Immunizations Flashcards
Difference between polysaccharide and conjugate vaccines
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)
Which vaccines are live
Injections: MMR MMRV Varicella Zoster (but now we have Shingrix) Yellow fever
Other routes: Flumist Rotavirus Cholera Typhoid
Risk with increasing or decreasing the interval between multi dose vaccines?
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
Necessary interval between an antibody containing blood product (IVIG, blood transfusions) and MMR or varicella containing vaccine…
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
At what age can babies receive live vaccines?
12 months
Can live vaccines be given on the same day?
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
How to avoid false negative with Tb skin testing in relation to timing of the vaccine
Give the same day as the skin test or wait 4 weeks before giving the skin test
Where should you report adverse events related to administering a vaccine?
Vaccine Adverse Event Reporting System (VAERS)
How many epinephrine pens should be on hand for pharmacists to use?
3 adult (0.3 mg) auto injectors Most adults require 1-3 doses spaced every 5-15 minutes until paramedics arive
Contraindications to use of live vaccine
Pregnancy and immunosuppression
HIV with CD4 count < 200 (MMR and varicella)
Pregnancy vaccines
Influenza, inactivated (in season)
Tdap x 1 for each pregnancy (optimal time between 27 and 36 weeks)
NO LIVE VACCINES
Asplenia vaccines
H influenzae type B
Pneumococcal (both)
Meningococcal (both)
Indications for DTaP
DTaP = more diphteria than Tdap
Given to children younger than 7 years of age
HPV vaccine schedule
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
Hepatitis A and B schedule
3-dose series given at months 0, 1, and 6
What are the H and N in flu subtypes, ie H1N1
H=hemagglutinin
N=neuramidase
The two surface antigens that viruses are categorized by, aside from A and B
Why is there a new flu vaccine every year?
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
How does the flu virus spread?
Primarily through respiratory droplet transmission (coughing, sneezing)
Who does CDC recommend receives flu vaccine?
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)
High dose flu shots
Fluad
Fluzone HD
Approved for age 65 and older
Trivalent inactivated influenza vaccines
Afluria
Fluvirin
Fluzone HD
Fluad
Quadrivalent inactivated influenza vaccines
Fluarix quadrivalent
Fluzone quadrivalent
+ others (not bolded)
Quadrivalent live attenuated vaccine
Flumist (intranasal)
Not recommended for use in 2017-2018 season
Which flu vaccine can be given with a needle free jet injector
Afluria
MMRV storage
MMRV=MMR plus varicella
Store vaccine in freezer, diluent at room temp or in refrigerator
Meningococcal vaccine brands, schedule
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
Menveo clinical pearl
Menveo = meningococcal vaccine (MCV4)
Both vials (poweder and liquid) contain vaccine - use only supplied liquid for reconstitution
Pneumococcal vaccine schedule
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
When do we give Pneumovax before age 65?
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)
When do we give Prevnar before age 65?
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
How to dose pneumococcal vaccines in immunocompromised patients
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)
How to dose pneumococcal vaccines in patients 65 or older
Give prevnar 13 x 1 dose, followed by pneumovax 1 year later
Need to separate pneumovax 5 years from any previous pneumovax dose
Rotavirus vaccine schedule
Given to infants, do not give after age 15 weeks
Oral vaccine
RotaTeq is the brand
Poliovirus vaccines schedule
Given to all children
Tdap brands, vaccine schedule
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
Td brand, vaccine schedule
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
Varicella brand, vaccine schedule, considerations
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
Needle size for IM injections
1 inch needle (or 1.5 for women over 200 lb or men over 260 lb), 22-25 gauge
Needle size for SC injections
5’8’’ needle, 23-25 gauge at 45 degree angle
Which vaccines are SC?
MMR MPSV (meningococcal polysaccharide) PPSV (can be IM or SC) Varicella Zoster
