Naplex - Immunizations

Function of the FDA and vaccines

Approve the indications for a vaccine based on safety/efficacy

Function of the Advisory Committee on Immunization Practices (ACIP) and vaccines

Provides recommendations for who should get the vaccine and when

Function of the Centers for Disease Control (CDC) and vaccines

Approves ACIP recommendations and publishes them in the CDC Morbidity and Mortality Weekly Report and the Pink Book

Federal law requires that the _____ be provided to patients to explain vaccine benefits and risks

Vaccine Information Statements (VIS)

Define active immunity

Person's own immune system produces antibodies

Define passive immunity

Immunity is passed down to someone else

Two examples of passive immunity

Pregnancy

IVIG

Define live attenuated vaccines

Produced from a modified antigen that has the ability to replicate but not cause illness

In what patient populations are live attenuated vaccines contraindicated?

Immunocompromised

Pregnant

Hx anaphylaxis to vaccines

Define inactivated vaccines

Composed of a killed antigen to create immunity that diminishes over time and requires "boost" doses

List the types of inactivated vaccines

Polysaccharide

Conjugate

Recombinant

Toxoid

mRNA

MOA polysaccharide vaccines

Antigen taken from the outer sugar layer of encapsulated bacteria

Polysaccharide vaccines do NOT produce strong immunity in patients < ___ years old

two

MOA conjugate vaccines

Antigen taken from the outer sugar layer of encapsulated bacteria and attached to a carrier protein for a stronger immune response

MOA recombinant vaccines

A gene segment from a protein of the bacteria is inserted into the gene of another cell (i.e. yeast) for replication

MOA toxoid vaccines

Vaccine targeted against a toxin produced by a disease (i.e. diphtheria)

MOA mRNA vaccines

The vaccine instructs the body to produce proteins specific to an antigen to trigger an immune response

types of live vaccines

MICRO-VY

MMR

Intranasal influenza

cholera

rotavirus

oral typhoid

varicella

yellow fever

(other but not key: TB, dengue, smallpox, ebola)

Increasing the interval between doses of a vaccine given in a series will:

Decreasing the interval between doses of a series can:

Increasing the interval between doses of a vaccine given in a series will not diminish effectiveness but will delay protection.

Decreasing the interval between doses of a vaccine can interfere with antibody response and is avoided. (decreased efficacy)

Live vaccines are withheld in a child until what age? what is the exception?

What age can inactivated vaccines be given? what is the exception?

live: 12mos old, except rotavirus

inact: can be given at any time, but usually 2 months, except hep b which is at birth.

Most live vaccines are withheld until a newborn is at least ____ until the mother's antibodies are depleted to allow adequate response

12 months

Inactivated vaccines are started when an infant is ____ months old except for the ____ which is started at birth

Two

hepatitis B vaccine

How to manage timing around the live TB vaccine and a TB test to prevent a false positive

option1: Give the live TB vaccine that same day as the TB test

option2. Wait until at least 4 weeks after the live TB vaccine is given to test

option 3. Get the TB test, wait >/=24 hrs for the result, then give the live TB vaccine

Multiple live vaccines can be given on the same day, otherwise they must be spaced at least ___ weeks apart

four

Wait time for: (MMR/varicella containing/live) vaccine → __timing between__ → antibody containing product

AB contiang eg (IVIG, blood transfusion)

2 weeks

Wait time for: antibody containing product → __timing between__ → (mmr/varicella contianing/live) vaccine

AB contiang eg (IVIG, blood transfusion)

3-11 months

T/F: a vaccine and immunoglobulin can be given at the same time for post-exposure prophylaxis (eg. hep a, rabies)

true

rabavert

rabies vaccine

A one year old male presents for a routine checkup at the pediatrician. He receives the mmr vaccine, but the office has used their last dose of var I va X and PREVNAR 1 3 so he is unable to receive these at the current visit. How long must he wait before receiving these vaccines?

MMR = live

varvX = live (varicella) -> must wait 4 weeks (28 days) b/t live vaccines

prevnar = inactivated -> no minimum interval (any time) -> can give as soon as get stock

Adverse reactions that occur as a result of vaccines should be reported to the ____

FDA's Vaccine Adverse Event Reporting System (VAERS)

With live vaccines, mild systemic reactions can occur ___ after the vaccine is given.

3-21 days

intransal flu vaccine can cause mild

cold-like symptoms such as runny nose

Minor allergic reactions to vaccines can be treated with ____

diphenhydramine

hydroxyzine

NOT CI for future vaccines

Treatment of severe allergic reaction to vaccines

pre-filled epi auto-injectors - > at least 3 should be on site

Which vaccines carry the precaution of Guillain-Barre syndrome?

Diphtheria

Tetanus

Pertussis

Influenza

Which vaccines are contraindicated with severe egg allergies?

Yellow fever vaccine

Live influenza vaccine

Vaccines recommended in infants and children

3-dose hepatitis B at birth

At 2 months: PCV15/20, DTaP, Hib, polio, rotavirus

At >/ 12 months: MMR, varicella

RSV monoclonal antibody: if mom wasnt vaccinated during preg

Vaccines recommended in adolescents and young adults

Meningococcal quadrivalen (MenACWY-> Menveo, menquadfi)

2 doses: x1 at 11-12 yo; x1 at 16 yo

1 dose: college students if not prev vaccinated

HPV: x1 at 11-12 yo followed by 1 dose OR 3 doses if start >15yrs old

Tdap: x1 at 11-12 yo then q10yrs

Vaccines recommended during pregnancy

Inactivated influenza ( any trimester)

Tdap x1 per pregnancy (27-36 weeks preferred)

RSV (abrysvo) IF at 27-36 weeks during during rsv season

Vaccines recommended in older adults

Herpes zoster: if age >/= 50

-2 doses, 2-6 mos apart

Pneumococcal: if >/= 65

-PCV20 x1

OR

PCV15 x1, then PPSV23 x1 >/=12mos later (or >/=8 wks if immunocomp'd)

Vaccines recommended in patients with diabetes

Pneumococcal:

-PCV20 x1

OR

PCV15 x1, then PPSV23 x1 >/=12mos later (or >/=8 weeks if immunocomp'd)

Hepatitis B: if age >/= 60

x1 (if not given at birth)

Vaccines recommended for healthcare professionals

Annual influenza

Tdap if not up to date

Hepatitis B (if not previously/negative titer)

Varicella (if not previously/negative titer)

MMR (if not previously/negative titer)

Vaccines recommended for sickle cell disease/asplenia

Hib x1 (for h.flu)

Pneumococcal: (PCV)

-PCV20 x1

OR

PCV15 x1, then PPSV23 x1 >/=8 weeks

Meningococcal x1 (quadrivalent & serogroup B (menB))

Vaccines recommended for immunodeficient patients

Pneumococcal:

-PCV20 x1

OR

PCV15 x1, then PPSV23 x1 >/=8 weeks

Herpes zoster (shingrix): if >/=19

-2 doses, 2-6mos apart

IF HIV: meningococcal x1, hepatitis A x1, hepatitis B x1

LIVE ARE CI

List immunocompromising vaccines that require additional vaccinations

Chronic renal failure

Nephrotic syndrome

Malignancy

HIV

Solid organ transplant

Immunosuppressive medications

How often is Td/Tdap given?

every 10 years

Which adult patient populations are recommended to receive the shingles vaccine?

All adults >/ 50 yo

>/ 19 yo and immunosuppressed

Describe the dosing schedule with the pneumococcal vaccine

PCV20 x1 or

PCV15 x1 followed by PPSV23

In what adult patient populations is the pneumococcal vaccine recommended?

Age 19-64 yo with certain conditions*

>/ 65 yo

*AUD, current smoker, diabetes, heart/lung/liver disease, sickle cell, asplenia, HIV, malignancy, transplant, renal failure, immunosuppressive meds

When is hpv vaccine recommended in adults?

>/= 26 who didnt complete the series

What adult patient populations should receive the hepatitis B vaccine?

All adults 19-59 yo

>/ 60 years old with risk factors*

*liver disease, HIV, MSM, multiple partners, IVDU, incarcerated, blood exposure, dibates, dialysis

Which adult patients should receive the meningococcal vaccine?

Asplenia, HIV, endemic travel, military, dorm students if not up to date

Which adult patients should receive the hepatitis A vaccine?

Undeveloped travel, newly arriving adopted child exposure from an infected area, chronic liver disease, hemophilia, MSM, IVDU, homeless, HIV

In healthy adults the PCV15 and PPSV23 should be given _____ apart

>/ 12 months

In immunocompromised adults the PCV15 and PPSV23 should be given _____ apart

8 weeks

Which vaccine is given orally?

Rotavirus

Cholera

Typhoid

What medication should be stopped at least 24 hours before the varicella vaccine?

antivirals

The first dose of the rabies post-exposure vaccine should be given with ____

1 dose of rabies immunoglobulin

Counseling pearls for the typhoid vaccine oral capsules

Store in the fridge

Take on an empty stomach

Take with cold or lukewarm water

T/F: the cholera vaccine is a live vaccine

true

Which vaccines are stored in the freezer?

Varicella

MMRV

Oral cholera

Which vaccines are given ONLY SQ?

Yellow fever

Dengue

Smallpox

Monkeypox

Priorix(MMR)

Needle length and gauge for SQ injections

23-25 gauge

5/8" needle

Needle length and gauge for IM injections (and exceptions)

22-25 gauge

1" needle

EXCEPT: < 130lbs = 5/8 - 1" needles; > 260 lbs (M) or > 200 lbs (F) = 1.5" needles

Diptheria and Tetanus Toxoids, Acellular Pertussis Vaccine - which version is pediatric? adult?

Big D (DTap) = little kids <7

Little d (Tdap, Td) = adults

Tdap/Td is given for wound prophylaxis if:

deep or dirty wounds + has been >5 yrs since last booster

Pediarix

DTaP-HepB-IPV

adacel

Tdap

boostrix

Tdap

havrix

hep a

vaqta

hep a

engerix-B

hepatitis B vaccine

heplisav-B

hepatitis B vaccine

recombivax HB

hepatitis B vaccine

gardasil 9

HPV9

Which flu vaccines are preferred for patients aged 65 years or older?

high dose

fluzone HD

fluad

flublok

Which are the egg free formulations of the flu vaccine and who can receive them?

age >/= 6 mos: flucelvax

>/= 18: flublok

flumist + age range

influenza vaccine live

2-49 yo

inactivated flu vaccine names

afluria

fluarix

flulaval

fluzone

all are ok for age >/= 6 mos

how is flumist administered?

0.2 mL divided between 2 nostrils

proquad

MMR + Varicella

MenQuadfi

Menveo

age ranges

quadfi: >/=2

veo: 2mos-55

MenACWY vaccine names

menquadfi

menveo

MenB vaccine names

Bexsero

trumenba

MenABCWY ( all of them) vaccine name

penbraya - must use both the syringe and the vial

Children <2 should not receive which pneumococal vaccine?

pcv23 -> polysaccharide version

rotarix

rotavirus vaccine

rotateq

Rotavirus

abrysvo

Respiratory Syncytial Virus Vaccine (Recombinant) -> goes to mom only not baby

beyfortus

Nirsevimab - rotavirus mAb - 1 dose for baby

synagis

Palivizumab - rotavirus mAb -= premature infants

varivax

varicella vaccine - chickenpox

shingrix

Herpes zoster vaccine (shingles)

do not give any varicella/zoster vaccine if allergic to

gelatin or neomycin

where to store varivax and shingrix? + routes

varivax (chickenpox) - in the freezer

-give sc or im

shingrix (shingles) - DO NOT STORE IN FREEZER, REFRIDGE ONLY

-IM ONLY

MMRII is stored

in fridge or freezer

SC only