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Immunization + travel vaccination Flashcards

1
Q

vaccine resources

A
  • FDA approved
  • Advisory Committee on Immunization Practices (ACIP)
  • CDC
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2
Q

VIS

A

vaccine info statements, handed to pt before admin
found on CDC website

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3
Q

Thimerosal

A

mercury-containing preservatives.. in some vaccines. no evidence that it poses a risk for autism.
in some multidose flu vacine…

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4
Q

Gelatine-containing products

A

from pigs, used in some vax as stabilizer

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5
Q

immunity

A

antigen- foreign
antibodies- immunoglobins, made or given

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6
Q

inactive vaccines

A

used kill version of a wild virus or bacteria that causes the disease. CAN NOT replicate and cause disease.

Less affected by circulating antibodies than live vaccines
limitation: immunity is not as strong as with live vaccines
Boosters: may be required for ongoing immunity

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7
Q

Polysaccharides, conjugated and recombinant vaccines

A

target a section of the organism, such as protein, sugar or capsid (outer casing)

these are types of vaccines in the inactive vax group

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8
Q

Polysaccharide Vaccines

A

molecules taken from the outer layer of encapsulated bacteria (such as pneumoccal serotypes; each serotype matches a circulating strain of the organism).
ex: Pneumovax 23

Do NO produce a good immune response in <2 years
inactive-vax group

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9
Q

Conjugated Vaccines

A

polysaccharides (sugar), molecules from the outside layer of encapsulated proteins and JOIN the molecules of carrier proteins.

increase immune response in infants, and antibody booster response to multi doses of vax
ex. Prenar 12, Menactra
inactive-vax group

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10
Q

Recombinant vaccines

A

a gene segment of a protein from the organism is inserted into the gene of another cell, such as a yeast cell, where it can replicate.
ex: Gardasil 9, FluBlox Quadrivalent
inactive-vax group

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11
Q

Toxoid Vaccines

A

vaccine targes a toxin produced by the diese
ex: diphtheria toxoid vac, tetanus toxoid vax
inactive-vax group

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12
Q

mRNA

A

vaccine gives instructions to the body’s cells (in the form of mRNA) to produce a protein specific to the pathogen, which then triggers an immune response
ex: covid 19 vax
inactive-vax group

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13
Q

Live vaccines

A

similar to the actual disease, provides a strong, long-lasting immune response

Limitations: 1) pt who are immunocompromised may not be able to halt replication; could cause the disease 2) circulating antibodies could interfere w/ vaccine replication

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14
Q

common live vax
MICRO-VY

A

MMR
Intranasal influenza
Cholera
Rotavirus
Oral Typhoid
Varicella
Yellow Fever

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15
Q

tuberculin skin test (TST)

A

live vax can cause a false-negative
1) give live vax the same day as the TST
2) wait 4 weeks after live vax to perform TST
3) admin TST first, wait 48-72 hrs to get results, then give live vax

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16
Q

General rule for all vax
timing and spacing

A
  • can be usually given at the same time (same visit/day)
    —– except in pt w/ asplenia, Prevnar and Menactra should be separated by 4 weeks
  • multi live vax can be given on the same day, if (not given on the same day) space 4 weeks apart
    —- except no separation is required for oral rotavirus vax
  • vax series requires >1 dose, intervals can be extended w/o restarting but should not be shortened in most cases
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17
Q

interval between antibody-containing products and MMR and MMRV

A

minimum of 3 months and up to 11 months, depends on product and some

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18
Q

live vax and antibody
timing and spacing

A
  • MMR and varicella-containing (MMRV) products require separation from antibody-containing products (e.g. blood transfusion, IVIG)
    —-vax–> 2weeks–> antibody-containing products
    —-antibody-containing products–> 3 months or longer–> vax
  • simultaneous admin of vax and antibody (inform of immunoglobulin) is recommended for post-exposure prophylaxis for certain diseases (e.g. hep A &B, rabies, tetanus)
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19
Q

pt should be monitored for

A

15 min

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20
Q

live vaccines systematic reaction

A

mild reactions 3-21 days
intranasal flu vax, replicates in the upper airways, causes mild cold-line symptoms… runny nose

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21
Q

aqueous Epi

A

1mg/ml (1/1,000)

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22
Q

Epi IM

A

0.01mg/kg (max dose .5mg)

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23
Q

Epi autofill injectors

A

.3mg for adults

pharmacy should have 3 doses
a pt may require 1-3 doses admin every 5-15 min

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24
Q

live vax contra

A

prego and immunosuppression

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25
Diphtheria, tetanus, and pertussis vax contra and precautions
contra: - for pertussis-containing vax: encephalopathy (coma, decreased consciousness, prolonged seizures) that is not attributed to another cause within 7 days of receiving vax precaution: Guillain-Barre syndrome (GBS) within 6 weeks of a previous diphtheria, tetanus and/or pertussis vax for DTap and tdap only: infantile spasms, uncontrolled seizures.
26
hep B and HPV contra
hypersensitivity to yeast
27
vax infants and children
- 3 dose hep B started at birth - others start at age 2 months: including PCV13, Dtap, Hib, polio, rotavirus - live vax start >= 12 months, including MMR, varicella - no polysaccharides vax before 2 years
28
Healthcare Professionals
- annual influenza vax - Hep b if no evidence of vax - tdap: 1 dose, if not up-to-date , then td or tdap every 10 years - varicella: if no history of vax or chickenpox infection - MMR: if there is not history of vax or blood test showing immunity
29
Adolescents and young adults
- meningococcal vax (MCV4: menactra, Menveo or MenQuadfi) ---- 2 dose: 1 dose at 11-12 and 1 dose at 16 ---- first-year college students in residential housing ( if not previously vax): 1 dose - HPV vax ---- recommended at 11-12 years ---- 2 or 3 doses (depending on age at start) - Tdap: first dose at age >11 years
30
sickle cell disease & other causes of Asplenia (damaged/missing spleen)
- H. influenzae type b (Hib) vaccine - Pneumococcal vaccine (age 19-64), give one of the following regimens: ---- PCV20x1 ---- PCV15x 1, then PCV23 x 1>= 8 weeks later - meningococcal vax ---- meningococcal conjugated vax (Menactra, Menveo, or MenQuadfi) ---- serogroup B meningococcal vax (Bexsero or Trumenba)
31
Prego
- Live vax are contra - influenza vax (inactive) - Tdap x1 w/ each prego (week 27-36 optimal)
32
Older adults
- shingrix: age >50 years, 2 doses 2-6 month apart - Pneumococcal vax (age >= 65), give one of the following regimens: ---- PCV20x1 ---- PCV15x 1, then PCV23 x 1 >=12 months later (>= 8 weeks if immunocompromised)
33
Immunodeficiency
- live vax contra - - Pneumococcal vaccine (age 19-64), give one of the following regimens: ---- PCV20x1 ---- PCV15x 1, then PCV23 x 1>= 8 weeks later - HIV infection ---- meningococcal conjugated vax (Menactra, MEnveo, or MenQuadfi) ---- Hep A vax ---- Hep B vax
34
Diabetes
- Pneumococcal vax (age >= 65), give one of the following regimens: ---- PCV20x1 ---- PCV15x 1, then PCV23 x 1 >=12 months later (>= 8 weeks if immunocompromised) - Hep B: age 19-59 or >=60 if at risk for Hep B
35
Influenza vax for adults
annually for all adults >= 6 months old
36
Tdap, Td vax for adults
tdap x1 if not received previously td or tdap every 10 years
37
singhles vax for adults
shingrix: all adults >= 50 years or >=19 if immunosuppressed or expected to become immunosuppressed 2 dose series, with the second dose 2-6 months after (interval can shorten to 1-2 months if immunocompromised) vaccinate even if pt previously had chicken pox or shingles or received zostavax
38
HPV vax for adults
adults <26 years who did not complete the HPV series
39
Pneumococcal vax for adults
age 19-64 w/ specific medical condition or age >= 65 (if never received before): PCV 20 x1, or PCV 15 x1 followed by PPSV 23> 23 12 months later (or 8 weeks if immunocompromised)
40
Meningococcal vax for adults
2 vax adults need 1 or both serogroup B vaccines (Bexsero, Trumenba): give if complement component deficiency, taking eculizumab or ravulizumab, asplenia, microbiologist w/ exposure to Neisseria meningitis Conjugated vax (Menactra, Menveo, MenQuadfi): same group as above, plus : HIV, travelers/residents in countries in which disease is common, military recruits, first-year college dorm students- if not up to date
41
Hep B vax for adults
all adults age 19-59 and pt >60 w/ risk factors, including chronic liver disease, HIV, exposure risk, IV drug use, multi sex partners, travel, blood exposure etc. give alone (Engrex-B, Recombivax HB, Heplisav- B) or w/ hep A (twinrex)
42
Hep A vax for adults
adults traveling to developing countries and other risk factors similar to hep B Give alone (Havrix, VAQTA) or w/ hep B vax (twinrix)
43
Dtap
Daptacel, Infanrix routine childhood vax: 5 doses ages 2, 4, 6, 12-18 months and 4-6 years for children <7 years refrigerate- IM
44
Dtap-HepB-IPV:
Pediarix, DT same as Dtap, but used for children who have contra for acellular pertussis antigen in Dtap refrigerate- IM
45
tdap
Adacel, Boostrix given >11 if not previously received prego refrigerate- IM
46
Haemophilus influenza type B (Hib)- containing vax
Hib: routine childhood vax series given between ages 2-15 months ActHib and Hiberix are 4 dose series, PedvaxHib is a 3 dose series Give to adults w/ asplenia refrigerator- IM
47
Hep A
Havrix, VAQTA children: routine series, 2 doses given at age 12 months, and then 6-18 months later. Adults: men who have sex w/men, drug user, chronic liver disease, HIV etc., refrigerate- IM
48
Hep B
Engrex-B, Heplisav B, Recombivax HB children: routine, start 24 hrs after birth, 3 doses given at age 0, 1-2, and 6-18 months later adults: all ages 19-59 or those >= 60 at risk Engrex-B, Recombivax HB: >=18 years, 3 dose series, month 0, 1, and 6. can completed in 4 months if necessary but require 1 year booster Heplisav B: >=18 years, 2 dose series, month 0 and 1. Do Not use in prego refrigerate- IM
49
Hep A and Hep B
twinrix 3 dose series, given at months 0, 1, and 6. refrigerate- IM
50
HPV9
Gardasil age 9-26 years! recommended age: 11-12 years contra in severe yeast allergy start before 15 years, 2 doses at month 0 and 6-12 months later. if 15 years or older or immunocompromised--> 3 doses at month 0, 1-2 and 6
51
Influenza vax for >= 65
Fluzone High-Dose Quadrivalent and Fluad Quadrivalent
52
influenza vax for prego
any but DO NOT GIVE FluMist
53
MMR
M-M-R II - refrigerate or freeze MMRV: freezer only (varicella component) store diluents at room temp or in the refrigerator give SC DO NOT use in prego or immunocompromised (CD4> 200)
54
Meningococcal vax MenB
Bexsero, Trumenba ages 10-25 only! Bexsero: 2 doses 1 month apart Trumenba: 2 doses 6 months apart
55
Meningococcal vax MCV- conjugated
Menactra: 9 months- 55 years Menveo ages 2 months- 55 years MenQuadfi: >= 2 years Menactra and Menveo can be used in adults >=56 years if needed
56
Prenavir 13
PCV 13 children <5 years: 4 doses, 2, 4, 6, and 12-15 months refrigerate- IM
57
Vaxneuvance
PCV 15 adults 19-64 or >= 65 if never received before if pt had PSSV23 before, adm in 12 months after 1 dose. no additional dose needed refrigerate- IM
58
Prenvar 20
PCV20 adults 19-64 or >= 65 if never received before if pt had PSSV23 before, adm in 12 months after 1 dose. no additional dose needed refrigerate- IM
59
Pnumovax 23
PPSV23 children 2-18 years, after completion of PCV 13 Adults: see PCV 15 and PCV20 refrigerate- IM
60
Polio containing vax
DtaP-HepB-IVP: Pediarix childrine routine, 4 doses at age 2, 4, and 6-18 months, and 4-6 years. refrigerate- IM
61
Rotavirus
RV1- rotarix- 2 doses at 2 and 5 months RV5- RotaTeq- 3 doses at 2, 4, and 6 months give to infants, do not initiate after 15 weeks. give orally!
62
varicella virus - for chickenpox
Varivax - routine for children, 2 doses given at age 12-15 months and 4-6 years. - any adolescents or adult w/o evidence of immunity give 2 doses. - do not use in prego or immunocompro - store in freezer, need to reconstitute (30 min stability) - do not give if hypersensitivity to gelatin or neomycin (Give SC)
63
zoster virus vax
Shingrex all adults >50 years required 2 does, 2-6 months later. do not freeze, store refrigerator, reconstitute give IM
64
storage temp logs
keep for 3 years
65
routs of admin SC only
MMR, MMRV, Varicella, Yellow fever dengue, small pox and monkeypox
66
IM or SC
PPSV 23, IPV (IPOL)
67
Intranasal
FluMist (live)
68
PO
typhoid (vivotif) oral solutions: Cholera (Vaxcora), Rotavirus (RotaTeq, Rotarix)
69
travel info international
Yellow Book CDC
70
bismuth subsalicylate
BSS prophylaxis reduces incidence of TD by 50%, Do not use in pt with aspirin allergy, prego, renal insufficiency or gout or pt on anticoagulants
71
BSS + aspirin
cause salicylate tox cause BSS is a salicylate FDA approved OTC > 12 years, but off label can be used for >3 years if no recent or current viral infection cause of Reye's syndrome!!
72
BSS SE
black tongue/stools, risk of Reye's syndrome, salicylate tox
73
loperamide
4 mg after first loose stool and 2 mg after each subsequent loose stool max 16mg/day
74
Persistent TD
diarrhea last longer > 14 days
75
Cholera vaccine
Vaxchora live vax!
76
yellow fever vax
YF-VAX Live vax!
77
Typhid vax
Vovotif live vax oral typhim Vi (inactive, polysaccharide) Injection
78
Rabes vax
RabAvert, prevention if high risk 3 doses post-exposure- w/ prevention vax 2 doses post-exposure- w/o prevention vax: 4 doses, 1 dose of rabes immuno globulin (RIG) should be given with first vaccine dose
79
Malaria Prophylaxis Regimens start 1-2 days before travel
Doxy- stop 4 weeks after travel + Atovaquone/Proguanil (Malarone)- stop 1 week after travel + Primaquine - stop 1 week after travel start 1-2 days before travel
80
Malaria Prophylaxis Regimens start 1-2 weeks before travel
chloroquine- stop 4 weeks after travel + Mefloquine- stop 4 weeks after travel
81
flublok age
>18

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