Vaccines Flashcards
Diptheria
- caused by bacterial or virus?
- affects which part of the body?
- manifestation
- Complications
- bacteria; C. diptheriae
- may affect any part of the body; mainly the upper resp, oropharynx
- confluent gray pseudo membranes on roof of mouth
- myocarditis & neuritis
Tetanus
- caused by bacteria or virus?
- affects which part of the body?
- incubation period
- manifestation
- complications
- bacteria; Clostridium tetani
- toxin binds to CNS leading to muscle spasms. (spastic paralysis)
- 8 days
- lock jaw, diff swallowing, muscle rigidity, spasms (up to 3-4wks) *generally starts head to toe
- laryngospasm, fxs, pulmonary embolism, aspiration pneumo., death
Pertussis
- caused by bacteria or virus?
- manifestation
- bacteria; Bordetella pertussis, airborne
- onset similar to upper resp. infection, progress to severe coughing spells leading to diff breathing, vomiting, wt. loss, incontinence, rib fx, passing out from violent coughing.
“100 day cough”
Are whole cell pertussis vaccines used anymore?
no..
What do the capital and lower-case letters mean?
Upper-case letters denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism
– Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations.
What does DTaP stand for and in when are the boosters given?
(Tdap?)
-when are boosters given and what is the vaccine?
Diptheria, Tetanus, Pertussis
- DTaP is for infants and children ages 6 weeks through 6 years. (2,4,6 months, 15-18 months, and 4-6 years
- DT given to infants and children of these ages for those w/ CI of pertussis
- Tdap is given as a one time does to adolescents and adults. Women receive during each pregnancy (between the 27th and 36thweek)
- Td is the booster shot or after exposure, given to children and adults seven years and older, given every 10years
Adverse Rxns to Diptheria, tetanus, and pertussis vaccines
- Local rxn: erythema, pain. induration (sclerosis)
- Systemic rxn: fever, HA, n/v, diarrhea, stomach ache, joint pain, rash
CI diptheria tetanus and pertussis
- severe allergic rxn to vaccine component or following prior dose
- severe adverse effect to vaccine component or following prior dose
Diptheria Tetanus and Pertussis Precautions
moderate/severe acute illness
temp >105
collapse or shock like state
persisitant inconsolable crying lasting greater than 3hrs
*the above rxns occur within 48hrs
convulsions w/ or w/o fever within three days of previous dose
DTaP primary vaccination schedule
Dose 1; Age Interval
6-8wks ---
Dose 2: Age Interval
4mo 4wks
Dose 3: Age Interval
6mo 4wks
Dose 4; Age Interval
15-18mo 6mo
Dose 4: Age Interval
4-6yrs 6moBooster Schedule Tdap
11 or 12yrs of age if 5 years since last dose
every 10yrs there after (Td or Tdap)
H. Influenza type b (HIB)
- bacterial or viral?
- where does this organism colonize?
- prior to the vaccine what are some majory illnesses did this cause?
- not routinely given to what age group?
- why would you give this to someone not in the specified age group?
- bacterial
- nasopharynx
- childhood meningitis, pneumonia, EPIGLOTTITIS
- younger than 6weeks and children 5yrs and older
- given to those w/ sickle cell, HIV, asplenia, chemo when older than 5yrs
HIB primary Vaccination schedule?
Dose: 1 Age Interval
6-8wks --
Dose2: Age Interval
4mo 4wks
Dose3: Age Interval
6mo 4wks
Booster: Age Interval
15-18mo 6moHIB adverse rxn
local- erythema, induration (sclerosis), swelling
systemic- rash, fever, anorexia, diarrhea, vommiting
CI for HIB vaccine
- sever allergic rxn or severe adverse effect to vaccine component or following a prior dose.
- less than 6weeks of age
Measles
- bacteria or virus?
- where does this organism colonize?
- Incubation period
- manifestation
- virus, airborne disease
- replication in the nasopharynx and regoinal lymph nodes
- 10-12days
- prodrome; fever to 103 or higher, cough, coryza (rhinitis), conjunctivitis, koplik spots in mouth(white/gray/blue elevations, measles)
- rash- 2-4days after prodrome and 14days after exposure, maculopapular(flat and bumpy), becomes confluent lasting 5-6days, fades in order of appearance (head to toe)
Measles Complications
otitis media pneumonia encephalitis laryngotracheobronchitis (croup; barking cough, noisy breathing) death
Mumps
- bacteria or virus?
- manifestation
- complications
- more common in male or female?
- virus
- fever, HA, muscle pain. loss of appetite, parotitis
- deafness, meningitis, painful swelling of testicles or ovaries, sterility (rare)
- male
Rubella (German Measles)
- bacteria or virus?
- manifestation
- CI
- virus
- rash, arthritis (females), mild fever
- getting rubella while pregnant, may result in miscarriage or baby born w/ serious birth defects
- may lead to death or premature delivery
*generally not a serious disease for “healthy” individuals.
Congenital Rubella Syndrome
-affected areas of body
- deafness
- cataracts
- heart defects
- microcephaly
- mental retardation
- bone deformity
- liver and spleen damage
MMR Dosing Schedule
Dose 1: 12-18mo
Dose 2: 4-6 years
*2nd dose may be given any time at least 4weeks after the first dose
Precautions and CI MMR Vaccie
Precaution- moderate to severe acute illness
- pregnancy
- immunosuppression
- sever allergic rxn to vaccine component or following prior dose to to neomycin
Varicella Zoster Virus (VZV)
- bacteria or virus?
- primary infection
- recurrent infection
- incubation period
- manifestation
- herpes virus
- varicella (chickenpox)
- herpes zoster (shingles)
- 14-16days
- prodrome 1-2 days, rash w/ vesicular lesions (head to toe, highest conc. on trunk)
Varicella Complications
- bacterial infection of skin lesions
- pneumonia
- CNS manifestations
- Reyes Syndrome
- Hospitalization
- Death
- Postherpetic neuralgia
Herpes Zoster (shingles)
- manifestation
- potential causes
- painful, unilateral vesicular eruption, restricted to one dermatome
- aging, immunosuppression, younger than 18mo
Complications of Herpes Zoster
postherpetic neuralgia
opthalmic zoster (may cause blindness)
dissemination w/ generalized skin eruptions and involvment of the CNS, lungs, liver, and pancreas
Congenital Varicella Syndrome
- results from maternal infection during pregnancy
- period of risk extended through first 20weeks of pregnancy
- low birth weight, atrophy of extremity with skin scarring, eye, and neurologic abnormalities
Varicella-containing Vaccines?
Varivax= just chicken pox
Zostavax= just for shingles
MMRV (ProQuad)= good for kiddos, MMR and varicella in one shot.
Varivax
- what type of vaccine?
- prevents what disease?
- dosing (adult and child)
- precautions
- CI
- live attenuated vaccine
- prevents primary varicella infection (chickenpox)
- Child dose: 1st dose at 12-15mo and 2nd dose at 4-6yrs, may be done earlier if 3mo have lapsed after 1st dose.
-adult dose: those who recieved only 1 dose of vaccine recieve a 2nd dose at least 4wks apart
- precautions: moderate to severe acute illness, varicella vaccine and aby-containing products (immune globulin, blood products) NOT administered simultaneously.
- avoid salicylates for 6wks to avoid Reyes syndrome
-CI: pregnancy
immunosuppression
severe allergic rxn to vaccine component or following prior dose
Zostavax (Herpes Zoster vaccine)
- what type of vaccine?
- dosing
- Precautions
- CI
- Adverse Rxn
- live attenuated vaccine
- recommended in pts older than 60yr of age inluding patients who report a pervious episode of zoster, approved for persons >50yrs
- precautions; postherpatic neuropathy, TB, VZV infection, antiviral drugs
- CI: pregnancy, immunosuppression, severe allergic rxn to vaccine component or following a prior dose
- Adverse rxn
- local (erythema, pain)
- rash (maculopapular)
MMRV (ProQuad)
- what vaccines are included?
- dosing
- measles, mumps, rubella, and varicella
-approved children 12mo up to 13yrs
Dose 1: 12-15mo
Dose 2: 4-6yrs
*interval is 3mo
Hepatitis A virus (HAV)
- bacteria or virus?
- entry route
- replication of organism site?
- incubation period
- manifestation
- picornavirus
- fecal oral route
- replication in liver, present in blood and feces10-12 days after infection
- 30days
- manifestation: usually silent in children
- flu like illness to fulminant (severe and sudden in onset) hepatitis (acute liver failure)
- prodromal symptoms- fatigue, malaise, n/v, anorexia, fever, RUQ pain
- progress to dark urine, acholic stool(light colored stool lacking bilirubin pigment), jaundice, pruritis
Hep A Vaccine
- what type of vaccine?
- indications
- dosing
- adverse rxns
- CI/precautions
-inactivated whole virus
- indications:
- all children 12-23mo.
- international travelers
- Men sex men
- persons who use illegal drugs, occupation risk, chronic liver disease
dosing:
dose 1: 12mo
Dose 2: 24 mo
*interval 6-18mo between dose 1 and 2
- Adverse rxn
- local rxn; pain erythema
- systemic; malaise fatigue fever
- CI
- allergic rxn or adverse rxn to vaccine component or following prior dose
-Precaution: moderate to sever acute illness
Hep A post exposure prophylaxis dosing
- healthy persons 12mo to 40yrs give single Ag Hep A vaccine ASAP after exposure
- persons older than 40, give immune globulin, vaccine can be used if IG cannot be obtained
Hepatitis B Virus (HBV)
- bacteria or virus?
- incubation period
- complications
- manifestation
- At risk people; adults and infant(treatment)
- virus, hepadnaviridae family
incubation: -60-150days
complications:
- chronic infection
- fulminant hepatitis
- hospitilization
- cirrhosis
- HEPATOCELLULAR CARCINOMA**
- Death
-manifestation: at least 50% are asymptomatic
At risk adults:
- sex partners of hep B ag + person
- sexually active persons not in a long term/monogomus relationship (6mo w/ 1 sex partner)
- persons seeking evaluation or treatment for STI
- men who sex men
- household contacts of HBsAg+ persons
- healthcare and public safety workers exposure to blood or blood-contaminated body fluids
- current or recent IVDU (IV drug user)
- international travelers
- persons w/ HIV infection
At risk infants:
- born to HBsAg+ mother
- treatment: admin. Hep B vaccine and HBIG (hep. B Ig) within 12hrs of birth. SHould be tested for aby 1-2 mo after completion of hep B series
Hep B Vaccine Schedule
Dose 1: birth
Dose 2: 6-8wks (interval 4weeks)
Dose 3: 6-18mo (interval is 8weeks)
*** third dose must be separated from 1st dose by at least 16 wks, if done too soon its like giving only one shot, doesnt have the same effect as booster shots.
Influenza
- bacteria or virus?
- transmission
- manifestations
- complications
- RNA virus of Orthomyxoviridae
- transmitted through the air
- fever/chills, sore throat, athralgias (muscle aches), HA, coughing, weakness/fatigue
- pneumonia, severe diarrhea & dehydration, seizures, encephalitis, death
- most at risk are young children and ppl 65 or older
Types of Influenza Vaccines
& how many strains does it protect against?
-injectable; inactivated vaccines
3 types of injectable: standard (>6mo), high-dose flu (>65), intradermal(18-64)
- intranasal: live; ages 2-49 (healthy, not pregnant)
- 3-4strains
Influenza Dosing
-how long for protection?
children 6mo-8yrs get 2 doses the first year they are vaccinataed
everyone else gets it every year.
-2weeks
Timing of Influenza Vaccine Programs?
begins in october peaks in january/february
continue to vaccinate throughout flu season
INACTIVATED flu vaccine CI and Precautions
- CI: severe allergic rxn to vaccine component or following prior dose of vaccine
- precautions: moderate or severe acute illness, hx of guillian barre
LIVE attenuated flue vaccine Adverse Rxns
- rhinorrhea
- nasal congestion
- HA
- Sore throat
- anaphylaxis
- Guillain Barre
- Bells Palsy
- asthma exacerbation
Persons who should receive inactivated influenza vaccine (precautions)
- children younger than 5 yrs w/ asthma or wheezing
- moderate/severe acute illness
- chronic medical conditions
- children and adolescents receiving long term aspirin therapy
Persons who should not receive Live attenuated (CI)
- immunosuppression
- pregnant
- children younger than 2 years
- > 50yo
- severe anaphylactic allergy to egg
- history of guillian barre
Pneumocococcal Disease
- virus or bacteria?
- major clinical syndromes
- bacteria; Streptococcus pneumoniae
- pneumonia, bacteremia, meningitis
Pneuomococcal Vaccine Types
-live or inactivated?
- PCV13 (Prevnar13)= pediatric dose, pneumococcal conjugate vaccine, protects against 13types
- PPSV (pneumococcal polysaccharide vaccine)= protects against 23 types
- both are inactivated
Pneuomococcal Dosing Schedule
PCV 13 Dose1; 6-8weeks Dose2: 4 mo Dose 3: 6mo Booster: 12-15mo
PPSV
usually get one single dose per lifetime, >65yrs of age.
*May get vaccine between 2-64years if immunosuppressed or chronic medical conditions, 2nd dose only recommended if you are >65 who got first dose when you got your 1st dose younger than 65 but greater than 5 years ago.
Pneumococcal CI and Precautions
severe allergic rxn to vaccine component or following prior dose of vaccine or moderate to severe acute illness
Pneumococcal Adverse Rxns
Local rxn
fever, myalgia
severe adverse rxn rare
Meningococcal
- bacteria or virus?
- colonizes where in body?
- manifestation
- Adverse rxn
- CI
- Precautions
- bacteria, neisseria meningitidis
- nasopharynx, invade blood stream
- fever, HA, stiff neck, blood stream infection w/ petechial/purpuric rash, hypotension, multi-organ failure
–local rxn, systemic rxn; HA malaise, fatigue
-CI/precautions: severe allergic rxn to vaccine component or following a prior dose of vaccine, moderate or severe acute illness
Meningococcal vaccine types
2 types
MCV4 (menactra) meningococcal conjugate vaccine, 55yo and younger
MPSV4 meningococcal polysaccharide vaccine, ppl >65yo
*both vaccines prevent all four strains
Meiningococcal dosing schedule
MCV4
- Dose 1: 11-12
- booster 16yo
- adolescents in this age w/ HIV infection get 3 doses; 2 dose 2mo apart @ 11-12yrs and booster at 16
Human Papillomavirus (HPV)
- bacteria or virus?
- manifestations
- adverse rxn
- CI and precautions
- DNA virus
- asympotomatic mostly, anogenital warts, cervical cancer precursors, cancer (cervical,anal, vaginal, vulvar, penile, oropharyngeal
- adverse rxns; local, pain swelling, fever,
- CI: severe allergic rxn to vaccine component or following prior dose
- precautions: moderate or severe acute illness
HPV vaccine types
3 types
HPV 9 (Gardasil-9) nonavalent vaccine, for male and female, 6,11,16,18,31,33,45,52,58
HPV 4 (Gardasil) quadrivalent 6,11,16,18, males and females
HPV2 (Ceravix) bivalent, indicated only for females
- 6 & 11 cause warts
- 16 & 18 cause cancer
HPV dosing schedule
Gardasil recommended for all 11-12, started as early as 9yo through 26yo
Intervals: 0,2,6mo third dose should follow the first dose by at least 24wks
*series does not need to be re-started if schedule is interrupted
HPV Vaccine Special Situations vaccine can be administered
- abnormal pap test
- positive HPV DNA test
- genital warts
- immunosuppression
- breast feeding
HPV Vaccination during Pregnancy
- initiation or continuation of vaccine series should be delayed until after pregnancy
- if women is vaccinated during pregnancy it should be reported to the Merck registry
Rotavirus
- bacteria or virus?
- manifestations
- entry into body, replication site
- incubation period
- complications
- adverse rxn
- CI
- virus, reovirus (RNA)
- diarrhea, asymptomatic, severe dehydration, fever. vomiting
- entry through mouth, replication in endothelium of small intestines
- less than 48hrs
- complications: severe diarrhea, dehydration, electrolyte imbalance, metabolic acidosis
- adverse rxn; vomiting, diarrhea, irritability, fever
- CI: immunosuppression, acute gastroenteritis, hx of intussesception (intestines slides in on itself)
Rotavirus Vaccine Types
RV5 (RotaTeq) live attenuated, given in 3 doses, pentavalent
RV1 (Rotarix) live attenuated, given in 2 doses, monovalent
Rotavirus Dosing Schedule
Dose 1; 6weeks
Dose 2: 4 mo
Dose 3: 6mo (RotaTeq only)
maximum age for dose 1 is 14wks 6 days
minimum interval between 4weeks
maximum age for any dose is 8mo
Polio
- virus or bacteria?
- route of entry
- manifestations
- virus causing paralysis
- enters body through mouth
- paralysis, meningitis, death
- eliminated in US
Polio dosing schedule
4 doses of IPV (inactivated polio vaccine)
dose 1; 6-8weeks
dose 2; 4 mo
dose 3; 6-18mo
booster 4-6 years
Combo Vaccines goal
reduce # of injection
List the combo vaccines
DTap, DT, Tdap, Td
MMR
MMRV (proquad)
Pediarix= DTaP HepB IPV
Twinrix= Hep A HepB…….>18yo
Comvax= Hib HepB
TriHIBit= DTaP Hib…. can only be used as 4th dose
Combo Vaccination Schedule may look lilke this
birht: hepB
6wks: PCV, Hib, Pediarix
4mo: PCV, Hib, Pediarix
6mo: PCV, Hib, Pediarix
12mo: PCV, Hib, ProQuad, HepA
15-181mo: DTaP
18-24mo: HepA
4-6yrs: PCV, Hib, ProQuad
Twinrix vaccine schedule
series of 3 doses
0, 1, 6mo interval
* only given to those greater than 18yo
