PED Immunizations
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| Vaccination | is actual process of administering agent; can be a toxoid, antitoxin or Ig
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| Immunization | is process of inducing immunity which is active or passive
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| Active Immunization | via vaccination or natural infection; permanent . Vaccination results in active immunity and immunologic memory consistent with natural infection but without risk of disease
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| Passive Immunization | via exogenously formed antibodies; temporary
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| Types of Vaccines | Live, attenuated, inactivated, subunit vaccines, recombinant vaccines, conjugated vaccines.
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| Vaccines also usually contain: | Preservatives/stabilizers: (thymerosol) these inhibit microbial growthAdjuvants: usually aluminum salts that enhance host immune response
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| Inactivated Vaccines | cannot replicate in hostusually require multiple dosesprotected in vivo against circulating antibodies
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| Live, attenuated Vaccines | decreased pathogenicityeffectiveness depends on ability to replicateresponse similar to natural infectionusually effective with single dose
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| Inactivated Vaccines | Influenza (TIV), polio, Hep A, Hep B, Diptheria, tetanus, penumococcal, meningococcal, HIV, HPV
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| Live, attenuated Vaccines | measles, mumps, rubella,MMR, varicella, yellow fever, rotavirus, influencza (LAIV)
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| recombinant | genes that code for a specific viral protein are expressed in another microbe. Ex: Hep B, HPV
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| Conjugate | vaccines for bacteria with polysaccharide capsules; linked to protein carriers; ex: pneumococcal, HIV, meningococcal
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| Subunit | produced from specific purified antigens. Ex: DTap, Tdap
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| Vaccine general recommendation | Generally, vaccines recommended at youngest age at which risk of disease is greatest and desired immunologic response can be obtained
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| Oral vaccine | rotavirus
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| Routes of Administration | IM (most common; thigh), SQ: MMR, IPV, Varicella, Oral: rotavirus. Each injection is given at a different site with a different needle & syringe
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| Information to Log | Log date given, manufacturer and lot #, name, title and address of person giving vaccine(s)Vaccine Adverse Event Reporting System (VAERS)
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| Currently, most children receive about ___ vaccines | 40 between 0-18 years
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| DTP | diptheria, tetanus, pertussis
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| MCV | meningococcal
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| Influenza vaccine recommended up to age | 18
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| DTap | Diptheria Tetanus and acellular pertussis (never give to anyone over 7; amount of pertussis that you can give a 5 yo would seriously harm a 7 yo)
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| Tdap | given to kids over 7 yo.
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| Hep A Reasons to vaccinate | children often have asymptomatic and/or unrecognized infections and therefore play major role in transmission of disease to adults. ACIP began incremental implemented of HepA in 1996; added nationwide 2007
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| Only vaccine given 5 times before you are 6 yo | Diptheria, Tetanus, & Pertussis Vaccine (EXAM QUESTION)5 dose series given at 2 mos, 4 mos, 6 mos, 12-18 mos and a booster at 4-6 years
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| Hep A | inactivated
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| Hep B Reasons to vaccinate | Chronic infection more likely if infection acquired early in life. ~25% of HBV-infected infants will die of HBV-related disease. Transmission of HBV from child-to-child has been documented. 30% of HBV infxns occur in persons w/out a known risk factor
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| Diphtheria, Tetanus and Pertussis Vaccine: reasons to vaccinate | Pertussis infections occur in infants/young children:~20% in infants < 6 months and ~50% in children < 5 years. Serious complications: pneumonia, seizures, encephalopathy. Pertussis is highly contagious.
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| Waning/lost immunity is problem w/ Pertussis | 10x increase in pertussis cases in last decade with most cases in adolescents. Tdap vaccines debuted in 2005 for adolescents/adults. DTaP for children up to age 7
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| Td | Td is the adult vaccine routinely given for booster
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| adverse effects generally attributed to whole cell pertussis: | high fever, unusualy cry, seizures, rarely acute encephalitis, these have been decreased dramatically with DTap
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| Adacel | Tdap vaccine approved for 11-64 yo
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| Adolescents 11-18 who have already received Td | should get a single dose of Tdap
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| HIB (haemophilus influenza) vaccine: reasons to vaccinate - | Before vaccine availability HiB was responsible for invasive disease in 1 in 200 children < 5 yrswas #1 cause of bacterial meningitis in children < 5 yrs; high rate of neurologic complicationspneumonia, cellulitis, epiglottitis, septic arthritis.
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| IPV | inactivated polio virus. Reason to give:~85% of infected persons will transmit the virus to susceptible contactsmanifestations include subclinical infection (most common), non-specific viral syndrome, viral meningitis & paralytic polio (least common)
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| Oral Polio vaccine notes | Oral vaccine (OPV) was long-time standard but associated with an increased risk of indigenously acquired disease (VAPP)
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| Measles, Mumps, and Rubella (MMR) Vaccine; Reasons to vaccinate - | few practicing clinicians recognize measles!measles causes >1 million deaths/yr worldwide, mumps can be severely painful, fetal infxn with rubella can be devastating (frequent outbreaks in latino communities). Combined more effective than individual
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| AE of MMR | 5-15% incidence of fever, 5% incidence of rash. parotid swelling; arthralgias (mumps vaccine)
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| Varicella Vaccine | FDA-approved in 1995; widely adopted in 1999. Now required for school attendance in most states
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| PCV-7 | Pneumococcal conjugate vaccine (PCV-7) Prevnar
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| Major cause of severe gastroenteritis in children 0-5 yrs | Rotavirus. 1 in 80 US infants hospitalized annually. 1/2 million office visits annually. Immunocompromised children at increased risk of death. Virus shed in large #s in stool
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| RotaTeq (RV) | Rotavirus. Prentavalent LIVE vaccine given orally. targets strains that cause >90% of rotavirus gastroenteritis in US
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| Meningococcal vaccine is recommended between | ages 11-12. Highest risk populatinon: Freshmen in dormitories
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| Menomune and Menactra are the | Meningococcal vaccine.
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| TIV | Trivalent Inactivated Influenza Vaccine
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| LAIV | Live attenuated Influenza Vaccine
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| Don't give LAIV to | kids and adults with asthma
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| Influenza vaccine is recommended for | children with chronic disease and all children 6-59 months of age (now 6mos-18yrs) (TIV or LAIV if ≥ 2yrs)
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| Influenza vaccine: reasons to vaccinate - | highly contagious virus, 0-2 yo at increased risk: no prior immunity, increased rate of hospitalization, neurologic and pulmonary copmlications. Children have highest attack rate (daycare, schools facilitate spread)
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| Gardasil protects against which HPV strains? | 6, 11, 16 &18. IM injection. recommended age: 11-12 yo females
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| Most common STD in US | HPV. prevalence of HPV infections highest among sexually active females < 25 years of age. Infxn occurs early after onset of sexual debut.
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| Pediarix | DTaP + Hep B + IPV
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| ProQuad | MMR + Varicella
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| Pentacel | DTaP + IPV + HIB
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| Vaccine Caveats | 4 day grace period for vaccines given earlier than min. age, no max # of vaccines, vaccine shortages on/off, Manufacturer interchangeability, international adoptions, immunosuppression, Tb testing, Recent administrations of blood products (live vaccines)
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| Vaccine Precautions | moderate or severe acute illness with/w/o fever, severe sx </= 48 hrs after a previous dose of any vaccine, pregnancy, recent (</=11 months) receipt of Ab-containing blood product, thrombocytopenia, DTP/DTaP: AEs
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| Tb skin test and PPD administration | You can put on a Tb skin test and give a live vaccine at the same time. But if not given simultaneously, you must wait 6 weeks post vaccine to do the skin test.
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| Vaccine Contraindications | Severe allergic rxn after previous vaccine dose or to a vaccine component, pregnancy, known severe immunodeficiency, Encephalopathy or other serious neurologic sequelae after DTP or DTaP vaccination. Influenza vaccine in pts with severe egg allergy
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