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Pharm 446 Midterm #1 > Vaccine Preventable Diseases Part I > Flashcards

Vaccine Preventable Diseases Part I Flashcards

1
Q
  • What are the 6 LIVE-ATTENUATED vaccines
A
  • MMR - Measles, mumps, rubella
  • Varicella (chickenpox)
  • Rotavirus
  • Yellow fever
  • Oral Typhoid
    Zostavax

Think: MORVYZ - LIVE and MORBID

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2
Q

What are the 3 INACTIVATED/KILLED vaccines

A
  • Polio (IPV)
  • Hepatitis A
  • Rabies
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3
Q

What are the 8 SUBUNIT/CONJUGATE vaccines?

A

Hepatitis B
* Influenza (infection)
* Haemophilis influenza type b (Hib)
* Human papillomavirus (HPV)
* Pertussis
* Pneumococcal
* Meningococcal
* Zoster (shingles)

{basically everything that’s not live}

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4
Q

What are the 7 vaccines covered in part I?

A

Varicella and Herpes Zoster Vaccines
* Pneumococcal
* Influenza
* COVID-19
* Hepatitis A
* Hepatitis B
* Human papilloma virus

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5
Q

What are the 8 ROUTINE CHILDHOOD VACCINES?

A

-Dtap (diptheria, tetanus, pertusis)
-rota
-mmr
-var
-HepB
-Meningococcal
-pneumococal
-HPV9

{think: DR MMHHPV}

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6
Q

what are the 3 vaccines recommended DURING PREGNANCY?

A

Covid, influenza, and tdap

(give it EVERY TIME THEY GET PREGNANT even if had before).

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7
Q

What are the 4 Adult Vaccines we give?

A
  • Herpes Zoster/shingles
  • Pneumococcal- PS-23
  • Influenza
  • Td/Tdap: at least one dose of ACELLULAR PERTUSSIS AS AN ADUTL (Tdap) and Td q 10 yrs.
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8
Q
  • Does VARICELLA natural infection confer lifelong immunity?
A

yes!

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9
Q

Natural infection confers natural immunity in what infections?

A
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10
Q

what are the 2 preparations of varicella vaccine?

A

live attenuated univalent variclla (VARIVAX) and MMRV (proQUAD).

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11
Q

What are the VARIVAX INDICATIONS?

A

1) Healthy children (12 mos to <13): 2 doses no later than school entry.

2) Healthy Adults:

< 50: 2 doses if they’ve never had chickenpox (esp women of childbearing age)

> 50: 2 doses if never had chickenpox or vaccinated.

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12
Q

Compare ZOSTAVAX (LZV) vs SHINGRIX (RZV) in terms of :
1- vaccine type
-2 dose and route
3- indication
4- efficacy
5- storage

A

zostavax, shingrix:

1- live, inactivated+ adjuvanated

2- 1 dose SC vs 2 doses IM

3- adults> 60 (tho aprpoved fro >50), >50

4- 18-64%, 91-97
5- both refrigerated.

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13
Q

what are the 3 advantages of shingrxi?

A

Much more effective than a liveattenuated vaccine
-> adjuvant increases immune
response leading to longerlasting and greater
immunogenicity
-> high level of efficacy up to ~7
years of follow up

*Not a live vaccine, so increased data in
immunocompromised
individuals

  • better at preventing PHN vs zostavax.
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14
Q

what are the 3 disavantges of shingrxi?

  • inj site rxns occur more in what age groups?
A
  • 2 doses
  • epsensive and not publicaly funded
  • inj site rxns. –Reactions occur more
    often in people 50-69
    years (versus 70 years
    and older)
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15
Q

Shoudl shingrix be offered to those 50 and older who’ve alreayd been vaccinated with zostavax?

must wait how long after LZV dose can you re immunize with rzv ?

A

yes! at least 1 yr.

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16
Q

should you give shingrix to someone who’s alrady had a previous episode of shingles?

A

yes!

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17
Q

Can shingles vaccine be considered in those UNDER 50?

A

*YES, on case by case basis esp If they’ve had multipel episodes of shingles since 30, can give it before 50).

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18
Q

What is the minimum interval between two doses of Shingrix®?

A

4 wks (with exception) - 2months- just not closer than 4 wks.

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19
Q

If a patient does not come back to receive their 2nd dose of Shingrix®
between 2 and 6 months, do I need to restart the series?

  • Before administering Shingrix® is it necessary to ask if the person has
    ever had chickenpox or shingles?
  • Should people who haven’t had chickenpox be vaccinated with the zoster
    vaccine?
  • Can someone who has experienced an episode of shingles be vaccinated
    with the zoster vaccine?
  • Is Shingrix® publicly covered?
A
  • No. never restart the series, just continue where left off.
    • Yes sort of –> you know if they’re over 50 can assume they’ve been exposed. thats why shingrix ALWAYS INDICATED FOR >50.
    • Assume if you’re of the right age, you get the vaccine cuz we assume you’ve been exposed. Better to vax than send for blood work.
    • Yes! We want to give them longer term protection.
      No, not publicly covered.

nope!

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20
Q

What is the biggest thing we’re trying ot prevent with Pneumococcal vaccine?

A
  • Invasive pneumococcal disease (IPD):

where flu virus damages lung tissues, bacteria grows leading to secondary pneumococal inf that penetrates into blood leading to bacteremia, blood infection etc.

–> More often seen In young children, elderly and ppl who hgih risk cuz of underlyign health issues (diabetics, liver disease etc).

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21
Q

many ppl are ___ carriers for strep pneumonia.

A

asympotmaotic

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22
Q

What are the preps available for pneum vaccine?

Roa for each?

A

1) pneum conjugate (synflorxi, Prevnar 13) - IM only

2) Pneum polysacchard 23-valent (PNEUMOVAX23). IM OR SQ.

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23
Q

What are the INDICATIONS FOR PNEUMococcal vaccine in:

1) Infants (2 -12 mos)?
- what about for children at highr isk of IPD due to underlygin med condition?

2) Adults 65+? regardless of risk factors or previous vaccination.

3) Adults 18-65? at high risk of IPD due to underlyign medical conditions (chronic heart, kidney, liver, lung disease, or diabetes)?

4) Adutls 18-65 whoa re residents of LONG TERM CARE FACILIITES, SMOKERS, ALCOHOLICS OR HOMELESS?

5) ADULTS with immunocompromising condition ?

A

1) Infants:
- Pneu-C 13 (Prevnar 13)
- 4 doses Pneu C13 adn 1 dose of Pneu-PS 23 at 2 yrs.

2) 1 dose Pneu P 23

3) 1 dose Pneu P 23 + 1 BOOSTER dose Pneu P 23 at least 5 years later for ppl at highest risk of IPD.

4) 1 dose Pneu P 23.

5) 1 dose Pneu C 13
then 8 wks later 1 dose of PS 23 then 5 yrs later get booster of PS vax.

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24
Q

is Pneu C 13 vaccine routinely reccomended in adutls > 65 in addition to PS 23?`

A

no, shoudl be assessed on case by case basisi - not publically funded for individuals withotu additioanl ipd risk factors. PS23 is as effective at conjugate in preventing IPD. so benefit of conjugate vaccine is primarily from giving it to KIDS!

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25
Q

too many doses of PS vaccines can lead to what?

A

Hyporresponsiveness due to apotpososis of aby-synthesize MEMORY B cells. hence 2 dose max for PS vaccines.

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26
Q

which INFLUENZA STRAIN causes sig disease, infects both humans and otehr animals adn is repsonsible for epidemivs/pandemics?

A

Type A influenza (seasonal, avian, swine)

27
Q

which INFLUENZA STRAIN causes mild disease, ONNLY INFECTS HUMANS, and only causes MILDER epidemics?

A

Type B (seasonal influeza)

28
Q

whats the diff btwn trivalent vs quadrivalent vacciens?

A

trivalent has 2 infl A + 1 Infl B

  • quadrivalent= 2 Infl A + 2 Infl B
29
Q

what is ANTIGENIC DRIFT OF INFLUENZA?

A

Refers to SLIGHT geentic changes in a strain that occur WITHIN A HOST. –> Start feelign better, then get worse due to minor changes in genetic code. Happens interanlly in one person or through passes btwn ppl. Not seriosu cuz same virus.

30
Q

whawt is ANTIGENIC SHIFT OF INFLUENZA?
- only happens with which strain?
- causes _____.

A

Its when 2 OR MORE strains of influenza RECOMBINED IN A HOST producing a TOTALLY NEW TRAIN.

  • A
  • outbreaks. covid, swine flu.
31
Q

what is the ROA of the ONLY live influenza vax?

A

FLUMIST (intranazal)

32
Q

whcih influenza vax is not grown on egg?

A

FLUCELVAX QUAD

33
Q

HIGH DOSE influenza is indicated for what age and up?

A

65+ (QIV-HD covered in AB)

34
Q

Flu vaccine is indicated for all over what age?

A

> 6 mos

35
Q
  • Consequences of influenza infection during pregnancy:
  • ——— rates of hospitalization, cardiopulmonary complications and death
    (versus the general public)
  • ——- risk of premature labour and delivery
  • Influenza vaccination during pregnancy provides protection for
    the mother, —- and ——.
  • Influenza vaccination is associated with lower ______
    rates in pregnancy; infants less likely to be ______ or small
    for gestational age
  • Decades of passive surveillance – no safety concerns with
    inactivated influenza vaccine
  • Influenza vaccination rates in pregnancy well ____targets
    (ranges in studies from 16% to ~50%
A
  • Consequences of influenza infection during pregnancy:
  • higher rates of hospitalization, cardiopulmonary complications and death
    (versus the general public)
  • greater risk of premature labour and delivery
  • Influenza vaccination during pregnancy provides protection for
    the mother, fetus, and newborn (transplacental Abs)
  • Influenza vaccination is associated with lower hospitalization
    rates in pregnancy; infants less likely to be premature or small
    for gestational age
  • Decades of passive surveillance – no safety concerns with
    inactivated influenza vaccine
  • Influenza vaccination rates in pregnancy well below targets
    (ranges in studies from 16% to ~50%
36
Q

what are the 3 MOST RARE AE associated with INfluenza that we must talka bout with pts?

A

Anaphylaxis, GBS, OCS

37
Q

do not give flu vaccine to anyone who had GBS within how many wks of previous flu shot?

A

6 wks

38
Q

what is the deef of ORS?

A

Onset of BILATERAL red eyes AND/OR

RESP (cough, wheeze, chest tightness, diff nbreating) SX +/- FACIAL SWELLING.

WITHIN 24 HRS OF FLU SHOT.

39
Q

in waht 2 severities is it okay to give the flu shot in osmeone who had ORS sx?

A

in mild-mod ORS.

40
Q

in SEVERE ORS, when could you still give vax? when could you not?

A

if had NO LOWER RESP SYMPTOMS (no chest tightenss, difficutl breahtin go rswallowing), okay to give.

  • if had LOW RESP SX, should get permission from doc.
41
Q

What are the CONTRAINDICATIONS FOR THE TIV/QIV INACTIVATED FLU SHOT?

  • age?
  • what kidn of rxn?
  • known _____ to any ingredient except egg.
  • dx with _____ within 6 wks of flu shot.
  • expereinced ______ ______ iwthin 24 hrs ofl last flu shot.
A

< 2
- had anaphylaxis
- hypersensitiivty
GBS
- SEVERE OCS

42
Q

Children less than what age have to get 2 doses of the flu shot if receiving it for the frist time?

what is the separation interval?

if htey miss the second shot, how many doses would they get the next year?

A
  • children <9
  • 2 doses 1 mo apart (first dose is priming dose)
  • they will just get one dose the next year. and will just not be protected in that first year.
43
Q

what type of virus is covid?

A

rna virus

44
Q

what are the 2 mrna covid vaccines?

A

pfizer and moderna

45
Q

what is the most common correlate of protection?

  • anythign over ____ is in convalescent pts.
  • compared ot other covd vaccines, which one gives the highest NTAbs?
A

Neutroalizing Ab titers (NTab)

  • 160
  • bivalent mrna.
46
Q

waht is the best INTERVAL btwn covid doses?

A

16 wks apart

47
Q

can you give covid vaccines concurrently ot other live/non live vaccines?

A

yes! even on smae dya.

48
Q

covid vax indicated for anyone over what age?

A

6 months

49
Q
  • how is hep A transmitted?
  • incubation period?
  • Cases are infectious __ weeks before the onset of symptoms until __ week after onset of
    jaundice.
  • is this HEP associated with CHRONIC HEPATITIS OR CARRIER STATES?
  • does NATURAL INFECTION OF HEP A CONFER LIFELONG IMMUNTIY?
    • Infants and children can shed virus for up to _ months after infection.
A

fecal oral route- wash veggies!
- 28 days
- Cases are infectious 2 weeks before the onset of symptoms until 1 week after onset of
jaundice
- NO! does not cause hepatitis. - YEs!
* Infants and children can shed virus for up to 6 months after infection.

50
Q

waht are the main preps of Hep AV available?

  • route?
  • series?
A

AVAXIM and TWINRIX (combiend hepA and hep B).

  • IM
  • 1 dose for primary imunization folowed by BOSOTER 6-36 mos later.
51
Q

INDICATIONS FOR HAV VAXX?

1) for PRE-EXPOSURE?
- anyone over what age + what?

2) for POST-exposure?
- given to whom?
- when should vax be given for post exposure?

A

1) for PRE-EXPOSURE?
anyone 6 month+ and at incr risk of infection or SEVERE HepA. eg.. travel

2) for POST-exposure?
offered ot household and close ocntacs tf proven or suspected cases.
- asap and within 14 days.

52
Q

what are the eligibility criteria for HAV funding for PRe-exposure HAVax?

Chronic ____ disease (hepatitis B or C _____)

  • Candidates or recipients of ____ transplants
  • Residents of communities with high rates of hepatitis __ infection
  • Households or close contact of children adopted from hepatitis A
    ____ -_____
  • _______ risks (MSM, illicit drug use)
  • Zookeepers, veterinarians and researchers who handle _______
  • Residents and staff of institutions for the _______________ _______ in
    which there is evidence of sustained hepatitis A transmission
A

what are the eligibility criteria for HAV funding for PRe-exposure HAVax?

Chronic liver disease (hepatitis B or C carriers)

  • Candidates or recipients of liver transplants
  • Residents of communities with high rates of hepatitis A infection
  • Households or close contact of children adopted from hepatitis A
    endemic countries
  • Lifestyle risks (MSM, illicit drug use)
  • Zookeepers, veterinarians and researchers who handle primates
  • Residents and staff of institutions for the developmentally challenge in
    which there is evidence of sustained hepatitis A transmission
53
Q

In what pos would you consider PRE-IMMUNIZATION serology of rHAV antibodies (IGG (memory immunoglobulins))?

  • Individuals born prior to 19__
  • Individuals from an _____country
  • People with history of _____/_______ that may have been
    caused by HA
  • Individuals diagnosed with hepatitis __ and/or hepatitis ___ infection
A
  • Individuals born prior to 1945
  • Individuals from an endemic country
  • People with history of hepatitis or jaundice that may have been
    caused by HA
  • Individuals diagnosed with hepatitis B and/or hepatitis C infection
54
Q

HBV is a ____ virus

transmission?

Risk fo CHRONIC INFETION varies _____ with age. what means?

A

dna

blood semen, vaginal fluids

  • means highest risk of CHRONIC infection is in INFANTS exposed during child birth, NOT adutls.
55
Q

Waht are the preps of HBV vax available?

A
  • ENGERIX-B, RECOMBIVAX HV, TWINRIX (combo hep a and B)
56
Q

Indications for HEP B vaccine:

  • in infants and chldren?
  • in adutls?
  • publically funded for whom?
A
  • ROUTINE IMMUNIZATION IN KIDS.
  • all susceptible people who wish to decrease their risk should be
    encouraged to be vaccinated (response rate decreases with age and
    overall health).
    –> publicly funded vaccine for those with increased risk of
    exposure or complications. BASCIALLY ANYONE CAN GET IT FOR FREE IF THEY ASK FOR IT.
57
Q

IN whom is HBV Pre-immunization serology recommended for?

Individuals with ___, chronic
_____ disease, l______ risks
(e.g., high risk sexual
practices, seeking STI
treatment, unprotected sex
with new partners), use _______
drugs, non-immune adults
who have immigrated to
Canada from ______
areas

A

Individuals with HIV, chronic
liver disease, lifestyle risks
(e.g., high risk sexual
practices, seeking STI
treatment, unprotected sex
with new partners), use illicit
drugs, non-immune adults
who have immigrated to
Canada from endemic
areas

58
Q

HBV Pre-immunization serology interpretaiton:

what do the followign mean?
- Anti-HBs?
- HBs Ag ?
- anti -HBc?

A
  • Anti-HBs? means have aby to surface protien.
  • HBs Ag ?
  • anti -HBc? means have aby to core portein.
  • surface protein positive: means vaccinated.
  • core protein positive means they’ve had it and have natural immunity.
  • if have none,means susceptible. see slide 85.
59
Q

For HBV:

  • are ROUTINE BOOSTErs recommended for Hep B?
A

no! may be considerd if titres fall betlow 10 IU/L.

why? cuz memory cells presetn will activaet durign infection, even if circulating aby drops.

60
Q

waht is the most commonly sti ?

A

HPV

61
Q

___ of al cancers are ___ asscoaited

A

5%, hPv

62
Q

HPV 9 (aka ______) covers HPV types ?

  • series?
A

Gardasil -6, 11, 16, 18, 31, 33, 45,52, 58

  • 3 dose serieis!
63
Q

HPV9 indications?

1) for girsl and owmen?

boys men?

msm?

HPV vax is publicly funded for what age group?

A

1) For girls & women 9-27, any is fine. 2 4 or 9
- still recommended for women 27 (risk peaks at 45)

2) for boys/men:
- 9-27: hpv 4 or 9 to prevent warts and spread.
- 2 not approved in men.

3) MSM:
- 4 and 9 recommended for men < 27 and > 27 tho no data.

  • male snad females up to 26.

Pharm 446 Midterm #1 (7 decks)

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