Vaccination Protocols and Guidelines

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Questions and Answers

What is the recommended interval between doses for the Rotarix vaccine?

2 weeks

8 weeks

6 weeks

4 weeks (correct)

Which of the following populations should avoid the polysaccharide vaccine?

Patients with chronic lung disease

Children under 2 years

Asymptomatic HIV patients

Children in need of chemotherapy (correct)

What condition is a contraindication for the administration of the rotavirus vaccine?

Uncorrected congenital gastrointestinal malformation (correct)

History of asthma

Temporary flu virus

Mild allergy to dairy

Which vaccine has a protective efficacy of 88-91% against rotavirus gastroenteritis episodes?

Rotateq Signup and view all the answers

At what age should the second dose of the Rotarix vaccine be given?

24 weeks Signup and view all the answers

Which side effect is commonly associated with the oral live-attenuated rotavirus vaccine?

Diarrhea Signup and view all the answers

What is the duration recommended for starting chemotherapy after receiving the polysaccharide vaccine?

Less than 10 days prior to commencement Signup and view all the answers

Which of the following is not a possible high-risk condition for the receipt of the polysaccharide vaccine?

Normal immune system Signup and view all the answers

What major change was introduced in the fourth edition of the national protocol book for Paediatrics?

The content and colour scheme were updated. Signup and view all the answers

Which group primarily benefits from the fourth edition of the national protocol book for Paediatrics?

Young doctors with limited paediatric exposure. Signup and view all the answers

What has been retained from the previous editions in the fourth edition?

The layout of the current version. Signup and view all the answers

What future plans are mentioned for the protocol book beyond its current printed form?

Release as an iOS and Android app. Signup and view all the answers

What is the primary reason for the production of the fourth edition of the protocol book?

To help young doctors fill in knowledge gaps. Signup and view all the answers

Who provided a foreword for the fourth edition?

Datuk Dr Noor Hisham bin Abdullah. Signup and view all the answers

What significant updates were made in the 2nd Print of the 4th Edition?

Corrections for errors found in previous prints. Signup and view all the answers

What is the recommended interval for the primary series of the PCV vaccine in children under 2 years?

1 month apart Signup and view all the answers

Which notable resource was incorporated into the fourth edition?

The latest edition of a drug dosages handbook. Signup and view all the answers

Which group of children is recommended to receive the PCV vaccine at the ages of 12-15 months?

High risk children Signup and view all the answers

What is NOT a side effect of the pneumococcal vaccine?

Nausea Signup and view all the answers

Which of the following is NOT a contraindication for the pneumococcal vaccine?

Recent travel Signup and view all the answers

What is the recommended schedule for unvaccinated high risk children aged 2-5 years for the pneumococcal vaccine?

2 doses 6-8 weeks apart Signup and view all the answers

Which condition qualifies a child as high risk for receiving the pneumococcal vaccine?

Nephrotic syndrome Signup and view all the answers

How many doses should unvaccinated infants aged 7-11 months receive for the pneumococcal vaccine?

2 doses 1 month apart Signup and view all the answers

Which age group is NOT eligible for the single dose of the pneumococcal vaccine?

Healthy children under 6 years Signup and view all the answers

What is the recommended interval for the second dose of Varicella for children aged 12 months and above?

4 weeks apart Signup and view all the answers

Which fluid therapy is primarily used for circulatory support in the case of vascular collapse?

Intravenous fluid therapy Signup and view all the answers

When should intravenous fluids be prescribed to a well child?

When experiencing severe dehydration with ongoing losses Signup and view all the answers

Which vaccination requires consulting a doctor for the schedule based on the age of the child receiving the first dose?

Meningococcal Signup and view all the answers

According to the guidelines, which calculation is used to determine an individual’s maintenance fluid requirements?

Holliday and Segar formula Signup and view all the answers

What is a possible consequence of incorrectly prescribed or administered intravenous fluids?

Potential hazards to the patient Signup and view all the answers

What is the primary reason for intravenous fluids to be given in the case of severe dehydration?

To replace fluid and electrolyte deficit Signup and view all the answers

What is one of the important factors to monitor when administering intravenous fluids?

Fluid balance Signup and view all the answers

What is the maintenance fluid requirement for a child weighing 29 kg according to the Holliday-Segar calculator?

1680 mls Signup and view all the answers

In cases of sepsis, what is a critical factor to determine before starting intravenous fluid therapy?

Plasma electrolytes Signup and view all the answers

For the first 10 kg of body weight, how much fluid is allocated per kg in the Holliday-Segar calculator?

100 ml/kg Signup and view all the answers

Which condition is least likely to require increased fluid administration in children?

Routine hydration Signup and view all the answers

What is the infusion rate per hour for a child weighing 21 kg after calculating total fluid requirements?

70 mls/hour Signup and view all the answers

What is an acceptable estimation for insensible losses per square meter in a 24-hour period?

300-400 mls/m2/24 hours Signup and view all the answers

Children requiring fluid replacement for ongoing losses often have which of the following conditions?

Cystic fibrosis Signup and view all the answers

What category of weight in the Holliday-Segar calculation contributes 1 ml/kg/hour to the infusion rate?

All additional kg Signup and view all the answers

What is the recommended maximum rate at which serum sodium should decrease during rehydration in hypernatremic states?

0.5 mmol/l per hour Signup and view all the answers

Which fluid is recommended for replacing ongoing losses due to profuse diarrhea?

0.9% Normal Saline Signup and view all the answers

In the case of severe hypernatremia, which serum sodium level is considered severe?

<blockquote> 160 mmol/l </blockquote> Signup and view all the answers

Which clinical sign is NOT commonly associated with hypernatremic dehydration?

Increased urination Signup and view all the answers

When replacing fluid losses, if a patient has lost 200ml over the previous 4 hours, what replacement rate is recommended for the next 4 hours?

50ml/hr Signup and view all the answers

What is the daily sodium requirement for children?

2-3 mmol/kg/day Signup and view all the answers

What condition can result in hypernatremia due to water deficit?

Diabetes insipidus Signup and view all the answers

What is a common misconception regarding the appearance of children with hypernatremic dehydration?

They may appear sicker than expected for their degree of dehydration Signup and view all the answers

Study Notes

Paediatric Protocols (Malaysia)

Fourth edition, second printing of national protocol book for paediatrics, inspired by Sarawak Paediatric Protocols.
Main target audience: Young doctors preparing for district hospitals and health clinics.
Updated content and colour scheme maintains layout of previous edition.

Vaccine Schedules and Considerations

Pneumococcal (Polysaccharide): Recommended for high-risk children (under 2 and over 2 yrs.) Single dose for high risk over 2 years, revaccination within 3 years. Intramuscular or subcutaneous. Immunogenic in children ≥2 yrs, against 23 serotypes, booster at 3-5yrs in the healthy children; high risk children (immunosuppression, HIV, asplenia, nephrotic syndrome, chronic lung disease). Avoid during chemotherapy/radiotherapy.
Rotavirus: First dose for infants ≥6 weeks old (Rotateq – 3 doses, Rotarix – 2 doses; doses dependent of infant age: different schedule). Contraindications include prior hypersensitivity to vaccine components or uncorrected congenital GIT malformation. Side effects often include loss of appetite, irritability, fever, and diarrhoea. Live-attenuated vaccine; protective efficacies range from 63 – 91%.
Varicella (Chickenpox): For children 12 months to 12 years, scheduled dosing dependent on patient age & first vaccination. Live attenuated vaccine; pregnant patients contraindicated.
Meningococcal: Recommended for children travelling to high-risk areas; single dose, providing immunity for up to 3 years.
Hepatitis A: For children above 1 year; 2 doses, 6-12 months apart.

Paediatric Fluid and Electrolyte Guidelines

IV fluids used for circulatory support, deficit replacement, maintenance, and ongoing losses.
Holliday-Segar formula for calculating maintenance fluid requirements based on weight.
Close monitoring through clinical observation, fluid balance, weight, and daily electrolyte profiles is crucial.
Fluid losses >0.5ml/kg/hr require replacement.
Calculation can be based on previous hour or 4 hour period. For example, a 200ml loss over 4 hours will be replaced at a rate of 50ml/hr for the next 4 hours.
Ongoing losses replaced with normal saline or Hartmann’s solution; protein-rich losses/low albumin leads to 5% human albumin.
Fluid therapy is crucial to calculating maintenance rates, including insensible losses (300-400ml/m2/24 hours) + urine output.

Sodium Disorders

Normal serum sodium (135-145mmol/l)
Hypernatremia (serum Na+>150mmol/l) defined as moderate (150-160mmol/l) or severe (>160mmol/l): can be due to water loss or deficit, or sodium gain.
Symptoms include irritability, doughy skin, ataxia, tremor, hyperreflexia, seizures, reduced awareness, and coma.
Consult Endocrinology for hypernatremia due to central diabetes insipidus.

Drug Dosages

Frank Shann-Drug Doses Book (17th edition) incorporated.
Available through [email protected], iOS/Android stores, and www.drugdoses.com (printed versions available to MOH facilities only).

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Description

Test your knowledge on vaccination protocols, specifically regarding the Rotarix vaccine and polysaccharide vaccine guidelines. This quiz covers dosage intervals, contraindications, efficacy, and updates from the national protocol book for Pediatrics. Perfect for healthcare professionals and students in the medical field.