Vaccine information(NAPLEX)

Types of vaccines

Broken into two major groups:

Live vaccines: most similar to actual disease and provide longer lasting protection

• Limitations: can’t be used in immunocompromised or if pregnant

Inactivated vaccines: use the killed version of virus or bacteria

• Cannot replicate

• Limitation: immunity may not be as strong. Need boosters

• Broken into Polysaccharide/Conjugate/Recombinant, Toxoid, and mRNA

  • Polysaccharide: can’t be used if <2 years old

  • Conjugation: increases immune response in infants

Live vaccine separation

Live to live if not given on the same day: 4 weeks

Live & Ab

• if Ab given first: give vaccine 3-11 months later

• if live given first: Give Ab 2 weeks

Live & TST (TB skin test): can give false -; This can be avoided in three ways:

• live vaccine on the same day as TST administration

• TST, wait 48-72 hrs, then give live vaccine

• live vaccine, wait 4 weeks, then perform TST

At birth + 2 months + 1 year vaccinations (mneumonic)

He Ran

Down Her Pretty Pretty Road

Made Vaxed

At Birth:

• Hep B

• RSV antibody if mother was not vaxed during preg

2 months:

• DTap

• Hib

• Pneumococcal

• Poliovirus

• Rotavirus

1 year

• MMR

• Varicella

- or MMRV (Proquad) which is MMR + varicella

Vaccines recommended at 11-12 years old?

Mnemonic: Making Healthy Teens

Men ACWY

HPV

TdaP

Vaccines recommended for 50 years old + 75 years old?

At 50, you get Zero Pain, but at 75, you need Rest.

≥50 years: Herpes zoster, Pneumococcal

≥75 years: RSV

Pregnancy recommendations

• Flu
• Tdap @27-36 weeks gestation
• RSV(Abrysvo only) @32-36 weeks if during season

Live vax contraindicated

What vaccines should be given to those with asplenia?

Highly Protect My Midsection (Your spleen is in your midsection).

• Hib

• Pneumococcal

• Men ACWY

• Men B

What vaccine should be given to those immunocompromised?

Zippy Patients with HIV Make Healthy Habits.

• ≥ 19 yo: herpes zoster and pneumococcal

• if HIV infection also:

  • Men ACWY

  • Hep A

  • Hep B

What vaccines should HCP get?

• Hep B

• MMR

• Varicella

Vaccines recommended for those with DM or Heart or lung disease at 19 and 50?

Chronic illness needs 19 Pills or 50 Restrx.

• ≥ 19 yo: pneumococcal

• ≥ 50 yo: RSV

When is DTaP used vs TdaP

DTAP: used for children <7 yo

TdaP: at ages 11-12 yo, then every 10 years

• pregnant people in third trimester

• close contacts of infants

• wound prophylaxis if deep wound and >5 yo since last dose

When is Hep B indicated

• within 24 hours after birth

• Adults(if previously not vaccinated):

  • 19-59 yo

  • ≥ 60 with risk factors( liver disease, HIV, blood exposure)

When is Hep A indicated?

Childhood series

Adults:

• MSM

• illicit drug use,

• chronic liver disease,

• homelessness

• HIV

HPV dosing schedule considerations

• <15 yo: get 2 doses

• ≥ 15 yo: 3 doses

Influenza patient considerations

• children aged 6 months through 8 years who are getting their flu shot for the first time (or who have only ever received one dose in their lifetime), the schedule requires 2 doses given at least 4 weeks apart.

• Egg allergy: can receive any flu vaccine

• Pregnant: avoid flu mist

• Patients >65 yo: Fluzone, Flublok, or Fluad preferred

Inactivated flu vaccine names that are egg free?

• Flucelvax: egg free

• Flublok: egg free

When is MMR needed?

• routine childhood

• Adults: need 1-2 doses if no evidence of immunity and HCW

When is Men ACWY used?

• adolescent series

• special populations: if ongoing risk q 5years

  • trailers to meningitis belt

  • age >2 months with sickle cell disease/asplenia

  • lab workers

  • first year college students

When is Men B given

• adolescent

• if ongoing risk q 3 years:

  • Apslenia/sickle cell

  • lab workers

  • during outbreak

Dosing for pneumococcal vaccines

• routine childhood doses of PCV 15 or PCV 20

• if adults ≥ 50 years old or 19-49 years with certain conditions:

  • PCV20 ×1

  • PCV 21 ×1

  • PCV 15 × 1 then PPSV 23 × 1 ≥12 months or ≥8 weeks if immunocompromised

When to give RSV ab?

infants < 8 months in their first RSV season: 1 dose if mom was not vaccinated during pregnancy or vaccinated <14 days prior to delivery

When is RSV vaccine indicated?

• 32-36 weeks during RSV season

• adults >75 yo or 50-74 with increases risk: 1 LIFETIME dose

Notes about varicella

• adolescent without immunity: 2 doses

do not use if pregnant or immunicomprosed

stop all antivirals 24 hours prior to administration

CI if gelatin or neomycin allergy

Zoster vaccine indication

• >50 years old

• >19 years old with immunocompromised state

T/F: can revaccinate Shingrix if hx of zoster infection

True

Rabies vaccine

Rabavert

If person doesn’t have immunization and gets bite, they need

4 doses of rabies + 1 dose of rabies immune globulin with 1st vaccine dose

Where should you report adverse events with vaccinations?

VAERS (vaccine adverse effects reporting system)

FDA vs. ACIP vs. CDC vs. Pink book

• FDA approves the indication
• ACIP recommends vaccines
• CDC approves and publishes them in the morbidity and mortality weekly report
• Pink book provides vaccine information & education material for healthcare professionals

What are common live vaccines?

MICRO VY

• MMR

• Influenza(intranasal)

• Cholera

• Rotavirus

• Oral Typhoid

• Varicella

• Yellow fever

SQ vaccines only

Yes Sir My Dude

Yellow fever

Small Pox

Monkey Pox

Denuge

IM or SC vaccines

Make Me Push Vaccines

• MMR II

• MMRV

• PPSV23

• Varicella

PO vaccines

• Vivotif (typhoid)
• Rotavirus
• Cholera

Intranasal vaccines

FluMist

What vaccines should be kept in freezer?

• Varicella containing
• Smallpox
• Monkeypox

How should vaccines be stored in the fridge?

• Keep in OG packaging
• Keep on shelves
• Measure temp at least twice daily & keep logs for 3 yrs
• Use a buffered temp probe
• Rotate stock

IM vaccine administration

• 22-25 gauge

• 90 deg angle

• 1 inch unless >260 lb (M) or >200 lb (F) then 1.5 inch

• Adults into deltoid

SC vaccine administration

• 23-35 gauge
• 5/8 inch needle
• 45 deg angle
• Adults into fatty tissue over tricep
• Infants into thigh