well visit/immunizations

screening tests

newborn metabolic, hearing, vision, CBC, venous lead, PPD, lipid panel, STD testing

newborn inpt screening

metabolic, hemoglobin electrophoresis, congenital heart dz, hearing

newborn metabolic screening

PKU, galactosemia, congenital hypothyroidism, maple sugar urine dz, organic aciduria, cystic fibrosis

newborn hearing test

before discharge from hospital, f/u by 1 mo if failed and intervention by 6 mo

infant and toddler outpt screening

hearing and vision, anemia, lead, TB, lipid, dental

infant/toddler hearing tests

otoacoustic emissions device, in office exam of sound and speech, milestones

infant/toddler vision tests

spot vision screener, snellen chart, milestones

infant/toddler anemia screening

CBC at 12 mo

infant/toddler lead screening

venous lead at 12 and 24 mo

infant/toddler TB screening

PPD at 1 mo, 6 mo, 12 mo, then annually, CDC differs

infant/toddler lipid screening

screen for risk factors at 2, 4, 6, 8 yo then annually if RF are present

infant/toddler dental screenings

begin at 1 yo, cleanings every 6 mo

children 3+ screenings

hearing, vision, anemia, lead, TB, lipid, STD, depression

children 3+ lead screening

questionnaire

children 3+ lipid screening

children/adolescents w/ family hx of high cholesterol or heart disease, unknown family hx, comorbidities (obesity, HTN, diabetes)

children 3+ STD screening

annually for adolescents, any intercourse warrants PE and STD labs, pap smear at 21

children 3+ depression screening

annually beginning at 11, PHQ2/PHQ9

quick numbing of vaxx site

ethyl chloride spray

30-60 minute pre vaxx numbing

5% lidocaine-prilocaine topical

IM newborns-2 yo

anterolateral thigh

IM 3-18 yo

deltoid, anterolateral thigh

SQ under 12 mo

anterolateral thigh

SQ 12 mo+

upper outer triceps

how to give multiple vaxx in same site

1 inch apart

extra doses of vaxx

okay

missed doses of vaxx

no requirement to restart

multiple inactivated vaxx at same time

okay

multiple live attenuated vaxx at same time

can give multiple at same time OR 4 wks apart

which vaxx are live attenuated

MMR, varicella, rotavirus, intranasal flu

whole cell inactivated vaxx

bac/virus killed through physical/chemical process, polio, hep A

subunit vaxx

contain portion of bac/virus, flu, pneumococcal

toxoid vaxx

inactivated toxins produced by bac, tetanus, diptheria

recombinant vaxx

portion of bac/viral DNA, hep B, HPV, flu

RSV schedule

first dose birth to 6 mo (before first RSV seaason) depending on maternal vaxx status, one dose 8-19 mo

hep B schedule

first dose at birth, second dose 1-2 mo, 4 mo catch up vaxx, third dose 6-18 mo, up to 18 yo catch up dose

rotavirus schedule

first dose 2 mo, second dose 4 mo, third dose if 3 dose series 6 mo (RV1 is 2 dose, RV5 is 3)

DTaP schedule

first dose 2 mo, second dose 4 mo, third dose 6 mo, catch up 9-12 mo, fourth dose 15-18 mo, catch up 19 mo-3 yo, fifth dose 4-6 yo

H flu schedule

first dose 2 mo, second dose 4 mo, third dose if 4 part series 6 mo, 9-12 mo catch up, third/fourth dose 12-15 mo, 18 mo-5 yo catch up, 5+ yo for high risk

pneumococcal conjugate schedule

first dose 2 mo, second dose 4 mo, third dose 6 mo, 9 mo catch up, fourth dose 12-15 mo, 18 mo-5 yo catch up, 5+ yo for high risk

inactivated polio schedule

first dose 2 mo, second dose 4 mo, third dose 6-18 mo, 19 mo-3 yo catch up, fourth dose 4-6 yo, 7+ yo catch up

covid schedule

6 mo+ based on shared clinical decision making

IIV3/ccIIV3 flu schedule

1 or 2 doses annually 6 mo-9 yo, then 1 dose annually

LAIV3 flu schedule

2-9 yo 1 or 2 doses annually, then 1 dose annually

MMR schedule

6-9 mo for high risk, first dose 12-15 mo, 18 mo-3 yo catch up, second dose 4-6 yo, then catch up

varicella schedule

first dose 12-15 mo, 18 mo-3 yo catch up, second dose 4-6 yo, then catch up

hep A schedule

6-9 mo for high risk, 2 dose series 12-23 mo, then catch up

Tdap schedule

7-10 yo catch up, first dose 11-13 yo, then catch up/for high risk

HPV schedule

high risk/can start 9 yo, dose 11-12 yo, then catch up

meningococcal schedule

2 mo-10 yo for high risk, first dose 11-12 yo, 13-15 yo catch up, second dose 16 yo, then catch

men B schedule

9 yo+ for high risk, 16 yo+ based on shared clinical decision making

RSV schedule pregnancy

seasonally

dengue schedule

9 yo+ if seropositive in endemic areas

Mpox schedule

18+ for high risk

hep B transmission

parenteral or mucosal exposure to positive body fluids

hep B vaxx series

3 dose IM, birth-days after, 1-2 mo, 6 mo

hep B vaxx warnings

latex allergy, syncope, apnea, infants <2000 g

energix B, recombivax HB

hep B

pediarix

DTaP, hep B, IPV

vaxelis

DTaP, IPV, Hib, hep B

twinrix

hep A, hep B

beyfortux, enflonsia

RSV

what kind of vaxx is RSV

mab

when is RSV rec for infants <8 mo

shortly before first season if mother did not receive vaxx during pregnancy/status unknown, infant born w/i 14 days post maternal vaxx

RSV infant born October-March if

mother did not get vaxx/status unknown/birth w/i 14 days, then admin 1 dose w/i 1 week of birth

RSV infant born April-September if

mother unvaxx/status unknown/birth w/i 14 days, then admin 1 dose before RSV season

RSV warnings

hypersensitivity, coagulation d/o

can you administer RSV w/ other vaxx

yes

RSV children 8-19 mo

only if increased risk and entering second season, chronic lung dz, immunocompromised, CF, native

rotarix, rotateq

rotavirus

rotavirus transmission

fecal oral, person to person, fomites

self limited watery diarrhea, severe dehydrating diarrhea, fever, vomiting, dehydration, electrolyte imbalance

rotavirus

rotarix

2 mo, 4 mo

rotateq

2 mo, 4 mo, 6 mo

post rotavirus shedding

in feces

rotavirus warnings

latex allergy, GI d/o, immunocompromised, intussesception

rotavirus contraindications

hypersensitivity, congenital GI malformations, hx of intussusception, SCID

diptheria transmission

respiratory droplets, exposure to infected skin lesions, fomite

diptheria m/c site of infection

tonsils and pharyx

bluish white membrane on tonsils/pharynx

diptheria

diptheria complications

myocarditis, neuritis

tetanus transmission

contaminated wounds, reservoir contaminated soil, intestines of animals/humans

tetanus complications

laryngospasm, fx, death, aspiration PNA

pertussis transmission

respiratory droplets, contact w/ airborne droplets, exposure to contaminated fomites

pertussis occurs in

3 stages

pertussis complications

secondary bacterial PNA, infants highest risk

DTaP series

IM three dose, 6 wks-2mo, 4 mo, 6 mo

DTaP boosters

15-18 mo, 4-6 yo, 11 yo (Tdap, Td)

DTaP warnings

Guillain Barre, brachial neuritis, hx of seizure, immunocompromised, apnea in premies, syncope

DTaP contraindications

hx of hypersensitivity, encephalopathy w/i 7 days of previous dose, progressive neurologic d/o

H flu type b transmission

droplet inhalation, direct contact w/ respiratory tract secretions, amniotic fluid, genital tract secretions

H flu b m/c associated w/

meningitis, sepsis, epiglottitis, PNA, arthritis, cellulitis

H flu series

three dose IM, 1-6 wks, 4 mo, 6 mo, booster at 15-18 mo

H flu warnings

Guillain Barre, immunocompromised

H flu contraindications

hypersensitivity

pneumococcal transmission

droplets

pneumococcal complications

PNA, bacteremia, meningitis, otitis media

pneumococcal series

three dose IM, 6 wks, 4 mo, 6 mo, booster 12-15 mo

pneumococcal warnings

immunocompromised, apnea in premies

pneumococcal contraindications

hypersensitivity

polio transmission

fecal oral or oral oral