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NAPLEX 2024 > Chapter 20 & 21: Immunization/ Travelers > Flashcards

Chapter 20 & 21: Immunization/ Travelers Flashcards

1
Q

Vaccine Resources

A

■ FDA
■ The Advisory Committee on Immunization Practices (ACIP) provides the recommendations for vaccine administration in children and adults
■ CDC approves the ACIP recommendations and publishes them in the CDC’s Morbidity and Mortality Weekly Report (MMWR) and The Pink Book
(Epidemiology and Prevention of Vaccine-Preventable Diseases)

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2
Q

What is the primary function of the immune system, and how does it achieve immunity against foreign substances?

A

The immune system distinguishes between self and non-self substances (antigens) and produces antibodies (immunoglobulins) to fight off foreign antigens, providing immunity. When antigens are detected, antibodies are generated to destroy them.

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3
Q

Immunity is acquired actively or passively… Explain Active Immunity vs. Passive Immunity

A

Active Immunity: From the person’s own immune
system (from vaccines or fighting an infection). Lasts a long time, often a lifetime.
.
Passive Immunity:Receiving immunoglobulins from another individual, such as through pooled lg or maternal transfer to a baby, provides temporary immunity. These antibodies decrease over time as the individual’s own antibody production increases. Intravenous immunoglobulin (IVIG) offers pre-made antibodies for rapid immunity, useful in cases like immediate protection against rabies after exposure to the virus

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4
Q

What are the key differences between live attenuated and inactivated vaccines, and why are live attenuated vaccines not recommended for certain individuals?

A

Live attenuated vaccines are modified from disease-causing viruses or bacteria in labs, able to replicate and confer immunity without causing severe illness. They closely mimic the actual disease, eliciting a robust immune response. However, they’re not recommended for immunocompromised or pregnant individuals due to potential uncontrolled replication of the pathogen.

Inactivated vaccines can consist of whole or partial viruses or bacteria. Immunity from these vaccines may decline over time, necessitating booster doses to maintain effectiveness.

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5
Q

Polysaccharide Vaccines

A

Polysaccharide vaccines extract sugar molecules from the outer layer of encapsulated bacteria, like pneumococcal serotypes. However, they typically elicit a weak immune response in children under 2 years of age.
.
Ex: Pneumococcal Polysaccharide Vaccine (Pneumovax 23)

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6
Q

Conjugate Vaccines

A

Conjugate vaccines combine polysaccharide molecules from encapsulated bacteria with carrier proteins. This conjugation enhances the immune response in infants and improves the antibody booster response to multiple vaccine doses.
.
Ex: Pneumococcal Conjugate Vaccine (Prevnar 13),
Meningococcal Conjugate (Menactra, Menveo)

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7
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 replicates.
.
Ex: Human Papillomavirus Vaccine (Gardasil 9), Recombinant Influenza Vaccine (FluBfok Quadrivalent)

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8
Q

Toxoid Vaccine

A

The vaccine targets toxin produced by disease.
.
Ex: Diptheria Toxoid Vaccine

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9
Q

mRNA Vaccine

A

The vaccine gives instruction to the body’s cells to produce a protein specific to the pathogen, which triggers immune response
.
Ex. COVID-19 vaccine

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10
Q

Examples of Live Vaccines

A

Remember: MICRO-VY
- MMR
- Intranasal Influenza
- Cholera
- Rotavirus
- Oral Typhoid
- Varicella
- Yellow Fever

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11
Q

Vaccine Timing and Spacing

A
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12
Q

LIVE VACCINES AND THE TB SKIN TEST?: How can the risk of false-negative results in the tuberculin skin test (TST) be minimized when live vaccines are involved

A

The tuberculin skin test (TST), also known as a purified protein derivative (PPD) test, detects latent tuberculosis (TB). Live vaccines can lead to false-negative results. Strategies to minimize this risk include:

  1. Co-administering the live vaccine with the skin test.
  2. Waiting for 4 weeks after a live vaccine before conducting the skin test.
  3. Conducting the skin test first, waiting 48-72 hours for results, and then administering the live vaccine.
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13
Q

Vaccine Adverse Reaction: What measures should be taken to minimize adverse reactions to vaccines, and how should healthcare professionals handle severe reactions when administering vaccines?

A

Vaccines can cause adverse reactions, ranging from mild to severe, including anaphylaxis. Screening for precautions and contraindications is crucial to minimize severe reactions. Patients should be monitored for at least 15 minutes post-vaccination for signs of allergic reactions. Pharmacists administering vaccines must have an emergency management protocol in place for severe reactions until medical help arrives. Any adverse reactions requiring assistance should be reported to the FDA’s Vaccine Adverse Event Reporting System (VAERS).

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14
Q

Vaccines

Minor Allergic Reaction: Treatment/ Approach

A

Minor allergic reactions will resolve quickly and
can be treated with diphenhydramine (OTC) or hydroxyzine (prescription). A minor reaction is not a contraindication to future vaccination.

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15
Q

Severe Allergic Reactions (very rare): anaphlaxis; what are the symptoms?

A

Symptoms, occurring within minutes, include hives, throat swelling, breathing difficulties, abdominal cramps, and low blood pressure.

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16
Q

Invalid C/I to Vaccination: Vaccines may be given in these following situation

A

Note: Pregnancy and Immunocomp are 2 most important C/I to live vaccines!

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17
Q

Severe Allergic Reaction: Managment/ Emergency Protocol

A
  1. Administer aqueous epinephrine 1 mg/mL intramuscularly, with a dose of 0.01 mg/kg up to a maximum of 0.5 mg per dose for adults. (at least 3 doses should be avalible at pharmacy) Multiple doses may be required, spaced 5-15 minutes apart.
  2. Diphenhydramine can be administered to reduce swelling and itching. However, oral administration of medications is not advisable if there’s airway swelling due to a risk of choking.
  3. Position the patient supine unless there’s breathing difficulty. Elevating the head can aid breathing, but ensure blood pressure remains adequate.
  4. Perform CPR if necessary. Pharmacists administering vaccines should hold current basic life support (BLS or CPR) certification.
  5. Record all vital signs and medications administered.
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18
Q

Vaccination For Special Group

Infants and Children

A
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19
Q

Vaccination For Special Group

Adolescents and Young Adults

A

Meningococcal vaccine (MCV4; Menactra; Menveo; or MenQuadfi)

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20
Q

Vaccination For Special Group

Pregnancy

A

■ Live vaccines are contraindicated
■ Influenza vaccine, inactivated (not live), can be given in any trimester
■ Tdap x 1 with each pregnancy (weeks 27-36, optimally)

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21
Q

Vaccination For Special Group

Older Adults

A
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22
Q

Vaccination For Special Group

Diabetes

A
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23
Q

Vaccination For Special Group

Healthcare Professionals

A
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24
Q

Vaccination For Special Group

Sickle Cell Disease/ asplenia

A
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25
Q

Vaccination For Special Group

Immunodeficiency

A
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26
Q

Vaccination For Adults

Influenza

A

Annually for all patients 6 months and up

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27
Q

Vaccination For Adults

Tdap, Td

A

Tdap x 1 if not received previously
Td or Tdap every 10 years

28
Q

Vaccination For Adults

Human Papillomavirus (HPV)

A

Adults < 26 years who did not complete the HPV series (can be give nto 27-45 y/o based on shared decision making)

29
Q

Vaccination For Adults

Shingles

A
30
Q

Vaccination For Adults

Penumococcal

A
31
Q

Vaccination For Adults

Meningococcal

A
32
Q

Vaccination For Adults

Hep A

A

Adults traveling to undeveloped countries
outside of the U.S., household members and
other close contacts of adopted children newly
arriving from countries with moderate-high
infection risk, liver disease, hemophilia, men
who have sex with men, IVDAs, homeless
individuals , HIV
.
Give alone or with hepatitis B vaccine (Twinrix)

33
Q

Vaccination For Adults

Hep B

A

All adults age 19-59 y/o and patient >60 with risk factors: chronic liver disease, HIV, risky sex life, IV drug users, jail, blood exposure!
.
Can give alone or with hep A vaccine (twinrix)

34
Q

Routine Vaccine

Covid-19 Vaccines: Name, how to give

A

mRNA vaccines: Comirnaty (pfizer), Spikevax (moderna); Protein subuit: novavax
.
Age > 12 (no immunocop): 2 dose primary series at 0 and 4-8 weeks (moderna) or 3-8 weeks (pfizer)
.
Age < 12 or immunocop?: consult CDC

35
Q

Routine Vaccine

Diphtheria Toxoid-, Tetanus Toxoid- and acellular Pertussis-Containing Vaccines

A
  • The pediatric formulations (with the upper-case D, as in DTaP: Pediarix) and The adult formulations have a lower case d (Tdap: Boostrix, Adacel or Td)
  • DTaP: A routine childhood vaccine series; 5 doses given at ages 2, 4, 6, 12-18 months and 4-6 years.
    For children younger than 7 years of age
  • Tdap booster typically given at age 11 -12, routine booster given every 10 years in adults
36
Q

Routine Vaccine

Haemophilus influenzae type B (Hib)-Containing Vaccines

A

Hib: a routine childhood vaccine series given between ages 2-15 months .
.
Given to adults with asplenia

37
Q

Vaccine Routine

Hepatitis Containing Vaccines: names, schedule?

A

Hepatitis A Vaccines: Havrix,
VAQTA; Children: Routine childhood vaccine series, administered in two doses at 12 months and 6-18 months later. Adults: those who engage in risky stuff
.
Hepatitis B Vaccines: Engerix-B, Heplisav-B; Children: Routine childhood vaccine series initiated within 24 hours after birth; administered in three doses at 0, 1-2, and 6-18 months. Adults: HC worker/ risky

38
Q

Human Papillomavirus Vaccines

A

Prevents ~90% of cervical cancers, as well as vuIvar, vaginal, oropharyngeal, penile and anal cancers, and genital warts!
.
Gardasil9:
- Age 9-26: recc age 11-12; do not use if severe yeast allergy
- Regimen: If start before age 15 = 2 doses; if start at older than 15 or immunocop? = 3 doses

39
Q

Influenza Vaccine Tip Sheet

A
40
Q

Measles, Mumps and Rubella-Containing Vaccines (Live Attenuated)

A

Names:
- MMR : MMR II
- MMRV (MMR + Varicella): ProQuad
.
- Children: a routine vaccination series; 2 doses given at age 12-15 months and age 4-6 years.
- ProQuad: indicated for patients age 12 months-12 years.
- Adults: 1-2 doses if no evidence of immunity.

41
Q

Meningococcal Vaccines

A

MCV4, Menactra, Menquafi, Menveo
.
Routine Vaccination:
- Adolescents: Receive a 2-dose series at 11-12 years and 16 years (booster).
- Special Populations at High Risk: Includes travelers to regions like the meningitis belt in Sub-Saharan Africa. Also recommended for individuals aged 2 months and older with conditions such as HIV, asplenia/sickle cell disease

42
Q

Pneumococcal Vaccine: general/ key concepts to keep in mind

A

S. pneumoniae, or pneumococcus, is the primary cause of otitis media, pneumonia, meningitis, and bloodstream infections in children. Adults aged 65 and older, as well as individuals with specific chronic conditions or weakened immune systems, face higher risks of pneumococcal disease.
.
KEY CONCEPTS
- There are 3 pneumococcal conjugate vaccines (PCV13 (Prevnar13), PCV15 (Vaxneuvance), and PCV20 (Prevnar20) and 1 polysacch vaccine (PPSV23 (Pneumovax 23))
- Children < 5y/o receive PCV13 or PCV15 as a part of childhood vaccine routine (children under 2 should not get PPSV23 b/c they cannot produce an adequate antibody response to polysach vaccines
- Adults should get either PCV20 ALONE or PCV15 followed by PPSV23

43
Q

Pneumococcal vaccine schedule

A
  • Children < 5y/o: 4 dose series of PCV13 or PCV15 given at age 2, 4, 6, and 12-15 months
  • Adults (if never recieved before): PCV20 x1 OR PCV15 x1 then PPSV23 x1 +12 months later (PPSV23 may be given +8weeks if immunocomp)
44
Q

Poliovirus-Containing Vaccines: name and schedule

A

DTaP-HepB-IPV: Pediarix; 4 dose series given at age 2, 4, 6 -18months and 4-6 years

45
Q

Varicella-Containing Vaccines

A
  • Varicella Virus Vaccine (for chickenpox): Varivax
  • MMRV Vaccine (for measles, mumps, rubella, and varicella): ProQuad
  • Zoster Virus Vaccines (for herpes zoster / shingles): Shingrix, Zostavax
    .
    Varivax: 2 doses serie given at age 12-15 months and 4-6 years; but any adolescent or adult without evidence of immunity? give 2 doses!
    .
    Shingrix: all adult > 50 or adult > 19 with immunosupp: 2 doses given at month 0 and then month 2-6
46
Q

Non-routine vaccine

Rabies Vaccine Administration

A

Preventive for High-Risk Exposure:
Prevention: 3 doses
.
Post-Exposure Prophylaxis (With Previous Vaccination): 2 doses.
.
Post-Exposure Prophylaxis (Without Previous Vaccination): 4 doses + 1 dose of rabies immune globulin (RIG) administered with the first vaccine dose.

47
Q

Tips for Proper Vaccine Storage

A
  • Use refrigerator or freezer units designed for storing biologics, avoiding household or dormitory-style units.
  • Avoid placing vaccines in the doors of the freezer or refrigerator due to temperature instability.
  • Rotate stock to use vaccines with the earliest expiration dates first.
  • Keep vaccines in their original packaging for protection, especially from light.
  • Use calibrated thermometers or digital data loggers connected to buffered temperature probes in the refrigerator and freezer.
  • Read and document temperatures at least twice daily. Ensure a consistent power source.
  • Maintain temperature logs for at least 3 years, as per CDC recommendations (or longer if required by state regulations).
48
Q

VACCINE STORAGE REQUIREMENTS

A
  • Most vaccines are stored in the refrigerator (between 36°F-46°F, or 2°C - 8°C).
  • Some vaccines (varicella vaccine, MMRV, oral cholera vaccine) should be stored in freezer between Vaccines that should be stored in the freezer
  • MMRII is stored either in the refrigerator or freezer.
49
Q

Vaccine Route of Administration
1. IM only
2. SC only
3. IM or SC
4. Intranasal
5. PO

A
  1. IM only: most vaccines
  2. SC only: Yellow Fever, Dengue
  3. IM or SC: MMR, MMRV, Varicella, PPSV23
  4. Intranasal: Flumist (live vaccine)
  5. PO: Typhoid (vivotif), cholera and rotavirus
50
Q

Vaccine Administration Guidelines

A
51
Q

Travelers: What are some key considerations for travelers to keep in mind regarding their health and medical preparations, including documentation and disease prevention strategies?

A

Travelers should carry a list of medical conditions and medications. Vaccinations should be documented on the International Certificate of Vaccination or Prophylaxis (ICVP) card, also known as the yellow card. When preparing for travel, consider diseases spread through food and water, blood and bodily fluids, and insects. Utilize the CDC’s Yellow Book for comprehensive travel health information.

52
Q

Travelers’ Diarrhea (TD): What are the key characteristics, risk factors, and pathogens associated with TD

A

Traveler’s diarrhea (TD) is common, affecting 30-70% of travelers, especially in high-risk areas like Asia, the Middle East, Africa, Mexico, and Central/South America. It presents as sudden loose stools, possibly with blood (dysentery - this is severe!). Severity determines initial treatment. Bacterial or viral pathogens usually cause symptoms within 6-72 hours. E. coli is the primary bacterial pathogen (followed by campylobacter jejuni, shigella, and salmonella. Untreated bacterial diarrhea lasts 3-7 days. Persistent TD, lasting ~14 days, may require further testing.

53
Q
A
54
Q

TD Prevention: Non medical

A

Safe food and water practices can lower the risk of traveler’s diarrhea (TD), though not completely. The guideline “boil it, cook it, peel it or forget it” is useful for food safety. Recommendations include consuming only hot, freshly cooked food, avoiding buffet items, and eating raw fruits and vegetables that are washed or peeled. Bottled water or boiled water (for 1 min) should be used for drinking and brushing teeth, while ice should be avoided. Eating at reputable restaurants reduces the risk, as poor hygiene in local establishments can increase it. Additionally, maintaining hand hygiene, washing hands frequently with soap and water, or using alcohol-based hand sanitizers are essential precautions.

55
Q

Disease transmitted thru food/ water: Travelers Diarrhea

TD PPX and Treatment?

A

PPX Note: Do not use BSS in patients with an aspirin allergy, pregnancy, renal insufficiency, gout, or on anticoagulants…Antibiotic prophylaxis should not be used by most travelers.. but if needed? = rifaximin
.
TX Note: antimotility drug used for acute diarrhea is loperamide (ImodiumA-D): Take 4 mg after the first loose stool and 2 mg after each subsequent loose stool, up to a maximum of 16 mg/day ….Azithromycin is preferred for severe TD and dysentery.

56
Q

Disease transmitted thru food/ water: Typhoid Fever

Typhoid Fever: What preventive measures and vaccines are recommended for travelers to regions with a high risk of typhoid fever, and what are their respective efficacies and administration guidelines?

A

Typhoid fever, caused by Salmonella typhi, poses a significant risk in regions like East and Southeast Asia, Africa, and Central and South America. Spread through poop contaminated food or water, symptoms typically emerge 6 to 30 days after exposure, starting with fatigue and escalating fever. Typhoid vaccines like Vivotif (oral) and Typhim Vi (intramuscular) are recommended but offer only partial protection (50-80%). Safe food and water practices remain crucial. Vivotif, recommended for those over 6 years old, should be completed at least a week before travel, while Typhim Vi, for those over 2 years old, should be administered at least 2 weeks before exposure

57
Q

Disease transmitted thru food/ water: Cholera

Cholera: What measures should travelers take to prevent cholera, and what vaccination option is recommended for individuals traveling to regions with active cholera transmission?

A

Cholera, caused by Vibrio cholerae.Symptoms range from mild to severe, including profuse diarrhea and vomiting, leading to dehydration. “Rice-water stools” are characteristic of the disease. Alongside food and water precautions, travelers to cholera-endemic areas are advised to receive the live-attenuated vaccine Vaxchora. This vaccine is administered orally as a single dose at least 10 days before travel, approved for adults aged 18 through 64.

58
Q

Disease transmitted thru food/ water: POLIO

POLIO: What does the CDC recommend regarding the poliovirus vaccine for adults traveling to regions where poliovirus is circulating?

A

CDC recommends a single lifetime booster of inactivated poliovirus vaccine at least four weeks before travel for adults who completed a poliovirus vaccine series and are traveling to regions with circulating poliovirus.

59
Q

Disease transmitted thru blood/ body fluid: HEP B (Hep A is thru water/f

Hepatitis B : What are the key considerations and recommendations regarding Hepatitis B vaccination for travelers, particularly those engaging in high-risk activities, and what is the recommended vaccination schedule for optimal protection

A

Hepatitis B is primarily transmitted through contaminated blood or body fluids, with symptoms like malaise, jaundice, nausea, and abdominal discomfort. Chronic infection can lead to liver disease and cancer. Hepatitis B vaccination is crucial for travelers in high-risk situations (risk for people who do NOT participate in high risk behavior is LOW!) like medical work or unprotected sex. The vaccine series takes six months; an accelerated series can be used for immediate protection, but a booster is needed for long-term immunity.

60
Q

Disease trasmitted thru blood/ body fluid: Meningococcal meningitis

Meningococcal meningitis: What are the key considerations and recommendations regarding meningococcal meningitis for travelers to high-risk regions?

A

Bacterial meningitis caused by N. meningitidis is a severe condition (fever, severe HA, stiff neck) with a high mortality rate, requiring urgent medical attention. Vaccination is crucial for travelers to regions where the bacteria is prevalent, particularly in Africa’s meningitis belt during the dry season and for Hajj and Umrah pilgrimages. Current recommendations include only the quadrivalent vaccines (Menactra, Menveo, MenQuadfi) which contain four bacterial types: ACWY, while serogroup B vaccines are not advised for travelers.

61
Q

Disease Transmitted by Insect Bites

List the different disease that can be caused by insect

A

Insect vectors carry disease-causing organisms to humans, while reservoirs serve as habitats where diseases can multiply. Mosquitoes are the primary vectors for diseases such as Japanese encephalitis, yellow fever, dengue, malaria, and Zika virus among travelers

62
Q

Discuss dengue and Japanese encephalitis, in terms of transmission, symptoms, and preventive measures, and vaccination?

A

DENGUE:
Dengue, transmitted by Aedes mosquitoes, is endemic in tropical and subtropical regions, with high transmission during peak mosquito seasons. While most cases are asymptomatic, severe dengue can occur in up to 5% of patients, leading to life-threatening complications such as shock, bleeding, or organ failure. Treatment is supportive, with no specific medications available. Dengvaxia vaccine is recommended only for those with a previous dengue infection, emphasizing the importance of mosquito bite prevention.

JAPANESE ENCEPHALITIS:
Japanese Encephalitis (JE), also transmitted by mosquitoes, can lead to encephalitis with severe symptoms including seizures, coma, and death. Risk is highest in rural areas. Prevention involves minimizing mosquito exposure. The JE vaccine (Ixiaro) is advised for travelers planning extended outdoor activities or prolonged stays in endemic areas during the transmission season. An accelerated schedule is available for those with short notice travel plans.

63
Q

Malaria, transmitted by Anopheles mosquitoes, begins with multiplication in the liver before infecting red blood cells, leading to symptoms like shaking, chills, fever, and flu-like illness. Malaria remains potentially fatal even with treatment, prompting the recommendation of prophylactic medications for travelers to affected areas. What is the regimen? : QUICK START REGIMEN

A
64
Q

Malaria, transmitted by Anopheles mosquitoes, begins with multiplication in the liver before infecting red blood cells, leading to symptoms like shaking, chills, fever, and flu-like illness. Malaria remains potentially fatal even with treatment, prompting the recommendation of prophylactic medications for travelers to affected areas. What is the regimen? : ADVANCE START REGIMEN

A
65
Q

Yellow Fever

A

Yellow fever, transmitted by mosquitoes in tropical regions of Africa and Central/South America, often manifests with influenza-like symptoms. While most cases are mild, about 15% can progress to a more severe form with shock, bleeding, and organ failure. Treatment focuses on symptomatic relief, as there’s no specific cure. Prevention involves a live-attenuated vaccine, YF-VAX, administered at least 10 days before travel. The vaccine is C/I with hypersensitivity to EGG! amd severely immunocomp. D/T it’s serious AEs this vaccine is only for high risk travelers

66
Q

ALTITUDE SICKNESS AND MOTION SICKNESS: What is the primary PPX?

A

Acetazolamide (Diamox) is the main preventive medication, starting at 125 mg BID before or on the day of ascent. Higher doses are used for treatment, but side effects like increased urination, altered taste, and skin issues may occur. Acetazolamide is not suitable for those allergic to sulfa drugs.

NAPLEX 2024 (28 decks)

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