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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®)