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Immunizations Flashcards

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1
Q

What is the purpose of vaccine resources (FDA, CDC, ACIP)?

A
  1. FDA: indication and safety
  2. ACIP: recommendations for administration
  3. CDC: Morbidity/Mortality Weekly Report (MMWR), Pink Book, VIS
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2
Q

What must be handed to the patient/parent before vaccine admin?

A

VIS

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3
Q

How is passive immunity acquired?

A
  1. Mother to child/ breast milk
  2. IVIG/ already made antibodies
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4
Q

What vaccines are live?

A
  1. MMR
  2. Intranasal influenza
  3. Cholera
  4. Rotavirus
  5. Oral Typhoid
  6. Varicella
  7. Yellow Fever
    ***MICRO-VY
    Others:
  8. Tuberculosis (BCG)
  9. Dengue
  10. Smallpox
  11. Ebola
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5
Q

What are inactivated vaccines?

A

Killed version of wild virus/bacteria that cannot replicate; immunity not as strong boosters may be required

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6
Q

What are types of inactivated vaccines?

A
  1. Polysaccharide: sugar molecules taken from encapsulated bacteria
  2. Conjugate: sugar molcule joined to protein carrier; increased response in infants/antibody response
  3. Recombinant: gene segment from an organism’s protein is inserted into a carrier (yeast) cell to replicate
  4. Toxoid: targets a toxin produced by the disease
  5. mRNA: gives instruction to bodily cells to produce protein specific to the pathogen, triggering immune response
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7
Q

What are live vaccines?

A

Wild virus/bacteria that can grow/replicate and most similar to actual disease; strong immune response

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8
Q

What are CIs to live vaccines?

A
  1. Pregnant
  2. Immunocompromised
  3. Children <12 months (except rotavirus)
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9
Q

How long should live vaccines be spaced out from a TB test?

A
  1. Give them together on the same day
  2. Give the live vaccine and wait 4 weeks before giving TBT
  3. Give TBT and wait 24h after reading then give the live vaccine
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10
Q

How long should live vaccines be spaced from IVIG/ antibody-containing products?

A
  1. Give live vaccine and wait 2 weeks before giving antibodies
  2. Get antibodies/IVIG and wait 3-11 months for live vaccine
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11
Q

How long should live vaccines be spaced out from each other if not given on the same day?

A

4 weeks (no separation required if administering PO typhoid or PO rotavirus vax)

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12
Q

What are adverse reactions with vaccines?

A

Local: pain, redness, swelling
Systemic: fever, malaise, myalgia, headache, loss of appetite, mild illness
Live: Mild disease sx can occur 3-21 days after live vax (chickenpox after varicella)

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13
Q

What should be done for allergic reactions to vaccines?

A

MIld: PO diphenhydramine/ hydroxyzine
True anaphylaxis/thraot swelling: Epinephrine 0.3mg every 5-15 min x 3 doses

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14
Q

What should be done if a patient is having reaction/allergy to a vaccine?

A

Supine position; elevate head if SOB and elevate feet if hypotension

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15
Q

What are invalid reasons to delay a vaccine?

A
  1. Mild, acute illness (slight fever/mild diarrhea)
  2. Antimicrobial therapies (except live flu, varicella, oral typhoid)
  3. Previous local reaction
  4. Allergy to PCN/ products not in vaccine
  5. Immunosuppressed person in the household, recent disease exposure, convalescence (recovering from illness)
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16
Q

What vaccine is CI in patients with a neomycin or gelatin allergy?

A

Varicella (not Shingrix)

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17
Q

What vaccine is CI in patients with a egg (maybe gelatin) allergy?

A

Yellow fever vaccine

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18
Q

What vaccines are stored in the freezer?

A
  1. Varicella
  2. MMRV
  3. MMR-II (refrigerator or freezer)
  4. Jynneos (small pox/ monkey pox vaccines)
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19
Q

What vaccines can be given SQ?

A
  1. Yellow fever (only SQ)
  2. Dengue (only SQ)
  3. Small pox/monkey pox (only SQ)
  4. MMR-II (IM/SQ)
  5. MMRV (IM/SQ)
  6. Varicella (IM/SQ)
  7. PPSV23 (IM/SQ)
  8. IPV (IM/SQ)
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20
Q

What vaccines are administered PO?

A
  1. Typhoid (Vivotif)
  2. Cholera (Vaxchora)
  3. Rotavirus (Rotarix/RataTeq)
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21
Q

How should vaccines be stored in the refrigerator?

A
  1. Keep in original packaging
  2. Never place in the doors
  3. Use a buffered temperature probe
  4. Document temperatures at least 2x a work day
  5. Keep temperature logs for 3 years or longer
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22
Q

What patients require a 1.5in needle for IM injection?

A

Male>260 lbs
Female >200 lbs

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23
Q

What vaccine can cause a positive reaction to the TB test?

A

Tuberculosis Baccile Calmette-Guerin (BCG)

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24
Q

When is IVIG indicated with live vaccination?

A

Post-exposure to rabies without prior vaccination: give 1 dose of rabies IVIG with the first dose of vaccine

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25
What are CI and precautions with all vaccines?
CI: Severe allergy/anaphylaxis to vaccine/component of vax Precaution: Moderate-Severe illness reasonable to delay vaccination
26
What are CI and precautions with Diphtheria/tetanus/pertussis vaccines?
CI: Encephalopathy (coma, decreased conciousness, prolonged seizure) w/in 7 days not attributable to any other cause Precaution: Gillain Barre syndrome wi/in 6 weeks of previous vaccination DTaP/Tdap: infantile spasm, uncontrolled seizures
27
What are CI and precautions with HepB and HPV vaccines?
CI: HSR to yeast No precaution
28
What are CI and precautions with the live attenuated flu vax?
CI: 1. Aspirin products (children and adolescents), 2. Antiretroviral use (oseltamivir/zanamivir past 48h, peramivir last 5 d, or baloxavir last 17d 3. Children 2-4 w/ asthma or wheezing episode w/in 12 months 4. Close contact with an immunosuppressed person Precaution: 1. Asthma ≥5y 2. Underlying conditions that predispose to complications (chronic lung, heart, renal, hepatic, neurologic, hematologic, metabolic disorders, and DM)
29
What are precautions with all flu vaccines?
Guillain-Barre syndrome within 6 weeks of previous flu vaccine
30
What are CI and precautions with Shingrix RZV vaccine?
CI: none Precaution: consider delaying if pregnant or breastfeeding
31
What are precautions with varicella vaccines?
Use of acyclovir, famciclovir, or valacyclovir w/in 48h before vax; avoid use for 14 days after vax
32
What are CI and precautions with rotavirus vaccine?
CI: Hx of intussusception (when part of the intestine slides into the adjacent intestine blocking food/fluids) Precaution: chronic GI disease
33
What are CI and precautions with all vaccines?
CI: use non-latex packaging if anaphylaxis
34
What flu vaccines are approved for patients ≥6 months?
1. Afluria 2. Fluarix 3. FluLaval 4. Fluzone 5. Flucelvax (egg-free)
35
What flu vaccine is approved for patients ≥18y/o
Flublok (egg-free)
36
What flu vaccines are egg-free?
1. Flucelvax (≥6mo) 2. Flublok (≥18y)
37
What flu vaccine is approved for patients 2-49 y?
FluMist (Live Attenuated)
38
What flu vaccines are approved/ preferred for patients ≥65y?
1. Fluzone High-Dose 2. Fluad 3. Flublok (recombinant, egg-free)
39
How are flu vaccines administered?
IM except FluMist (intranasal)
40
How is FluMIst administered?
Intranasally 0.2mL divided between both nostrils
41
Which patient should recieve 2 doses of flu vaccine?
1st lifetime dose of flu vaccine AND <8 y/o (separate doses by 4 weeks)
42
At what age is the DTaP given?
Routine: 5 doses; Age 2 months, 4 months,6 months, 15-18 months, 4-6 years (less than 7)
43
At what age is Tdap given?
Booster at 11-12 y/o then every 10 years
44
In what cases would a Tdap booster be given <10 years?
1. Each pregnancy 2. Deep/dirty wound if given >5 years prior
45
Tdap
Adacel Boostrix
46
DTaP-HepB-IPV
Pediarix
47
When should Hep A vaccine be administered?
Children: 2 doses (separated by 6 months) given at age 12-23 months Adults: Chronic liver disease, Men sex with men, illicit drug use, homeless, HIV infection, travel to endemic area, anyone else who wants it
48
When should Hep B vaccine be administered?
Children: 3 doses; given 24h after birth, age 1-2 months, and 6-18 months Adults: All ages 19-59y or ≥60y with RFs (if not previously vaccinated)
49
What are risk factors for the Hep B vaccine in those ≥60y?
1. Chronic liver disease 2. HIV infection 3. Blood exposure (health care, dialysis, diabetes) 4. IV drug use 5. sexual risk (MSM, multiple partners) 6. Incarcerated people 7. travel to endemic area
50
What Hep B vaccines are avalible in pediatric and adult doses?
1. Engerix-B 2. Recombivax HB
51
What Hep B vaccines are only for ≥18y?
1. Heplisav-B 2. PreHevbrio
52
What HepB vaccine is indicated for dialysis patients?
High-dose Recombivax HB
53
Hep A-HepB
Twinrix
54
What ages is HPV9 (gardasil 9) approved for?
9-26y BUT recommended at 11-12y
55
How is HPV9 (gardasil 9) dosed?
Before 15y: 2 doses (month 0 and 6-12mo) 15 or older/immuncompromised: 3 doses (month 0, 1-2 mo, and 6 months)
56
What ages is the MMR approved for?
Children: 2-dose series at ages 12-15 months and 4-6y Adults: 1-2 doses (4 weeks apart) if no evidence of immunity to healthcare workers, HIV patients with CD4 ≥200 for at least 6 months, nonpregnant at childbearing age (if no immunity to rubella), international travelers, household contacts of immunocompromised people, and students in post secondary educational system *** Born before 1957 considered immune
57
How are MMR containing vaccines stored?
1. MMRV (MMR+ varicella)ProQuad: freezer 2. MMR II: refrigerator or freezer 3. Diluents: room temperature or fridge
58
What ages is the meningitis ACWY approved?
MenQuadfi: ≥ 2y Menveo: 2 months-55y (up to 56y) Children: 2 doses given at 11-12y and 16y Special Populations: 1. Travelers to African meningitis belt 2. ≥ 2months with asplenia/sickle cell/HIV, complement component deficiency, use of eculizumab/ ravulizumab 3. Lab workers 4. First year college student in residential housing 5. military recruits *** Revaccinate every 5 years if ongoing risk
59
What is important about Menveo reconstitution?
Vaccine contained in powder and diluent; MUST use supplies liquid for reconstitution
60
What patients are indicated to recieve the meningitis B vaccine?
≥10y at high risk: 1. Asplenia/sickle cell, complement component deficiency, use of eculizumab/ ravulizumab 2. Lab workers 3. Outbreak Not high risk: Optional in those 16-23y (16-18y preferred) and want the vaccine
61
How are meningitis B vaccines dosed/administered?
Bexsero (Men B) and Penbraya (Men ABCWY): 2 doses (1 month apart) Trumenbra(Men B): 2 doses (6 months apart); 3 doses (months 0, 1-2, 6) if an outbreak
62
What is important about reconstitution of Penbraya?
Must use prefilled syringe (men B) and vial (Man ACWY)
63
At what ages is the pneumonia vaccine indicated?
Children: 4 doses of PCV15 or PCV20 at 2,4,6, and 12-15 months ≥65y: PCV20 x1, PCV21x1, or PCV 15x1 then PPSV23X1 ≥12 months later (>8 weeks if immunocompromised)
64
What medical conditions would make someone eligible for the pneumococcal at age 19-64y?
1. Alcohol use disorder 2. cig smoking 3. DM 4. Chronic heart/lung/liver disease 5. Immunocompromised (sickle cell/asplenia, HIV, malignancy, solid organ transplant, chronic renal failure, immunosuppression drugs (chemo, long term systemic steroids)
65
Why can children not have PPSV23 (Pneumovax 23)?
<2 years inadequate antibody response to polysaccharide vaccines
66
PCV20
Prevnar 20
67
PCV 21
Capvaxive
68
PPSV23
Pneumovax 23
69
What age is the polio vaccine indicated for?
4 doses given at age 2 mo, 4 mo, 6-18 mo, and 4-6 y
70
What age is rotavirus vaccines approved for?
Do not initiate after 15 weeks of age Rotarix: 2 doses at 2 and 4 months RotaTeq: 3 doses 2, 4, 6 months
71
What are indications for the RSV vaccines?
1. Pregnant patients 32-36 weeks gestation during RSV season (Sept-Jan): 1 dose Abrysvo 2. ≥70y x 1 dose 3. ≥60y and increased risk: COPD, asthma, HF, kidney/liver disease, DM, immunocompromised, living in LTC
72
What is indicated for infants <8 months born during or entering RSV season if vaccine was not administered during gestation?
1. 1 dose of nirsevimab (Beyfortus) 2. Plivizumab (Synagis) is reserved for premature infants and infants at highest risk of hospitalization
73
What ages is the varicella vaccine indicated for?
Children: 2 doses at age 12-15 mo and 4-6 y Adults/adolescents without evidence of immunity: 2 doses (4 weeks apart)
74
Varicella
Varivax
75
What ages is the RZV indicated for?
Adults: ≥50 y or ≥19y who are/ will be immunocompromised: 2 doses given at months 0 and 2-6 (or months 1-2 if immunocompromised)
76
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