Vaccine-Table 1 Flashcards
1
Q
What is immunity?
A
the ability of the human body to tolerate self and to eliminate foreign (“nonself”) material
2
Q
What is the immune response?
A
a defense against the antigen
usually involves the production of protein molecules by B lymphocytes
3
Q
What is active immunity?
A
Protection that is produced by the person’s own immune system. This type of immunity is usually permanent.
4
Q
What is passive immunity?
A
Protection by products produced by an animal or human and transferred to another human, usually by injection.
5
Q
When are antibodies transported across the placenta?
A
last 1-2 months of pregnancy
6
Q
What can be given for post-exposure prophylaxis for Hep A and measles?
A
Homologous pooled human antibody (immune globulin)
7
Q
What can be given for post-exposure prophylaxis for Hep B, rabies, tetanus, and varicella?
A
Homologous human hyperimmune globin
8
Q
What can be used to tx botulism and diptheria?
A
Heterologous hyperimmune serum (antitoxin)
9
Q
What are monoclonal antibodies produced from?
A
Single clone of B cells
10
Q
What are monoclonal antibodies used for?
A
Diagnosing certain types of CA, tx of CA, prevention of transplant rejection, and tx of autoimmune dz
11
Q
What monoclonal antibody is used for prevention of RSV?
A
Palivizumab
12
Q
What are ways you can obtain active immunity?
A
Surviving infection and vaccination
13
Q
What factors influence immune response to vaccination?
A
Presence of maternal antibody Nature and dose of antigen Route of administration Presence of adjuvant (aluminum-containing material) Host factors
14
Q
What are live attenuated vaccines produced from?
A
Produced by modifying a disease-producing (wild type) virus or bacterium
Resulting organism retains ability to grow and produce immunity but usually does not cause illness
15
Q
What are inactivated vaccines composed of?
A
whole viruses or bacteria or fractions of either (protein based or polysaccharide based)
16
Q
What are the protein based inactivated viruses?
A
Toxoids (inactivated bacterial toxin)
Subunit or subviron products
17
Q
What are the polysaccharide based inactivated viruses composed of?
A
pure cell wall polysaccharide from bacteria
18
Q
Why are severe rxns possible in live attenuated viruses?
A
uncontrolled replication in pts with immunodef
19
Q
How are live attenuated viruses destroyed?
A
By heat and light
20
Q
What are the viral live attenuated vaccines?
A
Measles, mumps, rubella, vaccinia (small pox), varicella zoster, yellow fever, rotavirus, intranasal influenza, oral polio
21
Q
What are the bacterial live attenuated vaccines?
A
Oral typhoid vaccine
22
Q
How many doses does an inactivated vaccine typically require?
A
3-5 doses
First dose primes immune system, immune response develops after 2nd or 3rd dose
23
Q
The immune response to inactivated vaccines is what?
A
Usually humoral
24
Q
What are the viral whole cell vaccines?
A
Polio, hepatitis A, rabies
25
What are the bacterial whole cell vaccines?
Typhoid, cholera, plague – Not available in US
26
Wbat are the fractional subunit inactivated vaccines?
Hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax
27
What are the fractional toxoid vaccines?
Diptheria, tetanus
28
What are the types of pure polysaccharide vaccines?
Pneumococcal
Meningococcal
Salmonella Typhi (Vi)
29
What are the types of conjugate polysaccharide ( Tcell dependent) vaccines?
×Haemophilis influenzae type B (Hib)
×Pneumococcal
×Meningococcal
30
When should vaccines not be administered?
Do not administer before the minimum age
Do not administer before the minimum interval between doses
Do not restart series
31
Does coadmin of vaccines overload the immune system?
no
32
If live vaccines are administered together, should they be separated?
Yes, by 4 weeks
33
what is the timing for administering inactivated vaccines and antibodies?
before, after, or at the same time as each other
34
Can oral vaccines be affected by circulating antibodies?
No, live influenza and rotavirus are not believed to be affected by antibodies
35
How long should you wait after a live vaccine before giving antibodies?
2 weeks- this is the incubation period
36
How long should you wait to give a live vaccine after distributing antibodies?
3 mo
37
Does increasing the interval btwn dosing of multi dose vaccines diminish the effectiveness?
Nope, but DECREASING may interfere with antibody response and protection
38
What are the local ADRs of vaccines?
Pain, swelling, redness at site of injection
Common with inactivated vaccines
Usually mild and self limiting
39
What are the systemic ADRs of vaccines?
Fever, malaise, headache- nonspecific
| These s/s May be unrelated to vaccine
40
How long after live vaccines do systemic ADRs tend to occur?
7-21 days after vaccine
41
What are CI to receiving live vaccines?
```
Malignancy, radiation, chemotherapy
Immunosuppressive therapy
>20mg/d of prednisone
TNF and non-TNF biologics (e.g. infliximab, rituximab)1
HIV adult patients with CD4
```
42
What are not actual CI to live vaccines?
Mild disease –low-grade fever, URI, otitis media, mild diarrhea
Antibiotic therapy
Breastfeeding
Premature birth
Pregnancy or immunosuppression in household
Warfarin
43
What are permanent CI to live vaccines- by permanent, they will never receive the vaccine for the rest of their life?
Severe allergic reaction to a vaccine component or following a prior dose (all vaccines)
Allergic reaction to eggs no influenza vaccine
Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccine
Severe combined immunodeficiency (rotavirus)
44
When should you take precaution when administering vaccines?
- mod to severe acute illness- delay all vaccine until illness has improved
- if pt recently received antibody containing blood products, hold odd on MMR and varicella
45
What are the guidelines for pregnancy and vaccinations?
1) live vaccines are a no
2) inactivated are ok when indicated
3) household contacts should be vaccinated
46
Does breastfedding extend or improve passive immunity to vaccine preventable dzs?
NO
47
All preterm infants born to hepatitis B surface antigen positive mothers and mothers with unknown HBsAg status must receive what within 12 hours after birth?
immunoprophylaxis with hepatitis B vaccine and Hepatitis B immunoglobulin (HBIG)
48
What causes the toxin-mediated dz diptheria?
Corynebacterium diphtheriae
| Aerobic gram positive bacillus
49
What is the medical management for diptheria?
Diphtheria antitoxin neutralizes circulating (unbound toxin) –available from CDC
Antibiotics- ERY or procaine PEN G
50
How can diptheria be prevented?
Close contacts of ill: diphtheria booster and antibiotics
51
How is the diptheria toxoid available?
Combo with tetanus- different adult and peds
| Or combined with tetanus and pertussis
52
What is the difference btwn DT and Td?
DT contains 3-4 times as much diphtheria toxoid, but same amounts of tetanus toxoid
53
At what age should pts receive DT vs Td?
7 years should receive adult Td
54
Do DTaP and Tdap contain thimerosal as a preservative?
NOPE
55
What produces toxins in tetanus?
Clostridium tetani
56
How should you manage wounds with concern of tetanus?
Uncertain history or 0-2 prior doses of tetanus toxoid should receive TIG as well as Td or Tdap
TIG provides temporary immunity
57
How is the tetanus vaccine given?
DT pediatric
| Td for children 7 years and up
58
How is pertussis tx?
Management- Primarily supportive
| Erythromycin drug of choice
59
What are the 2 adult acellular pertussis vaccines?
Boostrix and Adacel – these have reduced diptheria toxoid
60
What should Tdap be administered?
1) Single dose of Tdap vaccine for previously unvaccinated individuals ≥ 11years of age
2) Td booster q 10 yrs
3) Preggos need Tdap at 27-36 weeks in each preggo
61
What was the leading cause of bacterial meningitis before the vaccine was introduced?
Haemophilus influenzae type B
| Gram negative coccobacillus, generally aerobic but can grow as a facilitative anaerobe
62
How is bacterial meningitis managed?
Third generation cephalosporin X 10 days
63
What are the H B vaccines?
1) Two conjugate Hib vaccines are licensed for use in infants as young as 6 weeks (ActHIB-3 dose series and PedvaxHIB- 2 dose series)
2) One (Hiberix) approved only for the last dose of the schedule among children 12 months and older (booster regardless of which primary vaccine)
64
What type of vaccine is Hep A?
Inactivated whole virus vaccines (HAVRIX and VAQTA)
| both available in pediatric(up to 18)and adult formulations
65
Who should be vaccinated for Hep A?
International travelers, men who have sex with men, illegal drug users, clotting factor disorders, occupational risk (those who work with hep A infected primates or with Hep A virus in a lab setting), chronic liver disease
66
What are the Hep B vaccine options?
Recombivax HB and Engerix-B – adult and peds
Comvax (combination Hib and Hep B)-not used under 6weeks or for the first schedule either at birth or 1 mo
Pediarix- DTaP, Engerix-B, and inactivated polio, cant be used for birth dose of hepB
67
When can an infant born to a HBsAg-positive women be considered protected?
if HBsAg not present and anti-HBs antibody is present following at least 3 doses of a Hep B series
68
What does the polio vaccine contain?
Inactivated Polio vaccine 1 vaccine IPOL contains trace amounts of neomycin, streptomycin, and polymixin B
69
What is the issue with the oral poliovirus vaccine?
shed in stool for up to 6 weeks (transmission possible)
70
What live attenuated viruses are conservative free and contain a small amount of albumin, neomycin, sorbitol, and gelatin
Measles/mumps/rubella
71
What are the types of rotavirus?
1) RotaTeq a live oral vaccine (RV5) contains rotaviruses from human and bovine parent strains
2) Rotarix (RV1) one strain of live attenuated human rotavirus
72
What are the 2 types of HPV vaccines?
Gardasil- Quadrivalent HPV (HPV4)
| Cervarix- Bivalent HPV (HPV2) Contains type 16 and 18
73
What does gardisil protect against?
types 16 and 18 (high risk-cervical cancer) and types 6 and 11 (low risk-genital warts)
74
What is gardisil approved for use for?
Approved for use in females and males age 9-26 years
75
What does cervarix protect against?
Types 16/18
76
What is cervarix approved for?
use in females age 10-25
77
What is the leading cause of bacterial meningitis and sepsis in the US?
Neisseria meningitidis -Aerobic gram negative bacteria
78
How is Neisseria meningitidis managed?
Empiric broad spec abx after cultures obtained, then more narrow PCN
79
What are the 2 vaccines for Neisseria meningitidis ?
Menactra and Menveo for persons 2 through 55 years of age
80
What are the types of egg based influenza?
```
Live attenuated (LAIV)- pts 2-49
Inactivated (IIV)- standard dose IM>6mo
High dose IM >/=65
```
81
What are the non egg-based influenza vaccines?
```
Cell culture (ccIIV), some egg protein and for pts >/= 18
Recombinant (RIV), >/=18
```
82
What is in the trivalent activated influenza vaccine?
three inactivated viruses: type A (H1N1, type A (H3N2) and type B
83
What are options for admin of live attenuated influenza?
Nasal spray or IM
84
What is the only issue with nasal spray flu?
Vaccinated children can shed vaccine viruses in nasopharyngeal secretions for up to 3 weeks
85
Pts ages 2-8 should receive what types of influenza vaccine?
LAIV
86
Pts >6 mo should receive the flu vaccines how often?
Seasonally
87
Pts >/= 65 should receive what influenza vaccine?
high dose IIV
88
What organism causes pneumococcal?
Streptococcus pneumoniae: Gram positive bacteria
89
What are the pneumococcal vaccine options?
Pneumovax 23- polysaccharide vaccine (PPSV23)
| PCV13- pneumococcal conjugate vaccine
90
What is the PCV 13?
Conjugated to nontoxic diptheria toxin to improve immunologic response in children
91
Does PPSV23 have good response in children?
No, poor immune response
92
When are PCV13 and PPSV23 recommended?
In pts with meningitis risk- cochlear implants and CSF leaks
| Adults >/= 65 who have not received PCV13
93
What pts are recommended to get PCV13 and 2 doses of PPSV23?
Immunocompromised- CRF
94
When is the PPSV23 recommended?
Adults >/= 65 who already had the PCV13
| Adults with chronic conditions like DM, asthma, CVD, nursing home resident, liver dz, smoker
95
What causes varicella caused by?
varicella zoster virus
primary infection= chickenpox
recurrent infection= zoster
96
What type of vaccine is varicella?
Live attenuated vaccine
97
Who is eligible for the herpes zoster vaccine?
Pts >60
98
Who should receive varicella vaccine?
Pts without documented immunity
99
When is it not recommended to receive varicella vaccine?
Documentation of two doses of varicella vaccine at least 4 weeks apart
US-born before 1980 (except healthcare personnel and pregnant women)
History of chickenpox or shingles based on diagnosis or verification by a healthcare provider
Laboratory evidence of immunity or confirmation of disease
100
Does concurrent admin of zoster and PPSV23 effect vaccine efficacy?
nope
101
What is immunity?
the ability of the human body to tolerate self and to eliminate foreign (“nonself”) material
102
What is the immune response?
a defense against the antigen
| usually involves the production of protein molecules by B lymphocytes
103
What is active immunity?
Protection that is produced by the person’s own immune system. This type of immunity is usually permanent.
104
What is passive immunity?
Protection by products produced by an animal or human and transferred to another human, usually by injection.
105
When are antibodies transported across the placenta?
last 1-2 months of pregnancy
106
What can be given for post-exposure prophylaxis for Hep A and measles?
Homologous pooled human antibody (immune globulin)
107
What can be given for post-exposure prophylaxis for Hep B, rabies, tetanus, and varicella?
Homologous human hyperimmune globin
108
What can be used to tx botulism and diptheria?
Heterologous hyperimmune serum (antitoxin)
109
What are monoclonal antibodies produced from?
Single clone of B cells
110
What are monoclonal antibodies used for?
Diagnosing certain types of CA, tx of CA, prevention of transplant rejection, and tx of autoimmune dz
111
What monoclonal antibody is used for prevention of RSV?
Palivizumab
112
What are ways you can obtain active immunity?
Surviving infection and vaccination
113
What factors influence immune response to vaccination?
```
Presence of maternal antibody
Nature and dose of antigen
Route of administration
Presence of adjuvant (aluminum-containing material)
Host factors
```
114
What are live attenuated vaccines produced from?
Produced by modifying a disease-producing (wild type) virus or bacterium
Resulting organism retains ability to grow and produce immunity but usually does not cause illness
115
What are inactivated vaccines composed of?
whole viruses or bacteria or fractions of either (protein based or polysaccharide based)
116
What are the protein based inactivated viruses?
Toxoids (inactivated bacterial toxin)
| Subunit or subviron products
117
What are the polysaccharide based inactivated viruses composed of?
pure cell wall polysaccharide from bacteria
118
Why are severe rxns possible in live attenuated viruses?
uncontrolled replication in pts with immunodef
119
How are live attenuated viruses destroyed?
By heat and light
120
What are the viral live attenuated vaccines?
Measles, mumps, rubella, vaccinia (small pox), varicella zoster, yellow fever, rotavirus, intranasal influenza, oral polio
121
What are the bacterial live attenuated vaccines?
Oral typhoid vaccine
122
How many doses does an inactivated vaccine typically require?
3-5 doses
| First dose primes immune system, immune response develops after 2nd or 3rd dose
123
The immune response to inactivated vaccines is what?
Usually humoral
124
What are the viral whole cell vaccines?
Polio, hepatitis A, rabies
125
What are the bacterial whole cell vaccines?
Typhoid, cholera, plague – Not available in US
126
Wbat are the fractional subunit inactivated vaccines?
Hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax
127
What are the fractional toxoid vaccines?
Diptheria, tetanus
128
What are the types of pure polysaccharide vaccines?
Pneumococcal
Meningococcal
Salmonella Typhi (Vi)
129
What are the types of conjugate polysaccharide ( Tcell dependent) vaccines?
×Haemophilis influenzae type B (Hib)
×Pneumococcal
×Meningococcal
130
When should vaccines not be administered?
Do not administer before the minimum age
Do not administer before the minimum interval between doses
Do not restart series
131
Does coadmin of vaccines overload the immune system?
no
132
If live vaccines are administered together, should they be separated?
Yes, by 4 weeks
133
what is the timing for administering inactivated vaccines and antibodies?
before, after, or at the same time as each other
134
Can oral vaccines be affected by circulating antibodies?
No, live influenza and rotavirus are not believed to be affected by antibodies
135
How long should you wait after a live vaccine before giving antibodies?
2 weeks- this is the incubation period
136
How long should you wait to give a live vaccine after distributing antibodies?
3 mo
137
Does increasing the interval btwn dosing of multi dose vaccines diminish the effectiveness?
Nope, but DECREASING may interfere with antibody response and protection
138
What are the local ADRs of vaccines?
Pain, swelling, redness at site of injection
Common with inactivated vaccines
Usually mild and self limiting
139
What are the systemic ADRs of vaccines?
Fever, malaise, headache- nonspecific
| These s/s May be unrelated to vaccine
140
How long after live vaccines do systemic ADRs tend to occur?
7-21 days after vaccine
141
What are CI to receiving live vaccines?
```
Malignancy, radiation, chemotherapy
Immunosuppressive therapy
>20mg/d of prednisone
TNF and non-TNF biologics (e.g. infliximab, rituximab)1
HIV adult patients with CD4
```
142
What are not actual CI to live vaccines?
Mild disease –low-grade fever, URI, otitis media, mild diarrhea
Antibiotic therapy
Breastfeeding
Premature birth
Pregnancy or immunosuppression in household
Warfarin
143
What are permanent CI to live vaccines- by permanent, they will never receive the vaccine for the rest of their life?
Severe allergic reaction to a vaccine component or following a prior dose (all vaccines)
Allergic reaction to eggs no influenza vaccine
Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccine
Severe combined immunodeficiency (rotavirus)
144
When should you take precaution when administering vaccines?
- mod to severe acute illness- delay all vaccine until illness has improved
- if pt recently received antibody containing blood products, hold odd on MMR and varicella
145
What are the guidelines for pregnancy and vaccinations?
1) live vaccines are a no
2) inactivated are ok when indicated
3) household contacts should be vaccinated
146
Does breastfedding extend or improve passive immunity to vaccine preventable dzs?
NO
147
All preterm infants born to hepatitis B surface antigen positive mothers and mothers with unknown HBsAg status must receive what within 12 hours after birth?
immunoprophylaxis with hepatitis B vaccine and Hepatitis B immunoglobulin (HBIG)
148
What causes the toxin-mediated dz diptheria?
Corynebacterium diphtheriae
| Aerobic gram positive bacillus
149
What is the medical management for diptheria?
Diphtheria antitoxin neutralizes circulating (unbound toxin) –available from CDC
Antibiotics- ERY or procaine PEN G
150
How can diptheria be prevented?
Close contacts of ill: diphtheria booster and antibiotics
151
How is the diptheria toxoid available?
Combo with tetanus- different adult and peds
| Or combined with tetanus and pertussis
152
What is the difference btwn DT and Td?
DT contains 3-4 times as much diphtheria toxoid, but same amounts of tetanus toxoid
153
At what age should pts receive DT vs Td?
7 years should receive adult Td
154
Do DTaP and Tdap contain thimerosal as a preservative?
NOPE
155
What produces toxins in tetanus?
Clostridium tetani
156
How should you manage wounds with concern of tetanus?
Uncertain history or 0-2 prior doses of tetanus toxoid should receive TIG as well as Td or Tdap
TIG provides temporary immunity
157
How is the tetanus vaccine given?
DT pediatric
| Td for children 7 years and up
158
How is pertussis tx?
Management- Primarily supportive
| Erythromycin drug of choice
159
What are the 2 adult acellular pertussis vaccines?
Boostrix and Adacel – these have reduced diptheria toxoid
160
What should Tdap be administered?
1) Single dose of Tdap vaccine for previously unvaccinated individuals ≥ 11years of age
2) Td booster q 10 yrs
3) Preggos need Tdap at 27-36 weeks in each preggo
161
What was the leading cause of bacterial meningitis before the vaccine was introduced?
Haemophilus influenzae type B
| Gram negative coccobacillus, generally aerobic but can grow as a facilitative anaerobe
162
How is bacterial meningitis managed?
Third generation cephalosporin X 10 days
163
What are the H B vaccines?
1) Two conjugate Hib vaccines are licensed for use in infants as young as 6 weeks (ActHIB-3 dose series and PedvaxHIB- 2 dose series)
2) One (Hiberix) approved only for the last dose of the schedule among children 12 months and older (booster regardless of which primary vaccine)
164
What type of vaccine is Hep A?
Inactivated whole virus vaccines (HAVRIX and VAQTA)
| both available in pediatric(up to 18)and adult formulations
165
Who should be vaccinated for Hep A?
International travelers, men who have sex with men, illegal drug users, clotting factor disorders, occupational risk (those who work with hep A infected primates or with Hep A virus in a lab setting), chronic liver disease
166
What are the Hep B vaccine options?
Recombivax HB and Engerix-B – adult and peds
Comvax (combination Hib and Hep B)-not used under 6weeks or for the first schedule either at birth or 1 mo
Pediarix- DTaP, Engerix-B, and inactivated polio, cant be used for birth dose of hepB
167
When can an infant born to a HBsAg-positive women be considered protected?
if HBsAg not present and anti-HBs antibody is present following at least 3 doses of a Hep B series
168
What does the polio vaccine contain?
Inactivated Polio vaccine 1 vaccine IPOL contains trace amounts of neomycin, streptomycin, and polymixin B
169
What is the issue with the oral poliovirus vaccine?
shed in stool for up to 6 weeks (transmission possible)
170
What live attenuated viruses are conservative free and contain a small amount of albumin, neomycin, sorbitol, and gelatin
Measles/mumps/rubella
171
What are the types of rotavirus?
1) RotaTeq a live oral vaccine (RV5) contains rotaviruses from human and bovine parent strains
2) Rotarix (RV1) one strain of live attenuated human rotavirus
172
What are the 2 types of HPV vaccines?
Gardasil- Quadrivalent HPV (HPV4)
| Cervarix- Bivalent HPV (HPV2) Contains type 16 and 18
173
What does gardisil protect against?
types 16 and 18 (high risk-cervical cancer) and types 6 and 11 (low risk-genital warts)
174
What is gardisil approved for use for?
Approved for use in females and males age 9-26 years
175
What does cervarix protect against?
Types 16/18
176
What is cervarix approved for?
use in females age 10-25
177
What is the leading cause of bacterial meningitis and sepsis in the US?
Neisseria meningitidis -Aerobic gram negative bacteria
178
How is Neisseria meningitidis managed?
Empiric broad spec abx after cultures obtained, then more narrow PCN
179
What are the 2 vaccines for Neisseria meningitidis ?
Menactra and Menveo for persons 2 through 55 years of age
180
What are the types of egg based influenza?
```
Live attenuated (LAIV)- pts 2-49
Inactivated (IIV)- standard dose IM>6mo
High dose IM >/=65
```
181
What are the non egg-based influenza vaccines?
```
Cell culture (ccIIV), some egg protein and for pts >/= 18
Recombinant (RIV), >/=18
```
182
What is in the trivalent activated influenza vaccine?
three inactivated viruses: type A (H1N1, type A (H3N2) and type B
183
What are options for admin of live attenuated influenza?
Nasal spray or IM
184
What is the only issue with nasal spray flu?
Vaccinated children can shed vaccine viruses in nasopharyngeal secretions for up to 3 weeks
185
Pts ages 2-8 should receive what types of influenza vaccine?
LAIV
186
Pts >6 mo should receive the flu vaccines how often?
Seasonally
187
Pts >/= 65 should receive what influenza vaccine?
high dose IIV
188
What organism causes pneumococcal?
Streptococcus pneumoniae: Gram positive bacteria
189
What are the pneumococcal vaccine options?
Pneumovax 23- polysaccharide vaccine (PPSV23)
| PCV13- pneumococcal conjugate vaccine
190
What is the PCV 13?
Conjugated to nontoxic diptheria toxin to improve immunologic response in children
191
Does PPSV23 have good response in children?
No, poor immune response
192
When are PCV13 and PPSV23 recommended?
In pts with meningitis risk- cochlear implants and CSF leaks
| Adults >/= 65 who have not received PCV13
193
What pts are recommended to get PCV13 and 2 doses of PPSV23?
Immunocompromised- CRF
194
When is the PPSV23 recommended?
Adults >/= 65 who already had the PCV13
| Adults with chronic conditions like DM, asthma, CVD, nursing home resident, liver dz, smoker
195
What causes varicella caused by?
varicella zoster virus
primary infection= chickenpox
recurrent infection= zoster
196
What type of vaccine is varicella?
Live attenuated vaccine
197
Who is eligible for the herpes zoster vaccine?
Pts >60
198
Who should receive varicella vaccine?
Pts without documented immunity
199
When is it not recommended to receive varicella vaccine?
Documentation of two doses of varicella vaccine at least 4 weeks apart
US-born before 1980 (except healthcare personnel and pregnant women)
History of chickenpox or shingles based on diagnosis or verification by a healthcare provider
Laboratory evidence of immunity or confirmation of disease
200
Does concurrent admin of zoster and PPSV23 effect vaccine efficacy?
nope
