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835 > Immunizations > Flashcards

Immunizations Flashcards

1
Q

Vaccines + Media

A
  • Stirred up fear and concern over vaccine safety

- Leading to increased questions from parents and some refusing to innoculate their children

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2
Q

Thimerosal

A
  • Mercury-containing compound that was used as a preservative
  • Thimerosal has largely been removed from vaccines with the exception of inactivated influenza vaccine
  • NEVER contained in MMR vaccine
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3
Q

MMR Vaccine

A
  • Live-attenuated triple viral vaccine against measles, mumps, and rubella
  • Max: 2 doses/lifetime
  • Single antigens are no longer available
  • MMRV with varicella is also available now
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4
Q

Measles

A
  • Vaccine-preventable disease
  • Despite vaccine, still a leading death of children worldwide
  • Highly contagious
  • Symptoms: cough, runny nose, full body rash
  • Complications: pneumonia, encephalitis
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5
Q

Mumps

A
  • Vaccine-preventable viral disease
  • Contagious
  • Symptoms: fever, headache, muscle aches, fatigue, swelling of salivary glands
  • Complications: orchitis, pancreatitis, encephalitis, hearing loss, miscarriage
  • > 99% since vaccine
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6
Q

Rubella

A
  • Vaccine-preventable viral disease
  • Contagious
  • Symptoms: fever, sore throat, rash, arthralgias
  • Complications: birth defects, miscarriage, encephalitis, otitis media
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7
Q

Wakefield Study

A
  • Study that suggested that MMR caused autism
  • Numerous larger studies have shown otherwise
  • Original article ended up retracted
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8
Q

MMR + Autism

A
  • Signs/symptoms have a temporal relationship
  • Autism is both genetic and environmental
  • CDC, Vaccine Injury Compensation Program, and Institute of Medicine don’t support the association
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9
Q

Addressing Parents’ Concerns

A
  • No vaccine is 100% safe/effective, but to do nothing is a higher risk
  • Establish rapport, be open/honest, identify concerns, identify sources of information, respond with evidence-based information, appeal to civic duty and risk
  • If parents refuse, respect decision and broach in the future
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10
Q

Pharmacist Responsibility + Vaccines

A
  • Promote vaccination
  • Ensure proper storage/administration
  • Observe correct timing and appropriate intervals of vaccinations
  • Follow contraindications and precautions
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11
Q

Passive Immunity

A
  • Protection transferred from exogenous source - blood, placenta
  • Wanes with time
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12
Q

Active Immunity

A
  • Produced from person’s own immune system - infections, vaccinations
  • Immunity persists for years
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13
Q

Live Vaccines

A
  • MMR
  • Varicella
  • Influenza
  • Rotavirus
  • Also, yellow fever, vaccinia (smallpox), oral polio (OPV), BCG for tuberculosis, and oral typhoid
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14
Q

Fractional Inactivated Vaccines

A
  • Only portion of virus or bacteria included to enact a response
  • Protein - toxin or subunit
  • Polysaccharide-based
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15
Q

Viral Whole Vaccines

A
  • Polio
  • Hep A
  • Rabies
  • Japanese encephalitis
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16
Q

Viral Fractional Vaccines

A
  • Hep B
  • Influenza
  • HPV
  • Anthrax
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17
Q

Inactive Bacterial Vaccines

A
  • All fractional
  • Tdap
  • Pneumococcal (23/13)
  • Meningococcal
  • Haemophilus influenzae type B
  • Typhoid Vi
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18
Q

Encapsulated Organisms

A
  • Polysaccharide capsules that make them antiphagocytic
  • Target for vaccine protection
  • Patients without spleen are susceptible to these infections
  • EX: S. pneumonia, H. influenzae, N. meningitidis
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19
Q

Pure Polysaccharide Vaccines

A
  • Traditionally adult formulations
  • Not consistently immunogenic in children <2 yrs
  • No booster response and immunogenecity in children improved with conjugation
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20
Q

Polysaccharide Conjugate Vaccines

A
  • Traditionally children formulations
  • Enhanced antibody production, especially in younger kids
  • Repeat doses elicits a booster resposen
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21
Q

Vaccine Precautions

A
  • Severe allergic reaction to vaccine/component
  • Severe illness (delay)
  • DON’T give immunosuppressed and pregnant live vaccines
  • Also don’t give live vaccines to <1 years old or to patients receiving a transfusion or other blood products
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22
Q

Invalid CI

A
  • Mild disease - low fever, URI, otitis media, mild diarrhea
  • Antibiotic therapy
  • Breastfeeding
  • Premature birth
  • Pregnancy/immunosuppression in the house
  • Warfarin
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23
Q

Vaccine Dose Timing/Intervals

A
  • DON’T give before recommended age and interval
  • Increasing the interval DOESN’T diminish the response (DON”T RESTART)
  • Immunosupressed: Administer >= 2 weeks prior to suppression for live vaccines and avoid live vaccines within 2 weeks
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24
Q

Simultaneous Administration

A
  • Okay to give to vaccines together to increase inoculation likelihood
  • DON’T give PCV 13/23 together
  • If LIVE vaccines are not given together, then separate by at least 4 weeks
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25
Q

Adverse Event Reporting

A
  • Use VAERS or Vaccine Injury Compensation Program (childhood vaccines)
  • Adverse events can be an adverse reaction (side effect)
26
Q

Meningococcal Disease

A
  • Encapsulated organism
  • 13 serotypes
  • Vaccines available that cover 5 of the types
27
Q

Meningococcal Risk Factors

A
  • Anatomic or functional asplenia
  • Terminal complement deficiency
  • Exposed labratory personnel
  • Foreign travelers
  • Military recruits
  • First year college students in dorm living
  • HIV
28
Q

Menactra/Menveo

A
  • Conjugate formulations for serotypes A, C, W, Y

- Pure polysaccharide formulation isn’t available

29
Q

MenB-4C/MenB-FHbp

A
  • Meningococcal B vaccines
  • B-4C: 2-dose series
  • B-FHbp: 2-3 dose series
  • Vaccines are not interchangeable and have different interval recommendations
30
Q

Pneumococcal Disease

A
  • S. pneumoniae
  • Encapsulated organism
  • Invasive diseases: pneumonia, meningitis
31
Q

Pneumococcal Risk Factors

A
  • Young/elderly
  • Health conditions like asplenia, heart disease, lung disease, asthma, ESRD, cirrhosis, DM, immunosuppression
  • Smoking
  • Alcohol abuse
32
Q

PSV23/13

A
  • 23: pure polysaccharide vaccine, doesn’t induce response in <2 years old
  • 13: conjugate vaccine, conugated to protein carrier for better children response, better responses in kids and adults
33
Q

Adults Needing Pneumococcal Vaccination

A
  • Adults >= 65 y.o. (prefer PCV23)
  • Heart disease
  • Lung disease/asthma
  • ESRD
  • Cirrhosis
  • DM
  • Tobacco Use
  • Alcoholism
  • Asplenia
  • Immunosuppression
34
Q

Adults >= 65 + PCV13

A
  • Nursing home/long-term care facilities
  • Low pediatric PCV13 uptake residences
  • Traveling to settings with no pediatric PCV13 program
  • Certain comorbid conditions
35
Q

Diphtheria/Tetanus Toxoids

A
  • Inactivated bacterial toxins
  • Available in combination: not single antigens
  • Adult formulations contain [lower] of diphtheria toxoid to prevent local reactions
  • Local site reactions in higher with each additional dose
36
Q

Pertussis Vaccine

A
  • Acellular vaccine with detoxified pertussis toxin
  • Better side effect profile than whole cell vaccine with comparable immunity
  • Precautions: T > 40.5C within past 48 hours without known cause, convulsions within last 3 days
  • CI: encephalopathy within past 7 days
37
Q

Influenza

A
  • Single stranded RNA virus
  • Influenza A is responsible for pandemics
  • Shift variations are major changes causing pandemics, drift variations are minor changes causing epidemics
38
Q

Live Flu Vaccine CI

A
  • Immunosuppression
  • Anatomical or functional asplenia
  • Pregnancy
  • Close contact/caregiver of immunosuppressed
  • Flu antivirals in last 48 hours
  • CSF leak or cochlear implant
  • History of severe allergic reaction to any part of vaccine
39
Q

Varicella

A
  • Primary infection: chickenpox
  • Highly contagious vesicular rash
  • Complications: lesion infections, encephalitis, pneumonia, CVS (congenital varicella syndrome)
40
Q

Herpes Zoster

A
  • Shingles
  • Recurrent infection: herpes zoster
  • Can occur decades after initial infection/vaccination
  • Associated with aging/immunosuppression
  • Post-herpetic neuralgia is a common complication
41
Q

Varicella Vaccine

A
  • Live
  • Two doses for those who don’t have immunity evidence
  • Can be given as a part of MMR (MMRV)
  • ADE: rash, infection site reactions, arthralgias/myalgias, respiratory tract infections
  • Don’t give zostavax (live) to preggo/immunosuppressed
42
Q

RZV + HIV Patients

A
  • No recommendation
  • Optimal timing and duration of immunity is unknown
  • Appears to be safe
  • Recommended for >= 50 y.o. with HIV
43
Q

Rotavirus Gastroenteritis

A
  • Almost all kids infected by 5 y.o.
  • Five strains account for 90% of infections
  • 1st infection after 3 months of age is most severe with T>102F
  • GI symptoms usually resolve in 3-7 days
  • Low mortality but high healthcare burden
44
Q

Rotavirus Vaccine

A
  • Live oral
  • Start at 2 months old, don’t start after 15 weeks old
  • Complete by 8 months
  • Two, interchangeable formulations available
45
Q

Poliomyelitis

A
  • Enterovirus with 3 serotypes

- Infection spreads in CNS and causing motor neuron destruction

46
Q

IPV

A
  • Inactivated polio vaccine
  • Protects against all serotypes
  • Given to children
  • Only give to unvaccinated adults if traveling to polio-endemic areas
47
Q

HPV

A
  • Sexually transmitted infections
  • Most are asymptomatic but some cause warts or cancer
  • Most clear the infection
  • Leading cause of cervical cancer
  • Vaccine covering 9 strains available
48
Q

Hep A Vaccine

A
  • 2 dose series
  • Child and adult dosing
  • Single or combination formulations available
49
Q

Hep A + High Risk Factors

A
  • Chronic liver disease
  • HIV infection
  • Sexually active gay men
  • Drug use
  • Occupational risk
  • At risk International travelers
  • Close contact with international adoptee
  • Pregnancy based on risk
50
Q

Hep B Vaccine

A
  • Single or combination formulations available
  • Recommended for all children

High-Risk Adults:

  • Chronic liver disease
  • HIV
  • Sexual exposure risk
  • Current/recent drug use
  • Percutaneous/mucosal risk exposure
  • Incarcerated persons
  • Travel to areas of risk
  • Pregnancy based on risk
51
Q

H. influenzae Type B Vaccine

A
  • Single or combination formulations
  • All vaccines are interchangeable for primary series/boosters
  • Children who fall behind may not need remaining doses
  • Not recommended for 5 y.o.+ unlesss high risk: HSCT, asplenia, sickle-cell disease
52
Q

Target Populations for Travel Evaluations

A
  • Military personnel
  • Peace Corps volunteers
  • Travelers to developing countries
  • Immigrants
53
Q

Other Travel Considerations

A
  • Age
  • Underlying illness
  • Medical history
  • Allergies
  • CI to meds/vaccines
  • Pregnancy/breastfeeding
54
Q

Travel Vaccinations

A
  • No schedule
  • Individual assessment
  • Good opportunity to review immunization status for scheduled vaccinations
  • Some vaccines may be mandatory
  • Patients may need to carry a copy of their vaccination records
55
Q

Typhoid

A
  • Caused by salmonella typhi
  • Fecal-oral transmission
  • Worldwide, Africa/South Asia/Indonesia/Peru have higher rates
  • Manifestation: high fever, gastroenteritis, diarrhea, rash
56
Q

Yellow Fever

A
  • Virus transmitted by mosquitoes
  • No treatment available
  • Phase I: flu like symptoms
  • Phase II: jaundice, arrhythmias, kidney failure, delirium, seizures, coma, usually fatal
57
Q

Japanese Encephalitis

A
  • Leading cause of viral encephalitis in Asia
  • Mosquito vector
  • Typically seasonal
  • Highest rates in rural areas that use flooding irrigation practices
  • Inactivated vaccine, not that effective
58
Q

Rabies

A
  • Zoonotic viral disease transmitted by bites
  • Incubation can be several months
  • Acute encephalitis is usually fatal within days
  • Vaccinate if wild/domestic animal contact expected, visiting remote areas, stay >1 mo where dog rabies is common
59
Q

Traveler’s Diarrhea + Self Treatment

A
  • Bacteria most common cause (E. coli)
  • Prophylactic antibiotics not recommended routinely
  • Use pepto bismol
  • Can use antibiotics to self treat in causes that are moderate to severe
  • Safe oral hydration is important to avoid traveler’s diarrhea
60
Q

Malaria

A
  • Transmitted by mosquitos
  • Different species
  • Usually causes death in US from failed prophylaxis, delay in seeking medical care, misdiagnosis
  • Exo-erythrocytic and erythrocytic cycles
61
Q

Malaria Signs/Symptoms

A
  • Initial presentation is non-specific: fever, chills, myalgias, HA
  • Erythrocytic phase: fever, hemolysis => anemia, severe pallor, cyanosis, tachycardia, delirium
  • Can have more severe complications depending on species infected
  • Diagnosis is usually a blood smear
62
Q

Chemoprophylaxis Counseling Points

A
  • Malaria risk
  • Personal protective measures to prevent bites
  • Mild N/V or loose stools shouldn’t dissuade from use
  • Continue for 1-4 weeks after leaving the endemic area
  • Seek early care/treatment for febrile illness

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