Immunizations Flashcards
What vaccine preventable disease kills the most kids annually?
- measles (745,000/1.5 mill total vaccine preventable deaths)
What is herd immunity?
- ability of a community to resist epidemic disease
- not every person in a pop has to be immunized in order for a community to be resistant to an epidemic disease
- unvaccinated individuals are indirectly protected by vaccinated individuals, as the latter will not contract and transmit the disease b/t infected and susceptible individuals
Active immunizations?
- antigen admin (either live, killed or derivative such as protein polysaccharide of microorganism) or toxoid (deactivated toxin)
- provides long term immunity
- meaningful immunity often not achieved until 2-4 wks after vaccination
- live versions more efficacious and provide longer lasting immunity than nonliving vaccines
Passive immunization?
- admin of preformed ab (immunoglobulin)
- results in immediate protective immunity
- short term though (typically lasts only 3-6 months)
Times when immunoglobulin therapy (passive immunization) is used?
- mother is HBsAg +, then HBIG is given within 12 hrs of birth
- Palivizumab (Synagis) is RSV immune globulin that is admin to children at risk for severe RSV
Live virus immunizations?
- MMR
- Varicella
- Zoster
- Nasal-spray Flu vaccine
- Yellow fever (not std in US)
- Oral polio
- typhoid (not std in US)
- TB (BCG - not std in US
Admin more than 1 live vaccine at same time?
- should be done on same day at diff injection site or 4 weeks apart
Most common side effects of vaccines in kids?
- mild side effects:
fever and local rxns at site of injection
True vaccine CIs?
- previous anaphylactiv rxn to specific vaccine
- hx of anaphylaxis to eggs or egg protein - avoid measeles, mumps, influenza and yellow fever vaccines
- previous anaphylactic rxn to neomycin or streptomycin: avoid MMR
- hx of severe systemic rxns to cholera, typhoid or plague vaccine
- adults who are immunocompromised - avoid live vaccines
- household members of immunocompromised pts have to avoid oral polio vaccine - if vaccine induced disease occurs it could be transmitted to immunocompromised individual
- pregnant women: avoid all live virus vaccines
Common misconceptions about vaccine CIs?
- not a CI to admin vaccine in pt with mild respiratory, intestinal, or flu-like illnes, low grade fever or hx of recent illness
- mild or moderate local rxns are not CI
- hx of seizures isn’t a CI
- hx of non-vaccine assoc demyelinating conditions (MS or guillain-barre syndrome) not a CI to vaccine admin)
Hep B vaccine infant schedule?
- 3 doses
- 1st: birth
- 2nd: 6-8 wks of age
- 3rd: 4-18 months
- some babies get 4 doses if giving combo vaccine using Hep B is used (Pediarix)
What is done for babies born with high risk of getting Hep B?
- for babies born to HBsAg+ mothers, admin HepB vaccine and 0.5 mL of HBIG w/in 12 hrs of birth
- these infants should be tested for HBsAg and ab to HBsAg 1-2 months after completion of HepB series
Strep pneumo is leading cause of what? And what else can it cause in young children?
- leading cause of bacterial pneumonia worldwide and principal cause of sepsis and meningitis, especially in kids younger than 2 yo.
- incidence of invasive pbeumococcal disease has declined 60-90% in kids since PCV13 has been added to routine immunization schedule
Recommended immunization schedule for PCV13?
- IM 0.5 mL/dose
- primary 1: 6-8 wks
- 2: 4 months
- 3: 6 months
- booster: 12-15 months
HIB used to be leading cause of what before HIB vaccine?
- leading cause of childhood meningitis, pneumonia, and epiglottitis
- incidence has fallen more than 99% since prevaccine era
Indications to admin HIB vaccine to adults and children older than 5?
- sickle cell disease
- HIV/AIDS
- removal of spleen
- bone marrow transplant
- cancer pts on immunocompromising chemo
HIB vaccine schedule?
- 1: 6-8 wks
- 2: 4 months (4 wk interval)
- 3: 6 months (4 wks)
- booster: 15-18 months (6 mos)
IPV schedule?
- 6-8 weeks
- 4 months
- 6-18 months
- booster dose at 4-6 years
How long is DTaP vaccine effective for?
- approximately 10 yrs
DTaP vaccine schedule?
- 1: 6-8 weeks
- 2: 4 months (4 wk interval)
- 3: 6 months (4 wks)
- 4: 15-18 months 6 mos)
- 5: 4-6 yrs (6 mos)
Booster doses for Tdap?
- 11 or 12 yrs of age if 5 years since last dose
- every 10 yrs thereafter (Td or Tdap)
- pertussis is making a comeback, recommended that all adults get at least 1 booster from Tdap formulation
Admin of rotavirus vaccine (rotarix, rotateq)? Why do we give this?
- admin orally
- rotavirus is single most impt viral cause of severe gastroenteritis in kids worldwide
- severe gastroenteritis affects kids 6mo-2 yrs
- vaccine to be started by 14 wks and is to be completed by 8 months
Dosage of RV5 (RotaTeq)?
- more common
- live attenuated
- route: oral 2 ml/dose/ 3 doses
- pentavalent human-bovine rotavirus reassortant vaccine
Dosage of RV1 (rotarix)?
- live attenuated vaccine
- route: oral 2 ml/ 2 doses
- monovalent vaccine derived from the most common human serotype
Rotavirus vaccines are assoc with an increased risk of?
- intussusception
Rotavirus vaccine schedlue (ratateq, rotarix)?
- first dose: 6-8 wks
- 2nd: 4 months
- 3rd: 6 months (only for rotaTeq)
Flu shot is recommended to who? How many doses are reqd when receiving flu vaccine for first time?
- How long does before vaccine is effective?
- recommeneded for all kids annually from 6 mo-18 yrs and close contacts of all kids 0-59 mos
- for kids aged 6 mos to 8yrs reqr 2 doses (sep by at least 4 wks) to kids who are recieving vaccine for first time
- inactivated vaccine protects against 3-4 diff influenza viruses
- Takes 2 weeks for protection
Intranasal flu vaccine?
- live, only approved for healthy pts 2-49 who are not pregnant
- viruses in nasal spray don’t cause the flu
What is the Hep A vaccine? When is it admin? Typical schedule?
- inactivated whole virus vaccine
- ped formulations vaccines approved for 12 months- 18 years
- admin with 2 dose series, 1st dose initiated at 12-23 months, 2 doses should be separated by 6-18 months
- schedule:
1st dose: 12 months
2nd: 24 months
MMR vaccine? Vaccination schedule?
- live virus attenuated vaccine at 0.5 ml dose via subQ route
- first dose: 12-18 months
- 2nd dose: 4-6 yrs (may be given any time at least 4 weeks after the first dose)
- first dose has to be given at exactly 12 months or later
Why do we worry about Rubella (german measles) so much?
- rubella virus causes rash, arthritis (mostly in females), and mild fever
- rubella in and of itself generally is a mild self-limiting disease but if a woman gets rubella while pregnant - lead to congenital rubella syndrome
Varivax? schedule?
- varicella vaccine
- live, attenuated
- ped dosing: 0.5 ml SubQ
- routine childhood vaccination is 2 doses
- 1st: 12-15 months
- 2nd: 4-6 yrs but may be admin earlier provided 3 or months have elapsed after first dose
Meningococcal vaccine?
- MCV4 and Menactra
- 2 doses of MCV4 recommend for adolescents 11-18 yrs of age:
1st dose at 11-12
booster: 16
HPV vaccine?
- gardisal
- ACIP recommends routine vaccination of all adolescents 11-12 yo
- can be started at 9
- catch up vaccination recommened for 13-26 yo
- routine schedule: 0, 2, 6 months
- 3rd dose should follow 1st dose by at least 24 wks
- series doesn’t need to be restarted if schedule is interrupted
- best time to get vaccine is before becoming sexually active
What vaccines are in Pediarix? schedule? What age group can get this?
- DTaP, Hep B, IPV combo
- min. age: 6 wks
- 3 doses at 2, 4, and 6 months
- not approved for boosters
- for children 6 wks-7 yrs
- Child can still get this if received birth dose of HBV vaccine, (4 doses of it in total)
- May be used in infants whose mothers are HBsAg + or status unknown
What does a typical vaccination schedule look like with combo vaccines?
- birth: HBV
- 2 months: prevnar, Hib, pediarix
- 4 months: prevnar, Hib, pediarix
- 6 months: prevnar, Hib, pediarix
- 12 months: prevnar, Hib, HepA
- 15-18 months: DTaP, ProQuad (MMRV)
- 18-24 months: HepA
- 4-6 yrs: Kinrix (DTaP-IPV) and ProQuad
If Hexavac gets approved what would the infancy vaccination schedule look like?
- only need to administer Prevnar and Hexavac through first year
