Ped Exam 1 Lecture 5: Immunizations Flashcards
Who should get the catch up schedule for vaccines?
- kids born outside the US
- kids w/illnesses that prevented them from getting vaccinated at normal time
What is the aim of childhood vaccinations from a public health perspective?
Prevention of acute and chronic diseases (liver and cervical cancer)
What disease is caused by toxin-mediated release and transmitted person to person usually by respiratory droplets
Diphtheria
What are the Sxs that diphtheria causes in the respiratory tract
- Membranous nasopharyngitis
- Obstructive laryngotracheitis
(thick grey pseudomembrane –> diffic swallow/breathing)
3 Complications of Diphtheria
“MAVis has diphtheria”
Myocarditis
Ascending paralysis
Vocal cord paralysis
Formulation of the Diphtheria vaccine if <7 y/o? older than 7?
< 7 –> DTaP or DT (“Dominic is 6”)
> 7 –> Tdap or Td (“Tommy is 8”)
note: capital D = higher diphtheria dose
What are 2 ways to prevent tetanus with the tetanus toxoid?
- Vaccine (given in combo w/diphtheria)
2. Tetanus Immune globulin (TIG)
Components of the DTap vaccine?
- Diphtheria toxoid
- Tetanus toxoid
- Bordella Pertussis
What is the minimum number of doses for the DTap vaccine? Why do you need more than 1 dose for this vaccine?
3 doses
Boosters are needed because the vaccine has shorter immunity
Why do you need more than 1 dose for both Tdap and DTap vaccine?
Boosters are needed because the vaccine has shorter immunity
What is the only CI to the Tdap vaccine?
Anaphylaxis after receiving any Tdap component
What age group should be given the Tdap vaccine as catch up?
adolescents (13-18 y/o)
What is the purpose of giving pregnant mothers the Tdap vaccine? How often/when should it be given?
Tdap ↓ risk of infant pertussis exposure and severe disease
GIVE DURING EACH PREGNANCY (ideal = 27-32 wks gestation)
What are the CIs (relative) to the pertussis vaccine?
- Anaphylatic rxn
2. Encephalopathy w/in 7 days
When is acceptable to defer immunization of the pertussis vaccine? What is given if the deferral occurs at the age of 1?
Evolving neuro d/o
Give DT if defer at age 1 (no pertussis)
What type of virus is the Polio virus?
When must the last dose be given?
Killed/inactivated virus
Last dose must be given at age 4+ & at least 6 mo after last dose
Why is the oral/live attenuated polio virus no longer used?
Some conversion/mutation of the live attenuated version that leads to paralysis
(killed version doesn’t have this risk)
What vaccine has eradicated the dz associated with it?
Haemophilus Influenza B (HiB) Vaccine
What are the 2 types of the HiB Vaccine?
- PRP-T
2. PRP-OMP
What combination is no longer available for the HiB vaccine?
HiB-MenCY
- HiB w/Meningococcal groups C & Y
Makeup of the HiB vaccine?
Problem associated w/this type of vaccine?
Polysaccharide Vaccine
- young kids have harder time responding to the vaccine
What is the benefit of a conjugate vaccine, such as the Pneumococcal Conjugate Vaccine (PCV13/Prevnar 13)?
Can be admin to younger kids who are able to mount a response (more immunogenic)
What populations are at increased risk of invasive pneumococcal dz and should therefore be given an additional dose of PCV13?
- Anatomic of Functional Asplenia (SCD)
- HIV or immunocompromised
- Cochlear implant or CSF leak
- Chronic Renal Falure or nephrotic syndrome
How is the Pneumococcal Polysaccharide Vaccine (Pneumovax) different from the Conjugate version?
Pneumovax
- less immunogenic than Prevnar13
- includes 11 more serotypes than Prevnar13
When are you more risk for getting S/Es with Pneumovax? Solution?
When given w/in 8 weeks of the Prevnar vaccine
wait more than 8 wks… be patient you fool
What are the indications for Pneumovax? When should you revaccinate?
High risk children, over age 2
revaccinate high risk kids ONCE after 5 yrs
What is not included in the Meningococcal Conjugate Vaccine (Menactra, Menveo)?
Note: usually first dose not given til older but special populations dosed in infancy
Serogroup B not included
Who can the Meningococcal B vaccine be given to?
adolescents who arent high risk
When can the Meningococcal B vaccine be given at age 10?
special high risk populations and during outbreaks
Major RF for Hep B?
UNKNOWN –> why vaccine needed
Content of Hep B vaccine? Duration of immunity?
HBsAg
Vaccine has long immunity ( > 30 yrs)
What is the content of the combination Hep B vaccine in children vs adults?
Children: DTaP + HepB + IPV
Adults: Hep A + Hep B
If a mother is HBsAg (-) how many doses of the Hep Vaccine should be given to the child?
How does the time of admin for the 1st dose differ when the baby is preterm (< 2 kg)
3 doses
1st dose in full term baby = at birth (w/in 24 hrs)
1st dose in preterm baby = 1 month of age or hospital D/C (whichever is first)
If a mother is HBsAg (+) what should be given to the child for protection vs Hep B & how soon?
Baby should get Hep B immunoglobulin w/in first 12 hours of birth
Other indications for Hep A vaccine, other than routine childhood immunization at age 1?
- Tavelers to endemic areas
- close contact w/internat’l adoptees
- Hep A outbreak
- Chronic Liver Dz
What type of cancer is most a/w HPV?
Cervical Cancer
What do low risk HPV types cause?
high risk?
low risk HPV –> warts
high risk HPV –> cancer
Why is it ideal to give the HPV vaccine prior to exposure?
Prevents infection, warts, and cancer
What the makeup of the Gardasil vaccine (9vHPV)?
Virus-like particles
NOT LIVE VACCINE
What is the maximum age the catch-up vaccination w/Gardasil can be given for females vs males?
Females –> 26
Males –> 21
What is the earliest age the HPV vaccine can be given?
9 years old
What vaccines are included in MMRV?
Measles, Mumps, Rubella, Varicella
Which one of the MMRV components is not a true live virus?
Varicella Vaccine - live attenuated virus
What are 3 CIs to the Measles Vaccine (applies to all live vaccines)
What is NOT a CI?
- Pregnancy
- Immunocompromised
- Recent Immunoglobulin
Egg allergy is NOT a CI
When should you still administer the Measles (or other live vaccines) to immunocompromised patients?
Admin if HIV+ and CD4 > 15%
When can the TST (TB Skin Test/PPD) be performed for the Measles Vaccine?
Day of vaccination or 1 month later
BUT NOT B/TWEEN THIS TIME PERIOD
During an outbreak of Measles what is the youngest age a child can be to receive the vaccine?
Why does this not count as the first dose for the vaccine at this age?
6 months old
Doesnt count at 1st dose of Measles b/c 1st dose must be given after 12 months
When is Mumps MC?
Winter and Spring
Mumps clinical presentation?
4 main complications of Mumps?
Mumps presents w/Parotitis
Complications
- Meningoencephalitis
- Sensorineural hearing loss
- Ochitis
- Pancreatitis
“PeoPle Often get Mumps in Spring”
How to Dx and Tx Mumps?
Dx: viral isolation by PCR
(by Saliva, buccal swab, CSF, or serology)
Tx = supportive
Although the Mumps is a live vaccine what is unique about it?
It doesnt often cause reactivity
Since Rubella is a fairly benign dz why is a vaccine given?
Rubella vaccine given to prevent intrauterine infection (during pregnancy)
Unique AEs a/w Rubella vaccine?
LAD, transient arthralgias
What is unique about when the Varicella vaccine can be given?
Varicella vaccine can be given post-exposure and is still very effective if given w/in 3 days
Unique AEs a/w Varicella vaccine?
Papulovesicular rash ("chicken pox like")
- localized at injection site, NOT SYSTEMICWhat med must you avoid for 6 weeks after giving Varicella vaccine? why?
ASA –> a/w Rye Syndrome
What are the two types of orally administered live Rotavirus vaccines and their associated # of doses?
Pentavalent RV5 - 3 doses
Monovalent RV1 - 2 doses
AE for Rotavirus vaccine
Risk of intussusception
CIs for Rotavirus vaccine
- SCID (Severe Combined Immunodeficiency)
2. Hx of intussusception
What is the maximum age that the Rotavirus can be given?
8 months
risk > benefit
What 4 vaccines is vaccination rate at or above target levels based on the Healthy People 2020 goals?
- MMR
- Hep B
- IPV
- Varicella
How do UNvaccinated children differ from UNDERvaccination?
UNvaccinated –> conscious refusal
UNDERvaccination –> related to SES and access
Obvious but possibly important points about vaccines (flip over for info)
- MMR/vaccines DONT CAUSE AUTISM (duh)
- No evidence to support that you may overwhelm the immune system w/multiple vaccines at once
- Natural immunity (getting the dz) has greater risk than passive immunity
1st dose of this vaccine can be given at birth?
Hep B
1st dose of what 5 vaccines can be given 2 months old at the earliest?
- RV
- DTaP
- HiB
- PCV13
- IPV
1st dose of what vaccine is given earliest at 6 months and yearly thereafter?
Influenza
1st dose of what 3 vaccines is given earliest at 1 year?
- MMR
- Varicella
- Hep A
