Vaccines Flashcards
what vaccines must be given to preschoolers< 5-6
Hib and PCV13
Pneumococcus and hemophilus important for preschoolers
when is Men-C-ACWY given?
in adolescence
how old before giving HPV
> 9
what vaccines are necessary for everyone
3 doses of T-D-IPV-P
2 doses of MMR
1 dose of Men C
what are the contraindications for LAIV (6)
<24 months
severe asthma (current high-dose inhaled steroids or systemic steroids)
medically attended wheezing in the past 7 days
immunodeficiency
pregnancy
ASA treatment
what influenza vaccine is recommended for children?
quadrivalent inactivated (2a’s and 2b’s)
who is at high risk for severe disease with influenza
all children aged 6-59 months anyone with the following conditions: - neuromuscular - cardiac or pulmonary disorders (including asthma) - malignancy, immunocompromised - diabetes and other metabolic disorders - morbid obesity (BMI>40) - renal disease - anemia or hemoglobinopathy - require salicylate therapy
all indigenous
all residents of chronic care facilities
anyone that lives in the same household as someone with one of the medical conditions
anyone that lives in the same household as a young infant
all pregnant women
adults >65 years
what are some contraindications for vaccines
allergy - anaphylaxis pregnancy - live vaccines immunodeficiency - some vaccines are not given others: GBS <6 weeks post- vaccination intussusception ( don't give rotavirus) severe asthma or recent wheezing (don't give LAIV) active TB (don't give MMR or varicella) SJS/TEN
is zoster a live vaccine??
NO!
what are some live vaccines? (3)
MMR
varicella
rotavirus (rotateq and rotarix)
patients with asplenia or hyposplenia are at increased risk of what infections?
Hib
pneumococcus
meningococcus
what vaccines for patients with asplenia or hyposplenia
PCV 13
PPSV23 >8 weeks post PCV13, age 2+
give Men-C-ACWY-____+ 4CMen B
- specific vaccine, #doses, time of boosters all depend on age
if >5 yo at diagnosis another dose HiB even if previously fully immunized
vaccines after bone marrow transplant
inactivated: PCV13 x 3 then PPSV23 influenza diphtheria, tetanus, polio, HiB, pertussis x3 Hep B x3 HPV x3 (meningococcal vaccine- routine)
live:
consider MMR and or varicella >24 months post if well
all other contraindicated (yellow fever if risk of exposure high)
after a solid organ transplant what vaccines should be given?
all inactivated vaccines not given pre transplant
no live vaccines!
What vaccines should be give pre solid organ transplant
routine vaccinations (ensure all completed, especially MMR and V) PCV13 x 1 then PPSV23 x 1 Hib x1 if >5 if travel planned: Hep A, yellow fever may need higher dose Hep B
how long do you wait after immunosuppressive (chemotherapy) therapy for vaccination?
wait 3 months after immunosuppressive therapy ends prior to vaccination
if systemic steroids >2mg/kg/day dosed for 14 days, when can you give vaccines?
wait 1 month
for all other regimens (longterm alternate day, low dose, topical, intraarticular etc) no delays**
after rituximab when can you vaccinate?
wait until they have b cells
for all congenital and or acquired immunodeficiencies who else should you immunize?
IMMUNIZE ALL CLOSE CONTACTS
For which of the following is PEP not achieved primarily through vaccination? measles hemophilus influenza b hepatitis a hepatitis b varicella
hemophilus influenza b- prophylaxis with antibiotics
when should you give PEP for measles and varicella
<72 hours
PEP hep A
anytime, ideally <14 days
PEP hep B
<12 hours in neonates, as soon as possible for all others
PEP meningococcus
as soon as possible
chemoprophylaxis more urgent for close contacts
what would be considered significant exposure to varicella
household contact
touching a lesion
in same room >1 hour
face to face contact >15 min
who should get VZIG
susceptible pregnant women
neonates whose mother developed varicella 5 d before to 2 d after delivery
some other neonates in NICU
susceptible immunocompromised patients
HSCT
ideally <96 hours, can give up to 10 days after exposure
when should rotavirus be given?
usually recommended starting at 6 weeks with the first dose NO LATER THAN 15 WEEKS
SERIES NEEDS TO BE COMPLETED BY 8 months
Name 3 contraindications for rotavirus?
intussusception
maternal use of biologic during pregnancy
immunocompromised
not contraindicated in children with a history of rotavirus infection
fine for premature infants if they are healthy
Those at high risk for pneumococcal infection should have what vaccines
PCV13- undiagnosed in infancy then 4 doses
if dx later on ensure PCV13 was given
PPSV23- if diagnosed in infancy then 1 dose at age 2
if later on then 1 dose at least 8 weeks after PCV13
what is the most common serogroxup for meningococcus
B!! (used to be C)
highest case fatality- C
what vaccine for meningococcus should be given for infants at high for for IMD
Men-C- ACWY- CRM
4CMenB
boosters q3y until age 7 then every 5 years
who is considered at high risk for IMD
high risk of severe disease: asplenia hyposplenia complement deficiencies primary antibody deficiency HIV
high risk of exposure:
travel (meningitis belt, Hajj)
lab worker, barracks living
what types of HPV cause genital warts
HPV 6 and 11
what types of HPV cause anogenital Ca
16,18
HPV vaccine is recommended for who?
females 9-45
males 9-26 (HPV 4/9)
how many doses of HPV for immunocompetent girls/boys age 9-14
2 dose series of any HPV vaccine
ideally same product for all doses
except those with advanced HIV and immunodeficient conditions then they need 3 doses regardless of age
strategies for vaccine hesitant parents
listen to concerns, ask to see literature/references/websites
provide resources
not vaccinating is not only putting their own child at risk but other in the community
discuss herd immunity (doesn’t work for tetanus for example)
