Peds - Immunizations

Question 1

This vaccine is contraindicated for those with egg allergies.

Answer 1

Flu vaccine

Question 2

What vaccine(s) are contraindicated in pregnant women and immunocompromised people?

Answer 2

MMR / Varicella (live vaccines)

Question 3

This vaccine is contraindicated for people allergies or have hx of anaphylaxis to streptomycin.

Answer 3

Varicella / IPV

Question 4

What general education would give your patient regarding what to expect after a vaccination administration?

Answer 4

1) Local muscle soreness
2) Low grade temperature
3) Local erythema and tenderness

Question 5

If there is a break in the immunization schedule, how should you proceed?

Answer 5

Resume immunizations according to the child’s current age regardless of the vaccines previously missed.

Question 6

Can you give Varicella and MMR at the same time?

Answer 6

No, separate administration of MMR from varicella by 1 month.

Question 7

You have a 12 year old child in your office, what vaccines should he receive?

Answer 7

1) Meningococcal conjugate vaccine (MCV4 - Menactra / Menveo)
* Given as a series of 2, at ages 11 - 12 years, and booser at 16 years.
* No booster required if 1st administration occurs at or after 16 years.
2) HPV - quad (Gardasil); bivalent ( Cervarix)
* Series of 3 (11 - 12 years, then 1 month, then 6 months after 1st dose)
* Can no longer receive after 26 years old.

Question 8

You’ve just given Johnny a Gardasil injection & ask him to sit for 15 minutes after administration, why do you do this?

Answer 8

Due to risk of labile syncope, postural hypotension, and vasovagal response.

Question 9

Jimmy is 12 years old coming into the clinic today for a PPD in order to go to a new school. What vaccine is Jimmy also due for, and what are some special considerations to have in mind prior to administering either the PPD or the vaccine(s)?

Answer 9

He is also due for his final MMR, which can be given simultaneously with the PPD, however, prefer to postpone the PPD for 4-6 weeks after receiving the MMR to avoid possible suppressive response to the PPD (prevent a false (-)).

Question 10

Kim is a 12 month old coming in for a well-child check, what vaccines do you anticipate administering?

Answer 10

1) Hib booster
2) PCV 13 booster
3) MMR (1st dose)
4) Varicella
5) Hep A

Question 11

At what age can you first administer MMR?

Answer 11

12 months (1 year), next does at 12 years old (series of 2)

Question 12

If your patient will be exposed to measles due to traveling to an endemic area, what is the earliest age at which you can administer MMR? What education must you give to your patient when MMR is administered early?

Answer 12

1) 6 months

2) Pt will still need to continue primary series at appropriate times (12 months and again at 12 years)

Question 13

Jim is a 2 year old with leukemia. Jim’s mother requests FluMist rather than the IM version of the flu vaccine. What education must you provide?

Answer 13

FluMist is a live attenuated inactive virus (LAIV) and can only be used as an alternative to the trivalent inactivated virus (TIV) in healthy, non-immunocompromised persons aged 2 - 49 years.

Question 14

Describe the administration schedule for IPV.

Answer 14

2, 4, 6 months, and 6 years old

Question 15

What is the difference between IPV and OPV?

Answer 15

Oral polio virus is a live virus and is discouraged. IPV is inactivated.

Question 16

When can OPV be administered?

Answer 16

OPV is only possible for doses #3 (6 months) and #4 (6 years)

Question 17

Johnny is a 8 year old child coming in for his flu shot, what special instructions do you give Johnny’s guardian?

Answer 17

In children less than 9 years old, they must receive two doses 1 month apart. Instruct Johnny’s parent to RTC in 1 month for next dose.

Question 18

At what age would administer a 0.25mL IM dose of the flu vaccine? And, at what age does the dose increase to 0.50mL?

Answer 18

1) from 6 to 35 months

2) children 3 years or older

Question 19

Sammy is in for her 6 month well baby check, what vaccines do you administer?

Answer 19

1) Hep B (series of 3, 3rd dose)
2) DTaP (series of 3, 3rd dose)
3) Hib (series of 3, 3rd dose)
4) IPV (series of 4, 3rd dose)
5) PCV13 (Prevnar) (series of 3, 3rd dose)
6) Flu vaccine (annually therafter)

Question 20

Anne is in for her 4 month well baby check, what vaccines do you administer?

Answer 20

1) DTaP (series of 3, 2nd dose)
2) Hib (series of 3, 2nd dose)
3) PCV13 (series of 3, 2nd dose)
4) IPV (series of 4, 2nd dose)

Question 21

Jimmy is in for his 2 month well baby check, what vaccines do you administer?

Answer 21

1) Hep B (series of 3, 2nd dose)
2) DTaP (series of 3, 1st dose)
3) PCV13 (series of 3, 1st dose)
4) IPV (series of 4, 1st dose)
5) Hib (series of 3, 1st dose)

Question 22

What is the administration schedule for hepatitis B?

Answer 22

Series of 3 (0 - 2- 6 months)

Question 23

What is the administration schedule for rotavirus?

Answer 23

Series of 3 from 6 weeks to 32 weeks

Question 24

What is the administration schedule for DTaP?

Answer 24

Series of 3 (2 - 4 - 6 months) and 2 boosters ( 15 months and 6 years)

Question 25

At what age is DTaP no longer indicated?

Answer 25

7 years old

Question 26

What is the administration schedule for Tdap?

Answer 26

Series of 1 at 11 or 12 years old, with boosters every 10 years, and should be administered to pregnant women at each pregnancy.

Question 27

What is the administration schedule for the pneumococcal vaccine?

Answer 27

PCV13 (Prevnar) - series of 3 ( 2 - 4 - 6 months) and 1 booster at 12 months

Question 28

When do you administer 23PS (Pneumovax)?

Answer 28

To children aged 24 to 59 months who completed the PCV13 series and are IMMUNE COMPROMISED.

Question 29

What is the administration schedule for IPV?

Answer 29

Polio vaccine, series of 4 (2 - 4 - 6 months and 6 years)

Question 30

At what age can you start give the flu vaccine?

Answer 30

At 6 months, children younger than 9 should get 2 doses, 1 month apart.

Question 31

What is the administration schedule for MMR?

Answer 31

Series of 2, 1 year (12 months) and 12 years

Question 32

What is the administration schedule for Varicella?

Answer 32

Series of 2, between 12 months 12 years, administer 2 doses 3 months apart.

Question 33

What is the administration schedule for Hep A?

Answer 33

Series of 2, give 2 doses starting at 1 year and space the doses 6 months apart.

Question 34

At what age should rotavirus vaccine no longer be given?

Answer 34

32 weeks ( 8 months) of age

Question 35

What vaccine is given at time of birth?

Answer 35

Hep B

Question 36

What vaccine can cause intussusception?

Answer 36

Rotavirus - can cause this 3 weeks after administration.

Question 37

After the age of 5, what vaccines do you no longer give as they are no longer efficacious after this age?

Answer 37

1) Hib
2) Pneumococcal (Prevnar)
3) Rotavirus

Question 38

If a caregiver for a child is immunocompromised should the child receive live vaccines?

Answer 38

No

Question 39

Anne is born to a hepatitis B antigen (HBsAg) positive mother, how should you proceed?

Answer 39

1) Administer Hep B vaccine and Hep B immune globulin (HBIG) 0.50mL within 12 hours of birth.
2) Test for HBsAg and antibody to HBsAg after 3 or more doses of the Hep B series (at ages 9 to 18 months)

Question 40

John is born to a mother with unknown HBsAg status, how should you proceed?

Answer 40

1) Determine mother’s status immediately following birth via a serology test.
2) Administer Hep B within 12 hours of birth.
3) If mother tests (+) then give HBIG no later than 1 week after birth.