Vaccines and Immunity Flashcards
live attenuated vaccines
MMR, varicella, live flu vaccine, polio, rotavirus, herpes zoster, typhoid, yellow fever, BCG
general principles for live vaccines
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
live attenuated influenza vaccine LIAV (Flumist) general
2 strains A, 1 strain B, intranasally given. live vaccine replicates in nasal mucosa
MMR vaccine general
2 doses 99% measles and 83% mumps efficacy. ADRs: fever 7-12d after vaccine. drug interactions: immune globulin, chemo, high dose steroids
live attenuated influenza vaccine LIAV (Flumist) contraindications
egg allergy, asthma, immunocompromised, prego, <2y/o, >49yo, not healthy
live attenuated influenza vaccine LIAV (Flumist) schedule
yearly (ages 2-49), but age 2-8 will need two doses in same year the first time get
MMR vaccine contraindications
neomycin allergy, prego, immunosupression, febrile illness (ok for egg allergy, breastfeed).
MMR vaccine schedule
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.
MMRV vaccine (ProQuad) contraindications
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
MMRV vaccine (ProQuad) ADRs
fever >102 (>21% vs 15% w/MMR),increased risk of febrile seizures. informed consent includes risk of fever and febrile seizures
MMRV schedule
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.
varicella vaccine general
2 doses >98% effective. can be given post exposure w/in 3 days. ADRs: fever, rash, injection site reaction
varicella vaccine contraindications
neomycin allergy, febrile illness, immunocompromised, prego, high dose steroids
varicella vaccine schedule
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
inactivated vaccines general principles
killed virus. may be given with other vaccines co administered. no need to restart series if patient gets off schedule (use catch up schedule)
contraindications for Dtap, Tdap, Td
anaphylactic reaction, progressive neurological disease, high temp or seizure after previous Dtap dose (not Tdap)
Dtap schedule
2mos, 4mos, 6mos, 15-18mos, 4-6y
Tdap schedule
give at age 11-12years. adults should get every 10 years. (or Td every 10 years)
Dtap vs Tdap
Dtap for before age 7, Tdap for after age 7
Dtap/Tdap/Td ADRs
pain at injection site, low grade fever, aches, headaches. give antipyretics to children with hx of febrile seizures
inactivated IM flu vaccine general
2 type A, 1-2 type B. ADRs: local reaction, mild systemic effects. drug interactions: theophylline, phenytoin, warfarin.
inactivated flu vaccine contraindications
anaphylaxis to eggs for the vaccine, BGS within 6 weeks of vaccine, febrile illness
inactivated flu vaccine schedule
yearly age 6mos and older. those younger than 9 y/o get 2 doses first year. high dose for >65y/o
vaccines of flu for those with egg allergy
FloBlok or Flucevax
immune globulin IG serums
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.
tuberculin purified protein derivative (PPD) general
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.
tuberculin purified protein derivative (PPD) contraindications
immunodeficiency, tuberculin positive reactors
tuberculin purified protein derivative (PPD) dosing
5TU intradermally. read reaction 48-72h. positive reading based on risk category
CDC ed for flu shot
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
CDC ed for flu intranasal vaccine
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
CDC ed for varicella
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)
chickenpox disease
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
CDC ed for MMR
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.
CDC for DTaP
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.
