Immunizations

Question 1

What is the difference between active and passive immunity?

Answer 1

Active: Protection produced by persons own immune system. Permanent. Surviving an infection or vaccination
Passive: Protection by antibody containing products of from passage from mom to baby, immunity usually weans over time

Question 2

Which vaccines are live?

Answer 2

MMR, MMRV (MMR w/ varicella), varicella, zostavax, yellow fever, flumist, rotavirus, cholera, Vivotif

Question 3

Polysaccharide vaccines should not be given to? Why?

Answer 3

Infants and young children because their immune system isnt fully developed yet and these vaccines do not provide effective immune response in children < 2 YO

Question 4

Live vaccines and antibody products can diminish immune response but is most concerning for MMR and varicella. How far apart should you separate these?

Answer 4

If you give the vaccine, wait 2 weeks before giving AB products.
If you give AB, wait 3-11 months before giving live vaccine
Consult the pink book.

Question 5

Multiple live vaccines must be given on the same day or they must be spaced out by how many weeks?

Answer 5

4

All live vaccines except oral rotavirus

Question 6

If a vaccine requires multiple dose series, can the intervals between doses be shortened or lengthened?

Answer 6

They can be lengthened but never shortened.

Question 7

In patients with asplenia, Prevnar and Menactra should be separated by how many weeks?

Answer 7

4

Question 8

Live vaccines can interfere with the tuberculin skin test (false negative). What can be done to prevent this interference?

Answer 8

Administer the live vaccine on the same day as the PPD skin test

Question 9

What are the 3 types of adverse reactions to vaccines?

Explain them

Answer 9

Local: Pain, swelling, redness at site (80%) -mild, self limited
Systemic: Fever, malaise, muscle pain
Allergic: Anaphylaxis, this is why we screen

Question 10

What are the 2 biggest contraindications to live vaccines?

Answer 10

Pregnancy and immunosuppression

Question 11

What dose of prednisone is considered immunosuppressed and thus shouldn’t receive vaccination?

Answer 11

Systemic steroids equivalent to prednisone 20mg/day for 14 days or longer

Question 12

Which vaccines are contraindicated in HIV patients with CD4 count < 200?

Answer 12

MMR and varicella

Question 13

Which vaccines are recommended during pregnancy?

Answer 13

Seasonal influenza, TDAP (3rd trimester), live vaccines are contraindicated

Question 14

Which vaccines are recommended in asplenia?

Answer 14

HiB, prevnar then pneumovax, menactra/menveo + bexsero/trumemba

Question 15

Which form of Tdap is given to children under the age of 7? When should it be given?

Answer 15

DTaP x 5 doses: 2, 4, 6, 12-18 months and 4-6 years, then Tdap x 1 at 11-12 years

Question 16

When should HiB be given?

Answer 16

As part of routine childhood vaccination and to adults after splenectomy

Question 17

Hep A and B vaccine schedule?

Answer 17

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

Question 18

Who should Gardasil-9 be given to?

Answer 18

Females 9-26 (ideally before sexual activity) ages 11-12 recommended
Males 9-26 (ages 11-21 and up to 26 recommended in HIV and men-men sex)
Regimens: If started before age 15 - 2 doses (0 and 6-12 mos)
If started after age 15 - 3 doses (0, 1-2, 6 mos)

Question 19

How is influenza virus spread?

Answer 19

Person to person through respiratory droplets

Question 20

Who is recommended to receive flu vaccine?

Answer 20

> 6 months unless there is contraindication

Question 21

Flu vaccine recommendations for patients age 6 months-8 YO who have never been vaccinated?

Answer 21

2 doses, 4 weeks apart

Question 22

What flu vaccine can patients with egg allergy recive?

Answer 22

FluBlok, only if they are over 18 YO

Question 23

Which 2 flu vaccines are recommended for age >65?

Answer 23

Fluad (adjuvanted influenza) Fluzone HD

Question 24

What is the difference between tri and quad valent flu vaccines?

Answer 24

Trivalent: 2 a strains, 1 b strain
Quad: 2 A, 2 B strains

Question 25

How should MMR and MMRV be stored?

Answer 25

MMR: Fridge or frozen
MMRV: Contains varicella so must be frozen

Question 26

What are the brand names of the MCV4 meningitis vaccines? What serotypes do they cover?

Answer 26

Menactra, Menveo cover serotypes ACWY

Question 27

What are the brand names of the meningitis vaccines that cover serotype B?

Answer 27

Bexsero, Trumenba

Question 28

Routine vaccination for MCV4 in adolescents?

Answer 28

one dose of MCV4 (Menactra or Menveo) at 11-12 years and give booster at 16 YO.

Question 29

What are the age cutoffs for use of each of the MCV4 vaccines? What about for the Men B vaccines?

Answer 29

Menactra: 9mos-55YO
Menveo: 2 mos-55years
Bexsero/Trumenba: 10-55 YO

Question 30

When should the first dose of prevnar be given as part of routine childhood vaccinations?

Answer 30

If first dose of PCV13 (Prevnar) is given > 6 YO, only 1 dose needed

Question 31

Adults over 65 who have not received any pneumococcal vaccines should receive what?

Answer 31

PCV13 then PPSV23 1 year later.

Question 32

Children < 2 YO should receive which type of pnemonia vaccine and at what age?

Answer 32

Prevnar by earliest age 6 weeks

Question 33

Which pneumonia vaccine can be given both IM or SQ?

Answer 33

Pneumovax (PPSV23)

Question 34

Immunocompromised pt ages 6-64 should receive how many pneumonia vaccines?

Answer 34

1 Prevnar + 2 Pneumovax (8 weeks after Prevnar, then 5 years after first dose of pneumovax)

Question 35

Anyone without evidence of immunity to varicella should receive how many doses of varicella vaccine?

Answer 35

2

Question 36

Which vaccines should be avoided if patient has allergy (hypersensitivity) to neomycin or gelatin?

Answer 36

Zostavax or varicella

Question 37

Some antivirals can interfere with varicella and zostavax. How long before and after vaccination should a patient hold antiviral medications?

Answer 37

Stop 24 hours before vaccination, do not take until 14 days have passed

Question 38

How is Vivotif given?

Answer 38

It is a live oral vaccine against typhoid fever and should be completed AT LEAST 1 week prior to travel and given Q 5 years if continued risk. It is 4 capsules taken on days 0, 2, 4, 6 on an empty stomach with cold or lukewarm water

Question 39

Japanese encephalitis vaccination schedule?

Answer 39

2 doses IM separated by 28 days, complete series at least 1 week prior to travel