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Vaccines Flashcards

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
Q

what hepA post-exposure prophyalxis is available? when do you give it?

A

use the vaccine if household exposure and 12 mo or older; use IMIG for passive protection if <1 yo

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26
Q

what is the normal schedule for DTaP?

A

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

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27
Q

when do you normally give Tdap? when else can you give it?

A

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

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28
Q

what vaccines do you give if pt has c/i to pertussis?

A

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

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29
Q

does having the pertussis infection change the vaccine schedule?

A

nope

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30
Q

absolute contraindications for DTap or Tdap?

A

h/o encephalopathy within 7 days of previously given vaccine (no evidence), anaphylaxis, h/o progressive neuro disease that is not stable

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31
Q

rare adverse events of DTaP or Tdap?

A

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

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32
Q

precautions for DTap or Tdap?

A

GBS within 6 weeks after a previous vaccine

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33
Q

what do you do for tetanus in a clean wound and pt has not had 3 doses yet or you don’t know?

A

give the vaccine

34
Q

what do you do for tetanus in a clean wound and pt has already had 3 or more doses?

A

give vaccine only if it has been 10 years or more since last dose

35
Q

what do you do for tetanus in a dirty wound and pt has not had 3 doses?

A

give the vaccine and TIG

36
Q

what do you do for tetanus in a dirty wound and pt has had 3 or more doses?

A

give the vaccine only if it has been 5 years or more since the last dose

37
Q

when do you normally give the pneumococcal vaccine?

A

2/4/6/12-15 mo

38
Q

if healthy child <5 yo who is unvaccinated, what pneumococcal vaccine do you give?

A

give 1 PCV13

39
Q

if incomplete series in unhealthy child aged 2-6 yo, what pneumococcal vaccine do you give?

A

Give x2 PCV13, 8 weeks apart; if already had 3 doses, give the 4th one

40
Q

if in high risk group and finished pneumococcal series, what else do you give them? when?

A

PPSV23 at 2 yo, at least 8 weeks after last PCV13; give 2nd dose 5 years later if immunocompromised

41
Q

if in high risk group and aged 6-18 yo and unvaccinated, what do you give for pneumococcal?

A

PCV13 x1 if never given before

42
Q

when do you normally give IPV?

A

2/4/6 mo and 4-6 yo

43
Q

when do you give additional IPV dose?

A

travel and >12 mo since last dose, or endemic area for at least 4 weeks

44
Q

which strains are contained in the MCV4 vaccine?

A

A, C, Y, W-135

45
Q

when do you normally give MCV4?

A

single dose at 11-12 yo with booster at 16-18 yo, 1 dose to college freshmen

46
Q

when do you give MenB?

A

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
Q

for high risk children, what meningococcal vaccine schedule do you give?

A

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
Q

who is considered high risk for meningococcal?

A

asplenia, community outbreak, complement deficiency, high risk travel, dormitory living

49
Q

what meningococcal vaccine schedule do you give in complement deficiency?

A

MCV4 x2, at least 12 weeks apart, between 9-23 mo; if older, give 2 doses at least 8 weeks apart

50
Q

what meningococcal vaccine schedule do you give in HIV/asplenia?

A

MCV x2, at least 8 weeks apart, after 2 yo, and at least 4 weeks after PCV13

51
Q

what are the MMR vaccine components made from?

A

M&M from chick embryos (minimal x-reactivity with egg protein so not c/i’d); R from human diploid cell culture

52
Q

common adverse effects of MMR vaccine? rare?

A

fever to 39.4C, rash 6-12 days after, joint pain in teens from rubella at 1-3 weeks; rare = thrombocytopenia

53
Q

time frame after MMR vaccine to wait to give Ig if needed?

A

at least 2 weeks - alters serologic reaction

54
Q

what c/s dose prompts change in MMR & V vaccine administration? what’s the change?

A

high dose oral c/s (2 mg/kg/day or more) or over 14 days = delay until 1 mo after course completion

55
Q

when is the time frame for increased risk of febrile sz after first dose of MMRV? what age group?

A

12-23 mo, at 5-12 days after vaccine

56
Q

when is it preferred to give MMRV as the first MMR / V dose?

A

at least 4 yo

57
Q

when is MMR normally given?

A

first dose at 12-15 mo, second at 4-6 yo

58
Q

if give MMR before 12 mo, what do you do with the normal course?

A

same thing; doesn’t count toward normal series; must be separated by at least 28 days

59
Q

when is varicella normally given?

A

first dose at 12-15 mo, second dose at 4-6 yo

60
Q

if MMR and V not given at the same visit, how much later must they be separated by?

A

at least 28 days

61
Q

common reactions to varicella vaccine? what recommendations do you give this pt?

A

localized rash in <3%, generalized in 3-5%; usually 5-26 days later, maculopapular (not vesicular); avoid contact with immunocompromised until rash resolves

62
Q

reaction in pt that is exposed to varicella but has been vaccinated? what recommendations do you give this pt?

A

mild rash (MP>vesicular), <50 lesions; exclude until no new lesions and lesions are crusted over

63
Q

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

A

1) give vaccine within 3-5 days, 2) vaccine within 5 days, 3) IM VZIG, 4) IVIG

64
Q

when do you not give varicella vaccine as post-exposure ppx?

A

pt has received 2 vaccines, pt has lab evidence of immunity, or pt has h/o zoster recorded

65
Q

at what age dose the minimum time between varicella doses change? what’s the change?

A

under 13 yo, need 3 mo between doses, 13 yo or more needs at least 28 days

66
Q

how is Hib vaccine made?

A

Hib capsular polysac conjugated to protein carrier

67
Q

when is Hib vaccine normally given?

A

2 mo, 4 mo, +/- 6 mo depending on which vaccine was used, + booster at 12-15 mo

68
Q

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?

A

1) give one dose; 2) healthy - skip; 3) i/c’d (sickle, HIV, asplenia) - give 1 dose

69
Q

what makes a pt high risk for varicella?

A

newborn, face to face play, household exposure, or hospital exposure

70
Q

what do you do with Hib vaccine if <2 yo and had Hib infection? why?

A

complete the course; start about 1 mo after infection; don’t make enough antibodies at this age

71
Q

what do you do with Hib vaccine 1) before splenectomy? when? or 2) with hematopoietic stem cell transplant? when?

A

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
Q

which strains are in 9vHPV?

A

6, 11, 16, 18, 31, 33, 45, 52, 58

73
Q

who do you give 9vHPV to?

A

all females 11-26 yo and all males 11-21 yo, + males who are i/c’d 22-26 yo (or MSM)

74
Q

what are the rules on timing of HPV vaccine? normal vs late?

A

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
Q

why observe pts for 15 min after HPV vaccine?

A

high risk of syncope

76
Q

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

A

1) give vaccine, 2) give 2nd dose, 3) give 3rd dose, 4) give a dose but it doesn’t count toward the series

77
Q

what 5 vaccines are given at 2 and 4 mo for normal course?

A

DTaP, Hib, IPV, rota, PCV13

78
Q

which 5-6 vaccines are given at 6 mo for normal course?

A

DTaP #3, PCV13 #3, IPV #3, HepB #3 or 4, rota #3 if needed, Hib #2-3

79
Q

when do you give booster for meningococcal? which pts?

A

Men4 before 10 yo if ongoing increased risk of meningococcal disease - HIV, complement deficiency, asplenia

80
Q

what is needed for meningococcal vaccines for CSF leaks or cochlear implant patients?

A

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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