preventative medicine synchronous

where are vaccine guidelines published?

MMWR publications

CDC website

MMWR publications

published recommendations for each individual vaccine

updated when ACIP recommendations change or new vaccines are approved

CDC Website

schedules that summarize vaccine recommendations for children and adults

2024-2025 COVID Vaccine

everyone 6 months+ should get vaccine

2024-2025 flu vaccine

now trivalent (3 strains of influenza)

• one strain of influenza B hasn’t been found since 2020

flu vaccine formulations that were only recommended for 65+ years and older are now

options for solid organ transplant recipients greater than 18 years old

general considerations for vaccines

defer vaccination in case of moderate to severe acute illness

wait 10-14 days for maximal immunity following vaccination

defer vaccination in case of moderate to severe acute illness

immune system will prioritize illness over the flu shot/vaccination so you don’t die

diminished immune response to vaccine

pts with mild illness can receive vaccine→ use clinical judgement

wait 10-14 days for maximal immunity following vaccination

if exposed to pathogen before body has developed immune response, adequate antibodies may not have been produced

you can get sick

side effects of vaccine

mild cold-like symptoms

clinical considerations for live vaccines

contraindications for all live vaccines

minimum intervals between multiple live vaccines

live non-oral vaccines

MMR

VAR

MPOX

LAIV

Yellow Fever

contraindications for all live vaccines

pregnant pts

those with immunocompromising conditions

pts taking immunosuppressing medications

pts taking immunosuppressing medications

organ transplant

autoimmune disorders

cancer

biologic medications

corticosteroids

minimal interval between multiple live vaccines

must administer multiple live vaccines during the same visit OR wait at least 28 days between vaccines

DOES NOT apply to oral live vaccines (i.e. rotavirus, cholera, typhoid)

sticking to recommended dose intervals

most vaccines require more than 1 dose at specific time intervals as recommended by the CDC

“missing” the recommended interval (waiting longer than recommended)

may result in suboptimal protection during extended interval

complete vaccine series as soon as possible

does not require restarting the vaccine series

administering doses too soon (shorter interval than recommended)

grace period of < 4 days is considered a valid dose

if dose is given sooner than 4 days from the recommended minimum interval, an additional dose is required

wait the minimum interval from the date of the error dose

allergens in vaccines

neomycin

gelatin

yeast

egg protein

polymyxin B

latex

latex

may be a component of syringe parts and my cause skin reactions in case of allergy

allergic reaction

immune response

true allergies to a component of a vaccine may cause hypersensitivity reaction:

• local or generalized urticaria (hives)

• angioedema (swelling of the throat, lips, tongue)

• difficulty breathing

• hypotension (BP of <90/60

adverse reactions

localized pain/redness at injection site

headache

fever

syncope

pts with previous allergic reactions to a vaccine should. . .

not receiveeg additional doses

egg allergy and influenza vaccines

many influenza vaccines utilize egg albumin during the manufacturing process to serve as culture medium

Guillain-Barre Syndrome (GBS)

rare condition in which the body’s immune system damages the nervous system

• lead to muscle weakness and paralysis

thought to be linked to viral or bacterial exposure

cases of GBS have been seen after influenza, shingles, tetanus, and J&J COVID vaccines

syncope

reaction following vaccination; called vasovagal reaction

• weakness

• dizziness/lightheadedness

• fainting

occurs within 15 minutes after vaccine admin

recommendations for vaccine admin

safety of provider

safety of pt

safety of provider

universal precautions

exposure protocol

universal precautions

prevent exposure to bodily fluids using PPE and safety measures for all pts

exposure protocol

establish procedures for occupational exposure to bloodborne pathogens via needlesticks

safety of pt

aseptic technique

observation pd

aseptic technique

minimize risk of contamination when preparing or reconstituting doses

observation period

pts should remain in the clinic for at least 15 mins following vaccination

shoulder injury related to vaccine administration (SIRVA)

injury to tendons, ligaments, or bursae in shoulder

causing pain, and limited ROM after vaccination

causes of SIRVA

vaccine is given too high on shoulder

needle is angled incorrectly

proper technique for injection on deltoid

inject 2 inches below the acromion process

middle of deltoid

give vaccine while vaccinator and pt are both sitting down

needle inserts at a 90 degree angle

vaccine adverse event reporting system (VAERS)

used to report possible adverse reactions after a pt received a vaccination

healthcare professionals and manufacturers are ___________ to report all adverse events they are made aware of

required

what is made available for the public?

aggregate data from VAERS

this is raw data, not everything reported is caused from the vaccine

COVID-19 VAERS reporting requirements

1. vaccine administration errors, whether or not associated with an adverse event

2. serious adverse events, regardless of causality

3. cases of myocarditis, pericarditis, or multisystem inflammatory syndrome after COVID 19 vaccine

4. cases of covid 19 that result in hospitalization or death

pt counseling requirements

vaccine information sheets

vaccine information sheets

required by LAW to be provided to all patients when administering a vaccine

must be given prior to vaccine

must be given at each dose of vaccine

pt can decline, but provider MUST offer

vaccine injury compensation program (VICP)

government funded program to provide financial compensation to individuals who file a petition and are found to have been injured by VICP-covered vaccine

waives pt’s right to sue provider

antivaccine movement: autism

Dr. Andrew Wakefield publiched a report that stated that the mmr vaccine caused autism in children

not true

he found children with developmental disabilities and saw if they got mmr vaccine and then used those children in his study

selection bias

antivaccine movement: thimerosal

thimerosal is a vaccine preservative, ethylmercury

fear related to mercury and its effect on health

in 1999 vaccine manufacturers agreed to eliminate thimerosal from almost all vaccine products

antivaccine movement: COVID-19

disinformation about vaccine

may have been contributed by:

• speed of dissemination of thoughts/opinions is faster than ever before

• polarizing political environment

• non-healthcare trained individuals interpreting or summarizing scientific publications

misinformation

truly didn’t know what “I” said is wrong

disinformation

inaccurate claims intended to mislead others

spread of false info deliberately

how was COVID vaccine made so quickly?

government was funding studies in order to get vaccine out ASAP

no steps were skipped