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Pedi Exam 1 > Immunizations > Flashcards

Immunizations Flashcards

1
Q

Immunization definition

A

The process by which a person becomes protected against a disease
Process confers protection then that protection is called immunity

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2
Q

Vax approval process: Phase 1

A

Initial human studies for safety and immunogenicity
Performed on a small number of people who are very closely monitored
All volunteers

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3
Q

Vax approval process: Phase 2

A

Dose ranging studies
Continue to monitor the safety and immunogenicity of vaccines
Studying on a larger number of people (several hundred)

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4
Q

Vax approval process: Phase 3

A

Provides documentation of effectiveness and additional safety data that required for licensing (thousands of people)

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5
Q

Vax approval process: Phase 4

A

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

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6
Q

VICP (Vaccine injury compensation program)

A

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)

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7
Q

VAERS (Vaccine adverse event reporting system

A

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

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8
Q

Vaccine Information System (VIS)

A

Required to be given prior to receiving each dose of vaccine, allowing the parent to ask questions regarding vaccine before administration
Informed consent

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9
Q

Documentation with Vax administration

A

Lot number on the bottle
Where you administered it, which side
That you gave parent vaccine information statement
Date of VIS

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10
Q

ACIP (Advisory Committee in Immunization Practices)

A

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

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11
Q

ACIP Members

A

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

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12
Q

ACIP Meetings

A

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)

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13
Q

Immunity

A

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

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14
Q

Precautions with: IPV

A

Pregnancy

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15
Q

Active immunity

A

Protection from our own immune system
Produces humoral immunity (antibody) and cellular immunity
Permanent: Memory B cells will quickly activate antibodies when reinfected

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16
Q

Active immunity: Received:

A

Surviving infection by disease causing organism

Vaccination that produce an immune response and confer immunological memory

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17
Q

Passive immunity

A

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)

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18
Q

Live attenuated Vaccine

A

Produced by modifying a disease producing virus or bacteria

Organism retain the ability to replicate and produce immunity but does not cause illness

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19
Q

Inactive Vaccine

A

Produced from whole or fractions of viruses or bacteria

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20
Q

Inactive Vaccine: Whole

A

Made from entire organisms but inactivated

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21
Q

Inactive Vaccine: Fractional

A

Either protein or polysaccharide based

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22
Q

Diphtheria: Transmission

A

Respiratory droplet

Skin to skin

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23
Q

Diphtheria: Clinical features

A

Involve any mucus membrane, typically classified based on the site of infection
Interior nasal, pharyngeal, tonsillar

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24
Q

Diphtheria: Complications

A

Attributed to the toxin the bacteria produces causing neuritis and myocarditis
Death: 5-10%

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25
Q

Diphtheria: Vaccine

A

Recommended: 2, 4, 6 mo, and 15-18mo

Booster at 4-6 years

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26
Q

Tdap

A

Given 11-12 yr
Given to pregnant women with each pregnancy (pertussis)
Lower case letters are Half strength dose!!

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27
Q

DTap

A

Only given up to 7 yr old

Upper case letters means full strength dose!!

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28
Q

Tetanus: Transmission

A

Contaminated wounds
Tissue injury
Puncture wounds

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29
Q

Tetanus: Clinical Features

A

Local: not common
Cephalic: rare
Generalized: most common affecting the whole body

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30
Q

Tetanus: Vaccine

A

DTaP: Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap: Given 11-12 yr+

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31
Q

Pertussis: Vaccine

A

DTaP: Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap: Given 11-12 yr+

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32
Q

Tetanus: Generalized Symptoms

A

Descending from the head down, affecting the jaw “lock-jaw” (trismus), difficulty swallowing, muscle rigidity, spasms

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33
Q

Tetanus: Complications

A

Most common: Laryngospasms, HTN, contractures, pulmonary embolism, aspiration pneumonia, death

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34
Q

Tetanus: Vaccine

A

DTaP: Recommended: 2, 4, 6 mo, and 15-18mo
Booster at 4-6 years
Tdap: Given 11-12 yr+ and pregnancy

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35
Q

Pertussis: Transmission

A

Respiratory droplets

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36
Q

Pertussis: Incubation period

A

7-10 days

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37
Q

Pertussis: Clinical features

A

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

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38
Q

Pertussis: Complications

A

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

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39
Q

Pertussis: Vaccine

A

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

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40
Q

Polio (IPV): Vaccine

A

2, 4, 6-18mo

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41
Q

Varicella (Chicken pox): Complications

A 
Bacterial infection on the open lesions can become massively septic 
Pneumonia
CNS manifestations
Reyes syndrome
Death 
Amputation
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42
Q

Side Effect

A

Any health problem shown by studies to be caused by a vaccine (mostly minor)

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43
Q

Hepatitis B: Comlpication

A

Cirrhosis
Liver cancer
Death

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44
Q

Hepatitis B: Vaccine

A

1st dose at birth
2nd dose at 1-2 months
3rd dose at 6-18 months

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45
Q

Risk of getting Hep B

A

Babies develop a robust response when given at such a young age
2000-4000 americans die of chronic hep B each year

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46
Q

Hep B: Risk for infants

A

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

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47
Q

Hand, Foot and Mouth: Contagious for…

A

2-3wks after infection starts

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48
Q

How to talk about Vaccines to patients:

A

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

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49
Q

Hepatitis A: Clinical features

A

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

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50
Q

Hepatitis A: Complications

A

Liver failure

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51
Q

Hepatitis A: Vaccine

A

12 and 18 months

Must have 6 months between doses

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52
Q

Hib (Haemophilus Influenzae Type B): Transmission

A

Gram negative bacteria via respiratory droplet

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53
Q

Hib (Haemophilus Influenzae Type B): Clinical features

A

Meningitis: fever, decreased mental status, stiff neck, epiglottitis, cellulitis, septic arthritis, pneumonia, osteomyelitis, pericarditis

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54
Q

Hib (Haemophilus Influenzae Type B): Complications

A

Hearing impairment
Neurological impairment
death

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55
Q

Pneumococcal (PCV): Transmission

A

Respiratory droplet

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56
Q

Pneumococcal (PCV): Clinical features

A

Abrupt onset: fever, chills, pleuritic chest pain, productive cough, dyspnea, tachypnea, hypoxia

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57
Q

Pneumococcal (PCV): Complications

A

Pneumonia, bacteremia, meningitis

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58
Q

Pneumococcal (PCV): Vaccine

A

PCV13 (Prevnar) 2, 4, 6, 12-15 months

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59
Q

Rotavirus: Transmission

A

Fecal-oral

Very contagious

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60
Q

Rotavirus: Clinical features

A

Asymptomatic
Most often: vomiting, severe dehydration, diarrhea, fever
GI symptoms subside in 3-7 days

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61
Q

Rotavirus: Vaccine

A

Given PO

Replicates and shed in the stool

62
Q

Rotavirus: Vaccine recommendation

A

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

63
Q

Measles, Mumps, Rubella (MMR): Transmission

A

Respiratory

Airborne

64
Q

Measles, Mumps, Rubella (MMR): Incubation period

A

10-14 days

65
Q

Measles, Mumps, Rubella (MMR): Clinical features

A

Fever, runny nose, cough, rash, parotiditis (swelling of the parotid glands associated with mumps), HA, muscle aches

66
Q

Measles, Mumps, Rubella (MMR): Complications

A

Pneumonia, hearing loss, encephalitis, seizures, swelling of the testes that can lead to sterilization, pancreatitis, arthritis, death (especially measles and rubella)

67
Q

Measles, Mumps, Rubella (MMR): Vaccine

A

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

68
Q

Polio (IPV): Transmission

A

Fecal-oral
Oral-oral
Still in 3rd world countries

69
Q

Polio (IPV): Clinical features

A

Flaccid paralysis with asymmetrically diminished deep tendon reflexes, weakness, paralysis of certain muscles, possible death

70
Q

Polio (IPV): Vaccine

A

2, 4, 6-18mo

Booster at 4-6 yr

71
Q

Varicella (Chicken pox): Transmission

A

Airborne droplet

Direct contact with lesions

72
Q

Varicella (Chicken pox): Clinical features

A

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

73
Q

Varicella (Chicken pox): Vaccine

A

12mo

Booster at 4-6

74
Q

Meningococcal (MCVaccine): Transmission

A

Respiratory droplets

75
Q

Meningococcal (MCVaccine): Clinical features

A

Fever, Ha, stiff neck, photophobia, AMS, meningococcal sepsis (fever, petechial or purpuric rash, hypotension, leading to organ failure)

76
Q

Meningococcal (MCVaccine): Complications

A

Brain damage, hearing loss, hydrocephalus, myocarditis, seizures

77
Q

Meningococcal (MCVaccine): Vaccine

A

Covers: A, C, W, Y
11-12 yr old
Booster at 16yr

78
Q

Meningococcal (MCVaccine): Highest risk

A

Between 17-21yr old

79
Q

Meningococcus B Vaccine

A

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

80
Q

Human Papillomavirus (HPV): Transmission

A

Direct sexual contact

81
Q

Human Papillomavirus (HPV): Clinical features

A

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

82
Q

Human Papillomavirus (HPV): Vaccine

A

11-12 yr old
Have immunological response
Given at this age before they become sexually active

83
Q

Seasonal Influenza: Transmission

A

Droplet

Direct or indirect contact

84
Q

Seasonal Influenza: Clinical features

A

Abrupt onset: high fever, fatigue, sore throat, non-productive cough, HA

85
Q

Seasonal Influenza: Complications

A

Pneumonia
Reyes syndrome
Myocarditis
Death

86
Q

Seasonal Influenza: Vaccine

A

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

87
Q

Seasonal Influenza: Live virus vaccine

A

nose spray

88
Q

Vaccination Route: IM

A

Majority of vax

89
Q

Vaccination Route: Oral

A

Rotavirus

90
Q

Vaccination Route: SC

A

MMR, Varicella, IPV

91
Q

Vaccination Route: Intranasal

A

Intranasal Flu

92
Q

Vaccination Route: Intradermal

A

not in children

93
Q

IM: Use size

A

22-25 gauge

94
Q

IM: Newborn

A

less than 1 month old: 5/8th in needle

Anterolateral thigh muscle (vastus lateralis)

95
Q

IM: Infant

A

1 in needle

Anterolateral thigh muscle (vastus lateralis)

96
Q

IM: Toddler-Teens

A

1-1.25in needle: Anterolateral thigh muscle (vastus lateralis)
or
5/8th -1in needle: deltoid

97
Q

SC: Use size

A

23-25 gauge

5/8th in needle

98
Q

SC: <12 months (infants)

A

fatty tissue over anterolateral thigh muscle and upper outer triceps if needed

99
Q

SC: ≥ 12 months

A

fatty tissue over anterolateral thigh muscle and upper outer triceps if needed

100
Q

Vaccine Precautions:

A

Weigh the risk v benefit of using the vaccine

101
Q

Vaccine Contraindications

A

Will cause the patient harm

102
Q

Precautions with: DTap, DT, Td, Tdap

A

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

103
Q

Precautions with: Rotavirus

A 
Altered immunocompetence
Moderate to severe acute gastroenteritis
Moderate to severe febrile illness
Chronic GI disease
Intussusception
104
Q

Precautions with: MMR (Live)

A

Recent IgG administration (should not be given for 3-6mo if IgG first, MMR first then wait 2 weeks for IgG)
Thrombocytopenia, thrombocytopenic purpura

105
Q

Precautions with: Varicella (live)

A

Recent IgG administration

Same as MMR

106
Q

Precautions with: PCV

A

Moderate to severe illness with or without fever

PPSV within last 2months

107
Q

Precautions with: Hep B

A

Perterm birth (baby needs to be at least 2000 grams)

108
Q

Precautions with: Seasonal Influenza

A

GBS within 6wk of pervious dose

109
Q

Precautions with: Hep B

A

Preterm birth (baby needs to be at least 2000 grams)

110
Q

How to talk about Vaccines to patients:

A

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

111
Q

Contraindication with: DTap, DT, Td, Tdap

A

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

112
Q

Contraindication with: Rotavirus

A

Severe allergic reaction after previous dose
Infants born to HIV + mother
Known or weakened immune system

113
Q

Contraindication with: IPV

A

Anaphylactic reaction to neomycin or streptomycin

114
Q

Contraindication with: MMR (live)

A

Pregnancy (because the MMR is a live virus vaccine)

Known altered immunodeficiency

115
Q

Contraindication with: Varicella (live)

A 
Severe allergic reaction after previous dose 
HIV
Immunodeficiency
Pregnancy
High dose of corticosteroid use
116
Q

Contraindication with: PCV

A

Severe allergic reaction a a previous dose

117
Q

Contraindication with: Hep B

A

Anaphylactic reaction to common baker’s yeast (is a component of the vaccine)

118
Q

Contraindication with: Hep A

A

Anaphylactic reaction to vaccine

Moderate to severe illness with or without fever

119
Q

Contraindication with: Seasonal Influenza

A 
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
120
Q

Contraindication with: MCV

A

Allergy to vaccine component

History of GBS

121
Q

Contraindication with: HPV

A

Pregnancy

Hypersensitivity to yeast or any vaccine component

122
Q

Chemotherapy & Vaccines

A

Up to the provider
Dependent on the CD4 count and the T lymphocyte levels
Try to give vax before the chemo

123
Q

Steroids & Vaccines

A

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

124
Q

Bone marrow transplant & Vaccines

A

Immunosuppressed before getting the transplant to prevent adverse reaction
Revaccination will happen about 6mo after transplant

125
Q

IgG therapy & Vaccines

A

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

126
Q

IgG therapy & Vaccines simultaneous administration

A

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.

127
Q

Immunocompromised household member or close contacts & Vaccines

A

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

128
Q

COVID: Transmission

A

Respiratory Droplet

129
Q

COVID: Clinical features

A

Fever, chills, SOB, fatigue, muscle ache, HA, loss of taste or smell, sore throat, congestion or runny nose, N/V/D

130
Q

COVID: Complication

A

Multisystem Inflammatory Syndrome in children

131
Q

COVID: Vaccine

A

Pfizer for those 12 and older

132
Q

Conjunctivitis (Pink eye): Cause: bacteria

A

Characterized by large amounts of purulent discharge

Caused from Staph, Strep, Haemophilus, or Pseudomonas organisms. Treat with antibiotic.

133
Q

Conjunctivitis (Pink eye): Cause: Viral

A

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

134
Q

Conjunctivitis (Pink eye): Allergic

A

Redness, cobblestone look to the eyelid, thin watery discharge

135
Q

Conjunctivitis (Pink eye): Non pharmacological treatment

A

Warm, wet compress to soothe the eye

136
Q

Strep throat: Cause

A

Group A Beta Hemolytic Streptococci

137
Q

Strep throat: Clinical manifestations

A

Abrupt onset: sore throat, HA, fever, abdominal pain, enlarged tonsils or cervical nodes, and
beefy red throat.

138
Q

Strep throat: Complications

A

Rheumatic Fever (usually results from an untreated Strep throat infection and may not present for
6-9 weeks after initial infection)
Acute Glomerulonephritis

139
Q

Strep throat: Treatment

A

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

140
Q

Fifth Disease: Cause

A

Human Parvovirus B19

Transmitted by respiratory secretions or blood

141
Q

Fifth Disease: Clinical manifestations

A

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.

142
Q

Fifth Disease: Most contagious

A

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.

143
Q

Fifth Disease: Most critical complication

A

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

144
Q

Fifth Disease: Pregnancy

A

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.

145
Q

Impetigo: Manifestation

A

Honey colored crust

Red macule that becomes vesicular that rupture easily and dry with a honey colored crust

146
Q

Impetigo: Management

A

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

147
Q

Impetigo: Biggest complication

A

Glomerulonephritis

148
Q

Hand, Foot and Mouth: Transmission

A

Viral (most commonly by Coxsackievirus A16 or Enterovirus 71)
Common <5yr
Most frequently in the summer and fall

149
Q

Hand, Foot and Mouth: Symptoms

A

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.

150
Q

Hand, Foot and Mouth: Treatment

A

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)

151
Q

How to talk about Vaccines to patients:

A

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

152
Q

Fifths Disease: Complication

A

Aplastic crisis in patients who have Sickle cell anemia

Pedi Exam 1 (18 decks)

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