hospital. She was given BCG, Hep B and vitamin K at
birth. At 2 months of age, he was brought to the health center for follow-up.
Guide Questions
1. Based on the national immunization program, give the recommended vaccines at this age.
● BCG and Hepatitis B vaccine at birth

● Pentavalent Vaccine, Oral Polio vaccine, and Pneumococcal conjugate vaccine at 1 ½ month.
● Bacille Calmette Guerin (BCG) ID 0.05ml after birth preferably within two months of life
● Pentavalent Diptheria, Tetanus, Pertussis Vaccine (DTP) IM given at a minimum age of 6 weeks
first dose
● Monovalent Hepatitis B Vaccine (HBV) IM within 24hours of life
2. If she was given Pentavalent vaccine at the time of consult, when can she receive the
Rotavirus?
Rotavirus vaccine can be given together with oral polio vaccine after the Pentavalent vaccine
however there are different formulation with different dosing and scheduling annotated below:
Human (RV1)
• 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 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.
3. What is the general rule on giving live and inactivated type of vaccine?
Live Attenuated Vaccines Derived from wild viruses or bacteria which are modified or
weakened in laboratories. Immunity is elicited by replication of the attenuated organism in the
vaccinated person. The immune response to a live attenuated vaccine is identical to that induced by
natural infection while Inactivated Vaccines Produced by growing the bacteria or virus in culture
media which are then subjected to heat or chemical agents. In fractional or subunit form of these
vaccines, organisms are treated to be able to derive those components needed to produce the
vaccines. Both inactivated or subunit preparations must contain sufficient antigenic mass to stimulate
desired response since it is incapable of replicating inside the host.
GENERAL RULE: The general rule for inactivated vaccine is that is not generally affected by
circulating antibody to the antigen, while the live-attenuated vaccine may be affected by circulating
antibody the antigen. Therefore, the live-attenuated vaccine require spacing if they are not given at
the same time. In giving inactivated vaccine, the general dosing interval would be 4 weeks and
inactivated vaccine can be given at the same time along with a live-attenuated vaccine.
4. If only the Pentavalent vaccine is available at the time of consult, give vaccines that can be
given to him as soon as possible?
The patient should receive the pentavalent vaccine (DTP, HepB, Hib), then oral polio vaccine
together with the rotavirus at the same time.
5. Her mother was very worried as she cries when touch in the injection site the next day
following immunization. How will you properly address his mother’s concern?
Continue breastfeeding since it has been proven for pain relief. Application of a clean, cool,
damp cloth on the injection site may also be done to reduce the redness, soreness, and/or swelling at
the injection site.
Clinical Vignette 2
Gigi recently celebrated her 5th birthday. A week after, her mom brought her to their family physician
with the following immunization history: 3-doses of DPT/IPV/HIB/HepB combination vaccines, 1-
Measles, 1- MMR
Guide Questions
1. What are the vaccines recommended at this age, if any?

- Influenza vaccine
- 2 doses of Japanese Encephalitis vaccine 4 weeks apart
- Varicella
- Pneumococcal conjugate
- Hepatitis A vaccine
2. How soon can Gigi receive Flu vaccine if she was given Varicella vaccine at the time of
consult?
All live vaccines (varicella and influenza vaccines) can be given at the same visit if indicated.
If live vaccines are not administered during the same visit, it should be separated by 4 weeks or
more. Example is Varicella Vaccine (Live Attenuated) given as a 2-dose series at a minimum
age of 6 weeks with a minimum interval of 4 weeks between doses.
3. What are other vaccines not part of the EPI may also be given to him?
- Hepatitis A
- Varicella Vaccine
- Influenza especially to high risk
- Pneumococcal conjugate
- Japanese encephalitis vaccines
4. If Flu vaccine and Hep B are scheduled at this visit, how are you going to give the 2 vaccines?
- Flu vaccine and Hep B vaccines are inactivated vaccines and can be given at the same time at
different injection sites but separate injection sites by at least one inch. Both inactivated vaccines
can be given at the same time but at different injection sites via IM on the deltoid muscle
5. Give conditions that are contraindicated for vaccination if Gigi has.

- Severe allergic reaction to vaccine component
- Moderate to severe illness
- Immunosuppression
- Recent receipt of blood products
- History of Guillain Barre syndrome following a previous dose (influenza vaccine)
- Encephalopathy
Clinical Vignette 3
Lili, 9-months old, is receiving vaccines from a barangay health center.
Guide Questions
1. Her mother asked you for any other vaccine needed. What vaccines are you going to
recommend?
- Measles vaccines
- Japanese Encephalitis vaccine
- Hepatitis B vaccine
- Influenza vaccine
- 3 doses of Pentavalent Vaccine
- 3 doses of OPV or 1 dose of IPV
- 3 doses of PCV
2. If she needs 1 more dose of Pentavalent vaccine, when can she receive Rotavirus vaccine?
- at the same visit
- we can give inactivated vaccine at the same time along with a live-attenuated vaccine
3. Pneumococcal conjugate vaccine was given to her at the time of consult. This vaccine is
recommended to be given at which route?
- Pneumococcal conjugate vaccine should be given intramuscularly (IM)
4. A day after vaccination, Lili had fever. What will be your assessment to the fever in
relation to vaccination?
Systemic reaction is usually non-specific. Assure the parents or guardians that this is self-limited
but observe for any other accompanying symptoms. Educate the caregiver or parents that vaccines
introduce components that are known to activate the immune response but it will not cause the patient
to become ill. Medications to alleviate fever are not necessary but keeping the patient hydrated should
be done.
5. An outbreak of Measles occurred at a nearby barangay where Lili lives. What will be your
plan of management in order to prevent her from acquiring the disease?
- Measles vaccine is given subcutaneously (SC) 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

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LASCANO, Joanne Alyssa H.

● BCG and Hepatitis B vaccine at birth

Human-Bovine live-attenuated reassortant (RV5) (oral liquid formulation)

Human-Bovine live-attenuated reassortant (RV5) (oral freeze-dried formulation)

1. What are the vaccines recommended at this age, if any?

5. Give conditions that are contraindicated for vaccination if Gigi has.

Lili, 9-months old, is receiving vaccines from a barangay health center.

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