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GreenC2- Vaccines
Board Study
| Question | Answer |
|---|---|
| Live vaccines | MMR, Varicella, Rotavirus. Also oral typhoid and Yellow fever |
| Vaccines for <1 year old | Only killed or recombinant vaccines. - except rotavirus which is live |
| Charts available | 0-6yo, 7-18yo, catch up for 4mo-6yrs and catch up for 7-18yo |
| Rotavirus | most common gastroenteritis in infants and young children, major problem in developing world |
| Rotavirus Vaccine | Live, oral, Rotateq: given at 2, 4, 6mo Rotarix: given at 2 and 4mo only |
| Rotavirus Vaccine- first dose | minimum age 6 weeks old, maximum age 14wks 6days |
| Rotavirus Vaccine- final dose | do not give final dose after 8mo 0days |
| Influenza- at risk | ages 6-23mo, ASA therapy (at risk for Reye S), Pulm (asthma) or CV dz, compromized resp fxn or handling of secretions, cognitive dysfxn, spinal cord injuries or neuromuscular d/o, resident of chronic care facility |
| Influenza vaccine- schedule | given 1 annually, first timer <9yo needs 2 doses with >4wks separation, also give 2 if last season was their first season and they only received 1. |
| Influenza vaccine- 2 kinds | 1) Trivalent inactivated influenza vaccine (minimum age 6mo). 2) Live attenuated influenza vaccine (nasal spray) (minimum age 2yo) |
| FluMist (LAIV)- limits | Do not use if pregnant or in ages 2-4yrs if they had wheezing in the last 12months |
| Influenza vaccine- when not to give | severe egg allergy (this is debatable), severe rxn to previous vaccination, Guillain-Barre within 6wks, <6mo old, severe current illness (less likely to respond) |
| Influenza vaccine- H1N1 | Children aged 6mo-8yo who received no doses of monovalent H1N1 in 2009, should receive 2 doses of 2010-2011 seasonal flu vaccine |
| TdaP | Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (minimum age 10yrs for Boostrix, 11yrs for Adacel), booster q10yrs |
| TdaP- catch up in 7-10yo | administer 1 TdaP if not fully immunized against pertussis (incomplete DTaP series) then refer to catch up schedule to complete the series using Td |
| HIB (Haemophilus influenza Type B) | causes meninigitis, epiglottis. Not to be confused with non-typeable HIB which is a frequent cause of AOM and URIs |
| HIB schedule | 4 doses: 2, 4, 6, 12-15mo (minimum age 6wks). Do not give over 5yo (except high risk then give 1 dose)- sickle cell, leukemia, HIV and splenectomy |
| HIB brand-names and their rules | PedvaxHIB or Comvax: do not need a dose at 6mo (give at 2, 4, then booster at 12-15mo). Hiberex is only for kids >12mo-4ys |
| Hepatitis B- first dose | give to newborn before d/c, if premie- give before d/c from NICU or at 1mo chronological age- whichever comes first. |
| Hepatitis B- schedule | 3 doses: birth, 1-2mo, 6-18mo (final dose must be given no earlier than 24wks). 4 doses is permissable if Hep B is being given in a combo vaccine (ex. birth, 2, 4, 6mo) |
| Hepatitis B monovalent vs. combo | only a monovalent vaccine can be given before 6weeks old. |
| What if Mom is HBsAg+ ? | give Hepatitis B vaccine + HBIG before 12hrs old (2 diff sites). Check for HBsAG now to document neg. Then check HBsAG and titers for HBsAg Ab 1-2 mo after completing the vaccine schedule (usually 9-18mo old) |
| what if Moms status is unknown? | give Hep B vaccine within 12hrs of birth. Determine Moms status ASAP, if + give HBIG (no later than age 1wk). |
| What if I miss a dose of HBV? | never start over, even if its been years |
| Catchup schedule for HBV | <11yo: give 3 doses (Dose 1-2 is 4wks apart, Dose 2-3 is 8wks apart). If >11yo: give 2 doses (4mo apart of Recombivax HB). |
| Hepatitis A vaccine | start at >1yo. 2 doses 6mo apart |
| Hepatitis A- older children | give to older children who live in areas of increased infection |
| Hepatitis A- postexposure prophylaxis | give Hep A vaccine for those >2yo, give immune globin if <2yo |
| Neisseria meningitidis | current vaccine is MCV4 (meningococcal conjugate vaccine- contains strains A, C, Y, W-135) note: we do not have a vaccine for strain B. The old vaccine was MPSV- meningococcal polysaccharide vaccine. |
| MCV4 schedule | given at age 11-12yo with a booster at 16yo. if previously unvaccinated then give 1 dose at age 13-18yo and to college freshman living in dorms. |
| MCV4 high risk pts- ages 2-10yo | Persistent complement compnent deficiency or asplenia: give 2 doses (8wks apart), then 1 dose q5years thereafter. HIV pts- give 2 doses 8wks apart. Those traveling to endemic areas or in outbreaks- give 1 dose. |
| What to do if at continued risk for meningococcal disease and previously vaccinated against meningitis? | Give booster dose of MCV4 if previous dose (either MCV4 or MPSV) was given between 2-6yo and its been more than 3years. |
| Varicella Vaccine | live- virus vaccine, contains small amounts of neomycin and gelatin |
| Varicalla schedule | give at 12-15mo old, 2nd dose at 4-6yo (along with MMR)- give only if NO h/o disease |
| Varicella intervals and catch-up dosing | <13yo: 3months (acceptable if it was given 4wks apart). >13yo: 4wks apart |
| Do not give Varicella Vaccine if: | On high dose steroids (>2mg/kg/day) OR pregnant women |
| Wait to give VZV after: | 1) TIG, IG for HepaA, HBIG: 3mo. 2) Packed RBCs: 5mo. 3)Whole blood: 6mo. 4) Plasma or platelets: 7mo. 5) IVIG (ITP- 400mg/kg/day): 8mo. 6) IVIG (Kawasaki- 2g/kg/day): 11mo |
| Coordination of VZV with MMR | give on the same day OR 1mo (or more) apart |
| Side effect of VZV | 3-5% mild generalized chicken pox rash, another 3-5% get localized chicken pox rash within 1 month of the vaccine |
| Pneumococcal Vaccine- high risk groups | Cochlear implant, CV or Pulm dz, Immunocompromised (SSD, asplenia, HIV, diabetes, cancer), and long-term steroid use |
| PCV13 schedule | 4 doses: 2, 4, 6, and 12-15mo old |
| PCV13 catch-up schedule | give one dose to all aged 24-59mo (<5yo) who are not completely vaccinated for age |
| Previous PCV7 recipient | complete the series with PCV13 (need 8wk interval between last PCV7 and PCV13); if 14-59mo then give 1 dose of PCV13; if 60-71mo (6yo) at high risk then give 1 dose of PCV13 |
| Polysaccharide Pneumoccal Vaccine (PPSV)-23 valent | administer at 2yo to those at high risk- at least 8wks after last dose of PCV13; booster in 5yrs for asplenia or other immunocompromising condition |
| Inactivated Polio Vaccine | 4 doses: 2, 4, 6-18mo, 4-6yo. 4th dose MUST be after 4th birthday and at least 6mo after the previous dose. However, a 4th dose is not necessary if 3rd dose is after the 4th birthday and there was a 6mo interval from the previous. |
| OPV (old vaccine but maybe tested) | Live, oral vaccine- shed in feces. Do not give to immunocompromised pts or those who live in household with an immunocompromised person (ex HIV mom) |
| MMR (measles, mumps, rubella) | Live vaccine. Give 2 doses: 12-15mo and 4yrs old. Minimal interval is 4wks- can be given <4yo. |
| PPD and MMR | measles vaccine may supress tuberculin reactivity so... give simultaneoulsy OR wait 6wks to place a PPD after giving MMR vaccine. |
| Do not give MMR | anaphylaxis to neomycin or gelatin (egg allergy is fine), pregnancy, or immunodeficiency (exception: safe in healthy HIV-infected pt) |
| Typical schedule: Birth | monovalent Hepatitis B +/- HBIG (if Mom +HBsAg) |
| Typical schedule: 2month | 2nd Hep B, DTap, IPV, HIB, PCV13 and Rotateq/Rotarix |
| Typical schedule: 4month | 3rd Hep B (only if given in combo), DTaP, IPV, HIB, PCV13 and Rotateq/Rotarix |
| Typical schedule: 6month | Hep B, DTaP, IPV, HIB (only if doses at 2,4mo were NOT Comvax or PedvaxHIB), PCV13, and Rotateq (Rotarix is complete with 2 doses at 2,4mo), Influenza #1 if in-season |
| Typical schedule: 9mo | Catch up on any previous missed vaccines- ?Influenza#2, check on Hepatitis B labs if treated with HBIG as newborn (HBsAg and HBsAg antibodies). |
| Typical schedule: 12mo | HIB, PCV13, MMR, VZV, Hepatitis A |
| Typical schedule: 18mo | Hepatitis A, DTaP |
| Typical schedule: Kinder Shots 4-6yo | DTaP, IPV, MMR, Varicella, annual flu shot, ?booster with PCV13 if previous series was PCV7 |
| Vaccines that are SubQ (3) | MMR, VZV, and IPV (all others are intramuscular) |
| Oral vaccine | rotavirus (previously OPV also) |
| Site for IM injections | infants: anterolateral thigh, once muscle mass big enough, administer in deltoid (avoid buttock for risk of sciatic n damage and inconsistent IM deposition) |
| Size of needles | 20-22-gauge 5/8 to 1.25inch needle for children. Adults 1.5in needle |
| Site for SubQ injections | infants: anterolateral thigh; adults: back of arm/triceps |
| True contraindications to vaccination | Seizure 1 day after a previous DTaP (no further DTaPs given), anaphylaxis to a vaccine or one of its components |
| Vaccine Antigens: Egg | Influenza (controversial), yellow fever |
| Vaccine Antigens: Steptomycin, neomycin, polymyxin B | IPV, OPV |
| Vaccine Antigens: Neomycin | MMR, varicella |
| Vaccine Antigens: Gelatin | MMR, varicella, yellow fever |
| Expected side effects to vaccines | local tenderness/swelling/redness, low-grade fever, minor irritability |
| Invalid contraindications | previous local reactions, current illness (mild acute illness or low-grade fever), current antibiotic use, or sick contact |
| Invalid contraindications | h/o PCN allergy or other nonspecific allergy, FHx seizures, FHx adverse reactions, Active TB infection or PPD-pos |
| Contraindications to DTaP (up to you) | Do not re-vaccinate if: hx encephalopathy w/in 7days of vaccine, hx of high fever (>40.5/105) w/in 48hrs of prior dose, Seizures w/in 3 days of prior dose, persistent/inconsolable crying lasting >3hrs w/in 48hrs |
| DTaP and seizures | there is no evidence that seizures after DTaP cause neurological damage or epilepsy. |
| Which country other than the US routinely recommends varicella vaccine? | South Korea |
| Human Papilloma Virus Vaccine (HPV) | 3 doses. Quadrivalent and Bivalent vaccines available (Gardesil vs Cervirex) |
| HPV for girls | Quadrivalent is for prevention of cervical precancers, cancers, and genital warts. Bivalent is for precancer and cancers only |
| HPV for boys (9-18yo) | prevention of genital warts (quadrivalent only given) |
| HPV schedule | start at 9yo. give at 0, 2, 6mo: second dose is 1-2mo after first and third dose is 6mo/24wks after first) |
| Which vaccine must be stored continuosly frozen at 5 F (2 C)? | VZV, MMR |
| Measles outbreak | MMR can be given down to 6mo of age, however it doesn't count towards vaccination- they still need 2 more 4 wks apart to be given after they turn 1yo |
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