Chapter 20: Immunizations Flashcards
FDA Approval Based On:
Safety and efficacy for the indication
Advisory Committee on Immunization Practices
(ACIP)
Provides recommendations for vaccine administration in children and adults
CDC
Approves ACIP recommendation and publishes them in Morbidity and Mortality Weekly Report (MMWR) and the Pink Book
Antibodies
Are naturally produced to provide immunity against antigens.
When an antigen is detected the body produces antibodies and destroys the antigen
Immunoglobulin is the medical term for antibody
Active Immunity
When the person’s own immune system produces antibodies to fight an infection or in response to vaccine administration
Passive Immunity
Is acquired from someone else
- Mother to baby
- IVIG therapy
Types of Vaccines: Live Attenuated
“Weakened” Vaccines
Produced by modifying a disease producing “wild” virus. They have the ability to replicate and produce immunity but do not cause illness
CI: immunocompromised and pregnant patients
Types of Vaccines: Inactivated
Made up of either a whole virus or bacterium or fractions of both. Immunity from this type of vaccine can diminish over time and a supplement dose may be required
Polysaccharide Vaccines
Inactivated
Polysaccharide molecules taken from the outside layer of encapsulated bacteria. These vaccines do not get a good response in children <2
E.g pneumococcal polysaccharide vaccine (pneumovax 23)
Conjugate Vaccines
Use polysaccharide molecules from outside layer of encapsulated bacteria and join the molecules to carrier proteins. Conjugation increases response in infants
E.g pneumococcal conjugate (Prevnar 13)
Recombinant Vaccines
A gene segment of a protein from the organism is inserted into the gene of another cell, such as a yeast cell, where it replicates
E.g Gardasil, Flublock
Toxoid Vaccines
Targets a toxin produced by the disease
E.g Tetanus toxoid vaccine
mRNA vaccines
Gives instructions to the body’s cells (in the form of mRNA) to produce a protein specific to the pathogen which triggers and immune response
E.g select Covid-19 vaccines
Common Live Vaccines
MICRO-VY M- MMR I- Intranasal flu C- Cholera R- Rotavirus O- Oral Typhoid V- Varicella Y- Yellow fever
Interval between MMR or Varicella and antibodies
A minimum of 3 months up to 11 months
Live vaccines and TB skin test
To reduce the risk of false negative
- give the live vaccine on the same day as the skin test
- Wait 4 weeks after a live vaccine to perform skin test
- Administer skin test wait 48-72 hours to get the result then give live vaccine
Invalid CI to Vaccines
- Mild acute illness (slight fever, mild diarrhea)
- Current antimicrobial therapy (exceptions: varicella, live flu, oral typhoid vaccine)
- Previous local skin reaction
- Allergies: bird feathers, PCN, allergies to products not in the vaccine
- Pregnancy (except live vaccines) breastfeeding and preterm birth
- Recent TB skin test
- Immunosuppressed person in the household, recent exposure to the disease
- family hx of adverse events to the vaccine
Vaccines for Special Groups: Infants and Children
- 3 doses Hep B started at birth
- Others start at 2 months: Prevnar 13, Dtap, Hib, Polio, Rotavirus
- Live vaccines start at >=12 months: MMR and Varicella
- no polysaccharide before 2
Vaccines for Special Groups: Adolescents and Young Adults
- Meningococcal Vaccine (2 doses; 1 at 11-12 and 1 at 16 or 1st yr college students in residential housing if not previously vaccinated)
- HPV 11-12 years (2 or 3 doses depending on start date)
- Tdap 1st dose at >11 yrs
Vaccines for Special Groups: Pregnancy
- Flu (not live)
- Tdap weeks 27-36 (with each pregnancy)
Vaccines for Special Groups: Older Adults
- Herpes Zoster >= 50 years
- Pneumococcal**
Vaccines for Special Groups: Diabetes
- Pneumococcal
- Hepatitis B age 19-59yrs (or >60 per healthcare provider discretion)
Vaccines for Special Groups: Healthcare Professionals
- Annual flu
- Hep B (if no evidence of series completion)
- Varicella (if no hx of vaccination or chickenpox infection)
- MMR (if no hx of vaccination or chickenpox infection)
Vaccines for Special Groups: Sickle Cell Diseases and other causes of Aslplenia
- H. influenzae type B (Hib)
- Pneumococcal
- Meningococcal
Vaccines for Special Groups: Immunodeficiency
- Pneumococcal
- HIV (CD4 count <200)
- meningococcal
- Hep A
- Hep B
Pediarix
Dtap, HepB, and IPV
Dtap for children <7 years
Tdap
Adacel or Boostrix
Wound prophylaxis: for deep dirty wounds revaccinate with Td or Tdap if it has been more than 5 years since last dose
Each pregnancy
Close contacts of infants
Hib
Vaxelis (Dtap-IPV/Hib)
Given to adult with asplenia
Hepatitis A
Havrix, VAQT
Given to patients with chronic liver disease
Hepatitis B
Engerix-B, Heplisav-B, Recombivax HB
Routine children: start within 24 hours after birth
Adults: healthcare workers, patients with ESRD, chronic liver disease, HIV, diabetes
Heplisav-B age >= 18 years
HPV9
Gardasil
Recommended 11-12 years
If started before age 15; 2 doses
If started >= 15 years 3 doses
Influenza A surface antigens
- hemagglutinin
- neuramidase
Trivalent Flu Vaccine
Fluad (adjuvanted)
for >=65 years
Quadrivalent Flue Vaccines
- Afluria
- Fluarix
- FluLaval
- Fluzone
- Flucelvax (egg free)
- Flublok (egg free)
- Fluzone HD (ages >=65)
Quadrivalent Live Flu Vaccine
FluMist (healthy people ages 2-49 years)
MMR vaccines
MMR II (store in fridge or freezer) MMR+Varicella: Proquad (store in freezer)
Given SubQ
Meningococcal Vaccines
MCV4
Menactra (ages 9 mo to 55 years)
MenQuadfi (>=2yr)
Menveo (2mo-55yr)
MenB (Bexsero, Trumenba for 10-25yrs)
Prevnar 13
Routinely for children <5 yrs
Adult Pneumonia Vaccination
Adults aged 19-64 years with certain underlying medical conditions OR age >=65 years if never given before:
PCV20 x1 or
PCV15 x1 followed by PPSV23 >=12 months later (>=8weeks if immunocompromised
Polio Containing Vaccines
Dtap-HepB-IPV (pediarix)
Rotavirus vaccines
RV1: Rotarix
RV5: RotaTeq
Given orally
Varicella Vaccines
Varivax (for chickenpox): anyone without evidence of immunity to varicella should receive 2 doses of varivax. Some antivirals interfere with varivax, stop 24 hours before
-Store in freezer, reconstitute immediately before administration, give subq
MMRV (proquad)
Shingrix (herpes zoster)
Non-routine Vaccines: Rabies
RabAvert
post-exposure (without previous vaccination):4 doses; 1 dose of rabies immune globulin with the 1st vaccine dose
Non-routine Vaccines: Typhoid Vaccine
Vivotif (oral) (live)
To prevent fever caused by Salmonella typhil
Complete at least 1 week prior to exposure
Typhin Vi (injection) ! dose at least 2 weeks prior to exposure
Non-routine Vaccines: TB
TB Calmette-Guerin (BCG)
not use often in US but can cause positive TB skin test
Non-routine Vaccines: Yellow Fever
YF-Vax (live)
CI: with severe, life-threatening, allergy to eggs or gelatin
International Certification of Vaccination (yellow card) is provided and good for 10 years
Reconstitute with provided diluent
Given Subq
Non-routine Vaccines: Cholera
Vaxchora (live)
Given to people age 18-64 years who are traveling to an area of active Vibrio Cholerae transmission
Store packet for reconstitution in freezer
How long to keep temp logs
3 years
