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LMCC Part II > Immunization > Flashcards

Immunization Flashcards

1
Q

what is the goal of immunization

A

to attenuate the hosts response to infection

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2
Q

what are the risks with:

poliovirus vaccines

A

OPV can have rare cases of paralytic poliomyositis

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3
Q

what are the risks with:

MMR

A

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
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4
Q

what ages are big for vaccines

A 
2 mo
4mo
6mo
age 1
18 mo
4-6 years
14-16 years
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5
Q

vaccines at age:

2 mo

A 
DTaP
IPV
Hib
meningococcal conjugate 
pneumococcal conjugate
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6
Q

vaccines at age:

4 mo

A 
DTaP
IPV
Hib
meningococcal conjugate
pneumococcal conjugate
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7
Q

vaccines at age:

6 mo

A

DTaP
IPV
Hib
pneumococcal conjugate

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8
Q

vaccines at age:

1

A

MMR
varicella
pneumococcal conjugate
meningococcal conjugate

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9
Q

vaccines at age:

18 mo

A

DTaP
IPV
Hib

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10
Q

vaccines at age:

4-6 years

A

DTaP
IPV
MMR
varicella

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11
Q

vaccines at age:

14-16 years

A

TdaP

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12
Q

when to administer the HPV vaccine

A

age 9-26 years

3 doses at 0, 2, 6 mo intervals

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13
Q

when to administer the influenza vaccine

A

age 6-23 months, 1-2 doses with interval of more than 4 weeks

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14
Q

when to administer Hep B vaccine

A

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

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15
Q

how do you administer vaccines to children not immunized in early infancy

A 
schedule of
visit 1
2 mo later
2 mo later
6-12 mo later
then at 4-6 years and 14-16 years
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16
Q

what are true contraindications to ALL vaccines

A
  1. anaphylactic reaction to previous dose of vaccine
  2. allergy to vaccine component
  3. moderate to severe illness with or without fever
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17
Q

is a mild to moderate local reaction to a previous injection of vaccine a contraindication to vaccination

A

no

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18
Q

is current antimicrobial therapy a contraindication to vaccination

A

no

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19
Q

what are some other things that are NOT contraindications to vaccination

A 
these are NOT contraindications:
prematurity
mild acute illness
convalescent phase of acute illness
recent exposure to infectious disease
personal or family history of allergy
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20
Q

what are some absolute contraindications to MMR vaccine

A

anaphylactic reaction to eggs or to neomycin

pregnancy

immunodeficiency state

hematologic or solid tumours

reaction to neomycin and gelatin

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21
Q

what are some precautions to take with MMR vaccine

A

avoid pregnancy for at least 28 days after vaccination

recent administration of IG would be a caution

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22
Q

at what age does HiB (haemophilus influenzae) vaccine stop being indicated

A

nor indicated for older than 5 years

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23
Q

other than MMR, what other vaccine should be avoided in egg allergy

A

influenza

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24
Q

what are absolute contraindications for varicella vaccine

A

immunocompromised states

pregnancy

moderate or severe illness

anaphylactoid reaction to neomycin or gelatin

receiving high doses of systemic glucocorticoids daily or alternative day

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25
Q

what should you avoid after varicella vaccine

A

avoid salicylates for at least 6 weeks

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26
Q

list the disease prevented by:

IPV

A

polio

27
Q

list the disease prevented by:

MMRV

A

measles
mumps
rubella
varicella

28
Q

when is hep B given routinely

A

grade 5

29
Q

list the disease prevented by:

gardasil

A

HPV 6, 11, 16, 18

30
Q

what % of cervical cancer do HPV 16 and 18 cause

A

70%

31
Q

what % of anogenital warts are cause by HPV 6 and 11

A

90%

32
Q

in what age group is gardasil approved

A

9-45 in women

9-26 in men

33
Q

what options are there for influenza immunization

A

yearly

IM (inactivated) or nasal spray (live attenuated)

34
Q

list the disease prevented by:

DTaP

A

diphtheria
pertussis
tetanus

35
Q

list the disease prevented by:

pneumococcal conjugate

A

step pneumo

36
Q

list the disease prevented by:

HiB

A

haemophilus influenzae serotype B

37
Q

list the disease prevented by:

menigococcal conjugate

A

neisseria meningitidis

38
Q

red flags for immunization (i.e reasons to avoid)

A

previous anaphylactic reactions
–urticaria, angioedema, respiratory distress, shock

recent steroids

recent blood transfusion products

39
Q

what PMHx to ask about specifically before vaccine

A 
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

40
Q

what allergies to ask about specifically in vaccines

A 
eggs
gelatin
neomycin
antibiotics
latex
41
Q

what social history to ask before vaccines

A

ethnicity
recent immigrations
travel history
community outbreaks

42
Q

what are the 3 types of vaccine

A

live attenuated

whole inactivated

subunit (organism parts, protein/toxoid, polysaccharide with or without conjugate)

43
Q

what are the live attenuated vaccines

A

MMR
varicella
(which is now combined as MMRV)

oral typhoid

yellow fever

BCG

*these are given SC

44
Q

how are most vaccines given

A

IM–except for live attenuated

45
Q

what else can you find in vaccines

A

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

46
Q

what do you say to parents that have concerns just generally

A

acknowledge and respect their concerns

always provide current information and let them make the decision

47
Q

what do you say to people with concerns about multiple vaccines early in life

A

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

48
Q

what do you say to people with concerns about MMR and autism

A

the 1998 study in the lancet claiming this link was fraudulent and has since been refuted by numerous studies

49
Q

what do you say to people with concerns about the safety of thimerosal

A

there is no legitimate safety reason to avoid the use of vaccines that contain thimerosal

50
Q

what are the benefits to vaccination to emphasize to parents

A
  1. an un-immunized child is at risk for serious infection
  2. 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)
  3. herd immunity–> high rates of vaccination/immunization reduce infection risk in individuals who cannot be immunized
51
Q

what are some examples of diseases prevented by vaccination

A

epiglottitis, measles, encephalitis, whooping cough, polio, meningitis, pneumonia, tetanus, hepatitis/cirrhosis, cervical cancer

52
Q

what are the common risks/side effects of vaccination

A

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

53
Q

what are some less common, moderate side effects of vaccination

A 
seizure
hypotonic unresponsive state
inconsolable crying (DTaP-IPV)
fever
arthralgias
parotitis (MMR)

*history of these adverse events is NOT a contraindication for future immunizations

54
Q

what are the rare, life threatening complications from vaccination

A

anaphylaxis (1-2/1 million)

GBS rate following influenzae vaccination may be higher than background rate of 1 additional case per million vaccinated

55
Q

which vaccine contains the following potential allergen:

neomycin

A 
IPV
DTaP
IPV
HiB
MMR
varicella
56
Q

which vaccine contains the following potential allergen:

gelatin

A

varicella

MMR

57
Q

which vaccine contains the following potential allergen:

bakers yeast

A

hep B

58
Q

which vaccine contains the following potential allergen:

eggs

A

influenzae

yellow fever

59
Q

which vaccine contains the following potential allergen:

streptomycin

A

IPV

60
Q

in what condition are all live vaccines contraindicated

A

immunodeficiency or immunosuppressive therapy

61
Q

can you vaccinate in HIV

A

vaccinate early in disease when CD4 counts are high

62
Q

is breastfeeding a contraindication to live vaccines

A

no

but do not do during pregnancy

63
Q

who should receive the BCG vaccine

A

infants of parents with infectious TB at time of delivery
high risk populations (aboriginal reserves)
health care workers at risk

LMCC Part II (52 decks)

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