Immunizations

Question 1

Treating a Severe Allergic Reaction

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

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

*Live vaccines are contraindicated!

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

Question 5

Vaccines in Asplenia or Sickle Cell Disease

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:
-Prevnar 20 (PCV20) x 1
OR
-Vaxneuvance (PCV15) x 1, then Pneumovax 23 (PPSV23) x 1 ≥ 8 weeks later

3) Meningococcal vaccines
-Menacentra, Menveo or MenQuadfi (Meningococcal Conjugate Vaccines)
-Bexero, Trumenba (Serogroup B Meningococcal vaccine)

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

*Live vaccines are contraindicated!

1) Pneumococcal vaccines:
-Prevnar 20 (PCV20) x 1
OR
-Vaxneuvance (PCV15) x 1, then Pneumovax 23 (PPSV23) x 1 ≥ 8 weeks later

2) Shingles Vaccine: age ≥ 19
2 doses (2-6 months apart)

3) Additional vaccines for HIV:
1) Meningococcal conjugate vaccines (Menactra, MenQuadfi or Menveo)
2) Hepatitis A vaccine
3) Hepatitis B vaccine

Question 8

Vaccines for Older Adults

Answer 8

1) Shingrix ≥ 50 2 doses (2-6 months apart)

2) Pneumococcal vaccines:
-Prevnar 20 (PCV20) x 1
OR
-Vaxneuvance (PCV15) x 1, then Pneumovax 23 (PPSV23) x 1 ≥ 12 months later

Question 9

Vaccines for patients with Diabetes

Answer 9

1) Pneumococcal vaccines:
-Prevnar 20 (PCV20) x 1
OR
-Vaxneuvance (PCV15) x 1, then Pneumovax 23 (PPSV23) x 1 ≥ 12 months later

2) Hepatitis B

Question 10

Meningococcal Vaccines

Answer 10

MenB (Bexero, Trumenba)

MenB [ Age ≥ 10 at high risk]:
- 2 dose series of Bexsero (MenB-4C) 1 month apart
- 2 dose series of Trumenba (MenB-FHbp) 6 month apart

MenACWY (MCV4, Menactra, MenQuadfi, Menveo)
Routine Vaccine: 2 doses give at age 11-12, and age 16
MenACWY
- 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

Brand: Engerix-B, Heplisav-B, Recombivax-HB

Adult Routine: All age 19-59 who have not been previously vaccinated, or those ≥ 60 with risk factors (chronic liver disease, HIV, blood exposure, etc.)

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

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

Question 12

Hepatitis A Vaccine

Answer 12

Brand: Havrix, Vaqta

Children routine vaccine: 2 doses (Age: 12 mths, 6-18 months after)

Adults: Give to high-risk adults: Men who have sex with men, chronic liver disease, homelessness, HIV infection, travelers to countries with high incidence or anyone else who wants it.

HepA + HepB: Twinrix 3 dose series 0,1,6 mths

Question 13

Tdap Vaccine

Answer 13

Brand: Boostrix, Adacel

DTap Childhood 5 series vaccine (12-18 mths, 2 yr, 4yr, 6yr and 4-6 year).

Tdap Booster: Age 11-12 years old, then every 10 years in adults!

-Wound Prophylaxis: for deep or dirty wounds, revaccinate if it has been ≥ 5 years since last vaccination.

Question 14

HPV Vaccine

Answer 14

Brand: Gardasil 9

Recommended Age: 11-12, but can be given from 9-26 year old.

Contraindication: yeast allergy

Regimen:
1) Age < 15: 2 doses, 6-12 months apart
2) Age ≥ 15 or immunocompromised: 3 doses (0, 1-2, 6)

Question 15

MMR Vaccine

Answer 15

Brand: MMR-II, Priorix, ProQuad (MMR + Varicella)

Children Routine: 2 doses, (1 dose at age 12-15, 2nd dose at age 4-6)

Adults: 2 doses if there is no evidence of immunity (4 weeks apart)

Question 16

Varicella and Zoster Vaccines

Answer 16

Varicella (Varivax)
-Given as a routine vaccine in childhood
-Adults: 2 doses
*Some antivirals can interfere with Varivax (live vaccine). Stop 24 hours before vaccine administration and do not take for 14 days after vaccination.
Contraindication: Allergic to gelatin or neomycin

Zoster (Shingles)
-All adults ≥ 50 years old.
-Adults ≥ 19 who are immunosuppressed

2 doses: 2-6 months apart

Question 17

Which vaccines should be stored in the freezer?

Answer 17

1) Varicella
2) MMRV
3) Oral Cholera
4) MMR-II (Freezer or Refrigerator)

Question 18

Needle for IM Injection

Answer 18

Needle Length: 1 inch (5/8” can be used for SubQ or children)
Needle Width: 22-25 gauge

Question 19

Prophylaxis for Travelers Diarrhea

Answer 19

Bismuth Subsalicylate 524-1050 mg PO QID with meals and at bedtime.

Antibiotic prophylaxis: Rifaximin preferred

Question 20

Travelers Diarrhea Treatment

Answer 20

1) Hydration + Increased salt intake
2) Optional anti-diarrheal meds (loperamide)
Loperamide: 4 mg after the first stool, then 2 mg after subsequent stools. MAX 16 mg/day. It can be used for self-treatment for up to 2 days.
3) Moderate TD: Azithromycin or Quinolone
4) Severe TD and dysentery: Azithromycin preferred

Question 21

Typhoid Fever

Answer 21

Transmission: contaminated food or water

Typhoid vaccines are only 50-80% effective and should be received ≥ 1 week prior to travel.