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Flashcards in Vaccine-Table 1 Deck (200):
1

What is immunity?

the ability of the human body to tolerate self and to eliminate foreign (“nonself”) material

2

What is the immune response?

a defense against the antigen
usually involves the production of protein molecules by B lymphocytes

3

What is active immunity?

Protection that is produced by the person’s own immune system. This type of immunity is usually permanent.

4

What is passive immunity?

Protection by products produced by an animal or human and transferred to another human, usually by injection.

5

When are antibodies transported across the placenta?

last 1-2 months of pregnancy

6

What can be given for post-exposure prophylaxis for Hep A and measles?

Homologous pooled human antibody (immune globulin)

7

What can be given for post-exposure prophylaxis for Hep B, rabies, tetanus, and varicella?

Homologous human hyperimmune globin

8

What can be used to tx botulism and diptheria?

Heterologous hyperimmune serum (antitoxin)

9

What are monoclonal antibodies produced from?

Single clone of B cells

10

What are monoclonal antibodies used for?

Diagnosing certain types of CA, tx of CA, prevention of transplant rejection, and tx of autoimmune dz

11

What monoclonal antibody is used for prevention of RSV?

Palivizumab

12

What are ways you can obtain active immunity?

Surviving infection and vaccination

13

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

14

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

15

What are inactivated vaccines composed of?

whole viruses or bacteria or fractions of either (protein based or polysaccharide based)

16

What are the protein based inactivated viruses?

Toxoids (inactivated bacterial toxin)
Subunit or subviron products

17

What are the polysaccharide based inactivated viruses composed of?

pure cell wall polysaccharide from bacteria

18

Why are severe rxns possible in live attenuated viruses?

uncontrolled replication in pts with immunodef

19

How are live attenuated viruses destroyed?

By heat and light

20

What are the viral live attenuated vaccines?

Measles, mumps, rubella, vaccinia (small pox), varicella zoster, yellow fever, rotavirus, intranasal influenza, oral polio

21

What are the bacterial live attenuated vaccines?

Oral typhoid vaccine

22

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

23

The immune response to inactivated vaccines is what?

Usually humoral

24

What are the viral whole cell vaccines?

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