Immunizations Flashcards
Immunization definition
The process by which a person becomes protected against a disease
Process confers protection then that protection is called immunity
Vax approval process: Phase 1
Initial human studies for safety and immunogenicity
Performed on a small number of people who are very closely monitored
All volunteers
Vax approval process: Phase 2
Dose ranging studies
Continue to monitor the safety and immunogenicity of vaccines
Studying on a larger number of people (several hundred)
Vax approval process: Phase 3
Provides documentation of effectiveness and additional safety data that required for licensing (thousands of people)
Vax approval process: Phase 4
Formal studies on a vaccine onceit is out on the market
Can be administered to anyone
FDA will continue to monitor everyone who receives vaccine for A/E
VICP (Vaccine injury compensation program)
People used to think that their children were getting harmed by vax and would sue pharmaceutical companies
These companies stopped making the Vax
We were at risk for vax shortage
This program says that the government compensates the people who have been found (through a court system) to really have been harmed.
(All vax on the childhood schedule are covered)
VAERS (Vaccine adverse event reporting system
Government relies on this system through which they identify problems after the marketing process begins
A way to report reactions and or adverse effects (anything!!!)
This is a public nationwide database to find trends
Vaccine Information System (VIS)
Required to be given prior to receiving each dose of vaccine, allowing the parent to ask questions regarding vaccine before administration
Informed consent
Documentation with Vax administration
Lot number on the bottle
Where you administered it, which side
That you gave parent vaccine information statement
Date of VIS
ACIP (Advisory Committee in Immunization Practices)
A group of individuals that look at all possible evidence available on this particular vaccine to determine whether it should be recommended as a routine vaccination
ACIP Members
Medical and public health experts
15 voting members
14/15 are Vaccinology, immunology, pediatrics, internal medicine, nursing, family med, virology, public health, and preventative medicine
1/15 is the consumer (regular person)
8 more: ex-officio: represent federal government
30 more non-voting members: liaison organization that help bring immunization expertise
ACIP Meetings
3 meetings each year
Broadcasted on the web
You can attend in person but must go through clearance
Participate in work groups broken up by specific preventable disease (work all year round)
Immunity
to tolerate self and eliminate anything it considers foreign or “non-self”
Give protection from infectious disease, since microbe identified as foreign by the immune system
Precautions with: IPV
Pregnancy
Active immunity
Protection from our own immune system
Produces humoral immunity (antibody) and cellular immunity
Permanent: Memory B cells will quickly activate antibodies when reinfected
Active immunity: Received:
Surviving infection by disease causing organism
Vaccination that produce an immune response and confer immunological memory
Passive immunity
Protection from another
Mom to baby (we don’t give MMR to babies <1yr) - during the last 1-2 mo of pregnancy
Breastfeeding
Temporary (Synagis must be given every 30 days)
Live attenuated Vaccine
Produced by modifying a disease producing virus or bacteria
Organism retain the ability to replicate and produce immunity but does not cause illness
Inactive Vaccine
Produced from whole or fractions of viruses or bacteria
Inactive Vaccine: Whole
Made from entire organisms but inactivated
Inactive Vaccine: Fractional
Either protein or polysaccharide based
Diphtheria: Transmission
Respiratory droplet
Skin to skin
Diphtheria: Clinical features
Involve any mucus membrane, typically classified based on the site of infection
Interior nasal, pharyngeal, tonsillar
Diphtheria: Complications
Attributed to the toxin the bacteria produces causing neuritis and myocarditis
Death: 5-10%
Diphtheria: Vaccine
Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap
Given 11-12 yr
Given to pregnant women with each pregnancy (pertussis)
Lower case letters are Half strength dose!!
DTap
Only given up to 7 yr old
Upper case letters means full strength dose!!
Tetanus: Transmission
Contaminated wounds
Tissue injury
Puncture wounds
Tetanus: Clinical Features
Local: not common
Cephalic: rare
Generalized: most common affecting the whole body
Tetanus: Vaccine
DTaP: Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap: Given 11-12 yr+
Pertussis: Vaccine
DTaP: Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap: Given 11-12 yr+
Tetanus: Generalized Symptoms
Descending from the head down, affecting the jaw “lock-jaw” (trismus), difficulty swallowing, muscle rigidity, spasms
Tetanus: Complications
Most common: Laryngospasms, HTN, contractures, pulmonary embolism, aspiration pneumonia, death
Tetanus: Vaccine
DTaP: Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap: Given 11-12 yr+ and pregnancy
Pertussis: Transmission
Respiratory droplets
Pertussis: Incubation period
7-10 days
Pertussis: Clinical features
Mild: insidious onset, runny nose, fever, non-specific cough that progresses to rapid coughing fits with a high pitch whooping sound when they are trying tp catch their breath
Vomiting (caused by coughing fits)
Coughing can persist up to 10 weeks
Pertussis: Complications
Pneumonia, seizures, encephalopathy, death
The younger the child the more likely they might die
Rates are higher for infants <1 yr, highest in hispanics, next highest in 10-17 yr/o
Pertussis: Vaccine
DTaP: Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap: Given 11-12 yr+
Mothers and anyone commonly around are the most likely to give pertussis to the child
Polio (IPV): Vaccine
2, 4, 6-18mo
Varicella (Chicken pox): Complications
Bacterial infection on the open lesions can become massively septic Pneumonia CNS manifestations Reyes syndrome Death Amputation
Side Effect
Any health problem shown by studies to be caused by a vaccine (mostly minor)
Hepatitis B: Comlpication
Cirrhosis
Liver cancer
Death
Hepatitis B: Vaccine
1st dose at birth
2nd dose at 1-2 months
3rd dose at 6-18 months
Risk of getting Hep B
Babies develop a robust response when given at such a young age
2000-4000 americans die of chronic hep B each year
Hep B: Risk for infants
Once infected about 90% of infants will develop chronic Hep B
25% of those chronically infected will die from cirrhosis or liver cancer by age 5
Hand, Foot and Mouth: Contagious for…
2-3wks after infection starts
How to talk about Vaccines to patients:
CASE
Corroborate: Restate/acknowledge parents concerns
About Me: Tell then your education staus, experience with vaccines, why they should trust you…
Science: Proven that the flu vaccine cant give you the flu
Explain/Advise: Get vaccines on the schedule to protect against disease and that many are still out there
Hepatitis A: Clinical features
Abrupt onset of fever, malaise, anorexia, nausea, abdominal discomfort, passing of dar urine, jaundice
Children > 6 yr of age are usually asymptomatic
Older children and adults are symptomatic
Hepatitis A: Complications
Liver failure
Hepatitis A: Vaccine
12 and 18 months
Must have 6 months between doses
Hib (Haemophilus Influenzae Type B): Transmission
Gram negative bacteria via respiratory droplet
Hib (Haemophilus Influenzae Type B): Clinical features
Meningitis: fever, decreased mental status, stiff neck, epiglottitis, cellulitis, septic arthritis, pneumonia, osteomyelitis, pericarditis
Hib (Haemophilus Influenzae Type B): Complications
Hearing impairment
Neurological impairment
death
Pneumococcal (PCV): Transmission
Respiratory droplet
Pneumococcal (PCV): Clinical features
Abrupt onset: fever, chills, pleuritic chest pain, productive cough, dyspnea, tachypnea, hypoxia
Pneumococcal (PCV): Complications
Pneumonia, bacteremia, meningitis
Pneumococcal (PCV): Vaccine
PCV13 (Prevnar) 2, 4, 6, 12-15 months
Rotavirus: Transmission
Fecal-oral
Very contagious
Rotavirus: Clinical features
Asymptomatic
Most often: vomiting, severe dehydration, diarrhea, fever
GI symptoms subside in 3-7 days
Rotavirus: Vaccine
Given PO
Replicates and shed in the stool
Rotavirus: Vaccine recommendation
2, 4, 6 months
If the child comes in at 4 months and hasnt received any doses, they will not get any doses
Once the child is 8 months and hasnt received it they can no longer get it
Measles, Mumps, Rubella (MMR): Transmission
Respiratory
Airborne
Measles, Mumps, Rubella (MMR): Incubation period
10-14 days
Measles, Mumps, Rubella (MMR): Clinical features
Fever, runny nose, cough, rash, parotiditis (swelling of the parotid glands associated with mumps), HA, muscle aches
Measles, Mumps, Rubella (MMR): Complications
Pneumonia, hearing loss, encephalitis, seizures, swelling of the testes that can lead to sterilization, pancreatitis, arthritis, death (especially measles and rubella)
Measles, Mumps, Rubella (MMR): Vaccine
12 months
Booster at 4-6 years
1st dose not given unit after 1 yr old, the baby still has antibodies from the mother and the babies antibodies from mom will fight the vaccine
Polio (IPV): Transmission
Fecal-oral
Oral-oral
Still in 3rd world countries
Polio (IPV): Clinical features
Flaccid paralysis with asymmetrically diminished deep tendon reflexes, weakness, paralysis of certain muscles, possible death
Polio (IPV): Vaccine
2, 4, 6-18mo
Booster at 4-6 yr
Varicella (Chicken pox): Transmission
Airborne droplet
Direct contact with lesions
Varicella (Chicken pox): Clinical features
lesions (hallmark), rash are vesicles that contain fluid inside
The fluid is where the virus is and is whats contagious
Rash on the head, face, then thorax
Varicella (Chicken pox): Vaccine
12mo
Booster at 4-6
Meningococcal (MCVaccine): Transmission
Respiratory droplets
Meningococcal (MCVaccine): Clinical features
Fever, Ha, stiff neck, photophobia, AMS, meningococcal sepsis (fever, petechial or purpuric rash, hypotension, leading to organ failure)
Meningococcal (MCVaccine): Complications
Brain damage, hearing loss, hydrocephalus, myocarditis, seizures
Meningococcal (MCVaccine): Vaccine
Covers: A, C, W, Y
11-12 yr old
Booster at 16yr
Meningococcal (MCVaccine): Highest risk
Between 17-21yr old
Meningococcus B Vaccine
Newer
One of the 5-6 strains of the bacteria that can cause illness that is most severe in children
Not currently recommended for children
Human Papillomavirus (HPV): Transmission
Direct sexual contact
Human Papillomavirus (HPV): Clinical features
Asymptomatic
anogenital warts, recurrent respiratory papillomatosis (papule in the esophagus), cervical intraepithelial neoplasia (precursor for cervical cancer), full blown cervical, anal, vaginal, vulvar, penile, head or neck cancer
Human Papillomavirus (HPV): Vaccine
11-12 yr old
Have immunological response
Given at this age before they become sexually active
Seasonal Influenza: Transmission
Droplet
Direct or indirect contact
Seasonal Influenza: Clinical features
Abrupt onset: high fever, fatigue, sore throat, non-productive cough, HA
Seasonal Influenza: Complications
Pneumonia
Reyes syndrome
Myocarditis
Death
Seasonal Influenza: Vaccine
yearly to everyone over 6 mo
6mo-9yr the patient will get 2 doses 28-30 days apart, only for the first flu season they receive a flu shot
10+ year olds will only get 1 shot
Seasonal Influenza: Live virus vaccine
nose spray
Vaccination Route: IM
Majority of vax
Vaccination Route: Oral
Rotavirus
Vaccination Route: SC
MMR, Varicella, IPV
Vaccination Route: Intranasal
Intranasal Flu
Vaccination Route: Intradermal
not in children
IM: Use size
22-25 gauge
IM: Newborn
less than 1 month old: 5/8th in needle
Anterolateral thigh muscle (vastus lateralis)
IM: Infant
1 in needle
Anterolateral thigh muscle (vastus lateralis)
IM: Toddler-Teens
1-1.25in needle: Anterolateral thigh muscle (vastus lateralis)
or
5/8th -1in needle: deltoid
SC: Use size
23-25 gauge
5/8th in needle
SC: <12 months (infants)
fatty tissue over anterolateral thigh muscle and upper outer triceps if needed
SC: ≥ 12 months
fatty tissue over anterolateral thigh muscle and upper outer triceps if needed
Vaccine Precautions:
Weigh the risk v benefit of using the vaccine
Vaccine Contraindications
Will cause the patient harm
Precautions with: DTap, DT, Td, Tdap
Fever ≥ 105 with in 48hr of prior dose
Collapse or shock like state
Seizures within 3 days of prior dose
Inconsolable crying lasting ≥ 3hr within 48hr of prior dose
Precautions with: Rotavirus
Altered immunocompetence Moderate to severe acute gastroenteritis Moderate to severe febrile illness Chronic GI disease Intussusception
Precautions with: MMR (Live)
Recent IgG administration (should not be given for 3-6mo if IgG first, MMR first then wait 2 weeks for IgG)
Thrombocytopenia, thrombocytopenic purpura
Precautions with: Varicella (live)
Recent IgG administration
Same as MMR
Precautions with: PCV
Moderate to severe illness with or without fever
PPSV within last 2months
Precautions with: Hep B
Perterm birth (baby needs to be at least 2000 grams)
Precautions with: Seasonal Influenza
GBS within 6wk of pervious dose
Precautions with: Hep B
Preterm birth (baby needs to be at least 2000 grams)
How to talk about Vaccines to patients:
CASE
Corroborate: Restate/acknowledge parents concerns
About Me: Tell then your education status, experience with vaccines, why they should trust you…
Science: Proven that the flu vaccine cant give you the flu
Explain/Advise: Get vaccines on the schedule to protect against disease and that many are still out there
Contraindication with: DTap, DT, Td, Tdap
Encephalopathy within 7 days of previous dose
Allergic reaction to vaccine
Moderate to severe illness (when you think child needs to go to ER) with or without fever
GBS (Guilain Barre Syndrome) < 6 wk after previous dose…because the vaccine is most likely what’s caused the GBS
Contraindication with: Rotavirus
Severe allergic reaction after previous dose
Infants born to HIV + mother
Known or weakened immune system
Contraindication with: IPV
Anaphylactic reaction to neomycin or streptomycin
Contraindication with: MMR (live)
Pregnancy (because the MMR is a live virus vaccine)
Known altered immunodeficiency
Contraindication with: Varicella (live)
Severe allergic reaction after previous dose HIV Immunodeficiency Pregnancy High dose of corticosteroid use
Contraindication with: PCV
Severe allergic reaction a a previous dose
Contraindication with: Hep B
Anaphylactic reaction to common baker’s yeast (is a component of the vaccine)
Contraindication with: Hep A
Anaphylactic reaction to vaccine
Moderate to severe illness with or without fever
Contraindication with: Seasonal Influenza
Egg hypersensitivity (if they are able to have cooked eggs without reacting, then getting the seasonal flu shot is ok. If have an anaphylactic rxn to cooked eggs, they can get the shot as well but under supervision and specified conditions of an allergist) Severe allergic reaction to previous dose LAIV * (live attenuated influenza virus) is nasal. Not given to: children <2 years or > 49 years, immunodeficient, on long-term Aspirin therapy, history of GBS or asthma
Contraindication with: MCV
Allergy to vaccine component
History of GBS
Contraindication with: HPV
Pregnancy
Hypersensitivity to yeast or any vaccine component
Chemotherapy & Vaccines
Up to the provider
Dependent on the CD4 count and the T lymphocyte levels
Try to give vax before the chemo
Steroids & Vaccines
Been receiving corticosteroids at least 2 mg/kg/day for > 14 days, we’ll defer live virus vaccines for 1 month after they’ve stopped using them
Bone marrow transplant & Vaccines
Immunosuppressed before getting the transplant to prevent adverse reaction
Revaccination will happen about 6mo after transplant
IgG therapy & Vaccines
Can cause a diminished response to live vaccines.
IgG has been administered
first, then the MMR or other live virus vaccine shouldn’t be given for 3-6 months, depending of dose of IgG
received. If MMR is given first, then IgG shouldn’t be given for 2 weeks.
No waiting period after administering Synagis
IgG therapy & Vaccines simultaneous administration
Post-exposure of certain
diseases such as Hepatitis B (Hep B + HBIgG), Rabies, and Tetanus.
Post-exposure prophylaxis so
we’re trying to prevent the transmission from mom to baby.
Immunocompromised household member or close contacts & Vaccines
Any household member who is immunocompromised or is living with an immunocompromised child should receive all age appropriate vaccines, expect the smallpox vaccine (eradicated)
Only time we wouldn’t give a live virus flu vaccine to a person who lives with an immunocompromised patient is when that person is in need of being in a protective environment
Any of the contacts shouldn’t get the live virus vaccine, rather contacts would get the inactivated vaccine
COVID: Transmission
Respiratory Droplet
COVID: Clinical features
Fever, chills, SOB, fatigue, muscle ache, HA, loss of taste or smell, sore throat, congestion or runny nose, N/V/D
COVID: Complication
Multisystem Inflammatory Syndrome in children
COVID: Vaccine
Pfizer for those 12 and older
Conjunctivitis (Pink eye): Cause: bacteria
Characterized by large amounts of purulent discharge
Caused from Staph, Strep, Haemophilus, or Pseudomonas organisms. Treat with antibiotic.
Conjunctivitis (Pink eye): Cause: Viral
Characterized by redness and a small amount of discharge that isn’t purulent, along with intense itching- highly contagious.
Caused by Adenovirus, Picornavirus, Rubella, or Measles
Conjunctivitis (Pink eye): Allergic
Redness, cobblestone look to the eyelid, thin watery discharge
Conjunctivitis (Pink eye): Non pharmacological treatment
Warm, wet compress to soothe the eye
Strep throat: Cause
Group A Beta Hemolytic Streptococci
Strep throat: Clinical manifestations
Abrupt onset: sore throat, HA, fever, abdominal pain, enlarged tonsils or cervical nodes, and
beefy red throat.
Strep throat: Complications
Rheumatic Fever (usually results from an untreated Strep throat infection and may not present for
6-9 weeks after initial infection)
Acute Glomerulonephritis
Strep throat: Treatment
Antibiotics: Penicillin, if allergy then use Erythromycin
Considered not contagious 24hr after start of ABX
Need to complete ABX to prevent resistance
Change toothbrush after recovery
Fifth Disease: Cause
Human Parvovirus B19
Transmitted by respiratory secretions or blood
Fifth Disease: Clinical manifestations
Bright red cheeks occurs first. Then child will break out into a lacy rash that covers body, it
usually is seen on upper and lower extremities. It takes a while for the lacy rash to go away.
Fifth Disease: Most contagious
Before the slapped cheek and lacy rash appear
While they present only a clear runny nose,
low-grade temperature, and HA. So stopping the spread is very difficult.
Fifth Disease: Most critical complication
When a pregnant woman who has never had the disease becomes infected
during the first half of the pregnancy
Hydrops fetalis (fetal anemia) and intrauterine death
Fifth Disease: Pregnancy
Go to the OBGYN to see if you’ve had the disease before or not.
Test your
antibody levels.
If you have had it before then you’re ok and won’t come down with it.
If not, then you will be monitored closely.
Impetigo: Manifestation
Honey colored crust
Red macule that becomes vesicular that rupture easily and dry with a honey colored crust
Impetigo: Management
Apply a warm, moist compress several times during the day to remove crust
Topical ABX ointment will be prescribed after crust is removed
PO ABX
Impetigo: Biggest complication
Glomerulonephritis
Hand, Foot and Mouth: Transmission
Viral (most commonly by Coxsackievirus A16 or Enterovirus 71)
Common <5yr
Most frequently in the summer and fall
Hand, Foot and Mouth: Symptoms
Starts off with common cold symptoms such as fever, sore throat, runny nose, anorexia
Progresses to sores/blisters inside mouth/buccal/tongue area, skin rash on palms, top of hands, buttocks, and soles of feet.
Blisters usually clear out in 7 days.
May have vomiting and diarrhea.
Hand, Foot and Mouth: Treatment
Symptomatic treatment
Rest
Drink lots of fluids (water, milk, avoid acidic drinks- coffee, OJ, soda)
Offer soft foods
Popsicles such as Pedialyte pops numb the blisters
Tylenol and Ibuprofen for fever
Magic mouthwash (Lidocaine)
How to talk about Vaccines to patients:
CASE
Corroborate: Restate/acknowledge parents concerns
About Me: Tell then your education status, experience with vaccines, why they should trust you…
Science: Proven that the flu vaccine cant give you the flu
Explain/Advise: Get vaccines on the schedule to protect against disease and that many are still out there
Fifths Disease: Complication
Aplastic crisis in patients who have Sickle cell anemia
