My version of Immunization Exam

What is the pathogen that causes influenza?

it’s the influenza virus

How is influenza A classified?

It’s by surface proteins Hemagglutinin (H) and Neuraminidase (N)

How is influenza B classified?

By lineage: victoria and Yamagata

Which influenza B lineage hasn’t been seen clinically since COVID onset?

Yamagata lineage

What complication can influenza vaccination help prevent?

Pneumonia, bronchitis, sinus infections, ear infections, death.

How is influenza transmitted?

via coughing, sneezing, or contact with respiratory secretion

What age groups are higher risk for severe influenza?

children under 5 (especially under 2) and adults over 50 (especially over 65)

What pregnancy related group is at high risk for severe infleunza?

Pregnant individuals and those less than 2 weeks postpartum(the period of time immediately following childbirth or delivery)

What types of chronic disease increase influenza risk?

Asthma, chronic obstructive pulmonary disease, heart disease (not isolated hypertension), diabetes, kidney, liver, neurologic, hematologic diseases)

Which immunocompromised groups are at higher risk for influenza complications?

HIV, cancer, transplant, or those on immunosuppressants

Which children are at higher risk for severe influenza complication?

Children under 18 taking aspirin.

Which BMI group is considered high risk for influenza

BMI over 40

Which racial/ethnic groups are at higher risk for severe influenzaA?

American indian/alaska Native population

What are the main categories of influenza vaccines?

IIV, RIV, LAIV

What does IIV stand for?

inactivated influenza vaccine (standard high dose adjuvanted, cell culture-based)

What is RIV?

Recombinant influenza vaccine (egg-free)

What is LAIV

Live attenuated influenza vaccine, intranasal

Name of all inactivated influenza vaccine

Afluria,Fluarix, Flulaval, Fluzone, flucelvax

What is the dose and route of IIV (inactivated influenza vaccine)

0.25-0.5mL IM, aged based.

what recombinant influenza vaccine is available?

Flublok, 0.5mL IM ≥9 years

What is the adjuvanted influenza vaccine for older adults?

Flaud, 0.5 mL IM ≥65 or ≥18 post transplant on immunosuppression

What is the high dose influenza vaccine for older adults?

Fluzone High dose, 0.5 mL IM, ≥65 years

What is the intranasal live attenuated influenza vaccine

Flumid, 0.2 mL IN, ages 2-49 healthy, non-pregnant

What is the influenza vaccination recomended?

At or older than 6 months for the most IIV vaccines

What is the age cutoff for Flublok?

At or older than 9 years.

Which influenza vaccines are specifically indicated for above age 65?

Fluad and fluzone high dose

What is the age range for flumist (LAIV)?

2-49 years, healthy, non-pregnant

Who should receive influenza vaccine annually?

all individuals ≥ 6 months old without contraindication.

What does the AAP recommend for children 3-17 hematopoietic cell transplant?

Two does of fluzone high dose (28-42 days apart). Not FDA approved, but recommended by AAP.

what are common systemic adverse effects of influenza vaccines?

low grade fever, fatigue, myalgia, headache.

What rare but severe adverse events is associated with influenza vaccine?

Anaphylaxis

What neurological condtion is a precaution after influenza vaccination?

Guillain Barre syndrome within 6 week after prior flu shot

Which antivirals interact with LAIV and should be avoided before or after vaccination?

Oseltamivir/zanamivir (avoid 48h), peramivir (avoid 5 days), baloxavir (avoid 17 days).

Which allergen in influenza vaccines isn’t a contradiction?

Egg protein

what allergens are present in flumist?

gelatin

What preservatives may be present in some influenza vaccine vials?

Thimerosal ( in multidose vials)

What is a genral precaution before giving the influenza vaccine?

moderate or severe illness(defer until recovery)

who shouldn’t receive LAIV?

pregnant individuals, children

What insurance covers infleunza B vaccine and administratin?

Medicare part B

What is the pathogen that caues pneumococcal disease?

Streptococcus pneumoniae

How is streptococcus pneumoniae classified?

By capsular polysaccharides serotypes

What invasive diseases are prevented by pneumococcal vaccination?

Meningitis, bacteremia, bacteremic pneumonia, osteomyelitis, peritonitis.

What non invasive diseases are prevented by pneumococcal vaccination?

Non-bactermic pneumonia, otitis media, sinusitis

How is pneumococcal disease transmitted?

Respiratory droplets (coughing, sneezing, secretions)

How else can pneumococcal spread aside from active illness?

From nasal carriage to invasive disease

What percentage of adults and childrens are asymptomatic carriers of pneumococcus?

Adults are 10%

childrens are 20-60%

What age groups are at higher risk for severe pneumococcal disease?

Children under 5 and adults over 65 years

Which chronic diseases increases risk for pneumococcal disease?

Diabetes,lung disease, liver disease, heart disease, kidney disease

What lifestyle chances can increase pneumococcal risk?

Alcoholism and tacacco

what immunocompromised conditions increase risk for pneumococcal?

Cancer, radiation therapy, HIV infection, immunosuppression, transplant

What non invasive diseases are prevented by pneumoccoal vaccination?

Non-bacteremic pneumonia, otitis media, sinusitis

What specific anatomic/functional conditions increase risk?

Cochlear implants, cerebrospinal fluid leak, asplenia, sickle cell disease

What type of vaccine is PPSV23?

Polysaccharide vaccine

What types of vaccines are PCB15, PCV20, PCV21

Conjugate vaccines (T-cell dependent, longer protection)

What is brand name of PPSV23

Pneumovax 23

What is the dose and route for PPSV23?

0.5 mL IM or SQ, covers 23 serotypes

What brand name is PCV15?

Vaxnuevance

What is the dose and route for PCV15?

0.5mL IM, covers 15 serotypes, contain alum adjuvant

What is the brand name for PCV20?

Prevnar 20

What is the dose and route for PCV20?

0.5mL IM, covers 20 serotypes, contains alum adjuvant.

What is the brand name for PCV21?

Capvaxive

What is the dose and route for PCV21?

0.5mL IM, covers 21 serotypes, approved for adults 18 years and older

How should pneumococcal vaccines be stored?

Refrigerate 36-46F, protect from light, don’t freeze

What is the minimum approved age for PPSV23?

at or above 2 years (risk-based)

What is the approved age range for PCV15 and PCV20?

At or above 6 weeks through adulthood

What is the approved age for PCV21?

Adults 18 years or older

What is the routine pneumococcal vaccine schedule for infants?

PCV15 or PCV20 at 2,4,6 and 12-15 months

What are the catch up recommendations for children?

Can receive catch up vaccine up till age 5 for healthy children and up till age 18 for high risk children.

What vaccine is recommended for adults at or above 50 years with no prior PCV?

give PCV15, 20 or 21

If PCV15 is used in adults, what additonal vaccine is required?

PPSV23 with timing based on risk( 8 weeks vs 1 year)

Which adults age 19-49 should be vaccinated with Pneumococcal vaccine?

Those with high risk conditions.

What is the timing recommendation for pneumoccal vaccines before certain procedures or therapies?

Vaccinate at least 2 weeks before splenectomy,cochlear implant, or immunosuppressive therapy if possible.

What are the common local adverse effects of pneumoccal vaccines?

Pain,redness,swelling

what are the common systemic adverse effects of pneumococcal vaccines?

Fever, headache, fatigue, myalgia, decreased appetite or sleep.

What severe allergic reaction can pneumoccal vaccines cause?

Anaphylaxis

Cna pneumococcal vaccines be given with other non pneumococcal vaccines?

Yes, they can be co-administered

If both PCV15 and PPSV23 are needed, what spacing should be used in immunocompromised patients, those with CSF leak, or cochlear implant?

8 weeks

If both PCV15, and PPSV23 are needed, what spacing shoudl be used in other adutls?

1 years

What preservation is in PPSV23?

Phenol

What adjuvants are in PCV15, PCV20, and PCV21?

aluminum adjuvant

What additional components are in PCV15 and PCV21?

Polysorbate and histidine

What is the main contradiction for pneumococcal vaccines?

severe allergic reaction to a prior dose or component.

What is a precaution of pneumococcal vaccines?

Moderate or severe acute illness (defer until recovery)

What medicare covers the vaccine and administration of Pneumococcal vaccine?

Medicare B

What pathogen causes COVID-19?

SARs-COV-2(RNA virus, coronaviridae)

What illness is prevented by COVID 19?

Mild to severe respiratory illness

What complications of COVID-19 are reduced by vaccination?

Pneumonia,myocarditis, blood clots, neurologic effects, long-COVID

How does COVID-19 vaccination benefit pregnancy?

Reduces preterm birth(born before 37 completed week) and stillbirth

How is SARS-CoV-2 transmitted?

Respiratory: airborne particles and droplets (coughing, sneezing, singing)

When a person with COVID becomes infectious?

From 2 days before symptoms onset to 8-10 days after symptoms begin.

Which ages have the highest risk of death from COVID-19?

Ages 75 years and older; 65-74years with comorbidities.

Which age group has the highest pediatric risk from COVID-19?

Less than 6 months

What chronic condition increases COVID-19 risk?

Asthma, COPD, diabetes, CKD, liver disease, CAD, stroke, obesity, smoking, mental health discorders, disabilities.

Which immune and blood conditions increase COVID-19 risk?

Immunocompromised states and blood disorders

Which populations related to pregnancy and childhood are higher risk for COVID?

Pregnant individuals; infants/young children; older children with chronic conditions

What are the mRNA COVID-19 vaccines?

Comirnaty (Pfizer), Spikevax(moderna), mNexspike(monderna)

What is the protein subunit COVID-19 vaccine?

Nuvaxvoid (Novavax, adjuvanted)

What are the Comirnaty(Pfizer) dose volumes and age group strengths?

0.3mL total volume: 3 mcg for 6 mos-4 yrs; 10mcg for 5-11yrs; 30 mcg for≥12 yrs

What are the Spikemax (Moderna) dose volumes and age group strength?

0.25mL (25mcg) for 6 mos-11yrs; 0.5mL (50mcg) for at or above 12 yrs.

What is the mNexspike(moderna) product dose?

0.2mL (10mcg) for at or above 12 yrs