Immunizations: Specifics

Question 1

Infants/Children

Answer 1

3 dose Hep B series started at birth

RSV (if mother not vaccinated during pregnancy)

2 months: PD RPH
-PCV15 or 20
-DTaP
-Hib
-Polio
-Rotavirus

Live vaccines at 12+ months:
-MMR
-Varicella

No polysaccharides before 2 years old

Question 2

Healthcare Professionals

Answer 2

-Annual flu

If no demonstrated immunity, do:
-Hepatitis B
-Varicella
-MMR

Question 3

Adolescents/Young Adults

Answer 3

-Meningococcal quad vaccine
(1 dose at 11-12, 1 dose at 16)
(first year college in dorm: 1 dose if not previously vaccinated)

-HPV (age 11-12, 2-3 doses)

-Tdap (first dose at 11-12)

Question 4

Pregnancy

Answer 4

-Flu (any trimester)
-RSV vaccine at 32-36 weeks during RSV season
-Tdap x 1 with each pregnancy at 27-36 weeks

No live vaccines ever

Question 5

Sickle Cell/Asplenia

Answer 5

-H. influenza type B (HIB)
-Pneumococcal (19-64 years old)
(PCV20 x 1 or PCV15 x 1 then PPSV23 8+ weeks later)
-Meningococcal vaccines
(MenB, MenACWY, Bexsero, Trumenba)

Question 6

Older Adults

Answer 6

-Herpes zoster (Shringrix) at 50+ (2 doses, 2-6 months apart)
-Pneumococcal vaccine (65+)
(PCV20 x 1 or PCV15 x 1 then PPSV23 x 1 12+ mo later -or 8+ wks later if IC-)

Question 7

Immunodeficiency

Answer 7

-Herpes zoster (Shringrix) at 19+
-Pneumococcal (19-64 years old)
(PCV20 x 1 or PCV15 x 1 then PPSV23 8+ weeks later)

Additional for HIV:
-Meningococcal vaccines
(MenACWY, Menveo, MenQuadfi)
-Hepatitis A/B

Question 8

Diabetes

Answer 8

-Hepatitis B if 60+ (not previously vaccinated)
-Pneumococcal vaccine (65+)
(PCV20 x 1 or PCV15 x 1 then PPSV23 x 1 12+ mo later -or 8+ wks later if IC-)

Question 9

Influenza

Answer 9

Annually for all patients

Question 10

Tdap, Td

Answer 10

Tap x 1 if not received previously
then Td or Tdap every 10 years

Question 11

Shingles

Answer 11

Shingrix:
All adults age ≥ 50 years or ≥ 19 years if
immunosuppressed (or expected to become immunosuppressed)

2-dose series, with second dose given 2-6 months after the first dose (can shorten to 1-2 months if immunosuppressed)

Vaccinate even if patient previously had chickenpox or shingles or received Zostavax

Question 12

HPV

Answer 12

Adults ≤ 26 years who did not complete the HPV series
(can be given at age 27-45 years based on shared clinical decision making)

Question 13

Pneumococcal

Answer 13

Age 19-64 years with a specific medical condition* or age ≥ 65 years (if never received before):
-PCV20 x 1
-or PCV15 x 1 followed by PPSV23 ≥ 12 months later (or ≥ 8 weeks later if immunocompromised)

Question 14

Meningococcal

Answer 14

Serogroup B (MenB, Bexsero, Trumenba)
-Complement component deficiency
-Taking eculizumab or ravulizumab
-Asplenia
-N. meningitidis exposure
-Serogroup B outbreak exposure

Quad (MenACWY, Menveo, MedQuadfi): same as above plus
-HIV
-Travelers/residents to countries which disease is common in
-Military recruits
-First year college students in dorms
-If not UTD

Question 15

Hepatitis B

Answer 15

If not previously vaccinated, all adults age 19-59 years and patients ≥ 60 years with risk factors like
-HIV
-MSM, multiple sex partners
-Chronic liver disease
-IV drug use
-Blood exposure
-Incarcerated
-Travel

Question 16

Hepatitis A

Answer 16

-Adults traveling to an endemic area
-Close contacts of adopted children newly arriving from countries with
moderate-high infection risk
-Liver disease
-Hemophilia
-MSM
-IV drug use
-HIV
-Homeless

Question 17

COVID-19 Vaccines

Answer 17

-Comirnaty (Pfizer)
-Spikevax (Moderna)
-Novavax (protein subunit)

12+ years:
-1 dose of Moderna or Pfizer or 2 doses of Novavax at 0 and 3-8 weeks

<12 years: check CDC

Question 18

DTaP and Td/Tdap

Answer 18

Upper D: kids, Lower D: adults

DTaP
-5 doses at 2, 4, 6, 15-18 mo, 4-6 yr
-For children <7

Td/Tdap
-Tdap booster at 11-12
-Routine booster every 10 years in adults
-Also: Each pregnancy (3rd tri), close contacts of infants <12 mo if not UTD, healthcare personnel if not UTD, wound ppx if more than 5 years since last dose

SHAKE prefilled syringe/vial before use

Question 19

Haemophilus influenza Type B (HIB)

Answer 19

Hib: a routine childhood vaccine series given between ages 2-15 months

-ActHIB and Hiberix are 4-dose series
-PedvaxHIB is a 3-dose series

Given to adults with asplenia

Shake before use

Question 20

Hepatitis A and B (in one)

Answer 20

Twinrix

3 dose: 0, 1, 6 months (can be done faster if needed to travel)

Question 21

HPV9

Answer 21

Gardasil 9

Age 9-26
-Recommended for 11-12 years (may start at 9)

CI in yeast allergy

Regimens
-Started before 15: 2 doses at 0 and 6-12 mo
-15 or older or IC: 3 doses at 0, 1-2, 6

Question 22

Egg-free Flu Vaccines

Answer 22

Flublok (18+ yr)

Flucelvax (6+ mo)

Question 23

Preferred Flu Vaccines in 65+

Answer 23

Fluzone High-Dose, Fluad or Flublok

Question 24

MMR/MMRV Storage

Answer 24

MMR II: fridge or freezer

MMRV: freezer (bc of varicella)

Store diluents in fridge or RT

Give SC (MMR II and ProQuad can be IM)

Question 25

Menveo Administration

Answer 25

Menveo: both vials (the powder and the liquid) contain vaccine; use only the supplied liquid for reconstitution all meningococcal vaccines in fridge

Question 26

Penbraya: Administration

Answer 26

-the prefilled syringe contains MenB and the vial contains MenACWY; use of both components is required

Question 27

Rotavirus Vaccines: Administration

Answer 27

-Live -Give ORALLY -Fridge

Question 28

Rabies Vaccine

Answer 28

RabAvert Non-routine: for prevention if there is high exposure risk (animal handlers, traveling) -Prevention: 2 doses -Post exposure with previous vac: 2 doses -Post exposure without previous vac: 4 doses + 1 dose of rabies immune globulin (RIG) with the 1st vaccine dose

Question 29

Typhoid

Answer 29

To prevent typhoid fever caused by Salmonella typhi Oral capsules and inj in FRIDGE, oral = on an empty stomach

Question 30

Yellow fever Card

Answer 30

The International Certificate of Vaccination (yellow card) is provided and is valid for 10 years, starting 10 days after vaccination -may be required for endemic areas

Question 31

Cholera Vaccine

Answer 31

Vaxchora (live) if traveling to area with Vibrio cholerae transmission Give 1 oral dose 10+ days prior to exposure

Question 32

Vaccine Storage

Answer 32

Keep temperature logs for 3 years or longer (state based) -Most in fridge -Varicella/MMRV in freezer -MMRII in either fridge or freezer Diluents of varicella/MMR/MMRV can be in fridge or RT -Reconstituted vaccines should be used shortly after prep

Question 33

Routes of Administration

Answer 33

IM only: most SC only: -Yellow fever -Dengue -Smallpox/Monkeypox (also intradermally during supply shortages) IM or SC: -MMR II -MMRV -Varicella -PPSV23 -IPV Nasal: -FluMist Quad PO: -Typhoid (Vivotif, capsules) -Cholera and rotavirus (solns)