Chapter 20: Immunizations Flashcards by Emily Jansen

Who provides the recommendations for vaccine administration in children and adults

The Advisory Committee on Immunization Practices (ACIP)

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Who approves the ACIP recommendations and where do these recommendations get published?

CDC
CDC’s Morbidity & Mortality Weekly Report (MMWR) & The Pink Book

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what is a VIS?

where can they be found?

Vaccine Information Statements prepared by CDC that must be handed to the patient before a vaccination is administered

can be found on CDC and Immunization Action Coalition websites

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active immunity is when ____

the person’s OWN immune system produces antibodies to fight

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passive immunity is when ____

antibodies are provided from someone else

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____ vaccines are produced by modifying a disease-producing (“wild”) virus or bacterium in a lab; they have the ability to replicate (grow) and produce immunity, but usually do not cause illness

Live attenuated

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Live attenuated vaccines are CI in which populations

immunocompromised and pregnant patients

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____ vaccines can be composed of either a whole virus or bacterium, or fractions of either. They cannot replicate

Inactivated

response can diminish and may require a booster

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Polysaccharide vaccines do not produce a good immune response in children < __ years of age

example: pneumococcal polysaccharide vaccine (Pneumovax23)

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Key live vaccines

Remember: MICRO Vaccines are Yellow (MICRO VY)
- MMR
- Intranasal influenza
- Cholera
- Rotavirus
- Oral Typhoid
- Varicella
- Yellow Fever

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When can most live or inactivated vaccines be administered

Simultaneously

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T/F: Increasing the interval between doses of vaccine given in a series does not diminish the effectiveness of the vaccine after completion of the series

True

Decreasing the interval between doses of vaccine can interfere with antibody response & protection

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Antibodies in some blood products and IVIG can interfere with ____ and a separation period may be required

live vaccine replication

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what is the interval required between an antibody containing product and MMR or varicella-containg vaccines?

minimum of 3 months, may be up to 11 months

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Which type of vaccine can be given at any time (within first 12 months of life)

Inactivated
live vaccines are not recommended until after 12 months old

rotavirus (live vaccine but shown to produce response)

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Inactivated vaccines are started when a baby is 2 months old, except for which vaccine that is given at birth

Hepatitis B

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Live vaccines can cause a false-negative TB skin test. Options to reduce the risk of a false-negative include:

give the live vaccine on the same day as the skin test
Wait 4 weeks after a live vaccine to perform the skin test
Administer the skin test first, wait 48-72 hrs to get the result, then give the live vaccine

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Multiple live vaccines can be given on the same day or (if not given on the same day) spaced _____ weeks apart

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T/F: If a vaccine series requires > 1 dose, the intervals between doses can be extended without restarting the series, but they cannot be shortened in most cases

True

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What is the recommended spacing between live vaccines and antibody administration

If giving a vaccine before antibody containing product
If giving an antibody containing product before a vaccine

Vaccine → 2 weeks → antibody-containing product

antibody-containing product → 3 months or longer → vaccine

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Simultaneous administration of vaccine and antibody (in the form of immunoglobulin) is recommended for post-exposure ppx of certain diseases, such as

Hep A & B, rabies and tetanus

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Adverse reactions that require some type of assistance should be reported to

FDA’s Vaccine Adverse Events Reporting System (VAERS)

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With live vaccines, mild systemic reactions can occur __ - ___ days after the vaccine is given

3-21 days

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Is the flu shot inactivated or live?

inactivated - it cannot cause the flu

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When does a vaccine become contraindicated in a person (besides being immunocompromised or pregnant with live vaccines)

Hx of a severe or anaphylactic reaction

What is the requirements for vaccine administration emergency protocols regarding epinephrine?

must have 3 prefilled autoinjectors on hand (doesn't have to be prefilled as long as 3 doses are available)

T/F: Treatment with antibiotics is NOT a valid reason to delay vaccines

True

T/F: If a person has a moderate-severe acute illness, it is not necessary to delay vaccines until the condition has improved

False - it is reasonable to delay the vaccine | mild illnesses are not a reason to avoid vaccines, though

How often is Tdap or Td given in adults

every 10 years

At what age can Shingrix be given

≥ 50 years old

T/F: Shingrix should still be given even if a patient has previously had chicken pox

True

When is the second dose of Shingrix given

2-6 months after the first dose

Patients aged ____ years should get 1 dose of PCV20 or 2 doses (PCV15 then PPSV23) if they have what conditions

19-64 Heart, lung, liver disease, diabetes, alcohol abuse, smokers, etc (immunosuppressed)

What is the difference betweeen the pediatric and adult formulation of diphtheria, tetanus, and pertussis containing vaccines? (tdap)

Tdap/Td in adults (lowercase d) TDaP in pediatrics has 3-5 times more diphtheria component

DTaP-HepB-IPV brand name

Pediarix

Tdap brand name

Adacel, Boostrix

Who is DTaP indicated for?

children < 7

Who is Td or Tdap indicated for?

- wound ppx: deep dirty wounds (if > 5 years since last vaccine) - Pregnancy - close contact with infants

Who should be given haemophilus influenzae type B vaccines?

adults with asplenia

Hepatitis A vaccine brand names

Havrix, VAQTA

Hepatitis B vaccine brand names

Engerix-B, Heplisav-B, Recombivax HB

Hep A vaccine indications

chronic liver disease | homesless, MSM, HepA, etc

Hep B vaccine indications

- children within 24 hours of birth - chronic liver disease - HIV infection - blood exposure (healthcare workers, dialysis, diabetes)

Age at which Heplisav-B is indicated

≥18

HPV9 (9-valent) vaccine brand name

Gardasil 9

recommended age for Gardasil 9 how many doses?

11-12 years < 15 = 2 doses ≥ 15 = 3 doses | as early as 9, as late as 26

What are the surface antigens on influenza A virus

hemagglutinin, neuraminidase

how does the flu spread?

through respiratory droplet transmission

type of symptoms with flu: abrupt or slow onset?

abrupt onset - fever, mylagias, ha, cough, sore throat)

1. Quadrivalent inactivacted (IIV4) brand name 2. which ones are egg-free? 3. Which are high dose?

- contains egg: Afluria, Fluarix, FluLaval, Fluzone - no egg: Flucelvax, Flublok - High-dose: Fluzone High-Dose, Fluad (ages ≥ 65)

1. Quadrivalent Live Attentuated Influenza Vaccine (LAIV4) brand name 2. Indication?

1. FluMist 2. health people 2-49 years old

Patients with an egg allergy can receive which influenza vaccine

- any-age appropriate inactivated influenza vaccine (NOT FLUMIST) even if severe allergy symptoms - if egg-containg product, must be under healthcare supervision - Flublok and Flucelax are egg-free options

Which influenza vaccines are indicated only for patients ≥ 65 years

Fluzone High-dose, Fluzone High-Dose Quadrivalent, and Fluad

How is FluMist administered (including the dose)

0.2 mL divided between the two nostrils

What is the combination MMRV (MMR + Varicella) vaccine brand name

ProQuad

Brand name of the MMR vaccine

M-M-R II

T/F: MMR vaccine can be given to pregnant and immunocompromised patients

false - it is a live vaccine

Where should the MMR vaccine be stored

In the fridge or freezer

Where should the MMRV vaccine be stored

freezer ONLY d/t the varicella component

What route is the MMR & MMRV vaccine given

Where should MMR vaccine diluents be stored

at room temp or in the refrigerator

Healthcare workers should receive __ doses of MMR

2 doses

Age ≥ ___ with high risk should receive MenB vaccine

10 years high risk like asplenia/sickle cell, lab workers, during outbreak | ages 10-25 years

Meningococcal vaccine names

MCV4 Menactra MenQuadfi Menveo

Who needes routine Meningococcal vaccines?

adolescents (2 dose series)

Who are special populations at high risk that need meningococcal vaccination

1. travelers to meningitis belt in sub-saharan Africa 2. >2 months with HIV, asplenia/sickle cell disease 3. lab workers 4. 1st year college students

important note for Menveo vials

BOTH vials contain vaccine (powder and liquid)

Children age < ___ years receive PCV___ as part of routine childhood vaccinations

5 years 13

How is PPSV23 given

IM or SC

Brand name of PCV13

Prenvar 13

Brand name of PCV 15

Vaxneuvance

Brand name of PCV20

Prevnar 20

Brand name of PPSV23

Polysaccharide Vaccine Pneumovax 23

Adults 19-64 with specific medical conditions should receive what pneumococcal vaccine

1. PCV20 x 1 2. PCV15 then PPSV23x1 (≥12mo later or ≥8 weeks later if immunocompromised)

What is the name of the polio vaccine

IPV

What are the brand names for the Rotavirus vaccines (RV1 and RV5)

Rotarix, RotaTeq

How is the Rotavirus vaccine administered

orally

Varicella Virus Vaccine (for chickenpox) brand name

Varivax

Anyone without immunity to varicella should receive how many doses of Varivax

Some antivirals (e.g, acyclovir, valacyclovir, famiciclovir) can interfere with the live vaccines (including varivax) & should be stopped how long before vaccine administration and should not be taken for 14 days after vaccination

24 hrs

Where must Varivax be stored

in the freezer

When should Varivax be reconstituted

Right away upon removal from the freezer and inject due to short stablility

Varivax should not be given if there is a hypersensitivity to ____ or ____

gelatin or neomycin | *remember: i am Vari allergic to gelatin and neomycin*

Varivax is administered via which route

How is Shingrix administered

Rabies vaccine brand name

RabAvert

A person who has been exposed to rabies without previous vaccination should get how many doses of Rabies Vaccine

4 doses: 1 dose of Rabies immune globulin should be given with the first vaccine dose

What is typhoid fever caused by?

Salmonella typhi

Typhoid vaccine comes in which formulations

Oral, Injection | *remember: typhOId, oral*, Injection

When should the oral Typhoid capsules be taken

at least 1 week prior to possible exposure

When should the injectable Typhoid vaccine be taken

at least 2 weeks prior to possible exposure

Oral Typhoid capsules should be stored

in the fridge

How should Typhoid capsules be taken

On empty stomach with cold or lukewarm water

What type of vaccines are the typhoid vaccines for both oral and injection (live or inactivated?)

oral - live injection - inactivated | MICRO-VY (O = oral typhoid)

Which vaccine can cause a positive reaction to the TB skin test

Tuberculosis Bacille Calmette-Guerin (BCG) vaccine

yellow fever is a live or inactivated vaccine?

live | remember MICRO-VY

Yellow Fever vaccine is CI with

severe (life-threatening) allergy to eggs or gelatin

What is provided and valid for 10 years after receiving Yellow Fever Vaccine

International Certificate of Vaccination (yellow card)

Yellow Fever Vaccine should be reconstituted with

Provided diluent

How should Yellow Fever Vaccine be administered

Where should the packet for reconstitution for the cholera vaccine be stored

in the freezer

Cholera is given to people traveling to an area of active toxigenic ____

Vibrio cholerae transmission

Never store vaccines where in refrigerators or freezers?

in the doors always keep in original packagin rotate stock to use vaccines with earliest expiration date

The CDC recommends a calibrated thermometer or a digital data logger be connected to a ____ in the fridge and freezer

buffered temperature probe

Temperatures in fridge and freezer should be read and documented at least ____ times per workday

most vaccines are stored in refrigerator what vaccines are stores in the freezer? | what temperature?

Varicella MMRV (has varicella in it) oral cholera **MMR can be stored in refrigerator or freezer | -58 to +5 F or -50 to -15 C

Temperature logs should be kept for how long

3 years or longer

What size needle should be used with a SC injection & how should it be inserted into the skin

5/8" | 45 degrees

What size needle should be used with a IM injection & how should it be inserted into the skin

1" (exceptions: weight < 130 lbs, use 5/8"-1" needle & males >260 lbs or females >200 lbs. use a 1.5" needle) 90 degrees