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Pediatrics > Lecture 9: Immunizations > Flashcards

Lecture 9: Immunizations Flashcards

1
Q

What is the main unfounded speculation regarding vaccines?

A

That they cause autism

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2
Q

Overall, how many injections are given normally between birth to 4?

A

18 injections if combo

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3
Q

When are immunizations checked?

A

EVERY WCC

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4
Q

Who formulates vaccine schedules?

A
  • ACIP
  • AAP
  • AAFP
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5
Q

What are the active immunization methods?

A
  • Vaccine
  • Toxoid
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6
Q

What vaccines are LIVE attenuated vaccines?

A
  • MMR
  • Varicella
  • FluMIST (IN)
  • Rotavirus (oral)
  • OPV (Oral polio virus)

MOV FoR live

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7
Q

What can interfere with live vaccines?

A
  • Blood products
  • Immunoglobulins

If given in past 3 months

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8
Q

Can we administer live vaccines together (i.e. MMR and varicella)?

A

Yes; otherwise split them up by 4 weeks.

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9
Q

What are the primary inactivated/killed vaccines?

A
  • Polio
  • Hep A
  • Flu shot

PAF is dead

IPV = inactivated polio to trigger PAF

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10
Q

What is a recombinant vaccine?

A

Viruses/bacteria in which we added harmless DNA encoded antigens to stimulate an immune response

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11
Q

What are the recombinant vaccines?

A
  • Hep B
  • HPV

Be on your Gard when recombining or HBV & HPV

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12
Q

What is the reassortant vaccine?

A

Rotavirus (Oral)

Live vaccine!

Combination of multiple strains of the same virus

Rotating and reassorting

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13
Q

What are the immunogenic components of bacteria vaccines?

A
  • Pertussis
  • HIB
  • Meningococcal conjugate
  • Pneumococcal conjugate

All BACTERIA

PHPM

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14
Q

What are the two toxoid vaccines?

A
  • Diphtheria
  • Tetanus
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15
Q

Preferred injection site for infants to age 4

A

Anterolateral thigh

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16
Q

Preferred injection site for children 5-18

A

Deltoid

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17
Q

If you want to give multiple vaccines at one visit, how do you inject them?

A

Different limbs or 1 inch apart

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18
Q

Birth vaccine

A

Hep B

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19
Q

2 Month vaccines

A
  • B: (Hep B)
  • D: DTaP
  • R: RV (rotavirus)
  • H: (HIB)
  • I: (IPV)
  • P: (PCV)

2 Be DR HIP

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20
Q

4 month vaccines

A
  • D: DTaP
  • R: RV
  • H: HIB
  • I: IPV
  • P: PCV

4 DR HIP

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21
Q

6 months vaccines

A
  • B: Hep B
  • D: DTaP
  • R: RV (if using 3-dose series)
  • H: HIB
  • I: IPV
  • P: PCV
  • IN: Influenza

Be DR HIP in 6 months

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22
Q

1 year to 1.5 year vaccines

A
  • V: Varicella (1y)
  • M: MMR (1y)
  • A: Hep A (1y)
  • D: DTaP (15 mo)
  • H: HIB (18 months)
  • I: IPV (if missed)
  • P: PCV (15 mo)

1 Very MAD HIPster

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23
Q

4-6 year vaccines

A
  • V: Varicella
  • D: DTaP
  • I: IPV
  • M: MMR

Very DIM between 4-6 pm

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24
Q

Vaccines at 9 years

A

HPV (Gardasil!)

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25
Q

11 year vaccines

A

Tdap & Men ACWY

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26
Q

16 year vaccine

A

Men ACWY (2nd dose)

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27
Q

17 year vaccines

A

MenB + booster in a month

Meningitis primarily college dorm caution, so last vaccines

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28
Q

What are the 3 types of vaccine exemptions?

A
  • Medical
  • Religious
  • Philosophical
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29
Q

What do parents predominantly cite for refusal of vaccination?

A

Safety & SEs (60-70%)

GBS, pain, fever

30
Q

What is the issue with alternative vaccine schedules?

A

Incomplete and delayed protection

31
Q

When do we implement alternative vaccine schedules?

A
  • Other options have failed
  • Parents will refuse to vaccinate completely
32
Q

What is WV’s immunization tracking program and what should you do if no record is found?

A
  • SIIS
  • If no record found, assume they are unvaccinated. Begin catch-up ASAP.

Statewide Immunization Information System

33
Q

In what scenario would you not vaccinate a premature baby at the same rate/time as a term baby?

A

If they are under 2kg.

Delay their first HBV to 1 mo WCC instead of at birth.

34
Q

What must all parents be given prior to immunizing their child?

A

Vaccine Information Statements by the CDC

National Childhood Vaccine Injury Act

Cover
Your
Ass

35
Q

What are the 3 general CI to vaccinations?

A
  • Anaphylaxis
  • Immunocomped or pregnant (Only for live vaccines)
  • Moderate/severe illness
36
Q

What dose of corticosteroids is equivalent to immunocompromised for live vaccination contraindication?

A

> 2 mg/kg/day over 2 weeks

37
Q

For HIV infected children WITHOUT evidence of severe immunosuppression, how do we adjust their MMR vaccine and to when?

A

MMR #2 should be given 1 month later instead of at 4-6

1 Very MAD HIP-ster + Very DIM at 4-6 pm is OG schedule

38
Q

What is a special contraindication for varicella?

A

Cellular immunodeficiency

39
Q

For HIV-infected children WITHOUT evidence of severe immunosuppression, what is the modified varicella schedule?

A
  • Original dose still at 12 months
  • Booster 3 months later

1 Very MAD HIP-ster + Very DIM at 4-6pm is OG schedule

40
Q

Who do we report clinically significant adverse events post immunization to?

A

VAERS (Vaccine Adverse Event Reporting System)

41
Q

How do people who have suffered an injury/death due to vaccine administration get compensation?

A

National Vaccine Injury Compensation Program

42
Q

If you suspect someone has a vaccine-preventable disease, what should you do?

A

Report to state or local health department

Pertussis, measles, etc

43
Q

Top 2 HPV strains for Cervical Cancer

A

16 & 18

44
Q

Earliest age you can get Gardasil

A

9

Usually start at 11-12 tho

45
Q

In what two scenarios do you need the triple dose gardasil series?

A
  • You’re starting after 15y (0,1-2mo, 6mo)
  • Immunocompromised

Normal is 2nd dose 6 months later.

46
Q

What are the two high-risk scenarios for contracting Bacterial meningitis?

A
  1. College dorms
  2. Army recruits

Very cramped areas

47
Q

What is unique about flu vaccine administration in children?

A

The very first flu vaccine they get should be a double dose

48
Q

If a child is very scared of needles, how do we vaccinate them against the flu?

A

Flumist for 2 and older.

49
Q

What is the consensus regarding egg allergies and the flu vaccine?

A

Still give it

Chance of anaphylaxis is 1 in a million

50
Q

In what situation do we withhold flu vaccination temporarily for children?

A

Moderate to severe illness

Fever is irrelevant

51
Q

What children CANNOT take the Live Attenuated Flu Vaccine?

A
  • Younger than 2
  • Asthma
  • Children 2-4 with hx of recurrent wheezing
  • Close contacts of severely immunocomped people

Flumist

52
Q

Measles buzzwords

A
  • Coryza
  • Conjunctivitis
  • Cough
  • Rash
53
Q

Mumps buzzwords

A
  • PAROTID swelling
  • Orchitis
  • Aseptic meningitis
  • Encephalitis

Mumps looks like you would mumble

lots of itis

54
Q

Rubella buzzwords

A
  • GERMAN measles
  • mild with rash
  • CONGENITAL RUBELLA SYNDROME
  • EYE HEART RUBY EARrings
55
Q

How effective is MMR?

A

99% reduction in measles since 1963

56
Q

Extra contraindication to MMR besides the regular ones

A

Do not get pregnant within 28d of getting MMR

57
Q

Can you get the flu from the flu shot

A

No.

58
Q

Are immunizations 100% effective?

A

No.

59
Q

What study made giving MMR 100000x harder

A

Wakefield studies

Fraud

60
Q

How much of the population needs to be immunized for herd immunity generally?

A

50-95% of the population

MMR outbreak @ disneyland

61
Q

What specific childhood illnesses require primary prophylaxis?

A

N. Menigitidis

62
Q

Who needs prophylaxis for N. menigitidis?

A
  • ALL household contacts
  • childcare/nursery in past week
  • Direct exposure to secretions
  • Flight buddies for > 8hr flight
63
Q

What is the prophylaxis for N. meningitidis?

A
  1. Rifampin BID for 2 days (2x2)
  2. Rocephin once
  3. Ciprofloxacin once

All 3 of these!

64
Q

When do you give the tetanus vaccine to a wound?

A

Hx of less than 3 doses or unknown

65
Q

When do you give tetanus immunoglobulin?

A

Hx of less than 3 doses or unknown + a non-minor wound

66
Q

When do you give rabies immunoglobulin?

A

IMMEDIATELY AFTER EXPOSURE

Symptom onset is too late.

67
Q

When do you quarantine an animal in relation to rabies?

A
  • ANY healthy-appearing domestic animal that bit someone unprovoked should be observed for 10 days to check if it develops rabies.
  • ANY wild captured animal should be euthanized immediately and have a brain autopsy to check for rabies (DO NOT WAIT AND OBSERVE)

You don’t need to prophylaxis someone if the animal isn’t sus.

68
Q

What animals are the highest risk for rabies?

A
  • Skunks
  • Trash Pandas
  • Foxes
  • Woodchucks
  • Bats
69
Q

How is the rabies vaccine dosed?

A
  • Day 0
  • Day 3
  • Day 7
  • Day 14
  • Day 28 (if immunocomped)

Also give them an injection of RIG AROUND the wound and rest into arm.

Just double it

70
Q

Post exposure abx for pertussis

A

Azithromycin

Monitor for 21 days

Pediatrics (23 decks)

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