Immunizations Flashcards
What’s active immunity?
Protection that’s produced by the persons own immune system.
Active immunity is produced by fighting infection and receiving vaccination
What’s passive immunity?
Protection produced by an animal or human and transferred to a human, usually by inj
This wanes w/in a few wks or months
What’s the most common form of passive immunity?
Antibodies an infant receives from the mother
What’s live attenuated vaccine?
Also called weakened vaccines are produced by modifying a dx-producing “wild” virus or bacterium in a lab.
They retain ability to replicate (grow) and produce immunity, but don’t cause illnes
What’s inactivated vaccine?
Can be composed of either whole viruses or bacteria or fractions of either
How long after giving vaccine should we wait b4 giving antibody?
2 wks
How long after giving antibody should we wait b4 giving vaccine? Exception?
Wait 3 months (may be up to 11 months) b4 giving vaccine
Zoster vaccine - not affected by circulating antibody
Advantages of simultaneous vaccine admin? CI to simultaneous vaccine admin?
Increases probability that the child will be fully immunized at the appropriate age
No! There are no CI
Which vaccines are non-simultaneous admin? How long do u wait btw admin?
Live parenteral (injected) vaccines e.g MMR, MMRV, varicella, zoster and yellow fever)
Separate by at least 4 wks from
Live Intranasal or influenza vaccine (LAIV)
Effect of increasing interval btw multi-dose vaccine?
It may delay more complete protection, but not effectiveness
Effect of decreasing interval btw multi-dose vaccine?
May interfere with antibody response and protection
When’s a shorter dosing interval used for Multi-dose vaccines?
Following a high risk exposure
What’s the preferred method to avoid a false negative response to the TB skin test?
Purified protein derivative (PPD) of tuberculin + live vaccines
If a live vaccine has been recently given, but not on the same day as the PPD, how long should u wait to avoid a false negative TB test result?
4 wks
List the categories that vaccine SEs or ADRs fall into?
Local
Systemic
Allergic
What’re the most common type of ADRs that are local rxns?
Pain
Swelling
Redness at site of inj
What’re the most common type of ADRs that are systemic rxns?
Generalized events and include
Fever,
Malaise
Myalgia (muscle pain)
Headache
Loss of appetite
When does systemic rxns typically occur!
Usually 7-12 days after vaccine (ie, after an incubation period of the vaccine virus))
What’s Intranasal LAIV? Implication?
Cold adapted vaccine ie can replicate in cooler temp of upper airways (nose and throat), but not in the higher temp of the lower airways and lungs
Mild cold-like sx eg runny nose may occur
How can anaphylactic rxn be prevented?
By good screening prior to vaccination
What’re the most common type of ADRs that are anaphylactic?
Mediated by IgE
S/sx:
Generalized urticaria (hives) Swelling of the mouth and throat Difficulty breathing Wheezing Abdominal cramping Hypotension Shock
Where should clinically significant AEs be reported to?
FDA vaccine adverse event reporting system (VAERS)
What must all providers that provide vaccine have?
Emergency protocols + supplies to treat anaphylaxis
What conditions are absolute CI to live vaccines?
Pregnancy
Immunosuppression
What’s a steroid-induced Immunosuppression?
Corticosteroids use of
20mg/ more per day of Prednisone
2mg/kg or more per day of Prednisone
What vaccine is indicated during pregnancy? When is the optimal time?
Tdap
Wk 27-36
List vaccinations for healthcare professionals
Hep B
Flu (influenza)
MMR
Varicella (chickenpox)
TdaP (tetanus, diphtheria, pertussis)
Meningococcal
T/F? Anaphylaxis after a previous dose of vaccine is a CI to the vaccine in the future?
T
What criteria should be used to determine if a pt can obtain inactivated influenza vaccine?
If a pt can eat lightly cooked eggs w/o a rxn
Or
If a pt experiences ONLY hives after eating egg-containing food
Admin vaccine and monitor pt for at least 30 min after admin
Which vaccines can provoke an allergic rxn in persons with an egg allergy?
Yellow fever
Rabies
Which vaccine is allergic rxn to egg no longer a consideration?
MMR
Which vaccine should not be given to any one with a true gelatin or neomycin allergy?
Varicella vaccines (Zostavax and Varivax)
MMR
Which vaccine is CI in streptomycin, Polymixin B and neomycin allergies?
Inactivated poliovirus vaccine (IPV)
In what population is DTaP recommended?
DTaP series given to children younger than 7 years of age
6 wks to 6 yrs
Brand name of HepA?
Havrix
Vaqta
Brand name of HepB?
Engerix-B
Recombivax HB
Brand name of HepA-HepB?
Twinrix
In what popu is Hep B (Engerix-B, Recombivax HB) recommended?
Health workers
MSMs
Anyone with multiple partners
IV drug users
ESRD
Chronic liver
Brand name of HPV2?
Cervarix (bivalent vaccine)
Brand name of HPV4?
Gardasil
When’s the 3 dose series of HPV vaccine indicated for females?
Btw the age of 11-12 yrs, with catch up vaccination at age 13-26 yrs
Can begin at age 9 and ideally prior to sexual activity
When’s the 3 dose series of HPV vaccine indicated for males?
9-26 yrs to reduce the likelihood of genial warts or anal cancers
What’s the brand name of live attenuated influenza vaccine (LAIV)?
FluMist Quadrivalent
What’s the brand name of inactivated influenza vaccine (IIV)?
Afluria
Fluarix
Fluarix Quadrivalent
FluLaval Quadrivalent
Flu iron
Fluzone
Fluzone Quadrivalent
Fluzone High-Dose
Fluzone Intradermal
Flucelvex
What’s the brand name of RIV (egg-free flu vaccine)?
FluBlok
Which flu vaccine was licensed for adults >= 65yrs?
High-dose (Fluzone)
What vaccine is recommended for 18-64 yrs only?
Fluzone Intradermal
Which flu vaccine is Trivalent (3 strains) and Quadrivalent (4 strains)?
Fluzone
Fluarix
FluLaval
Which flu vaccine is Quadrivalent (4 strains) only?
FluMist
Which flu vaccine is completely egg free?
FluBlok (recombinant)
When does ACIP recommend the use of Afluria?
9 yrs and older
Which flu vaccine is given intradermally?
Fluzone
Brand name for 13-valent pneumococcal conjugate vaccine (PCV13)?
Prevnar 13
Brand name of 23-serotype polysaccharide vaccine (PPSV23)?
Pneumovax 23
When is single TdaP dose recommended?
7-10 yrs for those not fully vaccinated with DTaP series (missed dose in series)
What’s TdaP used for?
1 time booster for ages 11-64 yrs with no previous record of TdaP, then 1 dose of Td Q10 yrs.
(TdaP x 1 dose; Td Q10yrs)
When should adults 65 yrs and older be given TdaP?
Those who haven’t received TdaP previously + who have close contact with an infant ages 12 months of less
When during pregnancy is TdaP recommended?
27-36 wks
Brand name of varicella containing vaccine, VAR?
Varivax (chickenpox)
Brand name of varicella containing vaccine, ZOS?
Zostavax (herpes zoster/shingles)
How should adults receive varicella vaccine?
All adults w/o evidence of immunity to varicella should receive 2 doses of varicella vaccine at least 4 wks apart
Potency of Herpes zoster vaccination versus Varicella?
Herpes zoster vaccination- potency 14 times greater than varicella
Where should varicella containing vaccines be stored?
Freezer (all other vaccines are stored in refrigerator) + protect from light (store in original container)
Where do u store diluent of varicella containing vaccines?
Refrigerator or room temp
In which Grp of pts is live vaccine CI?
Immunocompromised
Pregnant
Expecting to be pregnant w/in 4 wks
Hypersensitivity to gelatin or neomycin
How do u give varicella containing vaccines?
Reconstituted
Given by SC
How do u give yellow fever?
Reconstituted
Given SC
If vaccine is to be reconstituted, where should diluent be stored?
Refrigerator or at room temp
How are most adult vaccine given?
IM
Which vaccine is given intradermally?
Fluzone Intradermal
Which vaccine is given SC only?
MMR, MMRV, Zostavax, Varivax
Menomune
Which vaccine is given SC or IM?
Pneumovax
Polio (IPV)
When does CDC recommend use of acetaminophen?
After immunization to treat pain and fever from vaccination (not recommended b4 or at vaccination)
Where should vaccines be stored in the refrigerator?
On shelves away from the wall
Where should vaccines not be stored in the refrigerator?
Door of freezer or refrigerator (temp there is unstable)
How often should refrigerator or freezer temp be checked?
At least twice each day (in the morning and before the end of the workday)
How long should u keep temp logs for?
At least 3 yrs
What’s the site of IM injections?
In the deltoid muscle
What size of syringe should adults use?
1” syringe
5/8” for persons < 130lbs or 11/2” for women > 200lbs/ men> 260lbs
What’s the relationship btw gauge and needle?
The HIGHER the gauge, the THINNER the needle
What’s the site of SC injections?
Fatty tissue above the triceps with a 5/8”, 23-25 gauge syringe at 45 degree angle
Which vaccines admin by pharmacists are SC only?
Varicella and Zoster (shingles)
Which vaccines admin by pharmacists are SC or IM?
Pneumococcal polysaccharide vaccine (PPSV23, Pneumovax)
Which pts can use flu nasal mist vaccine? (Live vaccine)
Healthy (no chronic dx)
Non-pregnant females
Males 2-49 yrs
Name the 2 broad types of Influenza viruses
Influenza A and B
Influenza A viruses are further categorized into subtypes based on what?
Surface antigens:,Hemagglutinin and Neuraminidse
Effect of hemagglutinin on infection?
Immunity to the surface antigens, particularly the hemagglutinin, reduces the likelihood of infection and severity of dx if infection occurs.
What’s antigenic drift?
Freq dev of antigen variants thru antigenic drift is the virologic basis for seasonal epidemics and the reason for the usual incorporation of 1 or more new strains in each years flu vaccines
In what time period do the most dramatic antigenic changes or shifts occur?
Approximately every 30 yrs and can result in emergence of a novel influenza virus with the potential to cause a pandemic
How does the flu virus typically spread?
Person to person, primarily through respiratory droplet transmission
Characteristics of uncomplicated flu illness?
Abrupt onset of these sx:
Fever Myalgia Headache Malaise Non-productive cough Sore throat Rhinitis
How soon does uncomplicated flu illness typically resolve? What may linger?
3-7 days
Cough and malaise can persist for more than 2 wks
Which needle size is used for IM injections?
22-25 gauge, 1-11/2” needle
What angle do u admin IM injection?
90 degrees
Inj site for SC?
Fatty tissue over the triceps
Needle size used in SC inj?
23-25 gauge, 5/8” needle
Angle for SC inj?
45 degrees
If u have to give 2 SC inj, how do u space them out?
By a minimum of 1”
What does the fed law req that all pts getting vaccines receive?
Most up-to-date version of the Vaccine Info Statement (VIS) b4 each vaccine is admin
