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Vaccines Flashcards

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1
Q

rotavirus age restrictions?

A

first dose minimum 6 weeks and max 14+6; min time between vaccines is 4 weeks; max age for final dose is 8 mo +0

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2
Q

vaccines contraindicated in pregnancy?

A

live flu, MMR, varicella

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3
Q

conditions when live vaccines are contraindicated?

A

pregnancy, immunocompromised status (not HIV), HIV with CD4 <15% or <200

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4
Q

conditions with contraindications for live flu vaccine?

A

pregnancy, immunocompromised, heart disease, asthma 2-4 yo, CSF leaks, cochlear implants, asplenia, complement deficiency, live vaccine in past 4 weeks, on salicylates, h/o GBS, egg protein anaphylaxis, current antiviral treatment

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5
Q

subcutaneous vaccines?

A

MMR, V, MMRV

IPV & PPSV23 (IM or subcut)

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6
Q

Subcutaneous or IM vaccines?

A

IPV, PPSV23

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7
Q

Live attenuated vaccines?

A

MMR, V, MMRV, Rota, LAIV, oral typhoid, yellow fever

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8
Q

how to administer IM vaccine?

A

22 to 25 gauge needle; 1.25” for teens, 1.5” for adults; thigh for infants

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9
Q

how to administer subcut vaccines?

A

25-30 gauge needle; 5/8”

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10
Q

IPV is concerning if which anaphylactic allergies?

A

streptomycin, neomycin, polymyxin B

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11
Q

anaphylaxis to neomycin is a problem with which vaccines?

A

MMR, V, some DTaP, HepA, flu, rabies

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12
Q

anaphylaxis to gelatin is a problem with which vaccines?

A

MMR, V, MMRV, yellow fever, flu, rabies, oral typhoid

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13
Q

how long to wait after MMR vaccine to give PPD? why?

A

measles vax can suppress PPD reactivity; wait 4-6 weeks

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14
Q

when do pregnant women get Tdap?

A

every pregnancy, 27-36 weeks

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15
Q

any restrictions on vaccines in BF?

A

no

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16
Q

when do vaccine series need to be restarted if interrupted?

A

never

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17
Q

what anaphylactic allergy makes HepB c/i’d?

A

bakers yeast

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18
Q

if mom is HBsAg + or unknown, what does the baby need? what if baby is <2 kg?

A

HepB vaccine within 12 HOL, HBIG within 12 HOL or ASAP; if BW <2 kg, first vaccine doesn’t count toward series

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19
Q

for babies born to HBsAg + or unknown mom, when do you test the baby for hepB? what do you order? what if non-immune?

A

around 9-12 mo once vax series completed, or 1-2 mo after; test for HBsAg and anti-HBs; if non-immune, repeat the 3 doses

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20
Q

rules for 3rd hepB vaccine? when do you give 4th dose?

A

4 months or more after 1st dose, 2 mo or more after 2nd dose, older than 6 mo; give 4th dose if got birth dose

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21
Q

differences between the 2 rotavirus vaccines?

A

Rotarix is RV1, has latex in applicator, given at 2 and 4 mo; Rotateq is RV5, no latex, given at 2/4/6 mo

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22
Q

which vaccine do you avoid in spina bifida and latex anaphylaxis patients?

A

rotarix

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23
Q

when is rotavirus contraindicated (separate from other live vaccine contraindications)?

A

SCID and h/o intussusception

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24
Q

when do you give hepA vaccines?

A

first dose 12-23 mo, 2nd dose 6 mo later

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25
what hepA post-exposure prophyalxis is available? when do you give it?
use the vaccine if household exposure and 12 mo or older; use IMIG for passive protection if <1 yo
26
what is the normal schedule for DTaP?
5 doses before 7 yo - 2/4/6/15-18 mo, then 4-6 yo; need at least 6 mo between doses 3-4 and 4-5
27
when do you normally give Tdap? when else can you give it?
once 11-12 yo is normal; if incomplete course of DTaP and over 7 yo, give x1 Tdap - if this happens, don't give the normal one, just give a Td 10 years later; also give Tdap to all pregnant females with each pregnancy
28
what vaccines do you give if pt has c/i to pertussis?
1-6 yo give DT x2, 2 mo apart, then 3rd dose 6-12 mo later, and 4th dose at 4-6 yo (unless #3 was after 4 yo); use Td if 7 yo or older
29
does having the pertussis infection change the vaccine schedule?
nope
30
absolute contraindications for DTap or Tdap?
h/o encephalopathy within 7 days of previously given vaccine (no evidence), anaphylaxis, h/o progressive neuro disease that is not stable
31
rare adverse events of DTaP or Tdap?
fever >40.5 within 48 hr, shock within 48 hr, limb swelling after dose 4-5, seizure within 3 days, crying for over 3 hr within 48 hr
32
precautions for DTap or Tdap?
GBS within 6 weeks after a previous vaccine
33
what do you do for tetanus in a clean wound and pt has not had 3 doses yet or you don't know?
give the vaccine
34
what do you do for tetanus in a clean wound and pt has already had 3 or more doses?
give vaccine only if it has been 10 years or more since last dose
35
what do you do for tetanus in a dirty wound and pt has not had 3 doses?
give the vaccine and TIG
36
what do you do for tetanus in a dirty wound and pt has had 3 or more doses?
give the vaccine only if it has been 5 years or more since the last dose
37
when do you normally give the pneumococcal vaccine?
2/4/6/12-15 mo
38
if healthy child <5 yo who is unvaccinated, what pneumococcal vaccine do you give?
give 1 PCV13
39
if incomplete series in unhealthy child aged 2-6 yo, what pneumococcal vaccine do you give?
Give x2 PCV13, 8 weeks apart; if already had 3 doses, give the 4th one
40
if in high risk group and finished pneumococcal series, what else do you give them? when?
PPSV23 at 2 yo, at least 8 weeks after last PCV13; give 2nd dose 5 years later if immunocompromised
41
if in high risk group and aged 6-18 yo and unvaccinated, what do you give for pneumococcal?
PCV13 x1 if never given before
42
when do you normally give IPV?
2/4/6 mo and 4-6 yo
43
when do you give additional IPV dose?
travel and >12 mo since last dose, or endemic area for at least 4 weeks
44
which strains are contained in the MCV4 vaccine?
A, C, Y, W-135
45
when do you normally give MCV4?
single dose at 11-12 yo with booster at 16-18 yo, 1 dose to college freshmen
46
when do you give MenB?
high risk group (asplenia, sickle, complement deficiency) and >10 yo - need series of 2 (0 and 1 mo) or 3 (0, 1-2, 6 mo); teens age 16-23 yo if desired in 2 dose series at least 1 mo apart
47
for high risk children, what meningococcal vaccine schedule do you give?
MCV4 or Hib-MenCY-TT at 2/4/6/12 mo; need 2 doses if start later; if using MCV4, 2nd dose is at least 12 weeks after first and >12 mo; if MenHibrix then 2nd dose is at least 8 weeks after first
48
who is considered high risk for meningococcal?
asplenia, community outbreak, complement deficiency, high risk travel, dormitory living
49
what meningococcal vaccine schedule do you give in complement deficiency?
MCV4 x2, at least 12 weeks apart, between 9-23 mo; if older, give 2 doses at least 8 weeks apart
50
what meningococcal vaccine schedule do you give in HIV/asplenia?
MCV x2, at least 8 weeks apart, after 2 yo, and at least 4 weeks after PCV13
51
what are the MMR vaccine components made from?
M&M from chick embryos (minimal x-reactivity with egg protein so not c/i'd); R from human diploid cell culture
52
common adverse effects of MMR vaccine? rare?
fever to 39.4C, rash 6-12 days after, joint pain in teens from rubella at 1-3 weeks; rare = thrombocytopenia
53
time frame after MMR vaccine to wait to give Ig if needed?
at least 2 weeks - alters serologic reaction
54
what c/s dose prompts change in MMR & V vaccine administration? what's the change?
high dose oral c/s (2 mg/kg/day or more) or over 14 days = delay until 1 mo after course completion
55
when is the time frame for increased risk of febrile sz after first dose of MMRV? what age group?
12-23 mo, at 5-12 days after vaccine
56
when is it preferred to give MMRV as the first MMR / V dose?
at least 4 yo
57
when is MMR normally given?
first dose at 12-15 mo, second at 4-6 yo
58
if give MMR before 12 mo, what do you do with the normal course?
same thing; doesn't count toward normal series; must be separated by at least 28 days
59
when is varicella normally given?
first dose at 12-15 mo, second dose at 4-6 yo
60
if MMR and V not given at the same visit, how much later must they be separated by?
at least 28 days
61
common reactions to varicella vaccine? what recommendations do you give this pt?
localized rash in <3%, generalized in 3-5%; usually 5-26 days later, maculopapular (not vesicular); avoid contact with immunocompromised until rash resolves
62
reaction in pt that is exposed to varicella but has been vaccinated? what recommendations do you give this pt?
mild rash (MP>vesicular), <50 lesions; exclude until no new lesions and lesions are crusted over
63
if exposed to varicella and susceptible, what do you do? - 1) for high risk, 2) for 12 mo or older and healthy, 3) for i/c'd and within 10 days of exposure, and 4) for i/c'd and over 10 days since exposure
1) give vaccine within 3-5 days, 2) vaccine within 5 days, 3) IM VZIG, 4) IVIG
64
when do you not give varicella vaccine as post-exposure ppx?
pt has received 2 vaccines, pt has lab evidence of immunity, or pt has h/o zoster recorded
65
at what age dose the minimum time between varicella doses change? what's the change?
under 13 yo, need 3 mo between doses, 13 yo or more needs at least 28 days
66
how is Hib vaccine made?
Hib capsular polysac conjugated to protein carrier
67
when is Hib vaccine normally given?
2 mo, 4 mo, +/- 6 mo depending on which vaccine was used, + booster at 12-15 mo
68
what do you do for Hib with 1) 15-60 mo unvaccinated, 2) >5 yo unvaccinated and healthy, and 3) >5 yo unvaccinated but i/c'd?
1) give one dose; 2) healthy - skip; 3) i/c'd (sickle, HIV, asplenia) - give 1 dose
69
what makes a pt high risk for varicella?
newborn, face to face play, household exposure, or hospital exposure
70
what do you do with Hib vaccine if <2 yo and had Hib infection? why?
complete the course; start about 1 mo after infection; don't make enough antibodies at this age
71
what do you do with Hib vaccine 1) before splenectomy? when? or 2) with hematopoietic stem cell transplant? when?
1) give 2 weeks before if not previously completed; 2) give 3 doses at least 6 mo after transplant and end of i/s treatment
72
which strains are in 9vHPV?
6, 11, 16, 18, 31, 33, 45, 52, 58
73
who do you give 9vHPV to?
all females 11-26 yo and all males 11-21 yo, + males who are i/c'd 22-26 yo (or MSM)
74
what are the rules on timing of HPV vaccine? normal vs late?
first dose <15 yo = 2nd dose 6-12 mo later; first dose 15 yo or more, need 3 doses at 0, 1-2 mo later, and 6 mo later; can't give first dose over 18 yo
75
why observe pts for 15 min after HPV vaccine?
high risk of syncope
76
what do you do with mumps exposure for 1) unvaccinated and > 12 mo, 2) not fully vaccinated but had vaccine at least 28 days prior to exposure, 3) high risk but had 2 vaccines previously, 4) 6-11 mo and unvaccinated
1) give vaccine, 2) give 2nd dose, 3) give 3rd dose, 4) give a dose but it doesn't count toward the series
77
what 5 vaccines are given at 2 and 4 mo for normal course?
DTaP, Hib, IPV, rota, PCV13
78
which 5-6 vaccines are given at 6 mo for normal course?
DTaP #3, PCV13 #3, IPV #3, HepB #3 or 4, rota #3 if needed, Hib #2-3
79
when do you give booster for meningococcal? which pts?
Men4 before 10 yo if ongoing increased risk of meningococcal disease - HIV, complement deficiency, asplenia
80
what is needed for meningococcal vaccines for CSF leaks or cochlear implant patients?
essentially need at least 1 PCV13 and at least 1 PPSV23; if 2-5 yo and received 3, give another 13 and need at least one 23; if 2-5 yo and received <3, give 2 13s and at least one 23; if 6-18 yo and no history, give one of each separated by 8 weeks - just make sure they have 1 of each

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