Immunizations Flashcards
1
Q
Vaccines + Media
A
- Stirred up fear and concern over vaccine safety
- Leading to increased questions from parents and some refusing to innoculate their children
2
Q
Thimerosal
A
- Mercury-containing compound that was used as a preservative
- Thimerosal has largely been removed from vaccines with the exception of inactivated influenza vaccine
- NEVER contained in MMR vaccine
3
Q
MMR Vaccine
A
- Live-attenuated triple viral vaccine against measles, mumps, and rubella
- Max: 2 doses/lifetime
- Single antigens are no longer available
- MMRV with varicella is also available now
4
Q
Measles
A
- Vaccine-preventable disease
- Despite vaccine, still a leading death of children worldwide
- Highly contagious
- Symptoms: cough, runny nose, full body rash
- Complications: pneumonia, encephalitis
5
Q
Mumps
A
- Vaccine-preventable viral disease
- Contagious
- Symptoms: fever, headache, muscle aches, fatigue, swelling of salivary glands
- Complications: orchitis, pancreatitis, encephalitis, hearing loss, miscarriage
- > 99% since vaccine
6
Q
Rubella
A
- Vaccine-preventable viral disease
- Contagious
- Symptoms: fever, sore throat, rash, arthralgias
- Complications: birth defects, miscarriage, encephalitis, otitis media
7
Q
Wakefield Study
A
- Study that suggested that MMR caused autism
- Numerous larger studies have shown otherwise
- Original article ended up retracted
8
Q
MMR + Autism
A
- Signs/symptoms have a temporal relationship
- Autism is both genetic and environmental
- CDC, Vaccine Injury Compensation Program, and Institute of Medicine don’t support the association
9
Q
Addressing Parents’ Concerns
A
- No vaccine is 100% safe/effective, but to do nothing is a higher risk
- Establish rapport, be open/honest, identify concerns, identify sources of information, respond with evidence-based information, appeal to civic duty and risk
- If parents refuse, respect decision and broach in the future
10
Q
Pharmacist Responsibility + Vaccines
A
- Promote vaccination
- Ensure proper storage/administration
- Observe correct timing and appropriate intervals of vaccinations
- Follow contraindications and precautions
11
Q
Passive Immunity
A
- Protection transferred from exogenous source - blood, placenta
- Wanes with time
12
Q
Active Immunity
A
- Produced from person’s own immune system - infections, vaccinations
- Immunity persists for years
13
Q
Live Vaccines
A
- MMR
- Varicella
- Influenza
- Rotavirus
- Also, yellow fever, vaccinia (smallpox), oral polio (OPV), BCG for tuberculosis, and oral typhoid
14
Q
Fractional Inactivated Vaccines
A
- Only portion of virus or bacteria included to enact a response
- Protein - toxin or subunit
- Polysaccharide-based
15
Q
Viral Whole Vaccines
A
- Polio
- Hep A
- Rabies
- Japanese encephalitis
16
Q
Viral Fractional Vaccines
A
- Hep B
- Influenza
- HPV
- Anthrax
17
Q
Inactive Bacterial Vaccines
A
- All fractional
- Tdap
- Pneumococcal (23/13)
- Meningococcal
- Haemophilus influenzae type B
- Typhoid Vi
18
Q
Encapsulated Organisms
A
- Polysaccharide capsules that make them antiphagocytic
- Target for vaccine protection
- Patients without spleen are susceptible to these infections
- EX: S. pneumonia, H. influenzae, N. meningitidis
19
Q
Pure Polysaccharide Vaccines
A
- Traditionally adult formulations
- Not consistently immunogenic in children <2 yrs
- No booster response and immunogenecity in children improved with conjugation
20
Q
Polysaccharide Conjugate Vaccines
A
- Traditionally children formulations
- Enhanced antibody production, especially in younger kids
- Repeat doses elicits a booster resposen
21
Q
Vaccine Precautions
A
- Severe allergic reaction to vaccine/component
- Severe illness (delay)
- DON’T give immunosuppressed and pregnant live vaccines
- Also don’t give live vaccines to <1 years old or to patients receiving a transfusion or other blood products
22
Q
Invalid CI
A
- Mild disease - low fever, URI, otitis media, mild diarrhea
- Antibiotic therapy
- Breastfeeding
- Premature birth
- Pregnancy/immunosuppression in the house
- Warfarin
23
Q
Vaccine Dose Timing/Intervals
A
- DON’T give before recommended age and interval
- Increasing the interval DOESN’T diminish the response (DON”T RESTART)
- Immunosupressed: Administer >= 2 weeks prior to suppression for live vaccines and avoid live vaccines within 2 weeks
24
Q
Simultaneous Administration
A
- Okay to give to vaccines together to increase inoculation likelihood
- DON’T give PCV 13/23 together
- If LIVE vaccines are not given together, then separate by at least 4 weeks
25
Adverse Event Reporting
- Use VAERS or Vaccine Injury Compensation Program (childhood vaccines)
- Adverse events can be an adverse reaction (side effect)
26
Meningococcal Disease
- Encapsulated organism
- 13 serotypes
- Vaccines available that cover 5 of the types
27
Meningococcal Risk Factors
- Anatomic or functional asplenia
- Terminal complement deficiency
- Exposed labratory personnel
- Foreign travelers
- Military recruits
- First year college students in dorm living
- HIV
28
Menactra/Menveo
- Conjugate formulations for serotypes A, C, W, Y
| - Pure polysaccharide formulation isn't available
29
MenB-4C/MenB-FHbp
- Meningococcal B vaccines
- B-4C: 2-dose series
- B-FHbp: 2-3 dose series
- Vaccines are not interchangeable and have different interval recommendations
30
Pneumococcal Disease
- S. pneumoniae
- Encapsulated organism
- Invasive diseases: pneumonia, meningitis
31
Pneumococcal Risk Factors
- Young/elderly
- Health conditions like asplenia, heart disease, lung disease, asthma, ESRD, cirrhosis, DM, immunosuppression
- Smoking
- Alcohol abuse
32
PSV23/13
- 23: pure polysaccharide vaccine, doesn't induce response in <2 years old
- 13: conjugate vaccine, conugated to protein carrier for better children response, better responses in kids and adults
33
Adults Needing Pneumococcal Vaccination
- Adults >= 65 y.o. (prefer PCV23)
- Heart disease
- Lung disease/asthma
- ESRD
- Cirrhosis
- DM
- Tobacco Use
- Alcoholism
- Asplenia
- Immunosuppression
34
Adults >= 65 + PCV13
- Nursing home/long-term care facilities
- Low pediatric PCV13 uptake residences
- Traveling to settings with no pediatric PCV13 program
- Certain comorbid conditions
35
Diphtheria/Tetanus Toxoids
- Inactivated bacterial toxins
- Available in combination: not single antigens
- Adult formulations contain [lower] of diphtheria toxoid to prevent local reactions
- Local site reactions in higher with each additional dose
36
Pertussis Vaccine
- Acellular vaccine with detoxified pertussis toxin
- Better side effect profile than whole cell vaccine with comparable immunity
- Precautions: T > 40.5C within past 48 hours without known cause, convulsions within last 3 days
- CI: encephalopathy within past 7 days
37
Influenza
- Single stranded RNA virus
- Influenza A is responsible for pandemics
- Shift variations are major changes causing pandemics, drift variations are minor changes causing epidemics
38
Live Flu Vaccine CI
- Immunosuppression
- Anatomical or functional asplenia
- Pregnancy
- Close contact/caregiver of immunosuppressed
- Flu antivirals in last 48 hours
- CSF leak or cochlear implant
- History of severe allergic reaction to any part of vaccine
39
Varicella
- Primary infection: chickenpox
- Highly contagious vesicular rash
- Complications: lesion infections, encephalitis, pneumonia, CVS (congenital varicella syndrome)
40
Herpes Zoster
- Shingles
- Recurrent infection: herpes zoster
- Can occur decades after initial infection/vaccination
- Associated with aging/immunosuppression
- Post-herpetic neuralgia is a common complication
41
Varicella Vaccine
- Live
- Two doses for those who don't have immunity evidence
- Can be given as a part of MMR (MMRV)
- ADE: rash, infection site reactions, arthralgias/myalgias, respiratory tract infections
- Don't give zostavax (live) to preggo/immunosuppressed
42
RZV + HIV Patients
- No recommendation
- Optimal timing and duration of immunity is unknown
- Appears to be safe
- Recommended for >= 50 y.o. with HIV
43
Rotavirus Gastroenteritis
- Almost all kids infected by 5 y.o.
- Five strains account for 90% of infections
- 1st infection after 3 months of age is most severe with T>102F
- GI symptoms usually resolve in 3-7 days
- Low mortality but high healthcare burden
44
Rotavirus Vaccine
- Live oral
- Start at 2 months old, don't start after 15 weeks old
- Complete by 8 months
- Two, interchangeable formulations available
45
Poliomyelitis
- Enterovirus with 3 serotypes
| - Infection spreads in CNS and causing motor neuron destruction
46
IPV
- Inactivated polio vaccine
- Protects against all serotypes
- Given to children
- Only give to unvaccinated adults if traveling to polio-endemic areas
47
HPV
- Sexually transmitted infections
- Most are asymptomatic but some cause warts or cancer
- Most clear the infection
- Leading cause of cervical cancer
- Vaccine covering 9 strains available
48
Hep A Vaccine
- 2 dose series
- Child and adult dosing
- Single or combination formulations available
49
Hep A + High Risk Factors
- Chronic liver disease
- HIV infection
- Sexually active gay men
- Drug use
- Occupational risk
- At risk International travelers
- Close contact with international adoptee
- Pregnancy based on risk
50
Hep B Vaccine
- Single or combination formulations available
- Recommended for all children
High-Risk Adults:
- Chronic liver disease
- HIV
- Sexual exposure risk
- Current/recent drug use
- Percutaneous/mucosal risk exposure
- Incarcerated persons
- Travel to areas of risk
- Pregnancy based on risk
51
H. influenzae Type B Vaccine
- Single or combination formulations
- All vaccines are interchangeable for primary series/boosters
- Children who fall behind may not need remaining doses
- Not recommended for 5 y.o.+ unlesss high risk: HSCT, asplenia, sickle-cell disease
52
Target Populations for Travel Evaluations
- Military personnel
- Peace Corps volunteers
- Travelers to developing countries
- Immigrants
53
Other Travel Considerations
- Age
- Underlying illness
- Medical history
- Allergies
- CI to meds/vaccines
- Pregnancy/breastfeeding
54
Travel Vaccinations
- No schedule
- Individual assessment
- Good opportunity to review immunization status for scheduled vaccinations
- Some vaccines may be mandatory
- Patients may need to carry a copy of their vaccination records
55
Typhoid
- Caused by salmonella typhi
- Fecal-oral transmission
- Worldwide, Africa/South Asia/Indonesia/Peru have higher rates
- Manifestation: high fever, gastroenteritis, diarrhea, rash
56
Yellow Fever
- Virus transmitted by mosquitoes
- No treatment available
- Phase I: flu like symptoms
- Phase II: jaundice, arrhythmias, kidney failure, delirium, seizures, coma, usually fatal
57
Japanese Encephalitis
- Leading cause of viral encephalitis in Asia
- Mosquito vector
- Typically seasonal
- Highest rates in rural areas that use flooding irrigation practices
- Inactivated vaccine, not that effective
58
Rabies
- Zoonotic viral disease transmitted by bites
- Incubation can be several months
- Acute encephalitis is usually fatal within days
- Vaccinate if wild/domestic animal contact expected, visiting remote areas, stay >1 mo where dog rabies is common
59
Traveler's Diarrhea + Self Treatment
- Bacteria most common cause (E. coli)
- Prophylactic antibiotics not recommended routinely
- Use pepto bismol
- Can use antibiotics to self treat in causes that are moderate to severe
- Safe oral hydration is important to avoid traveler's diarrhea
60
Malaria
- Transmitted by mosquitos
- Different species
- Usually causes death in US from failed prophylaxis, delay in seeking medical care, misdiagnosis
- Exo-erythrocytic and erythrocytic cycles
61
Malaria Signs/Symptoms
- Initial presentation is non-specific: fever, chills, myalgias, HA
- Erythrocytic phase: fever, hemolysis => anemia, severe pallor, cyanosis, tachycardia, delirium
- Can have more severe complications depending on species infected
- Diagnosis is usually a blood smear
62
Chemoprophylaxis Counseling Points
- Malaria risk
- Personal protective measures to prevent bites
- Mild N/V or loose stools shouldn't dissuade from use
- Continue for 1-4 weeks after leaving the endemic area
- Seek early care/treatment for febrile illness
