Vaccinations Part 2 Flashcards

Question

Measles

Answer 1

- highly contagious viral illness - respiratory transmission of virus - replication in nasopharynx and regional lymph nodes - near universal infection of childhood in pre-vaccination era - common and often fatal in developing areas

Answer 2

Incubation period = 10-12 days -Prodrome stepwise increase in fever to 103 F or higher cough, coryza, conjunctivitis Koplik spots -1-3 mm whitish, grayish, bluish, elevations on an erythematous base -seen on the buccal mucosa typically opposite the molar teeth -pathognomonic for measles infection

Answer 3

Rash - 2-4 days after prodrome, 14 days after exposure - maculopapular rash --> becomes confluent - begins on face and head - persists 5-6 days - fades in order of appearance

Answer 4

- otitis media - pneumonia - encephalitis - Laryngotracheobronchitis (croup) - Death

Answer 5

virus --> headache, fever, muscle pain, loss of appetite, and swollen glands (parotitis) Complications include... - deafness - meningitis - painful swelling of the testicles/ovaries (orchitis) - rarely sterility

Answer 6

Rubella virus --> rash, arthritis (mostly in females) and mild fever Rubella in and of itself = generally mild, self-limiting disease but if a female gets rubella while pregnant can cause... - miscarriage - serious birth defects (congenital rubella syndrome)

Answer 7

- Infection may affect all organs - deafness - cataracts - heart defects - microcephaly (abnormal brain development) - mental retardation - bone deformities - liver & spleen damage - may lead to fetal death or premature delivery - severity of damage to fetus depends on gestational age - up to 85% of infants affected if infected during 1st Trimester

Answer 8

-live virus attenuated vaccine of 0.5 ml dose via SubQ route 1st dose of MMR at 12-19 months 2nd dose of MMR at 4-6 yrs (before kindergarten) -2nd dose may be given any time (at least 4 wks after 1st dose) -susceptible adolescents and adults without documented evidence of rubella immunity emphasis on non-pregnant females of childbearing age -particularly if born outside of US

Answer 9

- pregnancy - immunosuppression - severe allergic reaction to vaccine component or following a prior dose - severe allergic reaction to neomycin Precaution: moderate/severe acute illness

Answer 10

-herpes virus (DNA) primary infection --> varicella (chicken pox) secondary infection --> herpes zoster (shingles)

Answer 11

-respiratory transmission of virus Incubation period: 14-16 days (range 10-21 days) mild prodrome: for 1-2 days Rash: characterized by vesicular lesions generally appears on head 1st most concentrated on trunk successive crops over several days with lesions present in several stages of development

Answer 12

- bacterial infection of skin lesions - pneumonia (viral/bacterial) - CNS manifestations - Reye's syndrome - hospitalization: 2-3 per 1000 cases - Death: in 2013 the disease resulted in 7000 deaths worldwide - postherpatic neuralgia (complication of zoster)

Answer 13

-1 million episodes occur annually in US -about 1/3 of US population --> shingles risk increases after 50 years of age -50% of persons living until 85 yrs will develop zoster

Answer 14

-reactivation of varicella zoster virus - characterized by... - painful, unilateral vesicular eruptions - which usually occurs in a restricted dermatomal distribution - associated with... - aging - immunosuppression - varicella at younger than 18 months of age

Answer 15

- postherpetic neuralgia (PHN) - ophthalmic zoster (effects eye --> blindness) - dissemination with generalized skin eruptions and involvement of CNS, lungs, liver, pancreas - can cause systemic complications

Answer 16

- results from maternal infection during pregnancy - period of risk may extend thru 1st 20 wks of pregnancy - low birth weight - atrophy of extremity with skin scarring - eye & neurologic abnormalities -risk appears to be small (

Answer 17

- Varicella Vaccine (Varivax) - Herpes Zoster vaccine (Zostavax) - MMRV (ProQuad)

Answer 18

- Live attenuated vaccine - Prevents primary varicella infection (chicken pox) - does not prevent shingles Pediatric dosing: 0.5 ml SubQ ACIP recommends that routine childhood vaccines should be given with 2 doses -1st dose at 15-18 months of age -2nd dose at 4-6 yrs of age, but it may be given earlier provided >/= 3 months has elapsed since 1st dose Adult dosing: 0.5 ml SubQ ACIP recommends that all kids and adults who received only 1 dose of vaccine receive a 2nd dose at least 4 wks apart

Answer 19

-mod/severe acute illness -varicella vaccine and AB-containing products (immune globulin, blood products) should NOT be administered simultaneously -avoid salicylates (aspirin and aspirin-containing products) for 6 weeks: varicella may increase the risk for Reye's Syndrome

Answer 20

- pregnancy - immunosuppression - severe allergic reaction to vaccine component or following a prior dose

Answer 21

- live attenuated vaccine - approved for persons >/= 50 yrs of age - SubQ 0.65 ml administered as a single dose - ACIP recommends routine vaccination of all pt >/= 60 yrs of age - including pt who report previous episodes of zoster

Answer 22

-mod/severe acute illness - postherpetic neuropathy (PHN) - not for use in tx of PHN -TB: defer tx of pt with active untreated TB - VZV infection: - not for prevention of primary varicella virus infection (chicken pox) - or tx of active zoster outbreak - may be used in pt with previous hx of zoster (at least 6 months after zoster outbreak) -Antiviral drugs: meds active against the herpes virus family (acyclovir, famciclovir, valacyclovir) may interfere with zoster vaccine

Answer 23

- pregnancy - Immunosuppression - severe allergic reaction to vaccine component or following a prior dose

Answer 24

-local rxns (pain, erythema) - rash- 3-4% - may be maculopapular rather than vesicular - avg 5 lesions -systemic rxns: not common

Answer 25

Combo: Measles, Mumps, Rubella, and Varicella vaccine -approved for kids 12 months - 12 yrs of age (up to 13 yrs) ACIP guidelines: 2 doses of MMRV vaccine recommended - 1st dose at 12-15 months of age - 2nd dose at 4-6 yrs of age These are recommended ages, but kids can get 2nd dose up thru 12 yrs (as long as given at least 3 maths after 1st dose)

Answer 26

- picornavirus (RNA) - humans are only natural hosts - entry into mouth via 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 sx

Answer 27

Incubation period: 30 days (range from 15-49 days) -manifestations vary with age -usually silent/subclinical in kids -infxn in adults varies with severity (mild flu-like illness --> fulminant hep) * Abrupt onset of prodromal sx - fatigue - malaise - n/v - anorexia - fever - RUQ pain - progresses to dark urine, acholic stool (light colored stools, lacking bilirubin pigment), jaundice and pruritis (liver disease sx) - any type of hepatitis - hard to say what type unless have lab results (similar presentations)

Answer 28

- inactivated whole virus vaccine - Pediatric and Adult Formulations - Pediatric Formulation approved for 12 mths -18 yrs (0. 5 ml IM) -Adult Formulation approved for 19 yrs and older (1 ml IM)

Answer 29

-all kids b/n 1st & 2nd birthdays (12-23 months of age) - international travelers - men who have sex with men - illegal drug users - pt has occupational risk - pt has chronic liver disease

Answer 30

- all kids should receive Hep A vaccine at 12-23 months of age - kids who are not vaccinated by 2 yrs can be vaccinated at later visits - administered with a 2 dose series - 1st dose: given at 12-23 months - 2 doses should be separated by 6-18 months Typical Schedule - 1st dose: 12 months - 2nd dose: 24 months

Answer 31

- For healthy persons 12 months - 40 years of age - single antigen Hep A vaccine should be administered as soon as possible after exposure - For persons older than 40 yrs - immune globulin is performed - vaccine can be used if IG cannot be obtained

Answer 32

- local rxn (pain/erythema) | - systemic rxn (malaise, fever, fatigue)

Answer 33

- severe allergic rxns to vaccine component or following a prior dose - severe adverse rxn to previous dose Precaution: mod/severe acute illness

Answer 34

- epidemic jaundice described by Hippocrates in 5th century BC - Hepadnaviridae family (DNA) - humans are only known host - may retain infectivity for more than 7 days at room temp

Answer 35

Incubation period = 60-150 days (avg 90 days) - nonspecific prodrome: malaise, fever, headache, myalgias - illness nonspecific for Hep B - at least 50% of infections are asymptomatic

Answer 36

- chronic infections - fulminant hepatitis - hospitalizations - cirrhosis - hepatocellular carcinoma - death

Answer 37

- sexual exposure - sex partners of HBsAg-positive persons - sexually active persons NOT in a long-term mutually monogamous relationship - persons seeking evaluation/treatment for a sexually transmitted disease - men who have sex with men * persons with more than 1 sexual partner during the previous 6 months

Answer 38

Percutaneous/mucosal exposure to blood - current/recent IVDU (IV drug user) - household contacts of HBsAg-positive persons - residents & staff of facilities for developmentally disabled persons - healthcare & public safety workers with risk for exposure to blood or blood-containing body fluids - persons with end-stage renal disease

Answer 39

International travelers to regions with high/intermediate levels (HBsAg prevalence of 2% or higher) or endemic HBV infection *persons with HIV infection

Answer 40

*inactivated viral vaccine Recombivax HB (Merck) IM - 5 mcg/0.5 ml (pediatric) - 10 mcg/1ml (adult) - 40 mcg/1 ml (dialysis) Engerix-B (GSK) IM - 10 mcg/0.5 ml (pediatric) - 20 mcg/1 ml (adult) ***do not memorize dosing

Answer 41

Babies normally get 3 doses of Hep B vaccine - 1st dose = birth - 2nd dose = 6-8 wks of age - 3rd dose = 6-18 months of age - some babies might get 4 doses - ex if a combo vaccine containing Hep B is used (single shot, containing several vaccines) -the extra dose is not harmful

Answer 42

- infants born to HBsAg-positive females - administer Hep B vaccine & 0.5 ml of Hep B Immune globulin (HBIG) within 12 hours of birth -infants should be tested for HBsAg and AB to HBsAg (anti-HBs) 1-2 months after completion of Hep B series

Answer 43

Dose Usual Interval Minimal Interval Primary 1 0 ------------------- Primary 2 1 month 4 weeks Primary 3 6 months 8 weeks *3rd dose must be separated by 1st dose by at least 16 weeks

Answer 44

- commonly called the flu - caused by RNA viruses of the family Orthomyxoviridae - transmitted thru air or by direct contact with nasal secretions (coughing, sneezing, close contact)

Answer 45

- sx commonly confused with common cold although generally more severe including - fever/chills - sore throat - Arthralgias (muscle aches) - headache - coughing - weakness and fatigue

Answer 46

-pneumonia -severe diarrhea & dehydrations -myositis & rhabdomyolysis -seizures -encephalitis -each yr thousands of people in US die from the flu & many more are hospitalized *most at risk for complications are young kids, people 65 years and older, pregnant females, immunocompromised

Answer 47

- Injectable - inactivated vaccine - approved for use in pt older than 6 months including healthy pt and also those with chronic medical conditions 3 types available -standard flu shot: approved for people ages 6 months and older (0.5 ml dose IM) -High-dose flu shot: approved for 65 and older (60 mug of hemagglutinin per strain vs 15 mug of hemagglutinin per strain in the standard vaccine) - Intradermal flu shot: approved for 18-64 years of age (0. 1 ml/dose)

Answer 48

Intranasal -live vaccine - only approved for use in healthy pt ages 2-49 who are NOT pregnant - sometimes called LAIV (live attenuated influenza virus) * viruses in nasal spray vaccine do NOT cause the flu

Answer 49

- flu vaccine is recommended every year - kids 6 months - 8 yrs of age should get 2 doses the 1st yr they get vaccine - inactivated flu vaccine - protects against 3-4 different influenza strains - it takes about 2 weeks for protection to develop after vaccination and protection lasts several months to a yr - seasonal flu vaccines protect agains 3-4 influenza viruses that research indicates will be most common during the upcoming season - viruses in the vaccine can change each year based on the international surveillance and scientists' estimations about which types and strains of viruses will circulate in a given yr

Answer 50

- influenza activity can occur as early as October - in more than 80% of seasons since 1976 peak influenza activity has not occurred until January or later - in more than 60% of seasons the peak was in February or later - providers should begin offering vaccine as soon as it becomes available (if possible by October) - to avoid missed opportunities for vaccination: providers should offer vaccine during routine healthcare visits or during hospitalizations whenever vaccine is available - providers should continue to vaccinate thru out influenza season

Answer 51

- educate HCW about benefits for themselves, their families and their pt - educate staff about vaccine adverse rxns - provide free vaccinations at work site to all employees (including night and weekend staff)

Answer 52

- local rxns = 15-20% - fever/malaise - not common - allergic rxns - rare - neurological - very rare rxns

Answer 53

-severe allergic rxn to vaccine component (ex eggs) or following a prior dose of vaccine Precautions - mod/severe acute illness - hx of Guillian Barre within 6 weeks following previous dose Recombinant flu vaccine - does not use chicken eggs - safe for pt with egg allergies

Answer 54

Minor - rhinorrhea - nasal congestion - headache - sore throat Out of 2.5 million people the following adverse rxns were reported - anaphylaxis (7) - Guillian Barre (2) - Bells Palsy (1) - Asthma exacerbation among pt with hx of asthma (8)

Answer 55

- kids younger than 5 yrs with asthma/recurrent wheezing (ex hx of RSV) * - mod/severe acute illness - pt with chronic medical conditions* - kids/adolescents receiving long-term aspirin therapy* * pt should receive inactivated flu vaccine

Answer 56

- immunosuppression from any cause * - pregnant women * - kids younger than 2 yrs of age * - pt 50 yrs or older * - severe (anaphylactic) allergy to eggs or other vaccine components - hx of Guillian Barre * pt should receive inactivated influenza vaccine

Answer 57

- Streptococcus pneumoniae: 1st isolated by Pasteur in 1881 gram-positive bacteria - 90 known serotypes - 2nd most common cause of vaccine-preventable death in the US (after influenza) - major clinical syndromes include - pneumonia - bacteremia - meningitis - very young and very elderly = highest death rates - 100K-135K hospitalizations per yr - 4000 deaths/yr - common bacterial complication of influenza and measles

Answer 58

Pneumococcal conjugate vaccine (PCV13 or Prevnar 13) - protects against 13 types of pneumococcal bacteria - IM route 0.5 ml per dose Pneumococcal poly-saccharide Vaccine (PPSV) - protects against 23 types of pneumococcal bacteria - IM/SubQ 0.5 ml per dose

Answer 59

``` Dose Age Primary 1 6-8 wks Primary 2 4 months Primary 3 6 months Booster 12-15 months ```

Answer 60

-all adults 65 yrs of age or older - anyone 2-64 yrs of age who is immunosuppressed or has a chronic medical condition such as - heart/lung disease - sickle cell - diabetes - alcoholism - cirrhosis -any adult 19-64 yrs of age who is a smoker or has asthma

Answer 61

PPSV is usually given as a single dose per lifetime However 2nd dose is recommended for people... -65 yrs of age or older who got their 1st dose before 65 and it has been 5 or more yrs since 1st dose - for people 2-64 yrs of age who are immunocompromised - when a 2nd dose is given it should be given 5 yrs after the 1st dose

Answer 62

- Local Rxns - polysaccharide 30-50% - conjugate 10-20% - Fever/myalgia - polysaccharide

Answer 63

- severe allergic rxn to vaccine components or following a prior dose of vaccine - moderate/severe acute illness

Answer 64

- serious bacterial illness - caused by Neisseria meningitidis - organism colonizes nasopharynx and can invade blood stream --> infunction at distant site - it is the leading cause of bacterial meningitis in kids 2-8 yrs old in US - about 1000 people get meningococcal disease per year in US and even when treated with antibiotics 10-15% of these people die

Answer 65

- most common pathologic presentation of meningitis - result of hematogenesis dissemination - clinical findings - fever - headache - stiff neck

Answer 66

- bloodstream infection (sepsis) - may occur with or without meningitis - clinical findings - fever - petechial/purpuric rash - hypotension - multiorgan failure

Answer 67

2 types - meningococcal conjugate vaccine (MCV4, Menatra) - preferred vaccine for people 55 and younger - meningococcal polysaccharide vaccine (MPSV4) licensed for people 55 and older - Both vaccines --> prevent 4 strains - Route IM 0.5 ml dose

Answer 68

2 doses of MCV4 recommended for adolescents 11-18 yrs of age - 1st dose at 11-12 yrs of age - with booster dose at age 16 - Adolescents in this age group with HIV should get 3 doses - 2 doses 2 months apart at 11 or 12 yrs - plus booster at age 16

Answer 69

Local = 11-50% Systemic (headache, malaise, fatigue) = 4-22%

Answer 70

- severe allergic rxns to vaccine component or following prior dose of vaccine - mod/severe acute illness

Answer 71

- DNA virus - more than 100 types identified based on the genetic sequence of the outer capsid protein L1 - 40 types infect the mucosal epithelium - most common sexually transmitted virus in US - more than half of sexually active men and women infected with HPV at some time in their lives

Answer 72

most HPV infections are asymptomatic and result in no clinical disease clinical manifestations of HPV infections include - anogenital warts - cervical cancer precursors (cervical intraepithelial neoplasia) - cancer (cervical, anal, vaginal, vulvar, penile, oropharyngeal cancer)

Answer 73

3 types of HPV Vaccines -nonavalent vaccine HPV9 (Gardasil-9) indicated for males and females (6, 11, 16, 18, 31, 33, 45, 52, 58) -quadrivalent vaccine HPV4 (Gardasil) indicated for males and females -bivalent vaccine HPV2 (Cervarix) only indicated for females

Answer 74

ACIP recommends routine vaccination of all adolescents 11-12 years of age - the vaccine series can be started as young as 9 years of age (at clinician's discretion) - "catch up" vaccine recommended for adolescents 13-26 years of age

Answer 75

-high efficacy among females without evidence of infection with vaccine HPV types - Prior infection with 1 HPV type did not diminish efficacy of vaccine against other HPV types - Clinical trials of HPV vaccine in males has demonstrated similar immunogenicity with a favorable side effect profile

Answer 76

Routine Schedule = 0, 2, 6 months - 3rd dose should follow 1st dose by at least 24 weeks - an accelerated schedule using minimal intervals is NOT recommended - series does NOT need to be re-started if the schedule is interrupted

Answer 77

- equivocal/abnormal Pap test - positive HPV DNA test - genital warts - immunosuppression - breastfeeding * vaccine can be administered

Answer 78

- Local Rxns (pain/swelling) = 84% - Fever = 10%* - no serious adverse rxns reported * similar to reports in placebo recipients (9%)

Answer 79

- CI - severe allergic reaction to vaccine component or following a prior dose - Precaution - mod/severe acute illness (defer until sx improve)

Answer 80

- initiation of vaccine series should be delayed until after completion of pregnancy - if female found to be pregnant after initiating vaccination series --> remaining dose(s) should be delayed until after pregnancy - if vaccine dose has been administered during pregnancy there is no indication for intervention - any female vaccinated during pregnancy should be reported to Merck registry

Answer 81

- 1st ID as cause of diarrhea in 1973 - most common cause of severe diarrhea in infants/kids - nearly universal infection by age 5 yrs - responsible for up to 400K diarrheal deaths each year worldwide

Answer 82

- Reovirus (RNA) - 5 predominant strains (G1-G4, G9) and accounts for 90% of isolates - G1 strain accounts for 75% of infections - very stable and may remain viable for weeks/months if not disinfected

Answer 83

- entry thru mouth - replication in epithelium of small intestine - replication outside intestine & viremia uncommon - infection --> mod/severe diarrhea

Answer 84

-short incubation period (usually could die from dehydration)

Answer 85

- severe diarrhea - dehydration - electrolyte imbalance - metabolic acidosis - immunodeficient kids may have more severe or persistent disease

Answer 86

- RV5 (RotaTeq) - live attenuated vaccine - route: oral 2 ml dose/3 doses - Pentavalent human-bovine rotavirus reassortant vaccine - RV1 (Rotarix) - live attenuated vaccine - route: oral 2 ml dose/2 doses - monovalent vaccine derived from the most common human rotavirus serotype

Answer 87

Schedule 1st dose = 6 wks of age 2nd dose = 4 months of age 3rd dose = 6 months of age (only for RotaTeq) For both rotavirus vaccines - max age for 1st dose = 14 wks 6 days - min interval b/n doses = 4 wks - max age for any dose = 8 months 0 days

Answer 88

- vomiting = 15-18% - diarrhea = 9-24% - irritability = 13-62% - fever = 40-43% - serious adverse rxns = none

Answer 89

``` #infants vaccine recip Placebo recip RV1 63,255 7 cases 7 cases RV5 69,625 6 cases 5 cases ``` *RV1: 0-30 days after either dose RV5: 0-42 days after any dose

Answer 90

- Immunosuppression - Acute, moderate/severe gastroenteritis or other acute illness - hx of intussusception * decision to vaccinate (if precaution present) should be made on a case-by-case risk vs benefit basis

Answer 91

- caused by a virus - enters the body thru mouth - causes paralysis, meningitis and death 1916 Polio epidemic in US --> killed 6000 and paralyzed 27000 more early 50's > 25,000 cases of polio reported each year Polio vaccine was started in 1955 By 1960 # of reported cases dropped to about 3000 1979 there were only about 10 cases Today Polio eliminated from US, but still common in other parts of the world. It would only take one person coming from another country to bring the disease back here if we were not protected from the disease if the effort to eliminate the disease is successful --> then someday we might not need the polio vaccine until then we need to keep getting our kids vaccinated

Answer 92

kids get 4 doses of IPV at these ages - A dose at 6-8 weeks - A dose at 4 months - A dose at 6-18 months - Booster at 4-6 yrs

Answer 93

idea with combo vaccines is to cut down on # of injections some parents will state that they are only willing to have their child get x amount of vaccinations per visit and sometimes it is difficult to succeed at 100% recommended immunization combo shots allow for significantly fewer shots that what was previously required

Answer 94

- DTaP, DT, Tdap, Td - MMR - MMRV (ProQuad) - DTaP + Hep B + IPV (Pediarix) - Hep A + Hep B (Twinrix)-only approved > 18 yo - HIB + Hep B (Comvax)-can only be used as 4th dose

Answer 95

``` Birth = Hep B 6 wks = PCV, HIB, Prediarix 4 mths =PCV, HIB, Prediarix 6 mths =PCV, HIB, Prediarix 9mths = nothing 12 mths= PCV, HIB, ProQuad (MMRV), Hep A 15-18 mths = Hep A 4-6 yrs = DTaP, IPV, ProQuad (MMRV) ```

Answer 96

Pentavac: combo DTaP, IPV, HIB Hexavac: DTaP, IPV, HIB, Hep B (allow only Hexavac and PCV during infancy) DTaP, HIB, IPV, Hep A and Hep B

Answer 97

DTaP-Hep B-IPV combo minimum age = 6 wks approved for 3 doses (2, 4, 6 months) not approved for booster doses licensed for kids 6 wks - 7 years of age may be used interchangeably with other pertussis-containing vaccines if necessary -can be given at 2, 4, 6, months in infants who received a birth dose of Hep B vaccine (4 total doses) may be used in infants whose mothers are HBsAg-positive or status unknown

Answer 98

-combo Hep A vaccine (peds dose) and Hep B (adult dose) schedules -0, 1, 6 months or -0, 7, and booster at 12 months approved for persons 18 yrs of age and older