Immunizations

Question 1

Vaccines: Common side effects

Answer 1

• Fever
• Local pain, redness and swelling
• Soreness, myalgia with TIV
• Rash 1-2 weeks after MMR-V
• Rhinorrhea, sore throat with LAIV

Question 2

DTaP

Answer 2

• 2,4,6,15 months and 4-6 years

- 3 primary doses at least 4 weeks apart

Question 3

What is the difference between Tdap and DTap?

Answer 3

xx

Question 4

Hepatitis B

Answer 4

For all newborns (90% risk) and Adults at high risk
*****0,2,6 months

Must be 24 weeks of age for last dose. Do not give in the buttocks/ Intradermal

Question 5

H. Influenza type B - 1988

Answer 5

Was leading cause of meningitis (6-18 months) leading to hearing loss, nasopharyngeal carriage

• ActHIB (PRP-T), HiBTITRE (HbOC)
• –2,4,6 and 12-15 months
• Pedvax Hib/ Comvax (PRP-OMP) (Merck)
• –2,4, and 12-15 months

Given up to 59 months if delayed

Question 6

Pneumococcal vaccine: PCV13 (Prevnar):

Answer 6

• 2,4,6 and 12 months
• –88% Bacteremia/ 82% Meningitis
• –70% of pneumococcal otitis media
• –80% of penicillin- nonsusceptible strains

Given up to 59 months if delayed

Question 7

Pneumococcal vaccine: PPV23 (Pneumovax)

Answer 7

2 years and older with high risk and had 4 doses of PCV13: Those with Sickle cell, Asplenia, HIV, Cochlear implants or Nephrotic syndrome.

2nd dose 3-5 years later

Question 8

Meningococcal vaccine

Answer 8

College students in dorms, military
**11-12 years (2005), 11- 55 yrs

**Booster at 16 -18 years (2011)

T cell dependent response, Long lasting memory, Herd immunity; Eradication of nasopharyngeal carriage

Question 9

Meningococcal vaccine

Answer 9

2,4,6 and 12-15 months

Terminal complement deficiency (C5-C9), C3 or properdin deficiency, Anatomical or functional asplenia, HIV

Tdap and MCV4: Together or 1 month apart

Question 10

MPSV4: ACYW135

Answer 10

Shorter lived, T cell independent response. No Long lasting memory. No booster response. No Herd immunity. No reduction in nasopharyngeal carriage.

Question 11

Hepatitis A

Answer 11

12 - 23 months: 0.5ml, IM (1 ml > 18 years)

2 doses 6-18 months apart

IgG for pre/ post exposure prophylaxis: 0.02 ml/kg IM < 3 months travel/ post exposure. 0.06 ml/kg 3-5 months travel; every 5 months. 1 daycare child/ staff or 2 house holds cases.

Question 12

Human Papilloma Virus Vaccine

Answer 12

HPV types 6,11: 90% of genital warts
HPV types 16,18: 70 % of cervical cancer
Gardasil: Targets HPV types 6,11,16,18

Females/ males 11-12 years (9-26 years)

Cervarix targets HPV types 16,18

Three doses 0, 2 months and 6 months. Minimum 4 weeks between dose 1 and 2, 16 weeks between dose 2 and 3 and 24 weeks between dose 1 and 3.

Question 13

Rotavirus Rotateq :

Answer 13

Live oral bovine penta-valent
**2,4 and 6 months
Start at 6-14 weeks. Final dose no later than 32 weeks.

Question 14

Rotavirus Rotarix (G1P1):

Answer 14

**2 and 4 months

2 doses between 6 - 24 weeks. Protection against G1,G3,G4 and G9

Question 15

MMR: 1963/67

Answer 15

Single serotypes, live attenuated,0.5 ml - SC. **15 months and 4-6 years. 2 doses a least 4 wks apart for 1-12 yrs

Encephalitis risk 1:1 million dose. With disease 1:1000, death 1-3/1000, SSPE

Monovalent or MMR For 6-11 months at increased risk. Health care workers born after 1957. 2 doses, positive serology or physician diagnosed disease.

Question 16

MMR: Contraindications

Answer 16

Pregnancy
Anaphylaxis to first dose of vaccine (Neomycin/ gelatin)

Allergy to egg (NOT contraindicated)
Skin allergy testing is not recommended

Immunodeficiency (Asymptomatic/ non-severe HIV is NOT contraindication)

Question 17

MMR: Precautions

Answer 17

Recent Immunoglobulin (IG): 3 months (HAIG) & 11 months (ITP/ Kawasaki)

High dose steroid (2mg/kg or 20 mg) > 14 days (1 month)

History of thrombocytopenia (Especially within 2 months of 1st dose).

Place PPD on same day or 4 weeks later. Treat untreated TB before vaccine (Moderate to severe acute illness)

Question 18

Varicella: Contraindications

Answer 18

Pregnancy
Anaphylaxis to first dose of vaccine (Neomycin/ gelatin)

Allergy to egg (NOT contraindicated)
Skin allergy testing is not recommended

Immunodeficiency (Asymptomatic/ non-severe HIV is NOT contraindication)

Question 19

Varicella: Precautions

Answer 19

Recent Immunoglobulin (IG) administration (High dose steroid (2mg/kg or 20 mg) > 14 days )

1 month (~ MMR) (Salicylate use, Moderate to severe acute illness with or without fever)

Question 20

Influenza - TIV

Answer 20

All 6 months and older
High risk children: BA, CF, CHD, HIV, SS, ASA, Renal, DM

Close contact of high risk – YOU!

Contraindicated in Egg Anaphylaxis

2 doses 4 weeks apart if not previously vaccinated and < 9 years

0.25 ml (6-35mths) 0.5 ml (> 36 months)

Multi dose vial: Trace thimerosal

Question 21

Influenza - LAIV

Answer 21

Healthy 2-49 year olds

Not for high risk groups

Contraindicated in Egg Anaphylaxis, Salicylate therapy, H/o GBS, Pregnancy

2 doses 4 weeks apart if not previously vaccinated and less than 9 yrs

0.1 ml in each nostril

Protects against mismatched strains in children (IgA and IgG)

Question 22

Strain Drifts are a Common Occurrence

Answer 22

Unlike other childhood vaccines, influenza vaccines can only provide immunity for a limited duration. Consequently, focus has been on high-risk categories rather than universal vaccination. If the virus strain drift is considered significant, vaccine composition is changed.

Question 23

Live vs Dead Influenza

Answer 23

xx

Question 24

Polio Vaccines

Answer 24

Trivalent vaccines
*****2,4,6 months and 4-6 years

IPV (2000): No serious side effects
OPV: No longer available in US

Vaccine associated paralytic polio

Question 25

Killed vaccines:

Answer 25

Cannot replicate. Generally not as effective as live vaccines. Minimal interference from circulating antibody. Immune response is mostly humoral . B-cell mediated, producing antibodies. Little or no cellular immunity develops. Generally requires multiple doses; initial dose/s “prime” and later dose/s “boost” the immune system. Antibody titers diminish with time.

Question 26

Live Vaccines:

Answer 26

Attenuated (weakened) form of the “wild” virus or bacteria. Must replicate to be effective. Immune response similar to natural infection – cellular immunity. Long-lasting immunity. Usually effective after one dose. Person may develop symptoms similar to a mild case of the disease (e.g., rash, fever). Symptoms usually develop after an incubation period (7 - 21 days). Severe reactions are possible. Interference from circulating antibody. Fragile – must be stored and handled carefully. If not administered simultaneously, separate vaccines by at least 4 weeks