Preventative Pediatrics/Vaccines Flashcards
When can you give live vaccines after a recent course of steroids?
If course of steroids given lasted less than a total of 14 days, regardless of dose, any vaccine allowed
When do you need to delay live vaccines after a recent course of steroids? When do you give vaccines in this case?
If steroid course lasted 2 weeks or more AND EITHER:
(1) >2mg/kg/day steroids OR
(2) >20mg/day
Have to wait one month after the course is over.
Think twice about giving which vaccines to a premature baby?
Hep B (would give at DOL 30 or at hospital discharge, whichever comes first if <2kg)– would count toward series as long as MOP is HepB negative.
Rotavirus–risk of transmission of rotavirus while in the hospital, do NOT give while hospitalized
Live vaccines?
MMR Varicella Rotavirus Oral Polio (but USA uses IPV-inactive), Yellow Fever Influenza (inhaled only)
What criteria do you have to meet to receive the inhaled influenza vaccine?
At least 2 years old and healthy
No history of asthma
No hx of immunocompromise
Not pregnant
True or False. You can give live vaccines to a pregnant teenager.
FALSE.
True or False. You can give live vaccines to an HIV patient as long as they are otherwise healthy.
TRUE. Only if HIV+ AND have a low CD4 count (<200) would not give.
Can you give MMR and Varicella vaccines to household members of a pregnant or immunocompromised person?
Yes
Can you give Rotavirus vaccine to household members of an immunocompromised patient?
Yes, just warn about viral shedding in the stools
In what age window can the rotavirus vaccine be initiated?
6 weeks to 15 weeks (so if they come for the first time to clinic at 4 months old–would not give rotavirus)
Between what ages do you need to give 2 doses of flu vaccine for the first year they receive it?
6 months to 8 years, two vaccines six months apart.
After 8 years can just get one vaccine a year
Hepatitis A vaccine?
Two doses
First dose at 12 months, then 2nd dose at min 6 months after
Hep B vaccine–normal circumstances?
Birth
Between doses 1 and 2: one month (~2 mo WCC for simplicity)
Between doses 1 and 3: four months (~4mo WCC) AND not before 24 weeks of age
Need to have at least two months between doses 2 and 3.
Which, if any, of the following HepB vaccination schedule is NOT allowed?
0, 2, 6 months 0, 1, 6 months 2, 4, 6 months 0, 2, 4, 6 months 0, 2, 4 months
All except the last one is allowed.
Okay to have an extra HepB because of combination vaccines (one is wasted as part of a combination vaccine-but that’s okay per CDC)
Last one– cannot give last dose earlier than 24 weeks
HepB immunization if MOP’s HepBsAg is + and baby is term AGA?
Give HepB vaccine and HBIG within first 12 hours of life on separate extremities.
HepB immunization if MOP’s HepBsAg is unknown?
Give HepB vaccine at birth (or within 12 hours) and then send MOP’s HepBsAg– if positive, give baby HBIG within the first 7 days of life.
HepB immunization if MOP’s HepBsAg is + AND baby is premature?
Give HepB vaccine and HBIG within first 12 hours of life on separate extremities.
If baby is preemie AND BW <2000g, WOULD NOT count birth dose as part of vaccination series–so would need three additional doses.
HepB immunization if MOP’s HepBsAg is neg AND baby is premature?
If premature but >2kg, can give HepB immunization at birth and would count.
If preemie but <2 kg, give HepB vaccine at DOL 30 or at discharge, whichever comes first (this would count).
HPV vaccine? When would you need to get three doses?
HPV if started before age 15 years, 2 doses 6 mos apart.
If >15 years of age, 3 vaccines on a 0/1-2/6 month type schedule
Men(ACWY)– simple
1st dose: 11yrs
2nd dose: 16 years, otherwise about 3 years after first dose
Men(ACWY) if presenting as a unimmunized college freshman
Just one dose of Men(ACWY)
Men(B)
Recommended; given at 16 years, with booster dosing dependent on series used (between 1-6 months apart)
High risk population that should receive Men(B)?
Complement deficiency, spleen damage or removal, immunocompromised
Meningococcal post-exposure prophylaxis? What about if immunized?
Rifampin BID x 2days or Ceftriaxone x 1 dose IM for CLOSE intimate contacts (household, childcare contact, contact with oral secretions).
YES, even if fully immunized.
H. influenzae B post-exposure prophylaxis?
Rifampin BID x2 days– need at least TWO documented cases to start prophylaxis.
If unimmunized and confirmed infection, would give Hib vaccine to both patient and un-immunized household contacts.
Pertussis post-exposure prophylaxis? What about un-immunized?
Macrolide antibiotic to:
- All household contacts AND
- Exposed people at high risk (infants/preggo/hx of asthma)
Give vaccine if unimmunized
Hepatitis A post-exposure prophylaxis?
HepA IG for un-immunized household contacts only (do not give HepA vaccine after childhood typically)
Hep B Needle stick if patient is immunized?
Check immunity via titers, if up to date– do nothing.
If negative– give HBIG AND start three dose vaccination series
HepB Needle stick if patient is not immunized?
Give HBIG and start vaccination series x3 doses
Varicella post-exposure prophylaxis?
Immunoglobulin to high risk individuals (pregnant, immunocompromised, infants).
Would not give vaccine (live vaccine anyways)
Measles post-exposure prophylaxis if less than 6 months?
<6 months- give measles Ig (MIG)
> or equal to 6 months- depends on how long since exposure:
- Within last 72h, may give vaccine OR give MIG, do not give both at the same time.
- If exposure now between 72h-6 days old, give MIG.
- After 6 days- no prophylaxis
If you gave MIG, do not give MMR for at least 5 months after giving MIG.
Tetanus clean wound management?
> or equal to 3 vaccines?
If last vaccine <10 years ago, then would do nothing. If last vaccine >10 years ago, give vaccine.
<3 vaccines? given tetanus vaccine
Tetanus dirty wound management?
> or equal to 3 vaccines? Give TIG, no need to give vaccine
If <3 vaccines, give both vaccine and TIG
Which vaccine(s) does not need to be caught up after 5 years?
Hib and PCV13
DTaP absolute ontraindication?
Encephalopathy or prolonged seizures within a week after getting DTaP – aP (acellular pertussis component is contraindicated), given DT instead
DTaP relative contraindication
Progressive neurological disorder or uncontrolled seizure disorder
Brief seizure or high fever >105F within three days after receiving DTaP immunization in the past. If four or more days out, does not count!
Do MMR vaccines given <12 mo old count towards vaccinations?
No, need to restart.
Can you place a PPD the same day as giving the MMR vaccine?
Yes, can give MMR and PPD on the same day.
CANNOT place PPD if MMR was given within the last 6 weeks.
Hib and PCV13 vaccine catch up schedule if first vaccine given between 7-11 months?
Hib and PCV13 vaccine schedules are the same: primary series (2, 4, 6 mos) with booster vaccine between 12-15 mo.
If first vaccine is given between 7-11 months, missed the primary series, but still close.
Hib: 2 vaccines 4 weeks apart, then regular scheduled booster 8 weeks after the 2nd vaccine
PCV13: 2 vaccines 8 weeks apart, then regular scheduled booster 8 weeks after the 2nd vaccine
Hib and PCV13 vaccine catch up schedule if first vaccine given between 12-15 months?
Hib and PCV13 vaccine schedules are the same: primary series (2, 4, 6 mos) with booster vaccine between 12-15 mo.
If first vaccine is given after 12 months, missed the primary series.
Hib: give 1 vaccine, then regular scheduled booster 8 weeks after that
PCV13: give 1 vaccine, then regular scheduled booster 8 weeks after that
Which vaccine needs to be stored in the freezer? Which vaccine can be stored in the refrigerator or freezer?
Any vaccine containing VARICELLA needs to be stored in the freezer (monovalent or MMRV); MMR can be stored in other the refrigerator or freezer; remaining vaccines need to be stored in the refrigerator
How to salvage a tooth?
In Cold Cow’s milk–isotonic solution, will not lose integrity of the root of the tooth
True or False. You must delay vaccines (especially live vaccines) when there is an active fever/infection or receiving antibiotics.
FALSE. No reason to delay vaccines, just because there is a co-infection needing antibiotics.
Which vaccines can you not administer to household contacts of immunocompromised patients?
Oral polio vaccine and live attenuated influenza vaccine.
Most infants can soothe themselves to sleep by around what age?
3-4 months of age
When should night-time feedings stop?
Around 6-7 months of age.
Roughly how much sleep should a child be getting per appropriate age group?
Infant (<1 year): about 12-16 hours of sleep 1-2 years: 11-14 hours 3-5 years: 10-13 hours 6-12 years: 9-12 hours Teenagers: 8-10 hours of sleep
Rule for eruption of teeth
First tooth eruption variable– usually between 6-10 months of age
Then 7+4 rule for milestone ages (months) to roughly estimate number of deciduous teeth: 7 months old= 1 tooth 7+ 4 = 11 months (4 teeth) 7+ 8= 15 months (8 teeth) 7+12= 19 months (12 teeth) 7+16= 23 months (16 teeth) 7+20=27 months (20 teeth)
Order of teeth eruption
Mandibular central incisors, maxillary central incisors, upper lateral incisors, lower lateral incisors….
After what age are additional doses of rotavirus vaccine not recommended?
After 8 months 0 days of age.
Abnormal level of lead in serum?
> 5 ug/dL
MMR catch up schedule?
Give MMR today and then in 4 weeks
Varicella catch up schedule?
Give varicella today
- If <13 years old, second dose in 3 months
- If >13 years old, second dose in 4 weeks
Patient is 4 years old and received their first and only vaccine of Hib at 18 months of age. What does their catch up vaccine schedule for Hib look like?
Do not need any further doses of Hib– if they received a dose of Hib after 15 months of age, even if that was their only dose of Hib, that is enough to cover them for life.
Which children are considered high risk for pneumococcal disease?
Children with functional asplenia, sickle cell disease, any immunodeficiency, cochlear implants, chronic kidney disease, nephrotic syndrome or diabetes mellitus
Which high-risk group of children should receive two doses of PPSV23? When should they be given?
Two doses– children with immunocompromise, sickle cell disease, functional asplenia
Given when >2 years of age– 1st dose at least 8 weeks (2 months) since last PCV13 vaccine, 2nd dose at least 5 years from the first PPSV23 dose
Which high risk group of children should receive only one dose of PPSV23? When should it be given?
Cochlear implants, CKD, nephrotic syndrome, diabetes mellitus; PPSV23 dose should be given >24 months old at least 8 weeks from the last PCV13 dose
Exposure to active TB infection– what steps would you carry out if you’re 3 years old? What steps would you carry out if you’re an adolescent?
If <4 years old, high risk for disseminated TB. Obtain TST and CXR and start treatment for LTBI. First TBT may be negative (can take up to 10 weeks to build up reactivity), but still continue treatment until repeat TBT in 10 weeks. If that one is negative, can discontinue.
If older, not as high risk. Obtain TST and if negative, repeat TST in 10 weeks. If still negative, do nothing. If positive, start treatment for LTBI.
Why do you wait to place TB skin test 4-6 weeks after giving MMR vaccine?
Decreases reactivity and therefore increases false negative rate of TST.
