20. Immunizations Flashcards
___ are prepared by the CDC for each vaccine to explain benefits and risks
Vaccine Information Statements (VISs)
Federal law requires that a VIS be handed to patient/parent (before/after) a vaccination is administered
Before
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)
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
Common live vaccine mneumonic MICRO-VY
MMR
Intranasal influenza
Cholera
Rotavirus
Oral typhoid
Varicella
Yellow Fever
Others: tuberculosis (BCG), dengue, small pox, ebola
___ vaccines do not produce good immune response in children < 2yo
Polysaccharide vaccines (ex. Pneumococcal Polysaccharide Vaccine (Pneumovax 23))
____ 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)
What is a limitation of live vaccines?
Not recommended in immunocompromised/pregnant patients (may not be able to halt replication and cause disease)
What is a limitation of inactivated vaccines?
Immunity is not as strong compared to live vaccines; boosters may be required
T/F: Most live and inactivated vaccines can be administered simultaneously
True
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
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
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
The interval between antibody-containing product and MMR or Varicella vaccine is minimum of ____ and up to ___
3 months, up to 11 months
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
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
What is the concern with live vaccines + TB skin test?
Live vaccines can cause false negative TB skin test
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
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
What is the spacing requirement for live vaccines + antibody?
Vaccine first, 2 weeks, antibody containing product
Antibody-containing product, 3 months or longer, vaccine
Simultaneous administration of vaccine and antibody is recommended for post-exposure ppx of certain diseases such as ____
Hep A and B, rbaies, tetanus
Patients should be monitored for at least ___ after vaccination to watch for allergic reaction, syncope, dizziness, or fall
15 min
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
With live vaccines, mild systemic reactions can occur ___ after the vaccine is given (i.e. after an incubation period)
3-21 days
____ 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
IM
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
