Immunizations Review

Question 1

live vaccines list

Answer 1

MMR, varicella, rotavirus, and influenza (intranasal)

Question 2

Contraindications for all live vaccines

Answer 2

Pregnant patients
Those with immunocompromising conditions
Patients taking immunosuppressing medications

Question 3

Intervals between multiple live vaccines

Answer 3

Must administer multiple live vaccines during same visit OR
Wait at least 28 days between vaccines
Does not apply to oral live vaccines (i.e. rotavirus, cholera, typhoid)

Question 4

Recommended route of routine vaccination?

Answer 4

IM and SubQ

Question 5

“Missing” the recommended interval (waiting longer than recommended):

Answer 5

May result in suboptimal protection during extended interval
Complete vaccine series as soon as possible
Does not require restarting the vaccine series

Question 6

Administering doses too soon (shorter interval than recommended):

Answer 6

Grace period of < 4 days is considered a valid dose
If dose is given sooner than 4 days from the recommended minimum interval, an additional dose is required
Wait the minimum interval from the date of the error dose

Question 7

MPOX

Answer 7

Virus related to smallpox
Current outbreak are of the Clade II type
Rarely fatal (<1%)
Those who are immunocompromised, children <1 year old, or pregnant are at higher risk of becoming seriously ill

Question 8

MPOX symptoms

Answer 8

rash (which can be painful or itchy)
fever
chills
swollen lymph nodes
exhaustion
muscle aches
headache
cough

Question 9

MPOX Transmission

Answer 9

Direct skin to skin contact with mpox rash and scabs
also be transmitted via saliva, upper respiratory secretions, and contact with anal or vaginal secretions

Question 10

JYNNEOS

Answer 10

2-dose nonreplicating live viral vaccine

Question 11

JYNNEOS route of administration

Answer 11

Intradermal to extend vaccine supply
0.1mL injected intradermally 4 weeks apart
Jynneos was originally approved as a subcutaneous injection
0.5mL injected subcutaneously 4 weeks apart
Either route of administration is equally effective

Question 12

Is this a maximum number of
vaccines that can be administered
in one day?

Answer 12

• No!
• If giving >2 vaccines at once, separate injection site by 1 inch. If
  possible, administer doses in separate arms. Why?

Question 13

The needle came loose while I was
injecting a dose of vaccine, and some of
the dose was lost. Should I revaccinate
the patient?

Answer 13

• Use your clinical judgement to determine if at least half of the dose
  was administered. If not, another full dose may be re-administered
  immediately
• The additional vaccine volume will not harm the patient
• If the dose was a live vaccine and the patient cannot come back on
  the same day, wait 28 days before giving the repeat dose

Question 14

patient pulls away during administration of
a vaccine and the needle comes out, should I
reintroduce the same needle and finish the
injection?

Answer 14

No!
* The needle is contaminated and should be discarded. A new
syringe, needle, and dose of vaccine should be used.

Question 15

gave a dose of pediatric hepatitis A
vaccine to an adult patient by mistake.
What do I do?

Answer 15

If the error is discovered immediately, administer
the other “half” of the dose.
* Pediatric dose is ½ of adult dose for hepatitis A
* If the error is discovered later, the patient should
receive a full age-appropriate repeat dose.
* ALWAYS report vaccine administration errors to
VAERs!!

Question 16

patient came in for their flu shot today,
but reports currently taking antibiotics for
a sinus infection. Should I administer the
vaccine?

Answer 16

• Antibiotic treatment alone is not a valid reason to defer vaccination
• If the patient is otherwise well, or only has minor illness, the
  vaccine should be administered.