Immunization Flashcards
Can two live vaccines (IM/SC) be given on the same day?
Yes
Either same day or 28 days apart (prevent circulating antibodies from 1st vaccine from interfering with replication process of 2nd live vaccine)
Can live vaccines be given with immunoglobulins or blood transfusion?
No, these are antibody containing products
Must be spaced apart from live vaccines by 3-10months
Who does herd immunity protect?
Both vaccinated and unvaccinated individuals
*Impt as it can protect infants, immunocompromised who may not fulfill vaccination criteria
The percentage of population that needs to be vaccinated for herd immunity depends on _______
how contagious the disease is
e.g., measles vv contagious: require 83-94% vaccinated
The basis of vaccination is _______
memory from the adaptive immunity
- able to evoke secondary immune response after second exposure with shorter lag time, higher antibody titer, more specific response
What is the difference between primary dose and booster dose?
Primary dose: can be single dose or a few doses in a primary priming series => to induce adequate immunity
Booster dose: antibody conc. wane over time, booster/additional dose may be required to maintain protective levels of antibody
How many vaccines are included in the national childhood immunization schedule (NCIS)?
By which age should it be completed?
14
By 17 years
List all the diseases covered in NCIS
- Bacillus-Calmette-Guerin (BCG) - TB
- Hep B
- Diphtheria, tetanus, acellular pertussis (DTaP)
- Tetanus, reduced diphtheria, acellular pertussis (Tdap)
- Inactivated poliovirus (IPV)
- Haemophilus influenza type b (Hib)
- Pneumonoccal conjugate (PCV10 or PCV13)
- Pneymococcal polysaccharide (PPSV23)
- Measles, mumps, rubella (MMR)
- Varicella (VAR)
- Human papillomavirus (HPV2 or HPV4) *females
- Influenza (INF)
Which vaccines in the NCIS are live-attenuated and when are they administered?
MMR and Varicella vaccines
- Both are administered at 12months and 15 months
BCG is live-attenuated as well (but given at birth)
How many vaccines are included in the national adult immunization schedule (NAIS)?
11 diseases
For 18yo and older
List the vaccines in NAIS
Specific medical condition or indication or age requirement >=65y:
1. Influenza (INF) - 1 dose annually
2. Pneumonoccal conjugate (PCV13)
3. Tetanus, reduced diphtheria and acellular pertussis (Tdap) - 1 dose per pregnancy
- Tdap booster every 10 years
Previously not vaccinated:
4. HPV2 or HPV4
5. HepB
6. MMR
7. Varicella
The effectiveness of vaccines varies by vaccine (some more effective than others - e.g., Hep B 95% effective compared to Varicella 90% effective)
What are some other factors that can reduce vaccine effectiveness?
- Site of vaccination (e.g., IM in deltoid vs gluteus)
- Age and immune status/function (INF vaccine less effective in older pt)
- Cold chain problems (quality and stability of product)
What are some common adverse effects associated with vaccines?
Mild and common: pain, redness, swelling at injection site, headache, myalgia (muscle pain esp for IM)
Uncommon: fever, hematoma
Severe but rare: allergic reactions such as anaphylaxis, hypersensitivity
What are some contraindications and precautions to the use of vaccines?
- Allergy to vaccine or components
- Moderate/severe illness (e.g., fever)
- avoid attributing new symptoms to the vaccine
- avoid complicating illness - Bleeding risk (e.g., on anticoagulants, low platelet counts)
- avoid bleeding into muscle w IM injection - Pregnancy (live vaccines avoided)
- risk of fetal infection - Immunocompromised (live vaccines)
- uncontrolled replication
Most vaccines can be administered simultaneously or within same day (even live-attenuated), without reducing efficacy or increasing adverse effects
What are the exceptions?
Pneumococcal conjugate vaccine (PCV) and meningococcal conjugate vaccine in pt with functional or anatomical asplenia
=> these two vaccines require 4 week interval between them, as they interfere with each other
