Primary Health Care

Pediatrics
Proverbs 4:23 Guard your HEART the wellspring of life

6.
7.
PRIMARY HEALTH
CARE (PHC)
Transcribed from the lecture of Dr. Gironella
WHO-UNICEF, 1978 time when the PHC was

established
Definition: Essential health care made accessible to
individuals and people in the community by means
acceptable to them towards their full participation, at a
cost that the community can afford, in the spirit of selfdetermination.
Ultimate Goal: Health for ALL
Emphasis is on the importance of health promotion and
development.
Immunization
Treatment
REFERRAL SYSTEM as to LEVEL OF CARE:

1.
2.
3.
Basic requirements for a sound PHC (8 As and 3 Cs)

Appropriateness whether the service is needed in
relation to the human needs, priorities and policies
2. Adequate sufficient volume of service is able to meet
the needs and demands of a community
3. Affordability cost is w/in the means and resources of
the individual & community: cheap or free
4. Accessibility service is reachable, convenient as to
geographic, economic and cultural factor
5. Acceptability patients believes in the confidentiality
and privacy of the information
6. Availability medical care and means can be obtained
wherever the people needs it
7. Assessability medical care can be readily evaluated
8. Accountability the financial records or expenses of the
unit can be accounted for
9. Completeness all aspects of medical problem as to
prevention, early detection, diagnosis, treatment, followup measures and rehabilitation
10. Comprehensiveness care is understandable to all types
of health problems
11. Continuity care, management & monitoring of the
patients should be continuous and coordinated
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Primary level
a. Rural Health Care Unit (Health Center in the
Barangay)
b. Teacher, Health Guardians (doctor, nurse, Health
Assistant, midwives in the school or university)
Secondary Level
a. Emergency Hospital or Private Hospital hospital
w/ regular medical services such as Chest x-ray,
Clinical laboratory (CBC, Urinalysis, ECG,
Ultrasound)
b. Such as Lying-in Clinic for normal delivery of babies,
general practitioners or practice in field of specialty
doing minor surgical procedures
Tertiary Level
a. Provincial (National or Regional) Hospitals
(government funded) provided w/ advanced
medical services and facilities
b. Medical centers w/ complete and advanced
services and facilities
1.
PREVENTIVE PEDIATRICS:
ULTIMATE GOAL
Promotion of optimum health from fetal life thru
infancy, childhood and adolescent so that an adult who
is physically, mentally, and emotionally healthy is
produced.
Levels of PREVENTION for Preventive Pediatrics
1.
2.
3.
PHC includes the following:
Primary Health Care Provider (doctors head of the

PHC unit, midwives, nurses, dentists, medical
technologist, volunteer health workers)
Schedule of VISITS
Program Components of PHC

1.
2.
3.
4.
5.
Health Education
Proper Nutrition Promotion
MCH-Family Planning
Water and Sanitation
Control of Infectious Disease
Primary
Promote general health
Prevent specific disease
Example: Proper Nutrition and Immunization
Secondary
Early diagnosis of a symptomatic disease for
early therapy and prevention of sequelae.
Tertiary
Prevention of unnecessary disability to
establish symptomatic disease
Prenatal Period at least 1 visit every moth upon

th
diagnosis of pregnancy up to the 7 month then every 2
th
weeks on the 8 month then every week on the month
until delivery
Birth at least 2 examinations in the hospital (upon
delivery then on the time of discharge)
st
Neonatal 1 check-up is 3 day to 7 day of life then 1
month old
nd
Infancy (0-2) 1 year: monthly then on the 2 year:
every 2 months
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Pediatrics
Preschool (2-5) - every 3 months

School (5-6) twice a year
For 6 years and above: annually
Activities during consultations/Well Baby Clinics
Monitor Growth and Development

Nutrition
Anticipatory Guidance
Preventive Services: Screening tests, Accident
prevention, Prevention of infection
Conduct of Preventive Child Health Services

1.
2.
3.
Monitoring Growth And Development

A. Anthropometric measurements and percentile curve
I. Height (3y/o) or Length
II. Head circumference up to 3y/o
III. Weight
IV. Chest circumference start at 2y/o
V. BP starting 3 years except in patients w/
history of renal pathology at an early age
VI. Others: Midarm circumference, subscapular &
triceps skinfold test
B. Development Milestone
4 Fields of Behavior
1. Adaptive
2. Motor
3. Personal and Social Behavior
4. Language
- aims to prevent thru application of knowledge especially on
growth and development
e.g.: Genetic counseling
Establish a correct diagnosis
Determine if the defect is genetic/hereditary or
due to postconceptual
Take good family history and history during
pregnancy
Give the parents all available facts about the case
Risk factors during pregnancy
Preventive Services
Screening Tests
- should be simple, inexpressive, yield few false positive
and false negative results
1. Height and weight recording and head circumference
2. Newborn Screening test ideally done 48 hours old but
can be done as early as 24hrs but not later than 72hours
old; specimen is pricking at the heel of the baby
Galactosemia
Phenylketonuria (PKU)
Congenital Adrenal hyperplasia (CAH)
Congenital Hypothyroidism (CH)
Glucose 6 phosphate dehydrogenase (G6PD)
First four diseases are endocrine problems while
G6PD deficiency is genetic
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Specifically important for the premature<32

weeks or LBW <1.5 kg monitor O2 toxicity or
Retrolental fibroplasia/Retinopathy of
Premature (ROP)
Infants w/ metabolic disorders; family history
of retinoblasma or congenital cataract
Maternal history of rubella or STD
Squinting
Preschoolers 5 to 10% w/ visual impairment
School age 30% w/ impairment
Rubella, German Measles most common
cause of congenital cataract
4. Screening tests for Hearing now recommended at

birth or discharge of premature especially who were
given antibiotic therapy do the audiometry.
5. Iron Supplementation to prevent Nutritional Anemia
(most occurs 6 to 11 months)
Infants 1 kg or more iron at 2-3mg/kg/day

staring 6 to 8 hours old up to until 1 year)
Fe prep. Drops w/ 15mg elemental Fe/0.6ml
LBW: 0.3ml O.D up to 6 months
6-11 months: 0.6ml O.D x 3 months
Iron prep. Syrup w/ 30mg elemental Fe/5ml
1-5 years: 1 tsp x 3 months
Adolescent girls (10-19) 1 tab w/ 60mg
elemental Fe
6. Vitamin A Supplementation:
o
o
o
Infants 6 to 11 months but usually given at 9

months during measles vaccination
Single dose of 100,000 I.U capsule
Children 12 to 71 months
- 200,000 I.U capsule every 6 months
7. Tuberculosis Screening
o
o
8.
9.
Once in asymptomatic child (1-14y/o)

Using 5 Todd units PPD (Mantoux Test) for
Filipinos while 2 TU for foreigners to be read
after 48 to 72 hours
o Interpretation of Test:
> or 5mm induration is (+) result w/

history of family exposure to PTB,
CXR, of TB, clinical findings of
TB/immunosuppressed
> or 10mm induration is (=) w/o

apparent risk factors
Deworming: For soil-transmitted Helminthiasis
o Single dose of Mebendazole 500mg or
Albendazole 400mg atleast once a year
starting at 2 to 15 years old.
o Frequency depends on the prevalence in the
community (every 3 to 4 months a year)
Cholesterol screening
3. Screening for Visual Acuity (uses the Snellen chart)
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Pediatrics
Parents or Grandparents <55y/o History of MI,

Angina Pectoris, Vascular Dis., CVA or sudden
death
o Parent w/ blood cholesterol (>240md)
o Adolescents who smokes, drinks alcohol
10. Procedures Patients at Risks
o Hgb and Hct atleast once at 6 months to 6
years old; atleast once 10-19 years at risk
o Urinalysis for ill patients and at risks (w/
history and PE of renal disease)
o Lead screening 9 to 72 months
Critical lead levels of >10mg/dl of
blood
11. Development Assessment and Diagnosis
o Denver Development Screening Test most
commonly used
o Monitoring of delayed pubery Tanner
staging or Sexual Maturity Rating in
adolescents age > 10y/o
Active Immunization
Injury prevention use of helmets in riding bicycle,

motorcycles, skateboards; seatbelts in cars
Violence prevention R.A (Anti Child Abuse Law)
reporting of incidents should be done either oral or
written w/in 48 hours to the DSWD if not local police.
High levels of suspicion (Red Flags) unexplained
bruises, injuries reflecting shapes of articles,
unexplained burns, lacerations or fractures
Sexual abuse: Gonorrheal infection, trauma
bleeding in genital area, refusing to go to school,
early pregnancy, behavioral changes
IMMUNIZATION
Ultimate goal: eradication of disease
Immediate goal: prevention of disease
o
o
o
o
To accomplish these goals, physicians must maintain

timely immunization as high priority
Combine an effective immunization program w/
surveillance and effective public health control
measures worldwide
Objective is to provide effective immunity by
establishing adequate levels of antibody and a primed
population of memory cells w/c can rapidly expand on
renewed contact w/ an antigen and so provide
protection against infection
The effectiveness is assessed by the evidence of
protection against the natural disease
Serum antibody concentrations are not always
predictive of protection (SEROCONVERSION of at least
80% will be good vaccine.
Administration of all or a part of that microorganism to

evoke an immunologic response mimicking that of the
natural infection but which usually presents little or no
risk
Passive Immunization
Administration of antibody containing or serum or

sensitized cells is w/c provides passive protection for
the recipient
useful for individuals who cannot form antibody
immunocompromised host who might develop disease
before active immunization could stimulate antibody
production, w/c usually requires at least 7-10 days
Herd Immunity
o
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a non-immune individual who resides in a community

that has been well immunized against poliovirus and
who does not travel and has little opportunity to
encounter wild (virulent) virus.
Types of Immunity
A.
B.
C.
D.
Natural Active natural infection

Natural Passive transparental transfer of Hb from
mother to baby; breastmilk
Artificial Active vaccination
Artificial Passive giving of parenteral Ig
Requirements For A Successful Vaccine (Cases)

1. Cheapness what is cheap in the West may be
expensive in developing countries but WHO tries to
eliminate these pathogens
2. Availability readily cultured in bulk or accessible
source
3. Stability stable under extreme climatic condition,
preferably not requiring refrigeration (at room
temperature);
4. Effectiveness must evoke protective levels of
immunity at the appropriate site of relevant nature of
adequate duration; associated with SEROCONVERSION
5. Safety eliminate pathogenicity; least adverse effects
to the immunized
Major Constituents of a Vaccine
1.
Active Immunizing antigens

Single antigen that is a highly defined constituent
Complex and/or less well defined (live viruses or killed
bacteria)
2. Suspending Fluid
Sterile water for injection
Saline
Tissue culture fluid
Do not interchange the fluids of different
vaccines
3. Preservatives, stabilizers & antibiotics
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Pediatrics
Thiomersals and certain antibiotics (neomycin or

streptomycin)
Prevent bacterial growth or to stabilize
4. Adjuvants substances added to make it immunogenic
Aluminum salt frequently used to increase
immunogenicity to prolong the stimulatory effect
particularly for vaccines inactivated microorganisms or
their products
Types of Vaccines
1.
2.
3.
4.
5.
6.
7.
Killed Bacteria microbes to cause disease is destroyed

but the antigenic constitution is maintained less
potent, duration of protection is short; e.g., typhoid,
killed poliomyelitis (Salk)
Live Attenuated consist of modified organism w/c
mimics the natural behavior of the original microbe w/o
causing significant disease.
- Immunity conferred is more superior to killed
organism because the replication of the living microbes
confronts the host w/ a larger and more sustained dose
of antigen
- Immune response takes place largely at the site of
natural infection; e.g., BCG, trivalent oral polio vaccine
- contraindicated during pregnancy
Inactivated virus microorganisms was treated w/
formaldehyde or heated
Advantage: cant revert back to the virulent form
Disadvantage: require several doses or boosters
Example: Influenza virus vaccine, Hep A
Subunit part or component of microorganism w/c
includes only the known antigen
- use genetic engineering techniques
Purified Polysaccharide Vaccine requires coupling to
some immunologic carrier protein such as tetanus
tovoid; e.g. Haemophilus Influenza Type b,
Pneumococcal, Meningococcal
Advantages increased safety
- less antigenic competition
Disadvantage require more adjuvants (more S/E)
- duration of immunity is shorter
Gene Cloning
a. DNA recombinant- enables to makes genes
encoding part or the whole protein peptide
chain
b. Yeast derived fuse the gene w/ the element
of yeast w/c assembles into a highly
immunogenic virus like particle; e.g.,
Hepatitis B vaccine
Toxoid detoxified toxin products of the microorganism
- provokes the formation of protective antibodies w/c
neutralizes the toxin by stereochemistry blocking the
active site and encourage removal by phagocytic cells
Example: Tetanus and Diptheria (DPT vaccine)
Conjugate virus outer coats of organisms may disguise
as antigens; the immature immune system of young
infants are unable to recognize these harmful organisms
nd
- proteins or toxins from a 2 organism are linked to the
outer coat of the organism to induce AB formation
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Example: Haemophilus influenza serotype B vaccine (Hib

vaccine): capsular polysaccharide is conjugated to the
D/T
Method of Giving Vaccines
Per orem: by mouth

Intramuscular: 90 angle between skin and needle
Subcutaneous: 45 angle between skin & needle
Intradermal: 0-10 angle between skin & needle
Vaccine
BCG
Diphtheria
Tetanus
Pertussis
Polio
Hepatitis B
DPT, polio, &

Hep B (DTap +
Hep B)
Measles
Mumps
Rubella
Chicken pox
(Varicella)
Influenza
Pneumococcal
infections
Staphylococcal
infections
Meningococcal
infections
Haemophilus
Influenzae
type b (Hib)
Hepatitis A
Rabies
Human
papillomavirus
Rotavirus
(oral)
Typhoid
Route of
Administration
Intradermal
IM
IM
IM
Inactivated
IM
Live
Attenuated
Oral
IM
IM
Type of Preparation
Live Attenuated
Toxoid
Toxoid
Killed Bacteria(P) or
purified components (DPT) or
acellular pertussis ap
(DTap) - subunit
Inactivated
or Live Attenuated Virus
Protein (HBsAg) from the

surface of the virus thru gene
cloning - subunit
uses acellular pertussis and
IPV (Salk) combined vaccine
SC
SC
SC
SC
Live Attenuated Virus

IM
IM
Inactivated
Capsular polysaccharides 7
(PCV7) infants;
polysaccharides conjugated
to protein >2y/o
2 capsular polysaccharides
conjugated to protein
2 capsular polysaccharides
capsular polysaccharide
SC
IM
IM
IM
IM
Oral
IM
Inactivated
Inactivated
Recombinant (Quadrivalent
Serotypes; 6,11,16,18)
Live attenuated
3 types available:
a. Killed bacteria
b. Live attenuated
bacteria (oral)
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Pediatrics

c.
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EXPANDED PROGRAM ON
IMMUNIZATION
Polysaccharide
conjugated to
protein
MAIN OBJECTIVES:
To reduce the morbidity and mortality rates of the eight

EPI diseases
- TB
Diphtheria
Pertussis
- Hep B Poliomyelitis
Tetanus
- Measles
Haemophilus Influenza type b
- Rotavirus
- Pneumococcal
To reduce the incidence of neonatal tetanus by
providing women w/ tetanus toxoid
FULLY IMMUNIZED CHILD UNDER EPI (2014)
One dose of BCG at birth or any time before reaching 12

months
3 doses of Hepatitis B (at birth, 1 month, 6 month)
3 doses of Haemophilus influenza serotype b (6,10,&14
weeks)
3 doses of DPT and polio (6,10,&14 weeks)
3 doses of Rotavirus
One dose of measles at age of 9 months or before
reaching 12 months
1 dose of MMR at 12 to 15 months
3 doses of Pneumococcal
PROBLEMS ENCOUNTERED IN
IMMUNIZING
1.
2.
Combination Vaccines
Diphtheria, Pertussis, Tetanus, Hepatitis B
DT acellular, Pertussis (DTap), inactivated polio IPV
DPT, H. influenza serotype B (Hib)
DTap, IPV, Hib
DTap, IPV, Hepatitis B, Hib
Hepatitis A and Hepatitis B
MMR Measles, Mumps, Rubella
Not available in Phil: Yellow fever, Anthrax,
Cholera, Staphylococcal vaccines
3.
Lapsed Immunization
A lapse in the immunization schedule does not require
reinstitution of the entire series
If a dose of DTap, poliovirus vaccine, HiB or Hepatis B is
missed, immunizations should be given at the next visit
as if the usual interval had elapsed
Unknown or Uncertain Immunization Status
No evidence indicated that administration of MMR,
varicella, Hib, Hepatitis B or poliovirus vaccine to
already immune recipients is harmful; as long as the
shortest interval of the dose to be given is more than 4
weeks
Td rather than DPT should be given to those 7 years or
older
Vaccine Dose
Premature <1.5kg should not be immunized
Reducing doses of vaccine is not indicated in premature
or LBW
A previous immunization w/ a dose that was less than
the standard dose or one
Administered by a nonstandard route should not be
counted and the patient should be revaccinated as
appropriate for age
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Pediatrics
4.
Mild illness, low grade fever diarrhea are not

contraindications
5. Patient having seizures after DPT should receive the acellular
pertussis component instead
6. Pregnancy
Is a contraindication to the administration of all live
virus vaccines.
7. Patients w/ congenital immunodeficiencies
Are contraindications for live virus vaccine.
8. Allergies to eggs or chicken; precautions to MMR, Measles,
Influenza, Chickenpox vaccine
9. Stable, non-progressive neurologic disorders
Are not contraindications to giving of Pertussis vaccine
10. Intervals between the giving of vaccines &
immunoglobulins
In general, parenteral live virus vaccines should not be
given to individuals who received Ig w/in the previous 3
months
With inactivated, component and toxoid vaccines, no
interference in immune response is noted
11. An interval of 1 month in between vaccinations w/ live
vaccines should be observed.
Guidelines in Active Immunization
1.
2.
Vaccines must be stored in appropriate temperature

and handle correctly.
Recommendations for route, dose, and technique of
administration must be followed
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c. Subcutaneous abscess
d. Lupus vulgaris
e. Osteomyelitis, disseminated BCG infection
Accelerated BCG Reaction:
3-5mm within 24-48 hours, scar on the 15th day
Indicates the presence of the disease already
DPT (DIPTHERIA-PERTUSSIS-TETANUS)
Type: Diptheria toxoid; inactivated Pertussis; Tetanus

toxoid with Aluminum Salt
Preparation:
DPT (Diptheria Toxoid content = 7-25 Lf)
DT for children < 7y/o
dT Adult preparation Diptheria Toxoid
preparation < 2 Lf/dose; recommended for
children after 7th birthday & adults
Dose: 0.5 ml IM
Schedule:
Primary-initial: usually at 1 mos. Old
2nd & 3rd: 1 mo. Interval
4th dose: 12 mos. after last dose
Booster-DPT: 4-6 y/o
dT: 9-10 y/o
In epidemics: Immunization for Pertussis can be started
at 2 weeks old and subsequent doses at 4 weeks;
immunity in 80% with at least 3 doses
Administration of DPT vaccine is usually not
recommended earlier than 6 weeks of age.
WHO Guidelines for Health Workers in Developing Countries

POLIO VACCINE
1.
2.
3.
4.
5.
Risk of complication from vaccination is lower than risks

inherent in natural disease.
It is particularly important to immunize a malnourished
child (mild to moderate malnutrition)
Low grade fever, mild respiratory infections, diarrhea
are no longer contraindication.
Children requiring hospitalization may have their
immunizations deferred
Pertussis component of DPT should be eliminated for
those w/ severe adverse reactions (developed seizure
after injection)
VACCINES
BCG
Contains Bacillus Calmette-Guerin (BCG) weakened

bacterium that causes tuberculosis in cows
(Mycobacterium bovis)
Live attenuated or weakened vaccine
Keep away from direct sunlight
Once reconstituted, must be intradermally (ID)
administered within 8-24 hours after opening ampule
Preferably within first 2 months of life
Side effects:
a. Prolonged ulceration
b. Lymphadenopathy/lymphadenitis
Type 1: Oral Polio Vaccine (OPV)

Grown from monkey kidney cell culture
Excreted in the stool by healthy vaccines and
can infect susceptible household members
Type 2: Inactivated Polio Vaccine (IPV)
Storage:
Sensitive to heat
Storage temperature = -15 to -25 C
Dose, Route and Schedule
OPV
Oral route
Primary (4 doses)
Initial dose: 1 mos. Old
Subsequent 1-2 mos.
Interval at least 6 weeks
th
4 dose 6 mos. after last
dose
IPV
IM route (0.5ml)
Primary (4 doses)
Initial dose: 1 mos. old
Subsequent 1-2 mos.
Interval at least 6 weeks
th
4 dose 6 mos. after last
dose
SIDE EFFECTS
Rarely, paralysis
Local reactions
risk in vaccines = 1.87
Risk of vaccineM doses

associated paralysis
Risk among contacts
among adults is
= 1:5 M doses
slightly higher
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Pediatrics

o
o
Contraindications:
a. Immunodeficiency states (OPV)
Includes congenital immunodeficiency
Altered immunity, intake of of
immunosuppressive drugs
Higher risk of vaccine-associated paralysis
if given OPV
b. OPV should not be used in immunizing household
contacts of individuals with immunodeficiency
diseases or immunocompromised
Period of maximal excretion of vaccine
virus = 2 mos.
HEPATITIS B
Types
a. Plasma-derived
From plasma of HBsAg carriers
Only used in USA for hemodialysis
patients or those with allergy to yeast
Preferred preparation for AIDS patients
b. Recombinant
From bakers yeast
Component type
Storage: 2-8 C
Schedule:
0, 1, 6 mos; or
2, 4, 6 mos. + 1 yr after last dose
0, 1, 2 mos. + 1 yr after first dose
Booster: 5-7 y/o (areas where Hep B infection
is endemic)
Infants with HBs (+) and HBeag (+) mothers
a. HB vaccine within 7 days preferably within 12
hours
b. HBIg (0.5 ml IM) preferably within 12 hours
Infants should be tested for HBsAg and anti-HBs at 9
mos. old or later (at least 1 mo. After d3)
Side effects:
a. Soreness, erythema & induration
b. Fever, malaise, fatigue, myalgia, rashes, headache,
nausea & vomiting
c. Hypersensitivity to yeast/thiomersal
MEASLES
Type: Live attenuated vaccine (given SC)

Produces a mild, inapparent, non-communicable
infection
Preparation:
Chick embryo cell-cultured
Monovalent or combined (MMR, MR)
MMR is the vaccine of choice for children below 2
mos. old
Storage
Storage temperature: +2 to +8 C
Protect from light
Dose, Route, and Schedule
Dose and Route - 0.5 ml, SC, 6-9 mos. (EPI)
Schedule in areas with low measles incidence
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1st dose: 15 mos. old (MMR)

2nd dose: 4-6 y/o or at 10-15 y/o
In areas where outbreaks and epidemics occur,
monovalent vaccine may be given to infants as
young as 6 mos. old
In the Philippines, measles vaccine is
recommended at 9 mos. old then 2 more doses of
MMR at 15 mos. then 4-10 y/o
If tuberculin testing is to be done, do it on the day
of immunization or postpone for 4-6 weeks since
measles vaccination temporarily suppresses the
PPD reactivity.
Side effects:
a. Fever < 39.4 C for 1-2 days up to 5 days; appears
5-12 days after; 5-15%
b. Rashes mild without generalized distribution;
occurs 5-12 days after
Adverse effects:
a. CNS complications encephalitis/ encephalopathy
b. Subacute sclerosing panencephalitis (SSPE)
Post-exposure Immunization
a. ACTIVE Measles Vaccine: within 3 days of exposure
b. PASSIVE Immunoglobulins: after 3 days but within
7 days after exposure
HEMOPHILUS INFLUENZA TYPE B VACCINE (HIBV)
Type: Sub-unit, Conjugated
Preparation: IM
1985 1st HiB vaccine consisting of purified Type B

capsular polysaccharide
CURRENTLY LICENSED HiB VACCINES

a. ***PRP- (Polysaccharide Diptheria Toxoid
Conjugate) available in the Philippines
b. HbOC (Oligosaccharide CRM 197 Conjugate)
c. PRP OMP (Outer Membrane N. Meningitidis
Protein Conjugate)
d. PRP T (Tetanus Tozoid Protein Conjugate)

Dose: 0.5 ml (IM)
Primary (3 doses): 1 months, 2 , 3
months
4th dose: 15 18 months old
After 1 year old but less than 5 years old 1
dose ONLY.
PNEUMOCOCCAL
Types:
a. Conjugate (PCV serovalent 7) or (serov 13)
Younger patients
*3 doses: 6, 10, 14 weeks booster 1 year
after last dose
b. Polysaccharide (PPV 23 valent)
Same as **single dose for older patients
> 2 years old and above, older patients
w/ high risks
ROTAVIRUS VACCINE
Live attenuated oral preparation
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Pediatrics
Given 2 doses: earliest at 6 weeks old to 6 months old

with 4 to 8 weeks interval
With the 2nd dose, not older than 6 months
Though in early manufactured vaccines there is an
association with intussusceptions (telescoping of the
intestine)
INFLUENZA (FLU VACCINE)
Change annually because of shifts in influenza viruses

Given best February to June
Contains inactivated antigen: given IM
Infants 6 months to 8 years old
a. Given 2 doses (4 weeks interval)
b. Booster annually
More than 8 years old
1 dose only then booster annually
VARICELLA (Chickenpox Vaccine)
Oka strain
Live attenuated Varicella virus
Subcutaneous route
Seroconversion rates of >95%
Recommendation:
a. ** > 12 18 months booster at 4-6 years
b. ** >13 years old including adults 2 doses (4 weeks
interval)
HEPATITS A
Given in children > 2 years old

Subcutaneous route
Available: Meningococcal Polysaccharide Vaccine
A+C
RABIES VACCINE
Anti-rabies Act 2007 Recommends routine vaccination

of 5 to 14 years old (incidence > 2.5 cases/ 1M)
a. Human Diploid Cell Vaccine (HDCV)
b. ** Inactivated Rabies (Vero Cell) available in
Philippines
c. Duck Embryo Vaccine (DEV)
d. Simple nerve tissue vaccine
a. Verocell: 0.5ml IM 0, 7, 21, 28
b. IM or ID on deltoid area
HUMAN PAPILLOMAVIRUS VACCINE
Bivalent recombinant females 10 55 years old

Quadrivalent recombinant females 10 to 26
(Serotypes: 6, 11, 16, 18)
Schedule: 0, 1 or 2, 6 months IM
Prevention:
Cervical, vulvar vaginal and CA
Genital warts
Human papilloma virus infections
CHOLERA VACCINE Killed
Inactivated Hepatitis A virus

HM 175 strain derived from MRC-5 human diploid
fibroblasts
IM route
2 primary doses (360 ELISA units) 1 month apart and a
booster between 6 12 months
Recommended for travelers to endemic countries (Asia
and Africa)
50% protective
0.2 ml SC or IM for 2 doses 1 month apart
Not recommended for children younger than 6 mos. of
age.
TYPHOID VACCINE
a.
b.
Oral live attenuated preparation (Vivotif)

Ty21a strain of S. typhi
67 92% efficacy
3 enteric coated capsules on alternate days (1,
3, 5 d)
Not recommended for < 6 years
Vi Capsular Polysaccharide
Single dose
IM route
*** given at 2 years old booster every 3 years
MENINGOCOCCAL
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Quadrivalent A/C/Y/W 135 vaccine (subunit

capsular)
Bivalent (A and C) only
Not a recommendation
Only given in unusual number of cases
JSCalienta

Primary Health Care

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Primary Health Care

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Pediatrics

Proverbs 4:23 Guard your HEART the wellspring of life

WHO-UNICEF, 1978 time when the PHC was

REFERRAL SYSTEM as to LEVEL OF CARE:

Basic requirements for a sound PHC (8 As and 3 Cs)

PHC includes the following: