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f'A.'lGl<ALAHATAN

SUMMARY TABLE: Immunization of Teens and Pre-teens 2014

(7 to 18 yrs old}

Range of Dose(s) Schedule of Precautions

Vaccine Route of Administration and Contra-indications *
Recommended Age needed Immunization

Severe
allergicreactiontovaccinecompo
nent,
HepBVaccine Previous
lyunvaccinate
d 7-18yrs.old 3 0,1,6months Intramuscula
rly(IM)
moderate tosevereillness

2nddosegiven atleast6monthsfrom Severe

allerg
icreaction
tovaccine
HepAVaccine Prev
iouslyunvacci
nated7-18yrsold 2 Intramuscu
larly(IM)
1stdose component,
moderatetosevereillness

Previous
lyunvacci
nated7-18yrsold 2 4wksintervalbetwee
ndoses Severeallergicreaction
tovacci ne component ,
Subcutaneously
MMR Pregnancy, immunosu ppression, recentreceiptof
2nddosegivenanytimebutatleast (SC) bloodprodu cts, moderatetosevereillness
Incompletely ed7-18yrsold
vaccinat 1
4wksfrom1st dose

Previously
unvaccinated
7-12yrsold 2 Min
imuminterval
betweendosesis3months
Severe allergicreaction
tovaccine
Previous d ~ 13yrsold
lyunvaccinate 2 Minimumintervalbetweendosesisonemonth Subcutaneous
ly compone nt.Pregnancy , lmmunos
uppressi
on,
VaricellaVac
cine recentreceiptof blood products,
modera
teto
(SC)
severe illness
Anytime:
7-12yearsoldat lea.st 3mosfrom1stdose
Incomp 7-18yrsold
letelyvaccinated 1 ~ 13yearsoldatleast4weeks from1stdose

Intramuscu
larly (IM)/ Severeallergic
reactio
ntovacci ne,
moderatetosevere illness,
historyof
Influenza Vaccine 9-18yrsold annually Beginimmunizing in Feb
.
Subcutaneo
usly(SC) Guillain-
Barresyndrome followinga
previousdose

HPV:
Biva
lent HPV Fema
les: 10-18yrsold 3 0, 1and6 months Severeallergic
reactio
ntovaccine,
moderatetosevere illness
QuadrivalentHPV Females: 10-18yrsold 3 0,2and6 months Intramuscularly
(IM) Iffoundtobe pregnantafterstarting
Mal
es:10-18yrsold(forprevention
of immunizationdelayremainingdosesuntil
anogenitalwarts) completionofpregnancy

Fully
immuniz
ed 7-18yrsold 1 Eve
ry10yrs (GiveonedoseTdapinstead
ofdueTd)

Incomp
letelyimmunized7-18yrsold 1-2 OnedoseTdap
andTdforremainingdoses
Severe
allergicreactiontovaccine
,
Td/Tdap Unimmunized7-18yrsold 3 0,1and6 monthswithTdappreferablyas1stdose Intramuscularly
(IM)
Modera te tosevereillness
Fullyimmunized definedas5 doses
of DToPor 4 dosesof DToPif the4th
dosewasadministeredon or ofter
the 4th birthday.

*Reference:
CDCEpidemiology
andPreventionof Vaccine- Preventable
Diseases
, 12thEdition,2012
 Childhood Immunization Schedule 2014
/
...,
AGEIN BIRTH WE EKS MONTH S
II YEARS

0 2 4 6 8 10 12 14 16 18 20 22 8 10 12 14 16 18 20 4 6 8 10 12 14 16 18

BCG
I I (B4G)

L J HepB (H p B)

-
(Hep B* )
~

~
(HepB*)
_.._ -

F
(DTw P- HiB - (HepB* ) HN I
I - -- --
-----...J.- -
Hep B*)
and ot her
... (DTwP* )/ DTaP*
(DTwP*) / DTaP*
l .J
l ~

-
Td•p/(Td)

DTP
comb inatio ns [HiB* ) (HiB*)
l D DTaP
- IPV

IPV/OPV*
lco,v•11
....."".-
I
(OPV* J/IPV ---, I
(HiB* J

n
DTaP - IPV - HiB

r ~
(OPV* J/IPV

RV*
I I
(RV Series*)
J Cl -
-- -~ -
Measles (Measles)

MMR* j j- (MMR*) I
n- l I ~ I MMR
--
IMMR)

PCV*/PP V
~ )
'-
(PCV*)
(PCV* )
- PCV I PCY I
Infl uenza

Varicella

Hep A
---- l f
Varicella

-----
:
.....
,,.
Hep A Series
1 Influ enza Yearly

I
Varicella

HaoA
I _ l l l -
'--
HPV
I I I HPV Series
- ~

~ EPI Vaccines Range of Recommended Age - Catch Up Imm unizat ion - For High Risk Group • Primary do ses are g iven at least 4 wee ks apart
inside box

DISCLAIMER: PHILIPPINEEPIVACCINES: OTHERRECOMMENDEDVACCINES

:
The Childhood Immunization Schedule presents recommendations for immuniza tion for Vaccines in the pink box, enclosed in parenth eses, are vaccines given in the Other Recommended Vaccines are vaccines outside th e pink box. These vaccinesare not
children and adolescents based on the knowledge, experienceand premisescurrent at the Philippine Expanded Program of Immunization (PEPI)of the Department of Health. part of the Philippine EPI but becauseof merit are advocated by the Philippine Pediatric
time of publication. The schedule represents a consensus with which physicians may a t Vaccines in the PEPI include: Society (PPS), Pediatric Infectious Disease Society of th e Philippines (PIDSP), and the
times disagree. No claim is mode for infallibili ty, and the PPS,PIDSPand PFVacknowledge Philippine Foundation for Vaccination (PFV). Other Recommended vaccines include:
· BCG -Measles -PCV
tha t individual circumstances may warrant a decision differi ng from the • OTaP • IPV • Varicella • Influenza
• OTwP-HiB-HepB • MMR · Td
recommendations given here. The recommendations ore not absolute. Physiciansmust • Tdap/Td • MMRV • Hepatit is A • Human Papillomav irus
•O PV • Rotavirus vaccine
regularly update their knowledge about specific vaccines and their use because Vacci ne (HPV)
information about safety and efficacy of vaccines and recommendations relative to their
admini stra tion continue to develop ofter a vaccine is licensed.

VACCINES FOR SPECIAL GROUPS:

Annotations:
BCG
Givenintradermally (ID)
BCGshould be given at the earliest possible age after birth preferably
within the first 2 monthsofli fe.
For healthy infants and children> 2 monthswho arenot given BCG at birth,
PPD prior to BCG vaccination is not necessary. However, PPD is
recommended prior to BCGvaccination if any of the following arepresent:
- suspected congenital Tb
- history of close contact to knownor suspected infectious casesof TB
- clinical findingssuggestive ofTB and/or chest <-<aysuggestive ofTB
In the presenceof any of these conditions,an induration of > 5 mm is
consideredpositive.Thedoseof BCGis 0.05ml for children < 12 monthsof
age and 0.1 ml for children> 12months of age.
DIPHTHERIAAND TETANUSTOXOIC>S AND ACELWLAR/WHOLE CELL
PERTUSS ISVACCINE(OTaP/DTwP)
The following DTPcombination vaccinesare availablein the Philippines:
OTwP-Hib
DTaP -IPV
DTwP-HepB
DTaP -IPV-Hib
DTwP-HepB-Hib
DTaP-IPV-Hib-HepB
DTP
Givenintramuscularly (IM)
Givenat a minimum ageof 6 weekswith a minimum interval of 4 weeks
The 4th dose may be givenasearly as 12 monthsof age providedthere isa
minimum interval of 6 months from the third dose.The 5th dose may not
be given if the 4th dosewasadministered at age4 yearsor older.
Thepertussiscomponent mayeither bean acellular or whole cell formulation.
HEPA TITISB VACCINE
Givenintramuscularly OM)
The 1stdoseshould be given within the first 12 hours of life, and may be
counted as part of the ~ oseprimary series.Subsequentdosesare given
at least 4 weeksapart,with the 3rd dosepreferably given not earlier than 24
weeksof age.
Another doseof hepatiti sBis neededfor the following (to be administered
not earlierthan 24 weeksof age):
• Preterms <2 kgs whose 1st dose wasreceived at birth
•Infantsfor whom the 3rd doseis given at age< 24weeks
Preterm infantsborn to HBsAg(-) mothers who are medically stablemay
be given the 1st doseof HBV at 30daysof chronological age regardlessof
weight, and this can be counted aspart of the 3 dose primary series.
If mother isHBsAg(+), administer HBVand HBIG (0.5mOwithin 12 hoursof
life. If HBsAg status is unknown, administer HBVwithin 12 hours of birth
and determine mother's HBsAg as soon as possible. If HBsAg (+)
administerHBIG no laterthan 7 daysof age.
In the EPI schedule,HepatitisBisgivenasmonovalent hepatitisBvaccine at
birth then subsequent doses are given at 6, 10, 14 weeks of age as
combination vaccinescontaining DTwP-Hep B-Hib.
HAEMOPHILUSINFLUENZAETYPEB CONJUGATEVACCINE(HiB)
Givenintramuscularly (IM)
Givenat a minimum ageof 6 weekswith a minimum interval of 4 weeks.
If the first dose was given between 7-11 months of age, the 2nd dose
should be given at least 4 weeks later, and the 3rd dose at least8 weeks
from the 2nd dose.
A booster dose should be given between 12-1S months of age,with an
interval of 6 monthsfrom the 3rd dose.
One dose of the HiB vaccine should be considered for unimmunized
children aged S years or older who havesickle cell disease,leukemia, HIV
infectionor who had splenectomy
MEASLES VACCINE
Given subcutaneously(SC)at the age of 9 months.
May be given asearly as6 monthsof age in casesof outbreaksasdeclared
by public health officials.
MEASLES , MUMPS, RUBELLA(MMR)
Given subcutaneously(SC)
The minimum age for MMRis 12 months.
Twodosesof MMRare recommended.Thesecond dose isadministered at
ages 4-6 years but may be administered at an earlier age provided the
interval betweenthe first and second dose isat least4 weeks.
Children below 12 months of age given any measles containing vaccine
(measles,MR.MMR)should be given 2 additional dosesof MMR.The 1st
dose is given at age 12-1S months and should be separated by at least4
weeksfrom measlescontaining vaccine. The seconddose is administered
at age 4-6 years, but may be given at an earlier age provided the interval
between the 1st and 2nd doseisat least4 weeks.
Children 12 months or older given one dose of any measles containing
vaccine (measles,MR,MMR ) should be given a 2nd dose of MMRvaccine
separated by at least4 weeksfrom the 1st measlescontaining vaccine.
In the Philippine EPI,a second dose of MMR is given to high school
students (Grade 7-10) enrolled in public schools in selected cities
and provinces.
POLIOVIRUSVACCINE (OPV/IPV)
OPVgiven per orem (PO)
Given at a minimum age of 6 weekswith a minimum interval of 4 weeks.
In the Philippine EPlOPV is administered together with DwPT-Hep B -HiB
vaccinesat6, 10and 14weeksofage.
IPVgiven intramuscularly OM)
Given at a minimum age of 6 weeks with a minimum interval of 4 weeks.
The final dose in the series should be on or after the 4th birthday and at
least 6 monthsfrom the previousdose. If 4 or more doseshavebeen given
prior to age 4 years, an additional dose should be given at age 4 through
6years.
TETANUSAND DIPHTHERIATOXOID (Td)/ TETANUSAND DIPHTHERIA
TOXOID AND ACE.LLULARPERTUSSIS VACCINE(Tdap)
Given intramuscularly (IM)
In children who are fully immunized*,Td booster dosesshould be given
every 10 years.A single dose ofTdap can be given in placeof the dueTd
dose, and can be administered regardless of the interval since the last
tetanusand diphtheria toxoid containing vaccine.
Children aged 7 through 18 years who are not fully immunizedwith DPT
vaccine should receiveTdap as the 1st dose in the catch-up series. If
additional dosesareneededuse Tdvaccine.
Children and adolescentsaged 7 through 18 years who have never been
immunized with DPT vaccine should receivethe 3-dose series of tetanus
and diphtheria containing vaccinesusing the 0-1-6 months schedule. A
single dose ofTdap is given, preferably as the 1st dose. The remaining
dosesare given asTd.
*Fullyimmunizedis definedas S dosesof DTaP or 4 dosesof DTaPif the 4th
dosewasadministered on or afterthe 4th birthday.
In the Philippine EPi a single dose ofTd is given to high school students
(Grades 7-10) enrolled in public schoolsin selected citiesand provinces.
For the fully immunized pregnantadolescent.administer one doseofTdap
vaccine between the 3rd or late 2nd trimester of pregnancy (after 20
weeksgestation).
Unimmunized pregnant adolescentsshould receive the 3-dose series of
tetanus and diphthteria containing vaccines(Td/Tdap) following a 0-1-6
months schedule. Tdap should replace one dose of Td given preferably
during the 3rd or late 2nd trimester of pregnancy (after 20 weeks
gestation).
HEPAITTIS A VACCINE
Given intramuscularly (IM)
HepatitisA vaccine is recommendedfor all childrenaged> 12months.
A second doseof the vaccine isgivenat least6 monthsafter the first dose
ROTAVIRUSVACCINE (RV)
Givenper orem.
Theminimum interval between dosesis 4 weeks.
The monovalent human rotavirus vaccine (RVl) is given as a two-dose
seriesand the pentavalent humanbovine rotavirus vaccine(RVS ) isgiven as
a 3-dose series.
Thefirst doseshould be administeredbeginning at 6 weeksof age and the
lastdose should be administerednot laterthan 32weeksof age.
If RVl is administered for the first and second dose, a third dose is not
recommended.
VARICELLAVACCINE
Given subcutaneously (SC)
Two dosesof varicella vaccinearerecommended.
The first doseof the vaccine isadministeredfrom age 12 - 1S months. The
second doseof the vaccineis administered at~ years or at an earlier age
provided the interval between the first and the second dose is at least
3months.
A seconddose of the vaccine is recommended for children, adolescents
and adults who previously received only one dose of the vaccine. For
children below 13 years, the recommended minimum interval between
dosesis 3 months.However,if the second dosewasadministered at least 4
weeksafterthe first dose,it can be considered asvalid.
All individuals aged > 13 years and without immunity should receive2
dosesof varicella vaccinegiven at least4 weeksapart.
MEASLES, MUMPS, RUBELLA,VARICELLA(MMRV)
Given subcutaneously (SC)
Combination MMRV may be given as an alternati ve to separately
administered MMRand varicella vaccinefor healthy children 12 monthsto
12yearsof age.
Theminimum interval between the first and second dose is3 months.
HUMAN PAPILLOMAVIRUSVACCINE(HPV)
Given intramuscularly (IM)
Primary vaccinationconsistsof a 3-dose series.The minimum age for HPV
vaccination is 9 years.Therecommended schedule isasfollows:
• Bivalent HPVat0, 1 and 6 months
•Quadrivalent HP\!"at 0, 2 and 6 mos
The minimum interval between the 1st and 2nd dose is at least 1 month
and the minimum interval between the 2nd and 3rd dose is at least 3
months.The 3rd doseshould be given at least6 monthsafterthe first dose.
'The quadnvalentHPV con be given to moles 10- 18yearsof age for the
preventionof anogenita/warts.
INFLUENZAVACCINE
Givenintramuscularly (IM)or subcutaneously (SC)
All children from6 monthsto eighteenyearsshould receive influenzavaccine.
Children 6 months to 8 yearsreceiving influenzavaccine for the first time
should receive 2 dosesof the vaccine separated by at least4 weeks. If only
one dose was administered during the previous influenza season,
administer 2 doses of the vaccine then onedoseyearly thereafter.
Child renaged9 to 18 yearsshould receive one doseof vaccine yearly.
Annual vaccination should be given preferably between February to June,
but may be given throughout the year
PNEUMOCOCCA LVACCINES(PCV/ PPV)
Given intramuscularly (IMJ
The minimum age for pneumococcal conjugate vaccine (PCV)is 6 weeks.
Primary vaccination of PCVconsistsof 3 doseswith an interval of at least4
weeksbetween doses,plus a boosterat 6 monthsafter the 3rd dose.
Healthy children 2 to S yearsold who have no previous PCVvaccination
maybegivenonedoseof PCV13or2dosesofPCV10at least 8weeksapart.
Routine use of PCVis not recommended for healthy children aged ;a,
Syears.
For high risk children 2: 2 years of age, PPV is recommended after
completing PCVseries(refer to Vaccinesfor Special Groups).
For healthy children, no additional doses of PPV are needed if PCVseries
is completed.
Theseare the vaccines which are not part of the Philippine EPI or Other
Recommended Vaccinesbut available data support their use in certain
conditionsor in selectedpopulations. Vaccines for Special Groups include:
• MeningococcalVaccines
· RabiesVaccine
-Typhoid Vaccine
• PneumococcalVaccine (PCV/PPV)
MENINGOCOCCAL VACCINE
Tetravalent meningococcal (ACYW -135) conjugate vaccine (MCV4) given
intramuscularly (IM), tetravalent meningococcal polysaccharide vaccine
(MPSV4)givensubcutaneously (SC)
Two dosesof MCV4 given 2 monthsapart should be given to children aged
9 months and above at high risk for invasive disease (persistent
complement component deficiencies, anatomic/functional asplenia, HIV,
travelers to or residents of areas where meningococcal disease is
hyperendemic or epidemic.or belonging to a defined risk group during a
community or instit utional meningococcaloutbreak).
If MPSV4is used for high-risk indMduals as the first dose, a seconddose
using MCV4should be given 2 monthslater.
If the person remains at increasedrisk. an initial booster dose of MCV4
should be given 3 yearsafter completing the primary series,with continued
boostersat S-yearintervals afterthe initial booster dose.
Additional boosterdosesof polysaccha ride vaccinesare not recommended.
TYPHOIDVACCINE
Given intramuscularly (IM)
Recommended for travellers to areaswhere there is risk of exposure to S.
typhi and for outbreak situationsasdeclared by public health officials.
A single dose may be given as early as 2 years of age with revaccination
every2 to 3 yearsif there is continuedexposure to S.typhi
RABIESVACCINE
The AntHabies Act of 2007 recommendsroutine rabies ~ure
prophylaxis (PrEP)for children ages S-14yearsin areaswhere there is high
incidenceof rabiesand animalbites (definedas more than twice the national
average) .
Thereare2 recommendedregimensfor P~ ure Prophylaxis:
- lntramuscularregimen:PVRV0.Sml orPCECV 1 ml given on days0, 7,
21 or 28.
- lntradermal regimen: PVRVor PCECV0.1 ml given on days0, 7, 21
or 28.
A repeat dose should be given if the vaccine is inadvertently
givensubcutaneously.
Rabies vaccineshould never be given in the gluteal areasinceabsorption
isunpredictable.
Periodic boosterdosesin the absence of exposure arenot recommended for
the general population.
In the event of subsequent exposures, thosewho havecompleted 3 dosesof
pre- exposure prophylaxis, regardlessof interval between re-exposure and
lastdoseof the vaccine,will requireonly boosterdosesonday0an d 3.
Boosterd osesmaybegiven IM{0.5ml PVRVo r 1 mlPCECV)orlD(0.1 ml PVRV
or PCECV).Thereis no needto give rabiesimmune globulin.
PNEUMOCOCCALVACCINES(PCV/ PPV)
Given intramuscularly (IM)
For Children ;a, 2 years with the following underlying medical conditions
such as but not limited to anatomic/functional asplenia, HIV infection or
other immunocompromising condition, chronic lung, heart and renal
diseases,cochlear implant, or cerebral spinal fluid leak.
- Children aged24 to 71 months,give one doseof PCVl 3 if threedoses
of any PCVweregiven previously or give two dosesof PCV13 at least
8 weeksapart if lessthan 3 dosesof any PCVwere previously given.
- Children aged 6 to 18 yearswith no previous dosesof PCV,give a
single doseof PCV13.
- Children 2-18yearsold with the aboveconditions shouldreceive PPV
at least 8 weeksafter PCV.
A second dose of PPVis recommended S years after the 1st dose of
PPV only for those with anatomic / functional asplenia, congenital
immunodeficiency, HIV infection, chronic renal failure or nephrotic
syndrome, malig nancy, solid organ transplantation, and other diseases
associated with immunosuppressivedrugs or radiation therapy. No more
than 2 PPVdosesshould begiven.