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NAPLEx > Immunization + travel vaccination > Flashcards

Immunization + travel vaccination Flashcards

1
Q

vaccine resources

A
  • FDA approved
  • Advisory Committee on Immunization Practices (ACIP)
  • CDC
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2
Q

VIS

A

vaccine info statements, handed to pt before admin
found on CDC website

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3
Q

Thimerosal

A

mercury-containing preservatives.. in some vaccines. no evidence that it poses a risk for autism.
in some multidose flu vacine…

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4
Q

Gelatine-containing products

A

from pigs, used in some vax as stabilizer

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5
Q

immunity

A

antigen- foreign
antibodies- immunoglobins, made or given

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6
Q

inactive vaccines

A

used kill version of a wild virus or bacteria that causes the disease. CAN NOT replicate and cause disease.

Less affected by circulating antibodies than live vaccines
limitation: immunity is not as strong as with live vaccines
Boosters: may be required for ongoing immunity

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7
Q

Polysaccharides, conjugated and recombinant vaccines

A

target a section of the organism, such as protein, sugar or capsid (outer casing)

these are types of vaccines in the inactive vax group

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8
Q

Polysaccharide Vaccines

A

molecules taken from the outer layer of encapsulated bacteria (such as pneumoccal serotypes; each serotype matches a circulating strain of the organism).
ex: Pneumovax 23

Do NO produce a good immune response in <2 years
inactive-vax group

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9
Q

Conjugated Vaccines

A

polysaccharides (sugar), molecules from the outside layer of encapsulated proteins and JOIN the molecules of carrier proteins.

increase immune response in infants, and antibody booster response to multi doses of vax
ex. Prenar 12, Menactra
inactive-vax group

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10
Q

Recombinant vaccines

A

a gene segment of a protein from the organism is inserted into the gene of another cell, such as a yeast cell, where it can replicate.
ex: Gardasil 9, FluBlox Quadrivalent
inactive-vax group

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11
Q

Toxoid Vaccines

A

vaccine targes a toxin produced by the diese
ex: diphtheria toxoid vac, tetanus toxoid vax
inactive-vax group

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12
Q

mRNA

A

vaccine gives instructions to the body’s cells (in the form of mRNA) to produce a protein specific to the pathogen, which then triggers an immune response
ex: covid 19 vax
inactive-vax group

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13
Q

Live vaccines

A

similar to the actual disease, provides a strong, long-lasting immune response

Limitations: 1) pt who are immunocompromised may not be able to halt replication; could cause the disease 2) circulating antibodies could interfere w/ vaccine replication

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14
Q

common live vax
MICRO-VY

A

MMR
Intranasal influenza
Cholera
Rotavirus
Oral Typhoid
Varicella
Yellow Fever

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15
Q

tuberculin skin test (TST)

A

live vax can cause a false-negative
1) give live vax the same day as the TST
2) wait 4 weeks after live vax to perform TST
3) admin TST first, wait 48-72 hrs to get results, then give live vax

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16
Q

General rule for all vax
timing and spacing

A
  • can be usually given at the same time (same visit/day)
    —– except in pt w/ asplenia, Prevnar and Menactra should be separated by 4 weeks
  • multi live vax can be given on the same day, if (not given on the same day) space 4 weeks apart
    —- except no separation is required for oral rotavirus vax
  • vax series requires >1 dose, intervals can be extended w/o restarting but should not be shortened in most cases
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17
Q

interval between antibody-containing products and MMR and MMRV

A

minimum of 3 months and up to 11 months, depends on product and some

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18
Q

live vax and antibody
timing and spacing

A
  • MMR and varicella-containing (MMRV) products require separation from antibody-containing products (e.g. blood transfusion, IVIG)
    —-vax–> 2weeks–> antibody-containing products
    —-antibody-containing products–> 3 months or longer–> vax
  • simultaneous admin of vax and antibody (inform of immunoglobulin) is recommended for post-exposure prophylaxis for certain diseases (e.g. hep A &B, rabies, tetanus)
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19
Q

pt should be monitored for

A

15 min

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20
Q

live vaccines systematic reaction

A

mild reactions 3-21 days
intranasal flu vax, replicates in the upper airways, causes mild cold-line symptoms… runny nose

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21
Q

aqueous Epi

A

1mg/ml (1/1,000)

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22
Q

Epi IM

A

0.01mg/kg (max dose .5mg)

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23
Q

Epi autofill injectors

A

.3mg for adults

pharmacy should have 3 doses
a pt may require 1-3 doses admin every 5-15 min

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24
Q

live vax contra

A

prego and immunosuppression

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25
Q

Diphtheria, tetanus, and pertussis vax contra and precautions

A

contra:
- for pertussis-containing vax: encephalopathy (coma, decreased consciousness, prolonged seizures) that is not attributed to another cause within 7 days of receiving vax

precaution: Guillain-Barre syndrome (GBS) within 6 weeks of a previous diphtheria, tetanus and/or pertussis vax
for DTap and tdap only: infantile spasms, uncontrolled seizures.

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26
Q

hep B and HPV contra

A

hypersensitivity to yeast

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27
Q

vax infants and children

A
  • 3 dose hep B started at birth
  • others start at age 2 months: including PCV13, Dtap, Hib, polio, rotavirus
  • live vax start >= 12 months, including MMR, varicella
  • no polysaccharides vax before 2 years
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28
Q

Healthcare Professionals

A
  • annual influenza vax
  • Hep b if no evidence of vax
  • tdap: 1 dose, if not up-to-date , then td or tdap every 10 years
  • varicella: if no history of vax or chickenpox infection
  • MMR: if there is not history of vax or blood test showing immunity
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29
Q

Adolescents and young adults

A
  • meningococcal vax (MCV4: menactra, Menveo or MenQuadfi)
    —- 2 dose: 1 dose at 11-12 and 1 dose at 16
    —- first-year college students in residential housing ( if not previously vax): 1 dose
  • HPV vax
    —- recommended at 11-12 years
    —- 2 or 3 doses (depending on age at start)
  • Tdap: first dose at age >11 years
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30
Q

sickle cell disease & other causes of Asplenia (damaged/missing spleen)

A
  • H. influenzae type b (Hib) vaccine
  • Pneumococcal vaccine (age 19-64), give one of the following regimens:
    —- PCV20x1
    —- PCV15x 1, then PCV23 x 1>= 8 weeks later
  • meningococcal vax
    —- meningococcal conjugated vax (Menactra, Menveo, or MenQuadfi)
    —- serogroup B meningococcal vax (Bexsero or Trumenba)
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31
Q

Prego

A
  • Live vax are contra
  • influenza vax (inactive)
  • Tdap x1 w/ each prego (week 27-36 optimal)
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32
Q

Older adults

A
  • shingrix: age >50 years, 2 doses 2-6 month apart
  • Pneumococcal vax (age >= 65), give one of the following regimens:
    —- PCV20x1
    —- PCV15x 1, then PCV23 x 1 >=12 months later (>= 8 weeks if immunocompromised)
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33
Q

Immunodeficiency

A
  • live vax contra
    • Pneumococcal vaccine (age 19-64), give one of the following regimens:
      —- PCV20x1
      —- PCV15x 1, then PCV23 x 1>= 8 weeks later
  • HIV infection
    —- meningococcal conjugated vax (Menactra, MEnveo, or MenQuadfi)
    —- Hep A vax
    —- Hep B vax
34
Q

Diabetes

A
  • Pneumococcal vax (age >= 65), give one of the following regimens:
    —- PCV20x1
    —- PCV15x 1, then PCV23 x 1 >=12 months later (>= 8 weeks if immunocompromised)
  • Hep B: age 19-59 or >=60 if at risk for Hep B
35
Q

Influenza
vax for adults

A

annually for all adults >= 6 months old

36
Q

Tdap, Td
vax for adults

A

tdap x1 if not received previously
td or tdap every 10 years

37
Q

singhles
vax for adults

A

shingrix: all adults >= 50 years or >=19 if immunosuppressed or expected to become immunosuppressed

2 dose series, with the second dose 2-6 months after (interval can shorten to 1-2 months if immunocompromised)

vaccinate even if pt previously had chicken pox or shingles or received zostavax

38
Q

HPV
vax for adults

A

adults <26 years who did not complete the HPV series

39
Q

Pneumococcal
vax for adults

A

age 19-64 w/ specific medical condition or age >= 65 (if never received before):
PCV 20 x1, or
PCV 15 x1 followed by PPSV 23> 23 12 months later (or 8 weeks if immunocompromised)

40
Q

Meningococcal
vax for adults

A

2 vax adults need 1 or both

serogroup B vaccines (Bexsero, Trumenba):
give if complement component deficiency, taking eculizumab or ravulizumab, asplenia, microbiologist w/ exposure to Neisseria meningitis

Conjugated vax (Menactra, Menveo, MenQuadfi): same group as above, plus : HIV, travelers/residents in countries in which disease is common, military recruits, first-year college dorm students- if not up to date

41
Q

Hep B
vax for adults

A

all adults age 19-59 and pt >60 w/ risk factors, including chronic liver disease, HIV, exposure risk, IV drug use, multi sex partners, travel, blood exposure etc.

give alone (Engrex-B, Recombivax HB, Heplisav- B) or w/ hep A (twinrex)

42
Q

Hep A
vax for adults

A

adults traveling to developing countries and other risk factors similar to hep B

Give alone (Havrix, VAQTA) or w/ hep B vax (twinrix)

43
Q

Dtap

A

Daptacel, Infanrix
routine childhood vax: 5 doses ages 2, 4, 6, 12-18 months and 4-6 years

for children <7 years
refrigerate- IM

44
Q

Dtap-HepB-IPV:

A

Pediarix, DT
same as Dtap, but used for children who have contra for acellular pertussis antigen in Dtap
refrigerate- IM

45
Q

tdap

A

Adacel, Boostrix
given >11 if not previously received
prego
refrigerate- IM

46
Q

Haemophilus influenza type B (Hib)- containing vax

A

Hib: routine childhood vax series given between ages 2-15 months

ActHib and Hiberix are 4 dose series, PedvaxHib is a 3 dose series
Give to adults w/ asplenia
refrigerator- IM

47
Q

Hep A

A

Havrix, VAQTA
children: routine series, 2 doses given at age 12 months, and then 6-18 months later.

Adults: men who have sex w/men, drug user, chronic liver disease, HIV etc.,
refrigerate- IM

48
Q

Hep B

A

Engrex-B, Heplisav B, Recombivax HB
children: routine, start 24 hrs after birth, 3 doses given at age 0, 1-2, and 6-18 months later

adults: all ages 19-59 or those >= 60 at risk

Engrex-B, Recombivax HB: >=18 years, 3 dose series, month 0, 1, and 6. can completed in 4 months if necessary but require 1 year booster

Heplisav B: >=18 years, 2 dose series, month 0 and 1. Do Not use in prego

refrigerate- IM

49
Q

Hep A and Hep B

A

twinrix
3 dose series, given at months 0, 1, and 6.

refrigerate- IM

50
Q

HPV9

A

Gardasil
age 9-26 years!
recommended age: 11-12 years
contra in severe yeast allergy

start before 15 years, 2 doses at month 0 and 6-12 months later.
if 15 years or older or immunocompromised–> 3 doses at month 0, 1-2 and 6

51
Q

Influenza vax for >= 65

A

Fluzone High-Dose Quadrivalent and Fluad Quadrivalent

52
Q

influenza vax for prego

A

any but DO NOT GIVE FluMist

53
Q

MMR

A

M-M-R II - refrigerate or freeze
MMRV: freezer only (varicella component)

store diluents at room temp or in the refrigerator
give SC
DO NOT use in prego or immunocompromised (CD4> 200)

54
Q

Meningococcal vax MenB

A

Bexsero, Trumenba
ages 10-25 only!

Bexsero: 2 doses 1 month apart
Trumenba: 2 doses 6 months apart

55
Q

Meningococcal vax MCV- conjugated

A

Menactra: 9 months- 55 years
Menveo ages 2 months- 55 years
MenQuadfi: >= 2 years

Menactra and Menveo can be used in adults >=56 years if needed

56
Q

Prenavir 13

A

PCV 13
children <5 years: 4 doses, 2, 4, 6, and 12-15 months
refrigerate- IM

57
Q

Vaxneuvance

A

PCV 15
adults 19-64 or >= 65 if never received before
if pt had PSSV23 before, adm in 12 months after 1 dose. no additional dose needed
refrigerate- IM

58
Q

Prenvar 20

A

PCV20
adults 19-64 or >= 65 if never received before

if pt had PSSV23 before, adm in 12 months after 1 dose. no additional dose needed
refrigerate- IM

59
Q

Pnumovax 23

A

PPSV23
children 2-18 years, after completion of PCV 13

Adults: see PCV 15 and PCV20
refrigerate- IM

60
Q

Polio containing vax

A

DtaP-HepB-IVP: Pediarix

childrine routine, 4 doses at age 2, 4, and 6-18 months, and 4-6 years.
refrigerate- IM

61
Q

Rotavirus

A

RV1- rotarix- 2 doses at 2 and 5 months
RV5- RotaTeq- 3 doses at 2, 4, and 6 months

give to infants, do not initiate after 15 weeks.

give orally!

62
Q

varicella virus - for chickenpox

A

Varivax
- routine for children, 2 doses given at age 12-15 months and 4-6 years.
- any adolescents or adult w/o evidence of immunity give 2 doses.
- do not use in prego or immunocompro
- store in freezer, need to reconstitute (30 min stability)
- do not give if hypersensitivity to gelatin or neomycin (Give SC)

63
Q

zoster virus vax

A

Shingrex
all adults >50 years required
2 does, 2-6 months later.

do not freeze, store refrigerator, reconstitute
give IM

64
Q

storage temp logs

A

keep for 3 years

65
Q

routs of admin
SC only

A

MMR, MMRV, Varicella, Yellow fever

dengue, small pox and monkeypox

66
Q

IM or SC

A

PPSV 23, IPV (IPOL)

67
Q

Intranasal

A

FluMist (live)

68
Q

PO

A

typhoid (vivotif)
oral solutions: Cholera (Vaxcora), Rotavirus (RotaTeq, Rotarix)

69
Q

travel info international

A

Yellow Book CDC

70
Q

bismuth subsalicylate

A

BSS
prophylaxis reduces incidence of TD by 50%, Do not use in pt with aspirin allergy, prego, renal insufficiency or gout or pt on anticoagulants

71
Q

BSS + aspirin

A

cause salicylate tox cause BSS is a salicylate

FDA approved OTC > 12 years, but off label can be used for >3 years if no recent or current viral infection cause of Reye’s syndrome!!

72
Q

BSS SE

A

black tongue/stools, risk of Reye’s syndrome, salicylate tox

73
Q

loperamide

A

4 mg after first loose stool and 2 mg after each subsequent loose stool max 16mg/day

74
Q

Persistent TD

A

diarrhea last longer > 14 days

75
Q

Cholera vaccine

A

Vaxchora
live vax!

76
Q

yellow fever vax

A

YF-VAX
Live vax!

77
Q

Typhid vax

A

Vovotif
live vax
oral

typhim Vi (inactive, polysaccharide)
Injection

78
Q

Rabes vax

A

RabAvert,

prevention if high risk 3 doses
post-exposure- w/ prevention vax 2 doses
post-exposure- w/o prevention vax: 4 doses, 1 dose of rabes immuno globulin (RIG) should be given with first vaccine dose

79
Q

Malaria Prophylaxis Regimens
start 1-2 days before travel

A

Doxy- stop 4 weeks after travel +
Atovaquone/Proguanil (Malarone)- stop 1 week after travel +
Primaquine - stop 1 week after travel

start 1-2 days before travel

80
Q

Malaria Prophylaxis Regimens
start 1-2 weeks before travel

A

chloroquine- stop 4 weeks after travel +
Mefloquine- stop 4 weeks after travel

81
Q

flublok age

A

> 18

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