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USMLE STEP 2 and 3 > Vaccines > Flashcards

Vaccines Flashcards

1
Q

When is the first hep B virus vaccine given?

A

At birth within 12 hours

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2
Q

What specific consideration should be known for giving the first Hep B virus vaccination?

A

If the neonate has a low birth weight (less than 2 kg or 4.4 pounds), then the first HBV vaccine can be delayed for 1 month or until the neonate has reached 2 kg.

If the mother tests HBV positive, give IV immunoglobulin to the neonate.

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3
Q

What is the established vaccine series for Hep B virus?

A

First dose: Birth

Second dose: 1 month

Third dose: 6 months

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4
Q

When is RSV given to pregnant patients?

A

32 to 36 weeks

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5
Q

what is the vaccination schedule for Polio virus?

A

First dose: 2 months

Second dose: 4 months

Third dose: 6 months

Fourth dose: 4 years

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6
Q

What is the vaccination schedule for Hemophilus influenza (type b)?

A

First dose: 2 months (as early as 6 weeks)

Second dose: 4 months

Third dose: 6 months

Booster: 1 years

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7
Q

Rotavirus vaccine is given at ____ months and _____ months

A

Rotavirus vaccine is given at 2 months and 4 months

This is the only live-attenuated vaccine that is given to children less than 1-year old.

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8
Q

The contraindications for Rotavirus vaccine are ______ and ______

A

history if intussusception and SCID.

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9
Q

How many doses of DTaP are given to children before 7 years old?

A

5 Doses:
First dose: 2 months

Second dose: 4 months

Third dose: 6 months

Fourth dose: 15 months

Fifth dose: 4 years

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10
Q

When do patients begin receiving Tdap vaccine?

A

Starting at 11, at least 7 years old.

Td is given every 5 to 10 years until 65 years old

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11
Q

When do pregnant patients get Tdap?

A

27 to 36 weeks pregnant

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12
Q

What is the contraindication for pertussis-containing vaccines?

A

Encephalopathy within 7 days of vaccine administration.

Use PRECAUTION if within 6 weeks or less the patient develops a progressive neurological disorder such as GBS, infantile spasms, epilepsy, progressive encephalopathy, defer vaccine until neurological condition stabilizes.

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13
Q

Which Pneumococcal vaccine is given to children?

A

PCV15 or PCV20

First dose: 2 months

Second dose: 4 months

Third dose: 6 months

Fourth dose: 1 year

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14
Q

What additional considerations are there for children with risk factors for invasive pneumococcal disease?

A

They may require additional doses, including a dose of PPSV23.

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15
Q

Do children under 5 years who received a dose of PCV at 2 years of age or older need further doses?

A

No, further doses are not needed for these children.

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16
Q

What is the PCV primary series for children?

A

The PCV primary series includes 3 doses (PCV15 or PCV20):

Dose 1: at 2 months of age
Dose 2: at 4 months of age
Dose 3: at 6 months of age

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17
Q

When should a booster dose of PCV15 or PCV20 be given for children?

A

A booster dose should be given at 12–15 months of age.

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18
Q

If a patient has received one dose of PPSV23 (at an age less than 65 years old) and one dose of PCV13 (at any age), then what pneumococcal vaccine is indicated?

A

Give the patient either PCV20 or PCV21 at or greater than five years after their last pneumococcal vaccination. If the patient is older than 65 years, engage in shared decision-making to determine whether to administer PCV20 or PCV21, ensuring it is given at least 5 years after their most recent pneumococcal vaccination.

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19
Q

If a patient was given just PPSV23, without any other pneumococcal vaccines, then what vaccine would be indicated?

A

Give the patient PCV20 or PCV15 or PCV21 one year after administration of PPSV23.

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20
Q

What is the minimum age for PCV21?

A

18 years old

21
Q

What is the minimum age for PPSV23?

A

2 years

22
Q

What are the main risk factors for invasive pneumococcal disease?

A

Risk factors for invasive pneumococcal disease:

chronic heart disease, chronic lung disease, chronic renal disease (CKD or nephrotic syndrome), chronic liver disease (including secondary to excessive alcohol use), diabetes mellitus, CSF leak, cochlear implant, functional or anatomical asplenia (including sickle cell disease), immunosuppression from disease (including HIV) or treatment, and smoking.

Administer PCV15 or PCV20 first, then PPSV23 at least 8 weeks later.

When PCV20 is given, they do not require PPSV23.

23
Q

Is the PCV13 vaccine given anymore?

A

No, as of April 2024 this is no longer available.

If a patient has only obtained one dose of PCV13, then they need one dose of PCV20 or PCV21 (the same applies to PCV7). A patient does not need to wait one year after receiving PCV13 to receive a dose of PCV20 or PCV21.

24
Q

In what instances are the pneumococcal vaccines given to patients earlier than 65 years old?

A

The pediatric series (2 months, 4 months, 6 months, Booster at 1 year).

Vaccinate patients (older than 19 and less than 65 years old) who are at risk for pneumococcal infections. These are patients who have CSF leaks, cochlear implants, smoke, have liver disease or alcoholism, have COPD or other lung diseases like asthma or CF, are asplenic, have chronic heart disease or chronic kidney disease, are diabetic, or are immunocompromised due to immunotherapy, organ transplant, cancer (i.e. leukemia), or have contracted HIV.

If the patient is given PCV15, then the patient must also be given PPSV23, which is given 1 year after PCV15 but can be given as early as 8 weeks for immunocompromised patients. If the patient is given PCV20, then they do not require an additional vaccination for pneumococcous.

25
Q

What Pneumococcal vaccine is given to patients over 65 years old?

A

Give either PCV15 or PCV20 for all patients over 65 years old.

If the patient is given PCV15, then the patient must also be given PPSV23, which is usually given 1 year later.

An exception to the 1-year rule is allowed for the adult patients with immunocompromising conditions, cochlear implants, or CSF leaks, where in these cases, the follow-up vaccine can be given ≥ 8 weeks after a previous pneumococcal conjugate vaccine. If PPSV23 is unavailable, administer another dose of PCV20 or PCV21.

If the patient is first given PCV20, then they do not require a follow-up vaccination for pneumococcus.

26
Q

What is the minimum age for PCV15 and PCV20?

A

6 weeks.

27
Q

When is the MMR vaccine given?

A

First dose: 12 months

Second dose: 4 years

28
Q

When is varicella vaccine given?

A

First dose: 12 months

Second dose: 4 years

2 Doses at least 2 months apart of recombinant (RZV) for all patients over 50 years old and immunocompromised patients over 19 years old.

29
Q

Are neonates given influenza vaccinations?

A

No, the earliest a child can obtain an influenza vaccine is 6 months, and the IIV4 is given. Instead cargivers of children less than 6 months are given an influenza vaccine.

30
Q

What are the three main vaccines given for influenza?

A

Inactivated Influenza Vaccine (IIV4) which is an IM administered quadrivalent vaccine that protects against four strains (two influenza A and two influenza B).

Live Attenuated Influenza Vaccine (LAIV4): is either egg-based or culture-based administered intranasally and given to children over 2 years old. This vaccination is temperature sensitive and can replicate in the nose (but not in the lung).

Recombinant Influenza Vaccine (RIV4): is produced without the use of eggs, using recombinant DNA technology and is also administered IM.

31
Q

What consideration should be known for administration of any influenza vaccination with GBS?

A

Use caution (a precaution rather than C/I) for any patients who have a history of Guillain-Barré syndrome that occurred ≤ 6 weeks after an influenza vaccine.

32
Q

During what season are patients in the both the Northern and Southern hemispheres vaccinated for Influenza?

A

Northern Hemisphere Season: Influenza typically peaks during the fall and winter months (October to April).

Southern Hemisphere Season: Influenza typically peaks during the winter months (May to September).

33
Q

Which influenza vaccine is given to patients older than 65?

A

IIV4 or RIV4

34
Q

what are the major C/I for live attenuated influenza vaccine?

A
  • Adults older than 50
  • children less than 2
  • children between 2 and 4 with asthma or wheezing
  • long term salicylate therapy (Reye Syndrome)
  • Recent anti-viral therapy
  • Close contact with those who are immunocompromised
35
Q

which vaccination for influenza is given to patients who are in close contact with those who are immunocompromised or elderly?

A

Recombinant Influenza Vaccine (RIV4)

36
Q

Inactivated Influenza Vaccine (IIV4) is suitable for which age groups?

A

IIV4 is suitable for all age groups (children over 6 months), including pregnant individuals and those with weakened immune systems.

37
Q

What are the conditions for giving the Hep A vaccine?

A

2 doses at 1 years old and the second 6 months later.

Can provide to HIV and pregnant patients because the vaccine contains a killed virus.

Provide to patients traveling to or from South America, Africa, Eastern Europe, and Central America.

38
Q

What vaccines are provided for asplenic patients?

A

PCV15 (followed by PPSV23 8 weeks later)

Hib

Neisseria meningitidis (including vaccines for serotype B)

Influenza

Don’t forget about prophylactic daily antibiotics (Bactrim).

39
Q

What is the HPV vaccine schedule?

A

Given to both males and females.

2 doses 6 months apart between ages 9 and 14.

3 doses 6 months apart between ages 15 and 26.

Shared decision after 26 up to age 45.

40
Q

How is the vaccination for Neisseria formulated?

A

A vaccine with capsular polysaccharides of four serotypes of meningococcus with capsular antigens linked to a carrier protein (e.g., diphtheria toxoid).

By conjugating the bacterial polysaccharides to a protein carrier, it elicits a robust T-cell-dependent response, leading to longer-lasting immunity. Conjugate vaccines also reduce nasopharyngeal carriage, contributing to herd immunity.

41
Q

When do children get the meningococcal vaccine?

A

11 years old and 16 years old

42
Q

What are the countermeasures for preventing Neisseria meningitidis when taking immunpsuppressing medications?

A

Vaccination: Meningococcal vaccines (MenACWY and MenB) prior to starting therapy.

43
Q

What serogroups does the meningococcal conjugate vaccine (MenACWY) protect against?

A

Serogroups A, C, W, and Y.

Administer at age 11-12 years, with a booster at 16 years. It is mandatory for military recruits and travelers to the meningitis belt of sub-Saharan Africa.

44
Q

Who should receive the MenB vaccine?

A

Adolescents aged 16-18 years (clinical discretion) and high-risk groups (e.g., during outbreaks, individuals with complement deficiencies, or asplenia).

Serogroup B is responsible for outbreaks in developed countries, especially in close-living settings like dormitories.

45
Q

Who requires booster doses of the MenACWY vaccine?

A

Individuals at persistent high risk (e.g., asplenia, complement deficiencies, microbiologists exposed to N. meningitidis). Boosters are given every 5 years.

College freshmen living in dormitories are at increased risk and may also need vaccination.

46
Q

What vaccination is recommended for travelers to sub-Saharan Africa?

A

MenACWY vaccine, as serogroup A outbreaks are common in the meningitis belt. The vaccine is required for Hajj and Umrah pilgrims in Saudi Arabia.

47
Q

What is the public health strategy for managing meningococcal outbreaks?

A

Targeted vaccination campaigns with MenACWY or MenB vaccines based on the serogroup causing the outbreak.

Prophylactic antibiotics (e.g., rifampin, ciprofloxacin) are also used for close contacts of infected individuals.

48
Q

What are the contraindications for meningococcal vaccines?

A

Severe allergic reaction (e.g., anaphylaxis) to a prior dose or vaccine component. Minor illnesses (e.g., cold) are not contraindications; vaccination should proceed in these cases.

49
Q

What is a mnemonic to remember the Neisseria meningitidis vaccine schedule?

A

“11-16-Boost”:

11 years: First MenACWY dose.
16 years: Booster dose.
Boost every 5 years if high-risk.

USMLE STEP 2 and 3 (132 decks)

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