25 - Vaccines Flashcards
What are the 2 types of influenza vaccines?
1) Inactivated virus (effective in 2 weeks, lasts less than 12 months)
2) Live attenuated virus
What is the adult immunization schedule? What diseases does it protect against?
- All adults should receive Tdap (tetanus, diphtheria, and pertussis)
- All adults should receive Td (tetanus and diphtheria) every 10 years
- Adults over 65 y/o should receive the pneumococcal vaccine
- Everyone over 6 m/o should receive the flu shot every year
What can be done to improve influenza and pneumococcal vaccine delivery to high-risk individuals?
- Recommendation by health care provider
- Collaborate w/ pharmacist and specialist physicians to distribute info on benefits and risks
- Advertise in local newspapers, radio, television
- Issue reminders to px and healthcare workers
- Vaccinate on discharged from hospital or ER in fall, w/ home care or at clinics w/ high risk px
- Increase accessibility in institutions and community
What are situations that aren’t CI to vaccines but commonly mislabeled as such?
- Minor acute illness (including upper respiratory infection, diarrhea; exceptions = LAIV, rotavirus vaccine, and oral cholera)
- Antibiotic/antiviral therapy (exceptions = live oral typhoid and LAIV, herpes zoster and varicella)
- Adverse event following previous immunization
- Extensive limb swelling following immunization
- Febrile seizure or syncope after previous immunization
- Inconsolable crying
- Oculo-respiratory syndrome (except influenza vaccine)
- Non-anaphylactic allergies
- Multiple sclerosis
What is done to surveillance vaccine-associated adverse effects?
- During phase 1, 2, and 3 clinical studies
- Passive reporting to provincial health authority
- Active reporting through immunization monitoring program
What are the most common adverse effects of vaccines?
- Local = soreness, swelling, redness
- Systemic = tiredness, irritability, GI, fever, seizures
- Allergic = urticaria, angioedema, rhinitis, bronchospasm, anaphylaxis
What are the principles of effective and informed communication about vaccines and immunization?
- Communicate current knowledge
- Respect difference of opinion
- Represent risks and benefits of vaccines fairly and openly
- Adopt a patient centered approach
- Make the most of each opportunity to present clear, evidence-based messages regarding vaccinations and immunization
Should a 2 y/o w/ no contraindications receive the trivalent/quadrivalent or live attenuated influenza vaccine?
- Can have either
- Parent will likely choose live b/c available in a nasal spray
- If px has asthma, must have TIV
Should a pregnant woman receive the trivalent/quadrivalent or live attenuated influenza vaccine?
Must have TIV
Should a 67 y/o receive the trivalent/quadrivalent or live attenuated influenza vaccine?
Live is only for px aged 2-59, so this px needs TIV
Should a px w/ an egg allergy receive the trivalent/quadrivalent or live attenuated influenza vaccine?
- Can have either
- Egg allergy no longer CI for live
What is zostavax? What does it contain? When is efficacy greatest?
- Vaccine for prevention of herpes zoster (shingles) in px over 50 y/o
- Contains live attenuated varicella-zoster
- Efficacy highest in px 60-69 y/o
Can a px w/ an active case of herpes zoster receive the zoster vaccine?
No, must wait 1 year since last active infection to receive vaccine
What is the primary age group for HPV vaccination?
9-27 y/o females and males
What is the dosing schedule for the HPV vaccine?
Depends on the vaccine (gardasil, gardasil 9, or cervarix)
What is the most common cause of severe gastroenteritis in infants and children?
Rotavirus
When is the rotavirus vaccine recommended?
For infants starting at 6 weeks of age
Is the rotavirus vaccine injected?
No, given orally
What is the benefit to live attenuated vaccines?
Broader, stronger, and longer immunity
What are examples of live attenuated vaccines?
- MMR
- Varicella
- Yellow fever
- Oral typhoid
- Oral cholera
- Influenze (LAIV)
- Rotavirus
What are examples of inactivated vaccines?
- Poliovirus
- Influenza
What are purified or recombinant subunit vaccines? Do they provide better or weaker immunity and what does this mean for dosing?
- Given as protein (ex: toxoid), polysaccharide, or polysaccharide-protein conjugate
- Weaker immunity, so require multiple dose or adjuvant
What are examples of purified or recombinant subunit vaccines?
- DTaP
- Hib
- HBV
- Pneumococcal
- Meningococcal
Which vaccines produce the most adverse effects?
Live vaccines
What is passive immunity?
Immune globulin w/ performed antibodies for protection
What are advantages and disadvantages to combination vaccines?
- Advantages = easier storage and administration, potential increase in vaccine uptake, reduced exposure to adjuvants/additives
- Disadvantages - more complex pre-approval, difficult to determine component responsible for adverse event, increased cost
Where are ID injections injected?
Flexor surface of forearm
Where are SC injections injected?
45 degrees into upper triceps area of arm
Where are IM injections injected?
90 degrees into deltoid muscle in 1 year and older
What should be done if more than 1 injection is needed?
- Use both arms
- More than 2 injections = use 2 arms and third injection should be more than 1 inch from previous injection
Can vaccinations be given before or after their recommended schedule?
- Shouldn’t be given sooner than recommended b/c may cause less than optimal antibody response and shouldn’t be counted
- Can be given after w/o having to restart series
Hepatitis B vaccine is administered at 0, 1, and 6 months. What would you do if the 3rd dose was given at 3 months?
Ignore that dose and give another at 6 months
Which 2 vaccinations are commonly recommended to be administered simultaneously?
Pneumococcal and influenza
Can vaccines for the same disease be given simultaneously?
No, must be separated by at least 8 weeks
Can 2 live vaccines be given on the same day?
Yes or can be separated by 4 weeks
What should be done after administration of a vaccine?
Keep px nearby for 15 minutes
What are some contraindications to both inactivated and live vaccines?
- Anaphylaxis after previous dose of the vaccine
- Proven immediate or anaphylactic hypersensitivity to any component of the vaccine or its container
- Guillain-Barre syndrome w/in 6 weeks of receiving the vaccine (not immediate CI for influenza vaccine)
What are some contraindications to only the live version of a vaccine?
- Severe asthma
- Congenital malformation of GI tract, uncorrected (rotavirus is CI)
- Immunocompromised (can weigh risk vs. benefit in milder cases)
- Immunosuppressive therapy (ex: cancer tx, monoclonal antibodies)
- Pregnancy
- Active, untreated TB (MMR, MMRV, univalent varicella, herpes zoster, and BCG vaccines CI)
When are egg allergies CI for immunizations?
- Yellow fever
- Tick-borne encephalitis vaccine
- Some rabies vaccine
