EXAM 2- Dr. Gilmore- IMMUNIZATIONS

Which of the following describe live attenuated vaccines? SATA

a. made from pieces of a bacteria

b. made from viruses or bacteria

c. do NOT cause natural infection

d. cause natural infection

b, d

What are inactivated vaccines made from? Do they cause natural infection?

• made from pieces of viruses/bacteria

• do NOT cause natural infection

Answer the following table about vaccines:

	LIVE ATTEN.	INACTIVATED
Storage (freezer/fridge?)
Admin Site
Needle size
ADRs

	LIVE ATTEN.	INACTIVATED
Storage (freezer/fridge?)	freezer	fridge
Admin Site	SUBQ	IM
Needle size	5/8	1 inch, 1.5 inch in larger ppl
ADRs	injection site rxns “feeling blah” MAY CAUSE NATURAL DISEASE!!!	injection site rxns “feeling blah”

Can I give 2 live vaccines together on the same day? If no, why not?

yes

Can I get a live vaccine today, and then tomorrow come back and get another live vaccine? If no, why not?

NO!!!—> must separate by 4 weeks

Can I get a live vaccine today, and then tomorrow come back and get an inactivated vaccine? If no, why not?

yes

What are some screening questions associated with LIVE vaccines? recommendations?

• are you sick?

  • immunocompromised?

  • cancer?

  • chronic disease?

  • transplant?

  • on steroids? ≥20 mg/day for 14+ days of prednisone considered immunocomp.

  • look for drugs associated with these disease states like biologics (mAbs), antirheumatics, etc.

• pregnant?

  • technically 4 vaccines that can be given during preg.

  • most of the time defer until had baby

There are 2 types of inactive vaccines.

• What are they?

• Which are T-cell independent/dependent?

• short or long duration of immunity?

• which is immunogenic in children <2?

• 2 kinds: conjugate and polysaccharide

	POLYSACCHARIDE	CONJUGATE
T-cell	T-cell independent	T- cell dependent
Immunity Duration	short duration	produce immune memory
Immunogenicity	NOT immunogenic in children <2	Immunogenic in children <2

What are the risk factors for severe disease with RSV?

• children <6m

• individuals with chronic lung/heart disease

• weakened immune system

• adults >65

List the 3 current RSV vaccines:

• Arexvy

• Abrysvo

• mResvia

Answer the following about RSV vaccines:

	Arexvy	Abrysvo	mResvia
mono or bivalent?
adjuvants? yes/no
what kind of vaccine? mRNA or protein

	Arexvy	Abrysvo	mResvia
mono or bivalent?	mono	bi	mono
adjuvants?	yes	yes	no
what kind of vaccine? mRNA or protein	protein subunit	protein subunit	mRNA

What are the current recommendations for who receives the RSV vaccine? pregnancy recommendations?

• all adults ≥75 years old AND age 60-74 with increased risk of severe RSV receive a SINGLE dose of vaccine

• all pregnant women 32-36 weeks (8m preg) —> ONLY ABRYSVO APPROVED FOR THIS INDICATION

With RSV what rare side effect might be seen with vaccination?

With what type of vaccine has this seen more cases of?

Is there any statistical significance to this claim?

• rare ADR—> GBS

• seen with PROTEIN SUBUNIT vaccines (Arexvy, Abrysvo)

  • statistical sig seen with Arexvy

List the 4 current pneumococcal vaccines:

• PCV15- Vaxneuvance

• PCV20- Prevnar20

• PCV21- Capvaxive

• PPSV23- Pneumovax

What are the current recommendations for pneumococcal vaccines in PCV-naive pts.?

All PCV naive adults ≥50years old should receive a dose of PCV (doesn’t specify which one)

What are the current recommendations for pneumococcal vaccines in individuals with risk conditions?

for individuals 19-49 yrs old with risk conditions:

• should receive 1 dose of PCV15, PCV20, or PCV21

  • if PCV15 is used, a dose of PPSV23 should be administered one year later

• if a pt. previously received PCV13 or PPSV23, single dose of PCV21 or PCV20 should be administered at least 1 year after

What qualify as risk conditions for pneumococcal vaccines?

(idk how imp)

• alcoholism

• chronic heart/liver, lung disease

• DM

• smokers

How do the pneumococcal vaccine recommendations change when comparing at risk pts. and immunocompromised pts.?

for individuals 19-49 yrs old with risk conditions:

• should receive 1 dose of PCV15, PCV20, or PCV21

  • if PCV15 is used, a dose of PPSV23 should be administered one year later

IN IMMUNOCOMPROMISED GOES FROM 1 YR to 8 WEEKS

What is the name of the vaccine for Chikungunya?

live or inactivated vaccine?

IXCHIQ- live vaccine

What are the vaccine recommendations for Chikungunya?

(lowkey he said just to remember name)

• 1 dose rec for all those ≥18 yrs old who are traveling to country where there is an outbreak

• also may be considered if the country had evidence of outbreak in last 5 years

  • person aged >65 yrs old particularly with med conditions who are likely to have mosquitos or staying for 6m+

What are the current vaccine recommendations for HPV vaccines?

• 2 dose series for 9-14 yr olds, and 27-45 yr olds (new recommendation)

• 3 dose series for 15-26 yr olds

What’s the difference between antigenic drift and shift?

• drift: minor changes, why we change the vaccine up every year

• shift: major changes in mutations, responsible for pandemics

What do each of the following abbreviations mean:

• IIV

• IIV-HD

• ccIIV

• RIV

• alIV

• LAIV

• IIV: inactivated influenza vac

• IIV-HD: high-dose inactivated influenza vac

• ccIIV: cell-culture based inactivated influenza vac

• RIV: recombinant influenza vac

• alIV: adjuvanted inactivated influenza vac

• LAIV: live attenuated influenza vac

What are inactivated influenza vaccines grown in?

chicken/hen eggs

Risk of egg allergy in cell culture versus inactivated influenza vaccines?

in cell culture there is still some egg risk but less, grown differently

Risk of egg allergy in recombinant versus other influenza vaccines?

RECOMB IS EGG-FREE!!!!!!!!!!

Which of the following has a higher antigen load, x4 times as much compared to the other vaccines?

a. IIV

b. IIV-HD

c. ccIIV

d. RIV

d.

Anyone over the age of _______ should receive a flu shot.

6 months

What are influenza vaccine recommendations for children up to age 9?

give 2 doses at least 4w apart IM

What are influenza vaccine recommendations in adults aged ≥65 or older?

preference for IIV-HD, RIV, or allIV

What is the name of the Zoster vaccine?

what type of vaccine is it?

Shingrix- adjuvanted recombinant vaccine, inactive

What are the current recommendations for the Zoster vaccine?

immunocompromised?

• 2 0.5ml doses IM 2 months apart in pts. ≥50

• also rec for ≥19 yrs old and immunocompromised

What are the names and types of the 3 available COVID-19 vaccines?

• mRNA vaccines

  • moderna

  • pfizer

• protein based

  • noravax

What are the current recommendations for COVID-19 vaccine in individuals 12-64?

• 1 dose of mRNA vaccine

• 1 dose of Noravax (unless 1st time you would get 2 doses 3-8w apart)

What are the current recommendations for COVID-19 vaccine in individuals ≥65?

2 doses of any vaccine at least 6m apart

What are the current recommendations for COVID-19 vaccine in immunocompromised individuals?

2 doses of any vaccine at least 6m apart

WHO should be immunized for Hep B?

• all infants

• all adolescents not vaccinated

• all adults 19-59

• all adults ≥60yrs old with risk factors

• anyone over 60 that wants it

• BASICALLY EVERYONE up to 60 years old, then after 60 vaccinate if risk factors or if they want it

What are the names of the 4 current Hep B vaccines

• Engerix-B

• Recombivax HB

• Heplisav-B

• PreHevbrio

The Tdap vaccine covers what 3 diseases?

tetanus, diptheria, pertussis (whooping cough)

What is the cause of tetanus?

a. Clostridium tetani bacterial infection

b. Clostridium tetani toxins

c. Respiratory droplets and contact with contaminated surfaces

d. Various contagious bacteria that enter the body through wounds

b.—> caused by the TOXIN, not by the bacteria itself

Is Tdap and DTap the same thing?

a. yes

b. no

b.

Tdap products are approved for ages ___ and up.

4

What are the current vaccine recommendations for Tdap in children age 11+?

1 dose of Tdap and then a booster dose with either Td or Tdap every 10 years

What are the current vaccine recommendations for Tdap in pregnancy?

1 dose of Tdap during EVERY PREGNANCY at 27-36 weeks gestation

WHAT are the names of the current Tdap vaccines?

What ages are they approved in?

(gilmore- know these options)

• Adadel: for 10 and +

• Boostrix: for 4 and+

MMR vaccine is short for…

measles, mumps, rubella

Current MMR vaccine recommendations for children?

2 dose series at age 1 and 4

Current MMR vaccine recommendations for adults?

• if unvaccinated—> 1 dose should be fine

• some exceptions: healthcare workers, college students, international travelers

What is the MMR-II vaccine?

a. live, 0.5ml administered SQ

b. inactivated, 0.5ml administered SQ

c. live, 0.1ml administered IM

d. inactivated 0.1ml administered IM

a.