Vaccinations and travelers

Who authorizes vaccines?

FDA approves the indication for a vaccine based on demonstrated efficacy and safety

Who provides recommendations for vaccine administration?

Advisory committee on Immunization Practices (ACIP)

Who approves the ACIP and publishes it on their website?

CDC

What is the Pink book?

book on the epidemiology and prevention of vaccine preventable diseases

Who prepares the vaccine information sheets?

CDC

What is a vaccine information sheets?

it explains each vaccine benefit and risks.

it is required by law to be given to the patient before a vaccination is administered

Do vaccines cause autism:

no

Own immune system produces antibodies:

active immunity

Acquired immunity when antibodies are provided by someone else:

passive immunity

Examples of live vaccines:

MMR

Intranasal influenza

Cholera

Rotavirus

Oral typhoid

Varicella

Yellow fever

BCG

Smallpox

Dengue

Ebola

Weakened vaccines produced by modifying a disease producing virus or bacteria:

live attenuated vaccines

Contraindications to live attenuated vaccines:

pregnant

immunocompromised patients

Examples of inactivated vaccines:

Toxoid vaccines

conjugated vaccines: Prevnar 20, Menveo

Polysaccharides vaccines: pneumovax 23

recombinant vaccines: HPV (Gardasil 9), flublok quadrivalent

mRNA vaccines: Covid-19

How do you administer vaccines?

vaccines can be given at the same time and day

Multiple live vaccines can be given at the same day or if not given on the same day give 4 weeks apart

How do you administer a live vaccine with someone receiving antibodies?

MMR and varicella vaccines require separation from antibody containing products:

• give vaccine than wait 2 weeks to give antibodies or

• give antibody product and wait >3 months before given vaccine

In what case do you simultaneous administer a vaccine and antibody together?

for post exposure prophylaxis certain diseases: hepatitis A, rabies, tetanus

How long should a patient wait after receiving a vaccine?

15 minutes

Where do you report vaccine reactions?

FDA VAERS

Local reactions to vaccines:

pain

swelling

redness

Systemic reactions to vaccines:

fever

myalgia

headache

How long after receiving a vaccine can a patient see system reactions to the vaccine?

3-21 days

Treatment for true allergy to vaccine

minor reaction is treated with benadryl or hydroxyzine

for severe epipen: 1:1000

What are contraindications to diphtheria, tetanus, and pertussis vaccine?

encephalopathy that is not attributed to another cause within 7 days after receiving the previous pertussis vaccine

What are contraindications to hepatitis B and HPV vaccines?

allergic to yeast

Vaccine schedule for infants and children:

Hep B vaccine (3 doses): started at birth

RSV monoclonal antibody: given if mother did not receive during pregnancy

vaccines started at 2 months: PCV15 or PCV20, DTap, Hib, Polio, Rotavirus

Vaccines started at > 12 months: live vaccines ( MMR, varicella)

no polysaccharide vaccines before age 2 years

Vaccinations in adolescents and young adults:

meningococcal quadrivalent vaccine (Menveo or MenQuadfi):

• 2 doses: 1 dose at age 11-12 and 1 dose at 15

• 1st year of college students in resident housing( if not previously vaccinated): 1 dose

HPV:

• recommended at age 11-12

• 2 or 3 dose

Tdap:

• 1st dose at age 11-12 years

Vaccinations for pregnancy:

no live vaccines

inactivated influenza given in all trimesters

Given at 32-36 weeks during RSV season: RSV (Abrysvo)

Tdap x1 : weeks 27-36

Vaccine given at age >50 years old: 2 doses 2-6 months apart

herpes zoster vaccine (shingrix)

Vaccine given at age >65 years old: PCV20 ×1; PCV15 ×1, then PPSV23 > 12 months later or ( >8 weeks if immunocompromised):

Pneumococcal vaccine

Vaccinations for diabetic patients:

Pneumococcal vaccine (19-64 years old):

• PCV20 ×1

• PCV15 X1, PPSV23× 1 >12 months

Hepatitis B: age > 60 years old

Vaccines for healthcare professionals:

annual influenza vaccine: if required by employers

Hepatitis B, varicella, MMR if there is no demonstrated immunity: vaccination history or blood test

Vaccinations for patients with sickle cell or other asplenia causes:

H. influenzae

Pneumococcal vaccine

Meningococcal vaccines

Vaccinations for adults:

influenza

Tdap, Td

Shingles

HPV

Pneumococcal

meningococcal

hep B

hep A

Given 1 dose, then every 10 years:

Tdap, Td

Shringrix:

given in adults>50 years old or > 19 years old ( if immunocompromised)

2 dose series: 1st dose, then 2nd dose given 2-6 months after 1st dose

vaccinate even if the patient previously had chickenpox or shingles or recived Zostavax

When is HPV given to adults?

given to adults < 26 years old who did not complete HPV series

Pneumococcal vaccine:

age 19-64 years old ( immunocompromised) or patients age >65 years old:

• PCV20 ×1 or

• PCV15 ×1 followed PPSV23 ×1 > 12 months or > 8 weeks later if immunocompromised

Meningococcal: Serogroup vaccines (Bexsero, Trumenba)

• If complement component deficiency, taking eculizumab or eculizumab, asplenia, microbiologist with exposure to Neisseria meningitidis, serogroup B meningococcal disease outbreak exposure.

Meningococcal: Quadrivalent conjugate (Menveo, MenQuadfi):

•  Same group as above plus HIV, travelers/residents to countries in which the disease is common, military recruits, 1st year college students living in residential housing , if not up to date.

How can you give hepatitis B vaccine?

can give it alone or with hepatitis A vaccine (twinrix)

How should you give hepatitis A vaccine?

give alone or with hepatitis b (twinrix)

COVID-19 vaccine in patients >12 years old who are not moderately or severely immunocompromised

1 dose of moderna or pfizer or 2 dose novavax ( give at 0 and 3-8 weeks)

COVID-19 vaccine in patients <12 years old or immunocompromised

• Consult the CDC website for guidance on recommended vaccines and schedules.

pediatric formulations of diphtheria-toxoid, tetanus toxoid:

DTap

DTap-HepB-IPV (Pediarix)

DTap vaccine administration in pediatrics:

5 dose series given at 2, 4, 6, 15-18 years old

What formulation of diphtheria-toxoid, tetanus toxoid used in adults?

Tdap or Td

Tdap (adacel, boostrix):

given at 11-12 years old

given every 10 years in adults

given to pregnant women in 3rd trimester of pregnancy

given for wound prophylaxis if deep or dirty and it has been more than 5 years since last Td or Tdap dose

How do you store diphteria-toxoid, tetanus toxoid vaccines?

in the fridge

DO NOT FREEZE

How do you administer diphtheria-toxoid , tetanus toxoid?

IM injection

When is H. influenzae Type B (Hib) vaccine given?

adults with asplenia

How is Hib vaccine given?

IM

How is Hib vaccine stored?

put this vaccine in the fridge DO NOT FREEZE

Dosing of hepatitis A ( Havrix, Vaqta) in children:

2 dose series given at 12-23 months

Dosing of hepatitis B (Engerix-B, Heplisav-B, Recombivax HB) in children:

give 1st dose 24 hours after birth

3 doses at age 0, 1-2 months and 6-18m months

Dosing of hepatitis B (Engerix-B, Heplisav-B, Recombivax HB) in adults:

given to adults 19-59 years old or > 60 years old with risk factor including chronic liver disease, HIV infection, blood exposure

When do you give the Twinrix vaccine?

3 dose series at month 0, 1, and 6 prior to travel to high risk areas

How do you store Hepatitis vaccines?

store in fridge (DO NOT FREEZE)

Why is HPV vaccine given?

prevents cervical cancer

When is HPV vaccine recommended?

at age 11-12 years old , but can be started at 9 years old

if started before 15 years old: give 2 doses

if started before 15 or older , or immunocompromised: 3 doses

How do you store HPV?

you put this medication in the fridge and make sure not to freeze

What is the most common vaccine preventable illness in the US?

influenza vaccine

When is flu vaccine given?

annually

When is the flu vaccine recommended to start given to patients?

all patients at least > 6 months old unless they have a contraindication

Flu vaccine: age 6 months to 8 years old

give 2 doses 4 weeks apart

If a patient is allergic to eggs which flu vaccine is safe for them to take:

Flublok and Flucelvax

Which flu vaccines are preferred in patients age >65 years old?

fluzone high dose

fluad

flublok

How do you store MMRV: MMR+Varicella (ProQuad)?

store it in the freezer

How do you store MMR-II vaccine?

store this in the fridge or freezer

How do you administer MMR-II?

SUBQ injection

Contraindication to MMR vaccines:

This is a live vaccine so it can not be used in pregnant or immunocompromised patients

What patients can receive the MenQuadfi vaccine?

patients who are age >2 years old

in what patients do you give Menveo?

You give to patients age 2 months - 55 years old ; it can also be used in adults age > 56 years old

When do you give routine vaccine of meningococcal (MenQuadfi or Menveo) in adolescents?

2 dose series given at age 11-12 years and 16 years old

Special populations at high risk of meningitis and need to get meningitis (MenQuadfi or Menveo) vaccine:

african meningitis belt

age 2 months and older with asplenia/sickle cell disease, HIV infection

lab workers with N. meningitidis exposure

1st year college students living in residential dorms

Where do you store meningitis (MenQuadfi or Menveo) vaccines?

the meningitis vaccine should be stored in the fridge. do not freeze

When is Men B(Bexsero, Trumenba); MenACWY (Penbraya) used?

age > 10 years at high risk:

• asplenia/sickle cell

• lab workers with N meningitidis exposure

• during outbreak

not high risk:

• optional for patients at age 16-23 years who want the vaccine

Pneumococcal vaccine administration in children:

4 doses of PCV 15 or PCV20 given at age 2, 4, 6, and 12-15 months

Conjugated pneumococcal vaccines

Prevnar 20 (PCV20)

Vaxneuvance (PCV15)

Polysaccharide pneumococcal vaccine:

Pneumovax 23 (PPSV23)

Rotavirus:

live attenuated vaccine

given orally

RSV vaccine:

abrysvo, arexvy

Monoclonal antibodies used in RSV

nirsevimab (Beyfortus)

palivizumab (Synagis)

When do you give monoclonal antibodies for RSV?

neonates and infants <8 months born during or entering their 1st RSV season: 1 dose of nirsevimab

Varicella (Varivax) vaccine schedule for children

2 dose series given at 12-15 months and 4-6 years old

How do you store varicella vaccine?

store in freezer

How do you store shingrix vaccine?

put the shingrix vaccine in the fridge do not put in the freezer

How do you give rabies (RabAvert) vaccine?

give 1 dose of rabies immunoglobulin with 1st vaccine dose

Typhoid vaccine (oral):

vivotif

Typhoid vaccine injection:

typhim Vi

How do you store typhoid oral vaccine?

oral capsules are stored in the fridge

Contraindication to yellow fever:

severe life threatening allergy to eggs or gelatin

immunocompromised or pregnant patients due to this being a live vaccine

What do you give a patient after receiving their yellow fever vaccine?

a yellow card is given and is valid for 10 years

When is cholera vaccine given?

age 2-64 years old who are traveling to an area with active toxigenic Vibrio Cholera transmission

Which vaccines do you store in the freezer?

varicella and MMRV

Which vaccine can be stored in either the freezer or fridge?

MMR-II

How do you administer IM vaccines?

use 22-25 gauge needles and inject at a 90 degrees angle

in adults you inject the vaccines into the deltoid muscle

The IM needle length should be 1 inch for most adults , but for males > 260 lbs or females >200 pounds use a 1.5 inch needle

How do you administer SUBQ injections?

23-25 gauge, 5/8th needle at 45 degree angle.

inject intothe fatty tissue over the triceps

People who travel should always carry with them:

a list of all medical conditions and medications both OTC and RX

Vaccinations for travelers should be documented on:

yellow card

What should the healthcare provider consider when preparing a patient for travel outside the US?

diseases that spread through food and water

diseases that spread through body fluids

disease transmitted by insects