Immunization/Vaccination Flashcards
1
Q
A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response
A
Antigen
2
Q
A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response
A
Antigen
3
Q
Protein molecules (immunoglobulins) produce by B lymphocytes to help eliminate antigen
A
Antibody
4
Q
“Self”: protection produced by the person’s own immune system
Permanent or long-lasting
A
Active immunity
5
Q
“Non-self”: antibody transferred from another person or animal
A
Passive immunity
6
Q
What are the benefits of vaccination?
A
Protection from symptomatic disease
Improved Quality of Life (QOL)
Improved productivity
Prevention of death
7
Q
What is ACIP?
A
Advisory Committee on Immunization Practices
health experts that advise CDC on vaccine schedule
8
Q
What are the two classification of vaccines?
A
live attenuated or inactivated
9
Q
What are the characteristic of live attenuated vaccines?
A
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
10
Q
What are the characteristics of inactivated vaccines?
A
cannot replicate, minimal interference from ab, generally requires multiple doses, Ab levels will fall over time
11
Q
What is the rule for increasing intervals btw doses?
A
interval does not decrease effectiveness
12
Q
What is the rule for decreasing the interval btw doses?
A
Decreasing the interval between doses of a multi-dose vaccine may interfere with antibody response or increase frequency and severity of adverse reactions
13
Q
What is the rule for simultaneous administration?
A
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)
14
Q
What is the exception to simultaneous administration?
A
asplenic chidren pneumococcal conjugate and meningococcal vaccine >4 wk apart
15
Q
What is the spacing of vaccines not given simultaneously?
A
2 live injected vacines - minimal 4 wks apart
16
Q
What is the adverse reaction?
A
Extraneous reaction caused by vaccine
“side effect”
17
Q
What is adverse event?
A
Any event following a vaccine
May be true adverse reaction
May be only coincidental
18
Q
What are some examples of local adverse reactions?
A
Pain, swelling, redness at the site of injection
More common with inactivated vaccines
Usually mild and self limited
19
Q
What are some examples of systemic adverse reactions?
A
Fever, malaise, headache
Nonspecific
May be unrelated to vaccine
More common with attenuated vaccines
20
Q
What is the allergic adverse reaction examples?
A
Due to vaccine or vaccine component
Rare (1/500,000)
Risk minimized by screening
21
Q
A condition in a recipient which greatly increases the chance of a serious adverse reaction.
A
Contraindication
22
Q
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
A
Precaution
23
Q
When should live vaccines not be given?
A
women known to be pregnant, severely immunosuppressed
24
Q
What vaccine should be deferred during pregnancy?
A
HPV
25
What are disease that cause immunosuppression?
Congenital immunodeficiency
Leukemia or lymphoma
Generalized malignancy
26
What is chemotherapy that causes immunosuppression?
Alkylating agents
Antimetabolites
Radiation
27
How does steroid cause immunosuppression (dose)?
Corticosteroids
> 20 mg per day (prednisone)
> 2 mg/kg per day
28
What is the timeline to not give vaccines with steroid use from aerosols, topicals, alternate day, short course?
29
What are features of type A influenza?
moderate to severe illness
- all age groups
- humans and animals
30
What are the features of type B influenza?
milder disease
humans only
primarily effects children
31
What are the features of type C influenza?
rarely reported in humans
| no epidemics
32
What allows for influenza attachment and entry?
H1-H16 hemagglutinins
| target of neutralizing antibody
33
What allows the (cell explodes) spread of virus influenza?
N1-N9 neuraminidase
| Target of neuraminidase inhibitors --oseltamivir (Tamiflu) and zanamivir (Relenza)
34
What is influenza has shift?
type A only, major change, new type - may cause pandemic
35
What does antigen drift cause?
minor changes, same subtype, may cause epidemic
36
What causes epidemic?
drift
37
What causes pandemic?
shift
38
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
39
What are the complications of influenza?
```
Pneumonia
Primary influenza
Secondary bacterial
Reye Syndrome
Myocarditis
```
40
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
41
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)
```
42
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
43
What are the adverse reactions of influenza vaccine?
local reactions - 15-20%
fever, malaise - uncommon
allergic rxn - rare
neurological - very rare
44
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)
45
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
46
What are the local and systemic side effects of fluzone-high dose?
Similar systemic
| Local—10% higher pain; 4% higher erythema & swelling
47
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
```
48
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)
49
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)
50
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
51
What are adverse reactions of flumist?
Cough, runny nose, nasal congestion
Sore throat, irritability, headache, chills
Vomiting, muscle aches, malaise, fever
52
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
```
53
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
54
What is the newest flu vaccine?
flublok - not egg based, no perservatives, for 18-49 yo
| Flucelvax - adults 18+, grow mammalian cells
55
Healthy primary care PA (32 y/o); no contraindications
| IIV or LAIV
either as long as not caring for immunocompromised
56
38 y/o patient with diabetes
| IIV or LAIV
IIV
57
4 y/o healthy child with no contraindications
| IIV or LAIV
either
58
Pregnant patient with no contraindications
| IIV or LAIV
IIV
59
66 y/o patient who needs pneumococcal and zoster vaccines simultaneously with influenza vaccine
IIV or LAIV
IIV
60
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
61
What are the pneumococcal disease?
pneumonia, bacteremia, meningitis
62
What is the vaccine for pneumococcal?
pneumovax 23
63
What are features of pneumovax 23?
Not effective in children
64
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
```
65
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
66
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
67
What is the dose for PCV-13?
0.5 mL given IM
68
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
69
What causes meningococcal disease?
neisseria meningitidis
leading cause of bacterial meningitis and sepsis
B most common in infants
70
How is n. meningitidis transmitted?
airborne droplets, nasopharynx secretions
71
What is MPSV4 (meningococcal polysaccharide vaccine?
Quadrivalent: A, C, Y, W-135 (Menomune)
Dose = 0.5 mL subcutaneous
Not effective in children
72
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
```
73
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 +
74
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
75
All polysaccharide vaccines don't work in?
kids
76
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
77
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
78
What are the hepatitis A vaccine?
Inactivated whole virus
HAVRIX (GlaxoSmithKline)
VAQTA (Merck Vaccine Division)
79
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
80
What do you give to college age students for meningococcal?
booster dose
81
What are the characteristic of hep b?
human host
can live 7 days at RT
cause chronic hepatitis and cirrhosis
human carcinogen - hepatocellular carcinomas
82
What are the target groups for hep b vaccine?
infants, unvaccinated adolescents
83
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
84
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
85
Protein molecules (immunoglobulins) produce by B lymphocytes to help eliminate antigen
Antibody
86
“Self”: protection produced by the person’s own immune system
Permanent or long-lasting
Active immunity
87
“Non-self”: antibody transferred from another person or animal
Passive immunity
88
What are the benefits of vaccination?
Protection from symptomatic disease
Improved Quality of Life (QOL)
Improved productivity
Prevention of death
89
What is ACIP?
Advisory Committee on Immunization Practices
| health experts that advise CDC on vaccine schedule
90
What are the two classification of vaccines?
live attenuated or inactivated
91
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
92
What are the characteristics of inactivated vaccines?
cannot replicate, minimal interference from ab, generally requires multiple doses, Ab levels will fall over time
93
What is the rule for increasing intervals btw doses?
interval does not decrease effectiveness
94
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
95
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)
96
What is the exception to simultaneous administration?
asplenic chidren pneumococcal conjugate and meningococcal vaccine >4 wk apart
97
What is the spacing of vaccines not given simultaneously?
2 live injected vacines - minimal 4 wks apart
98
What is the adverse reaction?
Extraneous reaction caused by vaccine
| “side effect”
99
What is adverse event?
Any event following a vaccine
May be true adverse reaction
May be only coincidental
100
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
101
What are some examples of systemic adverse reactions?
Fever, malaise, headache
Nonspecific
May be unrelated to vaccine
More common with attenuated vaccines
102
What is the allergic adverse reaction examples?
Due to vaccine or vaccine component
Rare (1/500,000)
Risk minimized by screening
103
A condition in a recipient which greatly increases the chance of a serious adverse reaction.
Contraindication
104
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
105
When should live vaccines not be given?
women known to be pregnant, severely immunosuppressed
106
What vaccine should be deferred during pregnancy?
HPV
107
What are disease that cause immunosuppression?
Congenital immunodeficiency
Leukemia or lymphoma
Generalized malignancy
108
What is chemotherapy that causes immunosuppression?
Alkylating agents
Antimetabolites
Radiation
109
How does steroid cause immunosuppression (dose)?
Corticosteroids
> 20 mg per day (prednisone)
> 2 mg/kg per day
110
What is the timeline to not give vaccines with steroid use from aerosols, topicals, alternate day, short course?
111
What are features of type A influenza?
moderate to severe illness
- all age groups
- humans and animals
112
What are the features of type B influenza?
milder disease
humans only
primarily effects children
113
What are the features of type C influenza?
rarely reported in humans
| no epidemics
114
What allows for influenza attachment and entry?
H1-H16 hemagglutinins
| target of neutralizing antibody
115
What allows the (cell explodes) spread of virus influenza?
N1-N9 neuraminidase
| Target of neuraminidase inhibitors --oseltamivir (Tamiflu) and zanamivir (Relenza)
116
What is influenza has shift?
type A only, major change, new type - may cause pandemic
117
What does antigen drift cause?
minor changes, same subtype, may cause epidemic
118
What causes epidemic?
drift
119
What is gardasil 9?
9 valent, females 9-26 and males 9-15
120
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
121
What are the complications of influenza?
```
Pneumonia
Primary influenza
Secondary bacterial
Reye Syndrome
Myocarditis
```
122
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
123
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)
```
124
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
125
What are the adverse reactions of influenza vaccine?
local reactions - 15-20%
fever, malaise - uncommon
allergic rxn - rare
neurological - very rare
126
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)
127
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
128
What are the local and systemic side effects of fluzone-high dose?
Similar systemic
| Local—10% higher pain; 4% higher erythema & swelling
129
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
```
130
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)
131
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)
132
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
133
What are adverse reactions of flumist?
Cough, runny nose, nasal congestion
Sore throat, irritability, headache, chills
Vomiting, muscle aches, malaise, fever
134
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
```
135
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
136
What is the newest flu vaccine?
flublok - not egg based, no perservatives, for 18-49 yo
| Flucelvax - adults 18+, grow mammalian cells
137
Healthy primary care PA (32 y/o); no contraindications
| IIV or LAIV
either as long as not caring for immunocompromised
138
38 y/o patient with diabetes
| IIV or LAIV
IIV
139
4 y/o healthy child with no contraindications
| IIV or LAIV
either
140
Pregnant patient with no contraindications
| IIV or LAIV
IIV
141
66 y/o patient who needs pneumococcal and zoster vaccines simultaneously with influenza vaccine
IIV or LAIV
IIV
142
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
143
What are the pneumococcal disease?
pneumonia, bacteremia, meningitis
144
What is the vaccine for pneumococcal?
pneumovax 23
145
What are features of pneumovax 23?
Not effective in children
146
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
```
147
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
148
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
149
What is the dose for PCV-13?
0.5 mL given IM
150
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
151
What causes meningococcal disease?
neisseria meningitidis
leading cause of bacterial meningitis and sepsis
B most common in infants
152
How is n. meningitidis transmitted?
airborne droplets, nasopharynx secretions
153
What is MPSV4 (meningococcal polysaccharide vaccine?
Quadrivalent: A, C, Y, W-135 (Menomune)
Dose = 0.5 mL subcutaneous
Not effective in children
154
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
```
155
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 +
156
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
157
All polysaccharide vaccines don't work in?
kids
158
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
159
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
160
What are the hepatitis A vaccine?
Inactivated whole virus
HAVRIX (GlaxoSmithKline)
VAQTA (Merck Vaccine Division)
161
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
162
What do you give to college age students for meningococcal?
booster dose
163
What are the characteristic of hep b?
human host
can live 7 days at RT
cause chronic hepatitis and cirrhosis
human carcinogen - hepatocellular carcinomas
164
What are the target groups for hep b vaccine?
infants, unvaccinated adolescents
165
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
```
166
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
167
What is duration of immunity in hepatitis B?
>20 yr
168
How many doses for hep B vaccine?
3 Doses (0, 1, and 6 months)
169
What are all hep B vaccines?
IM
170
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)
```
171
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
172
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
173
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
174
What is diphtheria?
Aerobic, gram-positive bacillus
Occurrence rare in U.S.
Still seen worldwide, even in some developed countries
175
How diphtheria spread?
resp, mucous membrane
176
What are complications of diphtheria toxin?
```
Myocarditis & neuritis most common
Respiratory complications (5-10% death rate
```
177
What is pertussis?
highly contagious resp disease, whole cell vaccine
178
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
179
What are the complications of pertussis?
Pneumonia, seizures, encephalopathy, hypoxia, death
180
What is the 2011 vaccine recommendation for pertussis?
vaccinate all who will have close contact with infants
181
What is the reasons for pertussis increase in cases?
Clusters of unvaccinated children
| Waning protection offered by acellular pertussis
182
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
183
What are the tetanus and diphtheria vaccines?
```
Td = Tetanus toxoid
DTaP = Infanrix, Daptacel (children
```
184
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
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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
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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)
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What is herpes zoster associated with?
aging
immunosuppression
intrauterine exposure
varicella at younger than 18 months of age
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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
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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
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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
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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
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What are complications of varicella?
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Secondary bacterial infections
Pneumonia
Encephalitis
Hospitalization
Death
```
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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
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What are complications of mumps?
CNS involvement
Orchitis (up to 50% in post pubescent males)
Deafness
Death
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What are the symptoms of mumps?
Headache, fever, rash, malaise
| Parotitis (30-40% of cases)
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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
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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
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What is the HPV vaccine dose and age?
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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
```
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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)
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What is cervaix?
bivalent 16 and 18, females 9-26, males NA
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What is gardasil?
quadrivalent 6, 11, 16, 18, females 9-26. males 9-21 (to 26 for high risk)
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What is gardasil 9?
9 valent, females 9-26 and males 9-15
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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
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What are the vaccines for Hib and dose?
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Three vaccines (all conjugated)
ActHIB (Sanofi Pasteur)
PedvaxHIB (Merck)
Hiberix (GSK)
Only approved for booster dose
Dose= 0.5 ml I.M.
```
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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
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What is the IM site for infants?
anterolateral thigh
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Where do you give IM for >3 yo and adults?
deltoid muscle
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What do you need to remember for deltoid muscle?
dont inject too high
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What needle for IM for Men and women less than 60 kg (less than 130 lb)?
1 inch
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What needle for IM for Women 60–90 kg (130–200 lb)
Men 60–118 kg (130–260 lb)
1-1.5 inches
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What needle for Women more than 90 kg (more than 200 lb)
Men more than 118 kg (more than 260 lb)
1½ inches
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What needle for IM for kids?
⅝–1¼ inches
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How do you give IM?
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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
```
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What are sub Q vaccine?
⅝ inch
23–25 gauge
Insert at 45° angle
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How do you do subq vaccine?
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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
```
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Where do you do subq?
back of arm and pinch
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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
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With absence of data people make up their minds about something
Belief-dependent realism
