Lecture 9: Immunizations Flashcards
1
Q
What is the main unfounded speculation regarding vaccines?
A
That they cause autism
2
Q
Overall, how many injections are given normally between birth to 4?
A
18 injections if combo
3
Q
When are immunizations checked?
A
EVERY WCC
4
Q
Who formulates vaccine schedules?
A
- ACIP (advisory committtee on immunization practices)
- AAP (american academy of pediatrics)
- AAFP (american academy of family physicians)
5
Q
What are the active immunization methods?
A
- Vaccine
- Toxoid
6
Q
What vaccines are LIVE attenuated vaccines?
A
- MMR
- Varicella
- FluMIST (IN)
- Rotavirus (oral)
- OPV (Oral polio virus)
MOV FoR live
7
Q
What can interfere with live vaccines?
A
- Blood products
- Immunoglobulins
- circulating residual maternal antibodies in infants
If given in past 3 months
8
Q
Can we administer live vaccines together (i.e. MMR and varicella)?
A
yes to MMR and varicella. no to everything else, spread them out by 4 weeks minimum
9
Q
What are the primary inactivated/killed vaccines?
A
- Polio
- Hep A
- Flu shot
PAF is dead
IPV = inactivated polio to trigger PAF
10
Q
What is a recombinant vaccine?
A
Viruses/bacteria in which we added harmless DNA encoded antigens to stimulate an immune response
11
Q
What are the recombinant vaccines?
A
- Hep B
- HPV
Be on your Gard when recombining or HBV & HPV
12
Q
What is the reassortant vaccine?
A
Rotavirus (Oral)
Live vaccine!
Combination of multiple strains of the same virus
Rotating and reassorting
13
Q
What are the immunogenic components of bacteria vaccines?
A
- Pertussis
- HIB
- Meningococcal conjugate
- Pneumococcal conjugate
All BACTERIA
PHPM
14
Q
What are the two toxoid vaccines?
A
- Diphtheria
- Tetanus
15
Q
Preferred injection site for infants to age 4
A
Anterolateral thigh
16
Q
Preferred injection site for children 5-18
A
Deltoid
17
Q
If you want to give multiple vaccines at one visit, how do you inject them?
A
Different limbs or 1 inch apart
18
Q
Birth vaccine
A
Hep B
19
Q
2 Month vaccines
A
- B: (Hep B)
- D: DTaP
- R: RV (rotavirus)
- H: (HIB)
- I: (IPV)
- P: (PCV)
2 Be DR HIP
20
Q
4 month vaccines
A
- D: DTaP
- R: RV
- H: HIB
- I: IPV
- P: PCV
4 DR HIP
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
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
23
Q
4-6 year vaccines
A
- V: Varicella
- D: DTaP
- I: IPV
- M: MMR
Very DIM between 4-6 pm
24
Q
Vaccines at 9 years
A
HPV (Gardasil!)
25
11 year vaccines
Tdap & Men ACWY
26
16 year vaccine
Men ACWY (2nd dose)
27
17 year vaccines
MenB + booster in a month
| Meningitis primarily college dorm caution, so last vaccines
28
What are the 3 types of vaccine exemptions?
* Medical
* Religious
* Philosophical
29
What do parents predominantly cite for refusal of vaccination?
Safety & SEs (60-70%)
| GBS, pain, fever
30
What is the issue with alternative vaccine schedules?
Incomplete and delayed protection
31
When do we implement alternative vaccine schedules?
* Other options have failed
* Parents will refuse to vaccinate completely
32
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
33
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.
34
What must all parents be given prior to immunizing their child?
Vaccine Information Statements by the CDC
| National Childhood Vaccine Injury Act
## Footnote
Cover
Your
Ass
35
What are the 3 general CI to vaccinations?
* Anaphylaxis
* Immunocomped or pregnant (**Only for live vaccines**)
* Moderate/severe illness
36
What dose of corticosteroids is equivalent to immunocompromised for live vaccination contraindication?
> 2 mg/kg/day over 2 weeks
37
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
38
What is a special contraindication for varicella?
Cellular immunodeficiency
39
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
40
Who do we report clinically significant adverse events post immunization to?
VAERS (Vaccine Adverse Event Reporting System)
41
How do people who have suffered an injury/death due to vaccine administration get compensation?
National Vaccine Injury Compensation Program
42
If you suspect someone has a **vaccine-preventable** disease, what should you do?
Report to state or local health department
| Pertussis, measles, etc
43
Top 2 HPV strains for Cervical Cancer
16 & 18
44
Earliest age you can get Gardasil
9
| Usually start at 11-12 tho
45
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.
46
What are the two high-risk scenarios for contracting Bacterial meningitis?
1. College dorms
2. Army recruits
| Very cramped areas
47
What is unique about flu vaccine administration in children?
The very first flu vaccine they get should be a **double dose**
48
If a child is very scared of needles, how do we vaccinate them against the flu?
Flumist for **2 and older.**
49
What is the consensus regarding egg allergies and the flu vaccine?
Still give it
| Chance of anaphylaxis is 1 in a million
50
In what situation do we withhold flu vaccination temporarily for children?
Moderate to severe illness
| Fever is irrelevant
51
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
52
Measles buzzwords
* Coryza
* Conjunctivitis
* Cough
* Rash
53
Mumps buzzwords
* PAROTID swelling
* Orchitis
* Aseptic meningitis
* Encephalitis
| Mumps looks like you would mumble
## Footnote
**lots of itis**
54
Rubella buzzwords
* GERMAN measles
* mild with rash
* **CONGENITAL RUBELLA SYNDROME**
* **EYE (cataracts) HEART (PDA) RUBY EARrings (deafness)**
55
How effective is MMR?
**99% reduction in measles** since 1963
56
Extra contraindication to MMR besides the regular ones
Do not get pregnant within 28d of getting MMR
57
Can you get the flu from the flu shot
No.
58
Are immunizations 100% effective?
No.
59
What study made giving MMR 100000x harder
Wakefield studies
| Fraud
60
How much of the population needs to be immunized for herd immunity generally?
50-95% of the population
| MMR outbreak @ disneyland
61
What specific childhood illnesses require primary prophylaxis?
N. Menigitidis
62
Who needs prophylaxis for N. menigitidis?
* ALL household contacts
* childcare/nursery in past week
* Direct exposure to secretions
* Flight buddies for **> 8hr flight**
63
What is the prophylaxis for N. meningitidis?
1. Rifampin BID for 2 days (2x2)
2. Rocephin once
3. Ciprofloxacin once
| All 3 of these!
64
When do you give the tetanus vaccine to a wound?
Hx of less than 3 doses or unknown
65
When do you give tetanus immunoglobulin?
Hx of less than 3 doses or unknown + a **non-minor wound**
66
When do you give rabies immunoglobulin?
IMMEDIATELY AFTER EXPOSURE
| Symptom onset is too late.
67
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.
68
What animals are the highest risk for rabies?
* Skunks
* Trash Pandas
* Foxes
* Woodchucks
* Bats
69
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.
## Footnote
Just double it
70
Post exposure abx for pertussis
Azithromycin
| Monitor for 21 days
