Vaccinations

Question 1

DTaP

Answer 1

Diphtheria, Tetanus, Pertussis 
DT-Toxoid vaccines
Pertussis -Subunit vaccine
5-dose series
Administered: 2,4,6, 15-18 months, 4-6 year olds

Question 2

Tdap or Td

Answer 2

Tdap: Tetanus, Diphtheria, Pertussis
Td: Tetanus-Diphtheria, is given to adolescents and adults
11-19yo: one-time dose Tdap, then Td every 10 years unless injured
Pregnant women should receive Tdap in the third trimester of each of their pregnancies
Adolescents and adults who have close contact with an infant <12 months should receive Tdap

Question 3

Haemophilus Influenzae type b (Hib)

Answer 3

-Conjugate vaccine- Haemophilus Influenzae type b was a common cause of epiglottitis, meningitis, and bacteremia (bacteria in the blood)
Administered: 2,4,6, 12-15 months

Question 4

Rotavirus (RV)

Answer 4

Live, oral vaccine
2,4, +/- 6mos
2 vaccines, equal efficacy
Rotateq®: 2,4,6 months
Rotarix®: 2,4 months

Question 5

Pneumococcus (PCV13)

Answer 5

13 valent conjugate vaccine
Strep pneumoniae is a primary cause of bacterial disease: pneumonia, meningitis, bacteremia
Strep pneumoniae also a primary cause of otitis media
Administered: 2,4,6,12-15mos

Question 6

Pneumococcal (PPSV23)

Answer 6

Polysaccharide vaccine
Children 2 and older with specific medical conditions
E.g.: Sickle cell disease, cochlear implant, asplenia, leukemia
All adults 65 and older-one time dose
Adults younger than 65 with specific medical conditions
Residents of nursing homes or long-term care facilities
Adults who smoke cigarettes

Question 7

Polio (IPV)

Answer 7

Inactivated polio vaccine

Administered: 2,4,6-18mos,4-6yrs

Question 8

Measles, Mumps, Rubella (MMR)

Answer 8

Administered: 12-15mos, 4-6yrs
Adults born prior to 1957 are considered immune
Adults born after 1957 must have documentation of 1 or more doses or lab evidence of immunity

Question 9

Varicella (VAR)

Answer 9

Goal is to prevent complications from varicella-zoster virus including: pneumonia, meningitis
Administered: 12-15mos, 4-6 yrs
Teens and adults: 2 doses 4-8 weeks apart if no evidence or prior immunity
Prior to the vaccine 100-150 people died yearly secondary to complications of varicella infection (cdc.gov)

Question 10

Hepatitis A (HepA)

Answer 10

Inactivated vaccine
Hepatitis A: self-limited viral inflammation of liver
Source: contaminated food and water
Administered: 12mos, 18-24mos
Adults at high risk from lifestyle or medical conditions
MSM- man sex
IVDU- intravenous drug use
Research involving Hep A
Travel

Question 11

Hepatitis B (HepB)

Answer 11

Subunit vaccine
Liver disease, in some patients can lead to liver cancer or cirrhosis
Administered: Birth, 1-2mos, 6-18 mos
Adults at high risk from lifestyle, medical conditions, or occupation (health care providers)

Question 12

Human Papillomavirus (HPV)

Answer 12

Indicated for prevention of cervical cancer
Quadrivalent protects against cervical cancer, genital warts, and cancers of the vagina, vulva, anus
Inactivated subunit vaccine
Recommended for females 11- 26 years and males 11-21 years
Males ages 22-26 may be vaccinated
Schedule: 0, 1-2, 6 months
HPV4: 6,11,16,18 indicated for males and females
HPV2: 16, 18 indicated for females

Question 13

Meningococcal

Answer 13

MenACWY-D (Menactra)
MenACWY-CRM (Menveo)
Conjugate vaccines
Quadrivalent
Prevents disease by Neisseria meningitidis
Single dose of either Menactra or Menveo at age 11-12 with a booster at age 16
Children with sickle cell disease or other high risk conditions may receive a 4-dose infant series of Menveo
2 doses of Menactra or Menveo at least 2 months apart to adults with asplenia or persistent complement component deficiencies
Menomune is a polysaccharide vaccine
Indicated for adults 56 years and older with certain medical conditions

Question 14

Influenza vaccine

Answer 14

All persons 6 months and older should be vaccinated annually
Persons 6 mos and older can receive the inactivated influenza vaccine (IIV)
-Recombinant-
Persons 2-49 yo who are healthy, non-pregnant can receive either the live, attenuated influenza vaccine (LAIV) or IIV
Health care workers who care for severely immunocompromised persons should receive IIV
Adults 65 and older can receive the standard dose IIV or high-dose IIV

Question 15

Influenza Terms

Answer 15

Trivalent=Influenza A (H1N1) virus + Influenza A (H3N2) virus + Influenza B virus
Quadrivalent= Trivalent + additional influenza B strain

Question 16

How influenza vaccines are made

Answer 16

Egg based
Inactivated vaccine
Live attenuated
Cell based
Approved by FDA in 2012
Begins with egg grown viruses
Vaccine virus mixed with cultured mammalian cells (not eggs)
Recombinant
Approved for use in 2013
Virus protein is isolated and combined with another virus that grows well in insect cells
Only completely egg free vaccine
This type of vaccine production is the fastest
Flublok®

Question 17

Zoster

Answer 17

Zostavax
Live virus vaccine
One single dose is recommended for all adults 60 years and older
Regardless of whether previous episode of herpes zoster is reported
Reduces risk of shingles by 51%
Reduces risk of post herpetic neuralgia by 67%
Contraindication : pregnancy, immune deficiency

Question 18

Combination Vaccines

Answer 18

Twinrix®: Hep A, Hep B
Pediarix®: DTaP, IPV, Hep B
Comvax®: Hib, Hep B
Kinrix®: DTaP, IPV
Pentacel®: DTaP, IPV, Hib
Proquad®: MMR, Varivax
MenHibrix®: Meningococcal and Hib

Question 19

Adverse Reactions

Answer 19

Most common are local reactions: pain, swelling, redness at injection site
May occur in up to 80% of vaccine doses
Most common in inactivated vaccines
Systemic reactions: fever, malaise, muscle pain, headache
May be due to vaccine or concurrent viral infection
May occur 7-21 days after live vaccine, often mild fever and rash
Severe, anaphylactic reaction
May be caused by antigen or other vaccine component such as preservative. Rare: less than 1 per ½ million doses

Question 20

Contradiction and Precautions

Answer 20

Contradiction: a patient condition that greatly increases the risk of a severe adverse reaction
Precaution: a patient condition that might increase the risk or severity of an adverse reaction

Question 21

Contraindications

Answer 21

Severe allergic reaction to a vaccine component
Encephalopathy within 7 days of a pertussis vaccine
Severe combined immunodeficiency (SCID)
History of intussusception as contraindication to rotavirus vaccine
Pregnancy and immunosuppression: live vaccines

Question 22

Precautions

Answer 22

Temp 105 0 or higher, hypotonic/hyporesponsive episode, seizure, or inconsolable crying (>3hours) after DTaP
Patient Education: Thimerosal
Thimerosal
Mercury containing preservative
Prevents bacterial contamination of multi-dose vials
Used in some influenza vaccines
No evidence that it causes harm

Question 23

Patient Education: MMR and Autism

Answer 23

MMR and autism
MMR vaccine first given at 12-15 months
Signs of autism often appear at 12-18 months
Studies have found no association between the MMR vaccine and autism

Question 24

How vaccines work

Answer 24

Vaccines imitate an infection, but do not cause illness
T-lymphocytes and antibodies are produced
T-lymphocytes and B-lymphocytes will now remember how to fight against the disease
More than one dose of vaccine may be required for the body to produce enough antibodies to fight off an infection

Question 25

Why can’t we rely on natural immunity?

Answer 25

Vaccine preventable illnesses can have severe complications and be deadly
This is true even for illnesses some people consider mild- such as varicella
We can’t predict who will get a serious complication or die

Question 26

Live Attenuated Virus

Answer 26

Contain a weaker version of a living virus
Does not cause serious disease in healthy people
Examples: varicella, measles, mumps and rubella (MMR)
Contraindicated: HIV positive, chemotherapy, pregnant

Question 27

Inactivated virus

Answer 27

The microbe is killed with chemicals, heat, or radiation while making the vaccine
May need more boosters than live vaccines

Question 28

Toxoid vaccine

Answer 28

Prevent diseases caused by bacteria that produce toxins in the body
When vaccine is made toxins are weakened so they can not cause illness (toxoid)
Examples: diphtheria and tetanus

Question 29

Subunit vaccine

Answer 29

Include only parts (essential antigens) of the virus or bacteria
Side effects are less common
Example: pertussis

Question 30

Conjugate vaccine

Answer 30

Protect against bacteria with polysaccharide coated antigens
This coating makes it hard for the immune system to identify the antigen
Conjugate vaccines connect the antigen to the polysaccharide coating and a carrier protein. This helps the immune system recognize the coating and fight the antigen
Example: Hib, Prevnar-13

Question 31

Polysaccharides

Answer 31

Induce immune response against specific capsular polysaccharides
Encapsulated bacteria can cause significant morbidity and mortality from meningitis, pneumonia, bacteremia
Example: PPSV23

Question 32

DNA

Answer 32

Introduces the gene for a microbes antigen into the body, some cells take up that DNA and then start to produce the antigen

Question 33

Recombinant

Answer 33

Use attenuated virus or bacteria to introduce microbial DNA to cells of the body
Example: Recombinant influenza vaccine