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QUESTION: Anonymous Attendee

Since asymptomatic patients are not routinely tested for COVID status, what would be the risk to a possible asymptomatic COVID patient being given a vaccine, whether a live or inactivated one?

According to the WHO document , as of the moment vaccination may be allowed if there are no contraindications ( question included in the PPS /PIDSP webinar )

QUESTION: Anonymous Attendee

Can we administer the FLU vaccine simultaneously with the PCV under booster scheduled?

Yes

QUESTION: Anonymous Attendee

With regards to Rotavirus vaccine first dose should be given before 15 weeks up to when can this be given?

The first dose of Rotavirus vaccine should be administered orally to infants 6 weeks up to 15 months.

QUESTION: Anonymous Attendee

For Well Baby check up do we really need a PPE? If yes, how often do we need to change PPE?

If we are certain that the infant is not a suspect COVID case, then agree with full PPE . personally ,we should change gloves after each patient encounter and wash hands in between these changes . Disinfect equipment used after each patient encounter ( see PPS/PIDSP OPD guidelines too )

QUESTION: Anonymous Attendee

What will be the minimum required PPE for a doctor conducting a well child visit?

1. disposable gown or just an impermeable gown

2. face shield – if the is risk for aerosol generation during examination

3. surgical mask

4. gloves

QUESTION: Ma. Esel J. Bermejo

DOH recommends that patients be observed for 30 mins before being sent home after a vaccination. How shall we be able to do that if the procedure is done in a private clinic setting?

After immunization, the physician can explain the side effects of the vaccine . The physician can advise the parents to wait in the waiting room observing social distancing or at their private vehicle for 30 minutes after immunization.

QUESTION: Jonathan Lim

Not a question .. but just a comment/advice, We need to remind physicians that no vaccines are contraindicated at this time. It is important to continue or catch up all vaccines appropriate for age. If parents are apprehensive of adverse events, advice them ahead of what to watch out for and provide your number to them to put them at ease.

QUESTION: Rhina Valencia

To Doc Timmy, is it safe to do home visits to give immunization where ECQ is observed?

Personally, doing home visits is not recommended as there are a lot of factors to be considered. RISK vs BENEFIT that’s a guiding principle .

If you decide to do a home visit then it is recommended to wear a PPE.

QUESTION : Anonymous Attendee

For infants less than 6 months who may have missed their first round of 6/8 th week vaccines, and now come back after the ECQ at 4 months of life, will we give all the missed vaccines in one visits? Will this not overwhelm the child’s system?

Yes you may do catch up immunization , DPTIPVHIBHepB, PCV, Rotavirus at 4 months then the next two doses 4 weeks apart (5monhts old and 6 months old). It will not overwhelm the child’s immune system. Further information can be obtained from the Philippine Pediatric Society and Pediatric Infectious Disease Society Recommendation Regarding Vaccination During the COVID 19 Pandemic (29March 2020),

QUESTION: Anonymous Attendee

What is the minimum interval in giving FLU vaccine from the previous season to the present season. (example if a child received FLU vaccine last November 2019, when is the earliest possible time that we can give the FLU vaccine 2020?)

After 6 months . In your case May 2020.

QUESTION: Rein Miranda

To Dr. Gumpal: Is it possible that the decline in recorded cases of VPDs are due to the ECQ, where the community is afraid of having themselves checked up in a health facility?

For mild illnesses like simple cough and colds, parents or caregiver simply give supportive treatment at home like fluid therapy .But if it is worsening cough with fever(pneumonia) or with rashes(measles) or diarrhea, they will bring this child to health centers for the consultation and free medicines even during ECQ. In my opinion, the decrease in cases of measles, pneumonia and diarrhea is primarily due to strict preventive measures during ECQ that prevents the further transmission and spread of viruses or bacteria thru respiratory droplets, direct contact or fecal-oral. (Note: the data was derived from the cases seen in health centers only. Those seen in private clinics are not included.

QUESTION: Alvin Florentino

Do you think the low level of measles, pneumonia, and diarrhea cases in the community is also because mothers or caregivers didn’t want to bring their kids -- who were probably not as badly as affected – to the LHC?

Yes and also reporting / statistics may not be as accurate

QUESTION: Angie Pal

Health centers are close thus parents don’t know where to go

Not all health centers are closed. They can be referred to the main Rural Health Unit.

QUESTION: Anonymous Attendee

Health centers in the provinces deny immunization of well babies because they say it is not safe to go there as if this moment. What can you say about this?

Answered. during the webinar

QUESTION: Maricris S. Josol-Olaguer

What would be the minimum protective personal equipment that we should have at the OPD?

1. disposable gown or just an impermeable gown

2. face shield

3. surgical mask

4. gloves

QUESTION: Anonymous Attendee

I would like to ask if efforts of our healthcare facilities in determining the mentioned cases is also affected by COVID 19 and ECQ? Since it might affect the decrease in the cases.

No. Health centers are open from Monday to Sunday, 8 am to 5 pm to render essential health services during ECQ . Following the proper infection prevention and control, health workers render sick consultation , immunizations, prenatal & postnatal care, free medicines. Etc. All cases seen in the health center facilities are being recorded and reported monthly.

QUESTION : Jeff Tan

40 something year old here. No pneumococcal vaccine ever. Can I take the two Pneumococcal vaccine at the same time? Also take the FLU vaccine at the same time.

Considering your age at 40 if without co-morbidities like diabetes, asthma or immunocompromised you will only need Influenza vaccine. Adults aged 65 years or older who have never received any type of pneumococcal vaccine should receive PCV13 first followed by PPSV23 6-12 months later.

QUESTION : Anonymous Attendee

Are you in favor of the ‘drive-thru” vaccination? Is it safe for the baby?

One still needs to do complete history and physical examination prior to immunization and wait for 30 minutes after immunization. I do not think it is harmful to the baby.

QUESTION : KRM

Just want to clarify… are local health centers at present open for vaccination? According to my patients, there are no local health center open for EPI.

Local health centers are open and are doing routine EPI unless that barangay is in a lockdown for down for a positive COVID case.

QUESTION: Rosa Marie

I have an adult patient whom I vaccinated the 1st and 2nd vaccine Oct 15 and Nov 15, 2019 of Hepatitis B vaccine as per protocol to give the 1st and 2nd Hepa B vaccine one month apart.. For the 3rd and last vaccine it should have been given on March 2020 but the patient was in Hongkong and in quarantine. So the third vaccine was not given. Question was the Hepatitis B 2 vaccine alone sufficient. What should we do if not sufficient? Thanks

3 doses of Hepatitis B vaccine should be given to be protective. You can give the third dose anytime. Test for hepatitis b antibodies 3 months after the last hepatitis B vaccine. If levels are below the protective level then revaccinate the patient with 3 doses again of hepatitis B.

QUESTION: tin2duque

It’s good to hear that we have less cases of pneumonia, measles and other illness for children during this time of covid that were prevented because of the precautions we are observing to combat covid like social distancing etc. How are we preparing for the coming flu and dengue season this coming rainy season in more than a months time? Especially now we know that covid also presents with fever and thrombocytopenia.

Influenza vaccination should be started.

Regarding dengue, we should continue the DOH program of 4s Laban sa Dengue

Search and destroy breeding places

Seek early consultation

Self protection measures

Support fogging/spraying in hotspot areas

QUESTION: Anonymous Attendee

Does DOH continue to vaccinate pneumo vaccine among senior citizen even if we are on ECQ?

Yes

QUESTION: Anonymous Attendee

After all the discussions regarding the controversial dengue vaccine, what is the current stand of DOH with regards to its use? Do we give it or not?

In the Philippines, we still do not give it. There is no FDA approval.

QUESTION: Anonymous Attendee

If one PPE will be worn per patient wouldn’t we have a lot of PPEs used? If we will reuse it for the next patient, will we not be carriers to next patient? Maybe we can rearrange clinic to suit covid and cater to needs of patients? Para kada patient , we can wipe clean surfaces for next patient.

We suggest just you do only well baby check up and immunization. Change your gloves for every patient. Only one PPE is recommended per clinic then decontaminate.

Sick infants and children should be seen at the hospital on full PPE. If you want to see them in your clinic schedule an appointment and be on full PPE. Schedule all sick children in one day.

(Follow PPS/PIDSP OPD Guideline)

QUESTION: Ezel MD

For the 5 in 1 or 6 in 1 vaccines, PCV and Rota – up to when can we give the first dose? Since most of the mothers are afraid of going to the hospital. The babies mostly received only BCG and the first Hepa B only.

Pneumococcal vaccine can be started anytime up to5 yrs old the number of doses depending on the age.

0-6 months – 3 doses 1 month apart plus a booster dose 6 months after the 3rd dose

7-11 months – 3 doses the first 2 doses are given 1 month apart. The interval between 2nd and 3rd doses is at least 2 months but should ideally be given at or after the 1st birthday

For previously unvaccinated older children 12 months to 5 years old:

For PCV10 : 1-5 years old give 2 doses at least 2 months apart

For PCV 13: If first dose is given at 12-23 months give 2 doses at least 2 months apart

If first dose is given at 2-5 years old give 1 dose only

5in1 and 6in1

5 in 1 and 6in 1 can be started anytime after 6 weeks old 3 doses each dose 1 month apart

ROTAVIRUS: First dose should be given at 6 weeks and not later than 15 weeks old.

Please review the PPS and PIDSP recommendations regarding Vaccination During the COVID -19 Pandemic

QUESTION: Anonymous Attendee

If the child vaccinated develops fever? Ano po ang protocol? Shall the child be brought for consult or observe only since fever may be just be due to the vaccine and not COVID 19. Shall we safely say na sa bakuna lang yung fever?

Even before the COVID pandemic , before vaccinating the patient the physician should advise the parent/patient regarding the side effects of the vaccine. Fever and swelling are the usual side effects. During the COVID pandemic, if the side effects like fever persists beyond the expected duration with other signs and symptoms the physician should adequately advise the patient or parent.

QUESTION: Leo Notario

Parents can and will have their baby scheduled for vaccination. The baby is apparently well, no signs and symptoms or just slight colds or cough with no fever, claim of no possible covid exposure. Shall we go ahead and immunize?

Before scheduling a child for vaccination ensure that the child is well and:

Not suffering from fever, cough, colds, diarrhea, and influenza-like illness

Has had no significant exposure to a positive or suspected COVID 19 case in the last 14 days

Does not reside in an area with localized transmission or local community under enhanced quarantine. Check DOH updates to confirm if the child’s community is classified as such. Note also if there is household clustering of influenza-like illnesses, or if the child resides in a community with sustained community transmission.

Has no absolute contraindication to vaccination

QUESTION: Anonymous Attendee

Can doctors with co-morbidities and elderly Pediatricians resume their clinics? With the risk of getting COVID.

No

QUESTION: Cristal Laquindanum

Is there a prize freeze for vaccines? Some of our suppliers are increasing their prices. Thank you

There is no price increase.

QUESTION: Anonymous Attendee

How can we assure the parents that “fever” after immunization is a common side effect of the vaccine versus a symptom of COVID 19 infection?

Even before the COVID pandemic , before vaccinating the patient the physician should advise the parent/patient regarding the side effects of the vaccine. Fever and swelling are the usual side effects. During the COVID pandemic, if the side effects like fever persists beyond the expected duration with other signs and symptoms the physician should adequately advise the patient or parent.(in PPS/PIDSP webinar)

QUESTION: Anonymous Attendee

Would you recommend a private practitioner to visit the house of the patient for vaccination. And what PPE will you use considering that you are visiting their home?

Fr. Dra. Fatima Gimenez: Personally, I don’t recommend house calls. That’s on my end at least.

QUESTION: Anonymous Attendee

I am clinical research nurse. I am assigned in an on-going clinical trial for a vaccine. At this point, it will be unethical to stop the clinical trial, but rather, it is best to finish it as soon as possible. With the recommended guidelines for immunization be enough for it? Thank you

Yes

QUESTION: Anonymous Attendee

How are both government and private sector preparing for the rollout of the coronavirus vaccine, should it be produced at the nearest time (although unlikely)?

The COVID19 vaccine is still not available.

QUESTION: Sarah Santos

Thank you for this lecture. My question – Since we have asymptomatic patients, do we need to test patients prior to flu vaccination – for adult and pedia patients? And if + , then we should not give FLU vaccine?

No COVID rapid tests or RT-PCR swab tests are needed prior to any immunization. Immunization should be deferred temporarily for COVID + patient.

QUESTION: Anonymous Attendee

Is it safe to delay 1st dose of vaccines for newborn infants:

It is recommended to give all vaccines as scheduled.

QUESTION: Anonymous Attendee

What are the PPE requirements for the vaccinators?

1. disposable gown or just an impermeable gown

2. face shield

3. surgical mask

4. gloves

QUESTION: Anonymous Attendee

How can you distinguish symptoms of COVID vs adverse reactions from the FLU vaccine for an adult who goes out of the house to buy essential purchases. In the past, we see cases of URTI and fever as adverse reactions for patients vaccinated with FLU within 2 weeks after vaccination.

Adverse effects after Influenza immunization are very rare.

QUESTION: Faith Abigail Co

A physical barrier/enclosure is an effective way to prevent further transmission of disease from health worker to patient, and may also save us our priceless PPEs. Is it possible to create a uniform layout for our health centers that will minimize exposure by use of these physical barriers so that the health centers may apply the same precautions and protection seeing that this is the new normal and that we should comply with our vaccination schedule for our patients? Thank you

Please see PPS/PIDSP OPD Guidelines

QUESTION: Anonymous Attendee

In the community setting today, how do you do screening among children due for vaccination?

Before scheduling a child for vaccination ensure that the child is well and:

Not suffering from fever, cough, colds, diarrhea, and influenza-like illness

Has had no significant exposure to a positive or suspected COVID 19 case in the last 14 days

Does not reside in an area with localized transmission or local community under enhanced quarantine. Check DOH updates to confirm if the child’s community is classified as such. Note also if there is household clustering of influenza-like illnesses, or if the child resides in a community with sustained community transmission.

Has no absolute contraindication to vaccination

QUESTION: Anonymous Attendee

Is there a danger to the patient if we happen to administer vaccines in seemingly healthy patients but who happen to be already at incubation stage with COVID or in asymptomatic individuals?

No studies or report of any adverse effects

QUESTION : Anonymous Attendee

Good evening. How about for Rotavirus vaccine? How late can we give the last dose of Rotateq or Rotarix?

Human (RV1)

Given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should be administered not later than 24 weeks of age.

Human -Bovine live-attenuated reassortant (RV5)(oral liquid formulation)

First dose is given at 6-12 weeks, with a minimum interval of 4 weeks between doses. The last dose should not be administered beyond 32 weeks of age.

Human-Bovine live – attenuated reassortant (RV5) (oral freeze dried formulation)

Given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should not be administered beyond 12 months of age.

QUESTION: Maleen

Can we ask Dra. Gimenez regarding Rotavirus vaccine. Until when can we give the first dose considering the months ECQ?

Human (RV1)

Given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should be administered not later than 24 weeks of age.

Human -Bovine live-attenuated reassortant (RV5)(oral liquid formulation)

First dose is given at 6-12 weeks, with a minimum interval of 4 weeks between doses. The last dose should not be administered beyond 32 weeks of age.

Human-Bovine live – attenuated reassortant (RV5) (oral freeze dried formulation)

Given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should not be administered beyond 12 months of age.

QUESTION: Anonymous Attendee

Can we give dpthephib + opv in government sector beyond 1 year for catchup? Do you still give PCV13 beyond 6 months if they had 1st dose from a private clinic?

Yes we can give dpthephib+opv in government sector beyond 1 year old and up to 59 months old for catch-up. However, only a single dose will be given. If below 12 months old, all the 3 doses may be completed for catch-up immunization.

No at present, pneumococcal conjugate vaccines (PCV 13) for infants are of limited supply (PCV 13immunization for infants just started last January 2020) hence priority is being given to the routine immunization at 6 weeks,10 weeks, and 14 weeks of age. However, if enough supply permits , catch -up immunization may be given up to 12 months old for PCV-13 whether from public or private clinics.

QUESTION: Anonymous Attendee

For Dr. Panaligan, for do you recommend any brand of quadrivalent flu vaccine? Or base on your experience what brand of flu vaccine do you recommend?

No

QUESTION: Cecil Adaoag

How about the potential adverse effect of fever in FLU and pneumococcal vaccine? This could cause worry to the patients specially if given to the elderly.

Rare adverse effects.

QUESTION: Noel Borlongan

Is there a way for vaccination be part of the COVID 19 management plan?

Yes of course once the vaccine becomes available.

QUESTION: pmmagadan@up.edu.ph

Can we introduce routine vaccines to patients with COVID symptoms? Thank you

We do not immunize sick children/adults.

QUESTIONS: Anonymous Attendee

If the mother/relative has a history of COVID within 1 week , can we give influenza or live vaccines to the child?

The mother/relative should have been quarantined and be tested negative for COVID before she can take care of her child. The child should also be quarantined for at least two weeks after last exposure with the mother/relative and asymptomatic before the child can be safely immunized.

QUESTION: Anonymous Attendee

Can any vaccine be given to a COVID positive or survivor? Will there be no observable adversity?

Patient who are still COVID positive and symptomatic should not be vaccinated. For COVID survivor, like in any other illness, we can wait at least 2-4 weeks after the patients recovers from the illness.

QUESTION: Anonymous Attendee

How can we practice social distancing in the private clinics or in the health center? Is there a minimum number of children that we can entertain or vaccinate for a day?

Maintain 2 meters distance between patients. Schedule immunization by appointment.

QUESTION: Anonymous Attendee

Is face shield necessary to protect the frontliners especially doctors who will hold clinics?

Yes

QUESTION: Anonymous attendee

Why is it necessary to have conjugate vaccine for adults?

Pneumonoccal conjugate vaccine is recommended for adults with co-mobidities and elderly above 65 to have better protection against pneumococcal pneumonia.

QUESTION: Anonymous Attendee

Regarding the use of N95 masks vs surgical masks when vaccinating patients: wouldn’t a crying asymptomatic COVID 19 carrier aerosolize the virus, requiring the use of an N95 mask?

It is best to use a N95 mask but if not available a surgical mask with face shield is helpful.

QUESTION: Michelle

Can we give pneumococcal conjugate vaccines to well adults? Or only those with co-morbidities?

Adults with co-morbidities and elderly 65 years old and above

QUESTION: Anonymous Attendee

When is the best time to give the routine vaccine to those babies/children who recovered from COVID infection?

Like in any other illness, 2-4 weeks after negative COVID RT-PCR test.

QUESTION: Ma. Teresa Lopez

I would like to know the ideal time frame to vaccinate a person recovering from COVID.

Like in any other illness, 2-4 weeks after negative COVID RT-PCR test.

QUESTION: Psyche C Nebrada

Ideally if we plan to give 2 vaccines we will do it simultaneously however some patients after receiving a vaccine the patient decided to receive another vaccine after less than a month, can we give the desired vaccine?

Vaccine Interval:

Inactivated vaccine: no interval between two different inactivated vaccines

Inactivated and Live activated vaccines : no interval

Live activated vaccines: two different live vaccines should have at least 4 weeks interval

QUESTION: Margarita Alfonso

In the outpatient clinics we do triaging of patients before entering the clinic and refer to COVID centers patients with suspected symptoms of COVID. Do you do this in the health center? This is a concern for those well babies going to the centers for vaccination.

Yes