Immunization and Travelers Flashcards
Vaccine Resources
-FDA: package inserts
-Advisory Committee on Immunization Practices (ACIP)
-CDC: MMWR, The Pink Book
Common live vaccines
MMR
Intranasal Influenza
Cholera
Rotavirus
Oral Typhoid
Varicella
Yellow-fever
Vaccine Timing & Spacing
General Rules:
-vaccine can usually be given at the same time/day
-multiple live vaccines can be given on the same day or spaced 4 weeks apart
-If a vaccine series requires > 1 dose, the intervals between doses can be extended without restarting the series, but they should not be shortened in most cases
Live vaccines and antibodies:
-MMR and Varicella-containing vaccines require separation from antibody-containing products:
–> vaccine - 2 weeks - antibody containing product
–> antibody containing product - 3 months + - vaccine
-simultaneous administration of vaccine and antibody is recommended for post-exposure prophylaxis of certain diseases (heap A, B rabies, tetanus)
Invalid CI to vaccination
-mild acute illness (slight fever, mild diarrhea)
-current antimicrobial tx
-previous local skin rxn
-allergies: bird feathers, penicillin, allergies to products not in the vaccine
-pregnancy (except live vaccines), breastfeeding, preterm birth
-recent tb skin test
-immunosuppressed person in the household, recent exposure to the disease
-fam hx of adverse rxn to the disease
Contraindications to vaccination
for LIVE vaccines:
-pregnancy
-Immunosuppression
-a severe or anaphylactic reaction after a vaccine is contraindicated to future doses of that same vaccine
CI and Precautions of Diptheria, tetanus and pertussis vaccines
CI: for pertussis containing vaccines: encephalopathy, coma, dec level of consciousness, prolonged seizures
Caution: Gullain-Barre Syndrome within 6 weeks of a previous diphtheria, tetanus, and/or pertussis vaccine
-for DTaP and Tdap only: infantile spasms, uncontrolled seizures
Vaccines for specific conditions/populations: Pregnancy
-Live vaccines are CI
-Influenza vaccine, inactivated, can be given in any trimester
-Tdap x1 with EACH pregnancy (weeks 27-36)
Vaccines for specific conditions/populations: Sickle Cell/asplenia
-H. influenzae type B (Hib) vaccine
-Pneumococcal vaccines: age 19-65
–> Prevnar 20 (PCV21) x1 OR
–> Vaxneuvance (PCV 15) x1, then Pneumovax 23 (PPSVC 23) x1, > 8 week later
-Meningococcal vaccines
–> Menactra or Menveo AND
–> Bexsero or trumenbo (serogroup B)
Vaccines for specific conditions/populations: Immunodeficiency
-Live vaccines are CI
–Pneumococcal vaccines: age 19-65
–> Prevnar 20 (PCV21) x1 OR
–> Vaxneuvance (PCV 15) x1, then Pneumovax 23 (PPSVC 23) x1, > 8 week later
-Herpes zoster (Shringrix): . 19 y/o, 2 doses, 2-6 months apart
FOR HIV PTS:
-meningococcal: Menactra, Menveo or MenQuadfi
-Hep A
-Hep B
Vaccines for specific conditions/populations: Healthcare Professionals
-annual influenza vaccine
-Hep B
-Tdap x1 then Td every 10 yrs
-Varicella
-MMR
Vaccines for specific conditions/populations: older adults
-age > 50 y/o:
–> Herpes zoster (Shringrix) 2 doses, 2-6 months apart
-all others > 65 y/o:
–>Pneumococcal vaccine
-PCV21 x1
-PCV15 x1 then PPSV23 x2 > 12 months after (> 8 weeks if immunocompromised)
Vaccines for specific conditions/populations: Diabetes
-Pneumococcal (age 19-64):
–> PCV20 x1 OR
–> PCV15 x1 then PPSV23 x1 > 12 months later
-Hep B : > 60 y/o
Diphtheria, tetanus, and pertussis vaccines
–> Big D = kids
–> little d = adults
-DTaP: for children (< 7 y/o) in 5 shot series - 2,4,6,12-18 month, and 4-6 y/o
-DT: an alt if CI to acellular pertussis antigen in DTaP
-Td: routine booster q 10 yrs after age 7
–> wound ppx: revaccinate if > 5 yrs since last dose
-Tdap:
–> one dose routinely given at age 11 or 12
–> during pregnancy, close contacts of infants if not up-to-date, healthcare professionals, children 7-10 yrs not fully vaccinated with DTaP series
Haemophilus Influenzae type B (HIB) vaccine
-routine childhood vaccination series in children age 2-15 months
-adults with asplenia
Hepatitis-Containing vaccines
-Hep A (Havrix)
–> all children at 1 y/o (2 doses)
–> some adults: men sex w/ men, illicut drug use, chronic liver disease, traverlers to counteries
-Hep B (Enerix-B, Heplisav-B, Recombivax HB)
–> infants: 3 dose series given at birth, 4-8 weeks, and 24 weeks
–> some adults: HC workers, pts with ESRD, chronic liver disease, HIC, DM, IV drug users, men wo sex w/ men, anyone with multiple sex partners, incarcerated ppl
-Heplisav-B is a 2 dose series for age > 18 yrs (given 1 month apart)
Hep A +B: Twinrix
DTaP/Hep B/IPV = Pediarix
Human Papillomavirus Vaccines (HPV)
-Gardasil 9
-rec in females and males age 11-12, up to 26 y/o
Regimens:
- age < 15: 2 doses (0 and 6-12 months later)
-age > 15: 3 doses ( 0, 1-2, and 6 months)
Influenza vaccine tips
–> Alfuria, Fluarix, FluLaval, Fluzone: approved for > 6 months
–> Flucelvax: egg free, for > 6 months
–> Flublok (egg free) > 18 y/o
–> Fluzone high-dose, Fluad: approved > 65 y/o
–> Flumist (live) for healthy adults 2-49 y/o
-annually for everyone > 6 months
-children aged 6 mon - 8 yrs not previously vaccinated: 2 doses given 4 weeks apart
-egg allergu: any one except Flumist
-prego pts: any one except Flumist
Measles, Mumps ad Rubella Vaccines
live attenuated vaccines
-MMR (fridge, give SC)
-MMRV (ProQuad): MMR + varicella (freezer only, give SC)
2 doses at age 12-15 months and age 4-7 y/o
Meningococcal vaccines
-MCV4
-Menactra - 9 mon- 55 y/o
-MenQuadfi - > 2 y/o
-Menvei - 2 mon-55 y/o
–> 2 doses, age 11-12 and at 116 y/o
–> travelers, age 2 mon + with HIV or asplenia, 1st yr college students
MEN B
-Bexsero (2 doses, 1 month apart)
-Trumeba (2 doses, 6 month apart)
–> age > 10 y/o with high risk
Pneumococcal vaccines
-Prevnar 13 (PCV13)
-Vaxneuvance (PCV15)
-Prevnar 20 (PCV 20)
–> all IM
-give to children < 5 y/o: 4 doses of PCV13 or PCV15 at age 2,4,6 and 12-15 months
For adults age 19-64 or >/ 65 y/o:
–> Prevnar 20 x1 OR
–> Vaxneuvance (PCV15) 1, then Pneumovac 23 (PPSV 23 - give im/sc) x1 > 12 months after (or > 8 W if immunocompromised)
Polio Vaccine
-IPV: IPOL (IM or SC)
-DTap/Hep B/IPV (Pedianix)
–> 4 doses given at 2,4,6-18 mon and 4-6 y/o
Rotavirus vaccines
oral, live attenuated
-give to all infants, do not initiate the series after 15 weeks
-Rotavix: 2 doses at age 2 and 4 months
-RotaTeq: 3 doses at age 2,4, and 6 months
Varicella containing vaccines
-Viravax (live vaccine/Freezer)
-2 doses; given at 12-15 months and 4-6 y/o
CI: hypersensitivity to gelatin or neomycin, pregnancy
-stop antivirals 24 hrs before and do not take for 14 days after
-Shingrix: fridge/IM
-for all > 50 y/o, 2 doses given 2-6 months apart
Non routine vaccines
-Rabies: RabAvert (IM) (3 doses, prevention (4 doses, post exposer with RIG)
-Typhoid: Vivptif (PO)- live, in fridge, finish 1 week before travel, Typhim Vi (IM)
-Japanese encephalitis: Ixiaro (IM)
-BCG (live vaccine)
-Yellow fever (YF-VAX- SC) live
-Cholera: Vaxchora (PO), live vaccine
Vaccine storage requirements
-refrigerated: 35F-46F (2-8C)
-freezer: -58F - +5F (-50C to -15C) –> varicella, zostavax, MMRV, oral cholera
-MMR is stored in the fridge or freezer
-Diluents for MR, MMRV, Zostavax and Varivax can be stored at room temp or in the fridge
SC only admin vaccines
-MMR
-MMRV
-Varicella
-Zostavax
-Yellow fever
Resources for Travelers
-CDC: yellow book
-International society of international medicine (ISTM)
Travel vaccines needed: Inactivated vaccines
-Hep A (Havrix, VAQTA)
-Hep B (Engerix-B , Recombivanx HB)
-Hep A/B (Twinrix)
-Japanese encephalitis (Ixiaro)
-Meningococcus (Menvei, Menactra)
-Polio (IPOL)
-Ty[hoid-IM (Typhim Vi)
Travel vaccines needed: Live vaccines
-Cholera-PO (Vaxchora)
-Typhoid-PO (Vivotif)
-Yellow fever- SC (YF-VAX)
Drugs for travelers diarrhea: prophylaxis
-Bismuth subsalicylate 524-1050 mg PO 4 times daily (with meals and bedtime) - do not give to < 16 y/o or aspirin allergy
-abx for pts at high risk of complications (Rifaximin)
Drugs for travelers diarrhea: Treatment
MILD:
-loperamide or bishmuth subsalicylate
MODERATE:
-loperamide +/ abx
-azithromycin or a quinolone (if low resistance)
-rifaximin as alt
SEVERE/BLOODY Diarrhea
-abx +/- loperamide
- azithromycin preferred 1000 mg x1, rifaximin as alt
Typhoid fever
-caused by Salmonella typhi: HA, malaise, anorexia, intestinal hemorrhage/perforation
–> Typhim VI: give IM 2 weeks before travel in pts > 2 y/o
–> Vivotif (PO): give 1 week before travel in pts > 6y/o (keep in fridge)
Travelers: Cholera and Polio
C: caused by Vibrio cholerae, “rice-water stools”
- Vaxchora oral liq, > 10 days before travel, age 18-64
P: IPOL IM, give > 4 weeks before travel, single dose for previously vaccinated
Travelers: Hep A
-spread via fecal-oral route, can be asymptomatic, fever, malaise, jaundice, nausea
-Havrix, VAQTA (IM, inactivated), Twinrix (Hep A and B, inactivated)
diseases from insect bites
-Dengue (tropical, mosquitoes- supp care)
-Malaria (transmitted by the Anopheles mosquito, falciparum= most deadly)
-Japanese Encephalitis (farming, brain swelling)
-Yellow Fever (CI with egg allergy- yellow card 10 d before travel)
-Zika Virus (birth defects- microcephaly)
Malaria quick start PPX
-1-2 days before travel, taken daily, avoid in pregos
–> doxycycline (Doryx, Vibramycin): stop 4 weeks after travel, causes photosensitivity
–>Atovaquone/proguanil (Malarone): stop 1 week after travel
–> Primaquine
Malaria advanced start ppx
-start 1-2 weeks before travel, taken weekly, safe in pregos and children
–> Chloroquine: stop 4 weeks after travel (vision changes)
–> Mefloquine (Lariam) stop 4 weeks after travel
Altitude sickness prevention
-Acetazolamide (Diamox) 125 mg BID started the day before
SE: polyuria, photosensitivity, taste alteration, dehydration)
CI with sulfa allergy
