May 28-29, 2012

An Act providing for MANDATORY BASIC IMMUNIZATION SERVICES FOR INFANTS AND CHILDREN, repealing for the purpose Presidential Decree No. 996, as amended.

RA 10152
 Section 3. Coverage. –

The mandatory basic immunization shall be given for

free at any government hospital or health center to
infants and children up to five (5) years of age.

The Hib problem
 Globally, one of every 25 children under 5 years of age is estimated to die from Hib disease.  In most pre-vaccine studies Hib caused approximately 20% of severe pneumonia and was the leading cause of bacterial meningitis

 Estimated 2.7 million childhood pneumonia cases per year in PHL
 Hib possibly 10% to 30% of cases in PHL

Bacterial Meningitis Surveillance Philippines
 Sentinel surveillance of bacterial meningitis:  41% of cases were aged 1 year or less  57% of cases were under 5 years  71% of cases were under 15 years  Conclusion: meningitis is disproportionately a disease of infants  One third of these cases can be prevented by Hib immunization now  Reduction in other age groups expected from Hib vaccine interruption of Hib transmission

Hib pneumonia and meningitis burden is often underestimated
 Surveillance detects only a very small portion of the true

burden of Hib:
 lab infrastructure not sufficient;
 prior use of antibiotics  lumbar punctures not always done;  children with Hib never reach a healthcare facility.

 Hib studies show burden of Hib disease many times higher

than what was previously thought.  A Bangladesh study showed that the Hib vaccine prevented:
 over 1/3 of hospitalized pneumonias  and over 80% of hospitalized probable bacterial meningitis cases

What is Heamophilus Influenza Type B
 Hib is one of the six related types of H. Influenzae

bacterium  Hib’s victim are mainly children younger than five(5) years old  Hib bacteria are commonly present in the nose and throat  The bacteria are transmitted from person to person in droplets through sneezing and coughing

Signs and Symptoms
 Pneumonia and meningitis are the most important

diseases caused by Hib bacteria.  In developing countries, pneumonia is more common than meningitis in children with Hib disease.  Hib disease should be suspected in the case of any child with signs and symptoms of meningitis or pneumonia.

Complications of Hib
 Children who survive Hib meningitis may develop

1. permanent disability, including brain damage, hearing loss 2. mental retardation

3. 5% to 10% cases of Hib meningitis are at risk of dying

What is the treatment and Prevention for Hib?
 Hib disease can be treated with antibiotics.  Hib disease can be prevented with vaccine given in

early infancy

Hib Vaccine
 Are liquid or lyophilized (freeze-dried )  Monovalent, quadrivalent, Pentavalent - One injection against 5 diseases
Diptheria Pertussis Tetanus Hepatitis B

Hib

   

Stored at + 2 C and +8 C Extremely freeze-sensitive; Penta must NEVER be FROZEN Immunization Safety: Auto-disabled syringes No Pre-filling

Hib Vaccine/Pentavalent Vaccine - Given as a 0.5 ml, intramuscular injection in infant’s outer mid thigh
- Co-administration

- Pentavalent may be administered with OPV
 Recording and Reporting

Schedule (before…)
SCHEDULE SA PAGBAKUNA
EDAD BIRTH BCG 6 weeks Hep B
(OPTION 1) (OPTION 2) (penta)

MGA BAKUNA NA DAPAT MATANGGAP

Hep B 10 weeks

OPV1

DPT1

RV

RV

Hib

OPV2 14 weeks

DPT2

RV

RV

Hib

Hep B
9 months

OPV3

DPT3

RV

Hib

MEASLES 12-15 months

MMR

Schedule (Now…)
SCHEDULE SA PAGBAKUNA
EDAD BIRTH BCG 6 weeks Hep B
(OPTION 1) (OPTION 2)

MGA BAKUNA NA DAPAT MATANGGAP

PENTA
10 weeks

OPV1

RV

RV

PENTA

OPV2

RV

RV

14 weeks

PENTA

OPV3

RV

9 months MEASLES 12-15 months

MMR

Contraindications and Precautions to Vaccination
 Contraindicated for persons known to have experienced a severe allergic reaction (anaphylaxis) following a prior dose of that

vaccine.  Vaccination should be delayed for children with moderate or severe acute illnesses.  Minor illnesses (e.g., mild upper respiratory infection) are not contraindications to vaccination.

Adverse Reactions from Hib Vaccine
 Adverse reaction following Hib conjugate vaccines are

not common.  Swelling, redness, or pain have been reported in 5%– 30% of recipients and usually resolve within 12–24 hours.  Systemic reactions such as fever and irritability are infrequent.  Serious adverse reactions are rare

New Pentavalent Vaccine 5 in one
One vial = 5 antigens DPT-HepB-Hib

 Now DPT, HepB & Hib are all together  But birth dose HepB still needed  One vial contains ten doses
 Just like DPT

 Same schedule as DPT - 3 doses (6, 10 and 14

weeks of age)

Example of a health staff brochure

Simple messages for the public New 5 in one vaccine
 More protection for babies:  protects from 5 diseases  Less jabs  one jab contains 5 vaccines  Same times  3 doses: 6 weeks, 10 weeks, 14 weeks of age  Don’t let your baby miss any dose!

Simple message for health workers New 5 in one vaccine
 New Pentavalent vaccine has 5 vaccines in one vial  One vial contains DTP-HepB-Hib  This means More protection because DPT, HepB and Hib are all given      

together But Less injections because HepB is included in the 5 in one vaccine You will still need to give the birth dose of HepB, then you will give 3 doses of pentavalent at 6, 10 and 14 weeks; Same schedule as DPT. All other vaccines (BCG, OPV, measles) stay the same One vial of pentavalent vaccine (‘Penta’) contains ten doses, storage is the same as DPT: 2 to 8C and must never be frozen Immunization cards will be changed to help you record new Penta doses Please make sure every infant gets all its doses of all vaccines on time

 Disease burden highest among 4 mos. And 18 months.  Hib disease primarily pneumonia and meningitis in

young children, is a significant public health concern
 PENTAVALENT:

-We give to 6 weeks old up to below 5 yrs. -Over 5 years old, risk of Hib disease is low -“P” component in DPT can cause adverse reaction in > 5 yrs. Old, teenagers and adults

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