Immunization

Question 1

what is the goal of immunization

Answer 1

to attenuate the hosts response to infection

Question 2

what are the risks with:

poliovirus vaccines

Answer 2

OPV can have rare cases of paralytic poliomyositis

Question 3

what are the risks with:

MMR

Answer 3

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

Question 4

what ages are big for vaccines

Answer 4

2 mo
4mo
6mo
age 1
18 mo
4-6 years
14-16 years

Question 5

vaccines at age:

2 mo

Answer 5

DTaP
IPV
Hib
meningococcal conjugate 
pneumococcal conjugate

Question 6

vaccines at age:

4 mo

Answer 6

DTaP
IPV
Hib
meningococcal conjugate
pneumococcal conjugate

Question 7

vaccines at age:

6 mo

Answer 7

DTaP
IPV
Hib
pneumococcal conjugate

Question 8

vaccines at age:

1

Answer 8

MMR
varicella
pneumococcal conjugate
meningococcal conjugate

Question 9

vaccines at age:

18 mo

Answer 9

DTaP
IPV
Hib

Question 10

vaccines at age:

4-6 years

Answer 10

DTaP
IPV
MMR
varicella

Question 11

vaccines at age:

14-16 years

Answer 11

TdaP

Question 12

when to administer the HPV vaccine

Answer 12

age 9-26 years

3 doses at 0, 2, 6 mo intervals

Question 13

when to administer the influenza vaccine

Answer 13

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

Question 14

when to administer Hep B vaccine

Answer 14

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

Question 15

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

Answer 15

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

Question 16

what are true contraindications to ALL vaccines

Answer 16

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

Question 17

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

Answer 17

no

Question 18

is current antimicrobial therapy a contraindication to vaccination

Answer 18

no

Question 19

what are some other things that are NOT contraindications to vaccination

Answer 19

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

Question 20

what are some absolute contraindications to MMR vaccine

Answer 20

anaphylactic reaction to eggs or to neomycin

pregnancy

immunodeficiency state

hematologic or solid tumours

reaction to neomycin and gelatin

Question 21

what are some precautions to take with MMR vaccine

Answer 21

avoid pregnancy for at least 28 days after vaccination

recent administration of IG would be a caution

Question 22

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

Answer 22

nor indicated for older than 5 years

Question 23

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

Answer 23

influenza

Question 24

what are absolute contraindications for varicella vaccine

Answer 24

immunocompromised states

pregnancy

moderate or severe illness

anaphylactoid reaction to neomycin or gelatin

receiving high doses of systemic glucocorticoids daily or alternative day

Question 25

what should you avoid after varicella vaccine

Answer 25

avoid salicylates for at least 6 weeks

Question 26

list the disease prevented by: | IPV

Answer 26

polio

Question 27

list the disease prevented by: | MMRV

Answer 27

measles mumps rubella varicella

Question 28

when is hep B given routinely

Answer 28

grade 5

Question 29

list the disease prevented by: | gardasil

Answer 29

HPV 6, 11, 16, 18

Question 30

what % of cervical cancer do HPV 16 and 18 cause

Answer 30

70%

Question 31

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

Answer 31

90%

Question 32

in what age group is gardasil approved

Answer 32

9-45 in women | 9-26 in men

Question 33

what options are there for influenza immunization

Answer 33

yearly | IM (inactivated) or nasal spray (live attenuated)

Question 34

list the disease prevented by: | DTaP

Answer 34

diphtheria pertussis tetanus

Question 35

list the disease prevented by: | pneumococcal conjugate

Answer 35

step pneumo

Question 36

list the disease prevented by: | HiB

Answer 36

haemophilus influenzae serotype B

Question 37

list the disease prevented by: | menigococcal conjugate

Answer 37

neisseria meningitidis

Question 38

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

Answer 38

previous anaphylactic reactions --urticaria, angioedema, respiratory distress, shock recent steroids recent blood transfusion products

Question 39

what PMHx to ask about specifically before vaccine

Answer 39

``` 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

Question 40

what allergies to ask about specifically in vaccines

Answer 40

``` eggs gelatin neomycin antibiotics latex ```

Question 41

what social history to ask before vaccines

Answer 41

ethnicity recent immigrations travel history community outbreaks

Question 42

what are the 3 types of vaccine

Answer 42

live attenuated whole inactivated subunit (organism parts, protein/toxoid, polysaccharide with or without conjugate)

Question 43

what are the live attenuated vaccines

Answer 43

MMR varicella (which is now combined as MMRV) oral typhoid yellow fever BCG *these are given SC

Question 44

how are most vaccines given

Answer 44

IM--except for live attenuated

Question 45

what else can you find in vaccines

Answer 45

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

Question 46

what do you say to parents that have concerns just generally

Answer 46

acknowledge and respect their concerns always provide current information and let them make the decision

Question 47

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

Answer 47

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

Question 48

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

Answer 48

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

Question 49

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

Answer 49

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

Question 50

what are the benefits to vaccination to emphasize to parents

Answer 50

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

Question 51

what are some examples of diseases prevented by vaccination

Answer 51

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

Question 52

what are the common risks/side effects of vaccination

Answer 52

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

Question 53

what are some less common, moderate side effects of vaccination

Answer 53

``` seizure hypotonic unresponsive state inconsolable crying (DTaP-IPV) fever arthralgias parotitis (MMR) ``` *history of these adverse events is NOT a contraindication for future immunizations

Question 54

what are the rare, life threatening complications from vaccination

Answer 54

anaphylaxis (1-2/1 million) GBS rate following influenzae vaccination may be higher than background rate of 1 additional case per million vaccinated

Question 55

which vaccine contains the following potential allergen: | neomycin

Answer 55

``` IPV DTaP IPV HiB MMR varicella ```

Question 56

which vaccine contains the following potential allergen: | gelatin

Answer 56

varicella | MMR

Question 57

which vaccine contains the following potential allergen: | bakers yeast

Answer 57

hep B

Question 58

which vaccine contains the following potential allergen: | eggs

Answer 58

influenzae | yellow fever

Question 59

which vaccine contains the following potential allergen: | streptomycin

Answer 59

IPV

Question 60

in what condition are all live vaccines contraindicated

Answer 60

immunodeficiency or immunosuppressive therapy

Question 61

can you vaccinate in HIV

Answer 61

vaccinate early in disease when CD4 counts are high

Question 62

is breastfeeding a contraindication to live vaccines

Answer 62

no but do not do during pregnancy

Question 63

who should receive the BCG vaccine

Answer 63

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