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Block 6; Week 4-Michelle > Vaccines-Larson > Flashcards

Vaccines-Larson Flashcards

1
Q

What are some of the main issues surrounding the appropriate use of vaccines?

A

Timing & Spacing

  • *timing giving LAV when a person’s blood already has antibody
  • *simultaneous admin v. nonsimultaneous
  • *interval b/w doses of the same vaccine
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2
Q

What are the 3 kinds of vaccines?

A
  1. Passive Immunity–solutions that already have antibody in them.
  2. Active Vaccines-Killed vaccine. Give somewhat killed antigen.
  3. Active Vaccines-Live attenuated vaccine. Still alive different than normal virus.
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3
Q

What is a situation in which you would want a passive immunity vaccination?

A

perhaps when you have already experienced an outbreak & need extra protection for a time. A good opportunity to give a pt antibodies. It won’t be lasting, but it’ll help for a time.

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4
Q

Why is it that you have to be careful when you give live attenuated vaccines following a person’s blood containing antibodies to that virus?

A

so…LAV go in & cause infection. That’s how they give immunity.
If there are antibodies to the live virus, it will never be able to infect & provide ultimate protection.

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5
Q

T/F Vaccines protect people against viral infection.

A

False. They don’t protect against infection, but they do protect against disease. Ex: You’ve had the Hep B vaccine. You could still get infected with Hep B. You won’t get hepatitis, though.

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6
Q

How long do you have to wait after a person has been given antibody to virus X or has had a blood transfusion before you can give them a LAV?

A

3 months or longer.

Then you can give them MMR or MMRV etc.

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7
Q

What does MMRV stand for?

A

measles
mumps
rubella
varicella

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8
Q

If a live attenuated vaccine is given…how long do you need to wait before giving therapeutic antibody?

A

2 weeks. Then, the vaccine won’t be compromised in the presence of antibody.

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9
Q

T/F If you have been given antibody X, you can’t give a killed vaccine to virus X until 3 months have past.

A

False. This only applies to live viruses. Killed viruses will still be able to produce antibodies.

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10
Q

What are some exceptions to the rule that LAV are affected by circulating antibody?

A

Oral vaccines that are LAV
These are local vaccines & circulating antibody have no effect.
Ex: Oral Typhoid, Yellow Fever, Rotavirus

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11
Q

T/F LAV are virulent.

A

False. They don’t cause disease, just infection.

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12
Q

T/F It is best to give all recommended vaccines at one encounter.

A

True. Get a giant & effective immune response. More practical-esp with peds.
Could get interference if you break up the shots.

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13
Q

T/F It is best to mix all of the vaccines that are given at an encounter into one syringe.

A

False. This is a bad idea unless it is licensed that you can do that. Ex of one that’s okay: pentacel.

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14
Q

Why are combination vaccines preferred to single component live attenuated vaccines?

A

usu doesn’t cause interference
one combo has 5 antigens in 1 vaccine.
otherwise, need to wait 4 weeks b/w each LAV. Note: doesn’t apply to oral LAV

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15
Q

MMR has to be separated from LAIV by how many weeks? What does LAIV stand for?

A

LAIV: live attenuated internasal vaccine

Separated by 4 weeks b/c they are both live attenuated.

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16
Q

T/F Increasing intervals b/w doses of a multidose vaccine diminishes its effectiveness.

A

False. It doesn’t change the effectiveness. So, if kid doesn’t come in on time-no worries!

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17
Q

T/F Decreasing interval b/w doses may interfere with antibody response & protection.

A

True. Need time to make antibody.

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18
Q

How are the optimal intervals for vaccines determined?

A

by studies of safety & efficacy

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19
Q

Which age was determined to be the perfect age for first vaccination to provide optimal efficacy?

A

12 mo

MMR after 12 mo

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20
Q

T/F You should only receive one dose of MMRV in your lifetime.

A

False. It can last a lifetime, but just to be safe it is recommended that people receive 2 doses. This applies to live attenuated vaccines.

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21
Q

T/F You need multiple doses of killed vaccines to achieve immunity.

A

True. Necessary for optimal antibody levels. Periodic boosting is also required for some vaccines-like diphtheria, tetanus, pertussis

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22
Q

What are some permanent contraindications or precautions that you need to take with vaccines?

A
  • *severe allergic rxn (anaphylaxis, not hives) to a vaccine
  • *encephalopathy w/i 7 days of pertussis vaccine & with no other identifiable cause
  • *SCID-don’t give live attenuated, oral or injectable
  • *History of intussusception-don’t give rotavirus
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23
Q

What type of vaccine is a rotavirus vaccine? Why shouldn’t it be given to a person with a hx of intussusception?

A

Rotavirus is an oral live attenuated virus
infection with rotavirus affects the gut.
Lymph nodes of the gut can enlarge & can act as a focal point for the gut to twist around.

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24
Q

When can you say that an adverse event is due to a vaccination?

A
  • *health problem occurred during plausible time period after vacc (w/i 1 mo)
  • *AE corresponds to one previously noted
  • *Event conforms to clinical syndrome that has biological plausibility (anaphylaxis) or looks like the disease caused by the virus
  • *Event recurs after readmin
  • *Controlled clinical trial or epidemiological study proves it.
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25
Q

It is important to screen potential vaccine recipients for conditions that may be contraindicated. What types of things do you want to screen for?

A 
moderate--severe illness
pregnant
immune compromised
anaphylaxis hx
had blood transfusion
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26
Q

What are some basic questions you want to ask on a vaccine screening form?

A
  • *sick today?
  • *allergies to meds, etc?
  • *serious rxn to vaccine in the past?
  • *seizure, brain or nerve problem?
  • *other health problems: asthma, lung disease, heart disease, kidney disease, metabolic disease-diabetes, blood disorder?
  • *cancer, leukemia, AIDS?
  • *had cortisone, prednisone, anticancer drugs in the past 3 mo?
  • *transfusions of blood or antibodies?
  • *pregnant?
  • *vaccines in the last month?
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27
Q

If a person has any of the medical conditions listed-does that mean that they shouldn’t have a vaccine?

A

not necessarily

diabetes-recommendations to get more vaccines.

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28
Q

What is the ACIP?

A

Advisory Committee on Immunization Practices-health experts that give recommendations to CDC on schedules.

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29
Q

What is the first vaccine that a child gets? When?

A

Hep B vaccine given to child right after birth
Need 3 doses. Intervals important.
1st @ birth, 2nd 1-2mo later, 3rd: 6 mo later
need at least 6 mo b/w the 1st & 3rd.
No boosters needed!

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30
Q

What type of vaccine is a rotavirus vaccine? When do you need to give those doses?

A

oral live attenuated vaccine

3 doses: 2, 4, 6 mo

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31
Q

What is the dosing of DTAP?

A

2, 4, 6, 15 mo

Booster 4-6 yo

32
Q

What is the difference b/w DTAP & TDAP?

A

different doses of diphtheria & tetanus

**booster for TDAP given at 12 yo

33
Q

H influenza type B has what dosing schedule? What type of vaccine is it?

A

Killed vaccine-need multiple doses!

2, 4, 6, 12-15 mo.

34
Q

What is the dosing schedule for the pneumococcal conjugate vaccine?

A

2, 4, 6, 12-15 mo.

35
Q

The inactivated polio shot should be given when?

A

2, 4, 6, 18 mo. Again at 4-6 yo.

Give immunity to the 3 polio strains.

36
Q

When should annual influenza vaccines start for kids?

A

starting at 6 mo

can be given live attenuated vaccine thru nasal spray after 2 years (can sniff properly)

37
Q

When should MMR & varicella be given?

A

12-15 mo. Booster at 4-6 yo.

38
Q

When should the Hep A vaccine be given? Why?

A

2 series starting @ 12 mo.
Inactivated vaccine
have to wait until 1 yo b/c of interference w/ maternal antibodies.

39
Q

HPV is a killed vaccine that has a 3 dose series. When should you begin it?

A

11-12 yo

40
Q

When do you need your booster meningococcal vaccine?

A

need the 2nd one at 16-18 yo.

41
Q

What’s the deal with catch up vaccine schedules?

A

these are necessary when you have no previous records of vaccinations.
usu the shots are spaced out 4 weeks b/w each other.

42
Q

What are some of the vaccines that adults need to get?

A

annual influenza
1 TDAP as adult, DT every 10 years.
2 doses of varicella if you’ve never had chickenpox.

43
Q

You can get the HPV vaccine until you are how old?

A

26 yo

44
Q

When should you get the Zoster vaccine?

A

after 60 yo

45
Q

If you have never had the MMR vaccine, how many doses do you need as an adult?

A

2 doses

46
Q

Which vaccines do you need in pregnancy?

A

influenza
TDAP
repeated for every pregnancy
pregnant women are at greater risk for H1N1 & pertussis

47
Q

Do pregnant women receive LAV like MMR?

A

No, just to be on the safe side. Given right after they give birth.

48
Q

Case 1: You are working with an immunization clinic. A parent brings in a 2 yo for “shots.” They recently moved to Reno from Mexico and don’t have any records. What immunizations do they need now? Next ones & when?

A 
Annual Influenza
Hep B
DTAP (not TDAP)
Prevnar
Rotavirus-not given to any infant greater than 8 mo. Kid probably already had rotavirus & is done. This is worst at 6 mo.
MMRV
Hep AHIB H influenza Type B
Come back in 4 weeks.
Then you get: another Hep B, another DTAP, another inactivated polio, maybe a HIB & Prevnar
49
Q

Case 2: A 6 mo infant comes to the Health Department to get shots. She is “on time”. What immunizations does she need?

A 
3rd dose Hep B
DTAP 
Prevnar
Maybe a polio
influenza
50
Q

Case 3: A pregnant woman comes in for her 6 mo OB check up. What immunizations should she be offered? What about her family? What questions will you ask?

A

TDAP
Influenza
Qs: cocooning-making the environment safe for the baby when they are born. Ask the adults & adolescents in the household if they have had their TDAPs or DTAPs.
Ask screening Qs: Have you ever had an allergic rxn to a vaccine?

51
Q

What is proof of immunity required for?

A

school
work
wellness benefits

52
Q

What are some special populations to consider in vaccinations?

A

pregnant women
healthcare workers
international adoptees/travelers
immunosuppressed persons

53
Q

What are some ways that the healthcare community has attempted to reduce the barriers to vaccine access, esp for parents?

A

vaccine clinics
VFC (vaccines for children) federal funding
Longer hours & weekend times for immunization
Pharmacies can immunize (only not young children)

54
Q

What type of registry data is available for immunization records?

A

universal access to vaccine record
mandatory in Nevada unless you sign a declination form
Registry data-for clinics, hospitals, vaccine clinics
Schools look at this!

55
Q

T/F Most people are more likely to know someone with a vaccine related side effect than someone with the disease.

A

True.

VAERS reports 28K adverse events a year (true & false)

56
Q

What does VAERS stand for?

A

Vaccine Adverse Events Reporting System

57
Q

Why is maintaining public confidence so critical for preventing outbreaks?

A

b/c immunization rates directly effect herd immunity & the protection of immunocompromised people

58
Q

Why is it that more vaccinated people often get the disease than unvaccinated people when an outbreak occurs?

A

b/c SO many more people are vaccinated! % of vaccinated people who get the disease is usu 2%. But 2% vaccinated could equal # of unvaccinated.

59
Q

T/F Measles is more of a hassle than a health risk.

A

FALSE.
Measles kills.
Can cause pneumonia & encephalitis.

60
Q

T/F Those people who have asthma & use a steroidal inhaler are somewhat immunocompromised.

A

True.

61
Q

What are the most communicable diseases?

A

Measles
Pertussis
Chickenpox

62
Q

What is a good argument against the assertion that the decrease in deaths from certain diseases isn’t due to vaccines, but due to better hygiene & nutrition?

A

chickenpox vaccine (varicella) wasn’t introduced until the mid 1990s. 85% drop! We certainly had good hygiene before that.

63
Q

What is a good argument against the assertion that natural immunity is better than vaccine acquired immunity?

A
  • *natural immunity is dangerous to get in some cases-could easily die.
  • *natural immunity could put you in a position where you infect an immunocompromised person & kill them
  • *HIB & Tetanus vaccines are better than natural immunity.
64
Q

Describe the public health issue surrounding vaccines.

A

social conflict b/w individual rights & societal interests

prevention by high levels of immunization–herd immunity then less risky for unvaccinated persons

65
Q

Are there any legal mandates for vaccination?

A

Yes, in all 50 states.

66
Q

What are some of the side effects of vaccines?

A

minor side effects
arms hurts, swollen, fever
Severe & rare side effects:
seizures, paralysis (polio)

67
Q

What is one exception to the rule that vaccines are spread from person to person?

A

tetanus

68
Q

What is the only infectious disease that has been completely eradicated from the world?

A

small pox! thru vaccines!

69
Q

What are some programs that have helped the US keep high vaccine rates?

A

FDA role in licensure of vaccines to keep them safe
National Childhood Vaccine Injury Act
National Vaccine Injury Compensation Program (take burden off of vaccine manufacturers to keep their incentive alive)
Vaccine Adverse Event Reporting System

70
Q

To improve access to vaccines, the CDC has 2 grant programs that funded over 50% of vaccines in 2000. What are they?

A

Vaccine for Children (VFC)

317 funding program to individual states

71
Q

How did the school vaccination laws develop?

A

1850 in Massachusetts–small pox, required in schools
1960-measles outbreaks, required
1980-all states have laws covering students entering schools

72
Q

T/F Proof of immunity is required for access to licensed day cares.

A

True.

73
Q

What about those kids who want to go to school & have reasons that they can’t take vaccines?

A

Legitimate Reasons: reaction to vaccines, immunocompromised

They are allowed to go to school, but if there is an outbreak, they are asked to leave so they don’t get sick.

74
Q

What is the constitutional basis for vaccine mandates?

A

rests in the police powers of the states
Jacobson v. Massachusetts: upheld rights of states to compel vaccination
Police powers reserve rights to protect the public health & safety

75
Q

Which school vaccine law was dealt with in 1922 in the supreme court?

A

Zucht v. King
denied a 14th amendment challenge to the constitutionality of excluding children from school attendance for failure to vaccinate

76
Q

What is the doctrine of parens patriae & how does it apply to vaccines?

A

state asserts authority over child welfare

rights of kids & religion & parents aren’t without limit

77
Q

What are the exemptions that states allow for vaccine laws?

A 
all states for medical reasons
48 states for religious reasons
15-philosophic exemption
NV-religious exemption
CA-religious & philosophic exemption

Block 6; Week 4-Michelle (5 decks)

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