Lecture 9 - Prevention

Question 1

When are live vaccines contraindicated?

Answer 1

pregnancy and immunocompromised

Question 2

Tdap or Td

Answer 2

appropriate for pretty much everybody

pregnant women should receive Tdap with EACH pregnancy between weeks 27-36

given Tdap for first dose then Td booster every 10 years

Question 3

MMR

Answer 3

live virus vaccine
(contraindicated in pregnancy, immunosuppression, and HIV with CD4 <200)

for most a single dose is sufficient but for some 2 doses at least 28 days apart are indicated:

• HIV infected with no evidence of immunity and CD4 >/= 200 for >6 months
• students in postsecondary educational institutions, international travelers and household contracts of immunocompromised people
• healthcare workers
• people who previously have only one dose but are found to be at risk for mumps

Question 4

VAR

Answer 4

live virus vaccine

two doses 4-8 weeks apart - if used in an HIV+ pt (CD4>/=200) doses should be 3 months apart

document immunity for healthcare workers and pregnant women, for others it can be assume for those born in US prior to 1980

Question 5

RZV or ZVL

Answer 5

RZV preferred
ZVL = live vaccine

RZV recommendations: 2 doses 2-6 months apart to all over 50 regardless of prior zoster infection or VZL

Question 6

HPV

Answer 6

best if given prior to sexual debut
subunit conjugate vaccine

age 9-14 start
only 2 doses needed, 5 months apart

if older, 3 doses at 0, 1-2, and 6 months

indicated up to age 26

Question 7

PCV13 and PPSV23

Answer 7

indicated for all over age 65
if not previously vaccinated give one dose of PCV13 followed by one dose of PPSV23 at least one year later

<65 get it if: 
chronic heart or lung disease (not HTN)
chronic liver disease 
alcoholism 
DM 
cigarette smoker 
immunodeficiency 
HIV 
asplenia

Question 8

HepA

Answer 8

killed vaccine
indicated for MSM, IVDU, or anyone who wants the vaccine

two dose series 6 months apart of 3 dose series (0, 1, 6 months) if combined with HBV

Question 9

HepB

Answer 9

subunit conjugate vaccines
indications mostly the same as HAV but no “close personal contact’
TEST FIRST
3 dose series given at 0,1 (at least 4 weeks) and 6 mo (as early as 3 mo if not given in combination with AHV)

Question 10

MenACWY vs MenB

Answer 10

MenACWY:
asplenia, HIV, complement component deficiency, ecluixumab use - given 2 doses at least 8 weeks apart then q5years
travel to endemic areas, sero-concordant disease outbreak, military, college dorms

MenB:
2 doses for healthy teens and adults or 3 doses for high risk or work exposure to N meningitidis

Question 11

Hib

Answer 11

indicated in asplenia (give at least 14 days prior to splenectomy surgery)

HSCT (hematopoetic stem cell transplant) - 3 doses 4 weeks apart starting 6-12 months after successful transplant