Adult Vaccines Flashcards
Adult vaccine recommendations per CDC?
- Influenza (seasonal)
- Tdap
- MMR
- Varicella
- Zoster recombinant (if immunocompromised)
- Pneumococcal (PCV15, PCV20, PPSV23)
- Hepatitis A, Hepatitis B
- Meningococcal (A, B, C, W, Y)
- COVID
Vaccine schedule
Vaccine schedule
Side effects/safety of vaccines
- Disease-like symptoms (milder, shorter compared to actual illness, no harm of severe illness or death)
- Guillain-Barre Syndrome (rare)
- Allergy (many egg derived, so if allergic to eggs will be allergic to egg-derived vaccine)
Hallmark symptoms of Guillain-Barre Syndrome?
Ascending muscle weakness with relatively unimpaired sensation; typical onset within 6 weeks
Influenza vaccine facts
- Multiple strains included (quadrivalent), predictions based on prior seasonal strains
- Inactivated vs live attenuated vs recombinant
What are inactivated vaccines?
Inactivated are grown within eggs and then inactivated by heat, UV, or chemical
What is a live attenuated vaccine?
Produced the same but “weakened” by only selecting samples that survive only at colder temperatures (i.e., the nose but not the lungs)
What is a recombinant vaccine?
Completely manufactured - surface antigen is coded and recombined with a non-influenza virus for delivery
TDap (or dtap) vaccine facts?
- Prevents against infection from Clostridium tetani (causes “lock jaw”)
- Every 10 years, or if susceptible wound and 5 years from most recent
Measles, Mumps, Rubella (MMR) vaccine facts?
- Administered in adulthood if not previously immunized or if born before 1957
- Mumps outbreaks are more common, typically amongst closely contacted individuals
How to differentiate between measles vs rubella rash?
Varicella vaccine facts?
- Usually given in childhood, or to adults in 2 doses if no prior immunity
- Caution in administering to immunocompromised (HIV, cancer with active treatment, chronic steroid use)
Zoster recombinant vaccine facts?
- Zoster vaccination reduces risks of reactivation and post-zoster complications (mostly post-herpetic neuralgia)
- Shingrix is given in 2 doses 1 month apart
- Should receive: age > 50, age > 18 and immunocompromised, prior Zostavax injection, prior chicken pox immunization
- Should not receive: active shingles, currently pregnant
- Efficacy: age 50-69 = 97%, > 70 = 91%
- Side effects: mild viral symptoms, no risk for shingles activation
Pneumococcal vaccine facts?
- Vaccine protects against Strep pneumoniae infections (lobar pneumonias causing serious illness, meningitis)
- 4 major types with 100 subtypes, all protected by vaccination (PCV 13, 15, 20; PPSV23)
- Give at any age, but specifically to adults age 65 or over
- Efficacy for age 65+: 46% against pneumonia, 75% against invasive pneumococcal disease (IPD)
Human papilloma virus vaccine facts?
- Prevents cervical and throat cancers, and genital warts, caused by HPV
- Must be given prior to initial contact with HPV, not routinely recommended after age 26
Meningococcus vaccine facts?
- Protects against Neisseiria meningitidis infection
- MenACWY given routinely in adolescence/early adulthood (or as a catch up series with usual spacing)
- MenB also given for at-risk populations (HIV, functional asplenia, complement deficiency diseases, military, occupational) - also requires booster q2-3y if risk persists
- OK to give to pregnant women if at increased risk
Remember: rashes on palms/soles is meningococcus until proven otherwise
Hepatitis vaccine facts?
- Hep A (fecal/oral) is recommended for high risk individuals: chronic liver disease, HIV, MSM, “injection or non-injection” drug use, homelessness, occupational, travel to endemic countries, contact with international adoptees
- Hep B (blood/sex) recommended for all age 19-60 and then high risk after 60 (same RF as above)
- Immunity drops/disappears within 10-20 years (HBsAg present in as few as 3-10% immunized individuals by age 18) - suggests need for booster
- No vaccine for HCV exists
- Vaccination prevents acute illness and chronic carriage (and therefore reduces HCC)
COVID-19 vaccine facts?
- mRNA vaccine developed from prior work on SARS outbreak 2002-2004, MERS 2012 (also coronaviruses)
- mRNA molecule encoding for externally presenting spike proteins injected into muscle
- Muscle cells produce the spike protein only, do not enter the nucleus so cannot affect existing DNA
- Immune system makes antibodies to that protein, signaling/priming for future true exposure
Special situations
- Splenectomy: vaccines administered regardless of age, also applies to functional asplenia
- The spleen is particularly helpful for protecting against encapsulated bacterial infections (S pneumoniae, N meningitidis, Hib)
- Pre-splenectomy (if time allows): above, plus flu, MMR, varicella, TDaP,
- Post-splenectomy (if emergent): above, but within 2 weeks post-procedure (commonly day of hospital discharge following injury)
- Immunocompromised - need to weigh risks of exposure to potential pathogen vs likelihood of recurrence secondary to immunocompromised (zoster)
- Exposure risk can be mitigated by inactivated rather than live-attenuated virus
Vaccine misconceptions?
- Vaccines make you sick
- Vaccines prevent infection - Influenza? COVID? Polio?
- Natural immunity is as good as vaccinated immunity (good for whom? Population? Individual?) Vaccines can overload my child’s immune system
- Microchips, magnetism, embryonic harvests, sterilization - should these be dismissed out of hand?
