Immunizations

Question 1

Difference between polysaccharide and conjugate vaccines

Answer 1

Polysaccharide not given to children under 2 yo because their immune system is not completely developed so they dont provide an effective immune response

Conjugated (combined w/ a protein molecule) improves the antibody response, so this vaccine is viable for children under 2 yo

(This is why children < 2 get the conjugated pneumococcal vaccine (prevnar) and then get the polysaccharide (pneumovax) when they’re older than 2 yo)

Question 2

Which vaccines are live

Answer 2

Injections:
MMR
MMRV
Varicella
Zoster (but now we have Shingrix)
Yellow fever

Other routes:
Flumist
Rotavirus
Cholera
Typhoid

Question 3

Risk with increasing or decreasing the interval between multi dose vaccines?

Answer 3

Increasing: does not diminish the effectiveness after completeness of all doses, but does delay complete protection

Decreasing: can interfere with antibody response and production

Safer to increase interval rather than decrease

Question 4

Necessary interval between an antibody containing blood product (IVIG, blood transfusions) and MMR or varicella containing vaccine…

Answer 4

If getting blood product first, wait minimum of 3 months and may be up to 11 months before vaccine

If getting vaccine first, wait 2 weeks before getting antibody containing blood product

Question 5

At what age can babies receive live vaccines?

Answer 5

12 months

Question 6

Can live vaccines be given on the same day?

Answer 6

Yes
Exception: in patients with asplenia, prevnar and menactra must be separated by 4 weeks

If not given on the same day, they must be spaced 4 weeks apart
Exception: no separation required for oral rotavirus vacicne

Question 7

How to avoid false negative with Tb skin testing in relation to timing of the vaccine

Answer 7

Give the same day as the skin test or wait 4 weeks before giving the skin test

Question 8

Where should you report adverse events related to administering a vaccine?

Answer 8

Vaccine Adverse Event Reporting System (VAERS)

Question 9

How many epinephrine pens should be on hand for pharmacists to use?

Answer 9

3 adult (0.3 mg) auto injectors
Most adults require 1-3 doses spaced every 5-15 minutes until paramedics arive

Question 10

Contraindications to use of live vaccine

Answer 10

Pregnancy and immunosuppression

HIV with CD4 count < 200 (MMR and varicella)

Question 11

Pregnancy vaccines

Answer 11

Influenza, inactivated (in season)
Tdap x 1 for each pregnancy (optimal time between 27 and 36 weeks)
NO LIVE VACCINES

Question 12

Asplenia vaccines

Answer 12

H influenzae type B
Pneumococcal (both)
Meningococcal (both)

Question 13

Indications for DTaP

Answer 13

DTaP = more diphteria than Tdap

Given to children younger than 7 years of age

Question 14

HPV vaccine schedule

Answer 14

before age 15: give 2 doses at month 0 then 6-12 months later

after age 15: give 3 doses (month 0, 1-2, then 6 months)

Females up to age 26, males up to age 21 or up to 26 in immunocompromised/men who have sex w men

Question 15

Hepatitis A and B schedule

Answer 15

3-dose series given at months 0, 1, and 6

Question 16

What are the H and N in flu subtypes, ie H1N1

Answer 16

H=hemagglutinin
N=neuramidase
The two surface antigens that viruses are categorized by, aside from A and B

Question 17

Why is there a new flu vaccine every year?

Answer 17

Frequent development of antigenic developments through antigenic drift, this is the basis for seasonal epidemics

Note: more dramatic antigenic changes or shifts occur approximately every 30 years, and can result in the emergence of a novel influenza virus with the potential to cause a pandemic

Question 18

How does the flu virus spread?

Answer 18

Primarily through respiratory droplet transmission (coughing, sneezing)

Question 19

Who does CDC recommend receives flu vaccine?

Answer 19

All patients age 6 months or higher unless there is a contraindication

Patients age 6 months to 8 years: should receive 2 doses if never vaccinated, spaced 4 weeks apart

Patients with egg allergy: Flublok (egg free product) approved for age 18+ only

Pregnant patient: inactivated vaccine only

Age 65+: fluzone, fluad (high dose)

Question 20

High dose flu shots

Answer 20

Fluad
Fluzone HD
Approved for age 65 and older

Question 21

Trivalent inactivated influenza vaccines

Answer 21

Afluria
Fluvirin
Fluzone HD
Fluad

Question 22

Quadrivalent inactivated influenza vaccines

Answer 22

Fluarix quadrivalent
Fluzone quadrivalent

+ others (not bolded)

Question 23

Quadrivalent live attenuated vaccine

Answer 23

Flumist (intranasal)

Not recommended for use in 2017-2018 season

Question 24

Which flu vaccine can be given with a needle free jet injector

Answer 24

Afluria

Question 25

MMRV storage

Answer 25

MMRV=MMR plus varicella | Store vaccine in freezer, diluent at room temp or in refrigerator

Question 26

Meningococcal vaccine brands, schedule

Answer 26

``` Menactra = age 9 months to 55 years Menveo = age 2 months to 55 years ``` Give one dose of MCV4 at age 11-12, give booster dose at age 16

Question 27

Menveo clinical pearl

Answer 27

Menveo = meningococcal vaccine (MCV4) Both vials (poweder and liquid) contain vaccine - use only supplied liquid for reconstitution

Question 28

Pneumococcal vaccine schedule

Answer 28

Children age < 2: Prevnar only (don't have immune response to respond to polysaccharide vaccines, like pneumovax) 65 and older w no previous pneomococcal vaccines: receive PCV13 then PPSV12 months later

Question 29

When do we give Pneumovax before age 65?

Answer 29

1 dose: Immunocompetent patients with diabetes, heart, lung, liver disease, alcohol abuse, smokers 2 doses of PPV23: Immunocompromised patients age 2-64 with sickle cell disease, asplenia, HIV, chronic renal failure, malignancy, transplant, or immunosuppressive drug use (including steroids)

Question 30

When do we give Prevnar before age 65?

Answer 30

Always! Indicated in children < 5 years, but also indicated in age 6-64 if they've never received if they're immunocompromised (HIV, sicke, asplenia, steroid use) and indicated in all patients > 65

Question 31

How to dose pneumococcal vaccines in immunocompromised patients

Answer 31

Age 6-64: 1 dose prevnar, 2 doses pneumovax Separate prevnar and pneumovax by 8 weeks, then pneumovax series by 5 years If pneumovax is given first, must wait 1 year to give prevnar (delays protection)

Question 32

How to dose pneumococcal vaccines in patients 65 or older

Answer 32

Give prevnar 13 x 1 dose, followed by pneumovax 1 year later Need to separate pneumovax 5 years from any previous pneumovax dose

Question 33

Rotavirus vaccine schedule

Answer 33

Given to infants, do not give after age 15 weeks Oral vaccine RotaTeq is the brand

Question 34

Poliovirus vaccines schedule

Answer 34

Given to all children

Question 35

Tdap brands, vaccine schedule

Answer 35

Boostrix, Adacel Give as booster age 11+ years with no previous Tdap record Indicated for pregnant or postpartum women, and family members with close contact to infants

Question 36

Td brand, vaccine schedule

Answer 36

Tenivac Routine booster every 10 years in patients 7+ For patients with deep or dirty wound who havent received a booster in the past 5 years

Question 37

Varicella brand, vaccine schedule, considerations

Answer 37

Varivax (chickenpox), zostavax/shingrix (herpes zoster/shingles) Varivax: 2 doses at age 12-15 months and again at 4-6 years, and anyone without evidence of immunity to varicella should receive 2 doses Zostavax: 14 times more potent than varivax, ACIP recommends use in 60+ years (FDA approved 50+) Antivirals (ayclovir, valacyclovir, famciclovir) can interfere with this live vaccine. Stop 24 hours before vaccine and do not administer for 14 days following vaccine Store in freezer and diluent in fridge or at room temp Reconstitute immediately after removing from freezer, give subcutaneously Do not give if hypersensitivity to gelatin or neomycin

Question 38

Needle size for IM injections

Answer 38

1 inch needle (or 1.5 for women over 200 lb or men over 260 lb), 22-25 gauge

Question 39

Needle size for SC injections

Answer 39

5'8'' needle, 23-25 gauge at 45 degree angle

Question 40

Which vaccines are SC?

Answer 40

``` MMR MPSV (meningococcal polysaccharide) PPSV (can be IM or SC) Varicella Zoster ```