Week 3 Immunizations Flashcards
Passive Immunization and when its useful
- Immunoglobulons like Palivizumab
- temporary immunity prior to or after exposure
- use when active immunization not available (RSV) or when a vaccine was not admin before exposure (rabies)
what is active immunization and its moa
vaccines; they contain antigens that are recognized by body’s immune system causing an immune response. Activating T cells or B cells. B cells cause antibody formation which attack antigens. Memory B and T cells are formed.
primary vs secondary response to vaccination
- Primary is in response to vacc, slow and not as strong
- Secondary is in response to infection that vaccine had antigens of, more rapid and stronger
Immediate vs Ultimate goal of vacc
Immediate: prevention
Ultimate: Eradication ex smallpox
live vaccines
Influenza (LAIV)
Measles
Mumps
Polio
Varicella
Rubella
Rotavirus
(I’M Probably Very Right)
4 Inactivated Vaccines
Hep A
Influenza (IIV)
Pertussis
Polio (IPV)
(HIPPA)
Recombinant vaccines
Hep B
HPV
RSV
Zoster (RZV)
Novavax
veryvery very bright
2 Toxoid Vaccines
Diphtheria
Tetanus
3 conjugated/ polysaccharide
Hib
Meningococcal
Pneumococcal
Pediarix components
Dtap + IPV+ Hep B
- dec vaccine load
Vaxelis components
DTap+ IPV+ Hib + Hep B
Pentacel and clinical pearl
Dtap + IPV + Hib
- dec vaccine load= dec aes
when is it appropriate to have gap between vaccines
with 2 or more live vaccines, 28 day minimum interval if not given at the same time
Cons of decreasing vs increasing interval between vaccines
- decreasing can reduce antibody response/ protection
- increasing can delay protection *give at next visit do not restart series
when do we not count vaccine as valid dose and repeat it
When vacc admin 5 or more days before the minimum dosing interval or age
when should we avoid/ postpone immunization
- pts with mod to severe illness
- Hx of anaphylaxis to vacc or its components
- avoid live vaccines in certain immunodeficiencies (luekemia, lymphoma, cancer, radiation, HIV, prednisone)
- in pregnancy LIVE vaccines CONTRAINDICATED, inactivated okay in 2nd tri
Pregnancy vaccinations; recommended and contraindicated
Recommended cocooning effect
- Inactivated Influenza
- Tdap
- covid
- rsv
CI
- live vaccines
*HPV not recommended
*no evidence that vacc cause fertility problems
Chemotherapy and Live vaccines
vaccinate 2 weeks before OR 3 months after treatment
Corticosteroids and Live vaccines
High dose: >2mg/kg/d or >20mg/d pred for 14 or more days
wait one month
When is it okay to vaccinate children during corticosteroid therapy
- topical therapy or local injections
- physiologic maintenance therapy
- low/mod dose systemic corticosteroids
When is it okay to vaccinate children after corticosteroid therapy
- high dose corticosteroids less than 14 days; vacc immediately or wait 2 weeks
- high dose corticosteroids 14/more; must wait 1 month to vacc
Immune globulin w/ live vaccines
- live vaccine should be admin 14 days b/f immoglubulin. if IVIG given b/f must revaccinate
- do not give live vaccine <3 months after immunoglobulin
PPD testing w/ live vaccines
Give at same time or wait 4-6 weeks to place PPD
adverse effect of live vacc
mild form of the natural illness
vaccines available as SQ
MMR
Varicella
PPV23
Polio
Meninogoccocal
zooster
SQ sites infants vs 1yo and older
infants : thigh
>1 : upper outer triceps
45 deg
IM sites
<3 yrs : anterolateral thigh
>3 years: deltoid
BUTT not useful= inadequate immune response/ risk of injury
Intranasal
do not redose if pt sneezes
oral vaccine options
Oral polio (OPV)
- if pt vomits w/in 10 minutes REDOSE
Rotavirus
- pt vomits do not redose
4 Vaccine Myths
- Lack of appreciation for/fear of the severity of these disease
- false sense of security
- lack appreciation for the benefits of vacc, think they are ineffective
- certain/all vaccines are not worth the risk
parental perspectives on vaccines
- painful for child to receive multiple shots during single visit
- too many in first 2 years of life
- may cause learning disabilities
Diphtheria occurence/severity
Infection most common and severe in non/incompletely immunized individuals
Tetanus what is it and Risk factors
- Toxin binds in CNS leads muscle rigidity/spasms, 30% fatality
-RF: Puncture wounds, IV drug use
Pertussis
Whooping Cough *extremely contagious
50% of hospitalizations in infants
Pertussis Stages
Stage 1- catarrhal stage; last 1-2 weeks very contagious
Stage 2 - Paroxysmal Stage lasts 1-6 weeks; fits of rapid coughing with whoop sound
Stage 3 - Convalescent Stage last 2-3 weeks; gradual recovery
Routine immunization Diph/Tetanus
<7= DTap or DT
7 and up= TD
11 and up= Tdap
Boosters Diph/Tet/Pret
- Diph every 10 years
- Tetanus every 10 years if no inury, every 5 years if at risk, and severe injury 1 year after last dose
- Pert give 1+ booster dose following DTaP series
Pregnancy Tdap every preg
Hib Vaccine high risk patients
Chemotherapy/Radiation
Immunodeficiency
Asplenia (sickle- cell disease)
Hep A formulations and indications
Havrix, Vaqta
- universal admin to all children 12-23 months
- 2 dose series
Twinrix (HAV+HBV)
- for 18 and older
- 3-4 dose series
Hep A vacc for high risk groups
International travel
male male sex
clotting disorders
chronic liver disease
drug use
Hep B maternal HBAG status
determines vaccination schedule of infants
- including weight and if mother is positive, unknown or neg
- child is premature and mother ststus unknow or positive give IVIG w/in 12 hrs with 3 additional vaccine doses
- child is >2kg and mother neg: vaccine in 24 and follow regular doing schedule
HPV Gardasil; complication, indication, schedule, AE,
- major complication: cervical cancer
- Indicated in females and males 9-45 yo to prevent cancer and genital warts
- 2 dose series for 9-14 yo; now then 6-12 mon later
- 3 dose series for 15 and up OR immunocompromised; now, 1-2 mon, 6 mon
- AE: fever, syncope
antigenic drift
gradual changes in protein due to mutations, substitutions and deletions
Antigenic shift
drastic protein changes in hemagglutinin or neuraminidase. causes epidemic and pandemics
IIV who eligible, doses, AE
6 months and older; 1-2 doses
- 2 doses if 1st lifetime dose or if <9 yo with 2 or less doses, separate by 4 weeks
- ae local rxns
LAIV who is eligible, AE, CI
2 years- 49 years
- AE: rhinorrhea
- CI: Childen <2, adults >50, pregnancy, child 2-4 with asthma or hx of wheezing, on aspirin, has csf leaks
MMR pearl and special situations
Immunity life long
- International travel; pt 6-12 get 1 dose (doesnt count as schedule), >12mons receive 2 doses prior to travel
Varicella primary infection and dosing schedule
- chickenpox
- <13 yo 2 doses >3 months apart s
->13 yo 2 doses >4 weeks apart
pneumococcus vaccines
pcv15 and pcv20 are conjugated, good for <2 years
pcv23 broader coverage; recommended for high risk children >2 yos
covid 19 complications
- Multisystem inflammatory syndrome in children (MIS-C) RARE
- Diabetes
- Myocarditis 5-18yo
Latex allergy contraindication
Rotarix (2 dose)
which vaccines are sensitive to light
ProQuad
reconstituted MMR
zooster
LAIV
Novavax
antiviral agents and live vaccines
if treated w/in 48 hrs to live vaccine wait 14 days a/f vacc to start antiviral again
Proquad AE
febrille seizures
Covid 19 options for 6 mon-4 yo including colors, doses and se
moderna 2 doses- dark blue/green
pfizer 3 doses- yellow
ae- inj site rxn and fever
Covid 19 options for 5yo-11 yo including colors, doses, and se
moderna 1 dose- dark glue/green
pzifer 1 dose- blue cap
ae- inj site, fatigue
Covid 19 options for 12 yo+ including colors, doses and se
Moderna 1 dose - blue/blue
Pzifer 1 dose- grey
novavax 2 doses- blue/blue
