Week 8 Flashcards
how is immunity developed?
- as a response to protect the body from attacks by foreign antigens, typically proteins
what are different kinds of immunity? (4)
- innate (natural/native)
- acquired
- resistance
- herd immunity (community)
what is innate immunity? what type of response does it provide?
- immunity present at birth
- provides a nonspecific response
what is acquired immunity?
- immunity protection gained after birth
what is active acquired immunity
- develops after the introduction of a foreign antigen resulting in the formation of antibodies or sensitized T lymphocytes
what is artifical active acquired immunity
- exposure due to immunization
what is passive acquired immunity
- intro of preformed antibodies such as transfusion of antibodies
- or passed from mother to fetus
what is resistance immunity
- the ability to limit pathogen burden
what is herd immunity
- the resistance of a group to invasion and spread of an infectious agent, based on high proportion of individual members of the group being resistant to infection
- ie. if a sufficient proportion of a group is vaccinated, both vaccinated and unvaccinated are protected from the disease
for the guideline “immunization services should be readily available”, how is this relevant to CHN? to acute care nurse?
- CHN: decrease barriers (ex. opening hours)
- acute care nurse: give vaccines at access points to care
for the guideline “vaccine providers should facilitate timely receipt of vaccine & eliminate unnecessary prepreqs to the receipt of vaccines”, how is this relevant to CHN? to acute care nurse?
- CHN: appointment only is a barrier
- ACN: no written order should be necessary
for the guideline “vaccine providers should use all clinical opportunities to screen for needed vaccines and to administer all vaccine doses for which a vaccine recipient is eligible at the time of each visit”, how is this relevant to CHN? to acute care nurse?
- CHN: always go over vaccine status (ie. during home visits)
- ACN: we should be allowed to check if someone is up to date on vaccination in clinical settings
for the guideline “vaccine providers should communicate current knowledge about immunization using an evidence based approach”, how is this relevant to CHN? to acute care nurse?
- CHN & ACN: evidence informed communication
for the guideline “vaccine providers should inform vaccine recipients and parents in specific terms about the risks and benefits of vaccines that they or their children are to receive”, how is this relevant to CHN? to acute care nurse?
- CHN and ACN: evidence informed communication
for the guideline “vaccine providers should ensure that all vaccinations are accurately and completed recorded”, how is this relevant to CHN? to acute care nurse?
- CHN and ACN: record appropriately
for the guideline “vaccine providers should maintain easily retriveable summaries of immunization records to facilitate age-appropriate vaccination”, how is this relevant to CHN? to acute care nurse?
- CHN and ACN: document
for the guideline “vaccine providers should report clinically significant adverse events following immunization promptly, accurately, and completely”, how is this relevant to CHN? to acute care nurse?
- CHN: report adverse events promptly, analyze, and evaluate
- ACN: report adverse events promptly
for the guideline “vaccine providers should report all cases of vaccine preventable diseases as required under provincial or territorial legislation”, how is this relevant to CHN? to acute care nurse?
- CHN : report all cases, keep an eye on epidemiological data, advocate for vaccination services
- ACN: report
for the guideline “vaccine providers should adhere to appropriate procedures for the storage and handling of immunizing agents”, how is this relevant to CHN? to acute care nurse?
- CHN: keep eye on storage chain
- ACN: check lot number, etc.
for the guideline “vaccine providers should maintain up to date, easily retrievable immunization protocols at all locations where vaccines are administered”, how is this relevant to CHN? to acute care nurse?
- CHN: create protocols, know where they are
- ACN: know where protocols are
for the guideline “vaccine providers should be properly trained and maintain ongoing education regarding current immunization recommendations”, how is this relevant to CHN? to acute care nurse?
- CHN: train and keep up to date
- ACN: train
for the guideline “immunization errors and immunization related incidents should be reported by vaccine providers to their local jurisdiction”, how is this relevant to CHN? to acute care nurse?
- CHN: report errors, analyze
- ACN: report errors
for the guideline “vaccine providers should operate an immunization tracking system”, how is this relevant to CHN? to acute care nurse?
- CHN: track
for the guideline “audits should be conducted in all immunization services to assess the quality of immunization records and the degree of immunization coverage “, how is this relevant to CHN? to acute care nurse?
- CHN: audit
what is important to overcome vaccine hesitancy
-communication
vaccine hesitancy can be caused by… (5)
- lack of understanding
- conflicting info
- mistrust of source of info
- perceived risks of serious adverse events
- lack of appreciation of the severity and incidence of the disease and sociocultural beliefs
how can communication help overcome vaccine hesitancy? (4)
- adopt a vaccine recipient-centered approach
- respect differences of opinion about immunization
- represent the risk and benefits of vaccines fairly & openly
- clearly communicate current knowledge using an evidence-based approach
what are general principles of vaccine interchangeability
- when possible, use the same manufacturer of all doses in a series
- vaccines are interchangable when authorized for the same indications, with similar schedule, same population, comparable type & quality, similar in terms of safety, reactogenicity, immunogenicity, and efficacy
should aspiration be done with immunizations?
- contraindicated as it can be painful & there are no large blood vessels at the recommended immunization sites
how are vaccines handled/stored?
- cold chain during transport, stroage, and handling (this is monitored)
age recommendations for vaccines are based on…
- when the risk of the disease is the highest and for which vaccine safety & efficacy has been demonstrated
vaccine doses given before the recommended age may lead to…
- less than optimal immune response
can more than one vaccine be given at the same time?
- yes , especially when these vaccines are inactivated
- with site rotation, live vaccines can be given together with other injection vaccines
if live vaccines are not given at the same time, live vaccines should be given at least __ weeks apart
- 4 weeks apart
what has been found to interfere w effectiveness of parental live vaccines?
- blood products
- human immune globulin
vaccines should be adminstered ____ before admin of blood products & human immune globulin
14 days prior , but preferably months
who recommends vaccine schedules?
- canada recommends but provinces and territories can determent the best schedule for their region
describe the prep of single dose vials
- can be reconstituted or drawn up immediately before admin
describe the prep of multidose vials
- can be reconstituted & marked with date & time
vaccines should be stored at what temps?
+2 to +8 degrees
- and based on manufacturer guidelines
when should vaccines be removed from fridge?
- only when using
when are vaccines discarded?
- discarded within a manufacturer set time frame
what does a missed appointment/interrupted vaccine doses mean?
- in general, does not require restarting of the series
- schedules can be delayed or accelerated and full immunization can still be achieved
what does CARD stand for?
Comfort
Ask
Relax
Distract
what is CARD?
- an evidence based framework that teaches how to prepare for vaccination
what are the benefits of CARD (3)
- reduces stress-related reactions (such as fear, pain, dizziness, and fainting during vaccination)
- improves the vaccination experience for people receiving a vaccine and for those who support them (ex. parents, HCP, educators)
- teaches lifelong coping skills that can be used for other stressful situations
what organism causes diphtheria?
cornebacterium diptheria
what is the mode of transmission for diphtheria
- direct contact
- indirect contact
what is the incubation period of diphtheria
- 2-5 days
what is the communicability of diphtheria for both treated & untreated
- untreated = 2 weeks to several months
- treated = 2-4 weeks
what is the reservoir for diphtheria
human carriers
what is the clinical presentation of diphtheria (6)
- greyish spots on tonsils
- sore throat
- enlarged lymph nodes
- swelling & edema of neck
- fever
- difficulty breathing
when does immunization occur for diphtheria (6)
- 2m
- 3m
- 6m
- 18m
- 4-6 yo
- every 10 years
what are complications of diphtheria (4)
- damage to heart muscles
- breathing problems
- paralysis
- 1 in 10 die (5-10%) case fatality rate
what are control measures for diphtheria (3)
- immunization
- abx
- isolation and disinfection of contact articles
what organism causes poliomyelitis?
- poliovirus, types 1, 2, and 3
what is the mode of transmission for poliomyelitis (3)
- fecal-oral contact
- contaminated food or water
- pharyngeal (during epidemics) (salivia)
what is the incubation period of poliomyelitis
3-21 days
what is the communicability for poliomyelitis
- 7-10 days after onset of symptoms –> up to 6 weeks or longer
what is the reservoir for poliomyelitis
- human carriers
what is the clinical presentation of poliomyelitis (7)
- fever
- sore throat
- drowsiness
- headache
- NV
- stiffness of neck & back, with or without flaccid paralysis
- muscle aches
what % of people are asymptomatic with poliomyelitis? minor illness for few days? viral mengingitis? flaccid paralysis?
- 90% asymptomatic
- 4-8% minor illness for few days
- 1-5% viral meningitis
- 1% flaccid paralysis
what are complications of poliomyelitis (3)
- paralysis
- death
- post-polio syndrome
what are control measures for poliomyelitis (2)
- vaccination
- isolation & disinfection of contact articles
what is the global goal for poliomyelitis
- eradication of polio
where is poliomyelitis eradicted?
- in western hemisphere in 1994, but not worldwide
what factors contributed to the re-emergence of polio in newyork
- pandemic related declines in childhood vaccinations (missed appts, delayed appts)
- vaccine hesitancy and misinformation (reinforced thru pandemic, strong anti-vaccine sentiment)
what are the 2 types of polio vaccine
- inactivated (injectable)
- oral polio vaccine (oral drops)
the inactivated polio vaccine is the vaccine of choice for…. and protects against…
- choice for routine immunization in polio-free countries
- protects against three strains of polio (1,2, and 3)
describe the production of antibodies with the inactivated polio vaccine
- produced in blood stream
describe the protection offerred by the inactivated polio vaccine
- does not fully block polioviruses from infecting the gut = people inoculated with IPV can still transmit polio
- protects the individual but not the community
what is the main tool in the global eradication of polio
- oral polio vaccine
what kind of vaccine is the oral polio vaccine
- live but weakened strains of polio (1,2,3)
describe how the oral polio vaccine works
- vaccine virus replicated and stimulates immunity in both gut & blood
the oral polio vaccine protects…
- the individual and community
what is one con with the oral polio vaccine
- cases of vaccine derived polio emerged in developing world (type 2)
- in 2016, bOPV (only strain 1 and 3) introduced… not well coordinated consequently, vaccine derived polio surged (type 2)
describe the “polio perfect storm” in new york (3)
- rockland county immunization rates = 60%
- IPV given = may allow greater transmission of virus
- vaccine derived poliovirus exposure to unvaccinated individual
describe the new york response to polio (4)
- one case signals many infections = declared “state of emergency”
- vaccination efforts in affected communities
- enhanced surveillance (waste water, reporting all vaccines given)
- US added to list of countries w circulating vaccine derived poliovirus
what organism causes pertusis
- bacteria bordetella pertussis
what is the mode of transmission of pertussis
- direct contact w resp secretions
what is the incubation period of pertussis
- 6-20 days, usually 7-10 days
what is the communicability of pertussis
- to 3 weeks after onset of paroxysmal cough, if not treated
what is the reservoir of pertussis
- humans
what is the clinical presentation of pertussis (4)
- begins with low grade fever
- runny nose
- mild cough (7-10 days)
- progresses to violent coughing & whooping which lasts up to 10 weeks
what are complications of pertussis (5)
- apnea
- seizures
- pneumonia
- 1-3 deaths in Canada yearly
- 1/400 deaths in infancy
when does immunization of pertussis occur (5)
- 2m
- 4m
- 6m
- 18m
- 14-16y
what are control measures of pertussis (3)
- immunization
- exclusion 5 days after treatment with antibiotics
- treatment of close contacts
what organism causes tetanus
- bacteria clostridium tetani
what is the mode of transmission of tetanus
- bacterial spores thru contaminated puncture wounds, burns, cuts
what is the incubation period of tetanus
- 3-21 days, average 10
what is the communicability of tetanus
- not transmitted person to person
what is the reservoir of tetanus
- soil or fornites contaminated with soil/feces
the clinical presentation of tetanus (3)
- muscle rigidity & spasm
- lockjaw
- respiratory and largyngeal spasm
what are complications of tetanus (1)? what is case fatality?
- bone fractures
- case fatality ranges from 10-90%
what are control measures of tetanus (3)
- immunization
- TIG (immunoglob)
- wound care
what organism causes haemophilus influenze
- bacteria –> H. influenza type B (hib), several types
is the mode of transmission of haemophilus influenze (3)
- droplet infection
- sneezing
- coughing
what is the incubation period of haemophilus influenze
2-4 days
what is the communicability of haemophilus influenze
1 week prior to illness & until treated
what is the reservoir of haemophilus influenze
humans
what is the clinical presentations of haemophilus influenze (8)
- sudden onset
- fever
- vomitting
- lethargy
- meningeal irritation
- otitis media
- sinusitis
- pneumonia
when does immunization of haemophilus occur (4)
- 2m
- 4m
- 6m
- between 12-23 months
what are complications of haemophilus influenze (3)
- neurological sequelae (10-15%0
- deafness (15-20%)
- case fatality rate (5%)
what are control measures for haemophilus influenze (2)
- immunization
- antibiotic prophylaxis
what organism casues meningococcal (type c)
- bacteria –> neisseria meningtides
what is the mode of transmission of meningococcal (type c) (2)
- direct contact w resp droplets
- 25% carriers
what is the incubation period of meningococcal (type c)
2-10 days
what is the communicability period of meningococcal (type c)
7 days prior to symptoms, until 24 hours of effective therapy
what is the reservoir for meningococcal (type c)
humans
what are clinical presentations of meningococcal (type c) (5)
- sudden onset
- fever
- vomitting
- stiff neck
- rash
what are complications of meningococcal (type c) (3)
- hearing loss
- amputations
- death (case fatality rate 15%)
what are control measures for meningococcal (type c) (2)
- immunization
- abx prophylaxis
what organism causes MMR (mumps)
- mumps virus
what is the mode of transmission of MMR (mumps) (2)
- droplet
- direct contact w salivia
what is the incubation period of MMR (mumps)
14-25 days
what is the communicability of MMR (mumps)
- 2 days before onset of symptoms up to 4 days after
what are symptoms of MMR (mumps) (4)
- swelling of salivary glands (usually parotid)
- fever
- aches
- sometimes aymptomactic in children
when does immunization of mumps occur
12m-18m
what are complications of MMR (mumps) (5)
- encephalitis (1-2/10000 cases)
- sterility rare
- orchitis (20-30% of postpubertal males)
- deafness
- fatality (1/10,000)
what are mumps cases in canada/year
1950s = 34,000
2004 = 32
what organism causes measles
- morbillivirus (measles virus)
what is the mode of transmission of measles (2)
- airborne by droplet spread
- direct contact with infected nasal or throat secretions
what is the incubation period of measles
7-18 days
what is the communicability of measles
- 1/2 day before onset of symptoms to 4 days after appearance of rash
what is the clinical presentation of measles (4)
- fever
- conjuctivitis
- cough
- rash beginning on face –> body
what are complications of measles (3)
- otitis media
- pneumonia
- encephalitis (1:1000 cases)
who are complications more common in with measles
- infants & adults
what is the case fatality rate of measles
2-3/1000 cases
- can be up to 30% in developing countries
what are nursing considerations for measles (3)
- immunization
- symptom relief
- isolation
what organism causes rubella
rubella virus
what is the mode of transmission of rubella (2)
- direct droplet
- congenital via placenta
what is the incubation period of rubella
14-21 days
what is the communicability of rubella
- 7 days before to 4 days after onset of rash
what are control measures for rubella (2)
- avoid contact with pregnant women
- exclude from school
what is the clinical presentation of rubella (5)
- fever
- rash
- joint pain
- lymphadenopathy
- conjuctivitis
when does immunization of rubella occur (5)
- 12m
- 18m
- childcare workers
- healthcare workers
- travellers
what are complications of rubella (10)
- congenital rubella syndrome
- cataracts, glaucoma, blindness, deafness
- malformations
- cardiac problems
- diabetes
- hypothyroidism
- hepatitis
- chronic pneumonia
- CNS defects
- encephalitis
what were rubella cases in canada/year from:
- 1971-1982
- 1998-2004
- 1971-1982 = 5300
- 1998-2004 = 30
most rubella cases now occur amongst which populations?
- those who refuse immunization
there have been no CRS cases since…
- 2006
what organism causes varicella (chicken pox)
- varicella zoster virus
what is the mode of transmission of varicella (chicken pox) (3)
- direct contact
- airborne
- household transmission amongst susceptible contact high
what is the incubation period of varicella (chicken pox)
10-21 days
what is the communicability of varicella (chicken pox)
2-5 days before onset of rash and until skin lesions have crusted
what is the clinical presentation of varicella (chicken pox) (4)
- slight fever
- maculopapular rash in trunk, face, scalp, mucous membrane of mouth
- then change to vesicular for 3-4 days
- lesions occur in successive crops
what are complications of varicella (chicken pox) (4)
- viral or bacterial pneumonia
- hemorrhagic complications
- encephalitis
- congenital varicella syndrome
who are at the greatest risk of complications from varicella (chicken pox)
- children with acute leukemia
what are control measures for varicella (chicken pox) (3)
- exclude from childcare, work, etc.
- avoid contact with immunosuppressed persons
- immunoglobulin for close contacts
what type of vaccine is the varicella (chicken pox) vaccine
- live vaccine
what can be checked for exposure to varicella (chicken pox)
- serology
what organism causes rotavirus
- viruses… several serotypes
rotavirus makes up _____% of all childhood GI illness
10-40%
what is the mode of transmission of rotavirus
fecal oral
what is the incubation period of rotavirus
18hrs - 3 days
what is the communicability of rotavirus
- viral shedding few days before onset of illness & up to 21 days after onset of symptoms
what is the reservoir of rotavirus
- humans
what is the clinical presentation of rotavirus (3)
- acute onset fever
- vomitting
- followed by 5-7 days diarrhea
what % of people see a physician, visit an ER, and are hospitalized with rotavirus
- 36% of cases see a physician
- 15% ER visit
- 7% hospitalized
what are control measures of rotavirus (3)
- immunization (syrup)
- routine practices
- antivirals
the rotavirus is only given to under…
- 8m
what causes pneumococcal pneumonia
- bacteria –> streptococcus pneumonia
what is the mode of transmission of pneumococcal pneumonia (3)
- droplet spread
- direct oral contact
- indirect contact w contaminated articles
what is the incubation period of pneumococcal pneumonia
1-3 days
what is the communability of pneumococcal pneumonia
- unknown
what are symptoms of pneumococcal pneumonia (5)
- sudden onset
- fever
- chest pain
- dyspnea
- productive cough
what are complications of pneumococcal pneumonia (3)
- pneumonia bacteremia
- meningitis
- death occurs in infants & elderly
what are control measures for pneumococcal pneumonia
- immunization
what organism causes hep B
- hepatitis B virus (HBV)
what is the mode of transmission of hep B (6)
- sexual
- perinatal
- percutaneous via blood
- serum fluids
- vaginal fluids
- carriers
what is the incubation period of hep B
45-180 days, usually 60-90 days
what is the communicability of hep B
- many weeks before onset of symptoms
- may persist for life
what is the reservoir for hep B
- humans
what is the clinical presentation of hep B in adults (4)
- nausea
- vomitting
- rash
- jaundice
what is the clinical presentation of hep B in children
- asymptomatic
what are complications of hep B (4)
- chronic hepatits
- cirrhosis
- liver failure
- liver cancer
what are control measures for hep B (3)
- immunization
- HGIB to contacts
- routine precautions to prevent blood & blood products
what organism causes human papillomavirus (HPV)
- human papillomavirus (16 & 18) (>130 types exist)
human papillomavirus (HPV) is one of the most common…
- STIs (70%)
what is the mode of transmission of human papillomavirus (HPV) (2)
- vaginal, oral, and/or anal intercourse
- skin to skin transmission
what is the incubation of human papillomavirus (HPV)
1-8 months
what is the communicability of human papillomavirus (HPV)
- active lesions
- clears with 1-2 years of infection
what is the reservoir for human papillomavirus (HPV)
- humans
what is the clinical presentation of human papillomavirus (HPV) (2)
- painless, warty growths on genital skin or mucous membrane
- may have no symptoms
what are complications of human papillomavirus (HPV)
- cervical cancer (20 year window)
what are control measxures of human papillomavirus (HPV)
- immunization
- screening for cervical cancer (pap smear)
who is eligible for the seasonal influenza vaccine
- everyone older than 6 months
high dose flu vaccine is given to..
- anyone over 65
what is the reservoir for influenza
- humans
what organism causes influenza
- influenza A, B, or C virus
what is the mode of transmission of influenza
- direct contact with resp secretions or contaminated articles
what is the incubation period of influenza
1-4 days
what is the communicability of influenza for adults vs children
- 24 hrs before onset of symptoms to 5 days (adults)
- up to 7 days children
what is the clinical presentation of influenza (6)
- sudden onset
- fever
- chills
- headache
- malaise
- cough
what is the recovery period for influenza
- 10-14 days
what are complications of influenza (4)
- pneumonia
- bronchitis
- worsening of pre-existing chronic illness
- death
what are control measures for influenza (3)
- immunization
- routine practices
- antivirals
with monkeypox, WHO declared…
- public health emergency of international concern (July 2022)
what organism causes monkeypox
- viral zoonotic infection (orthopoxvirus)
what is the reservoir for monkeypox
- rodents (dormice, striped mice Gambian rats, African rope squirrels)
how does the orthopoxvirus (monkeypox virus) enter the body?
- thru the skin, resp tract, or mucous membranes
describe transmission of monkeypox (3)
- animal to human
- person to person
- formites
what is the incubation period of monkeypox
5-21 days (average 6-13 days)
what is the period of communicability of monkeypox
- 5 days prior to rash until all lesion scabs have fallen off & intact skin is underneath (3-4 weeks)
what are the 2 phases of monkeypox
- invasion (prodromal)
- skin eruption
describe the invasion (prodormal) phase of monkeypox (9)
- fever
- chills
- lymphadenopathy
- headache
- mylagia
- arthralgia
- back pain
- weakness
- fatigue
how long does the invasion phase of monkeypox last
0-5 days
when does the skin eruption phase of monkeypox occur
1-3 days after onset of fever & lasts 2-4 weeks
describe the skin eruption phase of monkeypox
- face or extremities, hands, feet, mouth, genital, and perianal area
- rash –> macules to papules to vesicles to pustules… scab over
describe the diagnosis of monkeypox
- swab skin lesions (presence of MPX virus DNA by PCR or isolation of MPX virus)
what is the role of the PHN r/t monkey pox (4)
- mngmt of case
- mngmt of contacts
- pre-exposure protocol vaccination (PrEP)
- post exposure protocol (PEP)
describe the PHN mngmt of case r/t monkeypox (3)
- isolation while awaiting diagnosis
- isolation precautions during period of communicability (3-4 weeks)
- active monitoring by public health thru isolation period
describe the PHN’s mngmt of contacts r/t monkeypox (4)
- self isolation not required if asymptomatic
- monitor for 21 days
- consult w occupational health if work in high-risk setting
- PEP with Imvamune vaccine
describe the PrEP vaccination r/t monkeypox
- 2 doses imvamune 28 days apart
what is the eligibility for PrEP
- cisgender, transgender, or two-spirit people who self identify as part of the gbMSM community & meet one of the following criteria:
—> dx of STI in past year
—> 2 or more sexual partners in last 90 days
—> attended locations for sexual contact
—> anonymous sex in past 90 days - any sexual contacts of individuals described above
- individuals who self-identify as sex workers
- staff/volunteers in sex-on-premises venues where workers may have contact with objects/material that may be contaminated with MPX virus without PPE
describe PEP for monkeypox
- close contacts of confirmed/probably case
what are challenges r/t monkeypox (4)
- pandemic fatigue
- lack of knowledge
- vaccine supply
- communication strategy
describe the history of monkeypox vs polio
- monkeypox = little/no history
- polio = history of disease
describe the vaccines for monkeypox vs polio
- monkeypox = gbMSM population, limited vaccine
- polio = unvaccinated populations, vaccine supply ++
describe community engagement for monkeypox vs polio
- monkey pox = reduce stigma and misinfo, global coordination & collab
- polio = address misinformation, global coordination & collab
what organism causes hep A
- hep a virus
what is the mode of transmission of hep A
- contaminated food, water (fecal-oral)
what is the incubation period of hep A
- 14-28 days
what are indicators of hep A
- acute hepatitis
what are nursing considerations for hep A (4)
- vaccination (travel)
- bed rest
- avoiding hepato toxins
- nutrition
describe vaccine document administration (3)
- the personal immunization record held by the vaccine recipient, or his or her parent/guardian
- the record maintained by the HCP who administered the vaccine
- the local provincial or territorial immunization registry (if one has been restablished)
pre vaccine/admin checklist
https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-12-immunization-records.html#p1c11a3
when is the diphtheria, tetanus, pertussis, polio, haemophilus influenza type b (DTaP-IPV-Hib) vaccine given
- 2m
- 4m
- 6m
- 18m
when is the pneumococcal conjugate 13 valent vaccine given
- 2m
- 4m
- 12m
when is the rotavirus vaccine given
- 2m
- 4m
when is the measles, mupms, rubella, varicells (MMRV) vaccine given
- 12m
- 4-6y
when is the meningococcal C conjugate vaccine given
- 12m
- 4-6y
when is the Tetanus, Diphtheria, Pertussis, Polio (Tdap-IPV) vaccine given
- 4-6 years
when is the flu vaccine given
- all Manitobans 6 months of age and older are eligible each year