20. Immunizations Flashcards by Yerin M

___ are prepared by the CDC for each vaccine to explain benefits and risks

Vaccine Information Statements (VISs)

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Federal law requires that a VIS be handed to patient/parent (before/after) a vaccination is administered

Before

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What is the diff between active and passive immunity?

Active = person’s own immune system produces antibodies (in response to vaccine or infection)
Passive = antibodies are provided from someone else (e.g. mother to baby, IVIG)

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What is the difference between live attenuated vs inactivated vaccines

Live attenuated - produced by modifying a disease-producing (“wild”) virus or bacterium in a lab; have the ability to replicate and produce immunity but usually do not cause illness; produce strong immunity

Inactivated vaccine - either killed whole virus or bacterium, or fractions of either; immunity diminish with time and boosters may be needed

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Common live vaccine mneumonic MICRO-VY

MMR
Intranasal influenza
Cholera
Rotavirus
Oral typhoid
Varicella
Yellow Fever

Others: tuberculosis (BCG), dengue, small pox, ebola

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___ vaccines do not produce good immune response in children < 2yo

Polysaccharide vaccines (ex. Pneumococcal Polysaccharide Vaccine (Pneumovax 23))

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____ vaccines increases immune response in infants and antibody booster response to multiple doses of vaccine

Conjugation
Ex. Pneumococcal Conjugate vaccine (Prevnar 20), Meningococcal Conjugate vaccine (e.g. Menactra)

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What is a limitation of live vaccines?

Not recommended in immunocompromised/pregnant patients (may not be able to halt replication and cause disease)

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What is a limitation of inactivated vaccines?

Immunity is not as strong compared to live vaccines; boosters may be required

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T/F: Most live and inactivated vaccines can be administered simultaneously

True

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T/F: Increasing the interval between doses of a vaccine diminishes the effectiveness of the vaccine after completion of series

False - it does not but it may delay complete protection

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T/F: Decreasing the interval between doses of a vaccine may expedite complete protection but it is not generally recommended

False - Decreasing the interval can interfere with antibody response and is generally avoided

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What is the concern with live vaccines + antibody products (blood, IVIG)?

Antibodies can interfere with live vaccine replication and a separation period may be required

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The interval between antibody-containing product and MMR or Varicella vaccine is minimum of ____ and up to ___

3 months, up to 11 months

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Most live vaccines are withheld until a child is ___; at this time, the mother’s antibodies will be depleted. An exception is live ___ vaccine which is givent o infants.

12 mo
Rotavirus

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How old do pediatric patients have to be to get inactivated vaccines

Inactivated vaccines can be given at any time
Hep B is started at birth, others are typically when baby is 2 months old

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What is the concern with live vaccines + TB skin test?

Live vaccines can cause false negative TB skin test

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Live vaccines can cause false negative TB skin test. What are options to reduce this risk?

Give the live vaccine on the same day as the TST
Wait 4 weeks after live vaccines to perform TST
Give TST first, wait 48-72 hrs to get result and then give live vaccine

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Vaccines can usually be given at the same time (same visit or day). What are some exceptions?

Patients with asplenia
Prevnar and Menactra should be separated by 4 weeks

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What is the spacing requirement for live vaccines + antibody?

Vaccine first, 2 weeks, antibody containing product
Antibody-containing product, 3 months or longer, vaccine

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Simultaneous administration of vaccine and antibody is recommended for post-exposure ppx of certain diseases such as ____

Hep A and B, rbaies, tetanus

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Patients should be monitored for at least ___ after vaccination to watch for allergic reaction, syncope, dizziness, or fall

15 min

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Patient felt some systemic symptoms after a flu shot and came to the pharmacy saying the vaccine caused the flu. What is your response?

The flu shot is an inactivated (killed) vaccine and cannot cause disease

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With live vaccines, mild systemic reactions can occur ___ after the vaccine is given (i.e. after an incubation period)

3-21 days

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____ flu vaccine can replicate in the upper airways and cause cold cold-like symptoms such as a runny nose

Intranasal

Minor allergic reactions to vaccines typically resolve quickly and can be treated with ____ (OTC) and ___ (Rx)

Diphenhydramine Hydroxyzine

T/F: Minor allergic reaction to vaccines is a contraindication to future vaccinations

False

How many adult Epipens should be available at the pharmacy in case of severe allergic reaction to vaccines?

at least 3 adult (0.3mg) auto injectors Most adults will require 1-3 doses administered every 5-15 mins

T/F: Vaccinations cannot be given if pt has mild acute illness (slight fever, mild diarrhea)

False - may be given

T/F: Any vaccinations may be given if pt is on abx

False - most can be given but exceptions include varicella, live influenza, and oral typhoid vaccines

T/F: Vaccinations cannot be given if pt had previous local skin reaction (mild-moderate) from a vaccine

False - may be given

What is the difference between DTap and Tdap vaccine ?

DTap is for children < 7yo Tdap is given age 11-12 and adults

HPV vaccine recommended age

11-12 yo

HPV vaccine contraindicated with severe ___ allergy

yeast

HPV vaccine regimen if started before age 15 = ___ doses

2 (month 0 and 6-12 months later)

HPV vaccine regimen if started at age 15 or older or if immunocompromised = ___ doses

3 (months 0, 1-2, and 6)

Influenza A virus has subtypes based on the 2 surface antigens, ___ and ___

hemagglutinin and neuraminidase

Influenza vaccine is typically given to all pts age ≥6 mo and annually. When would 2 doses (4 weeks apart) be appropriate?

If age 6mo to 8yo and have not previously been vaccinated

Which influenza vaccines are indicated only for pts age ≥65yo

Fluzone High-dose and Fluad

Egg-free influenza vaccine includes ___ (approved only ≥18yo) and ___ (grown in cell culture approved for age ≥6 months)

Flublok Flucelvax

Which influenza vaccine is a live vaccine?

FluMist (approved for healthy ppl age 2-49yo)

All influenza vaccines are administered ____ except FluMist is intranasally divided between 2 nostrils

Storage for all influenza vaccines

Refrigerator Do NOT freeze

Storage for MMR vaccines

M-M-R II: store in refrigerator or freezer Priorix: store in refrigerator MMRV: store vaccine in freezer only d/t varicella component

How are MMR vaccines administered?

SC; MMR II and ProQuad may be given IM

Which vaccines require reconstitution with a diluent before use?

Varicella, MMR, and MMRV

Which vaccines require storage in the freezer?

Varicella (ProQuad, Varivax) and oral cholera vaccine

Which vaccines are given to adults with asplenia?

Pneumococcal, meningococcal, Hib vaccines

When is meningococcal vaccine recommended outside of routine vaccination as adolescents?

Travelers to certain countries such as meningitis belt in Sub-Saharan Africa age 2mo and older with asplenia/sickle cell disease, HIV Lab workers with N. meningitidis exposure First-year college students living in resident housing if not up to day During an outbreak

Quadrivalent meningococcal conjugate vaccines (MCV4) include which serotypes?

ACWY

MenB vaccine brand names

Bexesr, Trumenba

Pneumococcal vaccine recommendation for children < 5yo

4 dose series of PCV13 or PCV15 given at age 2, 4, 6, and 12-15 months

Pneumonoccal vaccine administration

PCV13, 15, 20 = IM PPSV23 = IM or SC

Rotavirus vaccine administration

oral

Varicella vaccine administration

Varivax SC or IM Shingrix IM

What vaccine can cause a positive reaction to TB skin test?

BCG vaccine

What vaccine is contraindicated with a severe (life-threatening) allergy to eggs or gelatin?

Yellow fever

Read and document refrigerator and freezer temps at least ____. Keep logs for at least ___

twice each workday 3 years

Which vaccines should be stored in the freezer?

Varicella MMRV Oral cholera vaccine MMR II can be either refrigerator or freezer

Which vaccines are SC only

Yellow fever Other: dengue, smallpox, monkeypox

Which vaccines are IM or SC

MMR, MMRV, varicella, PPSV23, IPV (IPOL)

Which vaccines are PO

Thypoid (Vivotif) capsules Oral solutions: cholera (Vaxchora), rotavirus (RotaTeq, Rotarix)

Administration technique and needle length for SC vaccines

5/8" needle at 45 degree angle into fatty tissue over triceps

Administration technique and needle length for IM vaccines

Adult: 1" needle at 90 degree into deltoid muscle above armpit level and below shoulder joint Exceptions: weight <130 points use 5/8"-1" needle Males >260lbs or females >200lbs use 1 1/2" needle

T/F: You can mix vaccines that are refrigerated and clear in the same syringe

False - never mix in the same syringe

MenB is indicated in certain patients ages ____

10-25yo

Which hepatitis vaccines contain hep B only?

Engerix-B Recombivax HB

Varicella vaccines are contraindicated in pts with hx of severe allergic reaction to ___

gelatin or neomycin