Immunizations Flashcards
What is the pink book?
Epidemiology and prevention of vaccine-preventable diseases
Who…
approves vaccines
provides recommendations for vaccine administration
approves those recommendations?
FDA approves
Advisory Committee on Immunization Practices (ACIP) recommends
CDC approves recommendations
Federal law requires the Vaccine Inforamtion Statements (VIS) is given to the patient when?
Before vaccine is given
What is thimerosal
Mercury-containing preservative used in some vaccines - some people believe this contributes to autism (no evidence)
Gelatin in vaccines - what groups do you have to take this into consideration?
Gelatin is a stabilizer that comes from pigs
Muslims, Jews, and Seventh-Day Adventists do not ingest pork, but some religious leaders approve the vaccines because it is not ingested
Antigen definition
foreign substances that induces an immune response
Antibodies (immunoglobulins)
Produced naturally to provide immunity against certain antigens
Active vs passive immunity
Active - from a person’s own immune system (from vaccine or fighting off an illness); lasts a long time
Passive - from someone else (mom to baby) or IV immunoglobulin that provides already made antibodies and can be used for quick immunity (like rabies)
Which vaccine types are contrindicated in immunocompramised and pregnancy?
Live attenuated
Which vaccine type usually requires supplemental doses?
Inactivated
What is the downside of inactivated vaccines?
immunity is not as strong and boosters may be required for ongoing immunity
How do polysaccharide, conjugate, and recombinant vaccines work?
Target a section of the organism, such as a protein, sugar, or capsid
Who should you not use a polysaccharide vaccine in and why?
Children <2
Does not produce a good immune response
Conjugation (i.e. conjugated vaccines) increase the immune response in what patients
Infants
***these vaccines are used in all age groups tho
How are recombinant vaccines made
Gene segment of a protein from an organism is inserted into the gene of another cell (e.g. yeast cell)
How are conjugate vaccines made
use polysaccharide molecules from outside layer of encapsulated bacteria and join the molecules to carrier proteins
How do toxoid vaccines work
target a toxin produced by the disease
What vaccines are most similar to the actual disease?
Live vaccines
Common live vaccines
CHEMISTRY DOV
Cholera Herpes Zoster (Zostavax) Ebola MMR Intranasal influenza Smallpox Tuberculosis Rotavirua Yellow fever
Dengue
Oral Typhoid
Varicella
Should children get more than one vaccine at a time?
Yes! Always encourage getting all vaccines in one visit to increase compliance and probability of being fully vaccinated
Which is worse, increasing or decreasing intervals between vaccines?
Decreasing is worse - can interfere with antibody response and protection
Why are live vaccines not given to infants <12 months old (except rotavirus vaccine)
Maternal antibodies are passed to baby and reduce baby’s response to live vaccines
When are inactivated vaccines started in infants?
2 months old (except hep B which is given at birth)
How long should you wait between a live vaccine and a tuberculin skin test? Why?
4 weeks
Can cause false positive
What vaccines can be given at the same time?
Generally all vaccines (except in patients with asplenia)
How far should live vaccines be spaced out? Can they be given on the same day?
Can be given on the same day or spaced by 4 weeks
How far do MMR and varicella-containing (not zoster) require separation from antibody-containing products (e.g. blood, IVIG)?
Vaccine –> 2 weeks –> antibody-containing product
Antibody-containing product –> 3 months or longer –> vaccine
Can administration of a vaccine and antibody be given on the same day?
Can be given for post-exposure prophylaxis of hepatitis A and B, rabies, and tetanus
How can minor allergic reactions to vaccines be treated? Is this a contraindication for future vaccines?
Benadryl or hydroxyzine
NOT a CI for future vaccines
Contraindication for live vaccines
Pregnancy and immunosuppression
Contraindication for Hepatitis B vaccine
hypersensitivity to yeast
Contraindication for flu vaccine
live, attenuated flu vaccine: severe egg allergy (anaphylaxis)
Use of aspirin containing products in adolescents
Use of influenza antiviral medications in the past 48 hours
Children 2-4 years with asthma or wheezing episode in last 12 months
Close contact with an immunosuppressed person
Recombinant zoster vaccine (RZV) and Zoster vaccine live (ZVL) contraindications
RZV: lactation, pregnancy
ZVL: hx of anaphylaxis to gelatin or neomycin, pregnancy
Contraindication for varicella vaccine
Hx of anaphylaxis to gelatin or neomycin
Contraindication for rotavirus vaccine
Hx of intussusception
Contraindication for yellow fever vaccine
Anaphylaxis to eggs
Contraindication for vaccines with latex stoppers and in prefilled syringes
Anaphylaxix to latex
***Most latex sensitivity is a contact-type allergy and does not prohibit vaccine administration
Vaccines recommended for infants and children
Birth: Hep B
2 months: Prevnar 13, DTaP, Hib, polio, rotavirus
>12 months: MMR, varicella
NO polysaccharide vaccines before age 2
Vaccines recommended for healthcare workers
Flu Hep B (if no immunity) Tdap q10 years Varicella (if no hx or immunity) MMR (if no hx or immunity)
Vaccines recommended for adolescents and young adults
Meningococcal
HPV
Tdap (first dose >11 years)
Vaccines recommended for sickle cell disease and other causes of asplenia (damaged or missing spleen)
H. influenzae type b (Hib) Pneumococcal vaccines (1 prevnar then 2 pneumovax before 65) Meningococcal
Vaccines recommended for Pregnancy
NO live vaccines!!!
Influenza (inactivated)
Tdap (gestation week 27-36)
Vaccines recommended for diabetes
Pneumococcal (1 dose pneumovax before 65)
Hepatitis B
Vaccines recommended for immunodeficiency
NO live vaccines
Pneumococcal vaccines (1 prevnar then 2 pneumovax before 65)
If pt has HIV give meningococcal, Hep A and Hep B
Vaccines recommended for older adults
Shingrix or zostavax
Pneumococcal vaccine
Vaccinations for adults
Influenza Tdap q10 years Shingles HPV (<23 years) Pneumococcal Meningococcal Hepatitis B and A
DTaP or Tdap administration recommendations
DTap for children <7 Tdap or Td for Deep or dirty wound Each pregnancy Close contacts of infants <12 months
H influenzae type B (Hib) administration recommendation
adults with asplenia
Hepatitis A administration recommendation
Adults with chronic liver disease
Hepatitis B administration recommendation
vaccine series started within 24 hours after birth
Healthcare workers, ESRD, chronic liver disease, HIV, diabetes age 19-59
Which hepatitis B vaccine can only be given to age 18 and up?
Heplisav-B
HPV9 (Gardasil) administration recommendation
Age 11-12 (may be started at 9)
If started before 15 - 2 doses
If started older than 15 or immunocompromised - 3 doses
If a patient is age 6 months to 8 years and is not previously vaccinated with the flu vaccine, what should be given?
2 doses 4 weeks apart
What egg-free flu vaccine is approved and for what patients?
Flubok
Ages 18 and up
What flu vaccine should not be administered in pregnant patients and why?
FluMist
It is a live vaccine
Who is FluMist approved for and how is it administered
Healthy people age 2-49
0.2 mL mist divided between the two nostrils
How is the MMR vaccine administered and who should it not be used it?
SQ
Do not use in pregnancy or immunocompramised
Who gets PCV 13 (prevnar 13)
Children <5 years old: 4 dose series
Immunocompromised patients 6-64: 1 dose if never received
Adults >65: give 1 dose if never received before (optional)
Who gets PPSV23 (pneumovax
All adults >65: 1 dose
Patients 2-64 years with select risk factors
What type of vaccines are Prevnar 13 and Pneumovax?
Prevnar 13 - conjugate
Pneumovax - polysaccharide
If Prevnar 13 and Pneumovax are both needed, which is given first?
PCV13 (prevnar 13)
How far should the 2 pneumonia vaccines be separated by if the patient is <65?
PCV13 –> 1 year –> PPSV23
PPSV23 –> at least 1 year –> PCV13 –> at least 1 year –> PPSV23
***PPSV23 vaccines should be at least 5 years apart
How is rotavirus vaccine administered?
Orally
Which varicella vaccines are live vaccines? What medications should be stopped 24 hours before administration of the vaccine?
Zostavax
Antivirals
Which vaccines need to be stored in the freezer
Varicella Zostavax MMRV Cholera Ebola Smallpox
Which vaccines are given SQ only
MMR, MMRV, Varicella, Zostavax, Yellow fever, Dengue, Smallpox
Which vaccines are given IM or SQ?
PPSV23
Which vaccines are given intranasally?
FluMist
Which vaccines are given PO
Typhoid capsules
What is the yellow book?
CDC’s standard resource on travel information
What is dysentery?
travellers diarrhea with blood
What is the most common primary pathogen for travlers diarrhea?
E. Coli
Prophylaxis with what helps reduce the incidence of travelers’ diarrhea by 50%?
bismuth subsalicylate (in Pepto-Bismol) four times daily (with meals and at bedtime)
How should mild travelers’ diarrhea be treated?
loperamide or bismuth subsalicylate
How should moderate travelers’ diarrhea be treated?
loperamide +/- antibiotics (quinolones, azithromycin, or rifaximin)
How should severe travelers’ diarrhea be treated?
antibiotics preferred (azithromycin preferred, quinolones, or rivaximin) +/- loperamide
Which vaccines should travelers have?
Inactivated: Hepatitis A and B, Japanese encephalitis, meningococcus, polio, typhoid
Live vaccines: cholera, typhoid, yellow fever
