Immunizations Flashcards
involves administration of an antigen to induce antibody formation (for active immunity) or administration of serum from immune people (for passive immunity).
Immunization
to protect infants against rotavirus gastroenteritis, an infection that causes diarrhea, vomiting, and fever.
Rotavirus vaccine (Rotateq)
recommended because protection against pertussis declines a few years after immu- nization with pertussis vaccine during infancy. Boostrix is used for persons aged 10 to 18 years, and Adacel is used for persons aged 11 to 64 years.
A booster dose of tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)
For adolescents, chickenpox vaccine for those who have never had chickenpox or been vaccinated previously; a second dose of chickenpox vaccine for adolescents who previously received a single dose
A second dose of chickenpox vaccine (e.g., Varivax) at 4 to 6 years old (first dose at 12–15 months).
It was formerly recommended for children in states with high rates of hepatitis A.
Hepatitis A vaccination for all children in the United States, with the first of two doses between 1 year and 2 years of age.
When to give flu vaccinations
Annual flu vaccination for children aged 6 months to 18 years and for household contacts, caregivers, and others who spend significant time with children from birth to 5 years.
When to give HPV vaccine
Human papilloma virus (HPV) vaccine (Gardasil) for all girls 11 or 12 years of age (can be given as early as 9 years) or up to 26 years of age if not received earlier, to help prevent HPV, a common sexually transmitted infection that can lead to genital warts and cervical cancer. Most effective if given before the person becomes sexually active. HPV vaccine if not previously received, up to age 26 years.
When to give meningococcal vaccine
Meningococcal vaccine at 11 or 12 years of age. If not received earlier, recommended at entry to high school or college.
When to give chickenpox vaccine
Chickenpox vaccine for adults who never had the disease or vaccine; a second dose of vaccine for adults who previ- ously received a single dose
Tdap booster vaccine for adults
recommended for all adults under 65 years of age who have not already received Tdap, especially health professionals and those who have close contact with infants (under 1 year of age).
Vaccine for herpes for adults
Zoster vaccine (Zostavax) is available to prevent herpes zoster (shingles) in adults 60 years and older.
Vaccine
are suspensions of microorganisms or their antigenic products that have been killed or attenuated (weak- ened or reduced in virulence) so they can induce antibody for- mation while preventing or causing very mild forms of the disease.
biologic products used for active immunity
Vaccines and toxoids
Toxoids
bacterial toxins or products that have been modified to destroy toxicity while retaining antigenic proper- ties (i.e., ability to induce antibody formation). Immunization with toxoids is not permanent; scheduled repeat doses (boost- ers) are required to maintain immunity.
Products containing aluminum
Products containing aluminum should be given intramuscularly only, because they cannot be given intravenously and greater tissue irritation occurs with subcutaneous injections
Maximum effectiveness of vaccines and toxoids
vaccines and toxoids must be given before exposure to the pathogenic microorganism. They should also be given by the recommended route to ensure the desired immunologic response.
Rubella during first trimester of pregnancy
Rubella during the first trimester of pregnancy is associated with a high incidence of birth defects in the newborn.
Vaccines and toxoids usually contraindicated in
febrile illnesses; immunosuppressive drug therapy (see Chap. 41); immunodeficiency states; leukemia, lymphoma, or generalized malignancy; and pregnancy.
biologic products used for passive immunity.
Immune serums. They act rapidly to provide temporary (for 1–3 months) immunity in people exposed to or experiencing a par- ticular disease. The goal of therapy is to prevent or modify the disease process (i.e., decrease the incidence and severity of symptoms).
For pregnant women not known to be immunized against rubella,
serum antibody titer should be measured to deter- mine resistance or susceptibility to the disease.
Administer this vaccine after exposure to Rubeola
For someone exposed to rubeola, administration of measles vaccine within 48 hours to prevent the disease
For someone with a puncture wound or a dirty wound,
administration of tetanus immune globulin to prevent tetanus, a life-threatening disease
For someone with an animal bite
washing the wound immediately with large amounts of soap and water. Health care should then be sought. Administration of rabies vaccine may be needed to prevent rabies, a life- threatening disease.
Rubella during pregnancy
contracting rubella or undergoing rubella immunization during pregnancy, especially during the first trimester, may cause severe birth defects in the infant. The goal of immunization is to prevent congenital rubella syndrome. Current rec- ommendations are to immunize children against rubella at 12 to 15 months of age. It is recommended that pre- viously unimmunized girls 11 to 13 years of age be immunized against rubella. Furthermore, nonpregnant women of childbearing age should have rubella anti- body tests. If antibody concentrations are low, the woman should be immunized. Pregnancy should be avoided for 3 months after immunization.
Storage of vaccines
To maintain effectiveness of vaccines and other biologic prepa- rations, the products must be stored properly. Most products require refrigeration at 2C to 8C (35.6–46.4F). Manufac- turers’ instructions for storage should be strictly followed.
Immunizations required for children by 4 to 6 years of age include
By 4 to 6 years of age, children should have received vaccinations for chickenpox (varicella), diphtheria, hepatitis A and B, influenza, measles, mumps, pertussis (whooping cough), polio, pneumococcal diseases, rubella (German measles), tetanus, and Haemophilus influenzae and rotavirus infections. Because some vaccines are adminis- tered more than once, a child may receive more than 20 injections by 2 years of age.
Indication for Haemophilius influenza vaccine
To prevent infection with Hib, a common cause of serious bacterial infections, including meningitis, in children younger than 5 years
Indications for hepatitis A vaccine (Havrix, Vaqta)
Workers in daycare centers, laboratories, food-handling establishments; men who have sex with men; IV drug users; military personnel; travelers to areas where hepatitis A is endemic; community residents dur- ing an outbreak; people with chronic liver disease (e.g., hepatitis B or C, cirrhosis)
Indications for hepatitis B vaccine (Engerix)
Pre-exposure immunization of high-risk groups, such as health care providers (nurses, physicians, dentists, laboratory workers); patients with cancer, organ transplants, hemodialysis, immunosuppressant drug therapy, or multiple infusions of blood or blood products; men who have sex with men; IV drug abusers; household contacts of hepatitis B virus carriers; residents and staff of institutions for mentally challenged people Persons requiring postexposure vaccine include infants born to carrier mothers, people with accidental exposure of skin or mucous membrane to infected blood (e.g., needle stick injuries), and household contacts or sexual partners of persons with acute hepatitis B infection
HPV vaccine indications
Prevention of diseases caused by HPV types 6, 11, 16, and 18 (cervical, vaginal and vulvar cancer; genital warts) in girls and women aged 9–26 y
Influenza vaccination indications (Fluzone, Fluvirin, FluMist)
Children between 6 months and 5 years old, Pregnant women, People older than 50 y, People who live in long- term health care facilities People with chronic med- ical conditions (e.g., dia- betes, lung disease, HIV/AIDS) People living with or caring for young children, nurs- ing-home residents, those with compromised immune systems, or those with chronic medical conditions
Measles, mumps, and rubella vaccine indications (MMR)
Immunization at 12–15 mo and a second dose at 4–6 y
Meningitis/meningococcal vaccine indications (Menactra)
Immunization of people at risk in epidemic or endemic areas Recommended for college students living in dormitories
Fluvirin in children
Fluvirin is indicated only in children 4 y and older. FluMist is indicated in healthy children and adolescents 5–17 y of age and in healthy adults 18–49 y of age (except during pregnancy).
Pneumococcal vaccine indications (Pneumovax)
Adults with disorders associ- ated with risk of pneumo- coccal infection (e.g., cardiovascular or pulmonary disease, diabetes mellitus, Hodgkin’s disease, multi- ple myeloma, cirrhosis, alcohol dependence, renal failure, immunosup- pression) Adults 65 y and older who are otherwise healthy Children 2 y and older with chronic disease associated with risk of pneumococcal infection (e.g., asplenia, nephrotic syndrome, immunosuppression)
Indications for polio vaccine (IPOL)
Routine immunization of infants Immunization of adults not previously immunized and at risk of exposure (e.g., health care or laboratory workers)
Indications for rabies vaccine (Imovax)
Pre-exposure immunization in people at high risk of exposure (e.g., veterinarians, animal handlers) Postexposure prophylaxis in people who have been bitten by potentially rabid animals or who have skin scratches or abrasions exposed to ani- mal saliva (e.g., animal lick- ing of wound), urine, or blood
Indications for rotavirus
Prevention of rotavirus gas- troenteritis in infants
Tuberculosis vaccine indications
People at high risk of expo- sure, including newborns of women with tuberculosis. Contraindicated in patients with impaired immune responses
Varicella vaccine (Varivax)
Immunization of children 12 mo and older
Immunization of adults
Contraindicated in people with hematologic or lymphatic malignancy, immunosuppression, febrile illness, or pregnancy
Zoster vaccine indications (Zostavax)
Prevention of herpes zoster in adults 60 y and older.
Redness, edema, tenderness at injection site were most common adverse reactions during clinical trials.
Diphtheria, tetanus, and pertussis vaccine indications
Immunization of children aged 6 wk–7 y
Booster dose for persons aged 10–18 y (Boostrix) or persons aged 11–64 y (Adacel)
DTaP and Haemophilus influenzae type b
Immunization of children 15–18 mo of age who have been previously immunized against diphtheria, tetanus, and pertussi
Diphtheria and tetanus vaccine indications (DT)
Routine immunization of infants and children 6 y and younger in whom pertussis vaccine is con- traindicated (those who have adverse reactions to initial doses of DTaP vaccine
Tetanus and diphtheria toxoids indications for adults
Primary immunization or booster doses in adults and children older than 6 y
Tetanus toxoid indications
Routine immunization of infants and young children
Primary immunization of adults
Prevention of tetanus in previously immunized people who sustain a potentially contaminated wound
Intravenous immune globulin indications
Immunodeficiency syndrome
Idiopathic thrombocytopenic purpura (ITP)
IGIV has been associated with renal dysfunction and failure and death. It should be used cautiously in patients with or at risk of developing renal impairment.
Rabies immune globulin indication
Postexposure prevention of rabies, in conjunc- tion with rabies vaccine
Respiratory syncytial virus immune globulin IV indications
Prevention of serious RSV infections in high risk children less than 2 y of age (i.e., those with bronchopulmonary dysplasia or history of premature birth [gestation of 35 wk or less])
Treatment of RSV lower respiratory tract infections in hospitalized infants and young children
Tetanus immune globulin indications
To prevent tetanus in patients with wounds possibly contaminated with Clostridium tetani and whose immunization history is uncertain or incomplete
Treatment of tetanus infection
Tetanus toxoid (Td) should also be given to initiate active immunization if minor wound and more than 10 y since Td, if major wound and more than 5 y since Td, or if Td primary immunization series was incomplete.
Varicella zoster immune globulin
Postexposure to chickenpox or shingles, to prevent or decrease severity of infections in children under 15 y of age who have not been immunized or who are immunodeficient because of illness or drug therapy
Infants born to mothers who develop varicella 5 d before or 2 d after delivery and premature infants of less than 28 wk gestation
provider recommends an immunization and you do not know whether you have had the immunization or the disease,
it is probably safer to take the immunization than to risk having the disease. Immunization after a previous immunization or after having the disease usually is not harmful.
Most vaccines cause __________
Most vaccines cause fever and soreness at the site of injection.
Women should avoid becoming pregnant after receiving rubella or varicella vaccine for ______ months
3 months.
After receiving varicella vaccine (to prevent chickenpox), __________________
avoid close contact with newborns, pregnant women, and anyone whose immune system is impaired. Vaccinated people may transmit the vaccine virus to susceptible close contacts.
Vaccine use in older adults
Recommended immunizations for older adults usually consist of a tetanus-diphtheria (Td) booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age. A second dose of pneumococcal vaccine may be given at 65 years if the first dose was given 5 years previously.
Patients with active malignant disease may be given killed vaccines or toxoids but should not be given
live vaccines (an exception is persons with leukemia who have not received chemotherapy for at least 3 months). When vaccines are used, they should be given at least 2 weeks before the start of chemotherapy or 3 months after chemotherapy is completed. Passive immunity with immunoglobulins may be used in place of active immunity.
In general, those with diabetes mellitus or chronic pulmonary, renal, or hepatic disorders who are not receiving immunosuppressant drugs may be given
both live attenuated and killed vaccines and toxoids to induce active immunity. However, they may need higher doses or more frequent administration to induce adequate immunity.
Patients with HIV infection have less-than-optimal responses to immunizing agents because the disease produces major defects in cell-mediated and humoral immunity. Live bacterial (BCG, oral typhoid) or viral (MMR, varicella) vaccines should
not be given because the bacteria or viruses may be able to reproduce and cause active infection. Persons with asymptomatic HIV infection should receive inactivated vaccines; those exposed to measles or varicella may be given immune globulin or varicella-zoster immune globulin for passive immunization.
For children with HIV infection, most routine immuniza- tions (DTaP, IPV, MMR, Hib, influenza) are recommended, but
MMR is not recommended in children with severe immuno- suppression, and varicella vaccine is recommended only for children with no evidence of immunosuppression. Pneumococ- cal vaccine is recommended for HIV-infected persons over 2 years of age.
Vaccine usage in patients with cancer
For patients with active malignant disease, live vaccines should not be given. Although killed vaccines and toxoids may be given, antibody production may be inadequate to provide immunity. When possible, patients should receive needed immunizations 2 weeks before or 3 months after immunosuppressive radiation or chemotherapy treatments. In addition, patients who have not received chemotherapy for 3 to 4 weeks may have an adequate antibody response to influenza vaccine.
Check the patient’s temperature before giving a vaccine.
Some immunizations are contraindicated during febrile illnesses.
After administration of an immunizing agent in a clinic or office setting, have the patient stay in the area for at least
30 minutes to observe for allergic reactions
Common adverse effects of DTaP
Soreness, erythema, edema at injection sites
Anorexia, nausea
Adverse effects of influenza vaccine
(1) Via injection—pain, induration, and erythema at injection sites; flu-like symptoms such as chills, fever, malaise, muscle aches (2) Via intranasal spray—runny nose, headache, cough, sore throat, irritability in children
MMR vaccine adverse effects
(1) Mild symptoms of measles—cough, fever up to 39.4C (102F), headache, malaise, photophobia, skin rash, sore throat
(2) Febrile seizures. These are rare but are more likely to occur in children less than 2 years of age
(3) Arthralgia (joint pain). Joint pain has been reported in as many as 25% of adult females 2–6 weeks after receiving rubella vaccine.
Egg allergy for MMR vaccine
The measles and mumps viruses used in MMR vaccine are grown in chick-embryo cell cultures. Recipients who are allergic to eggs should be observed for 90 minutes after the vaccine is injected. MMR vaccine should be given only in a setting where personnel and equipment are available to treat anaphylaxis.
Pneumococcal vaccine adverse effects
(1) Local effects—soreness, induration, and erythema at injection sites (2) Systemic effects—chills, fever, headache, muscle aches, nausea, photophobia, weakness
Varicella vaccine adverse effects
(1) Early effects—transient soreness or erythema at injection sites (2) Late effect—a mild, maculopapular skin rash with a few lesions
Vaccines may be contraindicated in patients receiving immunosuppressive drugs.
These patients cannot produce sufficient amounts of antibodies for immunity and may develop the illness produced by the particular organism contained in the vaccine. The disease is most likely to occur with the live-virus vaccines (measles, mumps, rubella). Similar effects occur when the patient is receiving radiation and phenytoin, an anticonvulsant drug that suppresses immune responses.
Natural acquired active immunity
Protection obtained by having the disease
Natural acquired passive immunity
Obtained antibodies via placental transmission or by breast milk, disappears by 15 minutes
Artificially acquired active immunity
Development of protection by vaccination
Artificially acquired passive immunity
Prophylactic protection
Contraindications for vaccine
Acute febrile illness, immunological deficiency or malignancy, immunosuppressive therapy, pregnancy, skin irritations or dermatitis, gamma globulin, plasma, or a blood transfusion in the previous 6-8 months, or known allergy
Principles of vaccination
There is no contraindication to simultaneous administration of any vaccines. It is not necessary to restart the series of any vaccine due to extended intervals between dose.
Pregnant women and vaccines
No live vaccine except OPV in certain situations. Inactivated vaccines cannot replicate and so cannot cause fetal infection.
2012 changes to immunization schedule
HPV vaccine is no longer just for girls. Give to males and females starting at age 11. Give Tdap to pregnant woman between 27 and 36 weeks gestation to pass on to fetus. Egg allergy is no longer a contraindication to the flu vaccine, but egg allergic pts must get the inactivated shot. The new ID needle is for 18 to 64 year olds. Everyone over 6 months old should be vaccinated for the flu.
