Flashcards in Preventative Peds Deck (111)
lead screening ages
level causing cognitive issues
level for chelation
level for severe tox
lead lines: calcification on bone xr, basophilic stippling
cognitive delay 10-20
chelation at >45 mcg/dl
>60: severe tox: ha, encephalopathy, above signs
type of level needed to base lead treatment on, and other studies for confirmation of lead poisoning (3)
venous lead level
XR long bones
When is DTaP given?
2, 4, 6,15 mos and kindergarten
S/e of DTaP
fever, irritability, local erythema
Tdap vs DTap
DTaP NOT used in anyone older than 7y (DTaP has higher diphtheria toxoid)
Adolescents 11-18 should get what if they had DTaP?
Rule of Td, Tdap
Tdap (Boostrix and Adacel)
Rule: need 5 yrs between Td and Tdap, unless very high risk then after 18 mos ok
Adolescents can receive what two vaccines, and time rule?
Tdap and MCV4, ok on same visit or wait 1 month
Which should be given to adol if they need tetanus toxoid?
What if not finished original tetanus series?
Tdap > Td
If no primary tetanus vaccination series, then ALSO needs tetanus IG
CAtch up regarding Dtap?
7-9y: 3 doses of Td, 1 --> 4wk --> 6 mos
10: Tdap for one dose can count as adolescent dose
11-18 y: two Td, one Tdap
Can check Ab concentrations to determine if prior immunity is inadequate
what to do if tdap in <7 of 4, 5 dose
3. if 7-9
1. redo, even on same day
2. its okay, just give DTap for 5th
3. tdap can count as adolescent booster, and give Td 10 yrs later
Can DTap be given for an adolescent?
it shouldn't be, but it would count
Precautions for Tdap vaccine? (3)
When is okay (5)
1. GBS after previous tetanus toxoid vaccine (w/in 6 wks of vacc)
2. progressive neurologic disorder due to the pertussis part
3. Defer if acute illness until resolved, or if hx of severe Arthus hypersens rxn after prior dose, defer 10yrs
4. okay to give vaccine if prior limb swelling, brachial neuritis, pregnancy/BF, immunosuppressed, minor illness
The situation with latex allergy and Tdap?
If anaphylaxis rxn, then would not give standard vaccine, but the single dose Boostrix and Adacel are latex free
When to give Tdap to pregnant lady?
T2 or T3, or immediately postpartum to prevent mother contracting and passing to baby (Td or Tdap)...
Should adol 11-18 w/ x pertussis receive Tdap?
Invasive Hib disease before age 5 prior to vaccination? Mortality rate?
1/200, 5% mortality
When are children at risk for Hep B? (three risk categories)
2. early childhood from household/daycare
How often are risk fx identified in childhood case of Hep B?
Typical timing of Hep B vaccinations?
birth, 1-2 mo, 6-18 mo (after 1st dose)
When should a newborn get hep B IG?
If mother is HBsAg positive or unknown hepatitis status
(If unknown, can give HBV, then wait to see if mom is positive within 7d, or just give if baby unstable in any way)
Only contraindication to Hep B vacc?
severe allergic rxn to dose, (Not pregnancy, SLE...)
When can't you give the DTaP, HeB, IPV combo vaccine?
1. >/= 7 y
2. prior to 6 wks of age
What strains does the new MCV4 vaccine provide coverage for?
What doesn't it cover?
A, C, Y, W-135
B is the common Bad strain of menigococcus, most common in Babies.
Who gets MCV4 vaccination? (3 groups)
Is it okay in HIV pos kids?
Is it sub q or IM comp to MSV4
If MSV4 was gievn, when can MCV4 be given in high risk patients 2-10 yo?
Preadol 11-12 y
adol at HS entry or 15yo
college dorm students
ok for HIV pos kids over age 2
MCV4 is IM, MPSV4 is sQ
need three yrs between MPSV4 and MCV4
HPV can be given to who?
age 9-26. recommended for 11-12yo
When is 2nd dose MMR given? WHy
Any time 4 wks after first, before age 11-12. Usu between 4-6y
Give the 2nd dose b/c 5% of children don't respond to only one dose. (99% respond after 2 doses)
When do you give MMR vs Measles IG in patient exposed?
Within 72 hrs of exposure: MMR vaccine protects if at least 6mos old.
If 72 hrs - 6 days, need Measles IG
All HIV infected within 6 days exosure regardless of previous vaccination
5% of kids get what reactions with MMR?
high fever and rash 7-12 days later, lasts 1-2 days... reassure
If someone gets measles Ig, when should they get MMR vaccine?
5-6 mos later (passive blocks active immunity)