Immunization Flashcards
Achieved by administration of preformed antibodies
Passive immunity
Passive immunity can be induced naturally through
transplacental transfer of maternal IgG
Live attenuated vaccines
Measles Mumps Rubella Varicella Rotavirus Live attenuated influenza vaccine BCG
Influenza 2 types
Live attenuated
Inactivated vaccine
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
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
Birth to 2 mos
BCG
Monovalent Hepa B
4-8 mos
Hep B
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
Vaccine spacing by at least
4 weeks
BCG is given
Dose
Intradermally
- 05ml for <12 mos
- 1 ml for >12
First two months of life
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
4 month old no BCG
Father sputum +
What is plan of action?
Do PPD prior giving BCG
Investigate
More than 2 months of age do not give BCG without prior BCG if
Congenital
PPD is positive if
induration of 5mm
No longer recommended to give BCG
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
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
If mother’s HBsAg is unknown
>/= 2 kg newborn
Administer Hep B within 12 hrs of life
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
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
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
Component of DPT vaccine is highly responsible for adverse effect after vaccination
Pertussis: seizure
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
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.
