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Allergy and Immunology > Immunizations > Flashcards

Immunizations Flashcards

1
Q

What is a vaccine?

A

any suspension containing antigenic molecules such as preparation of a weakened or killed pathogen derived from a microorganism, given to stimulate an immune response to an infectious disease

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2
Q

What is an immunization?

REMEMBER: includes passive and active immunity

A
  • stimulates the immune system

- process by which an individuals immune system becomes fortified against an agent

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3
Q

What is prophylaxis?

A

measure taken to maintain health and prevent the spread of disease, such as use of antibiotics to prevent infections

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4
Q

What is a titer? What is an example of a titer?

A
  • -measure of amount or concentration of a substance in a solute
  • examples are: medicine or antibodies found in patients blood
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5
Q

What is an antibody titer? What are examples of antibody titers that might be checked?

A
  • lab test that measures presence and amount of antibodies in blood
  • antibody level in the blood is a refection of past exposures to antigen
  • ex: MMR, varicella
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6
Q

If you give someone a tetanus shot after stepping on a nail, what kind of measure are you taking to prevent the patient from getting tetanus?

A

Prophylactic

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7
Q

What is herd immunity?

What kinds of people is it protecting?

A

a form of immunity that occurs when the vaccination of a significant portion of a population provides a measure of protection for individuals who have not developed immunity
protecting: people who cannot get vaccine, immunocompromised, babies

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8
Q

What is herd immunity threshold?

What threshold do most vaccines need to reduce spread?

A

% of population vaccinated at which herd immunity is induced

need: 85-95%

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9
Q

What do vaccines induce in the immune system? How do they work?

A

–induce B cell proliferation (MEMORY)
–Ab production and response
–T-cell sensitization
Similar to natural infection WITHOUT risk of disease

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10
Q

What is an active immunization? What kind of immunity does it provide? How long until reach meaningful immunity?

A 
Active = antigen administration (live, killed, or derivative protein or polysaccharide) or toxin (toxin derivative)
Provides = LONG term immunity
Meaningful = 2-4 WEEKS after vaccination
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11
Q

What is passive immunization? What kind of immunity does it provide? How long until protected?

A

Passive: administration of pre-formed ANTIBODY
Provides: SHORT term immunity lasting 3-6 MONTHS
Protected: immediately

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12
Q

What are examples of immunoglobulins therapy (passive immunity)?

A

Rabies exposure
Mom w/ HBsAg+ and give Hep B immune globulin within 12 hours of birth
Palivizumab (synagis) for RSV

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13
Q

What are populations that should not receive live vaccinations?

A

-preggos
-cancer pts
-HIV
Transplant
-SCID
-Chemotherapy and other immunosuppressive drugs (chronic steroids)

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14
Q

What are the viral attenuated vaccines?

A 
MMR
varicella/zoster
rotavirus
intranasal influenza
oral polio
yellow fever
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15
Q

What are the attenuated bacterial vaccines?

A

BCG (TB)

Typhoid

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16
Q

What do the fractional inactivated vaccines consist of

A

Protein based: toxoid, subunit

Polysaccharide: cell wall from bacteria, conjugate (polysaccharide is chemically linked to protein)

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17
Q

What are the characteristics of inactivated vaccines?

A
  • cannot replicate
  • not as effective as live
  • generally require 3-5 does
  • immune response is MOSTLY HUMORAL
  • ab titer may diminish with time
  • require boosters
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18
Q

What are the whole inactivated viral vaccines?

A

polio
hepatitis
rabies
influenza(not available in the US)

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19
Q

What are the inactivated bacterial whole-cell vaccines?

**None of these are available in the united states

A

pertussis
typhoid
cholera
plague

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20
Q

What are the inactivated fractional subunit vaccines?

A

Hep B
influenza
acellular pertussis (not whole form so know pts won’t get full side affect)HPV
anthrax

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21
Q

What are the inactivated fractional toxoid vaccines?

A

diphtheria

tetanus

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22
Q

What are the local side effects to vaccines?

A

pain, swelling, redness at injection site

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23
Q

Systemic side effects of vaccines?

A

fever, malaise, headache
allergic rxn
nonspecific
may be unrelated to vaccine

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24
Q

What is a contraindication?

A

condition in a recipient that greatly increases the chance of a serious adverse reaction

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25
Q

What is a precaution?

A

condition in a recipient that might increase the chance of a serious adverse reaction or compromise the ability of the vaccine to produce immunity

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26
Q

What are some invalid CI to vaccines?

A
  • -mild illnes
  • -abx therapy
  • -preggo or immunosuppressed person in house
  • -breastfeeding
  • -preterm birth
  • -allergy to products not present in vaccine or allergy that is not anaphylactic
  • -family hx of adverse effects
  • -tuberculin skin testing
  • -multiple vaccines
  • -gastric discomfort after eating eggs
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27
Q

What vaccines should household members of immunosuppressed persons get?

A

MMR
varicella
annual influenza

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28
Q

What is the providers role in vaccinations?

A 
management of side effects
reporting side effects
benefit and risk communication 
storage and administration
timing and space of vaccine doses
observation of CI and precautions
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29
Q

If you had previous anaphylactic rx to specific vaccine what should you do? can you give others?

A

avoid revaccination with specific vaccines and means you can still give all other vaccines

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30
Q

What vaccine do you not want to give if pt has hx of anaphylaxis to eggs or egg protein?

A

Avoid: MMR, influenza, yellow fever

CAN GIVE TETANUS, and all others

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31
Q

What vaccine do you not want to give if pt has hx of anaphylaxis to neomycin or streptomycin?

A

MMR

32
Q

What vaccines do you want to avoid in patients who are immunocompromised?

A

All live vaccines

33
Q

What vaccines do you want to avoid in patients who are preggo?

A

all live virus vaccines b/c of risk of harm to fetus

34
Q

Pt with a hx of severe systemic runs to cholera, typhoid or plague should or shouldn’t receive those specific vaccines because of risk of recurrence?

A

shouldn’t get vaccines because of risk of recurrence

35
Q

What are the two types of inactivated vaccines and their subtypes?

A

Whole cell: viral and bacterial

Fractional: subunit and toxoid

36
Q

What is Diptheria? What does it involve? How is it classified? What are its symptoms attributed to? What are the most common complications?

A

Diphtheria: acute bacterial respiratory or cutaneous illness cause by corynebcterium diphtheria
Involves: mucous membranes, classic “grey pseudomembranes” of tonsils and oropharynx
Classified: based on site of infection (laryngeal, cutaneous, ocular, genital)
Sx: from toxin
Complications: myocarditis, neuritis

37
Q

What is tetanus caused by? What is the MOA of the toxin?

A

Tetanus is caused by toxin producing anaerobe = Clostridium tetani
MOA: production of toxins that bind to CNS and block inhibitory NTM release so have uncontrolled and unopposed muscle contraction = SPASTIC PARALYSIS

38
Q 
What are the clinical features of tetanus? 
Incubation period:
Three forms:
How long do spasms continue
Recovery?
A

Incubation period: 8 days
clinical forms: local, cephalic, generalized = DESCENDING symptoms (difficulty swallowing, sx of truisms, spasms, muscle rigidity)
Spasms continue: 3-4 weeks
Recovery: if survive, can take months

39
Q

What are the complications of tetanus?

A 
Laryngospasm
fractures
PE
aspiration pneumonia
death
40
Q

What are the characteristiscs of pertussis? What causes it, what are signs and symptoms?

A

Caused by bordetella pertussis
highly contagious, insidious onset
signs and symptoms: severe coughing spells leading to difficulty breathing, vomiting, sleep disturbances, weight loss, incontinence, rib fx, syncope

41
Q

What kind of vaccine is this?
How many primary doses of DTaP should children get? When and how many boosters do they get?
**can give DT instead if child has allergy or CI to pertussis component

A 
Vaccine: formalin-INACTIVATED diptheria toxin
5 doses
6-8wks
4 mo
6mo
15-18mo
4-6years
BOOSTER at 11-12 years---USE Tdap!!!!
42
Q

What are AE to DTaP/Tdap?

A

local: erythema, pain, induration
Systemic: fever, HA, n/v/d, stomach ache, joint pain, rash

43
Q

CI to Tdap?DTaP?

A
  • -severe allergic rxn to vaccine component

- -severe adverse effect to vaccine component

44
Q

Precautions for Tdap/DTap?

A
  • moderate or severe illness
  • temp of greater than 105
  • collapse or shock-like state w/in 48 hours of previous dose
  • persistent crying greater than 3 hours from previous dose
  • -convulsions with or without fever w/in three days of previous dose
45
Q

What can HIB (haemophilus influenza type b) cause?

A
  • severe bacterial infection

- meningitis, pneumonia, epiglottitis (positive THUMB PRINT sign)

46
Q

What type of vaccine is HbOC?

A

polysaccharide-based conjugate vaccine

47
Q

Usually do not vaccinate with this vaccine if pt is older than five. There is an exception to administer after the age of 5 in certain populations What populations do you want to administer HIB (HbOC) to?

A

sickle cell disease, HIV/AIDs, spleen removal (asplenia), bone marrow transplant, cancer pts

48
Q

What are the adverse reactions of HIB (HbOC)?

A

local: pain, erythema, induration, swelling
systemic: fever, rash, anorexia, v/d

49
Q

What are the precautions and CI for HIB (HbOC)?

A

Precautions: moderate-severe illness
CI: severe adverse or allergic rxn to component
CHILDREN LESS THAN 6 WEEKS

50
Q

How many primary doses of HIB (HbOC) and boosters do children get?

A

6-8 weeks primary
4 months primary
6 months primary
15-18 months booster

51
Q

What are the characteristics of measles?

A
  • highly contagious viral illness
  • transmitted is respiratory = airborne
  • replicates in nasopharynx and regional lymph nodes
52
Q

What are the clinical features of measles?
Incubation period
Other identifying features?

A

Incubation = 10-12 days
prodrome
fever of 103 or higher
cough
conjunctivitis
KOPLIK SPOTS =whitish, grayish, bluish elevations on base, seen on buccal mucosa
MACULOPAPULAR rash that fades in order of appearance

53
Q

What are complications of measles?

A 
otitis media
pneumonia
encephalitis
laryngotracheobronchitis (croup)
death
54
Q

Mumps: what are the clinical presentations and what are the complications?

A

Clinical: fever, HA, swollen glands, loss of appetite
Complications: meningitis, deafness, swelling in ovaries and testies = sterility

55
Q

Congenital rubella syndrome, what are the affects?

A

all organs:
deafness, cataracts, microcephaly(small head), mental retardation, bone deformities, liver and spleen damage, heart defects

56
Q

MMR is a live virus. When do you give this virus to children? How many doses?

A

Two doses, not before 1 year old
give first dose at 12-18mo
second dose 4-6 years OR any time 4 weeks after first dose
if titer shows no immunity, get another booster

57
Q

Who should NOT get MMR?

A

Preggos, immunocompromised, allergic rxns, allergic rxns to neomycin

58
Q

What are the characteristics of varicella?

A
  • respiratory transmission
  • incubation period = 14-16 days
  • mild prodrome
  • rash is vesicular lesions that appear first on head then mostly on trunk
59
Q

What are the complications of varicella?

A
  • bacterial infection of skin lesions
  • CNS effects
  • pneumoina
  • reyes syndrom
  • postherpetic neuralgia
60
Q

What are the complications of herpes zoster?

A
  • Postherpetic neuralgia (PHN)
  • opthalamic zoster
  • dissemination with generalized skin eruptions and involvement of the CNS, lungs, liver and pancreas
61
Q

What are the precautions for varivax?

A
  • -varivax and antibody-containing productions SHOULD NOT be given together
  • -avoid salicylates (ASA) for 6 weeks after varicella injection because of risk of Reye’s syndrome
62
Q

What is the vaccine schedule for varivax in adults and children?

A

Children: 1st at 12-15 months, 2nd 4-6years OR greater than 3 months after first injection
Adults: 4 weeks in-between first and second injection

63
Q

Varivax and zostavax are live, attenuated virus. What are the CIs for giving varivax and zostavax?

A

preggos
immunocompromiesd
severe allergic rx to prior dose or vaccine component

64
Q

What are the precautions for Zostavax?

A
  • illness, moderate to severe
  • NOT FOR TREATMENT OF PHN
  • pts with active untreated TB
  • not for pts who have received varivax
  • antiviral drugs may interfere with vaccine (tamaflu)
  • give at least 6mo AFTER shingles outbreak
65
Q 
Hepatitis A virus (HAV) characteristics?
transmission
incubation
manifestations with age?
onset?
A
  • host is humans
  • fecal-oral
  • replicates in liver
  • incubation period is 30 days
  • manifestations: children = silent, adults = mild flu-like sx to full blown hepatitis
    onset: abrupt, fatigue, malaise, n/v, anorexia, fever, RUQ pain
66
Q

HAV when should you vaccinate kids and adults?

A

Kids: 1st dose at 12 months, 2nd at 24 months (6-18 months apart) if not vaccinated by 2 years, can still get vaccination
adults: any time

67
Q

Why do you use immune globulin AND vaccine for adults with post exposure to Hep A?

A

adults have worst reaction and are more prone to getting disease

68
Q

Why is hep B so hard to trace?

A

because incubation period is 60-150 days with average of 90 days

69
Q

What are complication from Hep B?

A

chronic infection, fulminant hepatitis, hospitalization, cirrhosis, hepatocellular carcinoma, death

70
Q

Hep B is an inactivated viral vaccine, there are two types . When do infants get them? How many doses?

A

3 doses, some babies get 4
1st dose at birth
2nd dose 6-8 weeks
3rd dose 6-18 months of age

71
Q

Hep B is an inactivated viral vaccine. What is the schedule for adult/adolescent dosing?

A

primary is 0, primary 2 is 4 weeks, primary 3 is 6 months and MUST be separated from the first dose by 16 weeks

72
Q

What kind of vaccine is the influenza vaccine? And what ages are each of the types for? What demographic should get 2 doses the FIRST year they are ever vaccinated?

A

inactivated = 6mo and older
high dose inactivated = 65 and older
intradermal 18-64yo
intranasal=live (LAIV) for healthy pts 2-49
children 6mo-8yrs of age should get 2 doses the first year they are vaccinated

73
Q

How many different flu viruses does the flu vaccine protect agains? How long until protection develops and how long does it last?

A

protects against 3-4 viruses
2 weeks for protection
lasts several months to a year

74
Q

What are the CI for INACTIVATED flu vaccine?

A
  • severe allergic rxn (now have recombinent flu that uses insect eggs)
  • hx of Guillian Barre’ syndrome
75
Q

What are the minor AE from the flu vaccine?

A

rhinorrhea, nasal congestion, HA, sore throat

76
Q

What are the CI and precautions for LIVE influenza vaccine?

These persons should receive the inactivated vaccine.

A
  • children with asthma
  • moderate to severe illnes
  • chronic med conditions
  • children on long term asa therapy (reyes syndrome will increase)
  • immunosuppresion
  • preggos
  • children under 2, adults over 50
  • hx of Guillian-Barre syndrome

Allergy and Immunology (9 decks)

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