Remember: COZY IV RM - Cholera - Oral Typhoid - Zoster - Yellow Fever - Intranasal influenza - Varicella - Rotavirus - MMR

Chapter 20: Immunizations Flashcards by Kristin Kattoula

Who provides the recommendations for vaccine administration in children and adults

The Advisory committee on Immunization Practices (ACIP)

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Who approves the ACIP recommendations and where do these recommendations get published?

CDC

CDC’s Morbidity & Mortality Weekly Report (MMWR) & The Pink Book

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____ vaccines are produced by modifying a disease-producing (“wild”) virus or bacterium in a lab; they have the ability to replicate (grow) and produce immunity, but usually do not cause illness

Live attenuated

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Live attenuated vaccines are CI in which populations

immunocompromised and pregnant patients

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____ vaccines can be composed of either a whole virus or bacterium, or fractions of either. They cannot replicate

Inactivated

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Polysaccharide vaccines do not produce a good immune response in children < __ years of age

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Key live vaccines

Remember: COZY IV RM

Cholera
Oral Typhoid
Zoster
Yellow Fever
Intranasal influenza
Varicella
Rotavirus
MMR

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When can most live or inactivated vaccines be administered

Simultaneously

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T/F: Increasing the interval between doses of vaccine given in a series does not diminish the effectiveness of the vaccine after completion of the series

True

Decreasing the interval between doses of vaccine can interfere with antibody response & protection

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Antibodies in some blood products and IVIG can interfere with ______ and a separation period may be required

live vaccine replication

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Which type of vaccine can be given at any time

Inactivated

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Inactivated vaccines are started when a baby is 2 months old, except for which vaccine which is given at birth

Hepatitis B

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Live vaccines can cause a false-negative TB skin test. Options to reduce the risk of a false-negative include:

give the live vaccine on the same day as the skin test
Wait 4 weeks after a live vaccine to perform the skin test
Administer the skin test first, wait 48-72 hrs to get the result, then give the live vaccine

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Multiple live vaccines can be given on the same day or (if not given on the same day) spaced _____ weeks apart

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T/F: If a vaccine series requires > 1 dose, the intervals between doses can be extended without restarting the series, but they cannot be shortened in most cases

True

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MMR & varicella-containing vaccines (not zoster) require separation from antibody-containing products (e.g., blood transfusions, IVIG).

The recommended spacing if giving a vaccine before antibody containing product is:
The recommended spacing if giving an antibody containing product before a vaccine is:

Vaccine → 2 weeks → antibody-containing product

antibody-containing product → 3 months or longer → vaccine

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Simultaneous administration of vaccine and antibody (in the form of immunoglobulin) is recommended for post-exposure ppx of certain diseases, such as

Hep A & B, rabies and tetanus

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Adverse reactions that require some type of assistance should be reported to

FDA’s Vaccine Adverse Events Reporting System (VAERS)

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With live vaccines, mild systemic reactions can occur __ - ___ days after the vaccine is given

3-21 days

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When does a vaccine become contraindicated in a person (besides being immunocompromised or pregnant with live vaccines)

A severe or anaphylactic reaction

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T/F: Treatment with antibiotics is NOT a valid reason to delay vaccines

True

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T/F: If a person has a moderate-severe acute illness, it is not necessary to delay vaccines until the condition has improved

False - it is reasonable to delay the vaccine

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How often is Tdap or Td given in adults

every 10 years

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At what age can Shingrex be given

> /= 50 years old

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T/F: Shingrex should still be given even if a patient has previously had chicken pox

True

When is the second dose of Shingrex given

2-6 months after the first dose

Pneumovax 23 is given to all adults >/= ___years

Patients age 2-64 years should get 1 dose of Pneumovax 23 if they have which condition(s)

Heart, lung, liver disease, diabetes, alcohol abuse, smokers

Patients age 2-64 years should get 2 doses of Pneumovax 23 if they have which condition(s)

Immunocompromised (e.g, SCD, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs including steroids)

T/F: Prevnar 13 is optional for adults age >/= 65 years

True

Any patients >/= 6 years old who are ____ should receive Prevnar13

immunocompromised

Which meningococcal vaccines are serogroup B

Bexsero, Trumenba

Which adult populations should receive Meningococcal serogroup B vaccines

complement component deficiency, taking aculizumab (Soliris), asplenia, microbiologist with exposure to Neisseia Meningitidis, serogroup B meningococcal vaccine exposure

Which meningococcal vaccines are conjugate vaccines

Menactra and Menveo

Which adult populations should receive Meningococcal conjugate vaccines

Same groups as serogroup B: complement component deficiency, taking aculizumab (Soliris), asplenia, microbiologist with exposure to Neisseia Meningitidis, serogroup B meningococcal vaccine exposure PLUS: HIV, Sickle Cell disease, travelers/residents to countries in which the disease is common (such as the meningitis belt in Sub-Saharan Africa), military recruits, first year college students living in dorms, if not up-to-date

Which adult populations should receive Hep B vaccine

Sexually active adults who are not in long-term, monogamous relationships, patients with diabetes age 19-59 years (or >/= 60 years per HCP discretion), household contact with an infected person, IV drug abusers (IVDAs), patients with HIV or chronic liver disease

What is the combination Hep A and B vaccine called

Twinrix

Which adult populations should receive Hep A vaccine

Adults traveling to undeveloped countries outside of the US, 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

What are the Hep B vaccine names

Engerix-B Recombivax HB Heplisav-B

What are the Hep A vaccine names

Havrix | VAQTA

Which formulation of the Diphtheria Typhoid vaccine is for peds (younger than 7 years old)

DTaP

Which formulation of the Diphtheria Typhoid vaccine is for adults

Tdap or Td

Tdap brand name

Adacel, Boostrix

DTaP-HepB-IPV brand name

Pediarix

When should someone get revaccinated with Td or Tdap

Wound ppx for deep or dirty wounds if it has been more than 5 years since the last dose

Who should receive a booster dose of Td or Tdap

- Pregnant or postpartum women with each pregnancy - close contacts of infants younger than 12 months - Healthcare personnel - Children age 7-10 years who did not get fully vaccinated with the DTaP series

Adults with ____ should receive Hib vaccine

asplenia

HepB vaccine is started within what time after birth

24 hrs

Which HepB vaccine is only given in patients >/= 18 years

Heplisav-B

Brand name for HPV9

Gardisil

Recommended age to receive HPV9 vaccine

11-12 years

If HPV9 is started before the age of 15, how many doses are needed If HPV9 is started at or after the age of 15 or if the patient is immunocompromised, how many doses are needed

2 doses 3 doses

Which patients need to receive 2 doses of the influenza vaccine 4 weeks apart

age 6 months to 8 years who are not previously vaccinated

Patients with an egg allergy can receive which influenza vaccine

any-age appropriate inactivated influenza vaccine (NOT FLUMIST) even if severe allergy symptoms

Which influenza vaccine is an egg-free product and what age group can receive it

Flublok | Age >/= 18 years

Which influenza vaccines are indicated only for patients >/= 65 years

Fluzone High-dose, Fluzone High-Dose Quadrivalent, and Fluad

Fluzone HD and Fluad are (trivalent or quadrivalent) inactivated vaccines

Trivalent | note: fluzone HD comes as a tri and quadrivalent vaccine

Afluria, Fluarix, FluLaval, Fluzone, Flucelvax, & Flublok are (trivalent or quarivalent) inactivated vaccines

Quadrivalent | note: fluzone HD comes as a tri and quadrivalent vaccine

Which flu vaccine is a quarivalent live attenuated vaccine

FluMist

What age group can receive FluMist

Healthy people age 2-49 years

How is FluMist administered (including the dose)

0.2 mL divided between the two nostrils

What is the combination MMRV (MMR + Varicella) vaccine brand name

ProQuad

What the the name of the MMR vaccine

M-M-R II

T/F: MMR vaccine can be given to pregnant and immunocompromised patients

false - it is a live vaccine

Where should the MMR vaccine be stored

In the fridge or freezer

Where should the MMRV vaccine be stored

freezer ONLY d/t the varicella component

What route is the MMR & MMRV vaccine given

Where should MMR vaccine diluents be stored

at room temp or in the refrigerator

Age >/= ___ with high risk should receive MenB vaccine

10 years

Children age < ___ years receive PCV13 as part of routine childhood vaccinations

5 years

How is PPSV23 given

IM or SC

How many times should a patient receive PCV13

once in their lifetime

How many times should a patient receive PPSV23

1, 2 or 3 doses - 1 dose before age 65 if they have diabetes, heart, lung or liver disease, alcohol abuse, smokers - 2 doses before age 65 if they have SCD, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs, including steroids - 1 dose age 65+ for all patients

If PCV13 is given to an immunocompetent person, how long must you wait to give PPSV23

1 year

If PPSV23 is given to a patient at age 63, how many years must you wait to give another dose if the patient is now 65

5 years after the last dose of PPSV23

If PCV13 is given to an immunocompromised person, how long must you wait to give PPSV23

at least 8 weeks

What is the name of the polio vaccine

IPV

What are the brand names for the Rotavirus vaccine

Rotarix, RotaTeq

How is the Rotavirus vaccine administered

orally

Varicella Virus Vaccine (for chickenpox) brand name

Varivax

Anyone without immunity to varicella should receive how many doses of Varivax

Some antivirals (e.g, acyclovir, valacyclovir, famiciclovir) can interfere with the live vaccines (including varivax) & should be stopped how long before vaccine administration and should not be taken for 14 days after vaccination

24 hrs

Where must Varivax be stored

in the freezer

When should Varivax be reconstituted

Right away upon removal from the freezer and inject due to short stablility

Varivax should not be given if there is a hypersensitivity to _____

gelatin or neomycin | *remember: i am Vari allergic to gelatin and neomycin*

Varivax is administered via which route

How is Shingrix administered

Rabies vaccine brand name

RabAvert

A person who has been exposed to rabies without previous vaccination should get how many doses of Rabies Vaccine

4 doses: 1 dose of Rabies immune globulin should be given with the first vaccine dose

Typhoid vaccine comes in which formulations

Oral, Injection | *remember: typhOid, oral*

When should the oral Typhoid capsules be taken

at least 1 week prior to possible exposure

When should the injectable Typhoid vaccine be taken

at least 2 weeks prior to possible exposure

Oral Typhoid capsules should be stored

in the fridge

How should Typhoid capsules be taken

On empty stomach with cold or lukewarm water

Which vaccine can cause a positive reaction to the TB skin test

Tuberculosis BCG vaccine

Yellow Fever vaccine is CI with

severe (life-threatening) allergy to eggs or gelatin

What is provided and valid for 10 years after receiving Yellow Fever Vaccine

International Certificate of Vaccination (yellow card)

Yellow Fever Vaccine should be reconstituted with

Provided diluent

How should Yellow Fever Vaccine be administered

Where should the packet for reconstitution for the cholera vaccine be stored

in the freezer

The CDC recommends a calibrated thermometer or a digital data logger be connected to a _____ in the fridge and freezer

buffered temperature probe

Temperatures in fridge and freezer should be read and documented at least how many times per workday

Temperature logs should be kept for how long

3 years or longer

What size needle should be used with a SC injection & how should it be inserted into the skin

5/8" | 45 degrees

What size needle should be used with a IM injection & how should it be inserted into the skin

1" (exceptions: weight < 130 lbs, use 5/8"-1" needle & males >260 lbs or females >200 lbs. use a 1.5" needle) 90 degrees