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
____ 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
pregnant patients
____ vaccines can be composed of either a whole virus or bacterium, or fractions of either. They cannot replicate
Inactivated
Polysaccharide vaccines do not produce a good immune response in children < __ years of age
2
Key live vaccines
Remember: COZY IV RM
- Cholera
- Oral Typhoid
- Zoster
- Yellow Fever
- Intranasal influenza
- Varicella
- Rotavirus
- MMR
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
Which type of vaccine can be given at any time
Inactivated
Inactivated vaccines are started when a baby is 2 months old, except for which vaccine which 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
MMR & varicella-containing vaccines (not zoster) require separation from antibody-containing products (e.g., blood transfusions, IVIG).
- The recommended spacing if giving a vaccine before antibody containing product is:
- The recommended spacing if giving an antibody containing product before a vaccine is:
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
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
When does a vaccine become contraindicated in a person (besides being immunocompromised or pregnant with live vaccines)
A severe or anaphylactic reaction
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
How often is Tdap or Td given in adults
every 10 years
At what age can Shingrix be given
> /= 50 years old
T/F: Shingrex should still be given even if a patient has previously had chicken pox
True
When is the second dose of Shingrex given
2-6 months after the first dose
Pneumovax 23 is given to all adults >/= ___years
65
Patients age 2-64 years should get 1 dose of Pneumovax 23 if they have which condition(s)
Heart
lung
liver disease
diabetes
alcohol abuse
smokers
Patients age 2-64 years should get 2 doses of Pneumovax 23 if they have which condition(s)
Immunocompromised
(e.g, SCD
asplenia
HIV
chronic renal failure
malignancy
transplant
immunosuppressive drugs including steroids)
T/F: Prevnar 13 is optional for adults age >/= 65 years
True
Any patients >/= 6 years old who are ____ should receive Prevnar13
immunocompromised
Which meningococcal vaccines are serogroup B
Bexsero
Trumenba
Which adult populations should receive Meningococcal serogroup B vaccines
complement component deficiency
taking aculizumab (Soliris)
asplenia
microbiologist with exposure to Neisseia Meningitidis
serogroup B meningococcal vaccine exposure
Which meningococcal vaccines are conjugate vaccines
Menactra
Menveo
Which adult populations should receive Meningococcal conjugate vaccines
Same groups as serogroup B:
complement component deficiency,
taking aculizumab (Soliris),
asplenia,
microbiologist with exposure to Neisseia Meningitidis,
serogroup B meningococcal vaccine exposure
PLUS: HIV, Sickle Cell disease, travelers/residents to countries in which the disease is common (such as the meningitis belt in Sub-Saharan Africa), military recruits, first year college students living in dorms, if not up-to-date
Which adult populations should receive Hep B vaccine
Sexually active adults who are not in long-term, monogamous relationships
patients with diabetes age 19-59 years (or >/= 60 years per HCP discretion)
household contact with an infected person
IV drug abusers (IVDAs)
patients with HIV or chronic liver disease
What is the combination Hep A and B vaccine called
Twinrix
Which adult populations should receive Hep A vaccine
Adults traveling to undeveloped countries outside of the US
household members and other close contacts of adopted children newly arriving from countries with moderate-high infection risk
liver disease
hemophilia
men who have sex with men
IVDAs
homeless individuals
HIV
What are the Hep B vaccine names
Engerix-B
Recombivax HB
Heplisav-B
What are the Hep A vaccine names
Havrix
VAQTA
Which formulation of the Diphtheria Typhoid vaccine is for peds (younger than 7 years old)
DTaP
Which formulation of the Diphtheria Typhoid vaccine is for adults
Tdap or Td
Tdap brand name
Adacel
Boostrix
DTaP-HepB-IPV brand name
Pediarix
When should someone get revaccinated with Td or Tdap
Wound ppx for deep or dirty wounds
if it has been more than 5 years since the last dose
Who should receive a booster dose of Td or Tdap
- Pregnant or postpartum women with each pregnancy
- close contacts of infants younger than 12 months
- Healthcare personnel
- Children age 7-10 years who did not get fully vaccinated with the DTaP series
Adults with ____ should receive Hib (Haemophilus Influenzae type b) vaccine
asplenia
HepB vaccine is started within what time after birth
24 hrs
Which HepB vaccine is only given in patients >/= 18 years
Heplisav-B
Brand name for HPV9
Gardisil
Recommended age to receive HPV9 vaccine
11-12 years
If HPV9 is started before the age of 15, how many doses are needed
If HPV9 is started at or after the age of 15 or if the patient is immunocompromised, how many doses are needed
2 doses
3 doses
Which patients need to receive 2 doses of the influenza vaccine 4 weeks apart
age 6 months to 8 years who are not previously vaccinated
Patients with an egg allergy can receive which influenza vaccine
any-age appropriate inactivated influenza vaccine (NOT FLUMIST) even if severe allergy symptoms
Which influenza vaccine is an egg-free product and what age group can receive it
Flublok
Age >/= 18 years
Which influenza vaccines are indicated only for patients >/= 65 years
Fluzone High-dose
Fluzone High-Dose Quadrivalent
Fluad
Fluzone HD and Fluad are (trivalent or quadrivalent) inactivated vaccines
Trivalent
note: fluzone HD comes as a tri and quadrivalent vaccine
Afluria, Fluarix, FluLaval, Fluzone, Flucelvax, & Flublok are (trivalent or quarivalent) inactivated vaccines
Quadrivalent
note: fluzone HD comes as a tri and quadrivalent vaccine
Which flu vaccine is a quadrivalent live attenuated vaccine
FluMist
What age group can receive FluMist
Healthy people age 2-49 years
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
What the the 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
Age >/= ___ with high risk should receive MenB vaccine
10 years
Children age < ___ years receive PCV13 as part of routine childhood vaccinations
5 years
How is PPSV23 given
IM or SC
How many times should a patient receive PCV13
once in their lifetime
How many times should a patient receive PPSV23
1, 2 or 3 doses
**1 dose before age 65 if they have
**diabetes **
heart
lung
liver disease
alcohol abuse
smokers
2 doses before age 65 if they have
SCD
asplenia
HIV
chronic renal failure
malignancy
transplant
immunosuppressive drugs including steroids
1 dose age 65+ for all patients
If PCV13 is given to an immunocompetent person, how long must you wait to give PPSV23
1 year
If PPSV23 is given to a patient at age 63, how many years must you wait to give another dose if the patient is now 65
5 years after the last dose of PPSV23
If PCV13 is given to an immunocompromised person, how long must you wait to give PPSV23
at least 8 weeks
What is the name of the polio vaccine
IPV
What are the brand names for the Rotavirus vaccine
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
inject due to short stablility
Varivax should not be given if there is a hypersensitivity to _____
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
Typhoid vaccine comes in which formulations
Oral, Injection
remember: typhOid, oral
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
Which vaccine can cause a positive reaction to the TB skin test
Tuberculosis BCG vaccine
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
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 how many times per workday
2x
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
