Intradermally 0. 05ml for 12 First two months of life

Immunization Flashcards by Denisse Tiangco

Achieved by administration of preformed antibodies

Passive immunity

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Passive immunity can be induced naturally through

transplacental transfer of maternal IgG

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Live attenuated vaccines

Measles
Mumps
Rubella
Varicella
Rotavirus
Live attenuated influenza vaccine
BCG

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Influenza 2 types

Live attenuated

Inactivated vaccine

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Wild virus or bacterium
Prolonged immunity
Multiplies in human host with stronger immune response
But can revert back to virulent form hence do not give to immunocompromised

Live attenuated

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Intramuscular
Do not multiply in human host
Immune response depends on antigen content
Little cell mediated immunity but no possibility of vaccine assoc infection

Inactivated vaccine

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Birth to 2 mos

BCG

Monovalent Hepa B

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4-8 mos

Hep B

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T/F: all vaccines can be administered at the same visit as all other vaccines

True

Except in persons with functional or anatomic asplenia PCV13 and Menactra meninggococcal conjugate should not be administered at same visit

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Vaccine spacing by at least

4 weeks

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BCG is given

Dose

Intradermally

05ml for <12 mos
1 ml for >12

First two months of life

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If more than 2 mos and patient wasn’t given BCG, do

PPD prior to BCG if

Congenital TB
Hx of close contact with known TB patient
Clinical finding suggestive of TB

Otherwise no PPD diff mx

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4 month old no BCG
Father sputum +

What is plan of action?

Do PPD prior giving BCG

Investigate

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More than 2 months of age do not give BCG without prior BCG if

Congenital

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PPD is positive if

induration of 5mm

No longer recommended to give BCG

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IM
Administer first dose as monovalent to all newborns within:

2nd dose given:

Final dose:

Hepa B
12 hrs of life

1-2 mos after birth

Final: not earlier than 24 weeks or after 6 mos of age

0-1-6

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If mother is HBsAg +

Administer Hep B and
HBIG 0.5ml
within 12 h of life not later than 7 days of age if not available

Give active and passive

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If mother’s HBsAg is unknown

>/= 2 kg newborn

Administer Hep B within 12 hrs of life

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If infant is preterm and mother is HBsAg negative

1st dose of HepB given at 30d chronological age
Hold at birth
Count as part of 3 dose primary series

If you give agad, not counted so give 3 more

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IM
3 dose primary series within minimum age of 6 weeks and interval of 4 weeks

Booster given between 12-15mos

HiB

6-10-14

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IM
Min age of 6 w with minimum interval of 4 weeks
Penta dose series
Do not give 5th if administered at 4 years or older

DPT

2-4-6-15 to 18 and 4-6 years

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Component of DPT vaccine is highly responsible for adverse effect after vaccination

Pertussis: seizure

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IM
Given in combination with DTaP and Hib with or without Hep B
Min age of 6 weeks with min interval of 4 weeks
Primary series consists of 3 doses 2-4-6 to 18 and 4 to 6

Booster given on or after 4th birthday at least 6 mos from previous dose

Inactivated poliovirus vaccine

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Given per orem

Min age of 6 weeks within min interval of 4 weeks between doses

Last dose should be administered not later than 32 weeks of age

Rotavirus

Rotarix give Rotateq give

2 dose at 2 and 4 mos 3 dose series 2, 4, 6 Max age for first dose at 14 weeks and 6 days Max age for final dose is 32 weeks (8 mos)

Rotavirus vaccine complication

Intusussception

IM Routine: 4 dose series at 2-4-6 m and booster at 12-15 mos Catch up: 1 dose of PCV13 to all healthy children aged 24 to 59 mos 2-5yrs not completely vaccinated

PCV

Trivalent given IM/SQ Quadri given IM Min age of 6 months Dose: 0.25 ml for children 6 mos to 35 mos and 0.5ml for children 36 mos to 18 years

Influenza

Children 6 m to 8 years for firs time, give

2 doses

Give LAIV or IIV if

Healthy Non pregnant 2-49 years

Do not give LAIV if

With severe allergic reactions Children 2-17 years receiving aspirin or aspirin containing products Egg allergy Pregnant Immunosupressed 2-4cyrs with asthma or wheezing If taken antiviral influenza within 2 days

SC | Age of 9 mos but given as early as 6 mos of age in case of outbreak

Measles

SC Min age of 12 mos 2 dose series (12-15 m and 4-6 y) 2nd dose may be given earlier but with min 4 week interval Catch up: all school aged children and adol 2 doses

MMR

SC Min 12 months 2 dose series at 12-15 at first and 4-6 yr Give 2nd dose earlier at interval of 3 mos from first dose Children 7-12yrs interval 3 mos

Varicella

IM Min age of 12 mos Initiate 2 dose HepA at 12 to 23 mos separate 2 doses by 6-18 mos

Hepa A

IM For 9-14 years a 2 dose series 0-6 Bi, quad or nona give at 0 (first) and 6 mos For 15 above, 3 dose series 0-2-6 For males 9-18 quad and nona given for prevention of anogenital warts or anal cancer

HPV

IM For children fully immunized (aka 5 dose series) 2,4,6,12-14 and 4-6 yr Td booster should be given every 10 years 7 and older single dose of TdaP given and replace due to Td Administered regardless of interval

Tetanus and Diptheria toxoid (Td) And Acellular Pertussis Baccine (TdaP)

Min 9 mos Admin Menactra kr Menveo at 13-18 If Menactra given to child with asplenia or sickle cell do not give 2 years of age and at least 4 weeks after completion of all PCV13

Meninggococcal vaccine

MMR may be given to HIV + child if

Asymp or symp without evidence of severe immuno

Varicella give to HIV + if

CD4 is at least 15%

If receiving >2 mg or >20 mg/ day prednisone for 14 days or more do not give On same dose level but <2 weeks, wait for

Live attenuated until discontinued at least 1 month 2 weeks after therapy discontinuation

Contraindication to vaccines

Anaphylactic reaction Anaphylactic hypersensitivity to vaccine constituent if essential, desensitize Defer in children with moderate to severe acute illness regardless of presence of fever until recovered

Arthritis after MMR is caused by

Rubella

Acellular type of Pertussis can be given with Hib conjugate

at the same time

No min interval bet 2 inactivated vaccine Min interval of 4 weeks for same inactivated vaccine Live and inactivated can be given at the same time ar different sites 2 live vaccines can be given at same time or 4 weeks interval

Vaccination p

Texas star vaccine Given to

Vibrio cholera Military

If px is allergic to eggs what vaccination should be cautioned

Influenza Yellow fever MMR Rabies

CI to vaccines

Moderate to severe acute illness with fever

Vaccines contraindicated to HIV and pregnancy

Live attenuated

Father of immunization Introduced vaccination Mild form of small pox

Edward Jenner

Max age for first dose of rota virus Last dose should be given at if first dose given

14 weeks and 5 days or less than 15 weeks 32 w

Congenital rubella:

``` IUGR Congenital cataract Microcephaly Heart defect(PDA) Salt and pepper retinopathy Blueberry muffin skin lesions Sensorineural deafness ```

Also presents with blueberry muffin skin lesions

Leukemia

Principle #5 Vaccine doses should not be adminstered at intervals less than the minimum intervals or earlier than the minimum age. Doses administered too close together or at too young an age can lead to a

suboptimal immune response

Accelerated schedules can be used

Catch-up immunization in children behind schedule Impending international travel Should not be used routinely

Exception to minimum intervals and minimum age

Measles during measles outbreak Original: 9 months May be administered as early as 6 months of age Dose should be repeated at 12 months of age or older Vaccine doses given up to 4 days before the minimum interval or age are counted as valid -> “The Grace Period” Does not apply to rabies vaccine

If minimum age or interval of vaccination has been violated -> dose is

invalid Action: A repeat dose should be administered for at least a minimum interval from the invalid dose

Principle #6 Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of vaccine Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection

Lapsed immunization will not reduce final response to vaccine. There is no need to re-start a series of give additional doses, do catch-up immunization.