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PEDIA 1

1. Describe the different procedures done


during a well baby visit.
Procedures done at the WBC:
A. Health appraisal – assessment of
growth and development
B. Feeding and nutrition advice
C. Prevention of communicable diseases
> thru health education with
emphasis on personal hygiene,
environmental sanitation and
IMMUNIZATION
D. Anticipatory Guidance – prevention of
accidents and injuries and early detection
of diseases and other defects, etc.
A 2 month old male was brought by his
grandmother to the Well Baby Clinic for
immunization. He was assessed to be at
par with age in his developmental
milestones. Since the baby was left to the
grandmother’s care because the parents
worked abroad, the grandmother wished
to know what other vaccines can be given
to him. She told the pediatrician this baby
has not receives any immunization yet.
2. Based on the DOH – EPI schedule,
give the vaccines that this 2 month
old male should receive specifying
the age at which they should be
given, route of administration and
the possible advese effects:
EPI vaccines that should be given to this baby:

Vaccine Age to be Route of Usual Accelerated


s given Administrati Reaction Reaction
on
At birth or Intradermal Induratio Induratio
BC anytime n (2-4 n: 2-3
G after birth wks) →
pustule
days
(5-7 wks) Pustule
formatio formation
n : 5-7 days
Scar Scar
formatio
n:
formation
2-3
: 2-3
months weeks
EPI vaccines that should be given to this baby:

Vaccine Age to be Route of Usual Adverse


s given Administrati Reaction Reactions
on -Subcutaneou
BC s abscess
- suppurative
G lymphadenitis
-Large
lymphadenop
athy
EPI vaccines that should be given to this baby:
Vaccine Age to Route of Usual Adverse
s be Administratio Reaction Reaction
given n
6, 10, IM -Fever up to - Fever
DTP 14 72 hours (low greater
weeks to moderate
than 40ºC
grade)
within 48
- restlessness
and hours
irritability after
administr
ation of a
previous
dose
EPI vaccines that should be given to this
baby:
Vaccine Age to Route of Usual Adverse
s be Administratio Reaction Reaction
given n
-Local - Collapse
DTP reaction: or shock-
pain and
like state
swelling at
the site of within 48
injection hours
after
receiving
a previous
dose
EPI vaccines that should be given to this
baby:
Vaccine Age to Route of Usual Accelerated
s be Administratio Reaction Reaction
given n
- Seizures
DTP within 3
days of
receiving
a previous
dose
EPI vaccines that should be given to this
baby:
Vaccine Age to Route of Usual Accelerated
s be Administratio Reaction Reaction
given n
-
DTP persistent,
inconsolabl
e crying
lasting for
3 hours
and within
48 hours
after
receiving a
previous
EPI vaccines that should be given to this
baby:
Vaccine Age to Route of Usual Accelerated
s be Administratio Reaction Reaction
given n
- Change
DTP in
sensorium,
drowsiness
, lethargic,
stupurous
convulsion
and / or
coma
EPI vaccines that should be given to this
baby:
Vaccine Age to Route of Usual Adverse
s be Administratio Reaction Reaction
given n
6, 10, oral No reaction Vaccine-
OP 14 related
V weeks
paralysis
EPI vaccines that should be given to this
baby:
Vaccines Age to be Route of Usual Adverse
given Administratio Reaction Rection
n

Hep 0, 1, 6 IM Pain
month and
B s swellin
g at
site of
injectio
n
Fever
EPI vaccines that should be given to this
baby:
Vaccines Age to be Route of Usual Adverse
given Administratio Reaction Reaction
n
9 - Fever Hypersensitivi
Measle with or ty reaction
months
s without (anaphylactic
reaction to
rash 5- chicken, eggs
12 days as
after aminoglycosid
injectio e)
n
3. Based on the AAP/PPS schedule,
what other vaccines should be given
aside from those listed in the EPI?
A. Hib 2, 4, 6, 12 – 15 IM
months
B. MMR 12 – 15 months SC
C. 1st booster of 16- 18 months IM / oral
DTP/OPV (IPV) IM
D. Varicella 12 months SC
E. Influenza As early as 6 IM
months then
yearly
F. Hepatitis A 2 years old and IM
above, then the
2nd dose is given
6-12 months after
the 1st
4. State the significance of fever following
DTP vaccination.

Low to moderate grade fever DTP


vaccination is an expected reaction and is
not a contraindication to the next of DTP

A child with history of a febrile convulsion


is not a contraindication. But a child with
seizure disorder is a contraindication to
give DTP.
5. Discuss the time-frame for BCG reactions.
Does BCG vaccination prevent Primary
Infection TB?

Usual BCG reaction:


o Induration – 2-4 weeks after administration
o Pustule formation – 5-7 weeks after
administration
o Scar formation – 2-3 months after
administration
Accelerated reactions:
> induration: 2-3 days
> Pustule formation: 5 -7 days
> scar formation: 2-3 weeks
Significance of Accelerated Reactions
>patient has primary TB
Contraindication for BCG
>should not be given to person with
burns
> primary and secondary
immunodeficiencies
> widespread skin infection
BCG vaccination does not prevent
Primary Infection TB but it prevents
disseminated and other life-
threatening infections of
Mycobacterium tuberculosis.
7. Discuss the future schedule of
immunization for M.J. including booster
doses.

Advise M.J.’s parents to bring her back to


the clinic at 4 years old for her 2nd booster
DTP/OPV, MMR booster and BCG2. At 11
years old, she needs Td booster then
every 10 years thereafter.
8. Discuss the benefit / risk ratio of
vaccination.

Advise the grandmother that the


pain of the injections and the
adverse reactions of vaccines are
minor discomfort compared to the
protection they give.