NAPLEX 2026 Immunizations: Ch. 20

What are the available vaccine resources? (3)

Advisory Committee on Immunization Practices (ACIP): provides recommendations for vaccine administration

CDC: approves ACIP recommendations and publishes them in Morbidity and Mortality Weekly Report (MMWR)

'The Pink Book:' Epidemiology and Prevention of Vaccine-Preventable Diseases

what are pharmacists legally required to give patients before getting vaccines?

VIS: Vaccine Information Statement

What entity prepares VIS: Vaccine Information Statement

CDC

What is informed consent

patient's ethical right to autonomy

does federal law require informed consent before vaccines?

no

T/F: Vaccines cause autism

F

____, a mercury-containing preservative in previous childhood vaccines was thought to cause autism, but it is not true.

Thimerosal

Another term for antibody is ...

immunoglobulin

what is active vs passive immunity?

Active: when someone's own immune system creates antibodies in response to a vaccine or infxn

Passive: immunity received from someone else such as immunoglobulins from other people or through transfer from mother to baby

what is the difference between live and inactivated vaccines?

live attenuated:

-produced by modifying a disease-producing virus or bacterium

-ability to replicate and produce immunity

-provide strong, long-lasting immunity

-NOT recommended in immunocompromised or pregnant

inactivated:

-composed of killed whole virus or bacterium or fractions of either

-cannot replicate

-immunity can diminish overtime and booster may be required

What type of vaccine is NOT recommended in immunocompromised or pregnant patients?

Live-attenuated

Polysaccharide vaccines - give an example

Pneumococcal polysaccharide vaccine (Pneumovax 23)

Polysaccharide vaccines - children?

Does not produce a good immune response in children < 2 yo

What common diseases are there live vaccines for?

"MICRO-VY"

MMR

Intranasal Influenza

Cholera

Rotavirus

Oral typhoid

Varicella

Yellow Fever

others:

Tuberculosis (BCG),

Dengue,

Smallpox,

Ebola

What are conjugate vaccines? Give 2 examples

Conjugate vaccines join the polysaccharides to carrier proteins to increase immune response in infants

1) Pneumococcal Conjugate vaccine (Prevnar 20)

2) Meningococcal Conjugate vaccine (Menveo)

T/F: Most live and inactivated vaccines can be administered simultaneously

T

(T/F) Increasing the interval between the doses of a vaccine given in a series diminishes the effectiveness of the vaccine after completion of the series

F

Vaccine is still effective but pt is delaying complete protection in between doses

Decreasing the interval between doses of a vaccine given in an interval can do what..?

Interfere with the antibody response

Antibodies present in ___ and ___ products can interfere with live vaccine replication

IVIG and some blood

1) What is the interval between anti-body containing product and a measles, mumps, and rubella-containing vaccine (MMR) or a varicella-containing vaccine?

2) What about vaccine and then anti-body containing product?

1) 3 to 11 months

2) 2 weeks

Most __ vaccines are withheld until the child is 12 months old except for ___

live

rotavirus

Inactivated vaccines can be given at any time except for ___ vaccine which is started at birth

Hep B

Timing of Live vaccine and Tuberculin Skin Test (TST) and why is this important

Live vaccine can cause FALSE NEGATIVE of TST

Give live vaccine on same day as TST

-or-

Wait 4 weeks after live vaccine for TST

What are the general rules for vaccine spacing?

Can they be given together?

Can intervals be changed?

Vaccines can be given at the same time

Multiple live vaccines can be given:

1) At the same time

2) Spaced 4 weeks apart ->

exception: no separation required for oral rotavirus or typhoid vaccines

If the vaccine series is > 1 dose, the intervals can be extended between doses, but not shortened

where do you report adverse reactions from vaccines?

VAERS: Vaccine Adverse Event Reporting System

Simultaneous administration of vaccine and antibody is recommended when...?

For post-exposure prophylaxis of certain diseases such as

Hep A and B

Rabies

Tetanus

how long should pts be monitored for after receiving a vaccine?

15 min

what are the most common local rxns of vaccines? (3)

pain, swelling, redness

Systemic rxns to live vaccines can occur when?

3-21 days

Intranasal flu vaccine symptoms?

Cold-like symptoms

What can minor allegic rxns from vaccines be treated with?

Diphenydramine or hydroxyzine

What is the presentation of a severe allergic rxn from a vaccine?

Anaphylaxis

Urticaria (hives),

swelling of mouth and throat,

difficulty breathing,

wheezing,

abdominal cramping,

hypotension

All providers who administer vaccines must have what in place in case of severe allergic rxn?

An emergency protocol and supplies to manage an anaphylaxis

Prefilled epi auto-injector. At least 3 adult (0.3 mg) injectors.

what are CI to vaccines?

immunosuppression and pregnancy for live vaccines

a severe anaphylactic rxn to same vaccine

moderate to severe sickness (temporary)

live vaccines and antibody products (temporary)

family hx of adverse events to vaccine

immunosuppressed person in the household

recent exposure to the disease or in recovery

antimicrobial treatment and taking the varicella vaccine, live influenza, or oral typhoid vaccine

Severe allergic rxn to eggs or gelatin and taking the yellow fever vaccine

which vaccine is CI if there is a severe allergic rxn to eggs or gelatin?

Yellow Fever vaccine

Dosing recommendation for COVID-19:

Age 12-64 and previously vaccinated

Age ≥ 65 and previously vaccinated

Age 12-64 and previously vaccinated:

1 dose

Age ≥ 65 and previously vaccinated:

2 dose

Tdap vs DTaP

Indications of Td or Tdap

DTaP is for pediatrics and has 3-5x more Diphtheria component

DTap is for age < 7 yo

Tdap is every 10 years

Each pregnancy

Close contacts of infants

Wound prophylaxis, if deep or dirty wound and > 5 years since last dose

Pediarix

DTaP-HepB-IPV

IPV = inactivated polio vaccine

Boostrix

Tdap

Adacel

Tdap

Who needs Haemophilus influenzae type B (Hib) vaccine?

Adults with asplenia (without a spleen)

Havrix

Hepatitis A

Vaqta

hepatitis A vaccine

Engerix-B

hepatitis B vaccine

Heplisav-B

hepatitis B vaccine

Recombivax

hepatitis B vaccine

Gardasil 9

Human papillomavirus vaccine

HPV9

Hepatitis A vaccine indication

Chronic liver disease

Hepatitis B vaccine administration time (USA)

children and adults

(usually) within 24 hours after birth

adults: if not previously vaccinated, all age 19-59 yo or those ≥ 60 yo with risk factors:

-chronic liver disease

-HIV

-Blood exposure (healthcare worker, dialysis, diabetes)

HPV vaccine indication

Prevent cervical cancer and genital warts from the virus

Recommended age to start HPV vaccine

Dosing regimens?

11-12 years

If started before age 15, then 2 doses

If started ≥ 15 yo, then 3 doses

____ is the most common vaccine-preventable illness in the US

Influenza

Flu vaccine age

≥ 6 months, annually

Flu vaccine naming

All contains "flu" in the name, eg Afluria

Flu vaccine:

Pt is between age 6 month- 8 years and hasn't had the first shot or had only one dose awhile ago, what should they do?

Give 2 doses, four week apart

Egg-free flu vaccines

Flublok (18±) and Flucelvax

T/F: Pts with egg-allergy, even if it's severe and required epipen, can still take any flu shot

T

Just observe for 15 min

Flu vaccines for pts 65±

Fluzone HD

Fluad

Flublok (18±)

Flu vaccines for children (≥ 6 mo)

Afluria

Fluarix

FluLaval

Fluzone

Flucelvax

T/F: Flu vaccine should be given as soon as it's available

T

FluMist route of admin

Intranasally between both nostrils

Who should receive MMR vaccine as an adult?

Healthcare workers

M-M-R-II vaccine storage

Fridge or freezer

MMRV vaccine storage

Freezer only due to varicella component

MMR vaccine diluent storage

Room temp or fridge

Flu vaccine route of admin

IM

Except flumist is intranasal

MMR vaccine route of admin

Subq

MMR vaccine is (live/inactivated)

live

Meningococcal vaccine: MenACWY age

Adolescents

Meningococcal vaccine: MenB age

Adolescents at high risk

High risk pts that will need meningococcal vaccine

1) certain countries -> African meningitis belt

2) Asplenia

3) Sickle cell disease

4) HIV infection

5) Lab workers

6) First-year college students

7) Outbreak

What is special about Menveo vials

Both contain MenACWY vaccine

What is special about Penbraya vials

Both contain MenB vaccine

what do the pneumococcal vaccines protect against?

S. pneumoniae

Children and pneumococcal vaccines

Age < 5 years should get PCV15 or PCV20

Age < 2 CANNOT get PPSV23 bc they will not produce an adequate antibody response

Adults and pneumococcal vaccine doses

One dose of either:

PCV20

PCV21

-or-

One dose of PCV15 then PPSV23 given 12 months later (≥ 8 weeks if immunocompromised)

PPSV23 (Pneumovax 23) route of admin

IM or subq

what are the different pneumococcal vaccines?

pneumococcal conjugate vaccines: PCV15 (Vaxneuvance), PCV20 (Prevnar 20), PCV21 (Capvaxive)

polysaccharide vaccine: PPSV23 (Pneumovax 23)

Route of admin for rotavirus vaccines (Rotarix or RotaTeq)

Oral

Abrysvo and pregnant pts

Give to pts at 32-36 weeks gestation during RSV season to prevent RSV in infants < 6 months old

RSV vaccine indication

Give to pts at 32-36 weeks gestation during RSV season to prevent RSV in infants < 6 months old

Adults ≥ 75 yo

RSV mAb vaccine indication

Neonates and infants in their first RSV season

1 dose of nirsevimab (Beyfortus) if mother is not vaccinated during pregnancy)

Varivax DDI

Some antivirals (acyclovir, famiciclovir) may interfere with vaccine, stop 24 hrs before

Varivax storage

Freezer

If removed, reconstitute and use immediately

Varivax contraindications

Hypersensitivity to gelatin or neomycin

Varivax route of admin

Subq

Shingrix storage

Fridge, do NOT freeze

Shingrix route of admin

IM

Shingrix age

Adults ≥ 50 yo, need 2 doses

T/F: Pts with a history of zoster infection do not need Shingrix shot

F

When and how to give a rabies vaccine?

Post-exposure:

1 dose rabies immune globulin with 1st vaccine dose (IM)

Oral typhoid vaccine is (live/inactivated)

Live

What is typhoid vaccine for, what's the pathogen?

To prevent typhoid fever caused by Salmonella typhi

Oral typhoid vaccine storage

Store capsules in fridge

T/F: Tuberculosis vaccine can cause a positive rxn on a TB skin test

T

Yellow fever vaccine is a (live/inactivated) vaccine

live

Yellow fever vaccine contraindications

Severe allergy to eggs or gelatin

What is the Yellow Card?

Aka the International Certificate of Vaccination, given after receiving the Yellow Fever Vaccine

How to admin the yellow fever vaccine

Reconstitute with provided diluent, give subq

Cholera vaccine is (live/inactivated)

live