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Allergy and Immunology > Immunizations > Flashcards

Immunizations Flashcards

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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
What is a precaution?
condition in a recipient that might increase the chance of a serious adverse reaction or compromise the ability of the vaccine to produce immunity
26
What are some invalid CI to vaccines?
- -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
27
What vaccines should household members of immunosuppressed persons get?
MMR varicella annual influenza
28
What is the providers role in vaccinations?
``` 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 ```
29
If you had previous anaphylactic rx to specific vaccine what should you do? can you give others?
avoid revaccination with specific vaccines and means you can still give all other vaccines
30
What vaccine do you not want to give if pt has hx of anaphylaxis to eggs or egg protein?
Avoid: MMR, influenza, yellow fever | CAN GIVE TETANUS, and all others
31
What vaccine do you not want to give if pt has hx of anaphylaxis to neomycin or streptomycin?
MMR
32
What vaccines do you want to avoid in patients who are immunocompromised?
All live vaccines
33
What vaccines do you want to avoid in patients who are preggo?
all live virus vaccines b/c of risk of harm to fetus
34
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?
shouldn't get vaccines because of risk of recurrence
35
What are the two types of inactivated vaccines and their subtypes?
Whole cell: viral and bacterial | Fractional: subunit and toxoid
36
What is Diptheria? What does it involve? How is it classified? What are its symptoms attributed to? What are the most common complications?
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
What is tetanus caused by? What is the MOA of the toxin?
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
``` What are the clinical features of tetanus? Incubation period: Three forms: How long do spasms continue Recovery? ```
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
What are the complications of tetanus?
``` Laryngospasm fractures PE aspiration pneumonia death ```
40
What are the characteristiscs of pertussis? What causes it, what are signs and symptoms?
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
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
``` Vaccine: formalin-INACTIVATED diptheria toxin 5 doses 6-8wks 4 mo 6mo 15-18mo 4-6years BOOSTER at 11-12 years---USE Tdap!!!! ```
42
What are AE to DTaP/Tdap?
local: erythema, pain, induration Systemic: fever, HA, n/v/d, stomach ache, joint pain, rash
43
CI to Tdap?DTaP?
- -severe allergic rxn to vaccine component | - -severe adverse effect to vaccine component
44
Precautions for Tdap/DTap?
- 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
What can HIB (haemophilus influenza type b) cause?
- severe bacterial infection | - meningitis, pneumonia, epiglottitis (positive THUMB PRINT sign)
46
What type of vaccine is HbOC?
polysaccharide-based conjugate vaccine
47
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?
sickle cell disease, HIV/AIDs, spleen removal (asplenia), bone marrow transplant, cancer pts
48
What are the adverse reactions of HIB (HbOC)?
local: pain, erythema, induration, swelling systemic: fever, rash, anorexia, v/d
49
What are the precautions and CI for HIB (HbOC)?
Precautions: moderate-severe illness CI: severe adverse or allergic rxn to component CHILDREN LESS THAN 6 WEEKS
50
How many primary doses of HIB (HbOC) and boosters do children get?
6-8 weeks primary 4 months primary 6 months primary 15-18 months booster
51
What are the characteristics of measles?
- highly contagious viral illness - transmitted is respiratory = airborne - replicates in nasopharynx and regional lymph nodes
52
What are the clinical features of measles? Incubation period Other identifying features?
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
What are complications of measles?
``` otitis media pneumonia encephalitis laryngotracheobronchitis (croup) death ```
54
Mumps: what are the clinical presentations and what are the complications?
Clinical: fever, HA, swollen glands, loss of appetite Complications: meningitis, deafness, swelling in ovaries and testies = sterility
55
Congenital rubella syndrome, what are the affects?
all organs: deafness, cataracts, microcephaly(small head), mental retardation, bone deformities, liver and spleen damage, heart defects
56
MMR is a live virus. When do you give this virus to children? How many doses?
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
Who should NOT get MMR?
Preggos, immunocompromised, allergic rxns, allergic rxns to neomycin
58
What are the characteristics of varicella?
- respiratory transmission - incubation period = 14-16 days - mild prodrome - rash is vesicular lesions that appear first on head then mostly on trunk
59
What are the complications of varicella?
- bacterial infection of skin lesions - CNS effects - pneumoina - reyes syndrom - postherpetic neuralgia
60
What are the complications of herpes zoster?
- Postherpetic neuralgia (PHN) - opthalamic zoster - dissemination with generalized skin eruptions and involvement of the CNS, lungs, liver and pancreas
61
What are the precautions for varivax?
- -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
What is the vaccine schedule for varivax in adults and children?
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
Varivax and zostavax are live, attenuated virus. What are the CIs for giving varivax and zostavax?
preggos immunocompromiesd severe allergic rx to prior dose or vaccine component
64
What are the precautions for Zostavax?
- 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
``` Hepatitis A virus (HAV) characteristics? transmission incubation manifestations with age? onset? ```
- 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
HAV when should you vaccinate kids and adults?
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
Why do you use immune globulin AND vaccine for adults with post exposure to Hep A?
adults have worst reaction and are more prone to getting disease
68
Why is hep B so hard to trace?
because incubation period is 60-150 days with average of 90 days
69
What are complication from Hep B?
chronic infection, fulminant hepatitis, hospitalization, cirrhosis, hepatocellular carcinoma, death
70
Hep B is an inactivated viral vaccine, there are two types . When do infants get them? How many doses?
3 doses, some babies get 4 1st dose at birth 2nd dose 6-8 weeks 3rd dose 6-18 months of age
71
Hep B is an inactivated viral vaccine. What is the schedule for adult/adolescent dosing?
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
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?
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
How many different flu viruses does the flu vaccine protect agains? How long until protection develops and how long does it last?
protects against 3-4 viruses 2 weeks for protection lasts several months to a year
74
What are the CI for INACTIVATED flu vaccine?
- severe allergic rxn (now have recombinent flu that uses insect eggs) - hx of Guillian Barre' syndrome
75
What are the minor AE from the flu vaccine?
rhinorrhea, nasal congestion, HA, sore throat
76
What are the CI and precautions for LIVE influenza vaccine? | These persons should receive the inactivated vaccine.
- 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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