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Flashcards in Immunization Deck (38)
0

Guidelines/references

www.pharmacist.com/imz (American pharmacist Association)
CDC.gov/vaccines
Immunize.org (immunization action coalition)

1

Safety concerns

Autism: thimerosal , a mercury containing preservative, was though to possibly be the cause however it has been removed from his childhood vaccines and autism rates have not decreased.... Nor have they decreased in areas where parents refuse more often

Side effects: mild fever, soreness, swelling, rarely anaphylaxis

2

Vaccine information statement (VIS)

Federal law requires that patients receive the most up-to-date version before each vaccine is administered

3

Active immunity

Protection that is produced by the person's own immune system

This is usually permanent and comes from surviving an infection but can be produced. Vaccination

4

Passive immunity

Usually acquired from a source or an injection an example would be antibodies an infant receives from its mother

5

Separation time between the measles and varicella (varivax) vaccines

His vaccine given first wait two weeks before giving antibody however if antibiotic given first wait three months or longer before giving vaccine

6

Simultaneous administration

Give them all at one time... It's better to give them them all than to have to wait for the separation time

7

Nonsimultaneous administration

If live parenteral vaccines and live intranasal or influenza vaccines are not administered at the same time they must be separated by at least four weeks

8

Live parenteral vaccines

MMR, MMRV, varicella, zoster, and yellow feve

9

Interval for administration of live vaccines and TB test

Can be administered on the same day as the preferred method to avoid a false-negative, but if the vaccine has been given recently but not on the same day as the PPD wait four weeks

10

What to do in the event of anaphylaxis

Call 911

Administer epinephrine 1:1000 dilution intramuscularly (0.01 mg/kg up to 0.5 mg max)

Administered diphenhydramine either orally or by injection but do not give Oriely if patient has signs of mouth throat or lips swelling and difficulty breathing

Give CPR if necessary

Repeat dose of epinephrine is EMS is not arrive

11

Absolute contraindications for live vaccines

Pregnancy and immunosuppression

12

What is classified as immunosuppression

Steroid induced: 20 mg or more per day, 2 mg per kilogram or more per day
*not intra-articular injections, metered dose inhalers, topical alternate day or short course for less than 14 days

Anyone receiving cancer treatment with alkylating agents or anti-metabolite or radiation therapy

Patients with HIV with a CD4 count of <200

Transplant patients (can receive pneumococcal but need PCV13 first then PPSV23)

13

Vaccinations for healthcare professionals

Hepatitis B, flu, MMR, varicella, Tdap (with Td boosters every 10 years), meningococcal

14

Egg allergy

If a person can eat lightly cooked eggs without a reaction or if the person experiences only hives after eating egg containing foods an inactivated influenza vaccine can be administered and the patients it should be observed for at least 30 minutes

* egg allergies are a concern with yellow fever, rabies, influenza vaccines

15

That seems contraindicated with Guillian-barre'

Tetanus containing vaccines, influenza, MCV should not be given

16

Gelatin or neomycin allergy

Both varicella vaccines (zostavax and Varivax) and MMR should not be given

17

Streptomycin, polymyxin B and neomycin allergy

Inactivated poliovirus vaccine (IPV) is contraindicated

18

Screening questions prior to vaccination

1. Are you sick today?
2. Do you have allergies to medications, food, vaccine component or latex?
3. Have you ever had a serious reaction to a vaccine?
4. Do you have long-term health problems or any blood disorder?
5. Do you have cancer, leukemia, AIDS, or any other immune system problem?
6. Do you take Cortisone, prednisones, other steroids, anticancer drugs, or radiation therapy?
7. Have you had a seizure or a brain or other nervous system problem?
8. Do you have cochlear implants or a cerebrovascular leak?
9. During the past year have you received a transfusion of blood, have you been on an immune or gamma globulin or an antiviral drug?
10. For women: are you pregnant or is there a chance you will become pregnant during the next month?
11. Have you received any vaccinations in the past 4 weeks?

19

Diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccines

DTaP: daptacel (infanrix, Tripedia) given to children younger than seven years of age
DTaP-IPV: KINRIX
DTaP-HepB-IPV: Pediarix
DTaP-IPV/Hib: Pentacel

Storage: refrigerator
Administration: IM

20

Haemophilus influenza type B containing vaccines

Hib: ActHIB, Hiberix, PedvaxHIB
Hib-hep B: Comvax
DTaP-IPV/HIB: Pentacel

Storage: refrigerator
Administration: IM

21

Hepatitis containing vaccines

HepA: Havrix, Vaqta
Hep B: Engerix-B, Recombivax HB
HepA-hep B: Twinrix

Who HepA? child >1year of age, men who have sex w/ men, IV drug abusers, pts with chronic dx, and travelers to countries with high HepA incidents

Who HepB? Healthcare workers, men who have sex w/ men, anyone w/ multiple sex partners, IV drug users, ESRD, chronic liver dX

Three-part series given a 0, 1 and 6months in adults and adolescents

Storage: refrigerator
Administration: IM

22

Human papillomavirus vaccine

HPV2: Cervarix a bivalent vaccine for immunity against the HPV strains that cause cervical cancer
HPV4: Gardasil a Quadrivakent vaccine for prevention of cervical cancer pap smear abnormalities and genital warts

Gardasil is indicated for females and males

Recommend the three does series between the age of 11-12 years with catch-up vaccination at age 13-26 for females

Recommended age for males is 9–26

Storage: in the refrigerator protected from light
Administration: IM

23

Influenza vaccine

LIVE attenuated influenza vaccine: fluMist (quad) CAN BE GIVEN IN PEOPLE AGED 2–49 yo INCLUDING HEALTHCARE PERSONNEL IF HEALTHY AND NOT PREGNANT

Inactivated influenza vaccine (trivalent): afluria, fluarix, fluvirin, Fluzone, Fluzone high-dose (>65 yo), Fluzone intradermal (18-64 yo ONLY)

RIV (egg free): FluBlok (recombinant)

Who: everyone >6 months of age and every year

Storage: refrigerator

Considerations: Jafar is patient has moderate to severe acute illness, and referred to physician patient has Gilian-barre' within six weeks of a prior dose of flu vaccine, also Afluria can only be given and children greater than nine

24

Measles, mumps and rubella containing vaccines

MMR:M-M-RII
MMRV: ProQuad

Given to children, patients born before 1957 generally are considered immune

Do not give in pregnancy as this is a live vaccine

Storage: refrigerator or freezer (MMR); freezer only due to varicella component (MMRV) protect from light

Administration: give SC

25

Meningococcal vaccines

MCV4: Menactra, Menveo
MPSV4: Menomune

1 dose 11–12 yo with one booster at age 16–18

1 dose at 13–18 yo if previously unvaccinated

Encouraged at 2–55 yo if at high risk: college, asplenia, military, immunodeficiency, travelers to high-risk countries such as Saharan Africa, lab workers with meningitis exposure, required by Saudi Arabia for annual travel during the period of the hajj

Storage: refrigerate, protect from light
Administration: MCV (IM), MPSV (SC)

26

Pneumococcal vaccine

13 valent pneumococcal conjugate vaccine (PCV13): Prevnar 13 (minimum age at immunization is six weeks)
23 serotype polysaccharide vaccine (PPSV23): Pneumovax 23 (minimum age at immunization is two years)

Prevnar: routine vaccination for all and infants at two, four, six and 12 to 15 months
Pneumovax: recommended for patients greater than 65, patient's age 19–64 who smoke or have asthma, patient's age 2–64 who have chronic illnesses (NOTE GIVE ONE DOES AFTER AGE 65 IF FIRST DOSE WAS BEFORE 65)

Storage: refrigerator
Administration: IM AND DO NOT MIX WITH OTHER VACCINES IN THE SAME SYRINGE

27

Tdap

Tdap: Adacel, Boostrix

Who: patient's age 7–10 that were not fully vaccinated with DTaP series, as a single booster for ages 11–64 with no previous record of Tdap then one dose of Td every 10 years, patients greater than 65 years old with no previous Tdap who have close contact with infant age less than 12 months, pregnant women during weeks 27–36

Storage: refrigerator
Administration: IM

28

Varicella containing vaccines

VAR: varivax (chickenpox)- age 12 months and 4 years, and all adults without immunity (prior outbreak) should receive two doses 4 weeks apart
ZOS: zostavax (herpes zoster – shingles)-indicated in age 50 and older but recommended in age 60 and older

LIVE VACCINES DO NOT GIVE IF IMMUNOCOMPROMISED OR PREGNANT and do not give if sensitive to gelatin or neomycin

Storage: store vaccine and freezer and protect from white and store diluent in refrigerator or at room temperature

Administration: SC; administer quickly after removing from freezer

29

Japanese encephalitis (Ixiaro)

Given and spending one or more months in an endemic area during transmission season especially if travel will include rural areas this vaccine is given
Administration:in two doses 28 days apart at least one week prior to potential exposure; IM

30

Rabies (Imovax, RabAvert)

Given if high risk exposure such as animal handlers, traveling to high-risk area or given with rabies exposure

Three doses for prevention

Four doses plus rabies immune globulin with first dose if exposed

Give IM

31

Smallpox

Currently eradicated but US government has vaccine

32

Typhoid
(Vivotif Berna) capsule
(Typhim Vi, Typherix) injection

REFRIGERATE CAPSULES

typhoid fever is caused by salmonella

Travelers from US to Asia, Africa, and Latin America at risk to reduce risk boil it, cook it, peel it or forget it

Take four capsules; one on alternate days (day 1, 3, 5 & 7) at least one week prior to exposure

33

Yellow fever

Patient should receive a yellow card valid 10 days after the vaccine for 10 years as proof of vaccine

Transmitted by mosquitoes use insect repellent and wear protective clothing

High risk and tropical and subtropical areas of South America and Africa

Give SC; reconstituted

Contraindicated with severe allergy to eggs, chicken proteins, or gelatin

34

Storage of all vaccines

Dormitory style refrigerator should not be used

Store away from the edges and never store on the doors of the refrigerator or freezer as the temperature there is unstable

Record the temperature at least twice a day and keep records for three years

35

Intramuscular injections

Given the deltoid muscle at a 90° angle making sure to separate two injections by 1 inch

Adults require a 1 inch needle unless greater than 200 pounds and women or 300 pounds and then at which point use one and a half inch needle

36

Subcutaneous administration

Given and the fatty tissue about the triceps

5/8 inch needle is used at a 45° angle making sure to separate two injections by 1 inch

Varicella, zoster, MMR, meningococcal given SC

pneumococcal can be given IM or SC

37

Symptoms of the flu

Abrupt onset of fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis

And children you may also see otitis media, nausea, and vomiting

Typically resolves after 3 to 7 days for the majority of patients