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Immunizations- COVID and Others > Immunizations > Flashcards

Immunizations Flashcards

1
Q

Vaccine Information Statements (VIS) are prepared by the CDC for each vaccine to explain the benefits and risks. Federal law requires that the VIS be handed to the patient (or parent) before the vaccination is given. VIS can be found on..

A

the CDC and Immunization Action Coalition websites

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2
Q

Thimerosal is contained in some multi-dose flu vaccines; parents may request a single-dose flu vaccine that does not contain a preservative, or…

A

a multi-dose vaccine without thimerosal.

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3
Q

CDC’s Pink Book is a useful resource for details…

A

regarding immunology and immunizations

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4
Q

Live attenuated vaccines are most similar to the actual disease and produce a strong immune response to the vaccine, they are contraindicated in…

A

immunocompromised and pregnant patients since uncontrolled replication of the pathogen can occur

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5
Q

Polysaccharide vaccines do not produce a good immune response in children < 2 years of age. Ex.

A

Pneumococcal Polysaccharide Vaccine (Pneumovax 23)

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6
Q

Conjugate vaccines use polysaccharide (sugar) molecules from the outside layer of encapsulated bacteria and join the molecules to carrier proteins. Conjugation increases the immune response in infants, and the antibody booster response to multiple doses of vaccine.

A

Ex. Pneumococcal Conjugate Vaccine (Prevnar 13); Meningococcal Conjugate (Menactra, Menveo, MenQuadfi)

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7
Q

A gene segment of a protein from the organism is inserted into the gene of another cell, such as a yeast cell, where it replicates.

A

Ex. Human Papillomavirus Vaccine (Gardasil 9), Influenza Vaccine, Recombinant (FluBlok Quadrivalent)

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8
Q

The vaccine targets a toxin produced by the disease.

A

Ex. Diptheria Toxoid vaccine, Tetanus Toxoid vaccine

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9
Q

The vaccine gives instructions to the body’s cells (in the form of mRNA) to produce a protein specific to the pathogen which triggers an immune response.

A

Ex. select COVID-19 vaccines

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10
Q

Common Live Vaccines:

A
  • MMR
  • Intranasal Influenza
  • Cholera
  • Rotavirus
  • Oral Typhoid
  • Varicella
  • Yellow Fever
    Remember: MICRO-VY
    Others: Tuberculosis (BCG), Dengue, Smallpox, Ebola, Zoster (Zostavax)
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11
Q

The interval between an antibody-containing product and a measles, mumps and rubella-containing vaccine (MMR), or a varicella-containing vaccine (Varivax or MMRV) is a minimum of…

A

3 months and can be up to 11 months. Can CDC’s Pink Book can be consulted for recommendations.

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12
Q

Live vaccines can cause a false-negative result. Options to reduce the risk of a false-negative TST result include:

A
  1. Give the live vaccine on the same day as the skin test
  2. Wait 4 weeks after a live vaccine to perform the skin test
  3. Give the skin test first, wait 48-72 hours to get the result, then give the live vaccine
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13
Q

General rules for All Vaccines:

A
  • Vaccines can usually be given at the same time (same visit or same day)
  • Multiple live vaccines can be given on the same day (if not given on the same day, spaced 4 weeks apart**)
  • If a vaccine series requires > 1 dose, the intervals between doses can be extended without restarting the series, but they cannot be shortened in most cases.
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14
Q

Live Vaccines and Antibody. MMR and varicella-containing vaccines require separation from antibody-containing products (e.g. blood transfusions, IVIG). The recommended spacing is:

A
  • Vaccine –> 2 weeks –> antibody-containing product
  • Antibody-containing product —> 3 months or longer –> vaccine
  • Simultaneous administration of vaccine and antibody (in the form of immunoglobulin) is recommended for post-exposure prophylaxis of certain diseases (e.g. hepatitis A and B, rabies, and tetanus)
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15
Q

The patient should be monitored for at least 15 minutes after vaccination to:

A

watch for an allergic reaction, syncope, dizziness, or falls

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16
Q

Adverse reactions that require some type of assistance should be reported to…

A

the FDA’s Vaccine Adverse Event Reporting System (VAERS)

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17
Q

Witth live vaccines, mild systemic reactions can occur 3-21 days after the vaccine is given. Intranasal flu vaccine can…

A

replicate in the upper airways (nose and throat) and can cause mild cold-like symptoms such as a runny nose

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18
Q

Minor allergic reactions will resolve quickly and can be treated with…

A

diphenhydramine (OTC) or hydroxyzine (Rx)

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19
Q

Severe allergic reactions ar very rare (<1 in 500,000 doses). A severe reaction with analphylaxis can be life-threatening if not managed correctly. Anaphylactic reactions are IgE-mediated and can occur within…

A

30-60 minutes of receiving the vaccine. Symptoms can coccure hives, swelling of the mouth and throat, difficulty breathing, wheezing, abdominal cramping and hypotension or shock.

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20
Q

All providers who give vaccines must have emergency protocol and supplies to treat anaphylaxis. If symptoms are severe, a second person should activate EMS by calling 911. Care should be provided until EMS arrives:

A
  • For adults, give aqueous epinephrine 1 mg/mL (1:1000 dilution) intramuscularly, 0.01 mg/kg, up to a 0.5 mg max per dose. Most pharmacies use prefilled epinephrine auto-injectors. At least three adult (0.3 mg) auto-injectors should be available. Most adults will require 1-3 doses every 5-15 minutes.
  • Diphenhydramine can be given to reduce swelling and pruritus. Drugs cannot be given orally if airway swelling is present due to a risk of clotting.
  • The patient shoulld be placed in a supine position (flat on the back). Elevating the head will help breathng, but caution must be taken to keep the BP adequate. If the BP is low, elevate the legs only. Monitor the BP and pulse every 5 minutes.
  • Provide CPR, if necessary. Immunizing pharmacies need current BLS or CPR certification.
  • Record all vital signs and administered medications.
    The reaction shoud be reported to the patient’s primary care physician and to the FDA’s VAERS.
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21
Q

A severe or anaphylactic reaction following a dose of vaccine is a contraindication to…

A

any subsequent doses of that vaccine.

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22
Q

Vaccinations may be given, if indicated, in the following situations:

A
  • Mild acute illness (slight fever, mild diarrhea)
  • Current antimicrobial treatment (**some exceptions)
  • Previous local skin reaction (mild/moderate) from a vaccine
  • Allergies (bird feathers, penicillin, allergies to products not in the vaccine)
  • Pregnancy (except live vaccines), breastfeeding, preterm birth
  • Recent tuberculin skin test
  • Immunosuppressed person in the household, recent exposure to the disease or convalescence
  • Family history of adverse events to the vaccine
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23
Q

An annual influenze vaccine is recommended for…

A

all special groups (age ≥ 6 months)

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24
Q

Infants and Children should receive:

A
  • 3-dose hepatitis B vaccine started at birth
  • Other vaccine series start at age 2 months, including: Prevnar 13, DTaP, Hib, polio, rotavirus
  • Live vaccine seires generally start at age ≥ 12 mo, including: MMR, varicella
  • No polysaccharide vaccines before age 2 years
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25
Q

Adolescents and Young Adults:

A
  • Meningococcal vaccine (MCV4; Menactra, Menveo or MenQuadfi)
  • 2 doses: 1 dose at age 11-12 years and 1 dose at age 16 years
  • First-year college students in residential housing (if not previously vaccinated): 1 dose
  • HPV (recommdned at age 11-12 years; 2-3 doses (depending on age at start)
  • Tdap: first dose at age > 11 years
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26
Q

Pregnancy:

A
  • Live vaccines are contraindicated
  • Influenza vaccine, inactivated (not live), can be given in any trimester
  • Tdap x 1 with each pregnancy (weeks 27-36, optimally)**
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27
Q

Older adults:

A
  • Herpes zoster vaccine (Shringrix): age ≥ 50 years, 2 doses, 2-6 months apart
  • Pneumococcal vaccine (age ≥ 65 years)
  • Pneumovax 23 x 1 (wait at least 1 year after Prevnar 13, if given, and at least 5 years after any prior dose of Pneumovax 23)
  • Prevnar 13 x 1 (if immunocompromised and not received previously; optional for all other adults)
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28
Q

Diabetes:

A
  • Pneumococcal vaccine
  • Before age 65 years: 1 dose of Pneumovax 23
  • Hepatitis B: age 19-59 years (or at age ≥ 60 years per healthcare provider discretion)
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29
Q

Healthcare Professionals:

A
  • Annual influenza vaccine is usually required (with proof/documentation of vaccination)
  • Hepatitis B: if there is no evidence of vaccine series completion or a blood test showing immunity
  • Tdap: 1 dose, if not up-to-date, then Td or Tdap every 10 years
  • Varicella: if there is no history of vaccination or chickenpox infection
  • MMR: if there is no history of vaccination or a blood test showing immunity
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30
Q

Sickle Cell Disease & Other Causes of Asplenia (Damaged/Missing Spleen)

A
  • H. influenze type b (Hib) vaccine
  • Pneumococcal vaccines (Prevnar 13 and Pneumovax 23)
  • Before age 65 years: 1 dose of Prevnar 13 (if not received previously) and 2 doses of Pneumovax 23
  • Give Prevnar 13 1st, then the 1st Pneumovax 23 ≥ 8 weeks later; give the 2nd Pneumovax 23 ≥ 5 years after the 1st dose
  • Meningococcal vaccines:
  • Meningococcal conjugate vaccine (Menactra, Menveo or MenQuadfi)
  • Serogroup B meningococcal vaccine (Bexsero or Trumenba)
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31
Q

Immunodeficiency:
Causes:
- Chemotherapy/bone marrow transplant drugs cause myelosuppression (decrease WBC, RBC, platelets)
- Strong immunosuppressant drugs used for autoimmune disease (eg, etanercept, infliximab) or transplant (eg, tacrolimus, cyclosporine)
- HIV with a CD4 count < 200 cells/mm^3 (AIDS)
- Systemic steroids for ≥ 14 days at ≥ 20 mg or 2 mg/kg prednisone daily, or an equivalent steroid dose
- Chronic renal disease

A
  • Live vaccines are contraindicated
  • Pneumococcal vaccines (Prevnar 13 and Pneumovax 23)
  • Give Prevnar 13 1st, then the 1st Pneumovax 23 ≥ 8 weeks later; give the 2nd Pneumovax 23 ≥ 5 years after the 1st dose
  • HIV (CD4 count < 200 cells/mm^3)
  • Meningococcal conjugate vaccine (Menactra, Menveo, or MenQuadfi)
  • Hepatitis A vaccine
  • Hepatitis B vaccine
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32
Q

Influenza

A
  • Annually for all patients ≥ 6 months old
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33
Q

Tdap, Td (for all adults)

A
  • Tdap x 1 if not received previously

- Td or Tdap every 10 years

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34
Q

Shingles

A
  • Shingrix:
  • Vaccinate all adults ≥ 50 years, even if they have had chickenpox or shingles or previously received Zostavax
  • 2-dose series, with second dose given 2-6 months after the first dose
35
Q

Human Papillomavrius (HPV)

A
  • Adults ≤ 26 years who did not complete the HPV series
36
Q

Pneumococcal

A
  • Pneumovax 23:
  • All adults ≥ 65 years
  • Patients 2-64 years: 1 dose if heart, lung, liver disease, diabetes, alcoholic abuse, smokers
  • Patients 2-64 years: 2 doses if immunocompromised
  • Prevnar 13 (if not received before):
  • Any patients ≥ 6 years old who are immunocompromised
  • Optional for adults ≥ 65 years
37
Q

Meningococcal:

A
  • Serogroup B vaccines (Bexsero, Trumenba): give if complement component deficiency, taking eculizmab or ravulizumab, asplenia, microbiologist with exposure to Neisseria meningitidis, serogroup B meningococcal disease outbreak exposure.
  • Conjugate vaccines (Menactra, Menveo, MenQuadfi): same groups as above, plus: HIV, travelers/residents to countries in which the disease is common, military recruits, first year college students living in dorms, if not up-to-date
38
Q

Hepatitis B:

A
  • Sexually active adults who are not in a long-term, monogamous relationship, patients with diabetes age 19-59 years (or ≥ 60 years per healthcare provider discretion), household contact with an infected person, IV drug abusers (IVDAs), patients with HIV or chronic liver disease.
  • Give alone (Engerix-B, Recombivax HB, Heplisav-B) or with hepatitis A vaccine (Twinrix)
39
Q

Hepatitis A:

A
  • Adults traveling to undeveloped countries outside of the U.S., household members and other close contacts of adopted children newly arriving from countries with moderate-high infection risk, liver disease, hemophilia, men who have sex with men, IVDAs, homeless individuals, HIV
  • Give alone (Havrix, VAQTA) or with hepatitis B vaccine (Twinrix)
40
Q

DTaP: For children younger than 7 years of age.

a routine childhood vaccine series; 5 doses given at ages 2, 4, 6, 12-18 months, and 4-6 years.

Storage: Store in the refrigerator. Shake the prefilled syringe or vial before use. Give IM.

A
  • DTaP: Daptacel, Infanrix
  • DTaP-IPV: Kinrix, Quadracel
  • DTaP-HepB-IPV: Pediarix
  • DTaP-IPV/Hib/HepB: Vaxelis
41
Q

DT:

Used for routine vaccine series in infants and children < 7 years old who have a contraindication to the acellular pertussis antigen in DTaP.

A

DT

42
Q

Td or Tdap:

  • Routine booster given every 10 years in patients age ≥ 7 years.
  • Wound prophylaxis: for deep or dirty wounds, revaccinate with Td or Tdap if it has been more than 5 years since the last dose. Tetanus immunoglobulin (TG) may be required if no previous tetanus vaccines have been given.

Tdap booster typically given at age ≥ 11 years (if not previously received).
Recommended in:
1) Pregnant or postpartum women, with each pregnancy.
2) Close contacts of infants younger than age 12 months (e.g. father, grandparents, and child-care providers), if not up-to-date.
3) Healthcare personnel with direct patient contact, if not up-to-date.
4) Children age 7-10 years who did not get fully vaccinated with the DTaP series; give a single dose of Tdap instead of DTaP.

A

Td: Tenivac, TDVax
Tdap: Adacel, Boostrix

43
Q

Hib-containing vaccines.

1) Routine childhood vaccine series given between ages 2-15 months
2) Adults with asplenia

Store in the refrigerator. Shake the prefilled syringe or vial before use. Give IM.

A

1) Hib: ActHIB, Hiberix, PedvaxHIB
2) DTaP-IPV/Hib (Pentacel)
3) DTaP-IPV/Hib/HepB (Vaxelis)

ActHIB and Hiberix are 4-dose series; PedvaxHIB is a 3-dose series.

44
Q

Hepatits A is:

1) a routine childhood vaccine series; 2 doses given at age 12 months and then 6-18 months.
2) given to adults: men who ahve sex with men, illicit drug users, chronic liver disease, homeless inidividuals, HIV, travelers to countries with high hepatits A incidence, or anyone else who wants it.

A

Hepatitis A- Havrix, VAQTA

Hepatitis A and B- Twinrix

45
Q

Hepatitis B is a:

1) routine childhood vaccine series started within 24 hours after birth; 3 doses given at age 0, 1-2, and 6-18 months.
2) Given to adults: healthcare workers, patients with ESRD (on dialysis), chronic liver disease (including HCV), HIV, diabetes (age 19-59 yrs, or ≥ 60 years at healthcare provider discretion, with shared decision making), IV drug abusers, men who have sex with men, anyone with multiple sex partners, incarcerated people, some travelers.

A
  • Hepatitis B: Engerix-B, Heplisav-B, Recombivax HB
  • Engerix-B and Recombivax HB: 3-dose series given at month 0, 1, and 6 (can be completed in 4 months if necessary, but requires a booster at 1 year if the series is accelerated)
  • Heplisav-B (age ≥ 18 years): 2-dose series given at month 0 and 1. Do not use in pregnant women.
46
Q

Hepatitis A and B (Twinrix):

A

3-dose series given at months 0, 1 and 6; can be completed faster if needed for use prior to travel to high-risk areas.

47
Q

Human Papillomavirus Vaccines:

Recommended age: 11-12 years (may be started at age 9** if history of sexual abuse). Use is contraindicated with a severe yeast allergy.

A

HPV9 (Gardasil 9)
Regimens:
- If started before age 15 –> 2 doses (at month 0 and 6-12 months later)
- If started at age 15 or older, or if immunocompromised –> 3 doses (at months 0, 1-2, and 6)

48
Q

Flu vaccine:

Patients age 6 months to 8 years (if not previously vaccinated)

A

Give 2 doses (4 weeks apart)

49
Q

Flu vaccine: patients with an egg allergy

A
  • Can recieve any age-appropriate inactivated influenza vaccine.
  • Flublok (an egg-free product) is approved for age ≥ 18 years only.
  • Flucelvax (egg-free; grown in a cell culture) is approved for age ≥ 4 years.
  • If using an influenza vaccine other than Flublok or Flucelvax in a patient with a severe egg allergy (i.g., more than hives), the vaccine should be given in a medical setting under the supervision of a healthcare provider who is able to recogize and treat severe allergic reactions.
  • Do not give the live influenza vaccine (FluMist).
50
Q

Flu vaccine: pregnant patients

A
  • Can receive any age-appropriate inactivated influenza vaccine. Exception**: Do not give the live influenza vaccine (FluMist).
51
Q

Flu vaccine: indicated only for patients age ≥ 65 years

A
  • Fluzone High-Dose Quadrivalent and Fluad (adjuvanted influenza vaccine)
52
Q

Fluzone High-Dose Quadrivalent: approved for ages ≥ 65 years

A
53
Q

Trivalent flu vaccines protect against 3 influenza viruses: 2 influenza A’s (H1N1 and H3N2) and one influenza B.

A

Fluad (adjuvanted): approved for age ≥ 65 years

54
Q

FluMist Quadrivalent: approved for healthy people age 2-49 years.

Given as 0.2 mL, divided between the two nostrils.

A

Do not use:

1) in pregnant patients
2) those immunocompromised
3) or if influenza medications were recently used (oseltamivir or zanamivir within past 48 hours, permaivir in the past 5 days, or baloxavir in the past 17 days)

55
Q

Flublok Quadrivalent (recombinant inactivated vaccine, RIV4, egg-free):

A

approved for ages ≥ 18 years

56
Q

Flucelvax Quadrivalent (grown in cell culture, ccIIV4, egg-free)

A

approved for age ≥ 4 years

57
Q

Other Quadrivalent Inactivated Influenza Vaccines:

A
  • Afluria Quadrivalent (≥ 18 years)- Can be given with a needle-free jet injector.
  • Fluarix Quadrivalent (≥ 3 years)
  • FluLaval Quadrivalent (≥ 6 months)
  • Fluzone Quadrivalent (≥ 6 months)
  • Fluzone Intradermal Quadrivalent (18-64 years)
58
Q

MMR is:

1) a routine vaccination series; 2 doses given at age 12-15 months and age 4-6 years.
2) given to adults as 1-2 doses if no evidence of immunity.
Give 2 doses (4 weeks apart) to: healthcare workers, HIV patients with a CD4 count ≥ 200 cells/mm^3 for at least 6 months, nonpregant women of childbearing age (with no evidence of immunity to rubella), international travelers, household contacts of immunocompromised people and students in postsecondary educational institutions.

Since it’s live, do not use in pregnancy or if immunocompromised.

A

MMRV (ProQuad): indicated for patients age 12 months-12 years

59
Q

MMR can be stored in the refrigerator or freezer.
MMRV: can be stored in the freezer only due to the varicella component. Store diluents at room temperature or in the refrigerator.

A

Give SC.

60
Q

MCV4: 2-dose series given at age 11-12 years and at age 16 years (booster dose)

Special Populations at High Risk:

  • Travelers to certain countries, such as the meningitits belt in Sub-Saharan Africa
  • Age 2 months and older with: HIV, aspelenia/sickle cell disease, complement compenent deficiencies or use of eculizumab or ravulizumab.
  • Lab workers with N. meningitidis exposure
  • First year college students (age ≤ 21 years) living in resident housing, if not up-to-date.
  • Military recruits.
  • The number of doses and timing (intervals) will depend on age and specific risk. People with ongoing risk of meningococcal disease should be revaccinated every 5 years.
A
  • Menactra: for age 9 months-55 years
  • MenQuadfi: for age ≥ 2 years
  • Menveo: for age 2 months-55 years

** Menactra and Menveo can be used in adults ≥ 56 years, if needed.

61
Q

MCV4

A
  • Store in the refrigerator. Do not freeze.
  • Give IM.
  • Menveo: both vials (the powder and the liquid) contain vaccine, use only the supplied liquid for reconstitution.
  • MCV4 vaccine is required by Saudi Arabia for travel to the Hajj and Umrah pilgrimages; proof of vaccination is required.
62
Q

MenB: Bexsero, Trumenba
For age 10-25 years

Age ≥ 10 years with High Risk:

  • Asplenia/sickle cell disease, complement component deficiencies, or use of eculizumab or ravulizumab.
  • Lab workers with N. meningitidis
  • During an outbreak
    • Optional for patients age 16-23 years who are not at high risk but want the vaccine (if given, the preferred age is 16-18 years)
A
  • Bexsero: 2 doses (given 1 month apart)
  • Trumenba: 2 doses (given 6 months apart). If high risk of meningococcal disease or during an outbreak: give 3 doses (at months 0, 1-2, and 6)
63
Q

The following patients are candidates for one dose of PCV13, if not received previously:

A
  • Immunocompromised patients ≥ 6 years of age.
  • Adults ≥ 65 years (optional based on a discussion between the patient and healthcare provider, not routinely recommended in adults ≥ 65 years unless immunocompromised)
64
Q

13-Valent Conjugate Vaccine (PCV13): Prevnar 13 is given to:

A
  • Children < 5 years: 4-dose series given at age 2, 4, 6 and 12-15 months*
  • Immunocompromised patients age 6-64 years: 1 dose if never received before.
  • Adults ≥ 65 years: optional to give 1 dose if never received before.
65
Q

23- Valent Polysaccharide Vaccine (PPSV23): Pneumovax 23

A
  • Patients age 2-64 years with select risk factors: 1 or 2 doses.
  • All adults ≥ 65 years: 1 dose.
  • Give IM or SC.
66
Q

Prevnar 13: Patients shoud receive PCV13 only once in their lifetime.

A

Give 1 dose (if never received):

  • Immunocompromised patients age 6-64 years: (e.g. sickle cell disease, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs, including steroids)
  • Can be considered in patients age ≥ 65 years (decision based on patient and healthcare provider discussion of benefits)
67
Q

Pneumovax 23 (may recieve 1-3 doses in their lifetime):

A
  • Give 1 dose before age 65 years:
  • Immunocompetent patients age 2-64 years (diabetes, heart, lung, or liver disease, alcohol abuse, smokers)
  • Give 2 doses before age 65 years:
  • Immunocompromised patients 2-64 years (e.g., sickle cell disease, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs, including steroids)
  • Give 1 dose at age ≥ 65 years:
  • All patients (whether 0, 1 or 2 doses were received before age 65 years)
68
Q

Polio-containing vaccines: Only inactivated vacine is used in the U.S. Oral live vaccine may be given in other countries.

A routine childhood vaccine series; 4 doses given at age 2, 4, 6-18 months, and 4-6 years.

A

IPV: IPOL (give IM or SC)

DTaP-IPV (Kinrix, Quadracel
DTaP-HepB-IPV (Pediarix)
DTaP-IPV/Hib (Pentacel)
DTaP-IPV/Hib/HepB (Vaxelis)

69
Q

RV1: Rotarix
RV5: RotaTeq
** Store in the fridge. Give orally.

A

Given to all infants. Do not start the series after age 15 weeks.

Rotarix: 2 doses at age 2 and 4 months
RotaTeq: 3 doses at age 2, 4, and 6 months

70
Q

Varicella Virus Vaccine (for chickenpox): Varivax **Live vaccine
MMRV: ProQuad

A

Varivax: a routine childhood vaccine series; 2 doses given at age 12-15 months and 4-6 years

  • Anyone without evidence of immunity to varicella should receive 2 doses of Varivax.
  • Do not use in pregnancy or if immunocompromised.
  • Some antivirals (e.g., acyclovir, valacyclovir, famciclovir) can interfere with Varivax (live vaccine). Stop 24 hours before vaccine administration and do not take for 14 days after vaccination.
71
Q

Varivax: storage and administration

A
  • Store vaccine in the freezer. Store diluent in the refrigerator or at room temperature.
  • Reconstitute immediately upon removal from the freezer and inject; short stability (30 minutes).
  • Do not give if there is a hypersensitivity to gelatin or neomycin.
  • Give SC.
72
Q

Zoster Virus Vaccine: Shingrix

A
  • ACIP recommends routine vaccination with Shingrix (2 doses given at month 0 and month 2-6) in patients ≥ 50 years including those who previously received varicella virus vaccine or Zostavax.
  • Vaccinate even if the patient has a history of zoster infection, since recurrence is possible.
  • The zoster vaccine is indicated for the prevention of shingles (not for tx of an active case). It can reduce complications, such as the severity of postherpetic neuralgia folloiwng infections.
73
Q

Shingrix: storage

A
  • Store vaccine and adjuvant liquid in the refrigerator. Do not freeze.
  • Give IM.
74
Q

Rabies vaccine (RabAvert, Imovax)

A
  • Give preventitively for high risk exposure (e.g. animal handlers, traveling to a high risk area). Prevention: 3 doses.
  • Give after a possible rabies exposure. Post-exposure: 2 or 4 doses
  • Post-exposure (with previous vaccination): 2 doses
  • Post-exposure (without previous vaccination): 4 doses; 1 dose of rabies immune globulin (RIG) shoud be given with the first vaccine dose.
  • ** - store in the refrigerator. Reconsitute with the provided diluent. Give IM.
75
Q

Typhoid Vaccine: Vivotif (oral, live vaccine)

A
  • To prevent typhoid fever caused by Salmonella typhi.
  • Oral: take 1 capsule PO on alternate days (day 0, 2, 4, and 6). Complete at least 1 week prior to possible exposure. Give every 5 years if continued risk or exposure.
  • Store oral capusles in the refrigerator.
  • Take on an empty stomach (1 hour before a meal) with cold or lukewarm water.
76
Q

Typhim Vi (inactivated polysaccharide vaccine). Store in the refrigerator. Do not freeze. Give IM.

A

Injection: give 1 dose at least 2 weeks prior to possible exposure. Give every 2 years if continued risk or exposure.

77
Q

Japanese Encephalitis Virus Vaccine: Ixiaro

A
  • Give if spending ≥ 1 month in endemic areas during transmission season, especialy if travel will include rural areas.
  • Give 2 doses, 28 days apart. Complete at least 1 week before potential exposure. - Store in the refrigerator (do not freeze)
78
Q

Yellow Fever Vaccine (YF-VAX): Live vacine

** Store in the refrigerator. Reconstitute with the provided diluent; swirl, do not shake. Give SC.

A
  • Give to those who travel to, or live in areas of risk, and to travelers to countries that require vaccination.
  • Contraindicated with a severe (life-threatening) allergy to egges or gelatin, immunosuppression, age < 6 month or breastfeeding.
  • Avoid donating blood for 2 weeks after receiving the vaccine.
  • The international Certificate of Vaccination (yellow card) is provided and is valid for 10 years, starting 10 days after vaccination. It may be required to enter edemic areas.
79
Q

Cholera vaccine: Vaxchora (live vaccine)

A
  • Give to people age 18-64 years who are traveling to an area of active toxigenic Vibrio cholerae transmission.
  • Give 1 oral dose ≥ 10 days before exposure.
80
Q

Cholera vaccine: store requirements

A
  • Store the packet for reconstitution in the freezer. Remove no more than 15 minutes prior to reconstitution.
  • Dissolve the buffer packet in 100 mL of cold or room temperature water, then add the active component packet; stir for 30 seconds and drink within 15 minutes.
81
Q

Dengue vaccine (Dengvaxia): live vaccine

A
  • Give to people age 9-16 years who have previously tested positive for dengue infection and live in endemic areas.
  • Not indicated for primary prevention.
  • Give 3 doses at months 0, 6 and 12.
  • Store in the refrigerator. Reconstitute with the provided diluent; swirl, do not shake. Give SC>
82
Q

Smallpox and monkeypox vaccine (Jynneos):

live vaccine

A
  • Give to adults ≥ 18 years who are at high risk for infection.
  • Give 2 doses, 4 weeks apart.
  • Keep frozen. Allow vaccine to thaw and reach room temperature before use. Swirl for at least 30 seconds.
  • Give SC.
83
Q

Ebola vaccine (Ervebo): live vaccine

A
  • Give to adults ≥ 18 years for the prevention of disease caused by the Zaire ebolavirus.
  • Not protective against other species of Ebolavirus or Marburgvirus.
  • Give 1 dose.
84
Q

Vaccines that should be stored in the freezer (-58°F and +5°F, or -50°C and -15°C) include:

A
  • varicella vaccine
  • MMRV
  • oral cholera vaccine
  • ebola vaccine
  • smallpox and monkeypox vaccine

Immunizations- COVID and Others (1 decks)

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