Immunization Flashcards
Safety concerns
Autism: thimerosal , a mercury containing preservative, was though to possibly be the cause however it has been removed from his childhood vaccines and autism rates have not decreased…. Nor have they decreased in areas where parents refuse more often
Side effects: mild fever, soreness, swelling, rarely anaphylaxis
Guidelines/references
www.pharmacist.com/imz (American pharmacist Association)
CDC.gov/vaccines
Immunize.org (immunization action coalition)
Vaccine information statement (VIS)
Federal law requires that patients receive the most up-to-date version before each vaccine is administered
Active immunity
Protection that is produced by the person’s own immune system
This is usually permanent and comes from surviving an infection but can be produced. Vaccination
Passive immunity
Usually acquired from a source or an injection an example would be antibodies an infant receives from its mother
Separation time between the measles and varicella (varivax) vaccines
His vaccine given first wait two weeks before giving antibody however if antibiotic given first wait three months or longer before giving vaccine
Simultaneous administration
Give them all at one time… It’s better to give them them all than to have to wait for the separation time
Nonsimultaneous administration
If live parenteral vaccines and live intranasal or influenza vaccines are not administered at the same time they must be separated by at least four weeks
Live parenteral vaccines
MMR, MMRV, varicella, zoster, and yellow feve
Interval for administration of live vaccines and TB test
Can be administered on the same day as the preferred method to avoid a false-negative, but if the vaccine has been given recently but not on the same day as the PPD wait four weeks
What to do in the event of anaphylaxis
Call 911
Administer epinephrine 1:1000 dilution intramuscularly (0.01 mg/kg up to 0.5 mg max)
Administered diphenhydramine either orally or by injection but do not give Oriely if patient has signs of mouth throat or lips swelling and difficulty breathing
Give CPR if necessary
Repeat dose of epinephrine is EMS is not arrive
Absolute contraindications for live vaccines
Pregnancy and immunosuppression
What is classified as immunosuppression
Steroid induced: 20 mg or more per day, 2 mg per kilogram or more per day
*not intra-articular injections, metered dose inhalers, topical alternate day or short course for less than 14 days
Anyone receiving cancer treatment with alkylating agents or anti-metabolite or radiation therapy
Patients with HIV with a CD4 count of <200
Transplant patients (can receive pneumococcal but need PCV13 first then PPSV23)
Vaccinations for healthcare professionals
Hepatitis B, flu, MMR, varicella, Tdap (with Td boosters every 10 years), meningococcal
Egg allergy
If a person can eat lightly cooked eggs without a reaction or if the person experiences only hives after eating egg containing foods an inactivated influenza vaccine can be administered and the patients it should be observed for at least 30 minutes
- egg allergies are a concern with yellow fever, rabies, influenza vaccines
That seems contraindicated with Guillian-barre’
Tetanus containing vaccines, influenza, MCV should not be given
Gelatin or neomycin allergy
Both varicella vaccines (zostavax and Varivax) and MMR should not be given
Streptomycin, polymyxin B and neomycin allergy
Inactivated poliovirus vaccine (IPV) is contraindicated
Screening questions prior to vaccination
- Are you sick today?
- Do you have allergies to medications, food, vaccine component or latex?
- Have you ever had a serious reaction to a vaccine?
- Do you have long-term health problems or any blood disorder?
- Do you have cancer, leukemia, AIDS, or any other immune system problem?
- Do you take Cortisone, prednisones, other steroids, anticancer drugs, or radiation therapy?
- Have you had a seizure or a brain or other nervous system problem?
- Do you have cochlear implants or a cerebrovascular leak?
- During the past year have you received a transfusion of blood, have you been on an immune or gamma globulin or an antiviral drug?
- For women: are you pregnant or is there a chance you will become pregnant during the next month?
- Have you received any vaccinations in the past 4 weeks?
Diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccines
DTaP: daptacel (infanrix, Tripedia) given to children younger than seven years of age
DTaP-IPV: KINRIX
DTaP-HepB-IPV: Pediarix
DTaP-IPV/Hib: Pentacel
Storage: refrigerator
Administration: IM
Haemophilus influenza type B containing vaccines
Hib: ActHIB, Hiberix, PedvaxHIB
Hib-hep B: Comvax
DTaP-IPV/HIB: Pentacel
Storage: refrigerator
Administration: IM
Hepatitis containing vaccines
HepA: Havrix, Vaqta
Hep B: Engerix-B, Recombivax HB
HepA-hep B: Twinrix
Who HepA? child >1year of age, men who have sex w/ men, IV drug abusers, pts with chronic dx, and travelers to countries with high HepA incidents
Who HepB? Healthcare workers, men who have sex w/ men, anyone w/ multiple sex partners, IV drug users, ESRD, chronic liver dX
Three-part series given a 0, 1 and 6months in adults and adolescents
Storage: refrigerator
Administration: IM
Human papillomavirus vaccine
HPV2: Cervarix a bivalent vaccine for immunity against the HPV strains that cause cervical cancer
HPV4: Gardasil a Quadrivakent vaccine for prevention of cervical cancer pap smear abnormalities and genital warts
Gardasil is indicated for females and males
Recommend the three does series between the age of 11-12 years with catch-up vaccination at age 13-26 for females
Recommended age for males is 9–26
Storage: in the refrigerator protected from light
Administration: IM
Influenza vaccine
LIVE attenuated influenza vaccine: fluMist (quad) CAN BE GIVEN IN PEOPLE AGED 2–49 yo INCLUDING HEALTHCARE PERSONNEL IF HEALTHY AND NOT PREGNANT
Inactivated influenza vaccine (trivalent): afluria, fluarix, fluvirin, Fluzone, Fluzone high-dose (>65 yo), Fluzone intradermal (18-64 yo ONLY)
RIV (egg free): FluBlok (recombinant)
Who: everyone >6 months of age and every year
Storage: refrigerator
Considerations: Jafar is patient has moderate to severe acute illness, and referred to physician patient has Gilian-barre’ within six weeks of a prior dose of flu vaccine, also Afluria can only be given and children greater than nine
Measles, mumps and rubella containing vaccines
MMR:M-M-RII
MMRV: ProQuad
Given to children, patients born before 1957 generally are considered immune
Do not give in pregnancy as this is a live vaccine
Storage: refrigerator or freezer (MMR); freezer only due to varicella component (MMRV) protect from light
Administration: give SC
Meningococcal vaccines
MCV4: Menactra, Menveo
MPSV4: Menomune
1 dose 11–12 yo with one booster at age 16–18
1 dose at 13–18 yo if previously unvaccinated
Encouraged at 2–55 yo if at high risk: college, asplenia, military, immunodeficiency, travelers to high-risk countries such as Saharan Africa, lab workers with meningitis exposure, required by Saudi Arabia for annual travel during the period of the hajj
Storage: refrigerate, protect from light
Administration: MCV (IM), MPSV (SC)
Pneumococcal vaccine
13 valent pneumococcal conjugate vaccine (PCV13): Prevnar 13 (minimum age at immunization is six weeks)
23 serotype polysaccharide vaccine (PPSV23): Pneumovax 23 (minimum age at immunization is two years)
Prevnar: routine vaccination for all and infants at two, four, six and 12 to 15 months
Pneumovax: recommended for patients greater than 65, patient’s age 19–64 who smoke or have asthma, patient’s age 2–64 who have chronic illnesses (NOTE GIVE ONE DOES AFTER AGE 65 IF FIRST DOSE WAS BEFORE 65)
Storage: refrigerator
Administration: IM AND DO NOT MIX WITH OTHER VACCINES IN THE SAME SYRINGE
Tdap
Tdap: Adacel, Boostrix
Who: patient’s age 7–10 that were not fully vaccinated with DTaP series, as a single booster for ages 11–64 with no previous record of Tdap then one dose of Td every 10 years, patients greater than 65 years old with no previous Tdap who have close contact with infant age less than 12 months, pregnant women during weeks 27–36
Storage: refrigerator
Administration: IM
Varicella containing vaccines
VAR: varivax (chickenpox)- age 12 months and 4 years, and all adults without immunity (prior outbreak) should receive two doses 4 weeks apart
ZOS: zostavax (herpes zoster – shingles)-indicated in age 50 and older but recommended in age 60 and older
LIVE VACCINES DO NOT GIVE IF IMMUNOCOMPROMISED OR PREGNANT and do not give if sensitive to gelatin or neomycin
Storage: store vaccine and freezer and protect from white and store diluent in refrigerator or at room temperature
Administration: SC; administer quickly after removing from freezer
Japanese encephalitis (Ixiaro)
Given and spending one or more months in an endemic area during transmission season especially if travel will include rural areas this vaccine is given
Administration:in two doses 28 days apart at least one week prior to potential exposure; IM
Rabies (Imovax, RabAvert)
Given if high risk exposure such as animal handlers, traveling to high-risk area or given with rabies exposure
Three doses for prevention
Four doses plus rabies immune globulin with first dose if exposed
Give IM
Smallpox
Currently eradicated but US government has vaccine
Typhoid
(Vivotif Berna) capsule
(Typhim Vi, Typherix) injection
REFRIGERATE CAPSULES
typhoid fever is caused by salmonella
Travelers from US to Asia, Africa, and Latin America at risk to reduce risk boil it, cook it, peel it or forget it
Take four capsules; one on alternate days (day 1, 3, 5 & 7) at least one week prior to exposure
Yellow fever
Patient should receive a yellow card valid 10 days after the vaccine for 10 years as proof of vaccine
Transmitted by mosquitoes use insect repellent and wear protective clothing
High risk and tropical and subtropical areas of South America and Africa
Give SC; reconstituted
Contraindicated with severe allergy to eggs, chicken proteins, or gelatin
Storage of all vaccines
Dormitory style refrigerator should not be used
Store away from the edges and never store on the doors of the refrigerator or freezer as the temperature there is unstable
Record the temperature at least twice a day and keep records for three years
Intramuscular injections
Given the deltoid muscle at a 90° angle making sure to separate two injections by 1 inch
Adults require a 1 inch needle unless greater than 200 pounds and women or 300 pounds and then at which point use one and a half inch needle
Subcutaneous administration
Given and the fatty tissue about the triceps
5/8 inch needle is used at a 45° angle making sure to separate two injections by 1 inch
Varicella, zoster, MMR, meningococcal given SC
pneumococcal can be given IM or SC
Symptoms of the flu
Abrupt onset of fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis
And children you may also see otitis media, nausea, and vomiting
Typically resolves after 3 to 7 days for the majority of patients
