Vaccines and Immunity

Question 1

live attenuated vaccines

Answer 1

MMR, varicella, live flu vaccine, polio, rotavirus, herpes zoster, typhoid, yellow fever, BCG

Question 2

general principles for live vaccines

Answer 2

not given to immunocompromised, usually not given if has febrile illness, not given in prego and avoid prego for 1 month after vaccine. drug interactions: antiviral drugs. if patient needs 2 live vaccines: give both same day or at least 4 weeks apart

Question 3

live attenuated influenza vaccine LIAV (Flumist) general

Answer 3

2 strains A, 1 strain B, intranasally given. live vaccine replicates in nasal mucosa

Question 4

MMR vaccine general

Answer 4

2 doses 99% measles and 83% mumps efficacy. ADRs: fever 7-12d after vaccine. drug interactions: immune globulin, chemo, high dose steroids

Question 5

live attenuated influenza vaccine LIAV (Flumist) contraindications

Answer 5

egg allergy, asthma, immunocompromised, prego, <2y/o, >49yo, not healthy

Question 6

live attenuated influenza vaccine LIAV (Flumist) schedule

Answer 6

yearly (ages 2-49), but age 2-8 will need two doses in same year the first time get

Question 7

MMR vaccine contraindications

Answer 7

neomycin allergy, prego, immunosupression, febrile illness (ok for egg allergy, breastfeed).

Question 8

MMR vaccine schedule

Answer 8

dose 1 age 12-15mos, dose 2 4-6y (or at least 4 weeks after first dose). dose 1 to any infant 6-12mos travelling inernationally, but doesnt count as first dose.

Question 9

MMRV vaccine (ProQuad) contraindications

Answer 9

neomycin allergy, prego, immunosupression, febrile illness (ok for egg allergy, breastfeed). caution with hx of cerebral injury, seizures, or physiological stress due to fever needs to be avoided

Question 10

MMRV vaccine (ProQuad) ADRs

Answer 10

fever >102 (>21% vs 15% w/MMR),increased risk of febrile seizures. informed consent includes risk of fever and febrile seizures

Question 11

MMRV schedule

Answer 11

dose 1 age 12-15mos, dose 2 4-6y (or at least 4 weeks after first dose). Howver, dont use combo shot for first dose, can use for second dose.

Question 12

varicella vaccine general

Answer 12

2 doses >98% effective. can be given post exposure w/in 3 days. ADRs: fever, rash, injection site reaction

Question 13

varicella vaccine contraindications

Answer 13

neomycin allergy, febrile illness, immunocompromised, prego, high dose steroids

Question 14

varicella vaccine schedule

Answer 14

dose 1 age 12-15mos, dose 2 4-6y (or at least 4 weeks after first dose). adolescents who never got the disease given 2 doses 4-8 weeks apart

Question 15

inactivated vaccines general principles

Answer 15

killed virus. may be given with other vaccines co administered. no need to restart series if patient gets off schedule (use catch up schedule)

Question 16

contraindications for Dtap, Tdap, Td

Answer 16

anaphylactic reaction, progressive neurological disease, high temp or seizure after previous Dtap dose (not Tdap)

Question 17

Dtap schedule

Answer 17

2mos, 4mos, 6mos, 15-18mos, 4-6y

Question 18

Tdap schedule

Answer 18

give at age 11-12years. adults should get every 10 years. (or Td every 10 years)

Question 19

Dtap vs Tdap

Answer 19

Dtap for before age 7, Tdap for after age 7

Question 20

Dtap/Tdap/Td ADRs

Answer 20

pain at injection site, low grade fever, aches, headaches. give antipyretics to children with hx of febrile seizures

Question 21

inactivated IM flu vaccine general

Answer 21

2 type A, 1-2 type B. ADRs: local reaction, mild systemic effects. drug interactions: theophylline, phenytoin, warfarin.

Question 22

inactivated flu vaccine contraindications

Answer 22

anaphylaxis to eggs for the vaccine, BGS within 6 weeks of vaccine, febrile illness

Question 23

inactivated flu vaccine schedule

Answer 23

yearly age 6mos and older. those younger than 9 y/o get 2 doses first year. high dose for >65y/o

Question 24

vaccines of flu for those with egg allergy

Answer 24

FloBlok or Flucevax

Question 25

immune globulin IG serums

Answer 25

provide passive immunity to infectious diseases. derived from pooled plasma of adults, processed by cold ethanol fractation. contraindications: dont give within 3 mos of live vaccine.

Question 26

tuberculin purified protein derivative (PPD) general

Answer 26

screen asymptomatic ppl for infection. ADRs: in highly sensitive ppl, vesiculation, ulceration, necrosis at site can occur. drug interactions: live virus vaccines, BCG and immunosupresants.

Question 27

tuberculin purified protein derivative (PPD) contraindications

Answer 27

immunodeficiency, tuberculin positive reactors

Question 28

tuberculin purified protein derivative (PPD) dosing

Answer 28

5TU intradermally. read reaction 48-72h. positive reading based on risk category

Question 29

CDC ed for flu shot

Answer 29

takes about 2 weeks for protection to start, and lasts through season (Oct-May). minor side effects: sore/red/swollen at site, hoarsness, sore/red/itchy eys, cough, fever, aches, HA, itching, fatigue. Usually begin shortly after shot and last 1-2 days. Serious: GBS 1-1mil; young children flu shot with PCV13 and/or DTaP same time higher risk for febrile seizure

Question 30

CDC ed for flu intranasal vaccine

Answer 30

delay vaccine if got live vaccine w/in 4 weeks, not feeling well, taken influenza antiviral in past 48h, have very stuffy nose. side effects for childre2-17: nasal cong/runny, cough, fever, HA, muscle ache, abdominal pain, vomiting, diarrhea, wheezing. adults: runny/congestion, sore throat, cough, chills, tired/weak, HA

Question 31

CDC ed for varicella

Answer 31

contras: severe allergy, prego (and avoid prego for 1+mos after), weak immune system, hx of immune problems in close relative, taking aspirin (avoid for 6 weeks after also), recent blood products/transfusion (wait 3+ mos), live vaccines in past 4 weeks, mod-severely ill. minor: sore injection site, fever, redness; usually 2 weeks after shot; less often after 2nd dose. more serious: seizure, infection of lungs or spinal cord, rash all over body (might be able to spread virus; stay away from infants, immune supressed)

Question 32

chickenpox disease

Answer 32

chickenpox can be serious for those <12mos, teens, adults, prego, and those with weak immune system. chickenpox causes rash for a week, fever, tired, no appetite, HA. serious complications: skin infections, pneumonia, BV inflammation, encephalitis, meningitis, blood/bone/joint infection, death, shingles years later

Question 33

CDC ed for MMR

Answer 33

dont get if: severe allergies, prego (avoid 1+mo after), weak immune system, close relative with immune system prob, bruise/bleed easy condition, recent blood/products, have TB, live vaccine 4 weeks, mod-severe ill. minor: sore arm, fever, red/rash at site, swelling of glands cheeks/neck w/in 2 weeks after shot, less often after 2nd dose. moderate: seizure with fever, temporary pain/stiff joints (mostly teen, adult women), bleeding/bruising (temp low platelets), rash all over body. severe (Rare): deaf, l/t sezirue/coma/lowered consciousness, brain damage.

Question 34

CDC for DTaP

Answer 34

only for age <7; not for severe allergy, coma or long repeated seizures from prior dose, seizures or another nervous system prob, GBS, severe pain or swell after previous dose, mod-severe ill. minor: red/sore/tender/swell at site, fever/fussy/tired/poor appetite/vomiting 1-3 days after. more serious: seizure, nonstop crying 3h, high fever >105, swelling of entire arm or leg especially older children 4th or 5th dose. extremely rare is long term seizures, coma, lowered consciousness, or brain damage.