Immunizations - Exam 2 Flashcards
When is an appropriate time to think about giving immunizations to kids?
anytime you have an encounter with kids in the office, any WWC or sick visit
How many doses of vaccines are given to a kid by age 18 months to be protected against 14 or more childhood diseases? If yes to combo vaccines, how many injections from birth to 4?
25 doses
18 injections
What 3 organizations set the standards for immunizations in the US?
Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (ACIP)
American Academy of Pediatrics (AAP)
American Academy of Family Physicians (AAFP)
What are the 2 different types of vaccines? What are the difference?
active or passive
Active immunization: induces immunity by vaccination with a vaccine or toxoid
(inactivated toxin)
passive immunization: includes transplacental transfer of maternal antibodies and administration of antibody, either as immunoglobulin or monoclonal antibody
aka mom gets the shot and passes it to baby, or IVIg
What are the 6 different types of active vaccines?
1.Live Attenuated (* Living )
2.Inactivated or Killed Viruses
3.Recombinant
4.Reassortant
5.Immunogenic Components of Bacteria
6.Toxoids
What is a live attenuated vaccine? How many doses are usually needed?
Vaccine created by reducing the virulence of a pathogen, although it is still a viable (live) vaccine
then REPLICATE in the body
immunity through a single dose
aka these type will give you symptoms of the disease
What are the 7 live attenuated vaccine examples?
Measles (MMR)
Mumps
Rubella
Varicella (chickenpox)
Intranasal Influenza (Flumist)
Rotavirus ( oral vaccine )
OPV- Oral Polio Virus
_____ and ______ can diminish response to LIVE virus vaccines if administered before the recommended interval (generally 3 months)
blood products and immunoglobulin
may inhibit the immune response
**How long should you wait between giving live vaccines?
at least 4 weeks
ex: MMR and Varicella
What is the make up of Inactivated or Killed Vaccines? Give 3 examples
Consists of virus particles which are grown in culture and then killed using a method such as heat, radiation or chemicals (formaldehyde)
Polio
Hep A
Flu shot
What is a recombinant vaccine? What are 2 examples?
Engineered viruses or bacteria into which harmless DNA encoded antigen is inserted and stimulates an immune response
Hep B
HPV
What is a reassortant vaccine? **Give 1 example. **What is super important to note about this type?
Human-Bovine reassortant:
A vaccine made by combining antigens from several strains of the same virus
Rotavirus (Rotateq): Oral vaccine
THIS IS A LIVE VACCINE
Immunogenic Components of Bacteria:
The use of ______ used to obtain immunity. What specifically?
bacterial surface components
Protein polysaccharide conjugate
What are 4 examples of Immunogenic Components of Bacteria?
Pertussis
Haemophilus Influenzae B (HIB)
Meningococcal conjugate
Pneumococcal conjugate
aka all conjugate vaccines
What is a toxoid vaccine? Give 2 examples
Bacterial toxin (usually an exotoxin) whose toxicity has been inactivated or suppressed either by chemical (formalin) or heat
Diphtheria
Tetanus
What is the preferred injection site in infants up to 3-4? _____ in children and adults 5-18 years old
anterolateral aspect of the thigh
Deltoid region
Is it safe to give multiple vaccines on the same day?
Multiple vaccines can be administered simultaneously at anatomically separate sites (different limbs or separated by >1 inch) without diminishing the immune response.
What 2 vaccines are given oral? What 2 are give subcutaneously? Which one is given ID?
oral: OPV and rotavirus
subQ: measles and yellow fever
intradermal: BCG
Does your vaccine schedule change if your kiddo was born premature?
NO!! vaccine schedule does NOT change if your kid was born premature
**How old must your kiddo be in order to receive MMR, Varicella and Hep A?
must be 1 year old
NOT 11 months and 30 days old, needs to be 12 months old
What is the birth to 4 year old vaccine schedule?
What is the vaccine schedule for age 9-17 years old?
What are the 3 types of exemptions to vaccine state laws?
medical exemption
religious
philosophical
What qualifies as a medical exemption to vaccines?
For children with valid medical contraindication to vaccine or vaccine component (ex: hx of anaphylaxis)
Which states allow for medical exemptions to vaccines? Does WV allow religious or non-medical exemptions?
ALL states allow medical exemptions
WV does NOT allow religious or non-medical exemptions
What are some common reasons parents refuse vaccines?
safety and SEs
do not want too many vaccines to overload the immune system
belief that vaccines are not necessary
lack of choice, parents know what is best for their kids
Belief that it is better to be naturally infected than vaccinated
lack of trust in the gov/health authorities
ethical, moral or religious objections
What is an approach to vaccine education? What does this look like practically?
vaccine refusal increases risk of outbreak
outbreak harms the individuals who CANNOT get vaccinated the most (too young, chemo, medical exception)
aka so do it so the people who CANNOT are more protected
establish a positive dialogue! identify parental concerns and provide education targeted to those concerns, while maintaining a relationship with the family! TRUST is super important
Most outbreaks of vaccine preventable disease have been linked to ______
Most outbreaks have been related to religious groups or communities opposed to immunizations
What are some helpful tips to establishing a positive dialogue for vaccine education?
start at the first encounter!! and continue at every visit after!!
Acknowledge shared goal (what is best for child)
Acknowledge large volume of complex, conflicting information about vaccine benefits and safety
provide online resources that have proper information (CDC and NIH sites)
** What is the con of an alternative vaccine schedule? When should they be considered?
Alternative vaccine schedules offer incomplete and delayed protection against life threatening illnesses
Should only be considered only after other options have failed and family would otherwise refuse entirely
pts are at an increased risk of undervaccination
**What is important to stress to the parents that they need to stress to healthcare professionals if their child is sick?
When they are ill, it is important to tell the provider they are not fully immunized!!!
If the kiddo is coming in to the office for a vaccine only appt, how should it be scheduled?
Put in as an ACTUAL appointment instead of “shot only” or on nursing only schedule
give yourself time for pt education!!!
What should you do if the kiddo is on a late, interrupted or catch up immunization schedule?
The recommended compressed, catch-up, or accelerated immunization schedule for such children is difficult to follow and understand but is provided annual and published for providers
aka you need to look it up!
What should you do if you do not know the vaccination status of a kiddo? What is the program called in WV? If no record found, the child should be presumed _____. What happens next?
In this situation, the clinician must determine if any records exist (previous pediatrician if transfer patient)
SIIS
unvaccinated, and vaccine schedule should be catch-up schedule
Children who are behind on immunizations should receive catch-up immunizations as _______
rapidly as feasible
**What is the exception to premature baby rule?
**premature babies less than 2000 grams (4# 6 oz should delay first HBV to 1 mo WCC)
but otherwise premature babies need to vaccinated on schedule!! regardless of weight
What 2 things does the national childhood vaccine injury act require?
Requires that all health care providers provide parents or patients with copies of Vaccine Information Statements prepared by the CDC (Centers for Disease Control and Prevention) BEFORE administering dose
requires that clinically significant adverse events after vaccination be reported to the Vaccine Adverse Event Reporting System (VAERS)
**What are the 3 general CI to vaccines?
- Serious allergic reaction (anaphylaxis) after a previous vaccine dose or to a vaccine component
- Immunocompromised states or pregnancy (for live virus vaccines)
- Moderate or severe acute illness with or without fever
What are the 7 CI for LIVE virus vaccines?
severe immunosuppression resulting from
- Congenital immunodeficiency
- HIV
- leukemia
- lymphoma
- cancer therapy
- prolonged course of high dose steroids (> 2 mg/ kg/ day for over 2 weeks)
- pregnancy
** What is considered high dose steroids for severe immunosuppression?
> 2 mg/ kg/ day for over 2 weeks
**What is the specific recommendation for HIV infected children and MMR vaccine?
**For HIV infected children who DO NOT have evidence of severe immunosuppression, MMR vaccination is recommended at 12 months of age with a second dose 1 month later rather than waiting until 4-6 years for booster
What is the varicella CI?
Vaccine is contraindicated for persons with cellular immunodeficiency
What is the Varicella recommendation for HIV infected kiddos?
Varicella is 2 doses, 3 months apart for these kids
What 8 things that are NOT CI to vaccinations? **Which one was highlighted during lecture?
Mild acute illness (with or without fever)
Convalescent phase of illness
Recent exposure to infectious disease
**Current antimicrobial therapy
Breastfeeding
Mild to moderate LOCAL reaction to previous vaccine
History of Penicillin or other non-vaccine allergy
Receiving allergy extract immunotherapy (allergy shots)
Read this slide a couple times
What are the primary objective of VAERS?
What is the national vaccine injury compensation program?
A no-fault system in which persons thought to have suffered an injury or death as a result of administration of a covered vaccine can seek compensation
Where should you reports vaccine preventable diseases? What about traceable diseases?
vaccine-preventable: should be reported to the state or local health departments
traceable disease , it reports to the
local Health Department
HPV types that cause cervical cancer are ____ and _____. The HPV vaccine prevents _____ of HPV cancer
16 and 18
90%
What are the HPV recommendations if given between the ages of 9 and 15? After 15? What if immunocompromised?
2 doses: 0 and 6-12 months later
After 15: 3 doses: 0, 1-2 months and 6 months
Immunocompromised: Gets all 3 doses
When is the routine age for HPV vaccines?
Age 11-12 but can be started as early as 9
When is the optimal time to vaccinate for HPV? What if the pt already has HPV?
prior to individual’s sexual debut
None of the HPV vaccines treat or accelerate the clearance of preexisting vaccine type HPV infections or related disease
If the pt has a history of genital warts, +HPV test result, abnormal cervical, vaginal, vulvar, or anal cytology, what does this indicate? Would you still recommend vaccination?
all indicate prior HPV infection but not necessarily with types in vaccine, so still recommended
What are the 2 types of meningococcal vaccines?
Meningitis ACWY (Menactra, Menveo, MenQuadfi)
Meningitis B (Trumenba or Bexsero)
What is the dosing schedule for Meningitis ACWY (Menactra, Menveo, MenQuadfi)?
Required before the 7th and 12th grade
Given 1 dose @ 11-13 year, then 16-18 years
What is the dosing schedule for Meningitis B (Trumenba or Bexsero)?
Give 1 dose @ age 16-18, with a second dose either 1 month apart or 6 months apart (depends on vaccine)
**What is the recommendation for the flu vaccine?
Recommended annually for children 6 months of age and up
Children 6 months to 8 years of age require 2 doses the first time they receive the flu vaccine, with single annual doses thereafter
How old do you have to be to use Flumist? Is it as effective?
age 2—live attenuated vaccine; sometimes not as effective
What are the 2 CI to the flu vaccine?
Children under 6 months of age
History of severe allergic reaction to influenza virus or any component of the vaccine.
**What is the recommendation that a pt with an egg allergy receive the flu vaccine?
pts with egg allergies should still receive the flu shot! need to observe for 30 minutes for signs of a reaction
staff just need to be prepared for a reaction. 1/million will have anaphylaxis
What is the recommendation for a pt with an egg allergy and the flu shot with hives only as a reaction?
Any influenza vaccine appropriate for age and health status annually
aka no change if hives is the reaction
What precaution is needed when giving the flu vaccine?
Should be withheld from children with moderate to severe acute illness until symptoms resolve
MINOR illness with or without fever, okay to give flu shot
What are the 3 CI for FluMist?
Children under 2
Children of any age with asthma and children 2-4 with a history of recurrent wheezing
Children who are close contacts of severely immunocompromised individuals (someone IC lives with them)
What type of vaccine is MMR? When is it given?
LIVE attenuated vaccine
Routine immunization with MMR is recommended for children at 12-15 months, and a second (MMRV) at age 4-6 years
Why do you have to be at least 4 to receive MMRV?
MMRV also includes varicella
This is due to an increase in risk of febrile seizures when MMRV is administered in children <4 yrs of age
Proceed with caution with the first dose if family has febrile Sz, need to separate MMR if hx of febrile seizures
What are the 2 CI to MMR?
Pregnancy-do not get pregnant for at least 28 days after MMR administration d/t theoretical risk of rubella
Immunodeficiency
What is your response to the myth: “I got the flu from the flu shot”?
May have mild flu symptoms, very mild (runny nose, headache, low grade fever)
Can still get flu if the vaccine does not match current subtypes
but cannot get the flu because the virus is already dead
Are immunizations 100% effective?
NO!! can still get mild form of the disease
What are the flaws with Andrew Wakefield study? What vaccine in particular?
only 12 kiddos were used
kiddos were carefully selected at a birthday party he attended
research funding was provided by lawyers acting for parents who wanted to sue the vaccine manufacturers
entire report was fraud for financial compensation
Wakefield and colleagues lost their licenses
MMR vaccine
**What percentage of the population needs to be vaccinated for herd immunity?
50-95% of population must be vaccinated
(to also protect immunocompromised kids who can’t receive vaccinations)
What is the difference between primary and secondary prophylaxis?
Primary Prophylaxis:
used to prevent infection before a first occurrence
Secondary Prophylaxis:
used to prevent recurrence after a first exposure.
Who qualifies for meningococcus prophylaxis?
Prophylaxis is recommended for:
-all household contacts, especially young children
-child care or nursery school contacts in the previous 7 days
-direct exposure to index patient’s secretions through kissing or sharing toothbrushes or eating utensils
-Contacts who frequently sleep or eat in the same dwelling
-Passengers seated directly next to the index case during airline flights lasting longer than 8 hours
Who is prophylaxis treatment NOT recommended for in meningococcus?
not recommended for casual contacts with no history of direct exposure to the patient’s oral secretions (work or school mate), indirect contact with the index patient or medical staff without direct exposure
What is the abx regimen for meningococcus prophylaxis?
Rifampin BID for 2 days, ceftriaxone once and ciprofloxacin once are recommended regimen
all 3 things!
What is the prophylaxis treatment for tetanus?
immediate cleansing using soap and water
Tetanus prophylaxis after wound cleansing includes vaccination (Toxoid) of person with incomplete immunization and tetanus immunoglobulin for contaminated wounds (soil, feces, saliva) puncture wounds, avulsions, crushing, burns or frostbite
Draw the chart for tetanus prophylaxis?
What is the rabies prophylaxis treatment?
Rabies immune globulin (RIG) and rabies vaccine are extremely effective for prophylaxis after exposure to rabies but are of no known benefit after symptoms appear.
needs to be given BEFORE symptoms appear, once symptoms appear it is too late
What is the observation window for rabies?
ANY healthy-appearing domestic animal responsible for an apparently unprovoked bite should be observed for 10 days for signs of rabies without immediate treatment of the victim.
wild animal is assumed rabid unless the animal is caught and euthanized and brain examined for evidence of rabies
What 5 animals are at high risk for rabies?
Skunks
Raccoons
Foxes
Woodchucks (chipmunks)
Bats
bat found and the person has a bite mark, assumed _____
has rabies
bat = has rabies
What is the treatment protocol for rabies prophylaxis?
All rabies post-exposure management begins with immediate cleansing with soap and water and if available a virucidal agent such as iodine
Rabies (Immunoglobulin) RIG: 20U/kg administered as a full dose of RIG infiltrated Subcutaneously into the area around the wound if possible–the rest in the arm
Rabies vaccine:
Dosed at day 0, 3, 7, 14
Day 28 for immunocompromised
What is the prophylaxis for Pertussis?
Azithromycin
Treat with antibiotics and monitor for symptoms for 21 days after exposure
