Week 3 Flashcards
dfine immunizarion
process of infucing/ providing immunity artificially by administering an immonobiologic agent
can be done passively or actively
passive immunity:
ex: IG
palivizumab
provides temporary immunity in an unimmunized person prior to or after exposure to an infectious disease
active immunity:
ex: vaccines
categories of vaccines
live attenuated
MMR
rubella
varicella
rotavirus
LAIV ingluenza
polio (OPV)
zoster (ZVL)
categories of vaccines
toxoids
diptheria
tetanus
categories of vaccines
inactivated
hepatitis A
influenza IIV
pertusis
polio (IPV)
categories of cvaccines
recombinnant
Hep B
HPV
RZV
categories of vaccines
conjugated/ polysaccharide
Hib
meningococcal
pneumococcal
ultimate goal of vaccines
eradification
guidelines for spacing of live and inactivated vaccines
> 2 inactivated: can be given at same time or at any interval between doses
inactiated + live: can be given at same time or anytime
> /2 live parenteral: 28 day min interval, if not administered simultaneously
not vaccinating on schedule consequences
too soon: reduce antibody response
too late: delayed protection
vaccine dose adminstered >5 days before the minimum dosing intervalor age should not be counted as valid doses and should be repeated as age appropriate
when should immunization be avoided
mod-severe illnedd
hx of typ1 anaphylaxis ANA
immunodeficiencies apples to live attenuated vaccines) leukemia, malignancy, hiv, chemo, redioation, prednisone
vaccination and pregnancy
live atewnnuated vaccine CI
recommended: influenze LIV, Tdap, covid 19
vaccine interactions
chemo/radiation (live virus vaccines)
vaccinate 2 weeks b4 or 3 mo after
systemic coticosteroids (live virus vaccines)
*high dose treatment for an extended duration >/2 mg/kg/d or >/20 mg/d prednison for >/14 days
when is it ok to vaccinate child during CTS trt
topical therapy or local injections
physiologic maintenance theraoy
low/mod systemic cts daily or on alternate days
when is it okay to vaccinate following cts treatment
high dose of systemic cts (2mg/kg) giben orally or on alternate days for fewer than 14 days. canvaccinate immediately following d/c or wait~2 eeks (14 days
high doses of systemic coticosteroids (2mg/kg) given daily or on alternate days for 14 days or more. must wait >1 month to vaccinate
ivig effects on vaccination
ivig should not be admin for 14 days after immunization.
if needed in <14 days, need to readminster vaccine
post ivig, vaccine shouls not be given <3 months post ivig. following high dose ivig fo rtrt of kawasaki disease, hold live vaccines for 11 months
ppd and live vaccines
live vaccines can supress tb skin tests
must be given simultaneously or wait 4-6 weeks to place ppd
antivirals and vaccination
may decrease effectiveneess of LAIV
avoid use 14 days after LAIV
inactivated and activated vaccine SS
inactivated
injectin site reactions w. or w.o fever
inflammtory reponse
welling redness pain
sq>im
activates: mild form of natural illness, tiredness
vaccine myths
diseases that vaccines prevent are not serious
Vaccine overview
Disease(s) covered:
diptheria, tetanus, pertussis
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Disease(s) covered:
a. Diptheria
b.Tetanus
c) Pertussis
Etiology:
a: corynebacterium diptheriae
b. Clostridium tetani (ubiquitous): causes muscle regidity and spasms.
c)Bordetella pertusis: whooping cough- very contagious
Vaccine(s) available):
1. DTap (infanrix, Daptacel) : use in children
2.Tdap (Adacel, Boostrix)
3. Td Tenivac, Tdvax)
4. DTAP+IPV (kinrix)
5.DTap +IPV+Hib (Pentacel)
6.DTap+IPV +HebB (pediarix)
7. DTaP+IPV+Hib+Heb B (Vaxelis
Vaccine Schedule:
DTap: 5 doses
*2,4,6 months
*15-18 months
*4-6 years
Tdap: 1 dose@11-12 y.o
followed by Tdap or Td booster q10 years and during every pregnancy regardless of when the most recent dose was given
Adverse effects:
local reaCTIONS(redness, swelling, pain
fever
Vaccine precautions:
hx of arthus type hy[ersensitivity reactions
unstanle progressive neurologic problem/uncontrolled seizures
Contraindications:
severe allergic reaction
hx of encephalopathy
Vaccine overview
Disease(s) covered: Haemohpalus influenze type B
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Disease(s) covered:
Haemophilus influenzae type B
Etiology: most common cause of childhood bacterial meningitis pre -vaccination
Vaccine(s) available):
Hib:( ActiHib, Hiberix, Pedvax Hib)
DTap +IPV+Hib (Pentacel)
DTaP+IPV+Hib+Heb B (Vaxelis
Vaccine Schedule:
2months, 4 months, and 12 -15 months (6 mo dose permissible if combo vaccine is used)
Also recommended for: high risk pts >12-15 mo old recieving chemo/radiation, immunodeficient, asplenia (including sicklecell)
Adverse effects:
local reactions, fever
Vaccine precautions: –
Contraindications: severe alergic reactions
Vaccine overview
Disease(s) covered: Hep A
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Disease(s) covered: HEp A
Etiology:
Vaccine(s) available):
HVA:Havrix, Vaqta
HVA+HVB: Twinrix
Vaccine Schedule:
HVA vaccine: all children 12-23 month
2 doses given months apart.
*can be given from 6-12 months if in high risk group
HVA+HVB: >/18 y.o high risk groups. 3-4 dose series (high risk groups such as chronic liver disease, clotting factor disease, MWHSWM injection or non injection drug use, homelessness, work w. ppl w. HVA, internatinal travel)
Also recommended for:
Adverse effects: injection stie sorenss and headache
Vaccine precautions:
Contraindications: severe allergy
Vaccine overview
Disease(s) covered: HBV
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Disease(s) covered: HBV
Etiology:
Vaccine(s) available):
Hep b: recombivax HB,Engerix-B
6.DTap+IPV +HebB (pediarix)
DTaP+IPV+Hib+Heb B (Vaxelis)
HVA+HVB: Twinrix
Vaccine Schedule:
3 doses
I.at birth (based on cdc recommendations)
II.1-2 months
III.6-18 months
Also recommended for:
Adverse effects: local pain, fatigue, low grade fever
Vaccine precautions:
Contraindications: severe allergic reactino
when to give Hep B based on maternal hep b status
Maternal sttaus negative:
>/2 kg: vaccine only w.in 24 hours of birth
</2: admin at 1 month or at baby discharge
Maternal sttaus unkown:
>/2 kg: vaccine only w.in 12 hours of birth
</2: vaccine AND HBIG within 12 hours at birth, then 3 additional doses starting at 1 mo
Maternal sttaus positive:
>/2 kg: vaccine and HBIG w.in 12 hours
</2: vaccine and HBIG w. in 12 hrs of birth, then 3 additional doses starting at 1 month
also note: when mom is hbv positive, baby should be tested at 9-12 months
Vaccine overview
Disease(s) covered: HPVV
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Disease(s) covered: HBV
Etiology: most common std in us causing genital warts. can cause cancer
Vaccine(s) available):
HPV: Gardisil 9
Vaccine Schedule:
if started 9-14: 2 dose series 6-12 months between eachother
>15: 3 dose series, first dose 1-2 months after 1st, then 6 months after second
Also recommended for:
Adverse effects: well tollerated
Vaccine precautions: pregnancy
Contraindications: hypersensitivity
Vaccine overview
Influenza type A and B
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Disease(s) covered: HBV
Etiology:
Vaccine(s) available):
trivalent (protect against 2 strains of type a and 1 strain of type b
quadrivalent: cover for 2-A strains a 2 b strains
inactivated vaccines that can be used in >6 mo: afluria, fluarix, flulaval, fluzone
Flumist: LAIV: age 2-49
Vaccine Schedule:
IIV: 6 months and older annually
LAIV: 2-49 y.o annually
NOTE: pts. <9 y.o who are receiving their first lifetime dosecan recieve flu vaccine in 1-2 doses seperated by 4 weekss
dose: 6-35 mo. .25-0.5 mL IM in one or 2 dose
3-8 years: 0.5 mL IM
>/9: 0.5 ML one dose
Also recommended for:
Adverse effects:
IIV: local reactions
LAIV: rhinorrhea
Vaccine precautions:
IIV/LAIV: history of GBS w.in 6 weeks of previous vaccination
LAIV: asthma >5 y.o; underlying medical conditions that increase influenza related complications; mod-severe illness.. other
Contraindications
vaccine allergy
LAIV: <2 y.o, adults >/50, pregnancy, healthcare workers that provide care to immunocompromised pts, asplenia, children 2-4 w. asthma or h/o wheezing in past 12 months
note: EGG ALLERGY NOT CI TO INFLUENZA VACCINATION
Vaccine overview
Diseases covered: MMR
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Diseases covered:
a) measles
b)mumps
c)rubella
Etiology:
a) rash, flat red spots.
b)rash
c)”german measles” congential rubella syndrome
Vaccine(s) available):
MMR
Proquad (MMR+V)
Vaccine Schedule:
2 doses:
1 @12 months
2@ 4-6 years
Pearl: admin pearl: for proquad. dose 1 of MMR+V can be adminstered as seperate vaccinations
if traveling to an area with measles
age 6-12 months: give b4 travel
>/12 months: give 2 doses of mmr >/4 weeks to travel
THESE DO NOT COUNT AS ONE OF THE SCHEDULED REG DOSES OF MMR
mups outbreaks: 3rd dose of mmr recommended
Adverse effects:
fever, rash, febrile seizures in pts who took MMRV vaccine
Vaccine precautions:
Contraindications
hypersensitivity
pregnancy
immunosupression
postpone vacination 1 mo following d/c og high dose CTS >/14 days
postpone vaccination several months after IVIG
Vaccine overview
varicella
Etiology:
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
Etiology: chicken pox
Vaccine(s) available):
Varivax
Proquad MMR+V
Vaccine Schedule:
2 doses:
1@12 mo
2@4-6 years
Also recommended for:
Adverse effects:
maculopapular rash
injection site reactions
fever
transmission of varicella
Vaccine precautions:
avoid use of antivirals 14 days after vaccination if possible
Contraindications
pregnancy
immunosupression
postpone vaccination 1 month after high dose cts >/14 days
posptpone vaccination several months after ivig
Meningococcus
available
schedule
menvea>/2 mo
Menactra >/9 months
schedule:2 doses
i1@11-12 doses: booster at 16
if dose 1 given at 13-15, booster at 16-18
if dose 1 given at >16: no booster needed
vaccination also recommended in immunocompromised, sicklecell,
meningococcal b vaccines not for routine use. can use in high risk pts
vaacine vaccine interactions:
menactra and PCV13: admin after 4 weeks of completion of pcv13
menactra and dtap: admin menactra before or concaminantly w.dtap
no interactions with manveo
Vaccine overview
Etiology: INVASIVE PNEU OCOCCUS
Vaccine(s) available):
Vaccine Schedule:
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
Vaccine overview
invasive pneumococcus
Etiology:
Vaccine(s) available):
Prevnar (PCV13): conjugate vaccine
pneumovax: polysaccharide vaccine
Vaccine Schedule:
2,4,6, months, then 12-16 months
also pts w. high risk conditions
also giver to immunocompromised,
Also recommended for:
Adverse effects:
Vaccine precautions:
Contraindications
pneumococcal vaccinairion in high risk pts age 2-5
determine if pcv13 series finished.
yes: and recieved 1 dose of ppsv23: no further interventin
not complete:
a) h/o 3 doses: give 1 dose of ppcv13 8 weeks apart, then 1 dose of ppsv23
b)h/o<3 doses: 2 doses pcv13 >8 weeks apart
—– then determine if they recieved ppsv23
if yes: no further intervention
if not: look at risk factors:
chd, cld, dm, csf leak, cochlear implant, high dose corticosteroids… give 1 dose of ppsv23
if immunocompromised: give 1 dose of ppsv23 >8 weeks after pcv13and then 2nd dose 5 years later
pneumoccoal vaccine in high risk pts ages 6-18 months
chd, cld dm: recieve ppsv23 after pcv13
csf, cochlear implant: need 1 dose of pcv13 , 1 dose of ppsv23 8 weeks later
immunocompromised, and crf: need 1 dose pcv13 and 2 doses ppsv23 ( 1 8 weeks after , then 5 years later)
poliomyolitis vaccine schedule
available vaccines:
IPV : IPV( IPOL)
4. DTAP+IPV (kinrix)
5.DTap +IPV+Hib (Pentacel)
6.DTap+IPV +HebB (pediarix)
7. DTaP+IPV+Hib+Heb B (Vaxelis
schedule:
2 months
4 months
6-18 months
4-6 years
CI: polymyxin, neomycin
rota virus:
LAIV:
rotateq:
rotarix:
schedule:
rotarix: 2.4 months
rotateq: 2,4,6 mo
MUST BEGIN B4 15 WEEKS: do not start if >/15 weeks
MUST COMPLETE BY 8 MONTHS, 0 days
pt should recieve same brand. if not available and any dose of the series was rotateq, default should be 3 doses
CI: LATEX ALLERGY w. roatrix
SCID
HX OF INTUSSICEPTION (folding of bowel)
covid vaccination
recommended in all children and adolescencts >6 mo
pfizer and moderna
novavaz: >12 years old
3 dose series with 3rd dose being bivalent
storage of pfizer: stored in ultracold freezer
moderna: cold freezer
AE: pain, fever, fatigue and sleepiness, irritability and crying
covid vaccine color caps
bivalent for children 12-17.
pfizer: grey cap
moderna: blue cap/ grey label
bivalent for 6-11 years
pfizer: orange cap
moderna: blue cap grey label
bivalent for 6mo-4 years:
pfizer: maroon cap
moderna: dark pink cap yellow label
dehydration in peds
intake of fluid less than loss of fluids
causes of dehydration
fever
GI losses: viral Gastroenteritis
bacterial/parasitic infections
DKA
etc.
sweating/heat/burns
polyurica DKA
does dehydratin occur more quicikly in neonayes/infants or adults
neonates
degree of dehydration:
mild
percent
pulse:BP
UO
mucose
skin tueger
mild:
infants: 1-5%
older children: 1-3%
generally normal SS with decreased UO and slightly dry mucosa
moderate:
infants: 6-9%
4-6%
tachycardia, normal to low bp, little to no output (<1 ml/kg), dry and sukin appearance, thirsty. cool skin
severe: infants: >10 (>15% shock)
older children>6 %: >9% shock
rapid and weak pulse
oligouria «1mL/kg/hr
how to calculate severeity of dehydration
preilness weight-illness weight / preillness weight
treatment strategies for fluids
mild-mod
mild-mod
oral rehydratino therapy
*50ml/kg over 4 hr
mod: 100 ml/kg
add 10ml/kg fpr each loose stool/ vomiting
trt strategy for severe =
IVF
phase 1: intial replacement
*IVF bolud
10-20 ml/kg/dose of NS or LR over 30-60 min repeated up to x3
phase 1: miaintenance
*first 8 hours: calculate deficit
next 16 hours: calculate and provide maintenance rae
building an ivf bag
- sodium: must be included to avoid hyponatremia, sodium shifts: ns
- dextrose: d5w
- potassium: standard conc 20meq/L (dont use if concernfor renal impairment)
additonal electrolytes: mag, phosphate, calcium
negative ions: standard Chloride
maintenance rate for IVF
wieght: < 10 kg: 4mL/kg/hr
10-20: 4 ml/kg/hr +2ml/kg/hr
>20 kg: 60 ml/hr+1ml/kg/hrx (weight-20kg)
outpt trt of gastroenteritis in children
ondansentron:
use in pts >6 months of age
probiotics: help reestablish normal intestinal flora
zinc:replace nutrient defriciency if that were cause: dose expressed in elemental zinc
Methods to assess adequate nutrition
Weight
Length (or height)
failure to thrive
wiehgt for age <5th percentile on multiple occasions
breastmilk nutritional content
20kcal/oz
breastfeeding recommended w.in first6 mo of life
itamin-mineral supplementation
vit. D
fluoride: >6 months 0.5mg/day
iron: start at 4 months
diet of peds:
solids starts 4-6 months of age
toddlers: regular diet
GER
tratment: nonpharm: supine position, small voluume of food mroe frequently
us ehigher caloric density formula
GERDS in peds
trial of acid supressin not recommended in dx of GERD
TRT: lifestyle modifications
pharm:
H2RAs: maintnenance for mild gerd
ae: tolerance
PPIs: maintenance for mild-severe
mor pptent: cyp polymorphisms: change sin cyp2c19 and 3a4. more metabolism , so children need more frequent dosing
prokinetic agents (metaclopromide etc.
antacids prn
