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Pediatric Immunizations Flashcards

1
Q

What is herd immunity?

A

Herd Immunity: the ability of a COMMUNITY to resist epidemic disease.

Vaccination acts as a sort of firebreak or firewall in the spread of disease. Unvaccinated individuals are indirectly protected by vaccinated individuals, as the latter will not contract and transmit the disease between infected and susceptible individuals

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2
Q

What is an active immunization?

What are the three ways they make this?

A

ANTIGEN ADMINISTRATION

  1. live derivative such as a protein or polysaccharide of a microorganism
  2. killed or derivative such as a protein or polysaccharide of a microorganism
  3. toxoid (deactivated toxin).
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3
Q

Active Immunizations
1. Duration of immunity?

  1. Meaningful immunity often not achieved until how many weeks of vaccinations?
  2. Advantages of a live vaccine? 2
A
  1. Provides long term immunity.
  2. 2 to 4 weeks after vaccination.
  3. Live versions
    - more efficacious and
    - provide longer lasting immunity than nonliving vaccines.
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4
Q
  1. Describe passive immunizations?
  2. Results in what?
  3. Duration of immunity?
A
  1. Passive: administration of preformed ANTIBODY (such as immunoglobulin).
  2. Results in immediate protective immunity.
  3. Immunity is short term (typically lasts only 3-6 months).
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5
Q

There are a number of times when we will use immunoglobulin therapy (passive immunization). Examples?
2

A
  1. Mother is HBsAg +, then Hepatitis B immune globulin (HBIG) given within 12 hours of birth.
  2. Palivizumab (Synagis) is a respiratory syncytial virus (RSV) immune globulin that is administered to children who are at risk for severe RSV.
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6
Q

The most important thing to understand regarding type of agent is whether or not the vaccine is a live virus. The following are live viruses:
8 (4 most common?)

A
  1. MMR (Measles, Mumps, Rubella)
  2. Varicella (Chickenpox)
  3. Zoster (Shingles)
  4. Nasal-Spray Flu Vaccine

These four are the most important to remember!!

  1. Yellow Fever (Not a standard vaccine in the US)
  2. Oral Polio Vaccine
  3. Typhoid (Not a standard vaccine, typically given to those traveling to areas where disease endemic)
  4. Tuberculosis vaccine (AKA – BCG) (Not a standard vaccine in the US)
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7
Q

If more than one live vaccine being administered (e.g. MMR and Varicella), they should administered how?

A

either be done on same day at different injection sites or 4 weeks apart.

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8
Q

Vaccines are extremely safe and generally only cause mild side effects (if any) which may include:
2

A
  1. Fever

2. Local reactions at the site of injection

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9
Q

When someone says the vaccine gives them the flu what are they referrring to?

A

Serum Sickness-like Reaction

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10
Q

State the reason for contraindication and recommended action with the following safety concerns:
1. Previous anaphylactic reaction to a specific vaccine?

  1. History of anaphylaxis to eggs or egg-protein?
  2. Previous anaphylactic reaction to neomycin or streptomycin?
  3. History of severe systemic reactions to the cholera, typhoid or plague vaccine?
  4. Adults who are immunocompromised as a result of disease or its treatment?
  5. Household members of immunocompromised patients?
  6. Pregnant women?
A
  1. Avoid revaccination with the specific vaccine because of risk of recurrence (which means you can do what?)
  2. Avoid measles, mumps, influenza and yellow-fever vaccine because these vaccines are prepared in embryonated chicken eggs or cultures and vaccines may contain residual egg protein
  3. Avoid measles, mumps, rubella (MMR) vaccine because the MMR vaccine contains trace amounts of neomycin
  4. Avoid revaccination with the specific vaccine because of risk of recurrence
  5. Avoid live virus vaccines because there is an increased risk of viral replication in immunocompromised individual
  6. Avoid oral polio because vaccine induced disease (if it occurs) could be transmitted to the immunocompromised individual. This concern does not apply to the MMR vaccine because infection with vaccine strain measles, mumps or rubella is not transmitted to others
  7. Avoid all live virus vaccines because of the potential risk to the fetus
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11
Q

MORE Misconceptions about Vaccine Contraindications:
What are false contraindications for vaccine?
4

A
  1. It is NOT a contraindication to administer a vaccine in a patient with mild respiratory, intestinal, or flu-like illness, low-grade fever, or a history of a recent illness.
  2. Mild or moderate local reactions (including tenderness, redness, or swelling at the injection site, or a low-grade fever) are NOT a contraindication to subsequent vaccination.
  3. A history of seizures is NOT a contraindication to vaccine administration.
  4. A history of non-vaccine associated demyelinating conditions (such as Multiple Sclerosis and Guillain-Barre Syndrome) is NOT a contraindication to vaccine administration.
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12
Q

“I’ve had one Hep B shot, but it was like years ago. Do I need to restart the series over?”

A

The interval between the doses is only important when it comes to minimum spacing. A series does not have to be restarted if it has been a significant amount of time greater than the recommended time interval.

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13
Q

Hepatitis B Vaccine
Routine Infant Schedule
1. How many doses?
2. At what schedule?

A
  1. Babies normally get 3 doses of hepatitis B vaccine:
    • 1st Dose: Birth
    • 2nd Dose: 6-8 weeks of age
    • 3rd Dose: 4-18 months of age
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14
Q

Why would some babies get 4 doses?

A

combination vaccine containing hepatitis B is used. (This is a single shot containing several vaccines.) The extra dose is not harmful.

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15
Q

For infants born to HBsAg + mothers, administer what?
2

These infants should be tested for what?
2

A
  1. HepB vaccine
  2. 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.
  3. HBsAg and
  4. antibody to HBsAg (anti-HBs) 1 to 2 months after completion of the HepB series.
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16
Q

Pneumococcal conjugate vaccine ( PCV13 or Prevnar®13):
What is the leading cause of bacterial pneumonia worldwide and a principal cause of sepsis and meningitis, particularly in infants and children younger than 2 years of age?

A

Streptococcus Pneumonia

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17
Q

Pneumococcal conjugate vaccine ( PCV13 or Prevnar®13): What kind of route and how many per dose?

A

IM route 0.5 mL per dose

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18
Q 
Pneumococcal conjugate vaccine ( PCV13 or Prevnar®13) recommended immunization schedule:
Dose:     
1. Primary 1?
2. Primary 2?
3. Primary 3?
4. Booster?
A

Age

  1. 6-8 weeks
  2. 4 months
  3. 6 months
  4. 12-15 months
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19
Q

Haemophilus influenzae type b Vaccine (HIB, HbOC): Prior to introduction of the vaccine, Hib was a leading cause of what? 3

A
  1. childhood meningitis,
  2. pneumonia
  3. epiglottitis,
    which is a true medical emergency (We hardly see epiglottitis anymore).
    Incidence has fallen more than 99% since prevaccine era
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20
Q

Haemophilus influenzae type b Vaccine (HIB, HbOC): Not routinely given to children age 5 years and older (Why not?)

A

Because they have

21
Q

Indications to administer Hib vaccine to adults and children > 5 include what?
5

A
  1. sickle cell disease,
  2. HIV/AIDS,
  3. removal of the spleen (asplenia),
  4. bone marrow transplant
  5. certain cancer patients on immunocompromising chemotherapy.
22
Q

Routine HIB Primary Vaccination Schedule: State the age and also the interval for each:

  1. Primary 1?
  2. Primary 2?
  3. Primary 3?
  4. Booster?
A 
Age
6-8 weeks
4 months
6 months
15-18 months

Interval:

  2. 4 wks
  3. 4 wks
  4. 6 mos
23
Q

Polio Vaccine (IPV)Schedule

  1. How many doses?
  2. At what ages?
A

Children get 4 doses of IPV, at these ages:

  1. A dose at 6-8 weeks
  2. A dose at 4 months
  3. A dose at 6-18 months
  4. A booster dose at 4–6 years
24
Q 
DTaP Vaccine
(Diphtheria, Tetanus, acellular Pertussis)
1. How many primary doses?
2. Boosters?
3. Efficacy?
4. Duration vaccine lasts?
A
  1. Schedule: Five primary doses +
  2. Booster every 10 years
  3. Efficacy Approximately 95%
  4. Duration Approximately 10 years
25
Q

What do the upper case and lower case letters mean in the Diptheria/Tetanus/Pertussis
Combinations?

A

Upper-case letters denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism

26
Q
  1. DTaP given to who?
  2. DTaP given when? 5
  3. DT given to who?
A
  1. Diphtheria and tetanus toxoids and acellular pertussis vaccine; given to infants and children ages 6 weeks through 6 years. Children should get 5 doses of
  2. one dose at each of the following ages: 2, 4, 6 months, and 15-18 months and 4-6 years.
  3. DT: Diphtheria and tetanus toxoids, without the pertussis component; given to infants and children ages 6 weeks through 6 years who have a contraindication to the pertussis component.
27
Q 
Routine DTaP Primary Vaccination Schedule: Age and Interval?
Dose
1. Primary 1
2. Primary 2
3. Primary 3
4. Primary 4
5. Primary 5
A

Age

  1. 6-8 weeks
  2. 4 months
  3. 6 months
  4. 15-18 months
  5. 4-6yrs

Interval

  2. 4 wks
  3. 4 wks
  4. 6 mos
  5. 6 mos
28
Q

Booster Schedule for Diphtheria, Tetanus Toxoids, and pertussis vaccination? 2

A
  1. 11 or 12 years of age if 5 years since last dose (Tdap)
  2. Every 10 years thereafter (Td or Tdap)

Pertussis is making a comeback, it is recommended that ALL ADULTS get at least one booster from the Tdap formulation

29
Q

Rotavirus Vaccine (rotateq, rotarix)

  1. Administered how?
  2. Extensive surveys have established rotavirus as the single most important viral cause of what?
A
  1. Orally

2. severe gastroenteritis in children worldwide.

30
Q

Rotavirus:

  1. Severe gastroenteritis particularly affects children of what ages?
  2. Series is to be started by what age and completed by what age?
A
  1. 6 months- 2 years

2. 14 weeks of age and completed by 8 months.

31
Q

RV5 (RotaTeq®)

  1. What kind of vaccine?
  2. Route? Dosing?

Pentavalent human-bovine rotavirus reassortant vaccine

A
  1. Live attenuated vaccine
  2. Route oral 2 mL dose/ 3 doses

Pentavalent human-bovine rotavirus reassortant vaccine

32
Q

RV1 (Rotarix)

  1. What kind of vaccine?
  2. Route? Dosing?

monovalent vaccine derived from the most common human rotavirus serotype

A
  1. Live attenuated vaccine
  2. Route oral 2 mL dose/ 2 doses

monovalent vaccine derived from the most common human rotavirus serotype

33
Q

Rotavirus Vaccine (rotateq, rotarix) Schedule? 3

Associated risk of what?

A

Schedule

  1. First Dose: 6-8 weeks of age
  2. Second Dose: 4 months of age
  3. Third Dose: 6 months of age (only for RotaTeq)

Associated with increased risk of intussusception

34
Q

Influenza (“flu shot”)

  1. Recommended for all children annually aged what? 2
  2. For children aged 6 mos to 8 yrs require how many doses? (separated by how much time?)
  3. Inactivated flu vaccine protects against how many strains?
  4. How many weeks for protection to develop?
  5. No longer made with what?
A
    • 6 mos to 18 yrs and
    • close contacts of all children 0-59 mos.
  2. 2 doses (separated by at least 4 weeks) to children who are receiving influenza vaccine for the first time
  3. 3 or 4 different influenza viruses.
  4. It takes about 2 weeks for protection to develop after the vaccination.
  5. NO LONGER made with horse serum (convince your older patients and your patients with serious illness to get this shot!).
35
Q

INfluenza: Intranasal – Live vaccine – ONLY approved for use in who?

A
  1. in healthy patients age 2-49 who are NOT pregnant.

Sometimes called LAIV for “Live Attenuated Influenza Vaccine”.
The viruses in the nasal spray vaccine do not cause the flu!!

36
Q

Hepatitis A Vaccine

  1. What kind of vaccine?
  2. approved for what ages?
A
  1. Inactivated whole virus vaccine

2. Pediatric formulations vaccines approved for persons 12 months through 18 years (0.5 mL IM)

37
Q

Hep A: How many doses in the series and at what ages?

Interval range?

A

Administered with a 2-dose series. 1st dose initiated at 12-23 months;
Typical schedule:
1st dose 12 months
2nd dose 24 months

the two doses should be separated by 6-18 months

38
Q

Measles, Mump, Rubella Vaccine (MMR)

  1. What kind of vaccine?
  2. First dose when?
  3. Second dose?
  4. Second dose interval has to be how much time after the first?
A
  1. Live virus attenuated vaccine of 0.5ml dose via SubQ route
  2. First dose of MMR at 12-18 months
  3. Second dose of MMR at 4-6 years
  4. Second dose may be given any time at least 4 weeks after the first dose
39
Q

Rubella can cause what?

So why is it so dangerous?

A
  1. Rubella virus causes rash, arthritis (mostly in females), and mild fever.
  2. Rubella in and of itself generally mild self-limiting disease but If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects (congenital rubella syndrome)
40
Q

Varicella vaccine (Varivax)

  1. What kind of vaccine?
  2. Pediatric dose?
  3. how many doses and at what ages? 2
A
  1. Live, attenuated vaccine
  2. Pediatric Dosing: 0.5 mL SubQ
  3. Routine childhood vaccination is 2 doses
    • 1st dose at 12-15 months of age
    • 2nd dose at 4-6 yrs but it may be administered earlier provided ≥3 months have elapsed after the first dose.
41
Q

Meningococcal Vaccine

  1. What kind of vaccine?
  2. schedule? 2
A
  1. Meningococcal conjugate vaccine (MCV4, Menactra)
  2. Two doses of MCV4 are recommended for adolescents 11-18 yrs of age:
    - the first dose at 11 or 12 years of age,
    - with a booster dose at age 16.
42
Q

HPV Vaccine (gardisil)

  1. What age?
  2. Can be started as young as what?
  3. Catch-up recommendations for what ages?
A
  1. ACIP recommends routine vaccination of all adolescents 11-12 years of age
  2. The vaccination series can be started as young as 9 years of age
  3. “Catch-up” vaccination recommended for adolescents 13 through 26 years of age
43
Q

HPV Vaccination Schedule

  1. Schedule?
  2. Third dose should follow the 1st dose by how much?
A
  1. Routine schedule is 0, 2, 6 months
  2. Third dose should follow the first dose by at least 24 weeks

Series does not need to be restarted if the schedule is interrupted

44
Q

Approved Combo Formulas Include

7

A
  1. DTaP, DT, Tdap, Td
  2. MMR
  3. MMRV (Proquad)
  4. DTaP + HepB + IPV (Pediarix)
  5. HepA + HepB (Twinrix)
    - -Only approved > 18yo
  6. Hib + HepB (Comvax)
  7. DTaP + Hib (TriHIBit)
    - –Can only be used as 4th dose
45
Q
  1. What is pediarix?
  2. Minimum age?
  3. Approved for what schedule?
  4. Not approved for what?
  5. Up to what age?
A
  1. DTaP – Hep B – IPV combination
  2. Minimum age 6 weeks
  3. Approved for 3 doses at 2, 4 and 6 months
  4. Not approved for booster doses
  5. Licensed for children 6 weeks to 7 years of age
46
Q

Pediarix:

  1. May be used interchangeably with what?
  2. Can be given at 2, 4, and 6 months in infants who received a birth dose of what?
  3. May be used in infants whose mothers are what?
A
  1. other pertussis-containing vaccines if necessary
  2. hepatitis B vaccine (total of 4 doses)
  3. HBsAg positive or status unknown*
47
Q

With the new vaccine combos, a typical vaccination schedule may look like this:
9

A
  1. Birth: Hepatitis B
  2. 2 Months: Prevnar, Hib, Pediarix
  3. 4 Months: Prevnar, Hib, Pediarix
  4. 6 Months: Prevnar, Hib, Pediarix
  5. 9 Months: Nothing
  6. 12 Months: Prevnar, Hib, HepA
  7. 15-18 Months: DTaP, ProQuad (MMRV)
  8. 18-24 Months: HepA
  9. 4-6 Years: Kinrix (DTaP-IPV) and ProQuad (MMRV)
48
Q

Other combination vaccines that are being studied include:

3

A
  1. Pentavac: combining DTaP, IPV, and Hib
  2. Hexavac: combining DTaP, IPV, Hib and hepatitis B (this would allow for just Hexavac and Prevnar during infancy!)
  3. DTaP, Hib, IPV, hepatitis A, and hepatitis B
49
Q

Routine Vaccination at WCC

  1. Birth? 1
  2. 6 weeks? 6
  3. 4 months? 6
  4. 6months? 6
  5. 9 months?
  6. 12 months? 3
  7. 15 months? 3
  8. 18-24 months? 1
  9. 4-6 yrs? 4
  10. 12 years? 3
  11. 16-18 yrs? 1
A
  1. Birth: Hep B
  2. 6 Weeks: PCV13, Hib, IPV, DTaP, Hep B, Rotavirus
  3. 4 Months: PCV13, Hib, IPV, DTaP, Hep B, Rotavirus
  4. 6 Months: PCV13, Hib, IPV, DTaP, Rotavirus , Influenza
  5. 9 Months: Nothing
  6. 12 Months: PCV13, Hib, HepA
  7. 15 Months: DTaP , MMR, Varicella
  8. 18-24 Months: HepA
  9. 4-6 Years: DTaP, IPV, MMR, Varicella
  10. 12 Years: Tdap (booster), HPV, Meningococcal
  11. 16-18 Years: Meningococcal (booster)

Pediatrics (18 decks)

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