AphA content

Examples of Active Immunity

infection with chickenpox and influenza vaccine

Examples of Passive Immunity

antibodies in breast milk, antivenom injection, and immune globulin infusion

Live vaccines

MMR, Varicella, Rotavirus, MMRV, Live attenuated influenza, Oral Typhoid Capsules, Yellow fever

Inactivated Vaccines

Flu, covid, rsv, pneumoccoal, hep a and b, meingococcal, Tdap, polio, zoster, HPV, typhoid injection, chikungunya

Can you separate injection sites

Yes by 1 inch

Minimum interval of 2 inactivated vaccines

No minimum

Minimum interval for inactivated and live vaccines

No minimum

2 live vaccines, if not simultaneous minimum interval

28 day minimum interval

Minimum interval for inactivated vaccines and antibodies

No minimum

Minimum interval for live vaccines followed by blood products

2 weeks

Minimum interval for blood product given before live vaccine

Minimum interval varies

Minimum interval live vaccine followed by PPD skin test

28 day minimum

PPD skin test followed by live vaccine minimum interval

Administer vaccine after PPD skin test has been read

ACIP grace period for vaccines

On time is within 4 days of the minimum interval; some states do not allow a grace period

Do live vaccines have a grace period

No

Universal contraindication for all vaccines

Severe allergy to a vaccine or vaccine component following a previous dose

Temporary contraindications

Pregnancy and immunosuppression

False contraindications

minor illness, allergies to products not in the vaccine, allergies that are not immediate and life threatening, pregnancy in the household, breastfeeding, premature birth

Vaccine Recommendation Process

FDA Approval, ACIP Recommendation, CDC Director Approval

Intended Audience of AAP

Pediatric health care providers

ACOG intended audience

OB/GYN and women’s health providers

AAFP intended audience

Family medicine and primary care providers

ACP Intended Audience

Internal medicine and adult primary care providers

ISDA intended audience

Infectious disease specialists and clinicians

Standard dose, unadjuvanted inactivated (IIV3)

-Fluarix,FluLaval,Fluzone,Alfuria
-Egg based manufacturing process that has been used for more than 70 years

-Candidate vaccine strain grown in fertilized chicken eggs and incubated to replicate

Cell Culture-based inactivated (ccIIV3)

-Flucelvax

-candidate vaccine strain grown in mammalian cells

Adjuvants inactivated (aIIV3)

-fluad

-uses egg based methods, after the virus is harvested and split into surface proteins it is blended with an oil in water adjuvant which boosts immunity

High dose inactivated (HD-IIV3)

-fluzone high dose

-uses egg based method with four times the antigen

Recombinant (RIV3)

• Flu

• flublok

• do not require the use of a candidate vaccine virus for production

• virus gene that contains the genetic instructions for making the HA which is then combined with baculovirus, a virus that infects inveterbrates

Live attenuated influenza vaccine (LAIV3)

• Flumist

• Use egg-based methods where weakened live viruses are injected in fertilized chicken eggs and incubated to replicate

• Strains are genetically modified to be cold adapted temperature sensitive

Did the child receive > 2 doses of trivalent or quadrivalent vaccine before July 1, 2026? No or Unknown

2 doses of 2026-27 influenza vaccine (administered >4 weeks apart)

Contraindication for flu

severe hypersensitivity to a component

LAIV contraindications

pregnancy, immunocompromised, HIV infection, asplenia, complement disorders, children <5 years with recurrent wheezing, asthma, drug interactions (aspirin, salicylates, antivirals targeting influenza virus)

Influenza Injection site

pain,erthema, tenderness, swelling, itching, soreness,brusing

Flu systemic symptoms

H/A, fatigue, irritability, lose of appetite, muscle ache, joint ache, abnormal crying, vomiting, diarrhea, syncope

Flu uncommon symptoms

anaphylaxis, Guillain-barre syndrome, febrile seizures

Flu Nasal Symptoms

runny nose, nasal congestion

Flumist

-use within 12 hours outside of refrigerator

-children <18 years should not self administer

Children and Adolescents Recommendations

-Age appropriate routine annual influenza vaccination is recommended for all persons aged 6 months through 18 years of age who do not have contraindications

-HD-II3 and aLL3 influenza vaccine as acceptable options for influenza vaccination of solid organ transplant recipients aged 18 years receiving immunosuppressive medication regimens without a preference over other age appropriate IIV3s or RIV3

recommendation for flu >65 years

high dose inactivated

recommendations for flu for 19-64 years solid organ transplant patients receiving immunosuppressive medication regimens

no specific recommendation

Vaccination during July and August not recommended for most groups except:

-pregnant persons in the third trimester

-children <9 years who need 2 doses in one season

-concern that vaccination later in the season might not be possible

For most persons who need only 1 dose of influenza vaccine for the season

September and October

PPSV

-different polysaccharides from different serotypes as the antigen

-immune response is T cell independent

PCV

-polysaccharides for different serotypes attached to a carrier protein

-T0cell dependent response that produces memory B cells and reduces carriage of the bacteria in the respiratory tract

PPSV23

Pneumovax

PPSV23 approved age recommendation

• 50 years and older

• > 2 years of age at risk for pneumococcal disease

PC15

VAXNEUVANCE

PCV15 Approved Age Indication

6 weeks of age and older

PCV20

prevent 20

PCV20 Approved Age Indication

6 weeks of age and older

PCV21

Capvaxive

PCV21 Approved Age Indication

• 18 years and older

• Children 2-17 years who have completed a PCV vaccine series and have at least one medical condition

Pneumococcal Vaccine Precatuion

Immune suppressing therapies could reduce efficacy

Pneumococcal Vaccine Contraindication

severe hypersensitivity to a component

PCV Vaccine- Injection Site

tenderness, redness, swelling, pain, induration, limited arm movement

PCV Vaccines- Systemic

irritability decreased, changes in sleep pattern, headache, muscle pain, joint pain, vomiting, chills, rash, syncope

PCV Vaccine and PPSV Vaccine- Uncommon

Anaphylaxis

PPSV Vaccine- Injection Site

pain, soreness, tenderness, swelling, induration, erythema

PPSV Vaccine- Systemic

headaches asthenia, fatigue, muscle ache

Pneumococcal Vaccine Recommendations- Children

Pneumococcal Vaccine Recommendation-Adults > 50 years

Single dose of PCV15 followed >1 year later by a single dose of PPSV23 or Single dose of PCV20 or Single dose of PCV21

Pneumococcal Vaccine Recommendation-Adults 19-64 years with certain medical conditions

Single dose of PCV15 followed >1 year later by a single dose of PPSV23 or Single dose of PCV20 or Single dose of PCV21

RSV mAb

-Antibodies circulate in the bloodstream and recognize and attach to the RSV virus if encountered, leading to elimination of the virus

-Provides passive immunization for immediate protection and lasts for about 5 months

Protein-Based RSV

-Recombinant protein vaccines that contain the perfusion form of the F protein found on the surface of the RSV virus

RSV mRNA

-mRNA that encodes the perfusion form of the RSV F glycoprotein

-mRNA vaccine temporarily enables some of the vaccine recipients own cells to produce the perfusion form of the RSV F protein, causing the immune system to respond by generating antibodies to it

mAB RSV vaccines

Nirsevimab and Clesrovimab

Nirsevimab age approved indication

Neonates and infants born during or entering their first RSV season. Children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season

Clesrovimab Approved Age Indication

Neonates and infants who are born during or entering their first RSV season

Nirsevimab mAb Recommendation

-Infants <8 months of age born during or entering their first RSV season if:

• Pregnant parent did not receive RSV vaccine during this pregnancy

• Pregnant parent’s RSV vaccine status is unknown, OR

• Infant was born <14 days after the pregnant parent’s RSV vaccination

• Born during RSV season; Administer 1 dose nirsevimab within 1 week of birth, ideally during the birth hospitalization

• Born outside of RSV season: Administer 1 dose nirsevimab shortly before or during the RSV season

RSV mAb Contraindication

severe hypersensitivity to a component

RSV mAb Injection Site

Pain, induration, edema, swelling

RSV mAb Systemic

maculopapular rash

RSV mAb Uncommon

anaphylaxis

RSV Vaccine you should give to pregnant patient

Abrysvo

Adjuvanted RSVPreF3

Arexy

Arexy approved age indication

18 years and older

Bivalent RSVpreF

Abrysvo

Abrysvo Approved Age Indication

-18 years and older

-32 through 36 weeks weeks gestational age of pregnancy

Nucleoside modified mRNA encoding the RSV F glycoprotein stabilized in pre F protein mRNA-1345

mRESVIA

mRESVIA Approved Age Indication

18 years and older

RSV Vaccine Safety- Protein Vaccines

Injection Site- Pain

Systemic- tiredness, headaches, muscle pain, joint pain, fever, chills

Uncommon- Anaphylaxis, Guillain-Barre Syndrome

RSV Vaccine Safety- mRNA Vaccine

Injection Site- pain, underarm swelling and tenderness

Systemic- fatigue, tiredness, headache, nausea, muscle pain, joint pain, chills

Uncommon-anaplylaxis

RSV Vaccine Recommendation-Adult

-All adults aged >75 years

-Adults 50-74 years who are at increased risk of severe RSV disease receive a single dose of RSV vaccine

Older Adults Correct RSV Product

Abrysvo, Arexvy, mResvia

mRNA COVID vaccine

Lipid nanoparticle formulated, nucleoside modified mRNA vaccines encoding the perfusion spike glycoprotein of SARS CoV2

Protein-based COVID Vaccine

-Contain pieces of the virus that causes COVID 19

-Contains an adjuvant

mRNA Covid 19 Vaccines

COMINARTY, SPIKEVAX,mNEXSPIKE

Protein-based Covid Vaccine

NUVAXOVID

Cominarty Age Approved Indication

-5 years to 64 years of age with at least one condition that puts them at that puts them at high risk for severe outcomes from COVID-19

-All adults 65 years and older

SPIKEVAX Age Approved Indication

-6 months to 64 years of age with at least one condition that puts them at that puts them at high risk for severe outcomes from COVID-19

-All adults 65 years and older

mNEXSPIKE Age Approved Indication

-12 to 64 years of age with at least one condition that puts them at that puts them at high risk for severe outcomes from COVID-19

-All adults 65 years and older

NUVAXOVID Age Approved Indication

-Ages 12-64 years with at least one underlying condition that puts them at high risk for severe outcomes COVID-19

-All adults ages 65 years and older

COVID 19 Vaccine Safety mRNA Vaccines

-Injection Site: pain, swelling, auxiliary swelling, redness

-Systemic: fatigue, headache, muscle pain, chills, joint pain, N/V, fever, syncope

-Uncommon: Anaphylaxis, myocarditis, pericarditis, Guillain-Barre Syndrome

COVID 19 Vaccine Safety Protein-Based Vaccines

-Injection Site: pain, tenderness, redness, swelling

-Systemic: Fatigue, malaise, muscle pain, headache, joint pain, N/V, fever, syncope

-Uncommon: Anaphylaxis, myocarditis, pericarditis, Guillain Barre Syndrome

Covid 19 Vaccine Recommendation Ages 6 months-18 years

No recommendation

Covid 19 Vaccine Recommendation Adults Age 19-64 years

AAFP one or two more doses

Covid 19 Vaccine Recommendation Adults Age >65 years

AAFP two or more doses