Adult Vaccines

Question 1

Adult vaccine recommendations per CDC?

Answer 1

• Influenza (seasonal)
• Tdap
• MMR
• Varicella
• Zoster recombinant (if immunocompromised)
• Pneumococcal (PCV15, PCV20, PPSV23)
• Hepatitis A, Hepatitis B
• Meningococcal (A, B, C, W, Y)
• COVID

Question 2

Vaccine schedule

Answer 2

Question 3

Vaccine schedule

Answer 3

Question 4

Side effects/safety of vaccines

Answer 4

• 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)

Question 5

Hallmark symptoms of Guillain-Barre Syndrome?

Answer 5

Ascending muscle weakness with relatively unimpaired sensation; typical onset within 6 weeks

Question 6

Influenza vaccine facts

Answer 6

• Multiple strains included (quadrivalent), predictions based on prior seasonal strains
• Inactivated vs live attenuated vs recombinant

Question 7

What are inactivated vaccines?

Answer 7

Inactivated are grown within eggs and then inactivated by heat, UV, or chemical

Question 8

What is a live attenuated vaccine?

Answer 8

Produced the same but “weakened” by only selecting samples that survive only at colder temperatures (i.e., the nose but not the lungs)

Question 9

What is a recombinant vaccine?

Answer 9

Completely manufactured - surface antigen is coded and recombined with a non-influenza virus for delivery

Question 10

TDap (or dtap) vaccine facts?

Answer 10

• Prevents against infection from Clostridium tetani (causes “lock jaw”)
• Every 10 years, or if susceptible wound and 5 years from most recent

Question 11

Measles, Mumps, Rubella (MMR) vaccine facts?

Answer 11

• Administered in adulthood if not previously immunized or if born before 1957
• Mumps outbreaks are more common, typically amongst closely contacted individuals

Question 12

How to differentiate between measles vs rubella rash?

Answer 12

Question 13

Varicella vaccine facts?

Answer 13

• 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)

Question 14

Zoster recombinant vaccine facts?

Answer 14

• 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

Question 15

Pneumococcal vaccine facts?

Answer 15

• 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)

Question 16

Human papilloma virus vaccine facts?

Answer 16

• 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

Question 17

Meningococcus vaccine facts?

Answer 17

• 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

Question 18

Hepatitis vaccine facts?

Answer 18

• 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)

Question 19

COVID-19 vaccine facts?

Answer 19

• 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

Question 20

Special situations

Answer 20

• 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

Question 21

Vaccine misconceptions?

Answer 21

• 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?