vaccinations

Question 1

live attenuated vaccines

Answer 1

derived from bacteria, weakened in lab
stimulates ACTIVE immunity
one dose
CI in pregnancy and immunosuppressed pts
MMR, varicella, zoster
yellow fever, rotavirus, influenza
BCG, OPV (not in US)

Question 2

inactivated vaccine

Answer 2

produced by growing bacteria or virus in culture media
inactivated with heat or chemicals
stimulates ACTIVE immunity, can’t cause disease
BOOSTER dose needed to activate B cells
OK to give in pregnancy
WHOLE-Polio, Hep A, Rabies
FRACTIONAL-Hep B, influenza, acellular pertussis
T-D, Tetanus

Question 3

Toxoid vaccines

Answer 3

Fractional vaccine made from formalin-inactivated toxin
DIPTHERIA-toxin converted to toxoid and absorbed onto aluminum salt
TETANUS - formaldehyde treated toxin, absorbed on aluminum salt, fluid toxoid

Question 4

Polysaccharide Vaccines

inc

Answer 4

Unique type of inactivated subunit of vaccine
long chains of sugar molecules,
surface capsule of bacteria
PNEUMOCOCCAL, MENINGOCOCCAL, Typhoid
Vaccine stimulates B cells
more success in adults than kids, immature immune system

Question 5

conjugated polysaccharide vaccines

Answer 5

chemically combined with protein molecule
makes it T cell dependent, 
increased immunogenecity in infants
HIB
pneumococcal
meningococcal

Question 6

Recombinant vaccines

Answer 6

produced by genetic engineering
Hep B - insertion of segment of viral gene into yeast cell
produces Hep B surface antigen
Live Typhoid vaccine (ty21a) - bacteria modified to not cause illness

Question 7

Immune globulines

Answer 7

Not vaccines
preformed antibodies
PASSIVE immunity
treatment, not prophylaxis, 
administered after exposure to disease
Hep B immune globulin (HBIG),Varicella Zoster (VZIG), rabies, RSV, Rhogam, tetanus, diptheria

Question 8

standard US vaccines

Answer 8

Hep A and B, diptheria, tetanus, pertussis, HIB, polio, rotavirus, MMR, varicella-zoster virus,
pneumococcus, flu, mengococcus,
HPV

Question 9

recombinant influenza, safe in egg allergic

Answer 9

yes, no egg in this type of flu shot

Question 10

varicella CI

Answer 10

severe immunodeficiency, pregnancy

Question 11

zoster CI

Answer 11

severe immunodef, pregnancy, antivirals within the last 24 h, no antivirals for 14 days after this vaccine

Question 12

immunosuppressive steroid dose

Answer 12

20 mg of prednisone, >2 weeks. Defer administration 1 month.

Question 13

reactivity between measles vac and PPD

Answer 13

measles and PPD on same day is OK, otherwise wait a month. Can do it sooner with understanding it may influence reactivity.

Question 14

Neomycin anaphylactic rxn hx, which vaccines are CI

Answer 14

IPV, MMR, varicella CI

Question 15

Streptomycin, polymyxin B, neomycin, which vaccines are CI

Answer 15

IPV, vaccinia (small pox) CI

Question 16

Bakers yeast anaphylactic rxn hx, with vaccines are CI?

Answer 16

Hepatitis B CI

Question 17

Gelatin, neomycin anaphylactic rxn hx, with vaccines are CI?

Answer 17

Varicella zoster CI

Question 18

Gelatin anaphylactic rxn hx, with vaccines are CI?

Answer 18

MMR CI

Question 19

Manifestation of anaphylaxis

Answer 19

Urticaria
Upper airway edema
dyspnea and wheezing
hypotension
headache
ith without rash
angioedema
Flush
dizziness and syncope
GI symptoms
substernal pain
seizure

Question 20

tx of anaphylaxis

Answer 20

SC or IM epinephrine
administer antihistamine (like diphenhydramin)
repeat epi in 5 minutes if symptoms persist or increase
repeat antihistamine (+/- H2 blocker)
may also need, IV fluids, vasopressor, corticosteroids, airway maintenance,
Observe, may have biphasic or protracted response

Question 21

pneumococcal vaccine adverse rxn

Answer 21

local rxn - 30-50%
fever myalgia - 11-40% in kids=Prevnar 13 conjugate, uncommon with polysaccharide=pneumovax 23
severe/life threatening=rare