First Aid, Chapter 7 Hypersensitivity Disorders, Vaccine Principles and Reactions

Question 1

What are the seven Ts of passive immunity (mnemonic)?

Answer 1

The seven Ts of passive immunity:
Transferred protection from human or animal
Temporary
Examples include: Transfusion (blood) Transplacental passage of IgG
Tetanus hyperimmune globulin (IG) (also rabies, hepatitis B, and varicella Ig) AntiToxins (botulism and diphtheria); cause serum sickness
Monoclonal anTibodies (Synagis) for RSV prevention.

Question 2

What are the live vaccines?

Answer 2

The LMNOP and RSV of live vaccines.

Live vaccines include:
MMR
Nasal flu
Oral Polio

Rotavirus
Smallpox (Vaccinia), Shingles (Zoster)
Varicella

Question 3

What patients is the live attenuated influenza vaccine contraindicated in?

Answer 3

The live, attenuated influenza vaccine is contraindicated in immunocompromised patients, patient with a history of Guillain-Barré syndrome, and in patients with a history of recurrent wheezing or severe asthma.

Question 4

What is a live attenuated vaccine? How many doses does it take to be effective? What can interfere with it?

Answer 4

This is a weakened form of “wild” virus or bacterium that replicates. It is similar to natural infection and usually protective after one dose; IVIG and Ig interferes.

Question 5

How are inactivated vaccines made?

Answer 5

These vaccines are produced by growing the virus or bacterium in culture media and then inactivating it with hear and chemicals (formalin).

Question 6

What are the types of inactivated vaccines?

Answer 6

Whole cell
Fractional
Polysaccharide
Conjugated

Question 7

How is the immunogencity of conjugated vaccines improved? Are they T-lymphocyte dependent? What are some examples?

Answer 7

Conjugated vaccine: Immunogenicity improved with conjugation of polysaccharide to protein and is T–lymphocyte-dependent; Hib, pneumococcal (13 serotype, Prevnar), and meningococcal (Menactra)

Question 8

Are polysaccaride vaccines t-lymphocyte dependent? Is the IgM or IgG response bigger? Is there an age after it works well? Is there a booster needed? HWat are examples?

Answer 8

Polysaccharide:
o Typically T–lymphocyte-independent (i.e., stimulates B lymphocytes without help from T lymphocytes)
o IgM is greater than IgG response
o Does not work well in patients younger than 2 years of age
o No booster response
o Pneumococcal (23-valent and Pneumovax)
o Meningococcal (Menomune)

Question 9

What are examples of fractional vaccines?

Answer 9

-Fractional: Subunit (hepatitis B, trivalent inactivated influenza virus vaccine (TIV), pertussis, and human papillomavirus [HPV]) or toxoid (tetanus and diphtheria)

Question 10

What are examples of whole cell vaccines?

Answer 10

-Whole cell: Polio (IPV), hepatitis A, and rabies

Question 11

Can multiple vaccines be give at the same visit?

Answer 11

Yes, all vaccines can be given on the same day.

Question 12

Is there a minimum interval between vaccines? Can you give a vaccine earlier than a minimum age? Should you restart the series if a patient misses a dose?

Answer 12

Live vaccines must be separated by 28 days if not given same day. Never give earlier than minimum age or interval; if late, never restart series for missed dose.

Question 13

How long can IVIG and RBC transfusions interfere with live vaccine responses? How long should you wait after:

• tetanus IG
• IVIG
• packed RBCs

If the live vaccine is given first, how long should you wait to give the antibody-containing product?

Do monoclonal antibodies interfere with live vaccines?

Answer 13

Passively acquired antibody (IVIG and RBC transfusion) can interfere with the response to live vaccines for more than 3 months. Wait before giving live vaccine (i.e., for tetanus IG, wait 3 months; for IVIG replacement therapy (400 mg/kg), wait 8 months; and for packed RBCs, wait 6 months); if live vaccine is given too soon, then repeat the dose.

-If live vaccine given first, wait more than 2 weeks to give antibody-containing product.

No, monoclonal vaccines do not interfere.

Question 14

What are the vaccines that contain egg protein?

Answer 14

Mnemonic

Vaccines containing egg protein: Egg in Your Face

Egg
Influenza
Yellow Fever

Question 15

How common are local reactions to vaccines? What type of vaccines are they more common with?

Answer 15

80% of doses.

More common with inactivated vaccines.

Question 16

What are arthrus reactions? When do they most commonly occur? What type of reaction is it?

Answer 16

Arthus reactions are severe, local reactions due to high antibody titers. They are most common after the fourth or fifth dose of diphtheria, tetanus, and pertussis (DTaP) vaccine or with frequent boosters. They are type III hypersensitivity reactions with immune complex deposition.

Question 17

What are systemic reactions to vaccines? When do they occur with live vaccines?

Answer 17

Systemic reactions are common adverse reactions that include fever, malaise, and headache. They can have a later onset with live vaccines (e.g., 7–21 days).

Question 18

Are allergic reactions to vaccines common? What is the incidence? What is the reaction due to?

Answer 18

Allergic (IgE) are rare (i.e.,

Question 19

What are the components of vaccines that people are most commonly allergic to?

Answer 19

Gelatin, Egg, Latex, Yeast

Question 20

What is gelatin used for in vaccines? What vaccines contain gelatin? What is the most commonly reported vaccine with this allergy?

Answer 20

Used as stabilizer; measles, mumps and rubella (MMR), varicella-zoster, rabies, and yellow fever all contain gelatin; MMR is most commonly reported.

Question 21

What vaccines contain egg? Is MMR contraindicated in egg allergy?

Answer 21

Influenza, yellow fever prepared with embryonated chicken eggs; MMR is not contraindicated in egg allergy (grown in chick fibroblasts).

Question 22

What precautions should be taken with vaccines in a patient with a history of anaphylaxis to latex?

Answer 22

In patients with anaphylaxis to latex, do not administer vaccine supplied in vials containing natural rubber unless benefits greater than risks; very small risk in reality.

Question 23

What vaccine contains yeast?

Answer 23

Hepatitis B vaccine contains yeast, which causes rare problems

Question 24

Which vaccine typically causes delayed urticaria and angioedema?

Answer 24

Japanese enchapalitis virus (JEV) vaccine.

Question 25

What are the recommendations for egg allergy in administering the influenza vaccine?

Answer 25

• No need to divide and administer vaccine by a two-step approach
• No need to skin test with vaccine, unless patient had reaction to vaccine itself
• Allergy with hives only: give influenza vaccine at primary care provider’s office and observe for 30 minutes
• Allergy reaction more severe than only hives: Give influenza vaccine at allergist’s office and observe for 30 minutes

Question 26

Are delayed local reactions to thimerosal a contraindication to vaccination?

Answer 26

No

Question 27

Are delayed type reactions to neomycin a contraindication to vaccination?

Answer 27

Delayed-type reactions to neomycin are not a contraindication to vaccination; only anaphylaxis to neomycin is.

Question 28

What are unique side effects of MMR?

Answer 28

Transient rash (5%), thrombocytopenia, and late fever (i.e., within 5–12 days)

Question 29

What are unique side effects of Tetanus vaccination?

Answer 29

Brachial neuritis and Arthus reaction

Question 30

What are unique side effects of Pertussis vaccination?

Answer 30

Febrile seizures, inconsolable crying, and hypotonic hyporesponsive event

Question 31

What are unique side effects of Varicella vaccination?

Answer 31

Varicella (chickenpox)-like rash

Question 32

What are unique side effects of Yellow fever vaccination?

Answer 32

Enchaphalitis

Question 33

What are unique side effects of smallpox vaccination?

Answer 33

Myopericarditis, eczema vaccinatum

Question 34

What are invalid contraindications to vaccination?

Answer 34

• Mild illness
• Antibiotics
• Lactation
• Preterm birth
• Immunosuppressed contact (exception: Smallpox)
• Family history of adverse events
• Multiple vaccines
• Disease exposure
• TB skin test (exception: MMR should be given same day or space 4 weeks apart)

Question 35

What are contraindications to vaccination?

Answer 35

• Severe allergic reaction (anaphylaxis) to prior dose
• Encephalopathy less than 7 days after pertussis-containing vaccine
• History of Guillain-Barré syndrome: Flu, meningococcal infection
• Live vaccine contraindications: Pregnancy and immunosuppression

Question 36

What is the vaccine adverse event reporting system?

Answer 36

This is a passive, national reporting system, to which anyone can send a report. It was created to help detect rare or new adverse events and patient risk factors for events

Question 37

A 16-month-old boy is scheduled to receive both the MMR and varicella vaccines during a health maintenance visit but parents only allow him to receive MMR. What is the minimum period of time that must elapse before the varicella vaccine may be administered to this patient?

Answer 37

Twenty-eight day

Question 38

What might increase the chance of an adverse reaction in future pertussis vaccinations?

Answer 38

Prolonged crying or high fever (>105°F) or seizure within 3 days after pertussis vaccination; and moderate or severe illness.