Vaccines and Immunoglobulins

Question 1

Diptheria

Answer 1

• Agent: Corynebacterium diptheriae (endotoxin)
• Vaccine: Toxoid; 16u for kids, 2u booster adult [TQ]
• Causes: sore throat, myocarditis, neuritis, paralysis, 5-10% fatal
• Misc.: vaccine does not eliminate carrier state

Question 2

Pertussis

Answer 2

• Agent: Bordetella pertussis
• Vaccine:
  
  • Accellular: contains toxin, good efficacy, few ADRs
  • Whole cell: all components, more ADRs, not used
• Causes: whooping cough (prodrome 1-2 weeks, cough 1-6 weeks, convalescence months)

Question 3

Tetanus

Answer 3

• Agent: Clostridium tetani
• Vaccine: Toxoid; every 10 years [TQ]
• Causes: tonic spasms, muscle stiffness (jaw, neck), highly fatal
• Misc.: over-immunization causes hypersensitivity immune complex reaction

Question 4

DTap

Answer 4

• For: infants
• Covers: diptheria, tetanus, pertussis
• Vaccine: 3 injections, boosted at 12-16 mo and 4-6 yrs
• Misc: vaccination against diptheria and tetanus (Td) should continue through life at 10 year intervals

Question 5

TdaP

Answer 5

• For: older children and adults [TQ]
• Covers: pertussis protection with Td
• Vaccine: adolescent single dose booster, adult single dose (before pregnancy or infant contact)

Question 6

H Influenzae type b (Hib)

Answer 6

• Agent: Haemophilus influenzae (6 types)
• Vaccine: 2 or 3 doses for primary series, boost as with DtaP
• Causes: leading cause of invasive bacterial disease in children, severe in those <2
• Misc.: 1st of conjugate vaccines (mult. products, interchangeable)

Question 7

Hepatitis A

Answer 7

• Agent: Hepatitis A virus (no carrier state)
• Vaccine: 2 dose series, 6 mo apart (lasts 5 years)
• For: all infants and un-immunized children/adolescents (not routine for food service or day care workers)
• Causes: fecal/oral, acute onset,
• Misc.: if outbreak occurs, give immunoglobulin and not vaccine

Question 8

Hepatitis B

Answer 8

• Agent: Hepatitis B virus (carrier state)
• Vaccine: 3 doses of recombinant HBV surface antigen
• For: universally given to all infants
• Causes: blood/mucosal/contact, insidious onset, 6-10% become chronic
• Misc.: give infants of HBV+ moms HBIG with vaccine

Question 9

HBIG

Answer 9

• Agent: HBV
• Vaccine: Immune Globulin, .5 ml within 12 hrs
• For: neonates with HBsAG+ moms
• Misc.: also give HBV vaccine as well

Question 10

HPV

Answer 10

• Agent: human papilloma virus (>100 types)
• Vaccine: quadravalent 6, 11, 16, 18; bivalent 16, 18 [TQ]
  
  • Gardasil (quad.): 3 injections over 6 mo
• For: sexually active men and women aged 9-26
• Causes: cervical cancer, cervical dysplasia, genital warts (90% caused by 6, 11 [TQ])

Question 11

Influenza

Answer 11

• Agent:
• Vaccine: differs each year based on current strains [TQ]
  
  • Inactivated IM vaccine:
    
    • split virus: for infants and children
    • surface antigen: older children and adults
  • Intranasal live attenuated vaccine:
    
    • healthy 5-49 years old
• For: >65, healthcare workers, high risk (heart, resp, renal, DM)
• Causes: the flu
• Misc.: given once a year, in mid sept-dec, 2-4 weeks to be protective

Question 12

Measles

Answer 12

• Agent: Rubeola virus
• Vaccine: live virus, lifelong immunity
• For: not for infants under 1 year (transplacentally aquired antibodies)
• Causes: highly contageous, infective in droplet form
• Misc.: egg protein allergies, give vaccine during epidemics

Question 13

Mumps

Answer 13

• Agent: mumps virus
• Vaccine: attenuated virus
• For: after 1 year
• Causes: glandular and nervous tissue, enlarged salivary glands, meningitis, orchitis, pancreatitis

Question 14

Rubella

Answer 14

• Agent: rubella virus
• Vaccine: may resul in viremia, fever, arthritis
• Causes: 3 day measles; growth/mental retardation, cataracts, microcephaly, deafness, heart disease in unborn babies

Question 15

MMR

Answer 15

• Covers: measles, mumps, rubella
• Vaccine: live, attenuated, trivalent vaccine; prepared in chick embryo cell culture
• For: everyone over 1 year, all born after 1956 need 2 doses
• Caution: pregnancy (bc baby could get rubella), egg and neomycin allergy
• Misc.: during measles outbreak, the vaccine is admisnistered within 72 hours, providing protection and prevention

Question 16

Neisseria Meningitidis

Answer 16

• Agent: 5 serogroups: A, B, C, Y and W135
• Vaccine: MPSV4, MenACWY, HiB MenCY
• Causes: meningitis and sepsis, rapid onset, highest in infancy and age 18, similar to flu, 10% die
• Misc.: occurs more in winter and spring

Question 17

MPSV4

Answer 17

• Covers: neisseria meningitidis serotype A
• Vaccine: Menomune
• For: infants older than 3 mo, 2 doses 3 mo apart, revaccinate 2-3 yr later; provides immunity for only 3-5 years
• Causes: meningitis and sepsis
• Misc.: will be phased out

Question 18

MenACWY

Answer 18

• Agent: N. meningitidis serotypes A, C, W and Y
• Vaccine: conjugated, menactra and menveo
• For: children >9 mo and those not vaccinated prior to HS and college; adults in close quarters, international travelers, bad spleens
• Causes: meningitis and sepsis
• Misc.: local reacitons common, guillain-barre syndrome

Question 19

HiB MenCY

Answer 19

• Covers: N. meningitidis C and Y; Hib
• Vaccine: conjugated; MenHibrix
• For: very young (2, 4, 6, and 12-15 mo)
• Causes: meningitis and sepsis

Question 20

Pneumococcal Disease

Answer 20

• Vaccine:
  
  • Conjugate: 13 valent
  • Unconjugated: polysaccharide 23 valent
• For:
  
  • Conjugate: <2 years, 4 doses
  • Unconjugated: 55-65 years and chronic diseased, boost in 6 years
• Misc.: protection is not lifelong, can be impaired by underlying disease

Question 21

Poliovirus

Answer 21

• Agent: entero polio virus
• Vaccine: 4 dose schedule, Salk (IPV inactivated, dead); Sabin (live, no longer used)
• For: children
• Causes: oral/fecal; resides in GI and invades blood and CNS
• Misc.: almost eradicated in west

Question 22

Rotavirus

Answer 22

• Agent: rotavirus
• Vaccine: live oral monovalent or pentavalent; 2-3 doses (all done by 32 weeks of age)
• For: under <32 weeks of age
• Causes: leading cause of infantile and early childhood vomiting and diarrhea
• Misc.: symptom efficacy 70%; ADRs include diarrhea, vomiting, otitis, nasopharyngitis, bronchospasm

Question 23

Variccella

Answer 23

• Agent: varicella-chickenpox
• Vaccine: live-attenuated; 1 dose at 1 yr and repeat at 12-13 years; 2 doses for >13 yrs (4-8 wks apart)
• For: all children over 1 year
• Causes: airborne virus or direct contact; milder disease if vaccinated and still contract
• Misc.: avoid salicylates for 6 wks to prevent Reye’s [TQ]; avoid pregnancy for 1 month

Question 24

Herpes Zoster Vaccine

Answer 24

• Agent: herpes zoster virus
• Vaccine: safe and effective
• For: adults >60 years
• Causes: used to reduce shingles, postherpetic neuralgia, and pain burden of shingles