Vaccines Flashcards
(51 cards)
1
Q
Live- attenuated vaccine
A
- used a weakened form of the actual pathogen
- replicates after administration to produce and immune response
- higher ADR rates but longer lasting immunity
- effectiveness can be damaged with heat or light
2
Q
Inactivated vaccines
A
- whole bacteria or virus or a component of it
- either protein based or polysaccharide based
- protein based more effective at activation T-cells
- polysaccharide may be cojugated to a protein to increase the effectiveness
3
Q
Recombinant vaccines
A
- consist of genetically engineered antigens , which are typically inactivated but can be live- attenuated
4
Q
Vaccine risks
A
- all vaccines have a small degree fo risk
- often smaller than the risk of serious complications of disease
- all serious reactions must be reported DHHS
5
Q
Proper vaccine storage
A
- if not stored correctly can make subponent vaccine
- must be a stand alone refrigerator not dorm style
- must keep them on shelves not in the door of fridge
- use thermometer to track correct temps
- consider back-up generator for power outage
6
Q
Live vaccine dosages in 24 hours
A
- 2 live vaccines can be given in the same day
- teens may have vasovagal response to vaccines so watch for 15 minutes after
- if patient decided o have 2 non-oral vaccines on different days , space them 4 weeks apart to avoid interference with immune system
7
Q
MMR vaccine
A
- live viral attenuated vaccine
- components not available in monovalent form in the US
- those who received monovalent in the past should f/u with 1 dose of MMR
- In most adults 1 dose is sufficient for immunity
- 2nd dose recommendations: HCW, those who work in secondary schools, or during a community outbreak
8
Q
MMR vaccine contraindications
A
- pregnant women
- immunosupressed
- lymphoproliferative malignancies and pharmacueticals (cytotoxic chemotherapy and steroids)
- HIV infected patients- consider giving if no evidence of immunudeficency ( T cell count <200 cells)
- history of anaphylaxsis to neomyocin or gelatin
9
Q
VZV vaccine
A
- varivax, live-attenuated vaccine
- 2 doses 4 weeks apart for non-immune adults
- non-immune pregnant women should receive the first dose postpartum before hospital discharge
10
Q
VZV vaccine- who to target and why
A
- susceptible adults: those who develop primary varicella are at greater risk for complications than children
- those working in close contact with those at risk for severe disease: HCW, family contacts of immunosupressed
- those at high risk of being exposed or transmitting varicella: College students, teachers, childcare workers, international travelers, military
11
Q
VZV vaccine- contraindications
A
- same as MMR
- pregnancy, immucompromised, lymphprolifereative malignancy, HIV
12
Q
VZV- adverse reactions
A
- local injection site reaction
- fever and injection site varicella like rash
- spread of the vaccine induced varicella lesions is very rare but has been reported
13
Q
Shingrix
A
- has completely replace Zostavax (live attenuated)
- recombinant vaccine that contains surface VZV glycoprotein E antigen, that has a liposomal adjuvant to enhance immune response
- 2- 0.5mL dosages IM 2-6 months apart
- duration of protective immunity is unknown
- can be given at the same time as pneumococcal, influenza, Tdap; but different injection site should be used
14
Q
Shingrix- who to target and why
A
- healthy adults > 50 years including those that recived Zostavax ( no waiting time period between these 2 vaccines has been set , likely 8 weeks)
- wait until herpes zoster systems have resolved to give vaccine
- shingirx preffered over zostavax
- can be given in low level immunisupression
- may be safe in high level immunosupression, but wait for CDC guidance
15
Q
Shingrix- adverse reactions
A
- myalgia, fatigue, headache , shivering, fever, GI symptoms
- injection site pain (78%) , redness, and swelling : 17% reported reduced usage of arm for 2 days
- long term safety data on Shingrix is lacking
- reactions not as bad with 2nd dose
16
Q
Shingrix- contraindications
A
- allergy to Shingrix or any of its components
- not contraindicated in immunosupressed ( being studied)
17
Q
Hepatitis A vaccine
A
- inactivated viral vaccine
- 2 forms that are interchangeable and equally immunogenic
- live viral exist but limited use in US
- epidemic in west/southwestern states and Alaska
- now part of routine pediatric immunization
- 2-3 doses (all equally effective)
- Harvix and VAQTA ( 2 does), TWINRIX (3 doses)
- booster doses not recommended for immunocompromised
18
Q
Hepatitis A recommendations for use
A
- Medical risk of HAV infection ( clotting factor disorder, chronic liver disease)
- occupational risk of HAV infection ( lab setting)
- Behavioral risk of HAV infection ( injection drug users and MSM)
- close contacts of adopted children from countries with high risk of HAV
- Susceptible travelers- Japan, Canada, Australia, western Europe
- All homeless populations
19
Q
Hepatitis A adverse reactions
A
- local injection site rxns
- malaise, low grade fever or fatigue
20
Q
Pneumovax 23- overview
A
- purified capsular polysaccharide antigen from 23 serotypes of S. pneumoniae
- serotypes in vaccine account for 85-95% of strains that cause invasive pneumococcal disease
- studies suggest polysaccharide vaccine can decrease incidence of IPD but not decrease mortality
- does not create a T-cell response that is vital for the development of immune cell memory
21
Q
Prevnar 13 - overview
A
- pneumococcal conjugate vaccine
- 13 pneumococcal serotypes conjugated to a protein–> increases immunogenicity
- includes 2/3 of serotypes that cause disease in kids <5 years and 1/2 that cause disease in immunocompromised adults
- does create a T-cell response
22
Q
Pneumovax- dose specifics
A
- Pt who receives dosage at < 65 years should receive another dose at 65 years
- All adults> 65 years
- All adults <65 and those with asthma and who smoke
- Pt at any age with chronic illness that puts them at risk for IPD (DM, heart disease, lung disease, liver disease, kidney disease, asplenia, those in long term care facilities)
- 2nd dose may be given after 5 years to any of those w/ immunocompromised disease regardless of age
23
Q
Prevnar dose specifics
A
- 1 time dose of prevnar approved for adults > 50 years
- ACIP has approved for those > 19 years with immunocompromising condition (less exhaustive list then PV23: HIV, hematological malignancies, functional or antomic asplenia, CSF leaks, or cochlear implants)
24
Q
Prevnar and Pneumovax used together
A
- all patients > 65 years and immunocompromised patients
- PCV13 should be given first , followed 8 weeks later by PCV 23
- If PCV 23 given first wait > 1 year to give PCV 13 because it can decrease effectiveness
- important to use together PCV 13 covers 1 strain not covered in PCV 23 and PCV 23 covers 11 strains not covered in PCV 11
- medicare part B pays for bothemedications
25
Prevnar and Pneumovax - adverse reactions/ contraindications
- injection site reactions
| - contraindication: hypersensitivity to pneumococcal vaccine or any of its components including diptheria toxoid
26
Menactra or Menveo vaccine
- 2 quadralvalent vaccines available against Nisseria meningitidis ( serogroups A,Y, W135)
- previous Menoimmune polysaccharide vaccine did not work as well
27
Menveo and Menactra - routine schedule
- 1-2 doses reccomended- sequence depends on age ( lasts 5 years)
- 1st dose at 11-12 years, and booster at 16 years
- if 1st dose > 16 years then just 1 dose
- routine risk of vaccination in those >21 years at increased risk not recommended
28
Those at risk for Nisseria Meningitidis
- 1st year college students, military , HIV infection or functional asplenia or terminal C deficiencies (revaccinated every 5 years)
29
Trumeba and Boxcero
- vaccines for N. Meningitidis serotype B
- not interchangeable
- Turmeba ( 2 dose series 1 month apart), Boxcero ( 2 dose series 2 months apart)
- same vaccine must be used for all doses
30
Truemeba and Boxcero doase recommendations
- persistent complement deficiency
- anatomic or functional asplenia
- persons at increased risk ( when there is a serotype B outbreak )
- consider for all 16-23 years
31
N. Meningitidis vaccines adverse side affects
- injection site rxn, headache fatigue, malaise
| - Gulliane Barre -rare and cause and effect not validated
32
N. Meningiditis contraindications
- hypersensitivity to other menningiococcal carrying vaccines or diptheria toxin or CMR197 (carrier protein for diptheria toxin)
33
Tdap vaccine
- inactivated tetanus and diphtheria toxoid, with acellular pertussis ( Adacel and Boostrix, approve for >19 years)
- make sure person has had Tdap as Td has been booster for years
- DTaP is not the same thing that is the pediatric version, larger doses of antigen
34
DTaP schedule
- 2, 4, 6, 15-18 months, then again at 4-6 years (5 doses)
35
Tdap dose recommendations
- adolescents: single booster at 11-18 years
- childhood series completed and history of Td: single dose of Tdap 10 years after last Td
- HCW or those around infants can get Tdap anytime to protect child from pertussis
- pregnant patient: vaccinate with each pregnancy (3rd trimester) allow maternal antibodies to be given to baby , helps newborn before first DTaP
- if mother vaccination history unknown- give 3 shot series now, 4 weeks, 6-12 months ( Tdap for first vaccine after 20 weeks, and Td for other 2)
36
Tdap adverse reactions
- injection site reactions (ertythema, induration, pain, puritus), Tdap > Td
- Arthus type reaction with pain and swelling with hx of
repeated vaccination
37
Tdap- precautions/ contraindication
- Hypersensitivity to tetanus, diphtheria, pertussis, or component of formulation
- h/o any of the following with previous pertussis vaccine: progressive neurological disorder, infantile spasm, uncontrolled epilepsy, encephalopathy occurring within 7 days and no other cause ( more common with whole cell vaccine)
38
Hep B vaccine
- Hep B surface antigen (HBsAg) made in baker' s yeast using recombinant DNA technology mixed with adjuvant
- inactivated vaccines include: Recombivax Hb, Engerix-B, Heplisav-B, and Twinrix ( with Hep A)
- all equally effective use the same one to complete series
39
Hep B vaccine recommended populations
- All adults with medical risk of HBV infection: hemodialysis, chronic liver dx, Pt < 60 years with DM
- occupational risk: HCW, lab, public safety
- PWID , MSM
- universal vaccination of infants has been universal since 1991
40
Hep B recommended dosage
- generally 3 doses
- interrupted does not need to be restarted
- Booster not recommended for immunocompromised adults
41
Influenza vaccine
- efficacy varies depending on the year and circulating strains, even poor vaccine match has been shown to reduce hospitalization and death
- available in 3 forms: inactivated IM, inactivated ID (Fluzone intradermal), live attenuated intranasal (Flumist)
- 2 non-egg vaccines available ( no egg allergy concerns, able to be made more quickly)
42
Flu vaccine - dosing
- initial vaccination 2 doses, 4 weeks apart
- subsequent yearly vaccines thereafter
- recommended for everyone > 6 months
- protect pregnant women and reduces illness in newborn up to 6 months
43
Flu vaccine - recommendations for use
- Inactivated ID better for adults takes advantage of APCs present in the dermis
- Live attenuated: felt to be better for those > 2 years, just came back for 2018/2019 season
- optimal time for vaccination mid-October/ November based on Ab production and protection 6-8 months
44
Flu vaccination recommendations for routes of administration
- inactivated vaccine: most data for all populations
- live-attenuated: Previously recommended for healthy non-pregnant people 2-49 years; previously recommended for immunosupressed, people with asthma, lung dz, kidney dz, metabolic disorders
45
Flu vaccine - adverse reactions
- IM: soreness at injection sight other ADRs rare, Gulliane Barre syndrome
- ID: local skin rxn (edema)
- Live attenuated: generally well tolerated, rhinnorhea, nasal congestion, sore throat, wheezing ( kids less than 5 and those with asthma)
- DO NOT CAUSE THE FLU, may cause cytokine release that makes you feel sick
46
Influenza vaccine precautions
- those receiving live attenuated vaccine should avoid contact w/ immunosupressed for 7 days for theoretical risk of spread
- should not receive hx of GBS
- vaccines are grown in eggs, but non-egg vaccines available
47
HPV vaccine
- first anti-cancer vaccine
- Gardasil original - recombinant quadrivalent (HPV 6, 11, and 16,18)
- now Gardasil 9 is standard , 5 more serotypes included
48
HPV vaccine recommended dosage
- should be given before time of first sexual activity
- Gardasil was approved for 9- 26 years
- Gardasil 9 now approved up to 45 years
- those exposed who have been exposed to HPV should still be vaccinated b/c they may not have been exposed to all serotypes
- 2-3 doses
- If 2 doses give 6 months apart
- 3 doses 0, 2 and 6 months
- can be started at 11-12 years of age
49
HPV precautions
- not a substitute for regular cervical cancer screenings
- no link between autoimmune destruction of the ovaries, VTE, or neurological disease
- do not give to anyone with hypersensitivity to the vaccine or any of its components ( yeast)
50
HPV: adverse reactions
- injection site rxns
| - fainting
51
HIB vaccine
- most adults do not require recombinant vaccine
- FDA approved only for use in children
- adults with chronic medical conditions at increased risk for HIB infection , but efficacy of vaccination unknown
