Chapter 20: Immunizations Flashcards
Who provides the recommendations for vaccine administration in children and adults
The Advisory Committee on Immunization Practices (ACIP)
Who approves the ACIP recommendations and where do these recommendations get published?
CDC
CDC’s Morbidity & Mortality Weekly Report (MMWR) & The Pink Book
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
active immunity is when ____
the person’s OWN immune system produces antibodies to fight
passive immunity is when ____
antibodies are provided from someone else
____ 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
Live attenuated vaccines are CI in which populations
immunocompromised and pregnant patients
____ 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
Polysaccharide vaccines do not produce a good immune response in children < __ years of age
2
example: pneumococcal polysaccharide vaccine (Pneumovax23)
Key live vaccines
Remember: MICRO Vaccines are Yellow (MICRO VY)
- MMR
- Intranasal influenza
- Cholera
- Rotavirus
- Oral Typhoid
- Varicella
- Yellow Fever
When can most live or inactivated vaccines be administered
Simultaneously
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
Antibodies in some blood products and IVIG can interfere with ____ and a separation period may be required
live vaccine replication
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
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)
Inactivated vaccines are started when a baby is 2 months old, except for which vaccine that is given at birth
Hepatitis B
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
Multiple live vaccines can be given on the same day or (if not given on the same day) spaced _____ weeks apart
4
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
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
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
Adverse reactions that require some type of assistance should be reported to
FDA’s Vaccine Adverse Events Reporting System (VAERS)
With live vaccines, mild systemic reactions can occur __ - ___ days after the vaccine is given
3-21 days
Is the flu shot inactivated or live?
inactivated - it cannot cause the flu
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)
- Quadrivalent inactivacted (IIV4) brand name
- which ones are egg-free?
- Which are high dose?
- contains egg: Afluria, Fluarix, FluLaval, Fluzone
- no egg: Flucelvax, Flublok
- High-dose: Fluzone High-Dose, Fluad (ages ≥ 65)
- Quadrivalent Live Attentuated Influenza Vaccine (LAIV4) brand name
- Indication?
- FluMist
- 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
SC
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
- travelers to meningitis belt in sub-saharan Africa
- > 2 months with HIV, asplenia/sickle cell disease
- lab workers
- 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
- PCV20 x 1
- 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
2
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
SC
How is Shingrix administered
IM
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
SC
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
2x
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
