W13 Respiratory Vaccines: Check Chu Hints

Question 1

Polysaccharide vs conjugate
Which has stimulates a stronger response?
Examples of conjugate vaccines? 4

Answer 1

● Polysaccharide vaccine (PSV):
○ Use of bacterial capsular polysaccharides to trigger the immune response, limited ability to activate T cells
○ Example: PPSV23 (pneumonia)
● Conjugate vaccine (CV), aka adjuvant):
○ Links the bacterial polysaccharide (a weak antigen) to a strong protein antigen that facilitates loading onto the MHC of antigen presenting cells
○ Enhances T cell activation and stimulates an immune response that is stronger and longer-lasting (via memory B cells)
○ Examples of conjugate vaccines:
—PCV20 (pneumonia, conjugated to a diphtheria toxin)
—PCV15
—Hib (haemophilus b, conjugated to a tetanus toxoid)
—FLUAD Quadrivalent (influenza)

Question 2

Pneumococcal
Immunity against?
Prevents which two diseases?
Precautions

Answer 2

● ⭐️Immunity against Streptococcus pneumoniae ⭐️
● Goal: prevent CAP, bacteremia, and serious invasive pneumococcal disease
● Contraindications:
—severe allergic reactions to any vaccine component; for the PCVs, reaction to any diphtheria-toxoid-containing vaccine (nontoxic variant of diphtheria toxin is used as the conjugate)
● Precautions:
—moderate or severe acute illness, with or without fever

Question 3

Adults > 65 y/o
⭐️ What is the complete pneumococcal vaccine schedule?

Answer 3

⭐️ Dr Chu:Most important is knowing who is eligible for this vaccine. Know population groups

Question 4

Pneumococcal adults 19-24y/o
W/ cochlear implant or CSF leak

Answer 4

Don’t think this needs to be memorised
FYI

Question 5

Influenza/flu
Recommended for who?
Precautions? 2

Answer 5

● Components change annually based on prior season, circulating subtypes, etc.
● ⭐️Recommended annually for all persons aged ≥ 6 mo ⭐️
● Contraindications: severe allergic reaction to any vaccine component
● Precautions:
—moderate or severe acute illness
—h/o Guillain-Barré syndrome (GBS) within 6 wks after any type of influenza vaccine

Question 6

Influenza vaccine options

Answer 6

Flumist = do not use with i/c patients
Note for the elderly
Egg free ones

Question 7

COVID-19
Which vaccines
Which rare ADRs

Answer 7

● Four COVID-19 vaccines approved/authorized in the US: (How COVID-19 Vaccines Work)
○ Pfizer-BioNTech (mRNA)
○ Moderna (mRNA)
○ Novavax (protein subunit vaccine)
○ J&J (viral vector vaccine; if had a severe reaction after an mRNA vaccine dose or severe allergy to ingredient of Pfizer or Moderna mRNA vaccines; unable to access Pfizer, Moderna or Novavax vaccines; wants to receive J&J despite safety concerns; is 18 yrs+)

● Adverse effects:
○ Anaphylaxis → rare
○ Thrombosis with TTS after J&J → rare
○ GB after J&J → rare
○ Myocarditis (primarily after Pfizer or Moderna) → rare

Question 8

COVID-19
What is “up to date”
What if you’ve had COVID, how long do you delay a vax?

Answer 8

● “Updated boosters” protect against both the original virus that causes COVID-19 and Omicron variants BA.4 and BA.5 (Pfizer and Moderna)
● You are up to date with your COVID vaccine if you have completed your primary series and have received the most recent booster dose recommended by the CDC
● If you have had COVID-19:
○ You still need to stay up to date with vaccines, but may delay 3 months from sx onset or first positive test
○ You may mix boosters, but do not mix products for your primary dose series

Question 9

COVID vaccine schedule
Pfizer

Answer 9

Question 10

COVID vaccine schedule: Moderna

Answer 10

Question 11

COVID vaccine schedule: J&J

Answer 11

Question 12

COVID vaccine schedule: Novavax

Answer 12

Question 13

Pertussis/whooping cough
Recommended for which populations? (3)
Available in which combo?

Answer 13

● Recommended for all, but especially for:
○ Preteens age 11-12
○ 3rd trimester pregnancy
○ COPD and other comorbidities/risk factors
● Only available in combination with tetanus and diphtheria, via
—DTaP (series for children < 7 yo)
—Tdap (older children and adults)

Question 14

Pertussis recommendations by age

Answer 14

● Birth through 6 yrs: DTaP at 2, 4, and 6 mo, at 15 through 18 mo, and at 4 through 6 yrs
● 7-10 yrs: single dose of Tdap for those not fully vaccinated, or additional doses per catch-up schedule
● 11-18 yrs: Tdap single dose (preferably 11-12 yrs) OR follow catch-up schedule if not fully vaccinated as child
● 19 yrs +: anyone who has never received a dose of Tdap should get one as soon as feasible, followed by a Td or Tdap shot every 10 years
● Pregnant women: should get a dose of Tdap during each pregnancy, especially weeks 27-36 → provides maternal pertussis antibodies to newborn

Question 15

Haemophilus B
Which ages?
For which adults? 2
Dose?

Answer 15

● Recommended for all children from 6 weeks to 5 years old, has mostly eradicated pediatric meningitis due to Hib
● In older children or adults, typically only recommended in asplenia or in recipients of hematopoietic stem cell transplant (Hib - encapsulated bacterium)
● 3 doses recommended in HSCT recipients