1. Childhood Immunization Schedule 2014
Vaccines given in the Philippines Expanded Program of
Immunization (PEPI) of the Department of Health include: BCG
DTwP-Hib-HepB OPV Measles MMR Rotavirus PCV Td
VaccineMinimum AgeDoseNoRouteInterval between
dosesAnnotations
BCGAt birth; preferably within the first 2 months of life 0.05ml
for NB0.1 ml for older infant1ID
DTP6 weeks0.5 ml3IM4 weeks
Hepatitis BAt birth0.5ml34 weeksMonovalent is given at birth
then subsequent doses are given at 6,10,14 weeks of age as
combination vaccines containing DTwP-Heb B-Hib
HiB6 weeks0.53IM4 weeks
OPV6 weeks2 drops3PO4 weeks
Measles9 months
0.5 ml1SCCan be given as early as 6 months in cases of
outbreak
MMR12 months0.5 ml2SC4 weeksSecond dose is administered at ages
4-6 years old
Rotavirus6 weeks3PO4 weeks
PCV6 weeks0.5 ml3IM4 weeksBooster 6 months after the 3rd
dose
TdPregnant adolescents0.5 ml3IM1 month then 6-12 months
2. Dengue blot interpretation
Primary dengue infectionSecondary dengue infection
NS1 antigensA glycoprotein essential for viral replication and
viability
Appears from Day 1 after onset of fever and up to Day 6
Circulate at high levels in serum during the entire clinical
illness and in the first fever days of convalescence
Not detectable once anti NS1 IgB Ab are produced (corresponds to
defervenscence)Similar response to primary infection
IgM antibodiesProduced approximately 5 days after symptoms
appears
Rise for 1-3 weeks, may persist up to 60 days
May be detectable for up to 6 monthsKinetics of IgM response is
variable
20-30% of patients do not produce IgM Ab by day 10, may not be
detected until 20 days after onset of infection, same false
negative results are observed
May be produced as low or undetectable levels for a shorter
period than in a primary infection
IgG antibodiesAppear approximately 14 days after onset of
symptoms
Persist for lifeRise rapidly 1-2 days after onset of
symptoms
Reach levels above those found in primary or past infection
Persist at high levels for 30-40 days then decline to levels
found in primary or past infection
3. Diagnostic criteria for SLE
MNEMONICS: SOAP BRAIN MD
Serositis such pleuritis or pericarditisOral ulcersArthritis
(usually oligo or polyarticular)Photosensitivity
Blood disorders: namely hemolytic anemia, leukopenia,
lymphopenia, and thrombocytopeniaRenal involvement with nephrotic
picture Anti nuclear antibodies in 95% of patientsImmunologic
abnormalities such as Anti-Sm, Anti-dsDNA, Anti-phospholipid,
positive syphilis serologyNeurologic: mainly seizure and
psychosis
Malar rashDiscoid rash
The presence of 4/11 criteria establishes the diagnosis of
SLE.
4. Recommended Antibiotics for Pediatric Community-Acquired
Pneumonia (2012 Update)
1. For a patient who has been classified as pCAP A or B without
previous antibiotic,1.1. Amoxicillin [40-50 mg/kg/day, maximum dose
of 1500 mg/day in 3 divided dosesfor at most 7 days] is the drug of
choice [Recommendation Grade B].
1.1.1. Amoxicillin may be given for a minimum of 3 days
[Recommendation Grade A].1.1.2. Amoxicillin may be given in 2
divided doses for a minimum of 5 days [Recommendation Grade B].
1.2. azithromycin [10 mg/kg/day OD for 3 days or 10mg/kg/day at
day 1 then 5 mg/kg/day for days 2 to 5, maximum dose of 500mg/day],
or clarithromycin [15 mg/kg/day, maximum dose of 1000 mg/day in 2
divided doses for 7 days] may be given to those patients with known
hypersensitivity to amoxicillin [Recommendation Grade D].
2. For a patient who has been classified as pCAP C, without
previous antibiotic,2.1. requiring hospitalization, and
2.1.1. has completed the primary immunization against
Haemophilus influenza type b, penicillin G [100,000 units/kg/day in
4 divided doses] administered as monotherapy is the drug of choice
[Recommendation Grade B]
2.1.2. has not completed the primary immunization or
immunization status unknown against Haemophilus influenza type b,
ampicillin [100 mg/kg/day in 4 divided doses] administered as
monotherapy is the drug of choice [Recommendation Grade B].
2.1.3. above 15 years of age [Recommendation Grade D], a
parenteral non- antipseudomonal -lactam (-lactam/-lactamase
inhibitor combination (BLIC), cephalosporin or carbapenem] +
extended macrolide [azithromycin or clarithromycin], or a
parenteral non-antipseudomonal -lactam [-lactam/ -
lactamaseinhibitor combination(BLIC],cephalosporinorcarbapenem]+
respiratory fluoroquinolones [levofloxacin or moxifloxacin]
administered as combination therapy may be given [Recommendation
Grade A].
2.2. who can tolerate oral feeding and does not require oxygen
support, amoxicillin [40-50 mg/kg/day, maximum dose of 1500 mg/day
in 3 divided doses for at most 7 days] may be given on an
outpatient basis [Recommendation Grade B].
5. Causes of Cellulitis
Most common organisms implicated are Staphylococcus aureus,
Streptococcus pyogenes, hemophilus influenza type b, Prevotella
spp, B fragilis group and Clostridium species.However usually
infection is polymicrobial that includes anaerobic bacteria and
isolation of a single organism is often not possible. Hib is most
common cause of periorbital and orbital cellulitis.