Immunization/Vaccination Flashcards
A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response
Antigen
A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response
Antigen
Protein molecules (immunoglobulins) produce by B lymphocytes to help eliminate antigen
Antibody
“Self”: protection produced by the person’s own immune system
Permanent or long-lasting
Active immunity
“Non-self”: antibody transferred from another person or animal
Passive immunity
What are the benefits of vaccination?
Protection from symptomatic disease
Improved Quality of Life (QOL)
Improved productivity
Prevention of death
What is ACIP?
Advisory Committee on Immunization Practices
health experts that advise CDC on vaccine schedule
What are the two classification of vaccines?
live attenuated or inactivated
What are the characteristic of live attenuated vaccines?
from weakened virus or bacteria, must replicate to be effective, immune response similar to natural infection, severe reaction possible, interference from circulating antibody, unstable to heat and light
What are the characteristics of inactivated vaccines?
cannot replicate, minimal interference from ab, generally requires multiple doses, Ab levels will fall over time
What is the rule for increasing intervals btw doses?
interval does not decrease effectiveness
What is the rule for decreasing the interval btw doses?
Decreasing the interval between doses of a multi-dose vaccine may interfere with antibody response or increase frequency and severity of adverse reactions
What is the rule for simultaneous administration?
No contraindication*
No increase in rates or severity of adverse reactions
Give at different sites
Do NOT mix in same syringe (okay to use commercially available combinations)
What is the exception to simultaneous administration?
asplenic chidren pneumococcal conjugate and meningococcal vaccine >4 wk apart
What is the spacing of vaccines not given simultaneously?
2 live injected vacines - minimal 4 wks apart
What is the adverse reaction?
Extraneous reaction caused by vaccine
“side effect”
What is adverse event?
Any event following a vaccine
May be true adverse reaction
May be only coincidental
What are some examples of local adverse reactions?
Pain, swelling, redness at the site of injection
More common with inactivated vaccines
Usually mild and self limited
What are some examples of systemic adverse reactions?
Fever, malaise, headache
Nonspecific
May be unrelated to vaccine
More common with attenuated vaccines
What is the allergic adverse reaction examples?
Due to vaccine or vaccine component
Rare (1/500,000)
Risk minimized by screening
A condition in a recipient which greatly increases the chance of a serious adverse reaction.
Contraindication
A condition in a recipient which may increase the chance or severity of an adverse event;
or
May compromise the action of the vaccine to produce immunity
Precaution
When should live vaccines not be given?
women known to be pregnant, severely immunosuppressed
What vaccine should be deferred during pregnancy?
HPV
What are disease that cause immunosuppression?
Congenital immunodeficiency
Leukemia or lymphoma
Generalized malignancy
What is chemotherapy that causes immunosuppression?
Alkylating agents
Antimetabolites
Radiation
How does steroid cause immunosuppression (dose)?
Corticosteroids
> 20 mg per day (prednisone)
> 2 mg/kg per day
What is the timeline to not give vaccines with steroid use from aerosols, topicals, alternate day, short course?
What are features of type A influenza?
moderate to severe illness
- all age groups
- humans and animals
What are the features of type B influenza?
milder disease
humans only
primarily effects children
What are the features of type C influenza?
rarely reported in humans
no epidemics
What allows for influenza attachment and entry?
H1-H16 hemagglutinins
target of neutralizing antibody
What allows the (cell explodes) spread of virus influenza?
N1-N9 neuraminidase
Target of neuraminidase inhibitors –oseltamivir (Tamiflu) and zanamivir (Relenza)
What is influenza has shift?
type A only, major change, new type - may cause pandemic
What does antigen drift cause?
minor changes, same subtype, may cause epidemic
What causes epidemic?
drift
What causes pandemic?
shift
What is influenza pathogenesis?
Respiratory transmission of virus
Replicates in respiratory epithelium with subsequent destruction of cells
Viral shedding in respiratory secretions for 5-10 days
What are the complications of influenza?
Pneumonia Primary influenza Secondary bacterial Reye Syndrome Myocarditis
What is the age recommendations for influenza?
6 months and older (because 19-49 year olds hit hardest by H1N1 in 2009)
High risk groups did not know they were high risk
Who is at increased risk of complications of influenza?
All children 6 months--4 years old All > 50 years old Chronic diseases (CV, pulmonary, metabolic) American Indians/Native Alaskans Immunosuppression Long-term care residents 6 month-18 year olds on chronic ASA Pregnant women Morbidly obese (BMI > 40)
What are the influenza vaccine recommendations?
Health care providers, including home care*
Employees of long-term care facilities
Household members of high-risk persons (including children 0-59 months)
*LAIV should not be administered to workers who have contact with severely Immunosuppressed patients (e.g., bone marrow transplant
What are the adverse reactions of influenza vaccine?
local reactions - 15-20%
fever, malaise - uncommon
allergic rxn - rare
neurological - very rare
What are contraindication and precautions to influenza vaccine?
Severe allergy to vaccine component (e.g., egg) or following prior dose of vaccine
Moderate to severe acute illness
History of Guillain Barre’ syndrome within 6 weeks following a previous dose (precaution)
What is fluzone-high dose influenza vaccine?
60 µg of each strain (instead of 15 µg)
Marketed for > 65 year olds because antibody response usually less than young adults
High cost
Only trivalent
What are the local and systemic side effects of fluzone-high dose?
Similar systemic
Local—10% higher pain; 4% higher erythema & swelling
What is fluzone intradermal?
“90% smaller needle” Dose is 0.1 ml vs 0.5 ml Ages 18-64 year olds Deltoid muscle More local reactions
What is flumist?
Intranasal administration
Quadrivalent approved Feb 2012 (2A+2B)
Approved for healthy persons aged 2-49 years
“Cold-adapted” = genetically manipulated to grow at 25o C (77o F) nasal mucosal temperature, but not warmer (discourage sniffing during administration)
“wild viruses” replicate efficiently at internal organ temperatures (lungs) of 37o C (98.6o F)
What are the cautions for live attenuated influenza vaccine?
Avoid if asthma or restrictive airway disease (especially in children)
Postpone if acute febrile or respiratory illness (afebrile for 72 hours)
What situation that do not have safety established and IM is preferred?
Chronic cardiovascular and respiratory disorders
Pregnancy during flu season
Chronic metabolic disease (DM), renal dysfunction, requiring regular medical care or hospital in past year
What are adverse reactions of flumist?
Cough, runny nose, nasal congestion
Sore throat, irritability, headache, chills
Vomiting, muscle aches, malaise, fever
What is the dosing for fluMist?
Dosing Adults 0.2 mL given as 0.1 mL in each nostril Dosing children 2 years and older Dose same as adult Dosing children 2-8 years old who have not previously received influenza vaccine—repeat 0.2 mL dose in 4 weeks
What are the rules for egg allergies and influenza vaccination?
If eat cooked eggs without Reaction give vaccine
If hives after eating eggs, give vaccine and observe for at least 30 minutes
If hives + other symptoms (e.g., wheezing, hypotension) then refer to physician allergy specialist
What is the newest flu vaccine?
flublok - not egg based, no perservatives, for 18-49 yo
Flucelvax - adults 18+, grow mammalian cells
Healthy primary care PA (32 y/o); no contraindications
IIV or LAIV
either as long as not caring for immunocompromised
38 y/o patient with diabetes
IIV or LAIV
IIV
4 y/o healthy child with no contraindications
IIV or LAIV
either
Pregnant patient with no contraindications
IIV or LAIV
IIV
66 y/o patient who needs pneumococcal and zoster vaccines simultaneously with influenza vaccine
IIV or LAIV
IIV
What is pneumococcal disease?
Caused by Streptococcus pneumoniae (Gram-positive bacteria)
90 known serotypes
Polysaccharide capsule important virulence factor
Second most common cause of vaccine- preventable death in the U.S.(after influenza)—primary cause of severe /fatal cases in 2009 H1N1 influenza season
Most common cause of bacterial meningitis among infants and young children
Increasing antibiotic resistance
What are the pneumococcal disease?
pneumonia, bacteremia, meningitis
What is the vaccine for pneumococcal?
pneumovax 23
What are features of pneumovax 23?
Not effective in children
What are indications for PPSV23?
Adults 65 + Adults 19 to 64 with asthma Adults 19 to 64 who smoke People 2 to 64 who have chronic illness Diabetes Cardiovascular disease Pulmonary disease
What is PCV-13?
Pneumococcal polysaccharide conjugated to nontoxic diphtheria toxin (13 serotypes)
Vaccine serotypes account for 86% of bacteremia and 83% of meningitis among children
Besides 6wk to 5 yr, who else gets PCV-13?
FDA approved for adults 50 and older
Recommended for immunocompromised, asplenia, CSF leaks, chronic renal failure, or cochlear implants
What is the dose for PCV-13?
0.5 mL given IM
What is the ACIP pneumococcal vaccine regulations?
Pneumococcal conjugate vaccine (PCV13–Prevnar 13)
Give first to unvaccinated adults who need both vaccine types
Adults 65 and over
Immunocompromised, Chronic renal failure, Asplenia (functional or anatomic), CSF leaks, Cochlear implants
Pneumococcal polysaccharide vaccine (PPSV23)
Give 1 year after PCV13 unless immunocompromised or above conditions, then >8 weeks
What causes meningococcal disease?
neisseria meningitidis
leading cause of bacterial meningitis and sepsis
B most common in infants
How is n. meningitidis transmitted?
airborne droplets, nasopharynx secretions
What is MPSV4 (meningococcal polysaccharide vaccine?
Quadrivalent: A, C, Y, W-135 (Menomune)
Dose = 0.5 mL subcutaneous
Not effective in children
What is MCV4 (meningococcal conjugate vaccine)?
Same Serotypes: A, C, Y, W-135 Conjugated to diphtheria toxoid Menactra, Sanofi Pasteur (2005); Menveo, Novartis (2010) Dose = 0.5 mL Intramuscular
What are the recommendations from ACIP for meningococcal vaccine?
Clarified who needs one or two vaccine doses
The conjugated vaccine (MCV4) is preferred in patients 55 years and younger
The polysaccharide vaccine (MPSV4) is preferred for 56 years +
What is the MCV4 recommendations?
One dose at age 11-12 with booster dose at 16 years of age
Give one dose ages 13-15 if not previously vaccinated with booster 16-18 years of age
Booster dose for either scenario above is strongly recommended for college freshman living in a dormitory.
Otherwise healthy persons who received 1st dose after age 16 do not need a booster
All polysaccharide vaccines don’t work in?
kids
What is the pathogenesis of hepatitis A?
Humans are only natural host
Entry into mouth (fecal-oral)
Viral replication in the liver
Children generally asymptomatic; adults symptomatic
What are the recommendations for hepatitis A vaccine?
International travelers
Men who have sex with men
Illegal Drug users
Persons with occupational risk
Persons with chronic liver disease, including hepatitis C
Household contacts international adoptees
What are the hepatitis A vaccine?
Inactivated whole virus
HAVRIX (GlaxoSmithKline)
VAQTA (Merck Vaccine Division)
What are the doses for hepatitis A vaccine?
Pediatric and adult formulations
Adult dose = 1 mL IM
For 18 years and younger dose = 0.5 mL IM
Give 2 doses at least 6 months apart
What do you give to college age students for meningococcal?
booster dose
What are the characteristic of hep b?
human host
can live 7 days at RT
cause chronic hepatitis and cirrhosis
human carcinogen - hepatocellular carcinomas
What are the target groups for hep b vaccine?
infants, unvaccinated adolescents
What is ACIP recommendations for Hep B in DM pt?
Recommended for adults 19-64 with Diabetes (type 1 & 2)
Adults 65+ with DM at the discretion of clinician
At higher risk of developing Hep B if exposed & higher mortality rate
What is ACIP recommendations for Hep B in DM pt?
Recommended for adults 19-64 with Diabetes (type 1 & 2)
Adults 65+ with DM at the discretion of clinician
At higher risk of developing Hep B if exposed & higher mortality rate
Protein molecules (immunoglobulins) produce by B lymphocytes to help eliminate antigen
Antibody
“Self”: protection produced by the person’s own immune system
Permanent or long-lasting
Active immunity
“Non-self”: antibody transferred from another person or animal
Passive immunity
What are the benefits of vaccination?
Protection from symptomatic disease
Improved Quality of Life (QOL)
Improved productivity
Prevention of death
What is ACIP?
Advisory Committee on Immunization Practices
health experts that advise CDC on vaccine schedule
What are the two classification of vaccines?
live attenuated or inactivated
What are the characteristic of live attenuated vaccines?
from weakened virus or bacteria, must replicate to be effective, immune response similar to natural infection, severe reaction possible, interference from circulating antibody, unstable to heat and light
What are the characteristics of inactivated vaccines?
cannot replicate, minimal interference from ab, generally requires multiple doses, Ab levels will fall over time
What is the rule for increasing intervals btw doses?
interval does not decrease effectiveness
What is the rule for decreasing the interval btw doses?
Decreasing the interval between doses of a multi-dose vaccine may interfere with antibody response or increase frequency and severity of adverse reactions
What is the rule for simultaneous administration?
No contraindication*
No increase in rates or severity of adverse reactions
Give at different sites
Do NOT mix in same syringe (okay to use commercially available combinations)
What is the exception to simultaneous administration?
asplenic chidren pneumococcal conjugate and meningococcal vaccine >4 wk apart
What is the spacing of vaccines not given simultaneously?
2 live injected vacines - minimal 4 wks apart
What is the adverse reaction?
Extraneous reaction caused by vaccine
“side effect”
What is adverse event?
Any event following a vaccine
May be true adverse reaction
May be only coincidental
What are some examples of local adverse reactions?
Pain, swelling, redness at the site of injection
More common with inactivated vaccines
Usually mild and self limited
What are some examples of systemic adverse reactions?
Fever, malaise, headache
Nonspecific
May be unrelated to vaccine
More common with attenuated vaccines
What is the allergic adverse reaction examples?
Due to vaccine or vaccine component
Rare (1/500,000)
Risk minimized by screening
A condition in a recipient which greatly increases the chance of a serious adverse reaction.
Contraindication
A condition in a recipient which may increase the chance or severity of an adverse event;
or
May compromise the action of the vaccine to produce immunity
Precaution
When should live vaccines not be given?
women known to be pregnant, severely immunosuppressed
What vaccine should be deferred during pregnancy?
HPV
What are disease that cause immunosuppression?
Congenital immunodeficiency
Leukemia or lymphoma
Generalized malignancy
What is chemotherapy that causes immunosuppression?
Alkylating agents
Antimetabolites
Radiation
How does steroid cause immunosuppression (dose)?
Corticosteroids
> 20 mg per day (prednisone)
> 2 mg/kg per day
What is the timeline to not give vaccines with steroid use from aerosols, topicals, alternate day, short course?
What are features of type A influenza?
moderate to severe illness
- all age groups
- humans and animals
What are the features of type B influenza?
milder disease
humans only
primarily effects children
What are the features of type C influenza?
rarely reported in humans
no epidemics
What allows for influenza attachment and entry?
H1-H16 hemagglutinins
target of neutralizing antibody
What allows the (cell explodes) spread of virus influenza?
N1-N9 neuraminidase
Target of neuraminidase inhibitors –oseltamivir (Tamiflu) and zanamivir (Relenza)
What is influenza has shift?
type A only, major change, new type - may cause pandemic
What does antigen drift cause?
minor changes, same subtype, may cause epidemic
What causes epidemic?
drift
What is gardasil 9?
9 valent, females 9-26 and males 9-15
What is influenza pathogenesis?
Respiratory transmission of virus
Replicates in respiratory epithelium with subsequent destruction of cells
Viral shedding in respiratory secretions for 5-10 days
What are the complications of influenza?
Pneumonia Primary influenza Secondary bacterial Reye Syndrome Myocarditis
What is the age recommendations for influenza?
6 months and older (because 19-49 year olds hit hardest by H1N1 in 2009)
High risk groups did not know they were high risk
Who is at increased risk of complications of influenza?
All children 6 months--4 years old All > 50 years old Chronic diseases (CV, pulmonary, metabolic) American Indians/Native Alaskans Immunosuppression Long-term care residents 6 month-18 year olds on chronic ASA Pregnant women Morbidly obese (BMI > 40)
What are the influenza vaccine recommendations?
Health care providers, including home care*
Employees of long-term care facilities
Household members of high-risk persons (including children 0-59 months)
*LAIV should not be administered to workers who have contact with severely Immunosuppressed patients (e.g., bone marrow transplant
What are the adverse reactions of influenza vaccine?
local reactions - 15-20%
fever, malaise - uncommon
allergic rxn - rare
neurological - very rare
What are contraindication and precautions to influenza vaccine?
Severe allergy to vaccine component (e.g., egg) or following prior dose of vaccine
Moderate to severe acute illness
History of Guillain Barre’ syndrome within 6 weeks following a previous dose (precaution)
What is fluzone-high dose influenza vaccine?
60 µg of each strain (instead of 15 µg)
Marketed for > 65 year olds because antibody response usually less than young adults
High cost
Only trivalent
What are the local and systemic side effects of fluzone-high dose?
Similar systemic
Local—10% higher pain; 4% higher erythema & swelling
What is fluzone intradermal?
“90% smaller needle” Dose is 0.1 ml vs 0.5 ml Ages 18-64 year olds Deltoid muscle More local reactions
What is flumist?
Intranasal administration
Quadrivalent approved Feb 2012 (2A+2B)
Approved for healthy persons aged 2-49 years
“Cold-adapted” = genetically manipulated to grow at 25o C (77o F) nasal mucosal temperature, but not warmer (discourage sniffing during administration)
“wild viruses” replicate efficiently at internal organ temperatures (lungs) of 37o C (98.6o F)
What are the cautions for live attenuated influenza vaccine?
Avoid if asthma or restrictive airway disease (especially in children)
Postpone if acute febrile or respiratory illness (afebrile for 72 hours)
What situation that do not have safety established and IM is preferred?
Chronic cardiovascular and respiratory disorders
Pregnancy during flu season
Chronic metabolic disease (DM), renal dysfunction, requiring regular medical care or hospital in past year
What are adverse reactions of flumist?
Cough, runny nose, nasal congestion
Sore throat, irritability, headache, chills
Vomiting, muscle aches, malaise, fever
What is the dosing for fluMist?
Dosing Adults 0.2 mL given as 0.1 mL in each nostril Dosing children 2 years and older Dose same as adult Dosing children 2-8 years old who have not previously received influenza vaccine—repeat 0.2 mL dose in 4 weeks
What are the rules for egg allergies and influenza vaccination?
If eat cooked eggs without Reaction give vaccine
If hives after eating eggs, give vaccine and observe for at least 30 minutes
If hives + other symptoms (e.g., wheezing, hypotension) then refer to physician allergy specialist
What is the newest flu vaccine?
flublok - not egg based, no perservatives, for 18-49 yo
Flucelvax - adults 18+, grow mammalian cells
Healthy primary care PA (32 y/o); no contraindications
IIV or LAIV
either as long as not caring for immunocompromised
38 y/o patient with diabetes
IIV or LAIV
IIV
4 y/o healthy child with no contraindications
IIV or LAIV
either
Pregnant patient with no contraindications
IIV or LAIV
IIV
66 y/o patient who needs pneumococcal and zoster vaccines simultaneously with influenza vaccine
IIV or LAIV
IIV
What is pneumococcal disease?
Caused by Streptococcus pneumoniae (Gram-positive bacteria)
90 known serotypes
Polysaccharide capsule important virulence factor
Second most common cause of vaccine- preventable death in the U.S.(after influenza)—primary cause of severe /fatal cases in 2009 H1N1 influenza season
Most common cause of bacterial meningitis among infants and young children
Increasing antibiotic resistance
What are the pneumococcal disease?
pneumonia, bacteremia, meningitis
What is the vaccine for pneumococcal?
pneumovax 23
What are features of pneumovax 23?
Not effective in children
What are indications for PPSV23?
Adults 65 + Adults 19 to 64 with asthma Adults 19 to 64 who smoke People 2 to 64 who have chronic illness Diabetes Cardiovascular disease Pulmonary disease
What is PCV-13?
Pneumococcal polysaccharide conjugated to nontoxic diphtheria toxin (13 serotypes)
Vaccine serotypes account for 86% of bacteremia and 83% of meningitis among children
Besides 6wk to 5 yr, who else gets PCV-13?
FDA approved for adults 50 and older
Recommended for immunocompromised, asplenia, CSF leaks, chronic renal failure, or cochlear implants
What is the dose for PCV-13?
0.5 mL given IM
What is the ACIP pneumococcal vaccine regulations?
Pneumococcal conjugate vaccine (PCV13–Prevnar 13)
Give first to unvaccinated adults who need both vaccine types
Adults 65 and over
Immunocompromised, Chronic renal failure, Asplenia (functional or anatomic), CSF leaks, Cochlear implants
Pneumococcal polysaccharide vaccine (PPSV23)
Give 1 year after PCV13 unless immunocompromised or above conditions, then >8 weeks
What causes meningococcal disease?
neisseria meningitidis
leading cause of bacterial meningitis and sepsis
B most common in infants
How is n. meningitidis transmitted?
airborne droplets, nasopharynx secretions
What is MPSV4 (meningococcal polysaccharide vaccine?
Quadrivalent: A, C, Y, W-135 (Menomune)
Dose = 0.5 mL subcutaneous
Not effective in children
What is MCV4 (meningococcal conjugate vaccine)?
Same Serotypes: A, C, Y, W-135 Conjugated to diphtheria toxoid Menactra, Sanofi Pasteur (2005); Menveo, Novartis (2010) Dose = 0.5 mL Intramuscular
What are the recommendations from ACIP for meningococcal vaccine?
Clarified who needs one or two vaccine doses
The conjugated vaccine (MCV4) is preferred in patients 55 years and younger
The polysaccharide vaccine (MPSV4) is preferred for 56 years +
What is the MCV4 recommendations?
One dose at age 11-12 with booster dose at 16 years of age
Give one dose ages 13-15 if not previously vaccinated with booster 16-18 years of age
Booster dose for either scenario above is strongly recommended for college freshman living in a dormitory.
Otherwise healthy persons who received 1st dose after age 16 do not need a booster
All polysaccharide vaccines don’t work in?
kids
What is the pathogenesis of hepatitis A?
Humans are only natural host
Entry into mouth (fecal-oral)
Viral replication in the liver
Children generally asymptomatic; adults symptomatic
What are the recommendations for hepatitis A vaccine?
International travelers
Men who have sex with men
Illegal Drug users
Persons with occupational risk
Persons with chronic liver disease, including hepatitis C
Household contacts international adoptees
What are the hepatitis A vaccine?
Inactivated whole virus
HAVRIX (GlaxoSmithKline)
VAQTA (Merck Vaccine Division)
What are the doses for hepatitis A vaccine?
Pediatric and adult formulations
Adult dose = 1 mL IM
For 18 years and younger dose = 0.5 mL IM
Give 2 doses at least 6 months apart
What do you give to college age students for meningococcal?
booster dose
What are the characteristic of hep b?
human host
can live 7 days at RT
cause chronic hepatitis and cirrhosis
human carcinogen - hepatocellular carcinomas
What are the target groups for hep b vaccine?
infants, unvaccinated adolescents
How are target hep B candidates for vaccination?
Men who have sex with men Heterosexual with multiple partners Persons diagnosed with an STD Prostitutes Injection drug users Prison inmates Persons receiving dialysis Health care workers Diabetics
What is ACIP recommendations for Hep B in DM pt?
Recommended for adults 19-64 with Diabetes (type 1 & 2)
Adults 65+ with DM at the discretion of clinician
At higher risk of developing Hep B if exposed & higher mortality rate
What is duration of immunity in hepatitis B?
> 20 yr
How many doses for hep B vaccine?
3 Doses (0, 1, and 6 months)
What are all hep B vaccines?
IM
What are the Hep B vaccines?
Recombivax HB (Merck)- 5 mcg/0.5 ml (pediatric)- 10 mcg/1 ml (adult)- 40 mcg/1 ml (dialysis) Engerix-B (GSK)- 10 mcg/0.5 ml (pediatric)- 20 mcg/1 ml (adult)
What is the management of nonresponsers to hep B vaccines?
Complete a second series of three doses
Should be given on the usual schedule of 0, 1 and 6 months
Retest 1 to 2 months after completing the second series
What is tetani?
Anaerobic gram-positive, spore-forming bacteria
Spores found in soil, dust, animal feces; may persist for months to years
Multiple toxins produced with growth of bacteria
Tetanospasmin estimated human lethal dose = 150 ng
What is tetanus pathogenesis?
Anaerobic conditions allow germination of spores and production of toxins.
Toxin binds in central nervous system & interferes with neurotransmitter release to block inhibitor impulses.
Leads to unopposed muscle contraction and spasm.
Generalized tetanus: descending symptoms of trismus (lockjaw), difficulty swallowing, muscle rigidity, spasms
What is diphtheria?
Aerobic, gram-positive bacillus
Occurrence rare in U.S.
Still seen worldwide, even in some developed countries
How diphtheria spread?
resp, mucous membrane
What are complications of diphtheria toxin?
Myocarditis & neuritis most common Respiratory complications (5-10% death rate
What is pertussis?
highly contagious resp disease, whole cell vaccine
What is pertussis pathogenesis?
Attaches to cilia of epithelial cells in respiratory tract
Paroxysmal cough lasts 1-6 weeks
Disease/complications more severe in children
What are the complications of pertussis?
Pneumonia, seizures, encephalopathy, hypoxia, death
What is the 2011 vaccine recommendation for pertussis?
vaccinate all who will have close contact with infants
What is the reasons for pertussis increase in cases?
Clusters of unvaccinated children
Waning protection offered by acellular pertussis
Why did pertussis switch from whole cell to acellular?
severe side effects
Increased pain at injection site
Fevers; some high enough to produce seizures(1case/1750 doses
What are the tetanus and diphtheria vaccines?
Td = Tetanus toxoid DTaP = Infanrix, Daptacel (children
What is the tetanus, diphtheria pertussis vaccine schedule?
Children: 5 dose series starting at 6 months
Not fully protected until 12-18 months old
Adults: If previously vaccinated need one Tdap booster; then Td every 10 years
Health care providers: one Tdap booster
What are recommendations for Tdap and pregnancy?
Give during every pregnancy regardless of Tdap history.
Give between weeks 27-36 to maximize maternal antibody response and passive antibody transfer
Women not previously vaccinated with Tdap, give immediately postpartum if not given during pregnancy
What is cocooning?
Concept of vaccinating pregnant women and all others who will have close contact with an infant before the infant can develop natural immunity from vaccinations.
Pertussis (12 months)
Influenza (6 months)
What is herpes zoster associated with?
aging
immunosuppression
intrauterine exposure
varicella at younger than 18 months of age
What are complications of herpes zoster?
Postherpetic neuralgia (PHN)
Ophthalmic zoster
Dissemination with generalized skin eruptions and involvement of the central nervous system, lungs, liver and pancreas
Can last for 30 days
What is the herpes zoster vaccine?
live attenuated vaccine
recommended to give 60 yo and older
vaccinate regardless of hx of herpes zoster
FDA approved for >50
What are contraindications of herpes zoster vaccine?
Immunosuppression
Leukemia, lymphoma or other malignant neoplasm affecting the bone marrow or lymphatic system
AIDS or other clinical manifestation of HIV infection
High-dose corticosteroid therapy
What is the storage and handling of varicella vaccine?
store frozen or lower at times
refrigerate 72 hr
store diluted at RT
discard within 30 min of reconstitution
What are complications of varicella?
Secondary bacterial infections Pneumonia Encephalitis Hospitalization Death
What is the varicella vaccine and what is the dose?
Varivax (Merck)-a live attenuated vaccine
Dosing:
Children: 1st dose 12-15 months & 2nd at 4-6 years
Adolescents/adults: 2 doses at least 4 weeks apart
Dose: 0.5 ml subcutaneously
What are complications of mumps?
CNS involvement
Orchitis (up to 50% in post pubescent males)
Deafness
Death
What are the symptoms of mumps?
Headache, fever, rash, malaise
Parotitis (30-40% of cases)
What is the dosing of MMR and MMRV?
Children: 1st dose at 12 months and 2nd dose at 4 to 6 years of age (any doses prior to 12 months are not valid and should be repeated)
For adults, adolescents (or children needing catch-up) at least 4 week spacing is needed between two doses
What is the target group for MMR?
Health care personnel
College students
International travelers
Non-pregnant females of child-bearing age without evidence of immunity
Adults born in or after 1957 who have not been vaccinated
What is the HPV vaccine dose and age?
Recommended for 11-12 years of age (can start as early as 9 years) Dosage Regimen: First dose: now Second dose: 1-2 months after 1st dose Third dose: 6 months after 1st dose
When can you give HPV if not given at 11-12?
Females ages 13 through 26 years
Males ages 13 through 21
or through age 26 for men who have sex with men and for immunocompromised (including HIV)
What is cervaix?
bivalent 16 and 18, females 9-26, males NA
What is gardasil?
quadrivalent 6, 11, 16, 18, females 9-26. males 9-21 (to 26 for high risk)
What is gardasil 9?
9 valent, females 9-26 and males 9-15
What are the target population for Hib?
Infants/young children (2 or 3 doses)
Asplenic adults or scheduled for splenectomy (14 days prior) 1 dose
Children > 60 months=1 dose
Immunosuppression from cancer chemotherapy/radiation or stem cell transplants=1 dose
What are the vaccines for Hib and dose?
Three vaccines (all conjugated) ActHIB (Sanofi Pasteur) PedvaxHIB (Merck) Hiberix (GSK) Only approved for booster dose Dose= 0.5 ml I.M.
What is the vaccine for polio and dose and target groups?
IPOL (Sanofi Pasteur)
Dose = 0.5 ml IM or subcutaneous
Target groups:
All infants dosed at 2, 4, 6-18 months, and 4-6 years
Adult international travelers to endemic areas
Keep vaccinating to eradicate the disease
What is the IM site for infants?
anterolateral thigh
Where do you give IM for >3 yo and adults?
deltoid muscle
What do you need to remember for deltoid muscle?
dont inject too high
What needle for IM for Men and women less than 60 kg (less than 130 lb)?
1 inch
What needle for IM for Women 60–90 kg (130–200 lb)
Men 60–118 kg (130–260 lb)
1-1.5 inches
What needle for Women more than 90 kg (more than 200 lb)
Men more than 118 kg (more than 260 lb)
1½ inches
What needle for IM for kids?
⅝–1¼ inches
How do you give IM?
The patient should be seated Uncover area Wipe with alcohol and let alcohol dry Tell patient to relax Insert needle at 90° to skin in a smooth controlled motion while bracing against the arm Depress the plunger Withdraw the needle swiftly Activate safety device immediately Dispose of syringe in sharps container Press cotton or gauze and tape to patient Wash hands
What are sub Q vaccine?
⅝ inch
23–25 gauge
Insert at 45° angle
How do you do subq vaccine?
The patient should be seated Uncover area Wipe with alcohol and let alcohol dry Tell patient to relax Pinch fold of skin Insert needle at 45° angle to skin while bracing against the arm Depress the plunger Withdraw needle swiftly Activate safety device immediately Dispose of syringe in sharps container Press cotton or gauze and tape to patient Wash hands
Where do you do subq?
back of arm and pinch
What are clinical pearls for LAIV intranasal?
Provide patient with a tissue prior to administration
Instruct patient not to sniff or inhale spray
Insert tip of the sprayer just inside the nose and depress the plunger to spray half the dose into the first nostril
Remove the dose-divider clip; administer second dose in the other nostril
No need to repeat if sneezing or coughing occur
With absence of data people make up their minds about something
Belief-dependent realism
