Vaccinations Flashcards
(164 cards)
1
Q
Define vaccine
A
Any suspension containing antigenic molecules (weakened or killed pathogen), given to stimulate an immune response to an infectious disease
2
Q
Define immunization
A
process by which an individual’simmune systembecomes fortified against an agent.
3
Q
Define prophylaxis
A
A measure taken to maintain health and prevent the spread of disease
4
Q
Define titer
A
measurement of the amount or concentration of a substance in a solution
5
Q
What is an example of a titer?
A
medicine or antibodies found in a patient’s blood.
6
Q
What is an antibody titer?
A
laboratory test that measures the presence and amount of antibodies in blood. The antibody level in the blood is a reflection of your past exposure to an antigen.
7
Q
What is herd immunity?
A
occurs when thevaccinationof a significant portion of apopulation(or herd) provides a measure of protection for individuals who have not developed immunity.
8
Q
What is the herd immunity threshold?
A
The percentage of the population vaccinated at which herd immunity is induced.
9
Q
What is an active immunization?
A
ANTIGEN ADMINISTRATION (either live, killed, or derivative such as a protein or polysaccharide) or a toxoid (deactivated toxin).
10
Q
What are the benefits of active immunizations?
A
Live versions more efficacious and provide longer lasting immunity than nonliving vaccines
11
Q
What is a passive immunization?
A
administration of pre-formed ANTIBODY (such as immunoglobulin)
12
Q
What are the effects of passive immunization?
A
Results in immediate protective immunity
Immunity is short term (typically lasts only 3-6 months
13
Q
What are some examples of immunotherapy (passive immunization)?
A
Hepatitis B immune globulin (HBIG) given within 12 hours of birth. Palivizumab (Synagis) is a respiratory syncytial virus (RSV) immune globulin. Rabies exposure
14
Q
So which type of immunization is congruent with vaccination?
A
Active immunization. (Passive immunization is NOT vaccination, therefore the two terms are NOT interchangeable. A vaccine can be termed an immunization but immunization cannot necessarily be termed vaccination)
15
Q
What are the classifications of vaccines?
A
live attenuated, inactivated (whole or fractional)
16
Q
What are some disadvantages of live attenuated vaccines?
A
possibility exists that a live attenuated vaccine could revert to a virulent form and cause disease. Not everyone can safely receive live, attenuated vaccines (ppl with immune system abnormalities).
17
Q
Describe characteristics of live attenuated vaccines
A
Attenuated (weakened) form of the “wild” virus or bacterium. Must replicate to be effective. Immune response similar to natural infection. produces immunity with one dose
18
Q
What are protein based fractional inactivated vaccines?
A
toxoid (inactivated bacterial toxin) . subunit products
19
Q
Describe polysaccharide-based fractional inactivated vaccines?
A
cell wall polysaccharide from bacteria conjugate. polysaccharide is linked to a protein to make it a more potent vaccine.
20
Q
Describe characteristics of inactivated vaccines?
A
Cannot replicate. not as effective as live vaccines, require 3-5 doses. Immune response is humoral. Antibody titer may diminish with time. Require booster shots
21
Q
What can be used for fractional inactivated vaccines?
A
toxoid or polysaccharide- based
22
Q
What steps should be taken in a vaccinating a patient with a previous anaphylactic rxn to a specific vaccine?
A
Avoid revaccination with the specific vaccine because of risk of recurrence.
23
Q
What local adverse rxn to vaccines?
A
pain, swelling, redness at site of injection
usually mild and self-limited
24
Q
What are systemic adverse rxn to vaccines?
A
fever, malaise, headache, allergic reaction
nonspecific, may be unrelated to vaccine
25
What used to be a mild SE of vaccines?
Serum sickness-like reaction (perhaps caused by residual animal proteins horse serum). Doesn't happen anymore cause we don't use horse serum
26
What vaccines should you avoid if you have a H/O of allergies to eggs or egg protien?
vaccines prepared in embryonated chicken eggs or cultures because these vaccines may contain residual egg protein (measles, mumps, flu, yellow fever)
27
What vaccines shouldn't be given to ppl with previous anaphylactic rxn to neomycin or streptomycin?
Avoid measles, mumps, rubella (MMR) vaccine because the MMR vaccine contains trace amounts of neomycin
28
What precautions should ppl who are immunocompromised take in regard to vaccines?
Avoid live virus vaccines because there is an increased risk of viral replication in immunocompromised individual
29
What vaccines should household members of immunocompromised patients avoid?
Avoid oral polio because vaccine induced disease (if it occurs) could be transmitted to the immunocompromised individual.
30
What kind of vaccines should pregnant women avoid?
Avoid all live virus vaccines because of the potential risk to the fetus
31
What kind of vaccine is the diptheria vaccine?
Formalin-inactivated diphtheria toxin
32
What is diphtheria?
An acute bacterial respiratory or cutaneous illness caused by Corynebacterium diphtheriae (C. diphtheriae)
33
How many doses of diptheria vaccine (DTap) should be given and when does it need a booster?
fFive doses + booster, Booster every 10 years
34
What do letters in diptheria/tetanus/pertussis combinations mean?
Upper-case letters denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism
35
What is included in DTaP and who is it given to?
Diphtheria and tetanus toxoids and acellular pertussis vaccine; given to infants and children ages 6 weeks through 6 years.
36
What is included in DT vaccine and who is it given to?
Diphtheria and tetanus toxoids, without the pertussis component; given to infants and children ages 6 weeks through 6 years who have a contraindication to the pertussis component.
37
What is included in Tdap and who is it given to?
Tetanus and diphtheria toxoids with acellular pertussis vaccine; given as a one-time dose to adolescents and adults. Women should receive Tdap during each of their pregnancies (preferably in the third trimester between the 27th and 36th week).
38
What is inclued in a Td vaccine and who is it given to?
Tetanus and diphtheria toxoids; given to children and adults ages 7 years and older as a booster shot or after exposure to tetanus.
39
What is tetanus?
Tetanus is a nervous system disorder characterized by muscle spasms that is caused by the toxin-producing anaerobe, Clostridium tetani.
40
What is the pathogenesis of tetanus?
Anaerobic conditions allow germination of spores and production of toxins. Toxin binds in central nervous system. Interferes with neurotransmitter release to block inhibitor impulses. Leads to unopposed muscle contraction and spasm
41
What are the clinical features of tetanus?
Incubation period; 8 days ,Spasms continue for 3-4 weeks, Complete recovery may take months
42
What is seen with generalized tetanus?
descending symptoms of trismus (lockjaw), difficulty swallowing, muscle rigidity, spasms
43
WHat are the three clinical forms of tetanus?
local (not common), cephalic (rare), generalized (most common)
44
What kind of vaccine is the tetanus toxoid?
inactivated tetanus toxin
45
What are complications of tetanus?
Laryngospasm, Fractures, Pulmonary embolism
| Aspiration pneumonia, Death
46
What are symptoms of pertussis?
severe coughing spells which can lead to difficulty breathing, vomiting, disturbed sleep, wt. loss, incontinence, rib fractures and passing out f
47
Who should receive a tetanus vaccine?
All adults who have not had a tetanus shot in the past 10 years should receive a Td booster dose.(Tdap) .Adults who received a Td only within the past 10 years should receive a dose of Tdap.
Pregnant women who have not received the primary tetanus vaccination series should begin this series during pregnancy, after 20 weeks, using Tdap.
48
What are symptoms of pertussis?
severe coughing spells which can lead to difficulty breathing, vomiting, disturbed sleep, wt. loss, incontinence, rib fractures and passing out
49
What is haemophilus influenzae B (HIB)?
Severe bacterial infection, particularly among infants. Organism colonizes nasopharynx. Hib was a leading cause of childhood meningitis, pneumonia, and epiglottitis,
50
What kind of vaccine is the HIB vaccine (HbOC)?
Polysaccharide-based conjugate vaccine
51
WHo should received HbOC over 5yrs of age?
ppl with sickle cell disease, HIV/AIDS, removal of the spleen (asplenia), bone marrow transplant, or cancer patients on chemotherapy.
52
What are some rxns to watch for after giving the diptheria/tetanus/pertussis vaccines?
Moderate or severe acute illness, Temperature >105°F (40.5°C), Collapse or shock-like state, Persistent, inconsolable crying lasting >3 hours, Convulsions with or w/o fever
53
When should booster doses of diptheria/tetanus/pertussis be given?
11 or 12 years of age if 5 years since last dose (Tdap). Every 10 years thereafter (Td or Tdap
54
What is the schedule for HbOC?
Recommended interval 8 weeks for primary series doses, Minimum interval 4 weeks for primary series doses, Minimum age 6 weeks
55
What are measles?
Highly contagious viral illness.Respiratory transmission of virus. Replication in nasopharynx and regional lymph nodes
56
What are clinical features of measles?
Incubation period 10-12 days
| Stepwise increase in fever to 103°F or higher, Cough, coryza, conjunctivitis, Koplik spots
57
What are Koplik spots?
whitish, grayish, or bluish elevations, seen on the buccal mucosa typically opposite the molar teeth.
pathognomonic for measles infection
58
Describe the rash that occurs with measles?
2-4 days after prodrome, 14 days after exposure
| Maculopapular,Begins on face and head, Persists 5-6 days. Fades in order of appearance
59
What are complications of measles?
Otitis media, Pneumonia, Encephalitis, Laryngotracheobronchitis (croup)
60
What is mumps?
a virus that causes fever, headache, muscle pain, loss of appetite, and swollen glands (parotitis).
61
WHat are complications of mumps?
deafness, meningitis, painful swelling of the testicles or ovaries (orchitis), and rarely sterility.
62
What is rubella (german measles)?
virus that causes rash, arthritis (mostly in women), and mild fever.
63
What happens if a pregnant women gets rubella?
she could have a miscarriage or her baby could be born with serious birth defects(congenital rubella syndrome)
64
What kind of vaccine is the MMR vaccine?
Live virus attenuated vaccine
65
What is the schedule for the MMR vaccine?
First dose of MMR at 12-18 months
Second dose of MMR at 4-6 years
Second dose may be given any time at least 4 weeks after the first dose
66
Who should receive MMR?
Susceptible adolescents and adults without documented evidence of rubella immunity
Emphasis on nonpregnant women of childbearing age, particularly those born outside the U.S.
67
What is varicella (chickenpox)?
Rash characterized by vesicular lesions most concentrated on trunk. Successive crops over several days with lesions present in several stages of development
68
What are complications of varicella?
Bacterial infection of skin lesions.Pneumonia.
Central nervous system manifestations.
Reye’s syndrome, Postherpetic neuraligia
69
What is the varicella zoster virus?
Herpesvirus (DNA), Primary infection results in varicella (chickenpox), Recurrent infection results in herpes zoster (shingles)
70
What is herpes zoster?
Reactivation of varicella zoster virus
| characterized by a painful, unilateral vesicular eruption, which usually occurs in a restricted dermatomal distribution
71
What is congenital varicella syndrome?
maternal infection during pregnancy
| Low birth weight, atrophy of extremity with skin scarring, eye and neurologic abnormalities
72
WHat is herpes zoster associated with?
aging, immunosuppression, varicella at younger than 18 months of age
73
What kind of vaccine is the varicella vaccine?
live, attenuated vaccine
74
What is the pediatric dosing for the varicella vaccine?
1st dose at 12-15 months of age, 2nd dose at 4-6 yrs, but it may be administered earlier provided ≥3 months have elapsed after the first dose.
75
What is the adult dosing for the varicella vaccine?
adults who received only 1 dose of vaccine receive a 2nd dose at least 4 weeks apart.
76
What are precautions of the varicella vaccine?
varicella vaccine and antibody-containing products (immune globulin, blood products) should not be administered simultaneously.
avoid salicylates for 6 wks since varicella may increase the risk of Reye's syndrome.
77
What are complications of herpes zoster?
```
Postherpetic neuralgia (PHN), Ophthalmic zoster
Dissemination with generalized skin eruptions and involvement of the central nervous system, lungs, liver and pancreas
```
78
What are precautions for the herpes zoster vaccine (Zostavax)?
Postherpetic neuropathy, Tuberculosis, VZV infection, Antiviral drugs
79
WHat are varicella-containing vaccines?
Varicella vaccine (Varivax).Herpes Zoster vaccine (zostavax). MMRV (ProQuad)
80
What is the dosing schedule for MMRV (proquad)?
1st at 12 through 15 months of age
| 2nd dose at 4 through 6 years of age
81
Describe characteristics of Hep A virus
Entry into mouth via the fecal-oral route. Viral replication in the liver. Virus present in blood and feces 10-12 days after infection. Virus excretion may continue for up to 3 weeks after onset of symptoms
82
How do the clinical features of Hep A vary with age?
usually silent or subclinical in children.
| infxn in adults varies in severity from a mild flu-like illness to fulminant hepatitis.
83
Describe clinical features of Hep A
Abrupt onset: fatigue, malaise, nausea, vomiting, anorexia, fever, and RUQ pain. Progresses to dark urine, acholic stool (light-colored stools lacking bilirubin pigment), jaundice, and pruritus
84
What kind of vaccince is the Hep A vaccines?
inactivated whole virus
85
What age are pediatric formulations for Hep A vaccines given?
12 months through 18 years (0.5 mL IM)
86
WHat age are adult formulations for Hep A vaccines given?
19 years and older (1mL IM)
87
What is in the herpes zoster vaccine and who is it used for?
live, attenuated vaccine. vaccination of all patients ≥60 years of age, including patients who report a previous episode of zoster
88
What is MMRV (ProQuad)?
Combination measles, mumps, rubella and varicella vaccine
89
What is the hep A postexposure prophylaxis for ppl >40yrs?
immune globulin is preferred. vaccine can be used if IG cannot be obtained
90
What is the hepatitis A virus?
Picornavirus (RNA)
91
What are indications for Hep A vaccine?
All children between their 1st and 2nd birthdays (12 through 23 months of age). International travelers. Men who have sex with men. Persons who use illegal drugs. Persons with occupational risk. Persons with chronic liver disease
92
What are clinical features of Hep B?
Nonspecific: malaise, fever, headache, myalgia
93
What are the scheduling of the Hep A vaccine?
1st dose 12 months. 2nd dose 24 months. Children who are not vaccinated by 2 years of age can be vaccinated at later visits. .
94
WHat kind of vaccine is the Hep B vaccine and what are the different kinds you can get?
Inactivated viral vaccine, recombivax and engerix
95
What is the scheduling of the Hep A vaccine for international travel?
at least 1 month before travel if at all possible. Persons planning to travel 2 weeks should also receive immune globulin
96
What is the hep A postexposure prophylaxis for ppl age 12 mo- 40yrs?
single-antigen hepatitis A vaccine should be administered as soon as possible after exposure
97
What is hep B?
Epidemic jaundice. Hepadnaviridae family (DNA
98
How long can Hep B retain infection capabilities?
7 days at room temp
99
WHat kind of vaccine is the Hep B vaccine and what are the different kinds you can get?
Inactivated viral vaccine. recombivax and engerix
100
What is the scheduling for infants with the Hep B Vaccine?
1st Dose: Birth
2nd Dose: 6 weeks of age
3rd Dose: 6-18 months of age
101
What infants are at high risk of Hep B?
born to HBsAg + mothers
102
What should infants who are at high risk of Hep B be given?
HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth
103
What should infants who are at high risk for Hep B be tested for?
for HBsAg and antibody to HBsAg (anti-HBs) 1 to 2 months after completion of the HepB series.
104
How long does third dose of Hep B vaccine need to be separated from first dose in adolescents and adults?
at least 16 weeks
105
What is influenza?
Caused by RNA viruses of the family Orthomyxoviridae. Transmitted through the air or by direct contact with nasal secretions (coughing, sneezing, close contact)
106
What are symptoms of influenza?
Fever/Chills, Sore throat, Arthralgias (muscle aches),Headache, Coughing, Weakness and fatigue
107
What are complications of influenza?
Pneumonia, Severe diarrhea and dehydration, Myositis and rhabdomyolysis, Seizures
108
What popns are at greatest risk for complications from the flu?
young children, people 65 and older, pregnant women, and the immunocompromised.
109
Who is the high-dose flu shot approved for?
for people 65 and older
110
What are the three types of inactivated flu vaccines?
standard, high-dose, intradermal
111
Who is the standard flu shot approved for?
ages 6 months and older: 0.5 mL/dose IM
112
Who is the intradermal flu shot approved for?
18 to 64 years of age: 0.1 mL/dose
113
Who is the live intranasal flu vaccine approved for?
healthy patients age 2-49 who are NOT pregnant.
114
How long does it take for the flu vaccine to be effective and how long does this protection last?
takes 2 weeks, lasts several months to a yr
115
What does the seasonal flu vaccine protect against?
against the three influenza viruses that research indicates will be most common during the upcoming season
116
What are the popn recommedations for the flu vaccine?
All healthy persons 6 mos of age or older. Residents of long-term care facilities. Pregnant women. Persons 6 months through 18 years receiving chronic aspirin therapy. Persons 6 months of age and older with chronic illness
117
What are precautions of live attenuated flu vaccine?
Children younger than 5 years with asthma or recurrent wheezing, Persons with chronic medical conditions. Children and adolescents receiving long-term aspirin therapy*
118
What is pneumococcal disease?
Second most common cause of vaccine-preventable death in the U.S. (after influenza). Major clinical syndromes include pneumonia, bacteremia, and meningitis
119
What are minor adverse rxns to live attenuated flu vaccine?
Rhinorrhea, Nasal congestion, Headache, sore throat
120
What are serious adverse rxns to live attenuated flu vaccine?
Anaphylaxis (seven), Guillain-Barré syndrome (two), Bell's palsy (one), Asthma exacerbation among individuals with a h/o asthma (eight) (numbers out of 2.5 million)
121
What are CI of live attenuated flu vaccine?
Immunosuppression from any cause. Pregnant women. Children younger than 2 years of age. Persons 50 years of age or older. Severe (anaphylactic) allergy to egg or other vaccine components. History of Guillian-Barré syndrome
122
What are clinical features of pneumococcal pneumonia?
Abrupt onset, Fever, Shaking chills, Pleuritic chest pain, Productive cough, Dyspnea, tachypnea, hypoxia
123
What are the different types of pneumococcal vaccines?
Pneumococcal conjugate vaccine ( PCV13 or Prevnar®13) and Pneumococcal polysaccharide vaccine (PPSV
124
What does Pneumococcal polysaccharide vaccine (PPSV) protect against?
23 types of pneumococcal bacteria
125
What does Pneumococcal conjugate vaccine ( PCV13 or Prevnar®13) protect against?
13 types of pneumococcal bacteria
126
What is the PCV13 or prevnar immunization schedule?
Primary 1- 6 wks
Primary 2- 4 mo
Primary 3- 6 mo
Booster -12-15 mo
127
What are the two types of meningococcal vaccine?
Meningococcal conjugate vaccine (MCV4, Menactra) and Meningococcal polysaccharide vaccine (MPSV4)
128
Who should get the PPSV?
All adults 65 years of age and older,heart or lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, smokers
129
When is a second dose of PPSV recommended?
65 yrs and older who got their 1st dose when they were younger than 65 and it has been 5 or more yrs since the 1st dose. for people 2-64 years of age who are immunocompromised
130
What is MCV4 recommendation for adolescents with HIV?
2 doses 2 months apart at 11 or 12 years, plus a booster at age 16.
131
What are clincal manifestations of HPV?
asymptomatic and result in no clinical disease. can lead to anogenital warts, cervical cancer precursors, Cancer (cervical, anal, vaginal, vulvar, penile, and oropharyngeal
132
What are recommendations for HPV vaccine?
all adolescents 11-12 years of age. can be started as young as 9 years of age
133
What is meningococcal disease?
Serious bacterial illness caused by Neisseria meningitidis. Organism colonizes nasopharynx and can invade the bloodstream and causes infxn at distant site
134
What are clinical findings of meningococcal meningitis?
fever, HA, stiff neck
135
What are clinical findings of meningococcemia?
fever, petechial/purpuric rash, hypotension,
| multiorgan failure
136
What is the pathogenesis of the rotavirus?
Entry through mouth. Replication in epithelium of small intestine. Replication outside intestine and viremia uncommon.
137
What are the clinical features of the rotavirus?
May be asymptomatic or result in severe dehydration due to diarrhea with fever and vomiting. Gastrointestinal symptoms generally resolve in 3 to 7 days
138
What are complications of rotavirus?
Severe diarrhea. Dehydration. Electrolyte imbalance. Metabolic acidosis. Immunodeficient children may have more severe or persistent disease
139
What age grp is the MCV4/Menactra vaccine recommended for?
ppl <55, the first dose at 11 or 12 years of age, with a booster dose at age 16.
140
What age grp is the MPSV4 vaccine recommended for?
ppl >55
141
What is HPV?
DNA virus, most common sexually transmitted virus in the United States.
142
What are the 2 types of HPV vaccine?
HPV4 gardasil (men/women) and HPV2 Cervarix (only for females)
143
What is HPV vaccination schedule?
Routine schedule is 0, 2, 6 months. Third dose should follow the first dose by at least 24 weeks
An accelerated schedule using minimum intervals is not recommended.Series does not need to be restarted if the schedule is interrupted
144
What should you do if a woman receives the HPV vaccine during pregnancy?
no indication for intervention. wait to give next does until she pops that sucker out
145
What is the rotavirus?
Most common cause of severe diarrhea in infants and children. Reovirus (RNA). may remain viable for weeks or months if not disinfected
146
What are the two rotavirus vaccines?
RV5 (RotaTeq) and RV1 (Rotarix)
147
What is the vaccination schedule for rotavirus?
First Dose: 6 weeks of age. Second Dose: 4 months of age. Third Dose: 6 months of age (only for RotaTeq
148
What are recommedations for the usage of both rotavirus vaccines?
maximum age for first dose is 14 weeks 6 days
minimum interval between doses is 4 weeks
maximum age for any dose is 8 months
149
What are adverse rxns to rotavirus vaccines?
vomiting, diarrhea, irritability, fever
150
What are unique precautions to rotavirus vaccine?
Acute, moderate or severe gastroenteritis, History of intussusception
151
What is polio?
Caused by a virus, it enters the body through the mouth. It causes paralysis, meningitis, and death.
152
What is the schedule for the polio vaccine?
A dose at 2 months. A dose at 4 months
| A dose at 6-18 months. A booster dose at 4–6 years
153
What are the advantages of combo shots?
allow for significantly fewer shots than what was required previously
154
What is TriHIBit?
DTaP-Hib combination
155
When can a TriHIBit be used?
May be used as the final (booster) dose of the Hib series at 12 months of age or older following any Hib vaccine
156
When should you not use TriHIBit?
Do not use for primary immunization at 2, 4, or 6 months of age
157
What is pediarix?
DTaP – Hep B – IPV combination
158
What use is pediarix approved for?
used in infants whose mothers are HBsAg positive or status unknown. for children 6 weeks to 7 years of age or Approved for 3 doses at 2, 4 and 6 months
159
What is pediatrix not approved for?
booster doses
160
What is twinrix?
Combination hepatitis A vaccine (pediatric dose) and hepatitis B (adult dose)
161
What is the scheduling for twinrix?
0, 1, 6 months, or 0, 7, and a booster dose at 12 months. Approved for persons 18 years of age and older
162
What is COMVVAX?
Hepatitis B-Hib combination
163
What is COMVAX used for?
Use when either antigen is indicated. Use when either antigen is indicated
164
What is the minimum age to receive COMVAX?
six weeks
