immunization quiz 2 Flashcards
(23 cards)
identify patients that are at risk for covid
- age: >65 years and very young children
- conditions: obesity, diabetes, kidney disease, COPD, neurocognitive disorders, heart conditions
- conditions are additive for risk
explain risks of covid
- complications include pneumonia, myocarditis, blood clots, neurologic effects, long-COVID
- reinfection can happen
identify and explain when based on CDC recommendations patients should receive COVID vaccine
- primary series of 2 (or 1 Janssen) recommended. mixing not authorized for primary doses
- Janssen boosters: 1 bivalent booster
- age 12+ booster: 1 bivalent booster
- age 5-11: Pfizer booster (monovalent)
- age 6mo-4yrs: primary series only
- immunocompromised people get an extra dose of primary series (considered separate than booster)
- if patient has received monoclonal antibodies, wait 2 weeks after vaccination and continue with additional doses
identify vaccine specific adverse effects to covid
- injection site pain
- fatigue
- headache
- myalgia
- adverse effects tend to be mild to moderate, happening 1-2 days from vaccine
- can be more frequent and severe after 2nd dose
- kids: injection site pain, fatigue, irritability, drowsiness, febrile seizures possible, also tend to be mild to moderate overall
- myocarditis (but there’s a higher risk with infection than vaccine, most common in males 12-39, increasing intervals between doses may help)
- Janssen also has risk of thrombosis, only recommended if it’s the only option, tell patients to look out for symptoms up to 2 weeks after (shortness of breath, chest pain, leg swelling, persistent abdominal pain, headache, easy bruising)
- very rare anaphylactic reaction
explain dosage, storage, administration technique, and schedule for covid vaccine
- Pfizer age 6mo-4years: 0.2mL
- Pfizer age 5-11: 0.2mL primary series, 0.2mL booster
- Pfizer 12+: 0.3mL primary series, 0.3mL booster
- Moderna 6mo-5years: 0.25mL
- Moderna 6-11: 0.5mL
- Moderna 12-17: 0.5mL
- Moderna 18+: 0.5mL primary series, 0.25mL booster dose
- Janssen 18+: 0.5mL
- Novavax 12+: 0.5mL
- storage depends per vaccine but generally fridge or freezer?, usually ok 12 hrs from opening but varies per vaccine
- all IM
identify contraindications for covid vaccine
- history of severe allergic reaction to previous dose/ to a component of COVID vaccine
- diagnosed allergy to component of COVID vaccine
- Janssen: TTS following previous Janssen COVID vaccine
- Janssen: not recommended if history of immune syndrome related to thrombosis
- Janssen: not recommended if Guillain Barre Syndrome occurs within 6 weeks of previous dose
- Janssen: precaution with any history of GBS
- precaution if history of an immediate allergic reaction to any vaccine other than COVID
- precaution if a non-severe, immediate allergic reaction to a previous dose occurred
- precaution if moderately to severely ill
- precaution if history of MIS-C or MIS-A
- precaution if history of myocarditis or pericarditis after a dose of a COVID vaccine
identify patients that are at risk for HIB related disease
- crowded/ large household
- daycare
- school-aged siblings
- chronic disease (sickle cell, cancer, etc)
- low parental education
- low socioeconomic status
- males have slightly higher risk
- race/ethnicity: African-Americans, Hispanics, Native Americans
explain what is severe/invasive HIB disease
related diseases include:]
- meningitis
- epiglottitis
- pneumonia
- arthritis
- osteomyelitis and bacteremia
- 6% mortality rate
identify and explain when based on ACIP/CDC recommendations patients should receive HIB vaccine
-primary series of 2-3 doses at 2, 4, and 6 months with a booster at 12-15 months
identify HIB vaccine adverse effects
- local swelling, pain, redness
- systemic fever, fussiness
- severe reaction rare
explain dosage, storage, administration technique, and schedule for HIB vaccination
- 0.5mL administered IM
- stored in fridge
- catch up recommended up to 5 years old
identify valid contraindications for HIB vaccine
- no less than 6 weeks old
- evaluate combination vaccine components
- defer if moderate to severe illness
- do not give if there is a known allergy to the vaccine or its components
identify patients at risk for meningococcal disease
- most common in adolescents and young adults
- highest risk groups: <1 and 19-22, college students during outbreak, microbiologists, asplenia increases fatality chance, complement inhibitor, persistent complement deficiency
- host factors: deficiencies in terminal complement, asplenia, chronic underlying illness, genetic, HIV infected
- exposure factors: household exposure, recent viral infection, household crowding, exposure to cigarette smoke, microbiologists
explain serious health effects from becoming sick with meningococcal disease
- very rapid onset
- 10-20% mortality
- common complications when body goes into DIC: loss of limb, scarring, cerebral infarction
- common complications with meningitis in 50% of cases: hearing loss and neurologic damage
- meningococcemia in 40% of cases: high fever, rash, shock (hypotension and multiorgan failure), acute adrenal hemorrhage, death within hours of onset
identify and explain why patients require meningococcal vaccines based on CDC guidelines
- Bexsero (men b): approved for 10-25years
- Trumenba (men b): approved for 10-25 years
- recommended for everyone?
- at risk patients stay up to date on boosters, 1 vaccine lasts 3-5 years
- Menactra (A,C,W,Y): approved for 9mo-55years
- Meveo (A,C,W,Y): approved for 2mo-55years
- Menquadfi (A,C,W,Y): approved for 2+ years
explain storage, administration technique, and schedules for meningococcal vaccination
- dose 0.5mL IM
- store in refrigerator
- note that Menveo has a special reconstitution fluid
- patients at high risk for men b should get revaccinated 1 year after first dose and continue to get it every 2-3 years if still at risk
identify adverse effects of meningococcal vaccines
- Bexero: injection site irritation, myalgia, fatigue, headache, nausea, arthralgia
- Trumenba: injection site irritation, headache, myalgia, chills
identify valid contradictions to meningococcal vaccination
- severe allergic reaction
- delay if moderate to severe illness
- pregnancy NOT contraindication
explain serious health effects and costs of becoming sick with pneumococcal disease
- invasive bacteria can cause meningitis, bacteremia with or without pneumonia, osteomyelitis, peritonitis
- non-invasive bacteria can still cause: pneumonia without bacteremia, otitis media, sinusitis
identify and explain why patients are recommended to receive pneumococcal vaccines
- high risk are young and old (especially old)
- asplenia (and sickle cell)
- immunodeficiency
- chronic renal failure
- cochlear implant
- lung and WBC disease
- seizure disorder, chronic liver disease, immunosuppressive drug/condition
- chronic heart disease, neuromuscular
- asthma, alcoholism, smoking, immunologic condition
- diabetes, chronic oral steroids
- pediatric recs: all infants need PCV13 or 15 3 dose series with booster at 12 mo. if high risk, get PCV23 if >2years
- adult recs: routine for patients 65+, routine for high risk aged 19-64
- if no record of PCV13: get PCV15 followed by PPSV23 1 year later or PCV20
- if they have PCV13, they can have PPSV23
- if they have PPSV23, they can get PCV15 or 20 1 year later
explain pneumococcal vaccine efficacy and adverse effects
- PPSV23- 21-46% effective against pneumonia, 38% against IPD; may cause injection site reaction, headache, fatigue, myalgia
- PCV13- 75% effective against IPD, works better in children; may cause injection site reaction, irritability, decreased appetite, change in sleep pattern, fever, headache, muscle ache
- PCV15- inferred from immunogenicity; may cause injection site reaction, fatigue, myalgia
- PCV20- inferred from immunogenicity; may cause injection site reaction, fatigue, myalgias
list dose, storage, administration technique, and schedule for pneumococcal vaccination
- 0.5mL IM (but PPSV23 can also be done SQ)
- all stored in fridge
- suspensions must be shaken before being drawn up
identify valid contraindications to pneumococcal vaccination
- prior severe allergic reaction to pneumococcal vaccine
- or prior severe allergic reaction to diptheria toxoid
- delay if moderate to severe illness
