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Medicine II: Pediatrics > Immunizations > Flashcards

Flashcards in Immunizations Deck (26)
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1

Vaccines: Common side effects

-Fever
-Local pain, redness and swelling
-Soreness, myalgia with TIV
-Rash 1-2 weeks after MMR-V
-Rhinorrhea, sore throat with LAIV

2

DTaP

-2,4,6,15 months and 4-6 years
-3 primary doses at least 4 weeks apart

3

What is the difference between Tdap and DTap?

xx

4

Hepatitis B

For all newborns (90% risk) and Adults at high risk
*****0,2,6 months

Must be 24 weeks of age for last dose. Do not give in the buttocks/ Intradermal

5

H. Influenza type B - 1988

Was leading cause of meningitis (6-18 months) leading to hearing loss, nasopharyngeal carriage

-ActHIB (PRP-T), HiBTITRE (HbOC)
---2,4,6 and 12-15 months
-Pedvax Hib/ Comvax (PRP-OMP) (Merck)
---2,4, and 12-15 months

Given up to 59 months if delayed

6

Pneumococcal vaccine: PCV13 (Prevnar):

-2,4,6 and 12 months
---88% Bacteremia/ 82% Meningitis
---70% of pneumococcal otitis media
---80% of penicillin- nonsusceptible strains

Given up to 59 months if delayed

7

Pneumococcal vaccine: PPV23 (Pneumovax)

2 years and older with high risk and had 4 doses of PCV13: Those with Sickle cell, Asplenia, HIV, Cochlear implants or Nephrotic syndrome.

2nd dose 3-5 years later

8

Meningococcal vaccine

College students in dorms, military
****11-12 years (2005), 11- 55 yrs

****Booster at 16 -18 years (2011)

T cell dependent response, Long lasting memory, Herd immunity; Eradication of nasopharyngeal carriage

9

Meningococcal vaccine

2,4,6 and 12-15 months

Terminal complement deficiency (C5-C9), C3 or properdin deficiency, Anatomical or functional asplenia, HIV

Tdap and MCV4: Together or 1 month apart

10

MPSV4: ACYW135

Shorter lived, T cell independent response. No Long lasting memory. No booster response. No Herd immunity. No reduction in nasopharyngeal carriage.

11

Hepatitis A

12 - 23 months: 0.5ml, IM (1 ml > 18 years)

2 doses 6-18 months apart

IgG for pre/ post exposure prophylaxis: 0.02 ml/kg IM < 3 months travel/ post exposure. 0.06 ml/kg 3-5 months travel; every 5 months. 1 daycare child/ staff or 2 house holds cases.

12

Human Papilloma Virus Vaccine

HPV types 6,11: 90% of genital warts
HPV types 16,18: 70 % of cervical cancer
Gardasil: Targets HPV types 6,11,16,18

Females/ males 11-12 years (9-26 years)

Cervarix targets HPV types 16,18

Three doses 0, 2 months and 6 months. Minimum 4 weeks between dose 1 and 2, 16 weeks between dose 2 and 3 and 24 weeks between dose 1 and 3.

13

Rotavirus Rotateq :

Live oral bovine penta-valent
****2,4 and 6 months
Start at 6-14 weeks. Final dose no later than 32 weeks.

14

Rotavirus Rotarix (G1P1):

****2 and 4 months

2 doses between 6 - 24 weeks. Protection against G1,G3,G4 and G9

15

MMR: 1963/67

Single serotypes, live attenuated,0.5 ml - SC. ****15 months and 4-6 years. 2 doses a least 4 wks apart for 1-12 yrs

Encephalitis risk 1:1 million dose. With disease 1:1000, death 1-3/1000, SSPE

Monovalent or MMR For 6-11 months at increased risk. Health care workers born after 1957. 2 doses, positive serology or physician diagnosed disease.

16

MMR: Contraindications

Pregnancy
Anaphylaxis to first dose of vaccine (Neomycin/ gelatin)

Allergy to egg (NOT contraindicated)
Skin allergy testing is not recommended

Immunodeficiency (Asymptomatic/ non-severe HIV is NOT contraindication)

17

MMR: Precautions

Recent Immunoglobulin (IG): 3 months (HAIG) & 11 months (ITP/ Kawasaki)

High dose steroid (2mg/kg or 20 mg) > 14 days (1 month)

History of thrombocytopenia (Especially within 2 months of 1st dose).

Place PPD on same day or 4 weeks later. Treat untreated TB before vaccine (Moderate to severe acute illness)

18

Varicella: Contraindications

Pregnancy
Anaphylaxis to first dose of vaccine (Neomycin/ gelatin)

Allergy to egg (NOT contraindicated)
Skin allergy testing is not recommended

Immunodeficiency (Asymptomatic/ non-severe HIV is NOT contraindication)

19

Varicella: Precautions

Recent Immunoglobulin (IG) administration (High dose steroid (2mg/kg or 20 mg) > 14 days )

1 month (~ MMR) (Salicylate use, Moderate to severe acute illness with or without fever)

20

Influenza - TIV

All 6 months and older
High risk children: BA, CF, CHD, HIV, SS, ASA, Renal, DM

Close contact of high risk – YOU!

Contraindicated in Egg Anaphylaxis

2 doses 4 weeks apart if not previously vaccinated and < 9 years

0.25 ml (6-35mths) 0.5 ml (> 36 months)

Multi dose vial: Trace thimerosal

21

Influenza - LAIV

Healthy 2-49 year olds

Not for high risk groups

Contraindicated in Egg Anaphylaxis, Salicylate therapy, H/o GBS, Pregnancy

2 doses 4 weeks apart if not previously vaccinated and less than 9 yrs

0.1 ml in each nostril

Protects against mismatched strains in children (IgA and IgG)

22

Strain Drifts are a Common Occurrence

Unlike other childhood vaccines, influenza vaccines can only provide immunity for a limited duration. Consequently, focus has been on high-risk categories rather than universal vaccination. If the virus strain drift is considered significant, vaccine composition is changed.

23

Live vs Dead Influenza

xx

24

Polio Vaccines

Trivalent vaccines
*****2,4,6 months and 4-6 years

IPV (2000): No serious side effects
OPV: No longer available in US

Vaccine associated paralytic polio

25

Killed vaccines:

Cannot replicate. Generally not as effective as live vaccines. Minimal interference from circulating antibody. Immune response is mostly humoral . B-cell mediated, producing antibodies. Little or no cellular immunity develops. Generally requires multiple doses; initial dose/s “prime” and later dose/s “boost” the immune system. Antibody titers diminish with time.

26

Live Vaccines:

Attenuated (weakened) form of the “wild” virus or bacteria. Must replicate to be effective. Immune response similar to natural infection – cellular immunity. Long-lasting immunity. Usually effective after one dose. Person may develop symptoms similar to a mild case of the disease (e.g., rash, fever). Symptoms usually develop after an incubation period (7 - 21 days). Severe reactions are possible. Interference from circulating antibody. Fragile – must be stored and handled carefully. If not administered simultaneously, separate vaccines by at least 4 weeks