Immunizations Flashcards
1
Q
Live Attenuated Vaccine
A
Contain a version of the living microbe (ex: MMR, Polio)
2
Q
Inactive/Killed Vaccine
A
Produced by killing the microbe with heat, chemicals or radiation (ex: cholera, influenza, rabies)
3
Q
Subunit Vaccines
A
Use of only the antigen that best stimulates the immune system; attached to an antigen (ex: HepB, Pertussis, Pneumococcal)
4
Q
Toxoid Vaccines
A
When the toxin is the main cause of the disease (Diptheria, Tetanus)
5
Q
Conjugate Vaccine
A
Linkage of an unrecognizable polysaccharide to one that is recognized and can help boost immunity (ex: Hib and penuomococcal-13)
*Linked to something else
6
Q
DNA Vaccines
A
Naked DNA vaccines; experimental (malaria, herpes, HIV)
7
Q
Recombinant Vector Vaccines
A
A carrier vector is used which is similar to DNA vaccines
8
Q
Vaccine Routes (5)
A
- Rotavirus - oral route
- Flu - intranasal (no longer recommended) or IM
- Varicella and MMR are subcutaneous
- IPV is subcutaneous or IM
- All other vaccines are IM
9
Q
Aluminum is present in which vaccines? (6)
A
- HepA
- HepB
- DTaP, Tdap
- Hib B
- HPV
- Pneuomococcus infection
*Unable to get these vaccines if allergic to aluminum
10
Q
IM Vaccine Needle Length and Site Per Age (4)
A
- Newborns (1st 28 days): 5/8th inch needle at anterolateral thigh muscle
- Infants (1-12 months): 1 inch needle at anterolateral thigh muscle
- Toddlers (1-2 years):
Either 1-1 and 1/4th at anterolateral thigh muscle OR 5/8-1 inch at deltoid muscle of arm - Children and teens (3-18 years old): either 5/8-1 inch at deltoid muscle of arm OR 1 inch to 1 and 1/4th at anterolateral thigh muscle
- Don’t use 5/8th inch needle after 4 months unless very skinny
- 1 inch if a lot of fat is present
11
Q
Methods to Reduce Pain of Vaccines (6)
A
- Proper length of needles (reduces redness and swelling)
- Vapocoolant spray or EMLA cream
- Numby stuff - cutaneous anesthesia to 10mm
- Cognitive behavioral use of pinwheel or popup book
- Buzzing toy
- NO TYLENOL unless child is running a fever; better to put ice on the area
12
Q
What does DTaP protect against? (3 with description)
A
- Corynbacterium Diptheria
* Nasopharyngitis
* Low grade fever with obstructive laryngotracheitis and bull neck (airway compromise) - Tetanus
* Caused by neurotoxin produced by clostridium tentani in contaminated wound
* Generalized form is lock jaw with a gradual onset over 1-7 days with severe spasms and autonomic dysfunction
* Local tetanus, local muscle spasms next to a wound
* Cephalic can present with cranial nerve dysfunction secondary to wound in head or neck (many times it is a terminal disease) - Pertussis
* Cough illness; fatalities and brain damage in young children
* Adolescents and adults are a reservoir
* Child may be very cyanotic, gasping for air
* Children below 2 do not cough with a cold - SUSPECT PERTUSSIS
13
Q
Pertussis Among Adolescents and Adults (5)
A
- Prolonged cough (3 months or longer)
- Post-tussive vomiting
- Multiple medical visits and extensive medical
evaluations - Complications: Hospitalization, Medical costs, Missed school and work, Impact on public health system
- Td booster may not protect you from pertussis if you are commonly around it
14
Q
Tetanus Containing Vaccine Schedule (7) MUST KNOW ALL
A
- Dose 1: DTaP @ 2 months
- Dose 2: DTaP @ 4 months (minimum interval of 4 weeks from previous dose)
- Dose 3: DTaP @ 6 months (minimum interval of 4 weeks from previous dose)
- Dose 4: DTaP @ 15-18 months (minimum interval of 6 months from previous dose; i.e., if 4 months between 3rd and 4th dose, do not repeat)
Secondary series…
5. Dose 5: DTaP between 4-6 years old if dose 4 occurred before 4th birthday
- Dose 6: Tdap @ 11-12 years old
- Then booster of Td every 10 years afterwards
15
Q
Pertussis-Containing Vaccine (1 and 2C)
A
- DTaP: approved for children 6 weeks through 6 years up until they turn 7
- Tdap (adolescence and adult): approved for persons 10-65 (Boostrix and Adacel)
A. Can be given regardless of the last interval between last tetanus and diptheria vaccine
B. One does in every pregnancy between 27-36 weeks gestation
C. Can give from 7-10 if no record of receiving pertussis vaccine
16
Q
DTaP Fourth Dose
A
Recommended at 15-18 months but may be given at 12 months of age if: Child is 12 months of age and it’s been 6 months since third dose of DTaP and the child is unlikely to return at 15-18 months
17
Q
DTaP School Entry: Fifth Dose (3)
A
- Given between 4-6 years
- Fifth dose is recommended when fourth dose was given before 4 years old (before 48 months)
- All DTaP vaccines are licensed for 5th dose after DTaP primary series
18
Q
3 Advantages and 3 Disadvantages to Combo Vaccines Containing DTaP
A
Advantages:
- Reduced number of injections
- Improved vaccination timeliness and coverage
- Reduced shipping and storage costs
Disadvantages:
- Potential for increased ADEs
- Extra doses of antigen
- Reduced immunogenicity at certain ages
19
Q
Pentacel Vaccine (4)
A
- DTaP, IPV, HIB
- Can be used for dose 1 through dose 4 series among children 6 weeks to 4 years old
- Should not be used for 5th dose of DTaP or for children 5 and older
- The DTaP-IPV solution should not be used separately (i.e., only use to reconstitute the Hib component); cannot use a different constitution; must mix IPV HIB solution
20
Q
Pentacel Vaccine Schedule (3)
A
Primary Series Schedule
- 4 doses at ages 2, 4, 6, and 15 through 18 months
- Each of the first 3 doses should be separated by a minimum of 4 weeks
- 4th dose may be administered as early as 12 months of age if at least 6 months have elapsed since the 3rd dose of DTaP
21
Q
Pediarix (6)
A
- DTaP, Hep B, IPV
- Minimum age is 6 weeks, maximum age is before 7
- Only approved for 3 doses at 2, 4 and 6 months
* Can be given to infants who received HepB at birth, so would have a total of 4 hepB doses after 6 month mark - NOT APPROVED FOR BOOSTER DOSES (4th and 5th)
- Can be used interchangeably with other pertussis-containing vaccines if necessary (but may not be used interchangeably with Pentacel)***
- May be used in infants whose mothers are HBsAg positive or status unknown**
22
Q
Kinrix Vaccine (5)
A
- DTaP/IPV combination
- Can be used ONLY for 5th dose of DTaP series and 4th dose of IPV series
- Approved for children 4-6 years old
- Prior DTaP vaccines were Infanrix (DTaP) and/or Pediarix for the first 3 doses and Infanrix (DTaP) for fourth dose
- If Kinrix is inadvertently administered as an earlier dose in the series, the dose may be counted as valid and does not need to be repeated if the minimum age and minimum interval since the prior dose are met
23
Q
DTaP Adverse Reactions (3)
A
- Local reactions: pain, redness, swelling
* MOST COMMON AFTER 4TH AND 5TH DOSE - Less common: temperature of 101 or higher
- Severe: exaggerated local reactions
24
Q
DTaP 4th and 5th Dose Adverse Reactions (4)
A
- Local reactions and fever increase with 4th and 5th dose of DTaP
- Reports of swelling of an entire limb
- Extensive swelling after fourth dose NOT contraindication of fifth dose
- Give in the thigh to reduce whole limb swelling
25
DTaP Contraindications (2)
1. Severe allergic reaction to vaccine component or following a prior dose
2. Encephalopathy not due to another identifiable cause occurring within 7 days after vaccine
26
Pertussis Containing Vaccines: Use in Children with Underlying Neurological Disorders (4)
1. Prior seizure: delay and assess
2. Suspected neurological disorder: delay and assess
3. Neurological event between doses: delay and assess
4. Stable/resolved neurological condition: vaccinate
27
DTaP Precautions (5)
1. Moderate or severe acute illness
* If child comes in with cold - vaccinate, if child comes in with high fever, don't vaccinate
2. Temperature over 105 (40.5 C) or higher within 48 hours and no other identifiable cause
3. Collapse or shock-like state within 48 hours
4. Persistent, inconsolable crying lasting over 3 hours, occurring within 48 hours
5. Convulsions with or without fever occurring within 3 days
28
Tetanus Containing Vaccines (3)
1. Tdap for one dose is the vaccine of choice for children over 7 through adulthood every ten years
* Usually booster is given at 11-12 but can be given at 7 if child never had pertussis vaccine
2. If previously unvaccinated, do 3 shot series, first two doses separated by 4 weeks and 2nd and 3rd doses separated by 6-12 months (one of those should be Tdap and then booster with Td every 10 years)
3. Tetanus vaccine is 100% effective for 10 years after full series
* Deep IM in thigh of infants
* Deltoid of older children and adults
29
Tdap Contraindications (2)
1. Previous severe allergic reaction to Tetanus or a component of the vaccine
2. Severe or moderate illness
* If unable to received Tetanus vaccine, individuals will need Tetanus immunoglobulin (TIG) with invasive, high risk injuries
30
Tdap Side Effects (4)
1. Local redness with swelling at injection site are common, with nodules and even abscesses occurring frequently
2. More severe reactions include peripheral neuropathy, Guillian Barre and urticaria
3. Fever and systemic symptoms are uncommon
4. Rare risk of seizure somewhat related to genetics
* SNCA1 Dravets syndrome (genetic seizure disorder)
31
Hib Vaccine minimum age and minimum interval
Minimum age: 6 weeks
Minimum interval between doses: 8 weeks
32
Clinical Manifestations of Hib Disease (6)
Present as a Serious Bacterial Illness (SBI)
1. Meningitis
2. Pneumonia
3. Bacteremia and Sepsis
Other Serious Bacterial illnesses
4. Osteomyelitis and Septic Arthritis
5. Urinary Tract infection (Pyelonephritis)
6. Bacterial enteritis
33
Hib Vaccine (5)
1. Inactivated vaccine, contains part of the bacterium
so cannot cause disease
2. Recommended in all children under 5 years
3. 3 (PedVaxHib) to 4 (ActHIB) doses depending on
which HIB vaccine and age at first dose
4. Given as an injection into the muscle
5. More than 95% effective if given 2 or 3 doses
34
ActHIB Vaccine
Given at 2 months, 4 months, 6 months and 12-15 month booster
35
Hiberix (2)
1. Attached to tetanus toxoid
| 2. 2 months, 4 months, 6 months and 12-15 month booster
36
PedVaxHib Vaccine (2)
1. 2 months, 4 months and 12-15 month booster
| 2. Alone and in combination with HepB such as COMVAX
37
Comvax
HIB and Hepatitis B; can be given from 6 weeks-15 months of age in newborns born to HBsAg negative mothers (mothers that are not carriers)
38
MenHibRix (4)
1. Neisseria meningitidis serogroups C and Y and Haemophilus influenzae type b
2. Approved for 6 weeks of age through 18 months of age
3. Four doses (0.5 mL each) by intramuscular injection at 2, 4, 6, and 12 through 15 months of age
4. Specifically for children 6 weeks through 18 months of age with functional asplenia, persistent complement deficiencies or during a community outbreak
39
HIB Vaccine contraindications (3)
1. Severe allergic reaction after a previous vaccine or vaccine component (HIB CONTAINS NEOSPORIN)
2. Age younger than 6 weeks
3. Severe illness with fever
40
HIB Vaccine Side Effects (3)
1. Few symptoms occur
2. 5-30% have local irritation at injection site
3. 1/20 get fever over 101
41
Polio Vaccine Schedule (4)
1. Dose 1: 2 months (minimum age is 6 weeks)
2. Dose 2: 4 months
3. Dose 3: 6-18 months
* Minimum of 8 weeks between first three doses
4. Dose 4: 4-6 years old; minimum of 6 months since dose 3
42
Clinical Manifestations of Polio (2)
1. Asymptomatic (most infections) to symptomatic, including acute flaccid paralysis of a single limb to quadriplegia, respiratory failure, and rarely, death.
2. Inactive polio vaccine booster is now recommended for more than 4 weeks of travel to affected countries
43
Live Attenuated Polio Vaccine
Only in developing countries (not in US) meaning that polio will be in the stool
44
Polio Vaccine Contraindications (3) and Side Effects (1)
1. Severe allergic reaction to neomycin, polymixin B, Streptomycin, the vaccine contains trace amounts of these antibiotics
2. Severe allergic reaction to a previous polio vaccine
3. Moderate illness
4. Side effects - soreness at injection site
45
IPV Catch-Up Schedule (4)
IPV for 7-18 years old:
1. Final dose int he series should be administered at least 6 months following the previous dose
2. If both OPV andIPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child's current age
3. A fourth dose is not needed if the third dose was administered after age 4 (Catch-Up)
4. IPV is not routinely recommended for 18 or older
46
Clinical Manifestations of Pneumococcal Disease (5)
1. Serious bacterial illness similar to HIB
2. Otitis Media
3. Sinusitis
4. Conjunctivitis
5. Occasionally causes mastoiditis, periorbital cellulitis, endocarditis, osteomyelitis, soft tissue infections, neonatal sepsis (rare)
47
PCV13 Schedule (3)
1. 4 Doses: 2 months, 4 months, 6 months, 12-15 months
2. For all children 2-59 months
3. Starting after 24 month through 59 months:
only need one dose if they have not received
vaccine
- Fewer doses if series started at 7 month of age.
- Children who received one or more dose of PCV 7 should complete with PCV 13
- Approved by FDA up to 17 years old
48
Pneumococcal Vaccine Contraindications (3)
1. Severe allergic reaction to a previous PCV vaccine
2. Mild or moderate illness
3. Safety in pregnancy not determined
49
Pneumococcal Vaccine Catch Up Series in Healthy Children (3)
1. If age is less than 24 months, 1st dose given before 12 months and give 3 doses
2. If age 24-59 mo.. and 1st dose given greater to or equal to 12m, give 2 doses
3. If age older or equal to 24mo give only 1 dose.
50
Risk Factors for Invasive Pneumococcal disease (6)
1. Decreased immune function
2. Splenii (functional or anatomic)
3. Chronic heart, pulmonary (asthmatics being treated with high dose steroids), liver or renal disease
4. Cerebrospinal fluid leak
5. Cochlear implant
6. Administer PCV-23 after age 2 year
51
ADEs of Pneumococcal Vaccine (2)
1. Local reactions
| 2. Fever, myalgia
52
Hepatitis B Manifestations (7)
1. Symptomatic or asymptomatic
2. Subacute illness with nonspecific symptoms
3. Full blown with jaundice as well as GI symptoms
Extrahepatic:
4. Arthralgia
5. Arthritis
6. Macular rash
7. Thrombocytopenia
53
Engerix B (4)
HepB vaccine
1. Administered into thigh of children less than 12 months, deltoid or thigh in older children and adults
2. Given in 3 doses: birth, 1-2 months later, and at or older than 24 weeks
3. HBIG given to infants born to HepB(+) mothers
4. If mother's status is unknown give HepB vaccine within 12 hours of birth and HBIG within one week of life
54
HepB Vaccine Contraindications (3) and side effects (2)
C/I:
1. Severe allergic rxn to previous HBV or one of its components in the past
2. Moderate to severe illness
3. Infant weighing less than 2,000g
S/E:
1. Soreness at injection site
2. Low grade fever
55
HepB Positive Mothers (2)
1. For infants born to hepatitis B surface antigen (HBsAg)-positive mothers, administer Hep B and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of
birth
2. Test for HBsAg and antibody to HBsAg (anti-HBs) at age 9 through 18 months or at 1 to 2 months after completion of the Hep B series (preferably at the next well-child visit)
* Must test at 9-18 months if vaccine was done at 4-6 months
* Testing has to be at least 1-2 months after HepB series is finished
56
Rotavirus Vaccine: Rotateq and Rotarix Ages
1. Minimum age: 6 weeks
2. Maximum age for first dose in a series: 14 weeks 6 days
3. Maximum age for any dose: 8 months
57
Rotavirus (5)
1. Initial symptoms of watery diarrhea follow fever and vomiting for 24 -48 hours
2. 1-3 day incubation period
3. 5 predominant strains in U.S. (G1-G4, G9) and account for 90% of isolates
4. G1 strain accounts for 75% of infections
5. Very stable and may remain viable for weeks or months if not disinfected
58
RV5 RotaTeq (3)
1. Contains five reassortant rotaviruses developed from human and bovine parent rotavirus strains
2. Vaccine viruses suspended in a buffer solution
3. Contains no preservatives or thimerosal
59
Rotarix (2)
1. Administer first dose to infants beginning at 6 weeks of age.
2. Administer second dose after an interval of at least 4 weeks and prior to 24 weeks of age.
60
Rotavirus Vaccines (5)
1. First dose: 6 weeks through 14 weeks and 6 days
* No first dosages can be initiated after 15 weeks and 0 days
2. The minimum interval dose is 4 weeks
3. All doses must be administered by 8 months and 0 days.
4. Any infant with an allergy to latex cannot receive the vaccine (Rotarix) since cap contains latex
5. Best at protecting against severe gastroenteritis but also protects against mild gastroenteritis
61
Rotavirus Vaccine Recommendations (3)
1. ACIP did not define a maximum interval between doses
2. If the interval between doses is prolonged, the child can still receive the vaccine as long as it can be given on or before the child’s 8 month birthday
3. It is not necessary to restart the series or add doses because of a prolonged interval between doses
62
Contraindications of Rotavirus Vaccine (7)
1. Hypersensitivity
2. Gastrointestinal Tract Congenital Malformation
3. History of Intussusception
4. Severe Combined Immunodeficiency Disease
5. Severe allergic reaction to prior dose or latex
6. SCID
7. History of intussusception
63
Rotavirus Vaccine Precautions (3)
1. Diseases that affect immune competence, spina bifida, bladder extrophy, gastro of moderate to severe
2. No repeating for spitting up or vomiting
3. Infants living in households with persons who have or are suspected of having an immunodeficiency disorder or impaired immune status CAN be vaccinated
* Protection provided by vaccinating the infant outweighs the small risk of transmitting vaccine viru
64
Rotavirus Vaccine - Conditions that are NOT precautions (2)
1. Pre-existing chronic gastrointestinal conditions
2. Recent receipt of antibody-containing blood
*ACIP recommends that rotavirus vaccine may be
administered at any time before, concurrent with, or after
administration of any blood product
65
Rotavirus Vaccine in Preterm Infants (3)
Supported if:
1. Chronological age is at least 6 weeks
2. Clinically stable and
3. Administered at the time of d/c or after d/c from NICU or nursery
66
ADEs of Rotavirus Vaccine (4)
1. Vomiting
2. Diarrhea
3. Irritability
4. Fever
67
Clinical Manifestations of Influenza (5)
1. Sudden onset of fever, with chills
2. Headache and malaise
3. Myalgia and cough
4. Followed by upper respiratory symptoms with conjunctival injection, abdominal pain with vomiting and diarrhea are less common
5. Death can occur and is associated with myocarditis, secondary bacterial illness and neurological complications
68
Influenza Vaccine Recommendations (4)
1. All persons 6 months and older should be vaccinated annually
2. Vaccinate by October if possible
3. First dose ONLY: children 6 months through 8 years should receive two doses separated by at least 4 weeks when they get their first vaccination
* Don't give two doses if flu vaccine was done before
4. IM or nothing and no more live attenuated vaccine
69
Contraindications and Precautions for Influenza Vaccine (2)
C/I
1. Severe allergic rxn to any vaccine component, including egg protein, or previous dose of any influenza vaccine
Precautions
1. Moderate to severe acute illness w/ or w/o fever
2. Hx of Guillain-Barre syndrome w/i 6 weeks of flu vaccine
70
Types of Flu Vaccines (3)
1. Quadrivalent vaccine, including additional B strain
2. Inactivated trivalent subunit (TIV)
* IM, trivalent, contains egg protein
* Special inactivated trivalent for >65 years old
3. Live attenuated/intranasal is no longer recommended
71
Trivalent inactivated Influenza Vaccine Schedule (3)
1. Ages 6-35 months: 0.25mL (either 1 or 2 doses depending on if it's their first)
2. Ages 3-8 years old: 0.50mL (either 1 or 2 doses depending on if it's their first)
3. 9 years or older: 0.50mL (only 1 dose)
72
Hepatitis A Vaccine Timeline (4)
1. Minimum age is 12 months
2. Minimum interval is 6 months between doses
3. Adults receive 1 dose then booster dose 6-18 months after their first dose
4. Children and Adolescents receive 1 dose and booster dose 6-18 months after first dose
73
HAVRIX vs VAQTA Vaccines
HAVRIX: 94% efficacy
VAQTA: 100% efficacy
74
C/I (3) and S/E (3) of HepA Vaccines
C/I:
1. Severe allergic rxn to vaccine or component
2. Moderate illness
3. Unclear about safety during pregnancy
S/E:
1. Soreness at injection site is common
2. Fever, fatigue, malaise, headache less common
3. Rare anaphylaxis
75
MMR Vaccine (7)
1. Given as a live attenuated strain of virus
2. Cannot catch the virus from the vaccine
MMR or MMRV:
3. Delivered as a subcutaneous injection
4. Licensed for use in persons 12mo through 12 years of age
5. Give first dose at 12-15 mo., second at 4-6 y
6. In unimmunized children, give one dose at first visit, second dose 4 weeks later.
7. After one dose, 95-98% immunity; after 2 doses, 99%.
76
Contraindications of MMR Vaccine (5)
1. Pregnancy, or plans to become pregnant within four weeks of vaccine
2. Severe allergic reaction to previous vaccine
3. Immunocompromised
4. Not contraindicated if allergic to eggs
5. Not contraindicated if breastfeeding
77
Side Effects of MMR Vaccine (3 Mild, 3 Moderate, 2 Major)
Mild:
1. Fever
2. Mild rash
3. Swelling of glands in the cheeks or neck
Moderate:
1. Seizure
2. Temporary pain and stiffness in the joints, mostly in teenage or adult women
3. Temporary low platelet count, which can cause bleeding
Major:
1. Serious allergic reaction
2. Deafness, long-term seizures, coma, or lowered consciousnes
78
MMR Vaccine Schedule 0-18 years (3)
1. The second dose may be administered before age 4
years, provided at least 4 weeks have elapsed since
the first dose.
2. Administer MMR vaccine to infants aged 6 through
11 months who are traveling internationally.
*This dose should be repeated at 12 months or older
and then receive a third dose at least 4 weeks later.
3. Recommended interval between catch up doses should be 4 weeks..
79
MMRV Vaccine (3)
Measles, Mumps, Rubella, Varicella
1. Approved for children 12 months through 12 years old up until they turn 13
2. Approved for both first and second doses of MMR and varicella vaccines
3. Minimum interval between doses is 3 months
80
Interval between immune Globulin Administration and Measles vaccine (3)
1. 3 month interval for: Hepatitis A prophylaxis of
IgG, Hepatitis B prophylaxis as HBIG and Tetanus prophylaxis as TIG, RBCs with saline added
2. 5 month interval for: Varicella prophylaxis as
VariZIP and Measles prophylaxis as IG/packed RBC
3. 6 month interval for: Botulinum immune Globulin IF and whole blood transfusion
81
Varicella Vaccine (6)
1. Minimum age: 12 months
2. Minimum interval: 3 months
3. Approved from 1-12 years old if ProQuad vaccine
4. Varicella vaccine = Varivax
* approved for persons 12 months and older
5. ProQuad = MMRV is approved for 12 months-12 years
6. Herpes zoster vaccine (Zostavax) is approved for persons 50 years and older
82
Varicella breakthrough infection
1. Immunity appears to be long-lasting for most
recipients
2. Breakthrough disease much milder than in unvaccinated persons
3. No consistent evidence that risk of breakthrough infection increases with time since vaccination
83
Varicella Vaccine Recommendations for Children (3)
1. Routine vaccination at 12-15 months
2. Routine second dose at 4-6 years
3. 12 months to 12 years of age (3 month interval)
84
Varicella Vaccine Recommendations for Older Children (3)
1. 2 doses recommended for all persons older than 4 to 6 years who do not have evidence of varicella immunity
2. Second dose recommended for persons of any age who have only received one dose
3. Minimum interval for 12 years and older is 4 weeks
85
Side effects of Varicella Vaccine (5)
Mild Problems
1. Soreness or swelling where the shot was given
2. Fever
3. Mild rash, up to a month after vaccination
* It is possible for these people to infect other members of their household, but this is extremely rare.
Moderate Problems
4. Seizure (jerking or staring) caused by fever (very rare).
5. Severe Problems- Pneumonia (very rare)
86
Varicella Vaccine ADEs (3)
1. Local reactions (pain, erythema)
- 19% (children)
- 24% (adolescents and adults)
2. Rash – 3%-4%; may be maculopapular rather
than vesicular
- average 5 lesions
3. Systemic reactions not common
* Adverse reactions similar for MMRV
87
Varicella-Containing Vaccine Contraindications and Precautions (5)
1. Severe allergic reaction to vaccine component or following a prior dose
2. Immunosuppression
3. Pregnancy
4. Moderate or severe acute illness
5. Recent blood product (except herpes zoster vaccine)
88
Clinical Manifestations of Meningococcal Bacteria
Severe disease, including meningitis, bacteremia, and septicemia, resulting in permanent disabilities and even death.
*ANY PETECHIAE BELOW THE NIPPLE LINE OF A FEBRILE CHILD -- CHILD MUST GO TO ER! Suspect meningoccocas
89
Indications for Meningococcal Vaccine: At Risk Children (4)
1. Complement component deficiencies
* C3, C5-C9, properdin, factor H, factor D
2. Functional or anatomic asplenia
* Includes infants with sickle cell disease
3. Infants who are in defined risk group for a community or institutional outbreak
4. Infants traveling to an area where meningococcal disease is hyperendemic or epidemic
* Travel to the Hajj, living in the Meningitis Belt
90
Menactra Vaccine (3)
Men ACWY-D
1. Diptheria toxoid carrier protein; 2 doses starting at 9 months, with 12 weeks between doses
2. Dose 1: 9 months
3. Dose 2: 12 months
91
MenHibrix Vaccine (2)
1. Carrier protein: Tetanus toxoid
| 2. Administered at 2, 4, 5, and 12 months
92
Menveo Vaccine (2)
MenACQY-CRM
1. CMR197 carrier protein
2. Administered at 2 months, 4 months, 6 months and 12 months
93
Meningococcal Immunization Schedule for at risk children 2-18 months old (2)
1. Children with persistent complement deficiencies, functional or anatomic asplenia or who are at risk due to community outbreaks
2. Four doses of HIBMenCY-TT (MenHibRix): 2, 4, 6 and 12-15 months
94
Meningococcal Immunization Schedule for at risk children 2-23 months old (2)
1. 2 to 23 months of age with high risk conditions such as persistent complement deficiencies, functional or anatomic asplenia, travel or are residents of countries where meningococcal disease is hyperendemic or epidemic or who are at risk due to community outbreaks
2. Receive 4 doses of Menveo (Men ACWY-CRM at 2, 4,6, or 12 months
95
Meningococcal Immunization Schedule for at risk children 9-23 months old (2)
2 doses of MenACQY, 12 weeks apart
96
Meningococcal Vaccine in Infancy (4)
1. 4 dose infant series (2, 4, 6, and 12 months) Concomitant DTaP-IPV-Hib or DTaP-IPV-HBV, PCV
2. No interference observed for DTaP, IPV, Hib, HBV antigens or for PCV after 12 month dose
3. 2 dose older infant series (7-9 and 12 months) Concomitant MMRV at 12 months
4. No interference observed with MMRV antigens
97
Meningococcal Conjugate Vaccine: MCV 4 (4)
1. Menactra® (sanofi pasteur)
2. Quadrivalent polysaccharide vaccine (A, C, Y, W-135) conjugated to diphtheria toxoid
3. Administered by intramuscular injection
4. Single dose vials do not contain a preservative
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MCV Revaccination Recommendations (5)
1. All 11-12 years olds should be vaccinated with meningococcal conjugate vaccine (MCV4).
2. A booster dose should be given at age 16 years.
3. For adolescents who receive the first dose at age 13 through 15 years, a one-time booster dose should be administered, preferably at age 16 through 18 years, before the peak in increased risk.
4. Adolescents who receive their first dose of MCV4 at or after age 16 years do not need a booster.
5. Meningococcal and other vaccines may be administered during the same visit, but at a differentanatomic site if feasible
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Who gets vaccinated with meningococcal vaccine aside from adolescents? (3)
1. College students and military recruits
2. People present during outbreaks caused by a vaccine serogroup
3. Other people with prolonged increased risk for exposure (e.g., travelers to or residents of countries where meningococcal disease is hyperendemic or epidemic and microbiologists routinely working with Neisseria meningitidis)
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Meningococcal Polysaccharide Vaccine (5)
1. MPSV - Menomune (Sanofi Pasteur)
2. Quadrivalent polysaccharide vaccine (A, C, Y, W-135)
3. Administered by subcutaneous injection
4. 10-dose vial contains thimerosal as a preservative
5. Adults aged 56 years and older
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Meningococcal Vaccine for Serogroup B (3)
1. Bexsero and Trumenba
2. 16 through 23 years of age
3. Not required; It means it will not be covered by Vaccine for Children Act
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HPV Vaccines (5)
1. Minimum age is 9 year old
2. Must have 4 weeks between first and second dose with third dose 24 weeks after first dose and 16 weeks after second dose
3. Bivalent: Cervarix
4. Quadrivalent: Gardasil
5. 9-valent: Gardasil 9 (recommended)
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Routine HPV Vaccination Recommendations (3)
1. ACIP recommends routine vaccination of females 11-12 years of age
2. The vaccination series can be started as young as 9 years of age at the clinician’s discretion
3. “Catch-up” vaccination recommended for females 13 through 18 years of age
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HPV Vaccination Schedule (4)
1. Dose 1 minimum age is 9
2. Dose 2 minimum interval is 4 weeks after dose 1
3. Dose 3 minimum interval is 12 weeks after dose 2 and 24 weeks after dose 1
4. Do not restart schedule if it is interrupted
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HPV Vaccine in Males (4)
1. HPV 4 may be administered in 3 dose series to males age 9 to 18 to reduce likelihood of acquiring genital warts
2. HPV 2 is not approved for males of any age
3. Can prevent genital warts, anal cancers, penile cancers, oropharyngeal and oral cavity cancers, recurrent respiratory papillomatosis
4. Syncope is chief side effect
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HPV Vaccine ADes (2)
1. Local reactions of pain and swelling
| 2. Fever
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Syncope Following HPV Vaccination
1. An increase in the number of reports of syncope has been detected by the Vaccine Adverse Event Reporting System (VAERS)
2. 11-18 year old females have contributed most
of the increase
3. Providers should strongly consider observing patients for 15 minutes after they are vaccinated
* Required that the child sits for 15 minutes before leaving the office due to syncope
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HPV Vaccine Contraindication and Precaution
C/I:
1. Severe allergic reaction to a vaccine component or following a prior dose
Precaution
1. Moderate or severe acute illnesses (defer until symptoms approve)
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HPV Vaccination During Pregnancy (4)
1. Initiation of the vaccine series should be delayed until after completion of pregnancy
2. If a woman is found to be pregnant after initiating the vaccination series, remaining doses should be delayed until after the pregnancy
3. If a vaccine dose has been administered during pregnancy, there is no indication for intervention
4. Women vaccinated during pregnancy should be reported to the Merck registry
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Provider and Vaccine: Malpractice (3)
1. Must given Vaccine Information Sheets
2. Must review them with families and document in chart
3. Make sure that medical assistant knows how to give shots; they are practicing under your license!
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Tetanus Toxoid Containing Vaccine Injury Table (2)
1. Anaphylaxis or shock would occur in 0-4 hours
| 2. Brachial neuritis would occur in 2-28 days
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Pertussis antigen containing vaccine injury table (2)
1. Anaphylaxis or shock would occur in 0-4 hours
| 2. Encephalitis or encephalopathy would occur in 0-72 hours
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MMR Injury Table (2)
1. Anaphylaxis or shock would occur in 0-4 hours
| 2. Encephalitis or encephalopathy would occur in 5-15 days
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Rubella Vaccine Injury Table
Chronic arthritis would occur in 7-42 days
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Measles vaccine injury table (2)
1. Thrombocytopenia purpura would occur in 7-42 days
| 2. Vaccine strain measles infection would occur in 0-6 months
