Immunizations Flashcards
What has the most recent and reliable information for a vaccine?
The Vaccine Information Statement (VIS) is the most up-to-date version of information and it must be given to the patient before each vaccine is administered
What is active vs. passive immunity?
Active - from the person’s own immunity (from vaccines or fighting an infection). This lasts a long time, often a life time.
Passive - received from someone else, like receiving immunoglobulin (Ig) that are pooled from other people, or through transfer from a mother to her baby.
- These decrease over time as the child’s own antibody production increases.
What are these types of vaccines:
- inactivated (what are the 3 types)
- live
Inactivated - use the killed version of a virus/bacteria. Inactivated vaccines cannot replicate or cause disease. The immunity is not as strong as with live vaccines, so they often require a booster.
- Polysaccharide: only effective if >2 years old; ex. Pneumovax 23
- Conjugate: join the molecules to carrier proteins to increase immune response; ex. Hib, Prevnar 20, Meningococcal Conjugate (Menveo)
- Recombinant: gene segment from the organism is inserted into the gene of another cell; HPV, FluBlok Quadrivalent
Live - made from the virus, but the virus is weakend. It produces a strong immune response that is similar to the actual disease. Immunocompromised patients may not be able to halt replication, so the vaccination could cause the disease.
What are some common live vaccines? (MICRO-VY)
MMR
Intranasal influenza
Cholera
Rotavirus
Oral Typhoid
Varicella
Yellow Fever
Can we give vaccines at the same time?
Can we lengthen/shorten the intervals in a vaccine series?
What vaccines require separation from antibody containing products and why?
What is the timing if we need to give vaccine and antibody?
When do we give antibody and vaccine simultaneously?
- vaccines can usually be given at the same time
- multiple live vaccines can be given on the same day. BUT, if not given on the same day, space them 4 weeks apart
- if a vaccine series requires > 1 dose, the intervals can be extended between doses without restarting the series, but they cannot be shortened.
MMR and varicella-containing vaccines (not zoster) require separation from antibody-containing products (ex. blood transfusions, IVIG). This is because antibodies can interfere with live vaccine replication.
- vaccine -> wait 2 weeks -> antibody
- Antibody -> separate by a minimum of 3 months -> vaccine
- simultaneous administration of antibody and vaccine is recommended for post-exposure prophylaxis of certain diseases (hep A and B, rabies, tetanus)
How can a live vaccine impact a TB skin test (TST)?
Live vaccine can cause a false negative TST result.
- give the live vaccine on the same day as the TST
- wait 4 weeks after live vaccine to perform the TST
When do we start giving babies live vaccines?
Live vaccines are withheld until the child is 12 months.
(exception is live rotavirus)
How long must you monitor a patient after vaccination?
15 minutes
How can we treat true allergic reactions to vaccines?
Minor: mild rash, hives
- treat with oral antihistamine (benadryl OTC, hydroxyzine Tx)
Severe: anaphylaxis
- treat with epinephrine (1:1000 w/v), most are 0.3mg
*must keep 3 adult 0.3mg auto-injectors on hand at all tiems
What are some INVALID contraindications to vaccines? (8)
CAN give vaccinations in these situations:
- mild acute illness (slight fever, mild diarrhea)
- current antimicrobial treatment (except varicella, zoster, and oral typhoid vaccines)
- previous local skin reaction (mild/mod)
- allergies to bird feathers, penicillin, allergies to products not in the vaccine
- pregnancy (except live vacccines), breastfeeding, preterm birth
- recent TB skin test
- immunosuppressed person in household, recent exposure to the disease
- family history of adverse event to the vaccine
What are the two contraindications to live vaccines?
pregnancy
immunosuppression
What are 5 causes of immunodeficiency?
- chemotherapy (cause myelosuppression)
- strong immunosuppressant drugs (ex. etanercept, infliximab)
- HIV with CD4 < 200 (AIDS)
- transplant patients taking immunosuppressant drugs (ex. tacrolimus, cyclosporin)
- systemic steroids for ≥ 14 days at ≥ 20mg or 2mg/kg prednisone daily
Diphtheria Toxoid-, Tetanus Toxoid-, and acellular Pertussis-Containing Vaccines: What is the formulation for pediatrics? What age group should get the pediatric vaccine? Outside of typical doses, when is Tdap recommended?
DTaP = pediatrics
Td or Tdap = adult
DTap is for children younger than 7 years old
Tdap booster typically given at age 11-12, routine booster given every 10 years in adults
Otherwise recommended for:
1. pregnant people, during EACH pregnancy
2. close contacts of infants younger than 12 months if not up to date
3. healthcare personnel in direct patient contact if not up to date
4. would prophylaxis - if deep or dirty wound & more than 5 years since last Tdap dose
Outside of routine Hib given during childhood, when is the Hib vaccine given?
Routine childhood vaccine given between ages 2-15 months
Given to adults with asplenia
When do children receive Hep A and Hep B vaccines? Which adults should receive them?
Hep A: all children at 1 year (2 doses)
- some adults: men who have sex with men, illicit drug use, chronic liver disease, travelers with high Hep A incidence
Hep B: infants (3 dose series at birth, 4-8 weeks, 24 weeks)
- some adults: men who have sex with men, healthcare workers, patients with ESRD, chronic liver disease, HIV, diabetes (age 19-59), IV drug users
When is HPV9 given and what are the dose regimens?
HPV prevents cervical and other types of cancers and genital warts
Recommended at age 11-12 (may be started at age 9)
If started before age 15 -> 2 doses (months 0 and 6-12)
If started after 15 -> 3 doses
What are specific flu vaccine tips for patients age 6 months to 8 years who have not previously received the vaccine, patients with an egg allergy, pregnant patients, and if the patient is ≥ 65 years old?
6 months to 8 years (not previously vaccinated): give 2 doses (4 weeks apart)
Patients with an egg allergy: can receive any age-appropriate influenza vaccine, even if severe allergy symptoms
- egg-free products: Flublox (≥18yo), Flucelvax (≥6yo)
Pregnant patients: can receive any age-appropriate inactivated vaccine. Not FluMist (live)
Patients ≥ 65 years old: Fluzone High-Dose, Fluad, Flublok
What is the criteria for receiving FluMist?
FluMist is approved for healthy people age 2-49 years old
How are MMR vaccines given? How is the MMR vaccine stored?
MMR and MMRV are live vaccines given subcutaneously!!
- Store MMR in the refrigerator or freezer
- MMRV: store vaccine in freezer only, diluents stored at room temp or in refrigerator
When are meningococcal vaccines given?
Routine: given to adolescents in a 2-dose series starting at age 11-12 and 16 years old
Special populations at high risk:
- travelers to the African meningitis belt
- asplenia/sickle cell disease, HIV
- lab workers
- first-year college students
When is MenB or MenABCWY given?
if age ≥ 10 years at high risk
- asplenia/sickle cell
- lab workers
- during an outbreak
not at high risk
- option for patients age 16-23 who want the vaccine
Which pneumococcal vaccines do children < 5yo receive as part of their routine childhood vaccinations? Which pneumococcal vaccines should adults receive?
Childen < 5 yo: PCV15 (Vaxneuvance) or PCV20 (Prevnar 20)
- young children < 2yo shouldn’t receive the polysaccharide vaccine (PPSV23) because they do not produce an adequate antibody response to polysaccharide vaccines yet
Adults (if never received before or if age > 65): PCV20 alone OR PCV15 followed by PPSV23
What route is the rotavirus vaccine given in?
Oral
Who should receive the RSV vaccine?
RSV vaccine
- pregnant people 32-36 weeks
- infants < 6 months old
RSV monoclonal antibody
- neonates and infants born during or entering their first RSV season (1 dose of nirsevimab if mother not vaccinated during pregnancy)
When is Varivax given? What are 3 contraindications? What type of medication may interfere with the vaccine? How do we store it? What is the route of administration?
Varivax: to prevent chicken pox
- routine childhood series: 2 doses at age 12-15 month and age 4-6 (same as MMR)
- all adults without evidence of immunity to varicella (2 doses at least 4 weeks apart)
Contraindications:
- hypersensitivity to gelatin or neomycin
- pregnancy
- immunocompromised
Antivirals can interfere with vaccine, so stop them 24 hours before and do not take for 14 days after
Storage: store vaccine in freezer only, store diluents at room temp or refrigerator
Give subcutaneously!!
Shingrix - who should receive it? How do we store it? What is the route of administration?
Shingrix:
- All adults > 50yo (2 doses); EVEN if pt previously received Varivax or Zostavax or hx of zoster infection
Store: refrigerator, DO NOT FREEZE
Route: give IM
When do we give a typhoid vaccine?
Typhoid vaccine is PO. It is a live vaccine to prevent typhoid fever caused by Salmonella typhi that should be taken prior to travel and completed at least 1 week prior to travel. It must be stored in the refrigerator
(there is also an injectable typhoid vaccine)
What are 2 contraindications to the yellow fever vaccine? What is the route of administration?
Contraindications:
- severe allergy to eggs
- severe allergy to gelatin
Give SC
How long must temperature logs be kept?
3 years
Which 2 vaccines must be kept in the freezer?
Varicella
MMRV
(MMR-II is either refrigerator or freezer)
