Pediatric Vaccinations

Question 1

Time: Birth

Answer 1

Hep B

Question 2

2, 4, 6, months

Answer 2

Rotavirus 
Hep B 
DTaP
Hib
Pneumococcal
IPV (inactivated polio vaccine)

Question 3

12 months

Answer 3

MMR
Varicella
Hep A
Hib
Pneumococcal

Question 4

5 years

Answer 4

DTaP
Polio
MMR
Varicella

Question 5

Hepatitis B

Answer 5

Sx: mild fever, GI upset, anorexia, vomit, diarrhea, jaundice, hepatomegaly
Tx: maternal seropositivity - hep B immune globulin w/in 12 hours along with vaccination

Vaccines:

• birth
• 1-2 month
• 6 month

Question 6

Rotavirus

Answer 6

Sx: fever, vomiting, watery diarrhea –> dehydration
Tx: rehydrate, good hygiene

Vaccine: live attenuated (PO)

RotaTeq: 2, 4, 6 mo
Rotarix: 2, 4 mo

Series should not be started in infants over 15wk old

All doses by 8 mo

Question 7

Diphtheria

Answer 7

Sx: sore throat, mild fever, hoarseness, inflammation, arrhythmias and paralysis, gray membranous pharyngitis
- Tx: antitoxin w/in 48hr, abx (pen, ery)

Question 8

Pertussis

Answer 8

Sx: 
- catarrhal: URI (1-2wk)
- paroxysmal: whooping cough (2-4wk)
- convalescent: dry cough (1-2wk)
Tx: culture from NP swap --> erythro for child and household contacts

Question 9

Tetanus

Answer 9

Sx: hypertonicity, spasm of regional muscles, trismus
- newborns: irritability, inability to nurse, jaw stiffness, dysphagia, hyperreflexia

high mortality

Question 10

DTaP vaccine

Answer 10

1. diphtheria toxoid
2. tetanus toxoid
3. acellular pertussis vaccine

Series of 4 doses

• 2, 4, 6 and 15-18 months
• booster dose at 4-6 years

Tdap at age 11-14 w/HPV and meningitis

Question 11

Hib

Answer 11

Sxs: meningitis, acute epiglottitis, septic arthritis, cellulitis

Vaccine: inactivated vaccine

• 2, 4, 6 and 12-15 months
• all patients 12-59yo should receive at least one dose of Hib vaccine

Question 12

Pneumococcal

Answer 12

Sx: bacterial meningitis, sepsis, pneumonia, acute OM, sinusitis
- highest mortality in kids and elderly

Vaccines

PCV13 (Prevnar) - conjugated

• 2, 4, 6, 12-15 mo
• 1 dose to all healthy kids 24-59mo who are not completely vaccinated for their age

PPSV23 (Pneumovax) - inactivated polysaccharide
- 2yo and high risk

Question 13

Polio

Answer 13

Inactivated vaccine
- 2, 4, 6-18mo and again at 4-6yr

• fecal-oral spread
• asymptomatic
• paralysis

Question 14

Measles (Rubeola)

Answer 14

Prodrome: fever, cough, conjunctivitis, coryza

• koplik’s spots (white spots on buccal mucosa)
• brick-red, maculopapular rash - spreads cephalocaudal

Tx: supportive

Question 15

Mumps (Parotitis)

Answer 15

• pain and swelling in front of and below ear
• complication: orchitis
• contagious 1-2d before parotid swelling to 5 days after

tx: complete recovery w/supportive care in 1-2wk

Question 16

Rubella (German Measles)

Answer 16

• rare
• pink, maculopapuluar rash beginning on face and progressing to toes

tx: supportive

Question 17

MMR Vaccine

Answer 17

• live attenuated

1st dose: 12-15 mo
2nd dose: 4-6 yr

Question 18

Varicella

Answer 18

Sx:

• pruritic, vesicular rash
• scattered lesions start on trunk, spread to face and extremities
• contagious 2d prior to rash to complete crusting
  tx: supportive

Vaccine: live attenuated
- 12-15 mo, 4-6 yr

Question 19

Hepatitis A

Answer 19

Sx: fecal-oral spread, fever, malaise, jaundice, HA, vomiting, abd pain, light-colored stool

Vaccine

• minimum age 12mo
• next dose 6 mo later

Question 20

HPV

Answer 20

Sx: cervical cancer, anogenital cancer, oral and esophageal cancer

Vaccine: Gardasil 9
- 11-12yo before start of sexual activity

1st dose before 15yo: 2 doses of HPV at 0, 6-12 month intervals

1st dose after 15yo: 3 doses at 0, 1-2, and 6 month intervals

Question 21

Meningococcal

Answer 21

• peaks infants <1yo and 17-20yo

Vaccine:

1. Menactra/Menveo (quad, no B coverage)
   - 11-18yo, college freshman in dorms
   - 1st dose 11-12yo and boost at 16-18yo
2. Meningococcal B Vaccine - Bexsero, Trumenba
   - 16-23yo, ideally 16-18yo
   - 2 or 3 dose series - brands not interchangeable

Question 22

Influenza

Answer 22

Sx: fever, HA, myalgias, sore throat, nasal congestion, cough

Vaccine:
1. inactivated influenza (quad, can be given to anyone)

2. live attenuated (Flumist) - avoid in asthmatics, chronic disease, immunosuppressed

Kids under 9 get 2 doses, a month apart, the first year of vaccination only

Annually thereafter