Vaccinations Flashcards
1
Q
Vaccine
A
Active immunization. Contains antigenic molecules such as a preparation of a weakened or killed pathogen.
2
Q
Immunization
A
The process of giving vaccines and stimulating the immune system.
Includes active and passive immunity
3
Q
Titer
A
Measurement of the amt of concentration of a substance in a solution.
-Medicine or antibodies found in the patient’s blood.
4
Q
Edward Jenner
A
Made the first vaccination for smallpox
5
Q
Herd immunity
A
Describes a form of immunity that occurs when the vaccination of a significant portion of a population provides a measure of protection for an unvaccinated individual.
6
Q
Herd immunity threshold
A
The percentage of the population vaccinated at which herd immunity is induced.
7
Q
Active Immunization
A
Antigen administration (live, killed, derivative) or a toxoid (deactivated toxin).
- Provides long-term immunity
- meaningful immunity not achieved till 2-4 weeks after vaccination.
- Live versions are more efficacious, last longer
8
Q
Passive Immunization
A
Administration of pre-formed antibodies, such as immunoglobulin.
- results in immediate protective immunity.
- immunity is short-term
- Rabies exposure, RSV, HepB for infant
9
Q
T of F: All immunizations are vaccines
A
False, all vaccines are immunizations, bot not all imunizations are vaccines. You can give antibody infusions that are not considered vaccinations
10
Q
Live Attenuated Vaccines (4 main ones)
A
MMR
Varicella/Zoster
Rotavirus
Intranasal influenza
11
Q
Inactivated Vaccines
A
Cannot replicate
Generally require 3-5 doses and a booster shot.
12
Q
Whole cell viral vaccines (types)
A
Polio, HepA, rabies
13
Q
Whole cell bacterial vaccines (types)
A
not available in the US
14
Q
Adverse Rxns
A
Extremely safe and generally only cause mild SE’s.
- Pain, swelling, redness locally.
- Fever, malaise, HA, allergic rxn, may be unrelated to vaccine.
15
Q
Precaution
A
A condition in a recipient that might increase the chance of an adverse rxn or compromise the ability for the vaccine to work.
16
Q
Diptheria
A
An acute bacterial respiratory or cutaneous illness caused by C. diptheriae.
Most common complications are myocarditis and neuritis.
Death occurs in 5-10% from resp. disease
17
Q
Diptheria Vaccine (DTaP, DT, Td, Tdap)
A
Formalin-inactivated diptheria toxin Schedule: Five doses + booster every 10 years Efficacy: 95% Duration: Approximately 10 years. Administered with tetanus.
18
Q
Diptheria, tetanus, pertussis combinations
A
Upper case means full strength doses
Lower case beans denote reduced doses
19
Q
DTaP
A
Diptheria, Tetanus and Acellular Pertussis
- Given to infants and children at 6 weeks to 6 years.
- 5 total doses
- 2, 4, 6 months, 15-18 months, 4-6 years.
20
Q
DT
A
Diptheria and Tetanus toxoids. Given to infants and children with contraindication for pertussis portion.
21
Q
Tdap
A
Given in one-time dose to adolescents and adults.
Women should recieve during each of their pregnancies.
22
Q
Td
A
Given to children and adults 7 yrs and older as a booster shot.
23
Q
Tetanus
A
Nervous system disorder characterized by muscle spasms and lock-jaw.
Incubation: 8 days
Complete recovery may take months
24
Q
Tetanus Toxoid
A
Schedule: 5 doses + booster
Efficacy: 100%
Duration: 10 yrs
Should be done in all adults who have not had a vaccine within 10 yrs
25
Pertussis
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Whooping cough (4-6 weeks in)
Highly contagious (even before whooping cough portion)
Can be fatal. 300,000 deaths worldwide.
```
26
Pertussis Vaccine
Schedule: 3 doses
Efficacy: 70-90%
Duration: 5-10 years
Local adverse rxns in whole cell
27
TDaP Precautions
1. Mod to severe acute illness
2. Temp >105 within 48hrs of last dose
3. Collapse or shock-like state within 48hrs of previous dose.
4. Persistent crying lasting >3hrs within 48hrs of last dose
5. convulsions form prev. dose
28
Tdap Boosters
11-12 years old.
| Every 10 years thereafter
29
Haemophilus Influenzae Type B (HIB)
- Severe bacterial infection among infants
- Meningitis, pneumonia, epiglottitis
- Incidence has fallen 99% since prevaccine era.
30
HIB Vaccine
```
HbOC
Schedule: 3+booster
Efficacy: 95%
Duration: Only needed for infancy
6kws, 4 months, 6 months
Booster: 16-18 months
```
31
Measles
- Highly contagious viral illness.
- Respiratory trasmission
- Near 100% infection in pre-vaccination era
- Incubation: 10-12 days
- Persists for 5-6 days
* *-Pathagnomonic for measles infection**
32
Mumps
- Virus that causes fever, HA, muscle pain, swollen glands
| - Deafness, meningitis, painful swelling of testis or ovaries, sterility (rare)
33
Rubella
- Virus that causes rash, arthritis, mild fever.
| - Generally mild, but during pregnancy can be fatal for the baby.
34
Congenital Rubella Syndrome
Babies generally die or are very sick for its entire life.
35
MMR
Live virus attenuated vaccine.
-First dose at 12-18 months
-Second dose at 4-6 years
Emphasis on nonpregnant women at child-bearing age.
36
Does MMR cause autism?!?
No, you are an moron.
37
Vericella Zoster Virus (VZV)
Herpesvirus DNA
Primarily results in chickenox (varicella)
Recurrent infection results in herpes zoster (shingles)
38
Varicella (chickenpox)
- Respiratory transmission of virus
- incubation 14-16 days
- characterized by vesicular lesions, appearing first on head, most concentrated on trunk.
- successive crops over several days.
- Can result in pneumonia, CNS infection, death (rare)
39
Herpes zoster (shingles)
- one million episodes occur annually in US
- 1/3 of US pop will get shingles
- Reactivation of varicella zoster virus
- Painful, unilateral vesicular eruption, restricted dermatomal distribution.
- Associated with: aging, immunosupression, chickenpox at 18 months or younger.
40
Complications of Herpes zoster
- Post-herpatic neuralgia
- Opthalmic zoster
- CNS, lung, liver, pancreas involvement.
41
Varicella Vaccine (Varivax)
Live, attenuated vaccine.
Prevents primary varicella infxn (chickenpox)
1st dose @ 12-15 months
2nd dose @ 4-6 yrs
42
Herpes Zoster Vaccine (Zostavax)
- Live, attenuated vaccine
- Approved for persons over 50 yrs
- Recommended vaccine for all persons >60, including patients who report previous zoster.
43
MMRV (ProQuad)
```
Measles, Mumps, Rubella and Varicella
Approved for children 12 months to 12 years
2 doses are recommended:
-1st dose at 12 to 15 months
-2nd dose at 4-6 yrs
```
44
Prodrome
An early symptom indicating the onset of a disease.
45
Hapatits A Virus (HAV)
- Picornavirus (RNA)
- Humans are the only natural host
- Entry into mouth via fecal-oral route
- Replicates in liver
- Present in blood 10-12 days after infection
46
HAV clinical features
- Incubation period ~30 days
- Usually silent in children
- Prodromal: FLS, RUQ pain
- Dark urine, jaundice, pruritis, light colored stools
47
HAV Vaccines
- Inactivated whole virus vaccine.
- Pediatric (1st: 12 mo 2nd 24 mo)
- Adult formulations 19 yrs and older
48
HAV vaccine reccomendations
- All children between 1st and 2nd birthdays
- International travelers
- Men having sex with men
- Illegal drug use
- Occupational risk
- Chronic liver disease
49
HAV Vaccine travelers
1st dose should be at least 1 month before.
| Only one dose required.
50
Post exposure HAV vaccine
for 12 months to 40 years: vaccine
For >40 years: Immune globulin is preferred.
-vaccine can be used if IG unavailable
51
Hepatitis B Virus (HBV)
- Hepadnaviridae family (DNA)
- Humans only known host
- May retain infectivity for >7 days at room temp.
- Incubation 60-150 days
- nonspecific prodrome (constitutional)
- 50% infections asymptomatic
52
HBV complications
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Chronic infection
Hepatitis
Hospititalization, death
Cirrhosis
Hepatocellular carcinoma
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53
HBV Perinatal Transmission
If mother is positive for HBs(surface)Ag and HBe(envelope)Ag:
- 80-90% of infants infected
- 90% of infected infants chronically infected
If positive for HBsAg only
- 5-20% infants infected
- 90% of infected infants chronically infected
54
HBV vaccine infant schedule
1st dose: birth
2nd dose: 6 weeks of age
3rd dose: 6-18 months of age
*Some babies might get 4 doses
55
HBV vaccine adult schedule
Primary: whenever
2nd Dose: 1 month after first
3rd Dose: 6 months after 2nd
56
Adults at-risk for HBV
1. Sexual exposure with:
- HbsAg + partners
- More than 1 partner is last 6 months
- Eval or tx for STD
- Men having sex w/ men
2. Percutaneous or mucosal exposure to blood
3. International travelers
4. Persons w/ HIV
57
Influenza (Flu)
- Orthomyxoviridae RNA virus
- Transmitted through air or nasal secretions
- fever/chills, ST, muscle aches, HA, COugh, Weakness/fatigue (these are all referred to as FLS)
58
Influenza Complications
1. Pneumonia
2. Severe diarrhea and dehydration
3. Rhabdomyolysis
4. Seizures
Young children and persons >65 at greatest risk, pregnant women, and immunocompromised.
59
Three types of flu shot
IM: standard, 6 months and older
High dose: 65 and older
Intradermal: 18-64 years of age
Intranasal: LIVE! 2-49 yo, healthy, not pregnant
60
Children from 6 mos through 8yrs of age should get ____ doses of flu vaccine for their first year of vaccination.
two
61
Pneumococcal Disease
- Streptococcus Pneumoniae
- 2nd most common cause of vaccine-preventable death in US
- Causes Pneumonia, Bacteremia, Meningitis
62
Pneumonia Clinical Features
- Abrupt onset
- Fever, chills
- Pleuritic chest pain
- Productive cough
- Dyspnea, tachy, hypoxia
63
Pneumococcal conjugate vaccine schedule (infant)
Primary: 6 weeks
2nd: 4 months
3rd: 6 months
Booster: 12-15 months
64
Pneumococcal polysaccharide vaccine (PPSV)
1. All adults 65 and older
2. Immunosuppressed individuals 2 through 64 years of age
3. Any adult 19-64 who smokes or has asthma
65
Meningococcal Disease
- Serious bacterial illness causes by Neisseria Meningitidis.
- Infects nasopharynx and can move to blood stream.
- Leading cause of bacterial meningitis in children 2-18 yrs in US
66
Meningococcal Meningitis
Most common pathogenic presentation of meningitis.
Clinical findings:
-Fever, HA, stiff neck
**Common if freshman in dorms**
67
Meningococcemia
-Sepsis
-May occur with or without meningitis
Clinical findings:
1. fever
2. petechial/purpuric rash
3. hypotension
4. multiorgan failure
68
Meningococcal vaccine (2 types)
1. Meningococcal conjugate vaccine (MCV4)
- for people 55 and younger
2. Meningococcal polysaccharide vaccine (MPSV4)
- for people older than 55
69
MCV4 recommendations
- Two doses recommended for adolescents 11-18 years of age.
- First dose at 11-12 yrs of age
- Booster at age 16
70
Human Papillomavirus (HPV)
- DNA virus
- Most common STI in the US
- More than half of sexually active men and women are infected at some point in their lives.
71
HPV clinical features
- Most are asymptomatic
- Anogenital warts
- Cervical cancer precursors
- Cancer (cervical, anal, vaginal, vulvar, penile, oropharyngeal)
72
HPV Vaccine (2 types)
1. Quadrivalent Vaccine (HPV4, Gardasil)
- For males and females
2. Bivalent Vaccine (HPV2, Cervarix)
- Only for females
73
HPV vaccine recommendations
All adolescents 11-12 years of age
| "Catch-up" vaccine recommended for 13-26 yrs of age
74
HPV vaccination schedule
Routine schedule is 0, 2, 6 months
75
Syncope can happen in ______ following an HPV vaccine
- 11-18 year old women.
| - Providers should observe for 15 minutes after vaccination
76
Rotavirus
- Most common cause of severe diarrhea in infants and children
- Nearly universal infections by 5 years of age
77
Rotavirus Pathogenesis
- Entry through mouth
- Replicate in small intestine
- infection leads to diarrhea
- Incubates for less that 48 hrs
- GI symptoms resolve in 3-7 days
78
Rotavirus Vaccines (2 types)
1. RV5 (RotaTeq)
- Live attenuated vaccine
2. RV1 (Rotarix)
- Live attenuated vaccine
- For most common rotavirus serotype
79
Rotavirus vaccine schedule
1st: 6 weeks of age
2nd: 4 months
3rd: 6 months (only for RotaTeq)
80
Polio
- Caused by a virus, enters thru mouth.
| - Paralysis, meningitis, death
81
Polio Vaccine (IPV)
```
Children get 4 doses
1st: 2 months
2nd: 4 months
3rd: 6-18 months
Booster @ 4-6 years
```
82
Pediarix Vaccine
DTaP, HBV, IPV Combination
| Doses @ 2, 4 and 6 months
83
Twinrix Vaccine
- HepA (peds dose) and HBV (adult dose) combination vaccine.
- 0, 1 and 6 months or..
- 0, 7 and a booster at 12 months
84
Comvax Vaccine
HepB and Hib combo
85
TriHIBit
DTaP and Hib combo
| Only for 4th dose of DTaP and Hib series
