Public Health & Preventive_Vaccine in Adults and Childrem

Question 1

What are examples of live vaccines?

Answer 1

• measkes
• mumps
• rubella

(MMR vaccine)

• Sabin polio vaccine
• varicella vaccine
• Rotavirus

Question 2

What is the major risk of oral polio vaccine? Some countries no longer distribute the vaccine for this reason?

Answer 2

Increased risk of vaccine-associated paralytic poliomyelitis

Question 3

Which populations should avoid live vaccines?

Answer 3

• pregnant women
• the immunocompromised
• close contacts of the immunocompromised

Question 4

What are the standard childhood immunisations?

Answer 4

• MMR
• varicella
• hepatitis B
• hepatitis A
• Haemophilus influenzae type b (Hib)
• inactivated polio (IPV)
• pneumoccocal conjugate vaccine (PCV7)
• diphtheria and tetanus and acellular pertussis (DTaP)
• rotavirus
• influenza

Question 5

What is the dosing schedule for the MMR vaccine?

Answer 5

• 2 doses
• 12-15 mnths and 4-6 years

Question 6

What is the dosing schedule for the varicella vaccine?

Answer 6

• 2 doses
• 12-15 mnths and 4-6 years

Question 7

Live vaccines are contraindicated in patients with HIV. True or False?

Answer 7

• false
  
  • MMR and the varicella vaccine can be given to HIV patients with a CD4 T cell count > 200 cells/mL

Question 8

What is the dosing schedule for the oral pentavalent rotavirus vaccine?

Answer 8

• Three doses:
  
  • 2, 4, and 6 months old.
• The series should not be started after the age of 12 weeks, and
• the final dose should be given by the age of 32 weeks.

Question 9

What is the dosing schedule for the hepatitis B vaccine?

Answer 9

• Three doses:
  
  • 0-1 month old
  • 1-4 months old, and
  • 6-18 months old

Question 10

What is the management of a child born to an HBsAg positive mom?

Answer 10

• Give the first dose of the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) at birth

Question 11

What is the dosing schedule for the hepatitis A vaccine?

Answer 11

• Two doses:
  
  • 1 year old and then 6-18 months later

Question 12

What is the dosing schedule for DTaP?

Answer 12

• Five doses:
  
  • 2, 4, 6, 15-18 months old, and
  • 4-6 years old;
• give Td (tetanus and diphtheria toxoids) boosters at age 11-12 years and then every 10 years

Question 13

What is the dosing schedule for the Hib vaccine?

Answer 13

• Four doses:
  
  • 2, 4, 6, and 12-15 months old

Question 14

Since the introduction of the Hib vaccine in 1987, the number of Hib (a cause of meningitis and epiglottitis) cases in children less than 5 years old has decreased by what percentage?

Question 15

• 99%

Question 16

What is the dosing schedule for the IPV?

Answer 16

• Four doses:
  
  • 2, 4, and 6 months old; 4-6 years old

Question 17

What is the dosing schedule for PCV7?

Answer 17

• Four doses:
  
  • 2, 4, 6, and 12-15 months old

Question 18

Who should be offered the conjugated quadrivalent meningococcal polysaccharide vaccine (MCV4)?

Answer 18

• 11-12 year olds, at age 13-18 if not previously vaccinated
• previously unvaccinated college freshmen living in dorms
• to children aged 2-10 with persistent complement component deficiency or anatomic or functional asplenia

Question 19

Who should be offered revaccination with MCV4?

Answer 19

• If the first dose was administered at age 2-6, then revaccinate children who remain at risk after 3 years.
• If the first dose was administered at age 7 years or older, then revaccinate after 5 years.
• Patients who remain at increased risk for meningococcal disease should be revaccinated at 5-year intervals.

Question 20

Asplenic patients are particularly vulnerable to what kind of infections?

Answer 20

Encapsulated bacterial infections

Question 21

What is the dosing schedule for the influenza vaccine?

Answer 21

• Everyone 6 months of age and older should get an influenza vaccine every year (influenza has a high rate of mutation).

Question 22

What time of year should the influenza vaccine be administered?

Answer 22

• Once it is available for a particular year, the vaccine may be administered at anytime (the earlier the better) before or during the influenza season, which usually peaks in the fall/winter months.

Question 23

Which patients should not be offered the influenza vaccine?

Answer 23

• Patients with anaphylaxis to eggs (since the vaccine is prepared from viruses grown in eggs)

Question 24

Who should be offered the H1N1 influenza vaccine?

Answer 24

All patients 6 months of age and older

Question 25

What is the current recommendation for HPV vaccination?

Answer 25

* HPV2 (protects against types 16 and 18) or HPV4 (protects against types 6, 11, 16, and 18) is recommended for females at age 11 or 12 years old * however, catch up vaccination can be done up until age 26.

Question 26

When should the second and third doses of HPV vaccine be administered?

Answer 26

* Second dose 2 months after the first and * the third dose 6 months after the first

Question 27

Can the HPV vaccine be administered to males?

Answer 27

HPV4 may be administered to males (9-26 years old) to help prevent genital warts

Question 28

Can females over the age of 26 receive the “quadrivalent” vaccine (HPV4 for HPV type 6, 11, 16 and 18)?

Answer 28

* Yes; however, studies are still ongoing proving safety of efficacy in this age group

Question 29

Should the vaccine be administered to those who have a history of genital warts, abnormal Pap, and/or positive HPV DNA test?

Answer 29

Yes. Vaccination is less effective for those who have already been infected with one or more of the HPV types; however, the vaccine should still be administered since there is still some protection conferred against the other HPV types.

Question 30

Why should females who have received the quadrivalent vaccine still be screened for cervical cancer?

Answer 30

* The vaccine does not protect against all HPV types that cause cancer. * Patients may not have received all the doses of the vaccine. * Patients who already have acquired HPV may not get the vaccine’s full benefit.

Question 31

Which patients should be offered pneumococcal polysaccharide vaccine (PPV23)?

Answer 31

* Adults ≥65 years old * patients with chronic respiratory disease (including asthma) * alcoholism * cardiovascular disease * diabetes * chronic liver disease * chronic renal failure * cochlear implants * nephrotic syndrome * nursing home residents * immunocompromised patients * asplenic patients * patients who smoke cigarettes

Question 32

What are the indications for revaccination with PPV(penumococcal polysaccharide vaccine) 23?

Answer 32

* Patient received the vaccine ≥5 years previously * \< 65 years old at the time of vaccination * immunocompromised * asplenia * postorgan or bone marrow transplantation

Question 33

Why can you not use PPV23 in children?

Answer 33

* PPV23 contains polysaccharide antigens that are not immunogenic in children \<2 years old (PCV7 contains 7 capsular polysaccharides conjugated to a protein)

Question 34

Which patients should be offered a single dose of the zoster vaccine to prevent shingles and postherpetic neuralgia?

Answer 34

* Adults aged 60 years and older

Question 35

Which patients should not receive the shingles vaccine?

Answer 35

* Pregnant women * those with a history of anaphylaxis to gelatin or neomycin * immunodeficient patient (including those with AIDS and on immunosuppressive therapies)

Question 36

The shingles vaccine can be given to those with history of shingles. True or False?

Answer 36

* True. The Advisory Committee on Immunization Practices recommends offering the vaccine regardless of prior shingles history though use of the vaccine has not specifically been studied in this population.