The Big 7 Vaccines (Rogan)

From PHAR 131 Intro to patient workup

Influenza

• inactivated Influenza vax recommended during pregnancy

• IIV3 (>6 months) (Afluria, Fluarix, FluLaval, and Fluzone), IIV3-HD (>65yrs), ccIIV3 (>6 months), RIV3 (>9 yrs), aIIV3 (>65yrs), LAIV3 (ages 2yrs - 49 yrs, no pregnant women!)

• ages >65yrs, HD-IIV3, RIV3, aIIV3, if none available, admin any other age appropriate vax

• most only need one dose for the season in Sept.-Oct.

  • exceptions: Pregnant in third trimester

  • Children <9yrs who need more than one dose in a season

  • Concerned that vax will not be available later in season

• No live vax to pregnant women

Pneumococcal

• 4 dif. types , PCV15 (15 valent pneumo… conjugate vax), PCV20 (20 valent pneum… conjugate vax), PPSV23 (23 valent pneumo… polysaccharide vax), PCV21 (21 valent pneumo… conjugate vax)

• PPSV23, contains 4 serotypes not available in any conjugate vs. of vax

  • 0.5 mL IM (or SC)

  • Single dose needed one year after, PCV15

• VAXNEUVANCE, 15 serotypes, 14 contained in PPSV23, one not contained in PPSV23 (6A)

  • children at ages 2, 4, 6, 12-15 mnths

• PCV20 - Prevnar 20 , 2 serotypes, 19 found in PPSV23, one not (6A), 0.5 mL IM

• PCV21 - 21 serotypes, 11 serotypes not found in PCV15, does not have 10 serotypes found in PCV20

Adults 19-49yrs w/ chronic health conditions (similar to individuals over age 50yrs)

• if none before, give PCV20 or give PCV15 then PPSV23 >1yr later

• if had PPSV23, give PCV20 or PCV21 >1 yr later OR PCV15 >1yr later

• if had PCV13 only, give PCV20 or PCV21 >1 yr later

• if PCV13 and PPSV23, no indications for additional vaccines

Hepatitis B

Recombivax HB and Engerix-B

• Infants, 3 doses, @birth, 1-2mths, 6mnths (no earlier than 24 wks), 0.5 mL IM

• Adolescents and adults, 3 doses, @birth, 1, 6 mnths (dosing age is dependent), adult recombivax is licensed for 2 doses for adolescents 11 to 15yrs (1 mL IM)

• HEPLISAV-B, 2 doses 1 mnth apart, >18yrs, 0.5 mL IM

• If Hep B Titer is zero, give one dose, wait one month and repeat titer, if high no more doses needed, if low or none —> complete series and repeat titer

Covid-19

• PfizerBioNTech, EUA for 6 mths to 11 yrs

• Moderna, Spikevax (6 mths to 64 yrs w/ one condition putting them at risk, and adults >65yrs) and mNEXSPIKE (those prev. vax with covid-19 vax, 12 mths to 64yrs age with one condition putting at risk, and all adults 65 yrs older)

• look at slide 172 / 317 APhA for differences

Tdap

• recommended during every pregnancy, 27 to 36 wks

• adult vs., Tetanus toxoid, reduced diptheria toxoid, and acellular pertussis absorbed

• Boostrix >10yrs, Adacel 10-64yrs

• admin Tdap to family if cocooning

• ages 6wks to 6 yrs, admin DTap to complete primary series

• ages 7 - 10 yrs who are not fully vax against pertussis —> give a single dose of Tdap

• 11 yrs older, if no record of Tdap dose, give 1 dose Tdap followed by 1 dose f Tdap q 10 yrs

• ages 65 yrs older, use Boostrix when possible, use Adacel to not miss vax opportunity

• Health Care providers, same as 11 yrs situation

• Pregnant women, every pregnancy, 27-36 wks

• Wound management, if no record, give 1 dose, if prev. vax, can give 1 dose

Shingles (Herpes Zoster)

• Shingrix, recombinant, adjuvanted zoster vax

  • available in powder or suspension

  • prefilled syringe

• two 0.5 mL doses admin IM at months 0 and 2

• ACIP recommend immunocompetent adults yoyrs older, including those prev. vax with this

  • and immunocompromised adults 19yrs older

RSV

• common respiratory virus —> spread by respiratory droplets, 4 to 6 days incubation

• Nirsevimab - infants entering 1st RSV season and those vulnerable in the 2nd season

  • 1st season - 50mg for those less than 5kg, 100 kg for those more than 5 kg

  • those vulnerable in the second, 200mg (2 100 mg inj.)

  • IM admin

  • pre-filled 50mg and 100mg syringes

• Clesrovimab - all neonates or infants born during or entering their first RSV season

  • 105 mg / 0.7 mL admin IM (not weight dependent)

    • available in pre-filled syringe

    • store in fridge, remove from fridge 15 min before admin

  • RSVPreF - 32 to 36 wks pregnant women

    • reduces risk of certain illnesses / diseases