Vaccinations

Question 1

Pneumovax

Answer 1

Indications 
Protects against invasive pneumococcal disease (i.e. pneumonia) 
Age/population 
1. >65
2. Immunocompromised 
3. DM
4. Liver disease 
5. Physiologic or anatomic asplenia
6. CHF
7. COPD
8. Renal failure 
Frequency 
-Duration of immunity not well known 
-Immunity conferred in 80% healthy adults. 50-80% in elderly & in specific patient groups

Question 2

Gardasil

Answer 2

Indications
For use in females (9-45 yrs) for the prevention of cervical, & some vulvar and vaginal cancers caused by HPV types 16, & 18.
For use in females (9-45 yrs) & males (9-26 yrs) for the prevention of anal cancer & precancerous anal lesions caused by HPV subtypes 16, 18.
Age/population
-Most effective when given before any type of sexual contact
-Publicly funded for grade 8 girls in Ontario
Frequency
-Quadrivalent vaccine targets HPV 16, 18, 6, 11 & is given at 0, 2, & 6 months
Additional information
1. ~30% of cervical cancers will not be prevented with this vaccine b/c does not completely prevent against persistent infection w/ other HPV subtypes that cause cervical cancer
2. ~10% of genital warts will not be prevented with this vaccine
3. Does not prevent STI’s
4. Does not treat infection with HPV or cervical cancer

Question 3

Zostavax

Answer 3

Indications
Prevents the reactivation of varicella virus (Herpes zoster) which causes shingles and decreases the complications of post-herpetic neuralgia if shingles does recur.
Age/Population
NACI recommends after 60 yrs
Frequency
One lifetime dose.
Additional information
1. Not covered by OHIP costs ~$190
2. Not a substitute for varicella vaccine for children
3. Consider checking varicella serology in high-risk groups
-Women of childbearing age
-Immigrants/refugees from tropical countries
-Household contacts of immunocompromised individuals
-Healthcare and child workers
-Cystic Fibrosis
-Exposed to a case of Varicella

Question 4

MMR

Answer 4

Indications
-Protection against mumps, measles & rubella
Age/Population
-1st dose 12-15 mo; 2nd dose 4-6
-Give 2nd dose if born b/w 1970-1992 in Ontario
-Those born before 1970 are thought to be immune to mumps
SE
-Fever, anterior cervical lymphadenopathy
-Myalgia, arthralgia
-Rash
-Meningitis (1 in 800 000)
-Temporary thrombocytopenia

Question 5

Adacel/Boosterix

Answer 5

Indications
-Protection against Tetanus, diphtheria, & pertussis
-Will not protect against lifelong diphtheria infection but will make illness less severe for those infected
Age/Population
-Adolescents 14-16y (up to 18 y of age if dose is missed)
-If miss adolescent dose, can get dose b/w 19-64 y
-Good esp if in contact w/ young children too young to get vaccinated
Frequency
-1 lifetime dose of Adacel/Boosterix
-1 Td (Tetanus & diphtheria) q10y

Question 6

Vaccine SE

Answer 6

1. Local Redness
2. Local Swelling
3. Local Pain
4. Fever
5. Other: H/A, myalgia, fever, rash, GI upset

Question 7

Contraindications for live vaccine

Answer 7

1. Pregnant women & women planning to get pregnant w/n

Question 8

Examples of live vaccines

Answer 8

1. MMR
2. Varicella
3. Yellow fever