Immunizations (peds) Flashcards
1
Q
Immunity (the basics)
A
- Body’s ability to tolerate presence of material indigenous to the body “self” & eliminate foreign material “non-self”
Passive Immunity
- Antibodies produced by animals/humans are transferred to another human
- Temporary - lasts a few weeks or months
Active Immunity
- Protection produced by one’s own immune system
- Usually permanent - lasts many years or lifetime, but requires time to develop
2
Q
Active Immunity
A
Antigens/vaccines stimulate the immune system to produce antibodies by lymphocytes and cellular immunity
Acquired by:
• Actively infected with disease/infection
• Vaccines - response dependent on:
- Vaccine formulation
- Presence of maternal antibody
- Host factors (possibly age, genetics, other diseases)
3
Q
Classification of Vaccines
A
Live Attenuated Vaccines (weakened)
- Produced by modifying disease-producing virus/bacterium
- Better response as vaccine resembles natural infection
- Higher immune response = higher risk for adverse reactions
- Long term effects and few doses
- More fragile, destroyed by heat and light
- Must replicate to be effective
- Weakened so does not cause illness, but immunocompromised have increased risk
- Affected by antibodies
- Not indicated for <1 year
- Delay administration if pts getting Ig infusions (antibodies)
Inactivated Vaccines (killed/non-alive)
- Produced by growing virus/ bacterium in culture media, then inactivating w/ heat or chemicals
- Requires multiple initial doses plus booster doses over time
- Antibody titers diminish
- Not alive, does not replicate, does not cause disease
- Does stimulate response from immune system
- Not affected by circulating Abs, generally
4
Q
Inactivated Vaccines
A
- Whole or fractions of viruses/bacteria
- Protein based or Polysaccharide-based
Pure Polysaccharide
- Not consistently immunogenic in kids < 2yo
- Pneumococcal – PPSV
- Meningococcal – MPSV4
Conjugate Polysaccharide
- Process where polysaccharide is chemically combined with a protein molecule
-
Increased immunogenicity in infants
- Pneumococcal – PCV13
- Meningococcal – MCV4
- Hib vaccine (only available as conjugate vaccine)
5
Q
Summary of Vaccines
A
Live attenuated Vaccines
- Intranasal influenza
- MMR
- Varicella
- Zoster
- Rotavirus** (oral)
Inactivated Vaccines
- Influenza
- Inactivated polio
- Hep A
- Hep B
- Pertussis (acellular)
- Diptheria, tetanus
- HPV
- Penumococcal
- Meningococcal
- Hib
6
Q
Combination Vaccines
A
Refers to products supplied by manufacturer in their final form
- Preferred over separate vax to reduce # of injections needed
DTaP-HepB-IPV Pediatrix – doses for 2,4,6 mo
DTap-IPV/Hib Pentacel – doses for 2,4,6, 15-18mo
DTap-IPV Kinrix – doses for 4-6yo
7
Q
Hep B Vaccine
A
Infants/Children
- All children should be vaccinated
- All newborns should receive dose #1 prior to discharge
- Minimum age for dose #3 is 6mo
- Do not restart series (no matter how long, just continue w/ #2 or 3)
- 3 dose series can be started at any age if entirely unvaccinated
- Adults receive the vaccine series 0, 1, 6 months apart
- Series may be completed w/ combo vaccine; results in 4 doses (OK’d by CDC)
- DTaP-HepB-IPV Pediarix
8
Q
Diptheria, Tetanus, acellular Pertussis
A
DTaP, DT
- Only for kids under 7y
- Try to administer same product for all doses if possible
Tdap, Td
- Only for kids/adults over 7y
- Lower dose of dip/pert to avoid local rxn
Booster
- Td booster every 10 years after primary series of either of the above
9
Q
Pertussis
A
- acellular Pertussis vaccine recommended to anyone in contact w/ infants <1y
- Recommended to all pregnant women during each pregnancy
- Preferred during 27-36w gestation regardless of last Td booster or Tdap
10
Q
HPV Vaccines
A
- Routine vaccination at age 11 or 12 years, (youngest age 9)
- Vaccinate females –> 26 years
- Vaccinate males–> 21 years, high risk males –>26 years
- Two doses recommended for most persons starting at <15y
-
Three doses if:
- Series started at 15y+
- Immunocompromised at any age
- Not recommended for use during pregnancy
11
Q
MMR Footnote
A
Footnote 8 states:
International travel and UNDER 1 YEAR:
- Administer an early first dose to infants 6-11 mo pre-international travel
- Revaccinated with 2 doses of MMR
- 1st at age 12-15mo, 2nd at least 4 weeks later
International travel and OVER 1 YEAR:
- Administer 2 doses of MMR vaccine to children aged 12 months and older before departure from US for international travel
- 1st dose on or after age 12mo, 2nd dose at least 4 weeks later
12
Q
Pneumococcal Polysaccaride Vaccine
A
Extra pneumoccocal coverage for high-risk patients (given after age 2, as it’s a PSV. PCV given in infancy)
1 dose PPSV23
- Chronic heart disease
- Chronic lung disease (including asthma treated with high-dose, oral corticosteroids)
- Diabetes mellitus
- CSF leak
- Cochlear implant
2 doses PPSV23 (5 years apart):
- Sickle cell disease
- Asplenia
- Congenital/acquired immunodeficiency
- Solid organ transplantation
- Chronic renal failure; nephrotic syndrome
- HIV infection; Malignant neoplasms, leukemias, lymphomas, Hodgkin disease
- Other diseases assoc w/ use of immunosuppressive drugs or radiation therapy
Administer PPSV23 at least 8 weeks after any prior PCV13 dose
13
Q
Meningococcal Vaccines
A
ACWY Strains:
- Age 11-12yo + booster at 16 years
- Unvaccinated college students living in dorms
- 2mo+ high risk patients with asplenia or HIV
B Strains (additional coverage) based on clinical decision:
- CDC recs permissive use of serogroup B vaccine for ages 16-23
- Preferred age of 16-18
- 10 years+ high risk patients with asplenia
14
Q
Rotavirus Vaccine
A
- Live vaccine status does not matter bc it’s oral/degraded by GI acid
- Minimum age: 6 weeks
- Rotarix: 2-dose series at 2 & 4 months
-
RotaTeq: 3-dose series at 2, 4, & 6 months
- If any dose in the series is either RotaTeq or unknown, default to 3-dose series.
- Catch-up vaccination:
- Do not start the series on or after age 15 weeks, 0 days.
- The maximum age for the final dose is 8 months, 0 days.
- Why? High risk of intussusception
15
Q
Influenza Vaccine
A
- Recommendations change yearly – published in August
- Recommended annually for all persons aged ≥6 mo without contraindications (seasonal, do not have to wait 1 year between doses)
- Children 6mo-8yo receiving influenza vaccine for 1st time require 2 doses administered > 4 weeks apart
- Egg allergy – egg-free version: quadrivalent, recombinant: RIV4
- IIV<strong>3</strong> = inactivated influenza vaccine trivalent
- IIV4 = inactivated “ quadrivalent
- LAIV4 = live attenuated influenze vaccine quadrivalent
- ccIIV4 = cell culture-based inactivated influenze vaccine quadrivalent
- contains virus grown in animal cell culture, can have egg cross contaminant
- Trivalent - A, A, B
- Quadrivalent - A, A, B, B
