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.