Immunization Recommendations

Question 1

What volume to administer vaccines?

Answer 1

0.5 mL, except for influenza

Question 2

Hep B Vaccine

Answer 2

-1st vaccine to be given at birth
-3 dose series
-Infants born to Hep B positive mothers, need vaccine and HBIG within 12 hours after birth. Recheck Hep B status after 9-18 months of age. If no immunity is seen, another dose may be given.
-Mothers who’s Hep B status is not known, must have testing done to find out status, baby should have vaccine by 12 hours after birth, and receive HBIG by 1 week after birth.
-Last dose (3rd dose) should be given at or after 6 months of age.

Question 3

Rotavirus Vaccine

Answer 3

-3 dose series.
-Cannot be given after 32 weeks old

Question 4

DTaP (Vaccine)

Answer 4

-Higher concentration of Diphtheria
-5 dose series (3 vaccines and 2 boosters)
-Diphtheria causes throat closure
-Cannot give after 7 years old

Question 5

Tdap (Vaccine)

Answer 5

-Give between 11-12 years old and Td every 10 years thereafter as a booster
-Given to women in 3rd trimester of pregnancy

Question 6

Hib Conjugate Vaccine (Hib) Vaccine

Answer 6

-Can be given as early as 6 weeks old
-Not recommended for children 5 years old or older

Question 7

Pneumococcal Vaccine

Answer 7

2 types: PCV13 and PPSV23
-Prevnar (PCV13) - can be given as early as 6 weeks
-Pneumovax (PPSV23) - Given at 2 years to patients who are immunocompromised

Question 8

Polio (IPV) Vaccine

Answer 8

-Not given oral anymore because of higher risk of passing the disease upon defecation

Question 9

Influenza (Flu) Vaccine

Answer 9

-Age 6 months = Inactivated
-After 2 years = Live vaccine

-6-35 months = 0.25 mL IM
-After 3 years = 0.5 mL IM

-Important: First dose of flu must be 2 dose series between ages 6 months-8 years.
-If children do not get 2 dose series the first time getting the vaccine, the next time they go to the clinic, they must get 2 doses. For example, a patient goes into your clinic at 6 months and gets 1 dose, but does not go back for the 2nd dose, once they go for the next annual visit, they need to get a 2 dose series (initially).

-9 years and older = 1 dose annually.

-Quadrivalent recommended after age 18.

Question 10

Covid-19 Vaccine

Answer 10

-Moderna and Pfizer can be given as early as 6 months.
-Novavax can be given starting 12 years.

-If giving Moderna - 2 dose series.
-If giving Pfizer - 3 dose series.

Question 11

MMR Vaccine

Answer 11

-Live vaccine
-2 dose series, minimum age is 12-15 months.
-If a patient is exposed or traveling to endemic areas, you can give a dose as early as 6 months, but it won’t count towards their 2 dose series.
-If the patient is getting MMRV (includes varicella), latest age to administer is 12 years old.
-If patient needs a PPD screening, postpone for about 4-6 weeks after MMR vaccine, because it may suppress the PPD results.

Question 12

Varicella Vaccine

Answer 12

-Live vaccine
-2 dose series

Question 13

Hep A Vaccine

Answer 13

-2 dose series
-At least 6 months apart

Question 14

Meningococcal Vaccine

Answer 14

-2 dose series
-1st dose at 11-12 years old
-2nd dose at 16 years old
-If receiving the 1st dose at or after 16 years, patients only need one dose, not 2
-CDC recommends to give vaccine as early as 2 months for patients that are immunocompromised

Question 15

Meningococcal B Vaccine

Answer 15

-CDC recommends to administer to patients who are immunocompromised, as early as 10 years old
-All patients 16-23 must receive 1 dose, regardless if immunocompromised or not
-Incidence of the disease peaks at ages 16-21.

Question 16

HPV Vaccine

Answer 16

-2 dose series
-Can be given as early as 9 years old, but recommended age is 11-12 years
-Given to both females and males
-Need to administer 3 doses if giving for the first time at or after 15 years old
-HPV is the most common STI
-Keep patients in the office for about 15 minutes after administration due to risk of syncope
-Painful vaccine

Question 17

What to do if you are not sure a patient was vaccinated?

Answer 17

Vaccinate them as if it was the first time (start all over with series depending on age)

Question 18

Special Concerns for Vaccines

Answer 18

-IPV is contraindicated in patients with anaphylaxis to streptomycin, poly B, or neomycin. Varicella is contraindicated in patients with allergy to the same meds.
-MMR and Varicella (live vaccines) are to be avoided in patients who are pregnant or immunosuppressed
-For female patients of child-bearing age receiving a live vaccine, do a pregnancy test before administration
-Influenza: For patients with moderate egg allergy, the vaccine can still be given either inpatient or outpatient with proper supervision to monitor for reactions
-Pregnant patients: give inactivated influenza vaccine and Tdap (3rd trimester).