Preventative Medicine - Immunizations Part 2

What are the 19 top vaccine-preventable diseases listed in the presentation?

Varicella, Dengue, Diphtheria, Influenza, Hepatitis A, Hepatitis B, Haemophilus influenzae type B (Hib), Human Papillomavirus (HPV), Measles, Meningococcal, Mumps, Pneumococcal, Polio, Rotavirus, Respiratory Syncytial virus (RSV), Rubella (German measles), Herpes Zoster, Tetanus, Pertussis.

True or false: Vaccines are among the most cost-effective clinical preventive services.

true

How effective are routine childhood immunizations in terms of saving lives and preventing disease?

They save 33,000 lives and prevent 14 million cases of disease.

What is the economic impact of routine childhood immunizations?

They reduce direct health care costs by $9.9 billion and save $33.4 billion in indirect costs.

How are vaccines described in terms of their cost-effectiveness as a preventive service?

They are among the most cost-effective clinical preventive services available.

What is the Healthy People 2030 developmental goal regarding the Tdap vaccine?

To increase the proportion of women who get the Tdap vaccine during pregnancy.

What is the Healthy People 2030 goal that is currently 'improving' regarding adolescent vaccination?

To increase the proportion of adolescents who get recommended doses of the HPV vaccine.

What is the status of the Healthy People 2030 goal to increase the proportion of people who get the flu vaccine annually?

It is getting worse.

What did the National Childhood Vaccine Injury Act of 1986 mandate for healthcare providers?

To follow vaccine directives, maintain records, and report adverse events.

What specific document from the CDC are healthcare providers expected to use when administering vaccines?

Vaccine Information Statements (VIS).

What pieces of information must be documented when a vaccine is administered?

- Type of vaccine and dose

- Site and route of administration

- Date administered

- Date next dose is due

- Manufacturer and lot number

- Name and title of person administering vaccine.

When should vaccines ideally be administered?

At the recommended times according to the schedule.

Can multiple vaccines be given at one time?

yes

What is a key benefit of giving multiple vaccines at one time?

It improves compliance.

What is the definition of a vaccine 'adverse reaction'?

An extraneous effect that is caused by the vaccine itself.

What is the definition of a vaccine 'adverse event'?

Any medical event that follows vaccination, which may be a true reaction or merely coincidental.

What are the signs of a local adverse reaction to a vaccine?

Pain, swelling, and redness at the site of injection.

When do local adverse reactions typically occur, and how severe are they?

They occur within a few hours of injection and are usually mild and self-limited.

What is the underlying cause of a typical local vaccine reaction?

It is the result of the body's immune response, not an allergic reaction.

Is a history of a local adverse reaction a contraindication for future vaccination?

No, it is not a contraindication for subsequent vaccination.

What are common systemic adverse reactions to vaccines?

Nonspecific symptoms such as fever, malaise, myalgias, and headache.

When do systemic adverse reactions typically manifest?

They usually occur 3-21 days after the vaccination.

What is a rare but severe systemic reaction to a vaccine, and how is its risk minimized?

Severe allergic reaction (anaphylaxis); the risk is minimized by pre-vaccination screening.

What is VAERS, and what is its purpose?

The Vaccine Adverse Event Reporting System, used to report any medical event following vaccination.

What general events must be reported to VAERS?

- Anaphylaxis within 7 days

- encephalopathy/encephalitis/seizures

- vasovagal syncope within 1 hour

- shoulder injury from administration

- any serious or unusual side effect

- side effects listed as contraindications for future doses.

What specific adverse event associated with the tetanus vaccine must be reported to VAERS and within what timeframe?

Brachial neuritis within 28 days.

What specific adverse event associated with the rubella vaccine must be reported to VAERS and within what timeframe?

Chronic arthritis within 6 weeks.

What specific adverse event associated with the measles vaccine must be reported to VAERS and within what timeframe?

Thrombocytopenic purpura within 7 to 30 days.

What specific adverse event associated with the rotavirus vaccine must be reported to VAERS and within what timeframe?

Intussusception within 21 days.

What specific adverse event associated with the influenza vaccine must be reported to VAERS and within what timeframe?

Guillain-Barré syndrome within 42 days.

What specific adverse events associated with the COVID vaccine must be reported to VAERS?

Myocarditis, pericarditis, or multisystem inflammatory syndrome.

Which vaccine is contraindicated for a person with a severe allergy to eggs?

Yellow fever vaccine.

Which vaccine is contraindicated for a person with a severe allergy to neomycin?

Hepatitis A vaccine.

Which vaccine is contraindicated for a person with a severe allergy to yeast?

Hepatitis B vaccine.

Which vaccines are contraindicated for a person with a severe allergy to polyethylene glycol?

COVID vaccines.

If a patient had an anaphylactic reaction to the Td vaccine, which two other vaccines are also contraindicated?

Meningococcal ACWY and PCV-20.

What is a contraindication to vaccination besides severe hypersensitivity reactions?

Neurologic complications.

Who absolutely cannot receive live, attenuated vaccines?

Immunocompromised patients.

What is considered a precaution, but not a contraindication, for vaccination?

A moderate to severe acute illness, with or without a fever.

What are the typical symptoms of a local reaction to a vaccine?

Pain, swelling, and redness at the injection site.

Name three vaccine-specific adverse events that must be reported through VAERS.

Any three of the following: brachial neuritis (tetanus), chronic arthritis (rubella), thrombocytopenic purpura (measles), intussusception (rotavirus), Guillain-Barré (influenza), myocarditis/pericarditis (COVID).

Which vaccine is contraindicated in individuals with an egg allergy?

Yellow fever vaccine.

If a patient experienced an anaphylactic reaction to the Td vaccine, which other vaccine is contraindicated?

Meningococcal ACWY and PCV-20.

Is a current mild illness, with or without a low-grade fever, a contraindication to immunization?

No, you can still give immunizations.

Is current or recent antibiotic use a contraindication to immunization?

No, you can still give immunizations.

Is a previous mild to moderate local reaction (soreness, redness, fever < 104.9°F) a contraindication to immunization?

No, you can still give immunizations.

Is a family history of an adverse reaction to an immunization a contraindication for a patient?

No, you can still give immunizations.

Is there a scientifically proven link between vaccines and Sudden Infant Death Syndrome (SIDS)?

No, no association has been found.

How significant is influenza in the United States annually in terms of mortality?

It is a serious disease that kills between 6300 and 52,000 people each year in the US.

What is the effect of the flu vaccine on disease severity if a vaccinated person still contracts influenza?

The course of the illness is typically milder.

What is the status of thimerosal, a mercury-containing compound, in childhood vaccines today?

It was removed from all childhood vaccines in 2001.

Does giving a child multiple vaccines at once increase their risk of side effects or overload their immune system?

No, the concept is that children are exposed to many antigens regularly, and vaccines are no different.

What is a major benefit of administering combination vaccines?

It increases patient compliance.

What was the origin of the false claim linking vaccines to autism?

It stemmed from a flawed study in 1998 that was later redacted (retracted).

What have numerous large-scale, extensive cohort studies found regarding the supposed link between vaccines and autism?

They have not found a link.

What does the chart of yearly measles cases from 2000-2025 generally show?

Relatively low case numbers for most of the period, with significant spikes around 2019 and a very large spike in 2025.

Where is wild polio seen?

In Afghanistan and Pakistan

In which two countries is wild poliovirus still endemic?

Afghanistan and Pakistan.

How does vaccine-derived poliovirus emerge?

It occurs when local immunity is low, allowing the weakened live-attenuated oral polio vaccine virus to circulate for a prolonged period, undergo genetic changes, and regain virulence.

What are seven common barriers to immunization?

- Missed opportunities

- Lack of a vaccine delivery system

- Patient/provider fears

- Concerns about efficacy

- Indications being overlooked

- Vaccine shortages

- Cost.

What is considered the most important aspect of the immunization process?

Patient education.

To explain why vaccination is important and to address any patient fears or concerns.

What is the route of administration for the majority of vaccines?

Intramuscularly (IM).

Which muscle is the preferred site for IM vaccine administration in adults? kids?

The deltoid muscle.

kids vastus lateralis

For which type of injection is the gluteal muscle sometimes used?

For large volume injections, such as immunoglobulins.

Name a vaccine that is administered subcutaneously.

Varicella.