Immunizations

Question 1

Hepatitis B - # Doses, Ages, SE

Answer 1

• 3 doses (first dose monovalent, other combos) for everyone
• @ Birth - 2 - 6 months
• Last dose cannot be given before 6 months
• Normal SE (fever, HA, site soreness)

Question 2

Hepatitis B - Special situations

Answer 2

1. Mother positive for Heb B: give HBIG immunoglobulin <12hrs of birth and first dose of vaccine
2. Mother’s status unknown? Give Hep B vaccine <12hrs of birth, and HBIG IF <2000g

*If >2000g, need HBIG < 1 week

Question 3

DTaP - # Doses, Ages, SE

Answer 3

• 5 doses
• @ 2, 4, 6, 15 -18 months, 4-6 years
• Irritability, anorexia, tiredness, vomiting + normal SE for 1-3 days

Catch up schedule dependent on child’s age at first dose

Start Tdap at 11 -12

Precaution recommended if hx of Guillen Barre within 6 weeks of prior T/Dtap dose

Question 4

DTaP /Tdap- Special situations (wound)

Answer 4

Wound management with hx of 3 doses:
<7 yrs give dose if > 5 years since last dose (unless clean/minor wound)

> 7 yrs, if clean/minor wound, yes if > 10 years since last dose

For other wounds, give if >5 years since last dose

Question 5

Tdap # Doses, Ages, SE

Answer 5

1 dose @ 11-12 years, then Q 10 years

Same SE as Dtap, minus irritability

1 dose early in every pregnancy (for pertussis)

Question 6

IPV - Doses, Ages, SE

Answer 6

4 - dose series
@ 2, 4, 6 - 18 months, and 4-6 years

*Final dose must be administered >on/after 4th birthday but > 6 months from prior dose

*If schedule started with OPV, should finish with IPV

SE are site swelling, pain, redness

Question 7

Rotavirus - Doses, Ages, SE, Special situations

Answer 7

Rotarix = 2 doses @ 2, 4 months
RotaT (THREE)eq = 3 doses @ 2, 4, 6, months

If type unknown, always default to 3 dose

Risk factor of intussusception, thus cannot give 8 months

Cannot starts series after 15 weeks

Question 8

PCV13 - Doses, Ages, SE, Special situations

Answer 8

4 dose series

@ 2, 4, 6 months and 12 - 15 months

Use separate injection site

If series incomplete, and ages 2- 4.9 years (59 months) give one dose if healthy

SE are site symptoms, HA, drowsiness, anorexia

Question 9

PPSV23 - Doses, Ages, SE

Answer 9

Can give @ 2 years - 18 years if:

• Hemoglobinopathies
• Spleen problems
• HIV
  -Kidney problems (nephrotic syndrome, failure)
• Chronic pulmonary/cardiac disease
• Diabetes or congenital immunodeficiencies

Question 10

Hib - Doses, Ages, SE

Answer 10

4 doses

@ 2, 4, 6, 12-15 months

If >5 years, no doses are recommended

SE are site swelling/redness/fever

Question 11

Influenza - Doses, Ages, SE

Answer 11

-IIV: >6 months
-LAIV4 > 2 years

RIV ONLY for > 18 years

If first dose ever and < 8years, give two doses 4 weeks apart

Common SE

Question 12

Influenza - special situations for LAIV4

Answer 12

• contains 4 viruses
• cannot give in pregnancy, or with those with immunosuppression?

-Nasal spray version may cause runny nose

Question 13

MMR - Doses, Ages, SE

Answer 13

2 doses

@ 12 months, 4-6 years (technically, 2nd dose can be give >4 weeks after dose)

Mild rash, temporary pain and muscle stiffness mostly in women not immune to rubella component

Question 14

MMR - Special situations

Answer 14

Contraindicated in:
- mod/severe illness, pregnancy, immunosuppression

Precaution for recent blood product, family history of any seizures (MMRV only)

May be given with TB testing, but precaution recommended however best practice to delay PPD for 4-6 weeks to avoid a suppressive response (cause a false negative TB result)

Early vaccination recommended at 6 to 11 months for children during a measles outbreak

Early vaccination is also recommended if an infant 6 to 11 months old is to travel outside of the United States

Question 15

Varicella - Doses, Ages, SE

Answer 15

2 doses

@ 12 months, 4-6 years

For catch up doses, wait 3 months between if < 13, or 4 weeks if > 13yrs

MMRV can be given at either if parents express preference, but max age is 12 years

SE are generalized rash, maculopapular, sometimes mild shingles, but not all cases caused by vaccine

Question 16

Varicella - Special situations

Answer 16

Contraindicated in mod/severe illness, pregnancy, immunosuppression

Precautions in recent blood product, acyclovir or aspirin

For MMRV family or personal hx of seizure

For catch up, wait 3 months between doses if <13, if >13 minimum of 4 weeks

Question 17

Hepatitis A - Doses, Ages, SE

Answer 17

2 doses

12 months, 18 months

Can give through age 18

Can’t give in moderate/severe illness

systemic reactions uncommon

Question 18

HPV - Doses, Ages, SE

Answer 18

2 doses if started before < 15 years, 2nd dose given 6-12 months later

3 doses if >15 years, or immunocompromised

SE can include muscle, joint pain, FAINTING, counsel to lie down and be observed for 15 minutes post admin

Question 19

Meningococcal sero group ACYW- Doses, Ages, SE

Answer 19

2 doses

@ 11-12 years, and 16 years

SE can be localized reaction, fever > 100, HA, malaise, fatigue

approved in infants as young as 2 months old, who are at an increased risk of meningococcal disease. Since asplenia poses a high risk of contracting meningococcal infection, the child should receive the meningococcal conjugate vaccine now, and continue to be revaccinated every 5 years for lasting protection.

Give meningococcal vaccine to child with sickle cell early (2 months), number of doses in series depends on age 4-2 doses (2 @ 7 months or older)

Question 20

Men B (sero group B) - Doses, Ages, SE

Answer 20

Not routine

2 doses, 2nd dose 6 months after first

3 doses starting at age 10 if sickle cell or asplenic (2nd dose in 1-2 months, 3rd dose at 6 months)

Can give starting @v 16 years - 23

Bexsero and trumenba not interchangeable

Question 21

Live vaccine pearls

Answer 21

• Live vaccines if not given on same day, must wait 4 weeks
• Ideal to give antibody products 2 weeks prior, or wait 3-11 months
• Delay live virus vaccines >3 months post chemo therapy