Lecture 5 - Immunizations Flashcards by Indy P

DTaP Vaccine

big D indicates for children under 7
this is a 5 dose series

diptheria
tetanus toxoids
selected bordetella pertussis components

2, 4, 6, 12-18, and 4-6 years of age

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Tdap Vaccine

> 7 years old

Td vaccine plus reduced acellular pertussis component

Acellular version doesnt last as long so

during EACH pregnancy, the mother gets Tdap vaccine —passive immunity
present infant pertussis infection s

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Which vaccines does a pregnant mother get every time she’s pregnant?

Tdap

to give infant passive immunity and prevent infant pertussis

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What are the contraindications of pertussis vaccine?

prior vaccine adverse event –anaphylaxis risk

encephalopathy within 7 days

defer immunization if encephalopathy but go ahead and given DT

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What kind of vaccine in the Polio vaccine?

inactivated - killed virus

given 2,4,6-18 months, 4-6 years
final dose > 4 years (at least 6 months from previous dose)

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Polio has been combined with what other vaccines?

DTaP - IPV
DTaP - IPV/Hib
DTaP - HepB-IPV

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What children are at increased risk for Pneumococcal disease and thus get an additional dose when they’re older?

anatomic or functional asplenia (sickle cell disease)
HIV or other immune compromise
Cochlear implant or CSF leak
Chronic renal failure, nephrotic syndrome

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How long is the duration of immunity for Hep B Vaccine?

> 30 years

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What is the vaccine administration for a child born to a HbsAg Neg mother?

3 dose 
1st at birth (within 1st 24 hours) 
2nd dose at 1-2 months age 
3rd dose at 6-18 months of age 
(>2 months after 2nd dose)

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What vaccines are given in early childhood?

HepB
DTaP
Hib
PCV13
IPV (polio) 
MMR
Varicella 
HepA
Influenza (annually)
RV

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What are the complications of diptheria?

myocarditis
ascending paralysis
vocal cord paralysis

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What are the 2 different vaccine types for diptheria?

<7 years old: DTaP or DT –big D means higher dose

> /=7: Tdap or Td – lower dose

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What are the different formations of tetanus vaccine?

DTaP, DT, Tdap, Td

tetanus immune globulin - TIG

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I need to find out when you would use TIG?

NOT DONE HERE

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What is included in DTaP vaccine?

diptheria
tetanus toxoids
selected bordatella pertussis components

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What is the timing of the DTaP vaccine?

5 dose series (minimum of 3 doses for protection)

2, 4, 6, 12-18 months and 4-6 years

only for <7 years old

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Who gets the Tdap vaccine?

routine at 11 - 12 (for kids >7 years of age)

any pregnant pt gets Tdap during EACH pregnancy (27-36 weeks gestation)

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What are relative contraindications of pertussis vaccine?

if you have had a prior adverse event —-anaphylactic reaction of encephalopathy

also differ the vaccine if you have evolving neurological disorder —give DT instead until you can give pertussis later

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What kind of vaccine is the Polio Vaccine?

IPV - inactivated polio vaccine

killed virus

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When do kids get IPV?

Inactivated Polio Vaccine

2, 4, 6-18 months, 4-6 years

final dose >/=4 years (must be at least 6 months from previous dose)

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What are the different ways you can get Polio vaccine (combo)?

DTaP - IPV
DTaP - IPV/Hib
DTaP - HepB - IPV

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Which type of vaccines do children have a harder time mounting a response to?

Polysaccharide vaccines

such as the Hib (haemophilus influenza type B vacine)

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When do children get the Hib vaccine?

depends on the type
PRP-T 2 months, 4 months, 6 months, and a booster at 12-15 months

if they get PRP-OMP 2 months, 4 months, and a booster at 12-15 months

these vaccines can be used interchangeably

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Prevnar 13

pneumococcal conjugate vaccine

>90% pediatric pneumococcal invasive serotypes

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When do children get the Prevnar 13?

2,4,6 and 12-15 months

Who gets an additional PVC13 dose when they're older?

children with increased risk those with anatomic or functional asplenia (sickle cell disease) HIV or other immune compromise Cochlear implant or CSF leak Chronic renal failure, nephrotic syndrome this extra dose will be given at 6-18 years of age (single dose)

PPSV23

Pneumovax - polysaccharide vaccine given to high risk children over the age of 2 must be given >8 weeks after last PCV13 dose

Menacrtra or Menveo

Meningococcal Conjugate Vaccine MenACWY-D MenACWY-CRM serogroups A, C, W-135, Y (does not include serogroup B) 1st dose given at 11-12 years 2nd dose given at 16 years high risk populations dosed in infancy

MenB-4C (Bexsero) | MenB-FHbp (Trumenba)

Meningococcal B Vaccine 2 dose serious administered at clinical discretion to adolescents 16-23 years who are not at high risk

What might you tell a patients family if they ask "Why does my child need a vaccine for a sexually transmitted disease" when you are trying to vaccinate for HepB?

there are 60% of HepB cases that are of unknown cause and there is always the risk of getting it via blood transfusions

What type of vaccine is the HepB vaccine?

HBsAg - surface antigen

At what age can the DTaP-HepB-IPV vaccine combo be given?

>6 weeks of age its okay if the child go the HepB at birth, an extra dose is OK

What is the dose vaccine of HepB for a pre-mature infant?

premature <2kg wait to give first dose until the child is chronologically 1 month or until hospital discharge ---whichever comes first

When do children get the HepA Vaccine?

``` 1 year (12-23 months of age) 2 doses 6 months apart ``` also travelers, chronic liver dz pts

What is the minimal age for getting HPV Vaccine?

``` 9 years (typically 11-12 years) 2 dose series unless 15+y/o at age of FIRST dose then its a 3 dose series ``` or if you're immune compromised you get 3 doses

Is the HPV vaccine a live vaccine?

What is the oldest age a person can get the HPV Vaccine?

Males - 21 | Females -26

Is the measles vaccine a live virus vaccine?

Yes

What is the potential adverse effects of the measles vaccine?

7-12 days after immunization | 5-10% get fever and rash

Pregnant pts

``` should NOT get: Measles vaccine Mumps Rubella Varicella ``` Should get Tdap during each pregnancy (27-36 weeks)

Immunocompromised Pts

``` should NOT get: Measles vaccine Mumps Rubella Varicella ```

What are the contraindications for Measles Vaccine

Pregnancy immunocompromised (exception: HIV with CD4 >15%) recent immunoglobin

When do pts get the measles vaccine?

2 doses after 1st birthday interval >1 month ideally 1st dose at 12-15 months 2nd dose at 4-6 years of age

How do the measles vaccine recommendations change if there is an outbreak?

can give dose as young as 6 months doesn't count towards 1st dose in series though

When during the year is mumps more common?

late winter and spring

What are the clinical sings of mumps?

parotitis: salivary gland swelling fever complications: -meningoencephalitis, sensorineural hearing loss, orchitis, pancreatitis

How do you dx mumps?

viral isolation by PCR --saliva, buccal swab, CSF, serology

What is the treatment for mumps?

supportive

Is the mumps vaccine a live virus?

yes

What are the contraindications for mumps virus?

pregnancy immunocompromised recent immunoglobulin

Is the rubella vaccine a live virus?

yes

What are the adverse reactions to the rubella vaccine?

mild rash, fever, adenopathy, transient arthralgias

What are the contraindications of rubella vaccine?

pregnancy immunocompromised recent immunoglobulin

Is the varicella vaccine a live virus?

yes - live attenuated virus

Can you give the varicella vaccine to a pt who has chicken pox?

yes if given within 72 hours of sxs onset

What are the adverse effects to the varicella vaccine?

``` local erythema, soreness (25%) papulovesicluar rash (5-10%) ```

When do children get the varicella vaccine?

2 doses 12-15 months 4 - 6 years

How does the varicella vaccine timing change if you are on the catch up schedule?

2 doses separated by at least 4 weeks

What are the contraindications for the Varicella vaccine?

immunocompromised (exceptions - impaired humoral immunity or HIV if CD4 >15%)

Is the rotavirus vaccine live?

yes 2 flavors Pentavalent RV5 - 3 dose series Monovalent RV1 - 2 dose series PO admin

What are the adverse effects of the rotavirus vaccine?

small increased risk of intussusception --benefits of the vaccine far exceed this risk

What are the contraindications of the rotavirus vaccine?

intussusception history | SCID (severe combine immune deficiency)

When do kids get the rotavirus vaccine?

all infants 1st dose 6-14 weeks of age max age for any dose is 8 months (since the risk of virus is lower at this age and thus doesn't outweigh the risk of intussusception ``` 3 doses RV5 (2,4,6 months) 2 dose (2, 4 months of age) ```

Which vaccines are started at 2 months of age?

``` rotavirus DTaP Hib PCV13 IPV ```

Which vaccines are started at 12 months of age?

MMR VAR HepA

At what age can you start giving annual flu shots?

6 months

With who do we normally see undervaccination?

low SES | or with access to healthcare

What is the most common reason for vaccine refusal?

69% of parents report concerns that the vaccine may cause harm

Autism was supposedly related to which vaccine?

MMR

Which type of research was done to defunct the MMR causing autism problem?

retrospective cohort study of all children born in denmark between january 1991 and decemeber 1998

VFC

Vaccines for Children program federally funded program providing no-cost vaccines to children who have inability to pay title 14 medicaid program

Who is eligible for VFC?

``` children up to age 18 medicaid eligible uninsured under-insured american indian or alaska native ```