Exam 1 - Immunizations Flashcards
Rotavirus route
Oral
Flu route
IM (intranasal no longer recommended)
Varicella route
Subcutaneous
MMR route
Subcutaneous
Which vaccines is ALUMINUM present in?
Hep A, Hep B, DTap/Tdap, Hib, HPV, PCV
DTaP, Tdap, Td schedule
- Min. age = 6 weeks
- Primary series @ 2, 4, 6, and 15-18 months
- Secondary series (“boosters”) @ 4-6 y/o, Tdap 11-12 y/o, and Td booster every 10 years thereafter.
DtaP vaccines
- Pentacel (DTap, IPV, HIB)
- Pediarix (DTap, IPV, Hep B)
- Kinrix (Dtap/IPV combo), only approved for secondary booster
DtaP contraindications
- Severe allergic reaction to vaccine component or following a prior dose
- Encephalopathy not due to another identifiable cause occurring within 7 days after vaccination
DtaP precautions
- Moderate or severe acute illness
- Temp >105 F or higher within 48 hours
- Collapse or shock-like state within 48 hours
- Persistent, inconsolable crying lasting >3 hours, occurring within 48 hours
- Convulsions with or without fever occurring within 3 days
DTaP/Tdap for previously unvaccinated individuals
- 3 shot series, first 2 doses should be separated by 4 weeks, 2nd and 3rd dose separated by 6-12 months.
- One of these should be Tdap.
Tdap contraindications
- Previous severe allergic reaction to Tetanus or a component of the vaccine
- Severe or moderate illness
- If unable to receive the vaccine, high-risk individuals will need Tetanus immunoglobulin (TIG)
Tdap side effects
- Local redness and swelling at injection site
- More severe reactions include peripheral neuropathy, Guillain-Barre and urticaria
- Fever and systemic symptoms are uncommon
- Rare risk of seizures: SNCA 1 Dravet’s syndrome
HiB schedule
3 (PedVaxHiB) to 4 (ActHiB) doses depending on which HiB vaccine and age at first dose. Generally 2, 4, 6 (except for PedVaxHiB), and 12-15 month booster.
“ActHiB” schedule
- 2, 4, 6 and 12-15 month booster
“HiBerix” schedule
- Attached to tetanus toxoid
- 2, 4, 6 and 12-15 month booster
“PedVaxHiB” schedule
- 2, 4, and 12-15 months
- Can be alone, when given in combo with Hep B it’s called “ComVax”
“Pentacel” schedule
2, 4, 6, 15-18 months
“Comvax”
- HiB + Hep B
- Approved for infants 6-15 months of age born to HBsAg negative mothers
HiB vaccine contraindications
- Severe allergic reaction after a previous vaccine or vaccine component
- Age younger than 6 weeks
- Severe illness with fever
- HiB vaccine has NEOSPORIN in it; so if they’re allergic to neosporin then it’s contraindicated
HiB side effects
- Few symptoms occur
- 5-30% have local irritation at injection site
- 1/20 have fever >101 F
IPV vaccine schedule
Ages 2, 4, 6-18 months and 4-6 years (4 doses)
IPV contraindications
- Severe allergic reaction to neomycin, polymyxin B, Streptomycin (the vaccine contains trace amounts of these antibiotics)
- Severe allergic reaction to a previous polio vaccine
- Moderate illness
IPV side effects
Soreness at site of injection.
PCV 13 schedule
- All children 2 to 59 months
- [4 doses] starting at age 2 months, continuing 4, 6, 12-15 months
PCV contraindications
- Severe allergic reaction to a previous PCV vaccine
- Mild or moderate illness
- Safety in pregnancy not determined
PCV adverse reactions
- Local reactions
- Fever, myalgia
- Severe adverse reactions are rare
“Energix B” (Hep B) schedule
- 1st dose given at birth, 2nd dose 1-2 months later, 3rd dose at age >24 weeks
- [3 doses] for children, and [2-3 doses] for adolescents and high risk adults
Hep B vaccine contraindications
- Severe allergic reaction to previous HBV or one of its components in the past
- Moderate or severe illness
- Infant weighing <2,000 g
Hep B side effects
- Soreness at the injection site
- Low grade fever
Rotavirus vaccines
“Rotateq” and “Rotarix”
“Rotarix” schedule
- Administer first dose to infants beginning at 6 weeks of age
- Administer second dose after an interval of at least 4 weeks and prior to 24 weeks of age
- Minimum interval dose is 4 weeks
- NO ADMINISTRATION AFTER 8 MONTHS
Rotavirus vaccine contraindications
- Hypersensitivity
- GI tract congenital malformation
- History of intussusception
- Severe combined immunodeficiency disease
- Severe allergic reaction to a vaccine component or following a prior dose of vaccine
- Latex allergy
Rotavirus vaccine precautions
- Other diseases that affect immune competence, spina bifida, bladder extrophy, gastro of moderate to severe
Rotavirus vaccine & Preterm infant guidelines
ACIP recommends to administer vaccine if:
- chronological age is at least 6 weeks
- clinically stable
- administered at the time of discharge or after discharge from the NICU/nursery
Rotavirus vaccine adverse reactions
- Vomiting
- Diarrhea
- Irritability
- Fever
- NO serious adverse reactions
Influenza vaccine schedule
For children aged 6 months to 8 years,
- First dose as soon as possible after vaccine becomes available
- Second dose >4 weeks later
Influenza vaccine contraindications
Severe allergic reaction to any vaccine component, including egg protein, or after previous dose of any flu vaccine
Influenza vaccine precautions
- Moderate to severe acute illness with or without fever; history of Guillain-Barre syndrome within 6 weeks of receipt of influenza vaccine
Hepatitis A vaccine schedule
Adults/children
- 1 dose (Min. age = 12 months)
- Booster dose 6-18 months after first dose
Hep A vaccine contraindications
- Severe allergic reaction to vaccine or components in the past
- Moderate illness
- Safety in pregnancy not studied (weight risk/benefit)
Hep A vaccine side effects
- Soreness at injection site
- Fever, fatigue, malaise, headache less common
- Rare anaphylaxis
MMR vaccine schedule
- [2 doses] First dose at 12-15 mo., second at 4-6 y/o
- Seroconversion is optimal at 15 months
- If there’s an outbreak, you can give it before 12 mo. but repeat at 12 mo.
- If un-immunized, give on dose at first visit, second dose 4 weeks later
- Administer MMR vaccine to infants age 6-12 months who are traveling internationally
MMR contraindications
- Pregnancy, or plans to become pregnant
- Severe allergic reaction to previous vaccine
- Immunocompromised
- NOT contraindicated if allergic to eggs
- NOT contraindicated if breastfeeding
MMRV vaccine
- Approved for children 12 months through 12 years
- Do not use for persons >13 y/o
- May be used for both first and second doses of MMR and Varicella vaccines
- Minimum interval between doses is 3 months
Varicella schedule
[2 doses] - minimum interval 3 months
- Routine first dose at 12-15 months of age
- Routine second dose at 4-6 years of age
Varicella-containing vaccines contraindications and precautions
- Severe allergic reaction to vaccine component or following a prior dose
- Immunosuppression
- Pregnancy
- Moderate or severe acute illness
- Recent blood product (except herpes zoster virus)
Indications for Meningococcal vaccine
- Complement component deficiencies
- Functional or anatomic asplenia (includes kids with SCD)
- Infants who are in defined risk group for a community or institutional outbreak
- Infants traveling to an area where meningococcal disease is hyperendemic or epidemic
Meningococcal immunization schedule (at-risk children)
- 4 dose infant series: 2, 4, 6, and 12 mo.
- 2 dose older infant series: 7-9 and 12 mo.
MCV4: Menactra schedule
- All 11-12 year olds
- Booster at 16 y/o
HPV schedule
- 3 dose series for females: 4 weeks between dose 1/2, 12 weeks between doses 2/3, 24 weeks between doses 1/3
- HPV 4 approved for 3 dose series in males age 9-18 to reduce likelihood of genital warts
HPV adverse reactions
- local reactions
- fever
- no serious adverse reactions reported
HPV and syncope
Providers should strongly consider observing patients for 15 minutes after they are vaccinated
HPV contraindications
Severe allergic reaction
HPV precaution
Moderate severe or acute illnesses (defer until symptoms improve)
