Immunization (pharmacy practice exam)

What are live attenuated vaccines?

- Made from viruses or bacteria

- Must replicate to work

- Replication mimics natural infection, which stimulates immune response

What are inactivated vaccines?

- Made from viruses or bacteria, or virus-like particles

- Do not replicate because they are not live

- May contain adjuvants to enhance immune response

Is MMR live or inactivated?

live

1 multiple choice option

Is varicella live or inactivated?

live

1 multiple choice option

Is rotavirus live or inactivated?

live

1 multiple choice option

Is MMRV live or inactivated?

live

Is the live attenuated influenza vaccine live or inactivated?

live

Are oral typhoid capsules live or inactivated?

live

Is yellow fever vaccinations live or inactivated?

live

Is chikungunya live or inactivated?

live

Is influenza live or inactivated?

inactivated

Is COVID-19 live or inactivated?

inactivated

Is RSV live or inactivated?

inactivated

Is pneumococcal live or inactivated?

inactivated

Are Hep A and B live or inactivated?

inactivated

Is meningococcal live or inactivated?

inactivated

Is Haemophilus influenza live or inactivated?

inactivated

Are diphtheria, tetanus, and pertussis live or inactivated?

inactivated

Is poliovirus live or inactivated?

inactivated

Is zoster live or inactivated?

inactivated

Is human popillomavirus live or inactivated?

inactivated

Is the typhoid Vi injection live or inactivated?

inactivated

What is a contraindication?

A condition that greatly increases the risk of an adverse reaction. Do not vaccinate if the vaccine is likely to injure the patient

What is the universal contraindication for all vaccines?

Severe allergy to a vaccine or vaccine component

What is a temporary contraindication? Give some examples

A contraindication that would delay a vaccination for a period of time. Examples are pregnancy and immunosuppression

List some false contradictions

Minor illnesses, allergies to products not in the vaccine, allergies that are not life threatening, pregnancy in the household, breastfeeding, and adjusting for premature birth

What groups are at higher risk for serious complications due to influenza?

Adults over 50 years, children 6-59 months, people with chronic medical conditions, and pregnant women

What influenza vaccine, dose, and number of doses is recommended for 6-35 month olds?

Vaccine: IIV3

Dose: 0.25mL or 0.5mL (IM)

Number of doses: 1 or 2

What influenza vaccine, dose, and number of doses is recommended for 3 to 9 year olds?

Vaccine: IIV3

Dose: 0.5mL (IM)

Number of doses: 1 or 2

What influenza vaccine, dose, and number of doses is recommended for 9 year olds and older?

Vaccine: IIV3

Dose: 0.5mL (IM)

Number of doses: 1

What influenza vaccine, dose, and number of doses is recommended for those 65 years and older?

Vaccine: HD-IIV3

Dose: 0.7mL (IM)

Number of doses: 1

or

Vaccine: aIIV3

Dose: 0.5mL (IM)

Number of doses: 1

What age group is the live attenuated influenza vaccine recommended in? What is the dose and number of doses recommended?

Age: 2-49 years

Dose: 0.2mL (1 spray in each nostril)

Number of doses: 1 or 2

Routine annual influenza vaccination is recommended in all persons:

aged >6 months and do not have contraindications

High-dose inactivated and adjuvanted inactivated influenza vaccines are acceptable options for:

Those receiving a solid organ transplant aged 18-64 years receiving immunosuppressants

What influenza vaccines are indicated for ages 65+?

Trivalent high-dose inactivated (HD-IIV3), Trivalent recombinant (RIV3), and Trivalent adjuvanted inactivated (aIIV3)

When do children need to receive two doses of the influenza vaccine?

In their first flu season (their first time receiving the dose). Needs to be spaced 4 weeks apart. After, they only receive one dose

When should most people who receive one dose of the influenza vaccine get the vaccine?

In September or October

Influenza vaccine in july or august should be avoided in:

Most adults (especially over 65) and for pregnant people in first or second trimesters

Influenza vaccine in july or august can be considered in:

Pregnancy in the third trimester and children of any age who require 1 dose

Influenza vaccine in july or august should be given if possible in:

Children receiving two doses of the vaccine

What two influenza vaccines are non-egg based?

Flucelvax (ccIIV3) and Flublok (RIV3)

Influenza vaccines are indicated for use in:

Preventing the flu

These vaccinations protect against tetanus, diphtheria, and pertussis

DTaP and Tdap

These vaccinations protect against tetanus and diphtheria

DT and Td

DTaP is used in ages:

7 and under

Tdap is used in ages:

over 10

Boostrix: >10

Adacel: 11-64

Is Tdap recommended in pregnancy?

Yes, around 27-36 weeks

Give DTaP to complete primary series in ages:

6 weeks to 6 years

Give Tdap in ages _________ who are not fully vaccinated against pertussis

7-10 years

What is the recommendation for tetanus, diphtheria, and pertussis vaccination in those 11 and older?

If no record of Tdap, give 1 dose

Afterwards, they can receive 1 dose of Td or Tdap every 10 years

Use Boostrix in those:

65 years and older

Pregnant women need a Tdap in ______ pregnancy

every

1 multiple choice option

What is the indication for MMR?

Prevention in contracting measles, mumps, and rubella

What is the primary population that receives the MMR vaccination? Give the doses required

Children in a 2 dose series

Dose 1: 12-15 months

Dose 2: 4-6 years

When should adults receive 1 dose MMR?

If they were born after 1957 and never received a dose

What population of adults need both doses of MMR (4 weeks apart)?

-Students entering post-high school education who never received a dose.

- Healthcare professionals who never received a dose

What is the primary population that receives the Varicella vaccination? Give the doses

Children (2 doses)

Dose 1: 12-15 months

Dose 2: 4-6 years

When do older children need Varicella?

If no evidence of immunity

7-12 years: 2 doses, 3 months apart

13 and older: 2 doses, 4-8 weeks apart

What is the indication for Varicella?

Chicken pox

What population receives Shingles vaccination?

- Adults 50 and older

- Adults 18 and older who are immunosuppressed

What is the indication of Shingles (RZV)?

Prevention of Herpes Zoster (characterized by intense neuropathic pain). Caused from reactivated dormant chicken pox virus

What is the indication of 9vHPV?

Prevent sexually transmitted diseases and complications that follow such as cervical cancer. Covers 9 types of HPV

What populations receive 9vHPV?

- Ages 9-14 (2 doses)

-Ages 15-26 (3 doses)

-Ages 27-45 if not vaccinated (3 doses)

Why is 9vHPV recommended in children?

To prevent HPV conditions before they have a chance to contract it in later years

Describe pneumococcal disease

A bacterial infection that can be present as a disseminated disease or diseases in the lower/upper respiratory systems

Pneumococcal as disseminated diseases

Bacteremia, meningitis, arthritis, and peritonitis

Pneumococcal in the lower respiratory system

Pneumonia

Pneumococcal in the upper respiratory system

Sinusitis and otitis media

What are the four pneumococcal vaccines?

PCV15, PCV20, PPSV23, PCV21

The age recommendation for the pneumococcal vaccine just changed from 65 to

50

Pneumococcal for infants and children

PCV15 or PCV20

Doses at 2, 4, 6, 12-15 months

24-59 months can have 1 PCV15 or PCV20 if incomplete series

Pneumococcal for 2-18 years with certain medical conditions completely vaccinated before 6 years.

PCV20 or PPSV23 at least 8 weeks after the last PCV15

(Do not need the vaccine if have 1 or more PCV20 doses in childhood)

Pneumococcal for 6-18 years with certain medical conditions without a PCV dose

PCV20 or PCV15 followed by PPSV23 8 weeks later

Pneumococcal for adults 65 and older and 19-64 with medical conditions

Single dose of PCV15 with PPSV23 a year later or

Single dose of PCV20 or

Single dose of PCV21

Adults who have received PPSV23 but have not received any PCV dose should receive

PCV15 or PCV20

Describe PCV21 and the target population

Recently approved in June of 2024 but not for use in children. It is an option for adults over 19 years.

What conditions qualify a 19-64 year to receive pneumococcal?

Alcoholism, chronic heart/liver/lung disease, chronic renal failure, smoking, cochlear implant, congenital or acquired asplenia, CSF leak, diabetes, generalized malignancy, HIV, Hodgkin disease, immunodeficiency, iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, organ transplant, sickle cell disease, etc.

What population is Hep A recommended for?

- Routine vaccination in children 1-2 years old

- Adults who desire it or have risk factors

2 doses, 6 months apart

What is the catch up recommendation for Hep A?

For children up to 18

What population is Hep B recommended for?

- All infants

- Adolescents and adults 19-59 who have not received it

- Adults over 60 with risk factors should get it

- Adults over 60 without risk factors, with diabetes, or requests it may get it

Describe RSV

A common respiratory virus that causes mild, cold-like symptoms. Spread via respiratory droplets. Infects 90% of children in first year of life. Most common cause of bronchitis and pneumonia in children under 1 year

Describe the symptoms of RSV seen in adults

Usually no symptoms in healthy individuals but can lead to upper and lower respiratory diseases in those with underlying conditions like asthma or COPD

More severe cases of RSV are more likely to be seen in:

Infants and young children, adults with chronic medical conditions, and older adults

RSV passive immunization

Nirsevimab-alip that is a long-acting monoclonal antibody that provides passive immunization for 150 days (during RSV season) for children (1-2 years) and older adults

Describe the dosing of Nirsevimab-alip

In a child's first RSV season:

50 mg for <5kg

100 mg for >5kg

In a child's second RSV season if still vulnerable:

200mg (2 x 100 mg vaccinations)

Who is Nirsevimab-alip recommended for?

First dose: Infants under 8 months in their first flu season

Second dose: children 8-19 months who are at increased risk

What are the three RSV vaccines for adults?

Adjuvanted RSVPreF3 by GSK

Bivalent RSVpreF by Pfizer

Nucleoside modified mRNA encoding by Moderna

What population is the GSK RSV vaccine approved in?

50-59 years and older

What population is the Pfizer RSV vaccine approved in?

60 years and older

32-36 weeks in pregnancy

What population is the Moderna RSV vaccine approved in?

60 years and older

What adult populations is RSV recommended in?

Everyone 75 and older: single dose

Those 60-74 years that are at increased risk of RSV: single dose

What conditions qualify a 60-74 year old to receive RSV?

Cardiovascular, lung, kidney, liver diseases, diabetes, obesity, decreased immune function, neuromuscular or neurologic conditions, hematologic conditions, frailty, residence in a nursing home, etc.

What is the only RSV vaccine that has been recommended in pregnant women?

RSVpreF by Pfizer

What population is Meningococcal (A, C, W, Y) recommended in?

All adolescents:

1 dose at 11-12

1 booster at 16

Adults with certain medical conditions:

2 doses at least 8 weeks apart

What age is Meningococcal no longer recommended?

19

What medical conditions indicate someone qualifies for Meningococcal?

Persistent complement component deficiency, anatomical or functional asplenia, and HIV

What population is Meningococcal B recommended in?

High risk patients 10 years and older:

-complement deficiencies

- asplenic

- microbiologist

- those exposed during outbreaks

What is the Poliomyelitis indicated for?

Polio

What population is Poliomyelitis recommended in?

Routine in infants: 4 doses

Adults who are not vaccinated should receive the series

What population is COVID-19 recommended in?

All people 6 months and older