Vaccines Flashcards
Vaccine Must-knows re timing
- DPTaP - Hib + PCV 13 need multiple doses < 12 mons
- Rotavirus series cannot start after 15 (20 wks) or end after 8 months
- MMR should not ROUTINELY be given < 12 mons
- 2 doses of V needed after 12 months of age
- first influenza vaccination is 2 doses (separated by 4 weeks) for young children
- MCV should be in infancy and adolescence
- both HepB and HPV are 2-dose series if given in early adolescents
Canada stance on LAIV over IIV
LAIV contraindications
NACI: LAIV can be used but is not preferred to IIV for children in 2016 - 2017
LAIV contraindications:
- < 24 months
- severe asthma (current high-dose inhaled steroids or systemic steroids)
- medically attended wheezing in past 7 days
- immunodeficiency, pregnancy
- ASA treatment (concern re Reye syndrome)
Who is indicated to get the flu shot?
Patients at high risk for severe disease
- children age 6 - 59 months
- anyone with the following conditions:
- neuromuscular, vascular, degenerative, developmental, sz disorder (inclu. febrile sz)
- cardiac or pulmonary disorders (incl. asthma)
- malignancy, immunocompromising conditions
- DM and other metabolic disorders
- morbid obesity (BMI > 40)
- renal disease
- anaemia or haemoglobinopathy
- require salicylate therapy
- all indigenous children
- all residents of chronic care facilities
Others who should be vaccinated
- anyone that lives in the same household as above
- anyone that lives in the same household as a young infant
Which vaccines are contraindicated in Egg allergy?
Only vaccines contraindicated for persons with egg allergy are:
- yellow fever
- tick-borne encephalitis (not available)
- RabAvert brand rabies vaccine (not Imovax)
-all influenza vaccines including LAIV can be given to those with egg allergy with no special precautions
Who should not be vaccinated?
Contraindications to vaccination
- allergy (anaphylaxis) to a vaccine or its components
- Immunodeficiency - some vaccines are not given
- Pregnancy - live vaccines not given
- Misc - GBS < 6 wk post-vaccination, intussusception (rotavirus), severe asthma or recent wheezing (LAIV), active TB (MMR, Varicella)
Which are NOT contraindications for vaccines
- acute illness
- previous severe local reactions
- hypotonic-hyporesponsive episode (recurrence is almost 0 )
- previous high fevers or prolonged crying post vaccination
- bleeding disorder (optimize control before vaccination)
How to vaccinate with an asplenic/hyposplenic patient
- ensure PCV13 administered (often extra dose)
- PPSV23 > 8 weeks post PCV13, age 2+, then subsequent single booster PPSV23 5 yrs later
- given MCV4 (specific vaccine, # doses, timing of booster, all depend on initiation time)
- given 4CMenB
- if > 5 yrs @ diagnosis: another dose of HiB even if previously fully immunized
How to vaccinate after a BMT
inactive (most 6 - 12 months post) -PCV 13 x 3 then PPSV23 x 1 -influenza -diphtheria, tetanus, polio, HiB, pertussis x 3 -HepB x 3 HPV x 3 -meningococcal vaccine - routine start all inactivated vaccines post, need to give almost all back again
live
- consider MMR and/or Var > 24 mon post
- all others contraindicated (yellow fever to be given if risk of exposure high)
Vaccinations for Solid Organ Transplant
given pre-transplant
- routine vaccinations (ensure all completed, especially MMR and Varicella)
- PCV13 x1 and PPSV23 x 1
- HiB x 1 if age > 5 yrs
- if travel planned: Hep A, yellow fever
- may need higher dose Hep B
Post transplant:
- no live vaccines
- any inactivated vaccines not given pre-transplant
Vaccines for pts with Primary Immunodeficiency
- give all component/inactivated vaccines, even if you don’t expect a response
- generally do not give live vaccines but can give those w/ IgA or igG subclass deficiencies, complement defects, consider MMR + V for CVID, XLA (difficult w IVIG)
- complement defects: reinforce pneumococcal and meningococcal coverage
- all vaccines (including live) recommended for close contacts)
How can you give vaccinations following immunosuppressive therapy?
- in general wait 3 months after immunosuppressive therapy ends prior to vaccination
- if systemic steroids > 2 mg/kg/day x > 14 days: wait 1 month
- all other steroid regimens- no delays
- post rituximab - usually 6 - 12 months b/c need B cells to be effective
- vaccinate close contacts
- post IVIG - wait 11 months
Who should get Varicella Ig as PEP
Those at high risk for severe disease who cannot receive vaccine
- susceptible pregnant women
- neonates who mothers developed varicella 5 days before to 2 days after delivery
- some neonates in NICU
- susceptible immunocompromised pts (note recent high-dose IVIG just as good)
- HSCT
-ideal < 96 hrs, but can give up to 10 days post exposure
Recommendations for Rotavirus vaccine
- start at 6 weeks w/n first dose no later than 20 wks and series needs to be complete by 8 months
- concern re intussusception (RotaShield)
- current gen vaccines are associated with very low rates of intussusception, often in the wk after immunization
- fine for premature infants that are healthy
- avoid in immunocompromised hosts
- avoid in infants with hx of intussusception
High-risk condition of pneumococcal infection?
- chronic pulmonary and cardiac disease
- chronic kidney, liver, metabolic (DM)
- immunosuppression
- neurologic swallowing disorder
- haemoglobinopathies
- malignancy, past HSCT
- chronic CSF leak
- SNHL requiring cochlear implants
How to immunize those at high risk with pneumococcal vaccine
PCV13
- if dx in infancy: 4 doses (2, 4, 6, 12 - 15)
- if dx later on: ensure PCV13 is/was given
PSV23 (Pneumovax)
- if dx in infancy: 1 dose at age 2
- if dx later on; 1 dose at least 8 weeks after PCV13
