Vaccines

Question 1

what vaccines must be given to preschoolers< 5-6

Answer 1

Hib and PCV13

Pneumococcus and hemophilus important for preschoolers

Question 2

when is Men-C-ACWY given?

Answer 2

in adolescence

Question 3

how old before giving HPV

Answer 3

> 9

Question 4

what vaccines are necessary for everyone

Answer 4

3 doses of T-D-IPV-P
2 doses of MMR
1 dose of Men C

Question 5

what are the contraindications for LAIV (6)

Answer 5

<24 months
severe asthma (current high-dose inhaled steroids or systemic steroids)
medically attended wheezing in the past 7 days
immunodeficiency
pregnancy
ASA treatment

Question 6

what influenza vaccine is recommended for children?

Answer 6

quadrivalent inactivated (2a’s and 2b’s)

Question 7

who is at high risk for severe disease with influenza

Answer 7

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

Question 8

what are some contraindications for vaccines

Answer 8

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

Question 9

is zoster a live vaccine??

Answer 9

NO!

Question 10

what are some live vaccines? (3)

Answer 10

MMR
varicella
rotavirus (rotateq and rotarix)

Question 11

patients with asplenia or hyposplenia are at increased risk of what infections?

Answer 11

Hib
pneumococcus
meningococcus

Question 12

what vaccines for patients with asplenia or hyposplenia

Answer 12

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

Question 13

vaccines after bone marrow transplant

Answer 13

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)

Question 14

after a solid organ transplant what vaccines should be given?

Answer 14

all inactivated vaccines not given pre transplant

no live vaccines!

Question 15

What vaccines should be give pre solid organ transplant

Answer 15

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

Question 16

how long do you wait after immunosuppressive (chemotherapy) therapy for vaccination?

Answer 16

wait 3 months after immunosuppressive therapy ends prior to vaccination

Question 17

if systemic steroids >2mg/kg/day dosed for 14 days, when can you give vaccines?

Answer 17

wait 1 month

for all other regimens (longterm alternate day, low dose, topical, intraarticular etc) no delays**

Question 18

after rituximab when can you vaccinate?

Answer 18

wait until they have b cells

Question 19

for all congenital and or acquired immunodeficiencies who else should you immunize?

Answer 19

IMMUNIZE ALL CLOSE CONTACTS

Question 20

For which of the following is PEP not achieved primarily through vaccination?
measles
hemophilus influenza b
hepatitis a
hepatitis b
varicella

Answer 20

hemophilus influenza b- prophylaxis with antibiotics

Question 21

when should you give PEP for measles and varicella

Answer 21

<72 hours

Question 22

PEP hep A

Answer 22

anytime, ideally <14 days

Question 23

PEP hep B

Answer 23

<12 hours in neonates, as soon as possible for all others

Question 24

PEP meningococcus

Answer 24

as soon as possible

chemoprophylaxis more urgent for close contacts

Question 25

what would be considered significant exposure to varicella

Answer 25

household contact
touching a lesion
in same room >1 hour
face to face contact >15 min

Question 26

who should get VZIG

Answer 26

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

Question 27

when should rotavirus be given?

Answer 27

usually recommended starting at 6 weeks with the first dose NO LATER THAN 15 WEEKS
SERIES NEEDS TO BE COMPLETED BY 8 months

Question 28

Name 3 contraindications for rotavirus?

Answer 28

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

Question 29

Those at high risk for pneumococcal infection should have what vaccines

Answer 29

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

Question 30

what is the most common serogroxup for meningococcus

Answer 30

B!! (used to be C)

highest case fatality- C

Question 31

what vaccine for meningococcus should be given for infants at high for for IMD

Answer 31

Men-C- ACWY- CRM
4CMenB
boosters q3y until age 7 then every 5 years

Question 32

who is considered at high risk for IMD

Answer 32

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

Question 33

what types of HPV cause genital warts

Answer 33

HPV 6 and 11

Question 34

what types of HPV cause anogenital Ca

Answer 34

16,18

Question 35

HPV vaccine is recommended for who?

Answer 35

females 9-45

males 9-26 (HPV 4/9)

Question 36

how many doses of HPV for immunocompetent girls/boys age 9-14

Answer 36

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

Question 37

strategies for vaccine hesitant parents

Answer 37

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)