Vaccines Flashcards
Immunizations + Travel vaccines
FDA vs ACIP vs CDC
FDA - approves indication
ACIP - provides recommendations
CDC - approves ACIP recommendations and publishes them in the MMWR & pink book
Live-attenuated vaccines are contraindicated in..
Immunocompromised
Pregnancy
Common Live Vaccines
MMR
Intranasal influenza
Cholera
Rotavirus
Oral Typhoid
Varicella
Yellow fever
MICRO-VY
Polysaccharide vaccines
Do NOT produce a good response in children under 2 yrs
Conjugate vaccines & infants
Increases immune response in infants
Live vaccines & age
Most live vaccines withheld until 12 months of age
EXCEPTION: rotavirus
Inactivated vaccines & age
Started when babies are 2 months old
EXCEPTION: Hep B vaccine (given at birth)
Live vaccines and TB skin test: effect
Can cause a false negative
Ways to reduce risk of Live vaccines causing false negative on TB skin test
- Give live vaccine same day as the TST
- Wait 4 weeks after live vaccine
- Administer the TST first, wait 2-3 days to get the results, THEN get the live vaccine
Live vaccines & antibodies timing
- Vaccine –> 2 weeks –> antibody product
- Antibody product –> 3 months + –> vaccine
The only REAL contraindications to vaccines
Live vaccines: immunocompromised, pregnant
Inactivated vaccines: anaphylaxis (to the same vaccine)
Vaccines for adults
Influenza: ≥ 6 months
Tdap x1 then Td or Tdap every 10 years
Shingrx ≥ 50 or ≥ 19 (if immunocompromised)
HPV ≤ 26 yrs who did not complete the HPV series
Pneumonia ≥ 65 or ≥ 19 with medical conditions
Meningococcal
Hep B: All 19-54 yrs, 60+ yrs with risk factors
Hep A: traveling, risk factors (same as hep B)
Pneumonia vaccine options
PCV20 x1 or
PCV15 followed by PPSV23 ≥ 12 months later (or 8 weeks later if immunocompromised)
Risk factors for Hep B
Liver disease, HIV infection, exposure via sexual activity, IVDU, travel to endemic areas, blood exposure
Vaccinations for infants & children
3-dose hep B at birth
2 months: PCV13 or PCV15, DTaP, Hib, polio, rotavirus
≥ 12 months: MMR, varicella (live vaccines)
No polysaccharide vaccine before 2 yrs of age
Vaccinations for healthcare professionals
Flu shot
Hep B
Tdap
Varicella
MMR
Vaccines for adolescents & young adults
Meningococcal: 1 dose at 11-12 yrs and 1 dose at 16 years. First yr college students at residential housing if not previously vaccinated: 1 dose
HPV vaccine: 11-12 yrs (2-3 doses depending on when started)
TDaP: 1st dose at 11-12 yrs
Vaccinations for Sickle Cell Disease/Asplenia
H. influenzae (Hib)
Pneumococcal: either PCV20 x1 or PCV15 then PPSV23 ≥ 8 weeks later
Meningococcal vaccines
Vaccinations for pregnancy
NO LIVE VACCINATIONS
Influenza
TDaP x1 each pregnancy (weeks 27-36 optimally)
Vaccinations for Immunodeficiency
NO LIVE VACCINATIONS
Pneumococcal vaccine
Herpes zoster vacines
Additional for those with HIV: Meningococcal, Hep A, Hep B
Vaccinations for diabetes
Pneumococcal vaccine
Hep B: age ≥ 60 yrs (if not previously vaccinated)
Egg-free influenza vaccines
FluBlok (18+)
Flucelvax
What forms of the pneumonia vaccine should those < 2 yrs NOT get?
Pneumovax 23 (PPSV 23)
Typhoid oral vaccine: administration
Take with empty stomach with cold/lukewarm water
When to give the Typhoid vaccines?
Oral - 1 week prior to exposure then every 5 yrs
IM - 2 weeks prior to exposure then every 2 yrs`
Yellow fever: contraindications
Severe allergy to eggs or gelatin
Immunosuppression, breastfeeding, pregnant
Age < 6 months
cholera vaccine: when to give
≥ 10 days prior to exposure
Cholera vaccine: storage
Freezer. Remove no more than 15 mins prior to administration
Which vaccines need to be in the freezer? (-50 to -15 degrees celcius)
Varicella, MMRV, oral cholera
M-M-R II can be stored in either the refrigerator or freezer
How long to keep temp logs
3 years+
Which vaccine is given SC only?
Yellow fever
Which vaccines are given either SC or IM?
MMR, MMRV, Varicella, PPSV23
Which vaccines are given oral?
Typhoid (Vivotif)
Cholera
Rotavirus (RotaTeq, Rotarix)
DTaP vs TDaP
DTaP (Peds formulation) have 3-5 times the diphteria component
DTaP given in < 7 yrs of age
When to give HPV9 (Gardasil 9) vaccine?
11-12 (May be started at 9 yrs if hx of sexual abuse)
HPV 9 regimen
Started before 15: 2 doses (6-12 months apart)
Started at 15+ or immunocompromised: 3 doses (2-3 months apart)
Travel vaccination should be documented in:
International certificate of vaccination or prophylaxis (ICVP) AKA “Yellow card”
Dysentery definition
If blood is mixed with stool
Often accompanied by systemic symptoms such as fever
Classified as severe
TD: prophylaxis
Bismuth Salicylate Reduces incidence of TD by 50%
Who should you avoid bismuth salicylate in:
Aspirin allergy, pregnancy, renal insufficiency, gout, ulcer, anyone taking anticoagulants, probenecid, methotrexate
Antibiotic prophylaxis for TD
NOT recommended for most (except immunocompromised, significant comorbidites)
Preferred: Rifaximin
ALT: Azithromycin, Rifamycin
TD treatment
Hydration
Loperamide (Max dose 16mg/day or OTC 8mg/day) x2 days
Bismuth subsalicylate
Antibiotics (only for moderate/severe): Azithromycin or quinolone (low resistance) OR Rifaximin
Which antibiotic is preferred for severe TD & dysentery?
Azithromycin
Typhoid fever: transmission
Food or water contaminated by feces of someone with acute or chronic asymptomatic carrier
Cholera: most common symptom
Rice-water stools
Travel vaccines
Hep A, Hep B, Japanese encephalitis, meningococcus, Polio, Typhoid (IM = inactivated, PO = live), Cholera-PO, Yellow fever-SC
Hep B Vaccine prior to travel
3 doses, takes 6 months to finish
Don’t forget that Hep B can also be transmitted by tattoos & piercings
Highest risk of meningitis
Meningitis belt of africa during the dry season
Meningitis & Saudi arabia
The government of Saudi arabia requires meningococcal vaccine for travel during the annual Hajj & Umrah pilgrimages
Type of meningococcal vaccines recommended for travels
Quadrivalent vaccines (Menactra, Menveo, MenQuadfi)
Mosquitoes can act as vectors and transmit the following diseases:
Japanese encephalitis, yellow fever, dengue, malaria, zika virus
Severe Dengue (5%)
Shock, severe bleeding, organ failure
Dengue: treatment
Supportive care
Dengvaxia - for those with past dengue infection
Japanese encephalitis: complications
encephalitis with rigors, seizures, coma & death
Who is the Ixiaro (JE) vaccine particularly recommended to?
Those traveling to asia with plans to spend extended exposure to the outdoors or spend 1+ month during JE transmission season
Malaria: transmission
Anopheles mosquito
Malaria: classic symptoms
Shaking, chills, high fever, flu-like illness
Which is the most common malaria species?
P. vivax contributes to half of cases in India
Which malaria species is the most deadly?
P. falciparum
Malaria ppx- quick starts (1-2 days prior)
Doxycycline daily: Stop 4 wks after travel
Atovaquone/Proquanil: Stop 1 week after travel
Primaquine: stop 1 week after travel. Avoid in G6PD deficiency
Avoid all these in pregnancy
Malaria ppx- advance starts (1-2 weeks prior)
Chloroquine weekly - stop 4 wks after
Mefloquine: start ≥ 2 weeks prior and stop 4 weeks after
BOTH SAFE IN CHILDREN, PREGNANCY
Chloroquine: side effects
Retinal toxicity/visual changes
Do not use Mefloquine in
Underlying psych conditions
Seizures
Arrhythmias
Yellow fever: treatment
symptomatic relief with fluids, analgesics & antipyretics
ASA and other NSAIDs can’t be used d/t inc risk of bleeding
Zika virus: complications
Fever, maculopapular rash, arthralgia, conjunctivitis
INFANTS BORN WITH MICROCEPHALY (small head)
Acetazolamide: contraindication
sulfa allergy
Engerix-B
Hepatitis B vaccine
When should loperamide NOT be used for TD?
When bloody diarrhea is present
What could interfere with the effectiveness of a dose of Varivax?
Systemic antivirals with effectiveness against herpes (Valtrex, Acyclovir) - 24 hrs before or 14 days after
Live vaccines - separate 4 weeks (if not given on same day)
The presence of a ESRD would qualify a patient for which of the hepatitis vaccines?
Hep B
age indications for FluMist?
Healthy patients 2-49 yrs old
What is an contraindication to receiving the Varicella vaccine?
Gelatin or neomycin allergy
Vaxchlora
Cholera vaccine
Live
Administered orally
Supplied as a powder & reconstituted with water
Stored in freezer
Children 6 months to 8 years: Flu vaccine recommendation if they have never received one
2 doses, separated by 4 weeks
Serogroup meningococcal vaccine is indicated for
ages 10-25 years old
exposure to N. meningitidis
asplenia/sickle cell disease
during outbreak season
VAQTA, Havrix
Hep A vaccines
ProQuad
measles, mumps, rubella, and varicella
