Immunizations

Question 1

Treating a Severe Allergic Reation

Answer 1

Call 911 and give EpiPen

Adult: 0.01 mg/kg/dose [MAX 3 doses or 0.5 mg/dose 5-15 mins apart] - Must keep 3 auto-injectors

Question 2

Contraindications to a Live-Vaccine

Answer 2

1) Pregnancy
2) Immunosuppression
3) Severe reaction in the past to the same vaccine

Question 3

Invalid Contraindications to a vaccine

Answer 3

1) Mild acute illness (Slight fever, mild diarrhea)
2) Current antimicrobial treatment
3) Allergies (except to the ingredients in the vaccine)
4) Pregnancy (except live-vaccines)
5) Breastfeeding
6) Immunosuppressed person in the household
7) Family history of adverse events to the vaccine

Question 4

Vaccination in Pregnancy

Answer 4

1) Influenza vaccine (not live) given in any trimester
2) Tdap x 1 with EACH pregnancy

Question 5

Vaccines in Asplenia

Answer 5

Asplenia is a damaged or missing spleen. The spleen contains T-cells and B-cells. This occurs in sickle-cell disease or splenectomy and causes a type of immunodeficiency.

Recommended Vaccines:
1- H. Influenzae type b (Hib) vaccine

2- Pneumococcal vaccines AGE 19-65
Prevnar 20 (PCV20) x 1
OR
Vaxneuvance (PCV15) x 1, then the 1st Pneumovax 23 (PPSV23) x 1 >= 8 weeks later

3- Meningococcal vaccines

Question 6

Who is considered Immunocompromised?

Answer 6

1) Chemotherapy/bone marrow transplant drugs
2) Strong immunosuppressant drugs
3) HIV with CD4 count < 200
4) Transplant patients taking immunocompromised drugs
5) Systemic steroids for >=14 days

Question 7

Vaccines for the immunocompromised

Answer 7

Pneumococcal vaccines AGE 19-65
Prevnar 20 (PCV20) x 1
OR
Vaxneuvance (PCV15) x 1, then the 1st Pneumovax 23 (PPSV23) x 1 >= 8 weeks later

*Live vaccines are contraindicated!

HIV Patients (CD4 < 200)
1) Meningococcal conjugate vaccines (Menactra or Menveo)
2) H. Influenzae type b (Hib) vaccine
3) Hepatitis B vaccine

Question 8

Vaccines for Older Adults

Answer 8

1) >= 50: Shingrix 2 doses (2-6 months apart)

2) Pneumococcal vaccine AGE >=65
Prevnar 20 (PCV20) x 1
OR
Vaxneuvance (PCV15) x 1, then the 1st Pneumovax 23 (PPSV23) x 1 >= 1 year later

Question 9

Vaccines for patients with Diabetes

Answer 9

1) Pneumococcal vaccine
Prevnar 20 (PCV20) x 1
OR
Vaxneuvance (PCV15) x 1, then the 1st Pneumovax 23 (PPSV23) x 1 >= 1 year later

2) Hepatitis B

Question 10

Meningococcal Vaccines

Answer 10

1) MenB [Age 16-23 who are not at an increased risk for meningococcal disease]:
- 2 dose series of Bexsero (MenB-4C) 1 month apart
- 2 dose series of Trumenba (MenB-FHbp) 0 and 6 months

2) Men ACWY
- Used for asplenia, HIV, travel to country with meningococcal epidemic, first-year dorm student, military
- 1 dose of MenACWY

Question 11

Hepatitis B Vaccine

Answer 11

Routine: Age 18-59

1) Heplisav-B (2 dose series) 4 weeks apart

2) Engerix-B, PreHevbrio, Recombivax HB (3 dose series) 0,1,6 months