Lecture 9: Immunizations Flashcards
What is the main unfounded speculation regarding vaccines?
That they cause autism
Overall, how many injections are given normally between birth to 4?
18 injections if combo
When are immunizations checked?
EVERY WCC
Who formulates vaccine schedules?
- ACIP (advisory committtee on immunization practices)
- AAP (american academy of pediatrics)
- AAFP (american academy of family physicians)
What are the active immunization methods?
- Vaccine
- Toxoid
What vaccines are LIVE attenuated vaccines?
- MMR
- Varicella
- FluMIST (IN)
- Rotavirus (oral)
- OPV (Oral polio virus)
MOV FoR live
What can interfere with live vaccines?
- Blood products
- Immunoglobulins
- circulating residual maternal antibodies in infants
If given in past 3 months
Can we administer live vaccines together (i.e. MMR and varicella)?
yes to MMR and varicella. no to everything else, spread them out by 4 weeks minimum
What are the primary inactivated/killed vaccines?
- Polio
- Hep A
- Flu shot
PAF is dead
IPV = inactivated polio to trigger PAF
What is a recombinant vaccine?
Viruses/bacteria in which we added harmless DNA encoded antigens to stimulate an immune response
What are the recombinant vaccines?
- Hep B
- HPV
Be on your Gard when recombining or HBV & HPV
What is the reassortant vaccine?
Rotavirus (Oral)
Live vaccine!
Combination of multiple strains of the same virus
Rotating and reassorting
What are the immunogenic components of bacteria vaccines?
- Pertussis
- HIB
- Meningococcal conjugate
- Pneumococcal conjugate
All BACTERIA
PHPM
What are the two toxoid vaccines?
- Diphtheria
- Tetanus
Preferred injection site for infants to age 4
Anterolateral thigh
Preferred injection site for children 5-18
Deltoid
If you want to give multiple vaccines at one visit, how do you inject them?
Different limbs or 1 inch apart
Birth vaccine
Hep B
2 Month vaccines
- B: (Hep B)
- D: DTaP
- R: RV (rotavirus)
- H: (HIB)
- I: (IPV)
- P: (PCV)
2 Be DR HIP
4 month vaccines
- D: DTaP
- R: RV
- H: HIB
- I: IPV
- P: PCV
4 DR HIP
6 months vaccines
- 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
1 year to 1.5 year vaccines
- 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
4-6 year vaccines
- V: Varicella
- D: DTaP
- I: IPV
- M: MMR
Very DIM between 4-6 pm
Vaccines at 9 years
HPV (Gardasil!)
11 year vaccines
Tdap & Men ACWY
16 year vaccine
Men ACWY (2nd dose)
17 year vaccines
MenB + booster in a month
Meningitis primarily college dorm caution, so last vaccines
What are the 3 types of vaccine exemptions?
- Medical
- Religious
- Philosophical
What do parents predominantly cite for refusal of vaccination?
Safety & SEs (60-70%)
GBS, pain, fever
What is the issue with alternative vaccine schedules?
Incomplete and delayed protection
When do we implement alternative vaccine schedules?
- Other options have failed
- Parents will refuse to vaccinate completely
What is WV’s immunization tracking program and what should you do if no record is found?
- SIIS
- If no record found, assume they are unvaccinated. Begin catch-up ASAP.
Statewide Immunization Information System
In what scenario would you not vaccinate a premature baby at the same rate/time as a term baby?
If they are under 2kg.
Delay their first HBV to 1 mo WCC instead of at birth.
What must all parents be given prior to immunizing their child?
Vaccine Information Statements by the CDC
National Childhood Vaccine Injury Act
Cover
Your
Ass
What are the 3 general CI to vaccinations?
- Anaphylaxis
- Immunocomped or pregnant (Only for live vaccines)
- Moderate/severe illness
What dose of corticosteroids is equivalent to immunocompromised for live vaccination contraindication?
> 2 mg/kg/day over 2 weeks
For HIV infected children WITHOUT evidence of severe immunosuppression, how do we adjust their MMR vaccine and to when?
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
What is a special contraindication for varicella?
Cellular immunodeficiency
For HIV-infected children WITHOUT evidence of severe immunosuppression, what is the modified varicella schedule?
- Original dose still at 12 months
- Booster 3 months later
1 Very MAD HIP-ster + Very DIM at 4-6pm is OG schedule
Who do we report clinically significant adverse events post immunization to?
VAERS (Vaccine Adverse Event Reporting System)
How do people who have suffered an injury/death due to vaccine administration get compensation?
National Vaccine Injury Compensation Program
If you suspect someone has a vaccine-preventable disease, what should you do?
Report to state or local health department
Pertussis, measles, etc
Top 2 HPV strains for Cervical Cancer
16 & 18
Earliest age you can get Gardasil
9
Usually start at 11-12 tho
In what two scenarios do you need the triple dose gardasil series?
- You’re starting after 15y (0,1-2mo, 6mo)
- Immunocompromised
Normal is 2nd dose 6 months later.
What are the two high-risk scenarios for contracting Bacterial meningitis?
- College dorms
- Army recruits
Very cramped areas
What is unique about flu vaccine administration in children?
The very first flu vaccine they get should be a double dose
If a child is very scared of needles, how do we vaccinate them against the flu?
Flumist for 2 and older.
What is the consensus regarding egg allergies and the flu vaccine?
Still give it
Chance of anaphylaxis is 1 in a million
In what situation do we withhold flu vaccination temporarily for children?
Moderate to severe illness
Fever is irrelevant
What children CANNOT take the Live Attenuated Flu Vaccine?
- Younger than 2
- Asthma
- Children 2-4 with hx of recurrent wheezing
- Close contacts of severely immunocomped people
Flumist
Measles buzzwords
- Coryza
- Conjunctivitis
- Cough
- Rash
Mumps buzzwords
- PAROTID swelling
- Orchitis
- Aseptic meningitis
- Encephalitis
Mumps looks like you would mumble
lots of itis
Rubella buzzwords
- GERMAN measles
- mild with rash
- CONGENITAL RUBELLA SYNDROME
- EYE (cataracts) HEART (PDA) RUBY EARrings (deafness)
How effective is MMR?
99% reduction in measles since 1963
Extra contraindication to MMR besides the regular ones
Do not get pregnant within 28d of getting MMR
Can you get the flu from the flu shot
No.
Are immunizations 100% effective?
No.
What study made giving MMR 100000x harder
Wakefield studies
Fraud
How much of the population needs to be immunized for herd immunity generally?
50-95% of the population
MMR outbreak @ disneyland
What specific childhood illnesses require primary prophylaxis?
N. Menigitidis
Who needs prophylaxis for N. menigitidis?
- ALL household contacts
- childcare/nursery in past week
- Direct exposure to secretions
- Flight buddies for > 8hr flight
What is the prophylaxis for N. meningitidis?
- Rifampin BID for 2 days (2x2)
- Rocephin once
- Ciprofloxacin once
All 3 of these!
When do you give the tetanus vaccine to a wound?
Hx of less than 3 doses or unknown
When do you give tetanus immunoglobulin?
Hx of less than 3 doses or unknown + a non-minor wound
When do you give rabies immunoglobulin?
IMMEDIATELY AFTER EXPOSURE
Symptom onset is too late.
When do you quarantine an animal in relation to rabies?
- 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.
What animals are the highest risk for rabies?
- Skunks
- Trash Pandas
- Foxes
- Woodchucks
- Bats
How is the rabies vaccine dosed?
- 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
Post exposure abx for pertussis
Azithromycin
Monitor for 21 days
