Immune Flashcards
Attenuated Live Vaccines
Live attenuated influenza vaccine (LAIV) Measles, mumps & rubella vaccine (MMR) Oral poliovirus vaccine Rotavirus vaccine Varicella virus vaccine Herpes zoster vaccine Typhoid vaccine Yellow fever vaccine Bacillus Calmette-Guerin (BCG) vaccine
Live Vaccines: General Principles
Not administered to immunocompromised patients
Usually not given if patient has febrile illness
If patient needs two live vaccines:
- Give both the same day OR
- Administer at least 4 weeks apart
Not administered in pregnancy
- Pregnancy should be avoided for 1 month after vaccination
Drug interactions
- Antiviral drugs
Separate IG administration from live vaccine administration
Live Attenuated Influenza Vaccine
- LAVI (Flumist)
- Contains two strains of Flu A and one strain of Flu B
- Administered intranasally
- Live vaccine replicates in nasal mucosa
- Contraindicated: egg allergy, asthma, immunocompromised state, pregnancy
- Administered annually to healthy patients at 2 years to 49 years
- – Children ages 2-8 years need two doses the first year
MMR Vaccine
- 2 doses 99% effective in providing immunity for measles (88% for mumps)
- Contraindications: neomycin allergy, pregnancy, immunosuppression, febrile illness
- – Ok to give to those with egg allergy
- – May be given to breastfeeding women
- ADRs: fever 7-12 days after vaccination
- Drug interactions: IG, high-dose corticosteroids, chemotherapy
- First dose given at age 12-15 months
- Second dose given at ages 4-6 years or at least 4 weeks after first dose
- One dose given to any infants 6-12 months who will be traveling internationally
- – Does not “count” as first dose; give a dose at 12-15 months
Measles, Mumps, Rubella, and Varicella (MMRV) Vaccine
ProQuad
Similar to MMR
Contraindications are the same as MMR
- Use caution in patients with hx of cerebral injury, seizures, or where physiological stress caused by fever should be avoided
ADRs: fever greater than 102 (21.5% vs 14.9% with MMR); increased risk of febrile seizures
May administer on same schedule as MMR
- Use MMR+ varicella for first dose and MMRV for second dose if there is a fever
- Informed consent includes risk of fever and febrile seizures
Oral Polio Vaccine (OPV)
Not used in U.S. since 2000
Effective, easy to administer
Virus lives in GI tract for 4-6 weeks after administration
Rare risk of vaccine-associated paralytic poliomyelitis
- patient and household contacts
Still used throughout the world
- Bivalent vaccine sued worldwide- not valid in the US
- Only trivalent OPV counts
Rotavirus Vaccine
- RotaTeq and Rotarix
- Orally administered and replicated in small intestines
- Contraindicated: immunocompromised state, febrile illness
- ADRs: mild GI upset, no or slight risk of intussusception in new vaccination
- First dose administered to infants by age 14 weeks and 6 days and last dose by 8 months
- – Rotarix (RV1): given at age 2 months, 4 months
- – RotaTeq (RV5): given at age 2 months, 4 months, 6 months
Varicella
- Varivax Vaccine
- 2 doses 98.3% effective against any disease
- May be administered after exposure (within 3 days)
- Contraindications: neomycin allergy, febrile illness, immunocompromised state, high dose steroids, pregnancy
- ADRs: fever, rash, injection site reaction
- First dose at age 12-15 months
- Second dose at age 4-6 years
- Adolescents and adults with no hx of varicella given 2 weeks 4-8 weeks apart
Herpes Zoster Vaccine
- Shingles caused by reactivation of varicella
- Zoster vaccine live (Zostavax)
- Reduces risk of herpes zoster by 51.3 %
- Reduces risk of post-herpetic neuralgia by 66.5% (reduced severity in 57%)
- Contraindications: neomycin or gelatin allergy, immunocompromised state, pregnancy, acute illness, age less than 60 years
- Drug interactions: high-dose steroids, antivirals
- One dose given to all patients age 60 years or older
- Decreased effectiveness beginning 1 year after administration, with less than 35% effectiveness 6 years after dose
Miscellaneous Live Vaccines - Oral Typhoid Vaccine
Travelers to South or Southeast Asia, Africa, Caribbean countries, Central and South America
Oral Capsule for age 6 years and up
Revaccination every 5 years
Miscellaneous Live Vaccines - Yellow Fever
Endemic in Sub-Saharan Africa and tropical South America
Certification required to enter some countries
Vaccination for all persons over 9 months of age traveling to endemic areas
- Use cautiously in patients over age 60 years
Miscellaneous Live Vaccines - Cholera Live Vaccine (Vaxchora)
Antibodies are measurable 10 days after vaccination
Drug interaction: do not administer systemic antibiotics within 14 days; chloroquine may decrease immune response
Clinical use: administer 10 days before possible exposure to adults age 18-64 years
- Store in freezer, mixed in bottled water
- Avoid eating or drinking for 60 minutes
Miscellaneous Live Vaccines - Bacillus Calmette-Guerin (BCG) Vaccine
Immune Stimulant
Most effective in children
ADRs: disseminated disease in patients with TB
- Skin lesions at injection site is normal reaction
May cause false-positive purified protein derivative (PPD) skin test result
Inactivated Vaccines
Diphtheria, tetanus, pertussis vaccine Haemophilus B conjugate vaccine Inactivated poliovirus vaccine Hepatitis B virus (HBV) vaccine Hepatitis A virus (HAV) vaccine Human papillomavirus (HPV) vaccine Influenza vaccine - Pneumococcal vaccine - Meningococcal polysaccharide vaccine Lyme disease vaccine Typhoid vaccine Cholera vaccine Japanese encephalitis virus vaccine Plague vaccine Rabies Vaccine
Inactivated Vaccines: General Principles
Inactivated vaccines: “killed” virus
May be co-administered with other vaccines
No need to restart series if patient gets off schedule (catch-up schedule used)