Top 300 Vaccines #2

Hepatitis A vaccines

Hepatitis A vaccines

Hep-A (Havrix®, Vaqta®) – vaccines considered interchangeable, but completion of series w/ same vaccine preferable

Vaccines (combination)

HepA-Hep B (Twinrix®)

Hep A vaccine products

Vaccine type

Inactivated vaccine – contains aluminum as an adjuvant

Age

12+ months

Storage

Refrigerate (2 to 8°C)

Dosing/route

Havrix®, Vaqta® – Pediatric: 0.5mL IM X 2 doses / Adult: 1mL IM X 2 doses. If vaccinated at <12 mo., re-vaccinate with 2 doses at age >12 mo.

Twinrix® – 1mL IM X 3-4 doses: Standard- 0,1 month and 6 months OR Accelerated- 0, 1 week, 3 weeks, and 1 yea

Efficacy

94-100%

Contraindications

h/o anaphylaxis to the vaccine/components:

• Havrix® and Vaqta® contain neomycin and commercially available prefilled syringes contain latex

• Twinrix contains yeast and neomycin

ADRs (common)

HepA: Fever, injection site erythema/swelling, rash

HepA-HepB (Twinrix®): Fever, headache, injection site pain, dizziness

Hepatitis B vaccines

Engerix-B®, Recombivax HB®– For kids; vaccines interchangeable

Heplisav® and PreHevbrio® = Adult (> 18 years)

Vaccines (combination)

HepA-Hep B (Twinrix®)

DTaP-IPV-HepB (Pediarix®)

DTaP-IPV-Hib-HepB (Vaxelis®)

Product

Vaccine type

Recombinant vaccine – contains aluminum as an adjuvant

Recommended age(s)

Minimum age = Birth

Storage

2-8 C

Dosing / Route

Engerix-B®, Recombivax HB® :

• Pediatric: 0.5mL IM X 3 doses

• Adult: 1mL IM X 3 doses

Twinrix®:

• 1mL IM X 3-4 doses: Standard- 0,1 month and 6 months OR Accelerated- 0, 1 week, 3 weeks, and 1 year

Efficacy

80-100% (complete series)

some patients may need a 2nd series – 95% patients respond to 2 series

contradictions

h/o anaphylaxis to the vaccine/components:

• Some commercially available Hep-B products contain latex

• Twinrix®-yeast and neomycin

• Pediarix®- neomycin and polymyxin B

• Vaxelis®- neomycin, polymyxin B, streptomycin.

ADRs (common

HepB: Local injection-site reactions: Pain (3-29%), erythema/swelling (3%), fever (1-6%), headache (3%)

HepA-HepB (Twinrix®): Fever, headache, injection site pain, dizziness

Special considerations

Serological testing recommended 1-2 months post-vaccination to confirm immunity in certain populations, including health workers:

• Anti-HBs conc. >10 mIU/mL = immune

• <10 requires re-vaccination (2nd series)

Human papillomavirus (HPV) vaccines

HPV (Gardasil 9®) – contains virus-like particles for high- (16, 18, 31, 33, 45, 52, 58) and low-risk types (6, 11)

Product

Suspension for injection (0.5 mL dose), single-dose prefilled syringe

Vaccine type

Recombinant vaccine – contains aluminum as an adjuvant

Recommended age(s) for HPV

Age 9-45 years; CDC/ACIP recommended at age 11-12 years (may administer as early age 9 years)

Storage

Refrigerate (2 to 8°C)

Dosing / Route

0.5 mL IM x 2 doses (aged 9-14 years) or 3 doses (aged 15-49 years, patients with immunocompromise)

Efficacy

>90%, no waning immunity observed over ~10 years

Contraindications

h/o anaphylaxis to the vaccine/components: (e.g., yeast); pregnancy – vaccinate after pregnancy

ADRs (common)

Local reactions such as pain, erythema, swelling (20-90%), fever (10-13%), syncope –observe recipients for 15 min after vaccination

Special considerations

Although contraindicated, pregnancy testing not needed prior to vaccination

Meningococcal vaccines

MenACWY-CRM (Menveo®) and MenACWY-TT (MenQuadfi®

Vaccines (combination)

MenABCWY (Penbraya®)

Product

Menveo®: Two vial presentation for reconstitution

MenQuadfi® and Penbraya®: Solution for injection (0.5 mL dose)

vaccine type

Conjugate vaccine

• MenACWY-CRM is conjugated to a diphtheria toxoid protein

• MenACWY-TT is conjugated to a tetanus toxoid protein

Recommended age(s)

Storage

Refrigerate (2 to 8°C)

Dosing / Route

0.5 mL IM X 1-2 doses

Efficacy

69%, as demonstrated by antibody response – immunity wanes over time

Contraindications

h/o anaphylaxis to the vaccine/components

ADRs (common)

ADRs similar with each formulation

• Pain (up to 69%) and erythema (up to 43%), irritability and sleepiness (in nfants/children), and myalgia, headache, and fatigue (in adolescents and adults)

Special considerations

Patients at ↑ risk for meningococcal diseases due to co-morbidities require vaccination q5 years (waning immunity)

Measles, Mumps and Rubella (MMR) vaccines

Measles, mumps, rubella (M-M-R II®, Priorix®) – vaccines are considered interchangeable

Vaccine combinations

Measles, mumps, rubella, varicella (ProQuad®)

Products

M-M-R II® and ProQuad®: Lyophilized (freeze-dried) powder

Priorix®: Lyophilized powder and Prefilled syringes

Vaccine type

Live-attenuated vaccine

recommended ages

Age > 6 months (note: MMRV licensed for use for age 6 months through 12 years)

Storage

Dosing / Route

0.5 mL SC (all) or IM (M-M-R II®/ProQuad®) X 1-2 doses.

• If vaccinated at <12 mo., re-vaccinate (2 doses) age >12 mo

Efficacy

Measles: 95% (1 dose) and 99% (2 doses) / Mumps: 78% (1 dose) and 88% (2 doses) / Rubella: 95% (1 dose)

Contraindications

• h/o anaphylaxis to vaccine/components:

  • M-M-R II® and ProQuad® contain neomycin/gelatin and prefilled Priorix® contains latex

• immunodeficiency (including med-induced); pregnancy

• antibody-containing blood products 3-11 mo. prior to & 14 d post-vaccine

• antivirals 24h prior to & 14 d post-vaccine (precaution)

• h/o seizures- precaution MMRV

ADRs (common

Fever (5-15% MMR/22% MMRV) 5-12 d post-vaccine, rash (5%) 7-10 d post-vaccine, arthralgia in adult women (25%)

ADRs (rare, but serious)

• Febrile seizures (3.3–14.0 per 10,000 doses), 2X ↑ risk with MMRV in children aged 12-23 mo.

  • Note: administer MMR and V separately for dose 1 (12-15 mo.) and combined MMRV for dose 2 (4-6 y)

• Thrombocytopenic purpura (rare)

Special considerations

Live-attenuated vaccines may be administered simultaneously, but if not, must be spaced > 4 weeks apart.

MMR and MMRV may suppress response to tuberculin skin testing (TST) – if not done simultaneously, delay TST for 4 weeks.

Varicella vaccines

Varicella (Varivax®)

Vaccines combination

Measles, mumps, rubella, varicella (ProQuad®)

Product

Vaccine type

Recommended age(s)

12+ months (note: MMRV licensed for use for age 6 months through 12 years)

Storage

Varivax®: Freezer (-50 to -15°C) or refrigerate (2 to 8°C)

ProQuad®: Freezer (-50 to -15°C); may be refrigerated (2 to 8°C) for < 72 hours prior to reconstitution

Dosing / Route

Varivax® and ProQuad®: 0.5 mL SC or IM X 2 doses

Efficacy

Pre-exposure: 82% (1 dose) and 92% (2 doses)

Post-exposure: 70-100% effective if given < 3-5 days of exposure

Contraindications

• h/o anaphylaxis to vaccine/components: Varivax® and ProQuad® contain neomycin/gelatin; immunodeficiency (including medication-induced)

• pregnancy

• antibody-containing blood products in past 3-11 months

• antivirals 24h

• prior to & 14 d post-vaccination (precaution); h/o seizures (precaution to MMRV)

• aspirin or other salicylate treatment during or 6 weeks after vaccination – risk of Reye syndrome (precaution

ADRs (common)

Rash at injection site (1-3%), generalized rash (4-6%), fever (10–15%

ADRs (rare, but serious)

Febrile seizures (MMRV

Zoster vaccines

Recombinant Zoster Vaccine (RZV) (Shingrix)

Product

Lyophilized (freeze-dried) powder for reconstitution (diluent provided)

Vaccine type

Recombinant vaccine with a novel adjuvant (AS01B)

Recommended age(s)

Adults aged > 50 years and adults aged > 18 years with immunocompromise

Storage

Refrigerate (2 to 8°C) and protect from light. All vial products must be administered within 6 hours of reconstitution

Dosing / Route

0.5 mL IM X 2 doses (second dose 2-6 months after dose 1)

Efficacy

Prevention of herpes zoster:

• Age 50-69 years = 97%, age > 70 years = 91%

Prevention of postherpetic neuralgia:

• Age >50 years = 91%, age > 70 years = 89%

Contradictions

h/o anaphylaxis to the vaccine/components

ADRs (common

• Minor injection-site pain (78%), myalgia (45%), fatigue (45%)

• Grade 3 reactions: Injection-site (pain, redness, and swelling) = 9.4% of vaccine recipients vs. 0.3% of placebo recipients

• Systemic events (myalgia, fatigue, headache, shivering, fever, and gastrointestinal symptoms) = 10.8% of vaccine recipients vs. 2.4% of placebo recipients

ADRs (rare, but serious

Guillain-Barré syndrome (GBS) < 42 days following vaccination in adults > 65 years of age. FDA determined that there is an association of GBS with Shingrix, but that available evidence is insufficient to establish a causal relationship.

• FDA advised revision to the Warnings and Precautions section of the Prescribing Information but determined that the benefits of vaccination with Shingrix continue to outweigh its risks

Special Considerations

Patients who previously received the live-attenuated herpes zoster vaccine (Zostavax): CDC/ACIP recommendation is to vaccinate with RZV, regardless of prior vaccination with Zostavax.

Haemophilus Influenzae Type B vaccines

Hib (PRP-T) (ActHIB® and Hiberix®); Hib (PRP-OMP) (PedvaxHIB®) – vaccines are interchangeable

Vaccines (combination)

DTaP-IPV-Hib (Pentacel®) – contains Hib (PRP-T); DTaP-IPV-Hib-HepB (Vaxelis®) – contains Hib (PRP-OMP)

Product

ActHIB® and Hiberix®: Single-dose vials of lyophilized vaccine, accompanied by saline diluent

PedvaxHIB®: Single-dose vials of vaccine suspension

Vaccine type

Conjugate vaccine (PCV) – Hib (PRP-T) is conjugated to a tetanus toxoid carrier protein; Hib (PRP-OMP) is conjugated to a meningococcal outer membrane protein and contains aluminum as an adjuvant

Recommended age(s)

Age 6 +weeks

Storage

Refrigerate (2 to 8°C

Dosing / Route

0.5 mL IM X 3-4 doses (# doses depends on type of vaccine)

Efficacy

95-100%

Contraindications

h/o anaphylaxis to the vaccine/components

ADRs (common)

Uncommon... Swelling, redness, or pain (5-30%) (usually resolve within 12 to 24 hours), systemic reactions such as fever (31%) are infrequent.

Other ADRs include irritability/crying (10%) and rash (9%). The median time from vaccination to onset of an ADR was 1 day

Special considerations

Hib is predominantly a pediatric infection. Adults rarely need vaccination; however, some patients are at heightened risk (e.g., patients with functional or anatomic asplenia and those who have undergone successful stem cell transplant)

Poliovirus Vaccines

Inactivated poliovirus vaccine (IPV) (IPOL®

Vaccines (combination)

DTaP-IPV (Kinrix®, Quadracel®)

DTaP-IPV-Hib (Pentacel®)

DTaP-IPV-HepB (Pediarix®)

DTaP-IPV-Hib-HepB (Vaxelis®)

Product

multi dose vial

Vaccine type

Inactivated trivalent vaccine

• Note: live-attenuated oral poliovirus vaccine (OPV) still used in developing countries

Recommended age(s)

6+ weeks (age indications vary for combo vaccines)

Storage

Refrigerate (2 to 8°C)

Dosing / Route

0.5 mL IM or SC X 4 doses

Efficacy

2 doses 90%; 3 doses 99%; 4 doses prolonged (probably lifelong)

Contradictions

h/o anaphylaxis to the vaccine/components (e.g., neomycin, polymyxin B, streptomycin)

• check combination vaccine labels as they may contain additional allergens

ADRs (common)

Local reactions mild/transient: Induration (18%), pain (13%), erythema (3%), low-grade fever (38%)

ADRs (rare, but serious)

Vaccine-associated paralytic polio (only with OPV) rare (1 in every 2 to 3 million doses)

Special Considerations

• Pregnancy is a precaution.

• Previous doses of trivalent (OPV), which would be any doses received prior to 2016, can be counted towards US vaccination requirements; many US citizens received OPV prior to changing recommendations, and it is common for individuals from outside the US to have received OPV.

  • The polio vaccine was changed to a bivalent formulation in 2016, which does not count towards the requirement.

Rotavirus vaccines

RV1 (Rotarix®)

RV5 (RotaTeq®)