Immunization Flashcards
what is the goal of immunization
to attenuate the hosts response to infection
what are the risks with:
poliovirus vaccines
OPV can have rare cases of paralytic poliomyositis
what are the risks with:
MMR
it is grown in chick embryo cell thus allergic reactions are possible
other adverse reactions occur after 6-21 days like: measles like rash fever LAD arthralgia arthritis parotitis hypersensitivity reactions febrile seizure
what ages are big for vaccines
2 mo 4mo 6mo age 1 18 mo 4-6 years 14-16 years
vaccines at age:
2 mo
DTaP IPV Hib meningococcal conjugate pneumococcal conjugate
vaccines at age:
4 mo
DTaP IPV Hib meningococcal conjugate pneumococcal conjugate
vaccines at age:
6 mo
DTaP
IPV
Hib
pneumococcal conjugate
vaccines at age:
1
MMR
varicella
pneumococcal conjugate
meningococcal conjugate
vaccines at age:
18 mo
DTaP
IPV
Hib
vaccines at age:
4-6 years
DTaP
IPV
MMR
varicella
vaccines at age:
14-16 years
TdaP
when to administer the HPV vaccine
age 9-26 years
3 doses at 0, 2, 6 mo intervals
when to administer the influenza vaccine
age 6-23 months, 1-2 doses with interval of more than 4 weeks
when to administer Hep B vaccine
at 0, 1, 6 months if born to chronic mother carriers with the first dose given at birth with the HBIG
Otherwise, usually grade 6-8
how do you administer vaccines to children not immunized in early infancy
schedule of visit 1 2 mo later 2 mo later 6-12 mo later then at 4-6 years and 14-16 years
what are true contraindications to ALL vaccines
- anaphylactic reaction to previous dose of vaccine
- allergy to vaccine component
- moderate to severe illness with or without fever
is a mild to moderate local reaction to a previous injection of vaccine a contraindication to vaccination
no
is current antimicrobial therapy a contraindication to vaccination
no
what are some other things that are NOT contraindications to vaccination
these are NOT contraindications: prematurity mild acute illness convalescent phase of acute illness recent exposure to infectious disease personal or family history of allergy
what are some absolute contraindications to MMR vaccine
anaphylactic reaction to eggs or to neomycin
pregnancy
immunodeficiency state
hematologic or solid tumours
reaction to neomycin and gelatin
what are some precautions to take with MMR vaccine
avoid pregnancy for at least 28 days after vaccination
recent administration of IG would be a caution
at what age does HiB (haemophilus influenzae) vaccine stop being indicated
nor indicated for older than 5 years
other than MMR, what other vaccine should be avoided in egg allergy
influenza
what are absolute contraindications for varicella vaccine
immunocompromised states
pregnancy
moderate or severe illness
anaphylactoid reaction to neomycin or gelatin
receiving high doses of systemic glucocorticoids daily or alternative day
what should you avoid after varicella vaccine
avoid salicylates for at least 6 weeks
list the disease prevented by:
IPV
polio
list the disease prevented by:
MMRV
measles
mumps
rubella
varicella
when is hep B given routinely
grade 5
list the disease prevented by:
gardasil
HPV 6, 11, 16, 18
what % of cervical cancer do HPV 16 and 18 cause
70%
what % of anogenital warts are cause by HPV 6 and 11
90%
in what age group is gardasil approved
9-45 in women
9-26 in men
what options are there for influenza immunization
yearly
IM (inactivated) or nasal spray (live attenuated)
list the disease prevented by:
DTaP
diphtheria
pertussis
tetanus
list the disease prevented by:
pneumococcal conjugate
step pneumo
list the disease prevented by:
HiB
haemophilus influenzae serotype B
list the disease prevented by:
menigococcal conjugate
neisseria meningitidis
red flags for immunization (i.e reasons to avoid)
previous anaphylactic reactions
–urticaria, angioedema, respiratory distress, shock
recent steroids
recent blood transfusion products
what PMHx to ask about specifically before vaccine
primary immunodeficiency history of immunoglobin or blood products transfusion chronic disease functional hyposplenia HIV guillaum barre seizures
prematurity
maternal serology
requirement for IVIG/vaccinations at birth
what allergies to ask about specifically in vaccines
eggs gelatin neomycin antibiotics latex
what social history to ask before vaccines
ethnicity
recent immigrations
travel history
community outbreaks
what are the 3 types of vaccine
live attenuated
whole inactivated
subunit (organism parts, protein/toxoid, polysaccharide with or without conjugate)
what are the live attenuated vaccines
MMR
varicella
(which is now combined as MMRV)
oral typhoid
yellow fever
BCG
*these are given SC
how are most vaccines given
IM–except for live attenuated
what else can you find in vaccines
in addition to the active ingredient:
may have adjuvant to enhance immune response i.e aluminum salt
may have preservative i.e thimerosal
may have stabilizers i.e albumin, gelatin, lactose or trace components from manufacturer i.e egg protein, formaldehyde
what do you say to parents that have concerns just generally
acknowledge and respect their concerns
always provide current information and let them make the decision
what do you say to people with concerns about multiple vaccines early in life
all vaccines are tested prior to use and early vaccination build immunity against vaccine preventable illnesses before children are likely to be exposed to causal organisms
what do you say to people with concerns about MMR and autism
the 1998 study in the lancet claiming this link was fraudulent and has since been refuted by numerous studies
what do you say to people with concerns about the safety of thimerosal
there is no legitimate safety reason to avoid the use of vaccines that contain thimerosal
what are the benefits to vaccination to emphasize to parents
- an un-immunized child is at risk for serious infection
- vaccines prevent infections that may result in serious illness or death (i.e epiglottitis, measles, encephalitis, whooping cough, polio, meningitis, pneumonia, tetanus, hepatitis/cirrhosis, cervical cancer)
- herd immunity–> high rates of vaccination/immunization reduce infection risk in individuals who cannot be immunized
what are some examples of diseases prevented by vaccination
epiglottitis, measles, encephalitis, whooping cough, polio, meningitis, pneumonia, tetanus, hepatitis/cirrhosis, cervical cancer
what are the common risks/side effects of vaccination
pain, erythema, swelling at injection site
irritability
rash
fever
*treat with 10-15 mg/kg acetaminophen q4h max 5 doses/day for fever or pain
what are some less common, moderate side effects of vaccination
seizure hypotonic unresponsive state inconsolable crying (DTaP-IPV) fever arthralgias parotitis (MMR)
*history of these adverse events is NOT a contraindication for future immunizations
what are the rare, life threatening complications from vaccination
anaphylaxis (1-2/1 million)
GBS rate following influenzae vaccination may be higher than background rate of 1 additional case per million vaccinated
which vaccine contains the following potential allergen:
neomycin
IPV DTaP IPV HiB MMR varicella
which vaccine contains the following potential allergen:
gelatin
varicella
MMR
which vaccine contains the following potential allergen:
bakers yeast
hep B
which vaccine contains the following potential allergen:
eggs
influenzae
yellow fever
which vaccine contains the following potential allergen:
streptomycin
IPV
in what condition are all live vaccines contraindicated
immunodeficiency or immunosuppressive therapy
can you vaccinate in HIV
vaccinate early in disease when CD4 counts are high
is breastfeeding a contraindication to live vaccines
no
but do not do during pregnancy
who should receive the BCG vaccine
infants of parents with infectious TB at time of delivery
high risk populations (aboriginal reserves)
health care workers at risk
