Vaccinations Flashcards
Vaccine
Active immunization. Contains antigenic molecules such as a preparation of a weakened or killed pathogen.
Immunization
The process of giving vaccines and stimulating the immune system.
Includes active and passive immunity
Titer
Measurement of the amt of concentration of a substance in a solution.
-Medicine or antibodies found in the patient’s blood.
Edward Jenner
Made the first vaccination for smallpox
Herd immunity
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.
Herd immunity threshold
The percentage of the population vaccinated at which herd immunity is induced.
Active Immunization
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
Passive Immunization
Administration of pre-formed antibodies, such as immunoglobulin.
- results in immediate protective immunity.
- immunity is short-term
- Rabies exposure, RSV, HepB for infant
T of F: All immunizations are vaccines
False, all vaccines are immunizations, bot not all imunizations are vaccines. You can give antibody infusions that are not considered vaccinations
Live Attenuated Vaccines (4 main ones)
MMR
Varicella/Zoster
Rotavirus
Intranasal influenza
Inactivated Vaccines
Cannot replicate
Generally require 3-5 doses and a booster shot.
Whole cell viral vaccines (types)
Polio, HepA, rabies
Whole cell bacterial vaccines (types)
not available in the US
Adverse Rxns
Extremely safe and generally only cause mild SE’s.
- Pain, swelling, redness locally.
- Fever, malaise, HA, allergic rxn, may be unrelated to vaccine.
Precaution
A condition in a recipient that might increase the chance of an adverse rxn or compromise the ability for the vaccine to work.
Diptheria
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
Diptheria Vaccine (DTaP, DT, Td, Tdap)
Formalin-inactivated diptheria toxin Schedule: Five doses + booster every 10 years Efficacy: 95% Duration: Approximately 10 years. Administered with tetanus.
Diptheria, tetanus, pertussis combinations
Upper case means full strength doses
Lower case beans denote reduced doses
DTaP
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.
DT
Diptheria and Tetanus toxoids. Given to infants and children with contraindication for pertussis portion.
Tdap
Given in one-time dose to adolescents and adults.
Women should recieve during each of their pregnancies.
Td
Given to children and adults 7 yrs and older as a booster shot.
Tetanus
Nervous system disorder characterized by muscle spasms and lock-jaw.
Incubation: 8 days
Complete recovery may take months
Tetanus Toxoid
Schedule: 5 doses + booster
Efficacy: 100%
Duration: 10 yrs
Should be done in all adults who have not had a vaccine within 10 yrs
Pertussis
Whooping cough (4-6 weeks in) Highly contagious (even before whooping cough portion) Can be fatal. 300,000 deaths worldwide.
Pertussis Vaccine
Schedule: 3 doses
Efficacy: 70-90%
Duration: 5-10 years
Local adverse rxns in whole cell
TDaP Precautions
- Mod to severe acute illness
- Temp >105 within 48hrs of last dose
- Collapse or shock-like state within 48hrs of previous dose.
- Persistent crying lasting >3hrs within 48hrs of last dose
- convulsions form prev. dose
Tdap Boosters
11-12 years old.
Every 10 years thereafter
Haemophilus Influenzae Type B (HIB)
- Severe bacterial infection among infants
- Meningitis, pneumonia, epiglottitis
- Incidence has fallen 99% since prevaccine era.
HIB Vaccine
HbOC Schedule: 3+booster Efficacy: 95% Duration: Only needed for infancy 6kws, 4 months, 6 months Booster: 16-18 months
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**
Mumps
- Virus that causes fever, HA, muscle pain, swollen glands
- Deafness, meningitis, painful swelling of testis or ovaries, sterility (rare)
Rubella
- Virus that causes rash, arthritis, mild fever.
- Generally mild, but during pregnancy can be fatal for the baby.
Congenital Rubella Syndrome
Babies generally die or are very sick for its entire life.
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.
Does MMR cause autism?!?
No, you are an moron.
Vericella Zoster Virus (VZV)
Herpesvirus DNA
Primarily results in chickenox (varicella)
Recurrent infection results in herpes zoster (shingles)
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)
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.
Complications of Herpes zoster
- Post-herpatic neuralgia
- Opthalmic zoster
- CNS, lung, liver, pancreas involvement.
Varicella Vaccine (Varivax)
Live, attenuated vaccine.
Prevents primary varicella infxn (chickenpox)
1st dose @ 12-15 months
2nd dose @ 4-6 yrs
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.
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
Prodrome
An early symptom indicating the onset of a disease.
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
HAV clinical features
- Incubation period ~30 days
- Usually silent in children
- Prodromal: FLS, RUQ pain
- Dark urine, jaundice, pruritis, light colored stools
HAV Vaccines
- Inactivated whole virus vaccine.
- Pediatric (1st: 12 mo 2nd 24 mo)
- Adult formulations 19 yrs and older
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
HAV Vaccine travelers
1st dose should be at least 1 month before.
Only one dose required.
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
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
HBV complications
Chronic infection Hepatitis Hospititalization, death Cirrhosis Hepatocellular carcinoma
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
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
HBV vaccine adult schedule
Primary: whenever
2nd Dose: 1 month after first
3rd Dose: 6 months after 2nd
Adults at-risk for HBV
- Sexual exposure with:
- HbsAg + partners
- More than 1 partner is last 6 months
- Eval or tx for STD
- Men having sex w/ men - Percutaneous or mucosal exposure to blood
- International travelers
- Persons w/ HIV
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)
Influenza Complications
- Pneumonia
- Severe diarrhea and dehydration
- Rhabdomyolysis
- Seizures
Young children and persons >65 at greatest risk, pregnant women, and immunocompromised.
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
Children from 6 mos through 8yrs of age should get ____ doses of flu vaccine for their first year of vaccination.
two
Pneumococcal Disease
- Streptococcus Pneumoniae
- 2nd most common cause of vaccine-preventable death in US
- Causes Pneumonia, Bacteremia, Meningitis
Pneumonia Clinical Features
- Abrupt onset
- Fever, chills
- Pleuritic chest pain
- Productive cough
- Dyspnea, tachy, hypoxia
Pneumococcal conjugate vaccine schedule (infant)
Primary: 6 weeks
2nd: 4 months
3rd: 6 months
Booster: 12-15 months
Pneumococcal polysaccharide vaccine (PPSV)
- All adults 65 and older
- Immunosuppressed individuals 2 through 64 years of age
- Any adult 19-64 who smokes or has asthma
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
Meningococcal Meningitis
Most common pathogenic presentation of meningitis.
Clinical findings:
-Fever, HA, stiff neck
Common if freshman in dorms
Meningococcemia
-Sepsis
-May occur with or without meningitis
Clinical findings:
1. fever
2. petechial/purpuric rash
3. hypotension
4. multiorgan failure
Meningococcal vaccine (2 types)
- Meningococcal conjugate vaccine (MCV4)
- for people 55 and younger - Meningococcal polysaccharide vaccine (MPSV4)
- for people older than 55
MCV4 recommendations
- Two doses recommended for adolescents 11-18 years of age.
- First dose at 11-12 yrs of age
- Booster at age 16
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.
HPV clinical features
- Most are asymptomatic
- Anogenital warts
- Cervical cancer precursors
- Cancer (cervical, anal, vaginal, vulvar, penile, oropharyngeal)
HPV Vaccine (2 types)
- Quadrivalent Vaccine (HPV4, Gardasil)
- For males and females - Bivalent Vaccine (HPV2, Cervarix)
- Only for females
HPV vaccine recommendations
All adolescents 11-12 years of age
“Catch-up” vaccine recommended for 13-26 yrs of age
HPV vaccination schedule
Routine schedule is 0, 2, 6 months
Syncope can happen in ______ following an HPV vaccine
- 11-18 year old women.
- Providers should observe for 15 minutes after vaccination
Rotavirus
- Most common cause of severe diarrhea in infants and children
- Nearly universal infections by 5 years of age
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
Rotavirus Vaccines (2 types)
- RV5 (RotaTeq)
- Live attenuated vaccine - RV1 (Rotarix)
- Live attenuated vaccine
- For most common rotavirus serotype
Rotavirus vaccine schedule
1st: 6 weeks of age
2nd: 4 months
3rd: 6 months (only for RotaTeq)
Polio
- Caused by a virus, enters thru mouth.
- Paralysis, meningitis, death
Polio Vaccine (IPV)
Children get 4 doses 1st: 2 months 2nd: 4 months 3rd: 6-18 months Booster @ 4-6 years
Pediarix Vaccine
DTaP, HBV, IPV Combination
Doses @ 2, 4 and 6 months
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
Comvax Vaccine
HepB and Hib combo
TriHIBit
DTaP and Hib combo
Only for 4th dose of DTaP and Hib series
