Vaccines

Question 1

MMR

Answer 1

• Live attenuated
• first dose at 12 months, 2nd dose 4-6 yrs
• If traveling overseas, child can be given fist dose at 6 months and 2nd 4 weeks later, w recommended booster at 12 months

Question 2

Varicella Zoster

Answer 2

• live attenuated
• Varivax can be given alone or pro quad in combination with MMR/MMRV
• First dose at 12 months, 2nd 3 months later
• contraindicated in pregnancy

Question 3

Shingles/ Varicella Zoster

Answer 3

• live attenuated
• Zostavax - same as Varivax but 14x more potent
• recommended for >60yo
• contraindicated in immunosuppressed pts
• not needed if pt has had Varivax before 60

Question 4

Rotavirus

Answer 4

• live attenuated
• Rotarix (RV1) - 2 doses, monovalent human attenuated
• RotaTeq (RV5) - 3 doses, 5 strains
• both 90% efficacy
• can be administered before 12 months because it is oral
• risk of intussusception a week after either dose

Question 5

Live-attenuated influenza

Answer 5

• cold adapted influenza strain that only replicated in upper RT
• intra nasal administration
• indicated for ages 2-49

Question 6

Smallpox vaccine (vaccinia)

Answer 6

• live attenuated
• results in actively shedding pox, take care to keep covered
• only indicated for research and military
• contraindicated by eczema
• be careful with immunosuppressed pts

Question 7

• Yellow Fever

Answer 7

• Live attenuated
• indicated for travel to endemic areas (Africa, SA)
• no booster ended for most travelers
• 99% efficacy after 30 days

Question 8

Live attenuated oral polio

Answer 8

• Only used in endemic areas
• trivalent - contains 3 serotypes of polio
• good mucosal immunity, useful bc polio is enteric

Question 9

Adeno type 4 and 7

Answer 9

• oral live vaccine, not attenuated
• only given to military recruits
• respiratory viruses, but can replicate in gut w few side effects
• good mucosal immunity, also prevents respiratory spread

Question 10

Inactivated polio vaccine (IPV)

Answer 10

• trivalent against 1,2,3
• no chance of Vaccine-Associated Paralytic Polomyelitis (VAPP)
• First dose at 2 months (4 total)
• 99% efficacy after 3 doses

Question 11

Hep A vaccine (Havrix, Vaqta)

Answer 11

• Recommended by 1 and 2 yrs, 2nd dose 6-18 months later
• Twinrix combines Hep A and B, use at 0, 1, 6, and again after a year
• 14-20 years protection in children, 25 in adults
• recommended for travel to countries with high to intermediate HAV, MSM, illegal drug users, researchers, chronic liver disease, clotting factor disorders

Question 12

Rabies

Answer 12

• inactivated vaccine
• 3 doses
• pre-exposure for vets, animal handlers, researchers, spelunkers
• post-exposure for bitten people

Question 13

Japanese encephalitis virus vaccine (JE-IXIARIO)

Answer 13

• recommended for travel to Asia, but not for urban only or 30 days or less
• 2 doses 28 days apart, can travel a week later

Question 14

Inactivated Influenza Vaccine (IIV)

Answer 14

• subunit vaccine
• split vaccine, virus is grown and treated w detergent to obtain Hemagglutinin and Neuraminidase
• recommended bw 6mo-2yrs, 2 doses separated by 4 weeks first time under 9
• recommended yearly for everyone else

Question 15

Hep B

Answer 15

• subunit vaccine, contains HBsAg
• first dose at birth, 3 doses total
• 95% efficacy from chronic infection
• efficacy can decline after 40
• recommended for health care workers
• some people are nonresponders

Question 16

HPV (Gadasil, Gardasil9, Cervarix)

Answer 16

• subunit vaccine against major capsid protein L1 (assembles into viral like protein)
• valency depends on vaccine
• recommended in females bw 11 and 13, up to 26
• in males from 13 to 21
  Not therapeutic against prev exposure, but can be used if infected w one strain to provide protection against particular strains in vaccine