Top 300 Vaccines #2

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Hepatitis A vaccines

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Hepatitis A vaccines

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

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Vaccines (combination)

HepA-Hep B (Twinrix®)

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Hep A vaccine products

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Vaccine type

Inactivated vaccine – contains aluminum as an adjuvant

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Age

12+ months

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Storage

Refrigerate (2 to 8°C)

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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

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Efficacy

94-100%

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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

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ADRs (common)

HepA: Fever, injection site erythema/swelling, rash

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

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Hepatitis B vaccines

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

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

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Vaccines (combination)

HepA-Hep B (Twinrix®)

DTaP-IPV-HepB (Pediarix®)

DTaP-IPV-Hib-HepB (Vaxelis®)

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Product

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Vaccine type

Recombinant vaccine – contains aluminum as an adjuvant

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Recommended age(s)

Minimum age = Birth

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Storage

2-8 C

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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

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Efficacy

80-100% (complete series)

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

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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.

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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

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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)

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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)

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Product

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

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Vaccine type

Recombinant vaccine – contains aluminum as an adjuvant

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Recommended age(s) for HPV

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

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Storage

Refrigerate (2 to 8°C)

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Dosing / Route

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

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Efficacy

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

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Contraindications

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

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ADRs (common)

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

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Special considerations

Although contraindicated, pregnancy testing not needed prior to vaccination

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Meningococcal vaccines

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

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Vaccines (combination)

MenABCWY (Penbraya®)

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Product

Menveo®: Two vial presentation for reconstitution

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

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vaccine type

Conjugate vaccine

  • MenACWY-CRM is conjugated to a diphtheria toxoid protein

  • MenACWY-TT is conjugated to a tetanus toxoid protein

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Recommended age(s)

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Storage

Refrigerate (2 to 8°C)

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Dosing / Route

0.5 mL IM X 1-2 doses

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Efficacy

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

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Contraindications

h/o anaphylaxis to the vaccine/components

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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)

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Special considerations

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

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Measles, Mumps and Rubella (MMR) vaccines

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

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Vaccine combinations

Measles, mumps, rubella, varicella (ProQuad®)

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Products

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

Priorix®: Lyophilized powder and Prefilled syringes

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Vaccine type

Live-attenuated vaccine

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recommended ages

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

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Storage

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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

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Efficacy

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

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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

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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%)

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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)

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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.

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Varicella vaccines

Varicella (Varivax®)

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Vaccines combination

Measles, mumps, rubella, varicella (ProQuad®)

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Product

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Vaccine type

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Recommended age(s)

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

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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

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Dosing / Route

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

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Efficacy

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

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

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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

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ADRs (common)

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

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ADRs (rare, but serious)

Febrile seizures (MMRV

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Zoster vaccines

Recombinant Zoster Vaccine (RZV) (Shingrix)

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Product

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

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Vaccine type

Recombinant vaccine with a novel adjuvant (AS01B)

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Recommended age(s)

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

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Storage

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

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Dosing / Route

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

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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%

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Contradictions

h/o anaphylaxis to the vaccine/components

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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

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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

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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.

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Haemophilus Influenzae Type B vaccines

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

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Vaccines (combination)

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

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Product

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

PedvaxHIB®: Single-dose vials of vaccine suspension

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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

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Recommended age(s)

Age 6 +weeks

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Storage

Refrigerate (2 to 8°C

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Dosing / Route

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

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Efficacy

95-100%

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Contraindications

h/o anaphylaxis to the vaccine/components

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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

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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)

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Poliovirus Vaccines

Inactivated poliovirus vaccine (IPV) (IPOL®

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Vaccines (combination)

DTaP-IPV (Kinrix®, Quadracel®)

DTaP-IPV-Hib (Pentacel®)

DTaP-IPV-HepB (Pediarix®)

DTaP-IPV-Hib-HepB (Vaxelis®)

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Product

multi dose vial

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Vaccine type

Inactivated trivalent vaccine

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

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Recommended age(s)

6+ weeks (age indications vary for combo vaccines)

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Storage

Refrigerate (2 to 8°C)

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Dosing / Route

0.5 mL IM or SC X 4 doses

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Efficacy

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

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Contradictions

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

  • check combination vaccine labels as they may contain additional allergens

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ADRs (common)

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

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ADRs (rare, but serious)

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

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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.

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Rotavirus vaccines

RV1 (Rotarix®)

RV5 (RotaTeq®)

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