Immunizations Flashcards
Antigen
A Live or Inactivated Substance Capable of Producing an Immune Response
Antibody
Protein Molecules Produced by B Lymphocytes to Help Eliminate an Antigen
Passive Immunity
The transfer of one person’s immunity to another (mother to child/infant through placenta or breast milk)
Active Immunity
The Stimulation of the Immune system to produce an antigen-specific antibody
Usually permanent
Methods: Survive infection: memory B cells remember the antigen and when exposed again , replicate and produce antibodies
vaccination: The injection of a small amount of antigen to produce an immune reponse.
Live Attenuated Vaccine Definition
Immune reponse is similar to natural infection, apparent after first dose for most people, can cause mild sx of disease, CI for immunosupressed, pregnancy, children under 1 y/o
List of Live Attenuated Vaccines
MMR, Vaccinia, Varicella, Zoster, Yellow Fever, Rotavirus, Intranasal Influenza, Oral Polio, Oral Typhoid
Inactivated Vaccine Definition
Contains Virus that has been inactivated by heat or chemicals, not alive therefore can not replicate, usually requires several doses,
Polysaccharide Vaccine Definition
Inactivated Vaccine that contains long chains of sugar molecules that make up the surface capsule protein of the bacteria.
Pure Polysaccharide Vaccines
Immune response does not require T-cells and is mediated through Be cells. Children under 2 are unable to form an immune response by this method.
Types of Vaccines
Pneumococcal (PPSV23)
Meningococcal (MPSV4)
Salmonella Tphi (vi)
Conjugate polysaccharide Vaccines
A polysaccharide vaccine that has an added protein which changes it to a T-cell mediated response. Now children under 2 y/o can form an immune response. Types of vaccines: Hib Pneumococcal (PCV13) Meningococcal (MCV4)
Inactivated Vaccine Definition
Contains Virus that has been inactivated by heat or chemicals, not alive therefore can not replicate, usually requires several doses,
How long must you wait between a live vaccine and giving circulating antibodies?
At least 2 weeks, however if antibody is given first must wait 3 months before administering vaccine.
Pure Polysaccharide Vaccines
Immune response does not require T-cells and is mediated through Be cells. Children under 2 are unable to form an immune response by this method.
Types of Vaccines
Pneumococcal (PPSV23)
Meningococcal (MPSV4)
Salmonella Tphi (vi)
If a live attenuated vaccine is not given at the same visit, how many weeks must it be separated by?
4 weeks (this does not apply to oral live attenuated vaccines)
Does increasing the interval between vaccine doses diminish the effectiveness?
No, but decreasing the interval b/t doses can decrease effectiveness.
True or False…Vaccines should not be given earlier than the minimum age requirement for the vaccine.
True: However an exception would be during a measles outbreak a MMR vaccine may be given before 12 months, but this dose would not count toward the series.
True or False..There is clinical data to support High Dose inactivated influenza vaccine vs. the TIV in the elderly population.
False..The CDC does not give preference due to lack of strong evidence.
Influenza Vaccine
All individuals over 6 months old should get influenza vaccine.
All children 6 months to 8 years who are receiving their first influenza vaccine should receive a total of two doses, at least 4 weeks apart.
Pneumonia Vaccine
PCV13: All children younger than 2 years, series of four doses, given at 2, 4, 6, and 12-15 months.
PPSV23: All patients 65 y/o and older
People 19-65 with asthma, cigarette smokers
People 2-64 with chronic illness, anatomic or functional asplenia, immunocompromised, HIV, environmental settings, cochlear implant
No person should receive revaccination more than once.
Meningococcal Vaccine
Inactivated; IM injection, two dose series, minimal interval between dose is 8 weeks.
MPSV4 (polysaccride) not as effective as the MCV4 (conjugate vaccine)
MCV4- patients 2-55
MPSV4- patients over 55 y/o
Recommendations:
All children age 11-12, booster at 16 y/o
if first dose given over 16, booster is not necessary
Individuals 2-54 at increased risk of menigococcal disease. (ie military, traveling to countries with epidemics, aslpenia)
Varicella Vaccine
Live attenuated, administered sub-Q, 2 dose series. First dose should be given at 12-15 months of age, then second dose at 4-6 months of age. However 2nd dose can be given as soon as 3 months after the first dose.
Patients older than 13 y/o can be given two dose series separated by 4 weeks.
Patients born before 1980 are considered immune.
Postexposure Prophylaxis: Can be 70-100% effective if given within 3 days of exposure to varicella virus.
Herpes Zoster Vaccine
Live attenuated, administered sub-q, same antigen as varicella vaccine however at a much higher dose. The vaccine can decrease the incidence of herpes zoster infections by 50%. More effective at 50-59 y/o and efficacy decreases with age.
True or False..All individuals 60 years of age or older regardless of their history of chickenpox or herpes zoster should be given the Herpes Zoster Vaccine.
True (is approved in >50 y/o now, however CDC has not yet changed the recommendation)
TdaP, TD, DPT, etc.
Inactivated Vaccine, no single agent available.
Pertussis is found in acellular form b/c whole cell vaccine was associated with severe ADRs.
Recommendations:
Children, birth to 6 years: Total of 5 doses of DTaP
2, 4, 6, and 15-18 months
Adolescents 11-2, once dose of Tdap
Adults 18 y/o and older
One dose of Tdap then TD every 10 years
Pregnant Women
one dose of Tdap with each pregnancy regardless of Tdap/Td history, preferably after 20 weeks gestation
Adults >65 y/o one dose of Tdap then Td every 10 years.
MMR Vaccine
Live Attenuated, Sub-Q Vaccine
Almost all patients have immune reponse after first dose, but up to 2-5% may not respond. Thus it is a 2 dose series. First dose given at 12 months or older, 2nd dose is usually given at age 4-6 but can be given as soon as 28 days after the first dose if needed. Adults born before 1957 are considered immune, otherwise need 1 dose if not given childhood series.
Hepatitis A Vaccine
Inactivated, whole cell virus vaccine. HAVRIX and VAQTA are brand names, no preference for which one, VAQTA is preservative free. Both are in peds and adult strengths. Seroconversion is 100% after two doses.
Since 2005, all children have been vaccinated 12-23 months of age.
Catch up for Travelers, illicit drug users, chronic liver disease, people who work with hepatitis A-infected animals.
Hepatitis B Vaccine
Recombinant, inactive vaccine. 3 dose series. At birth, 1-2 months, and 6-18 months.
High risk adults if not vaccinated as children. (DM, MSM, health care workers, traverls, HIV patients, etc.
Hib Vaccine
Polysaccharide-protein conjugate vaccine, approved for use in children 6 weeks and older, clinical efficacy has been shown to be 95-100% after 2-3 doses.
PRP-T (conjugated to tetanus toxoid) series of 3 doses at 2, 4, 6, one booster dose at 12-15 months.
PRP-OMP series of two doses at 2 and 4 months, one booster dose at 12-15 months.
Polio Vaccine
Oral Vaccine (Live attenuated vaccine) No longer used in US d/t limited cases of vaccine-associated paralytic poliomyelitis.
Inactivated Poliovirus Vaccine (IPV)- Sub-Q
- Vaccinate all children starting at age 2 months
- Series of four doses given at 2, 4, 6-18 months, and 4-6 years.
Rotavirus Vaccine
Live Oral Vaccine
(RV5) RotaTeq- 5 strains of rotavirus suspended in a buffer solution. Total of 3 doses
RV1 (Rotarix)- 1 strain of rotavirus, total of 2 doses. (2 months and 4 months) Must be completed by 24 weeks.
Virus can shed in feces for 15 days after administration. (2, 4, and 6 months) Must be completed by 32 weeks.
ACIP had no preference for one vaccine over the other. There should be at least 4 weeks b/t each dose.
Rotavirus Vaccine
TBD
