Preventative Medicine -- Vaccines

does not include pt 1 of vaccines

increase proportion of women who get the Tdap vaccine during pregnancy

increase proportions of adolescents who get recommended doses of HPV vaccine

increase the proportion of people who get the flu vaccine every year

general goals of healthy people 2030 in vaccine administration

National Childhood Vaccine Injury Act of 1986

law that tells providers to follow vaccine directives, maintain records, report adverse events; expected to use vaccine information statements from the CDC

type of vaccine and dose

site and route of administration

date administered

date next dose is due

manufacturer and lot number

name and title of person administering vaccine

required documentation for vaccines

Adverse reaction

extraneous effect caused by vaccine, side effect (redness, swelling)

Adverse event

any medical event following vaccination

pain, swelling, redness at site of injection

occurs within a few hours of injection

usually mild and self-limited

typically result of immune response NOT an allergic reaction

NOT A CONTRAINDICATION FOR SUBSEQUENT VACCINATION

examples of local adverse reactions

fever, malaise, myalgia, Ha, worse with LAIV

nonspecific systemic adverse reactions to vaccines

anaphylaxis (due to vaccine/component, rare, risk minimized by screening)

severe allergic reactions to vaccines

anaphylaxis or anaphylactic shock within 7 days of vaccine

encephalopathy, encephalitis, seizures

vasovagal syncope within 7 days of vaccine

shoulder injury related to vaccine administration

any serious or unusual side effects

any sequela of reportable events

vaccine side effects that are listed as contraindications for future vaccination

what vaccine-related adverse events are required to be reported to the department of health and human services

branchial neuritis within 28 days

what is an adverse event correlated with the tetanus vaccine

chronic arthritis within 6 weeks

what is an adverse event correlated with the rubella vaccine

thrombocytopenia purapura within 7-30 days

what is an adverse event correlated with the measles vaccine

intussusception within 21 days

what is an adverse event correlated with the rotavirus vaccine

Guillian-Barre within 42 days

what is an adverse event correlated with the influenza vaccine

myocarditis, pericarditis, or multi system inflammatory syndrome

what is an adverse event correlated with the COVID vaccine

yellow fever vaccine

if one is allergic to egg, they should avoid...

HepA vaccine

if one is allergic to neomycin, they should avoid...

HepB vaccine

if one is allergic to yeast, they should avoid...

COVID vaccines

if one is allergic to polyethylene glycol, they should avoid...

meningococcal, ACWY, PCV-20 (pneumococcal)

if one is allergic to Td vaccine, they should avoid...

immunocompromised state

what is a major contraindication to live, attenuated vaccines?

use caution in giving a vaccine to a person with moderate to severe illness with or without a fever

what is a precaution you must take with vaccines in ill patients?

missed opportunities

lack of vaccine delivery system

patient/provider fears

concerns about efficacy

indications overlooked

vaccine shortage

cost

barriers to immunization

explain why it is important

address pt fears/concerns

how to educate a pt about vaccines

intramuscularly

the majority of vaccines are administered...

deltoid

vaccine administration area for adults

lateral rectus/thigh

vaccine administration area for kids

gluteal (immunoglobulins)

vaccine administration area for large volume

varicella

what vaccine is given SQ?

resume series

if a vaccine dose is missed, what should the provider do?

Pfizer-BioNTech COVID-19 vaccine

Moderna COVID-19 vaccine

Novavax

types of COVID-19 vaccines

Unvaccinated adults or if only completed primary series

indications one dose of Pfizer-BioNTech COVID-19 vaccine

3 homologous vaccines 3-8 weeks apart

what is the recommendation for the Pfizer-BioNTech COVID-19 vaccine for those who are immunocompromised and unvaccinated?

Unvaccinated adults or if only completed primary series

indications for one dose of Moderna COVID-19 vaccine

2 homologous vaccines 4-8 weeks apart

what is the recommendation for the Moderna COVID-19 vaccine for those who are immunocompromised and unvaccinated?

Novavax

recombinant spike protein nanoparticle vaccine with adjuvant

2 dose series 3-8 weeks apart

unvaccinated adults who are older than 12 should get how many doses of Novavax?

kids

Novavax is not given to...

if one has a contraindication to mRNA vaccine or refuses to get mRNA booster in adults > 18 y/o (six months after initial series)

when is a Novavax booster indicated?

recombinant vaccine

what kind of vaccine is Novavax?

myocarditis/pericarditis

highest among males 12-39 y/o

what is an adverse reaction to COVID-19 vaccines

history of immediate allergic reaction or severe allergic reaction after first dose

history of allergy to polyethylene glycol

myocarditis/pericarditis within 3 weeks of vaccine

contraindications for covid vaccines

patient should be fully recovered from infection before vaccine is administered

when do you give a patient the COVID vaccine if they currently have COVID?

delay vaccine at least 90 days from time of treatment

applies to second dose as well

if a patient received monoclonal Abs or convalescent plasma for COVID, when should you give them the COVID vaccine?

annually for anyone older than 6 months

takes two weeks to become effective

begin vaccinating by end of october

when is the influenza vaccine indicated?

LAIV (FluMist)

[intranasal vaccine] is "live" attenuated influenza vaccine

egg and cell culture based

the quadrivalent flu vaccine is...

Fluad

Adjuvant trivalent inactivated flu vaccine

Flublok

recombinant flu vaccine

FluMist

nasal spray quadrivalent vaccine that is approved for non-pregnant patients ages 2-49

non-pregnant patients ages 2-49

FluMist is approved for...

severe allergy to previous influenza vaccine

prior hx of Guillain-Barre within 6 weeks of previous flu vaccine

children ages 2-17 taking aspirin (Reye Syndrome)

immunosuppressed/close contact with severely immunosuppressed pt

asplenia

CSF leak

cochlear implant

received antiviral medication in past 48 hours

pregnancy

contraindications for FluMist

not, patients older than 2 years old

the quadrivalent, cell-based flu vaccine (Flucelvax) are ___ grown in eggs, and are indicated for...

Fluzone

high dose flu vaccine; contains 4 times the amount of antigen compared to regular

those older than 65

what are the indications for Fluzone?

those older than 65

when is an adjuvant (Fluad) flu vaccine indicated?

for patients older than 18, egg-free

when is the recombinant (Flublock) vaccine indicated?

any of the inactivated influenza vaccines or LAIV

what vaccines are indicated for healthy, non-pregnant adults up to 49 years of age

any of the IIVs

what flu vaccines are indicated for those between 50-64 years of age or individuals less than or equal to 49 years of age who have a contraindication to receiving LAIV

High-dose IIV (Fluzone high dose) -- esp those who are taking a statin

what flu vaccines are indicated for individuals older than 65 years of age

patients with egg allergies can receive any age-appropriate influenza vaccine, including egg-based vaccines

what are the guidelines for receiving a flu vaccine in one who has egg allergies

vaccine should be administered in a setting equipped for tx of anaphylaxis if non-egg vaccine used

should be observed for 30 min after vaccination

what is the recommendation in a pt who has an egg allergy with a reaction that is more than hives

severe allergy to previous influenza vaccine

prior hx of Guillain-Barre within 6 weeks of previous influenza vaccine

contraindications to all flu vaccines

Streptococcus pneumoniae

gram-positive organism that has a polysaccharide capsule that makes it harder for the immune system to recognize pathogen; type specific antibody is protective

pneumonia

bacteremia

meningitis

what diseases can Streptococcus cause?

puts people in the hospital (more dangerous)

the pneumococcal vaccine protects against the type of pneumonia that...

Pneumococcal conjugate vaccine (PCV15)

Pneumococcal conjugate vaccine (PCV20)

Pneumococcal polysaccharide vaccine (PPSV23)

types of pneumococcal vaccines

longer protection because of T/B cell formation

conjugate pneumococcal vaccines provide....

B cell immunity -- decreased after 5-6 years

pneumococcal polysaccharide vaccine provides...

PCV-20 ONCE OR

PCV-15 followed by PPSV-23 at least 1 year later

pneumococcal vaccine recommendations for all patients over 65

DM

Heart, liver, lung disease

renal failure

malignancy

asplenia

hemoglobinopathies

immunosuppression

CSF leak

cochlear implant

alcoholism

cigarette smoking

high risk patients younger than 65 who should receive pneumococcal vaccine

one does PCV-20 OR

PCV-15 and PPSV-23 (interval shortened to 8 wks when immunocompromised but waiting 1 year has been immunogenicity

patients with any high risk condition and they are younger than 65 should receive what kind(s) of pneumococcal vaccine(s)

DTap vaccine

diptheria, tetanus, acellular pertussis

indicated in children < 7 years old

diptheria, tetanus, acellular pertussis

what makes up the DTap vaccine?

children < 7 years old

indications for DTap vaccine

Tdap vaccine

vaccine that contains tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis

tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis

what is contained within the Tdap vaccine?

> 11 years old

what population receives the Tdap vaccine?

Td

tetanus toxoid and reduced diphtheria

1 dose of Tdap/Td booster every 10 years

should have Tdap at least once as an adult

when is Tdap indicated in adults who received childhood immunizations?

each pregnancy -- ideally between 27-36 weeks

one should also get it if he or she is around a pregnant person to protect the baby

while being recommended every 10 years, Tdap is also recommended with...

Adacel

Boostrix

booster Tdap shots

series of 3 shots

- first dose Tdap

- wait at least 4 weeks -- Td/Tdap

- wait at least 6-12 months -- Td/Tdap

what do you give an adult if they have never been vaccinated for tetanus, diphtheria, or pertussis

administer tetanus immunoglobulin

begin vaccine series for Tdap/Td

what do you do if a patient presents with a severely contaminated wound and has NOT had at least 3 doses of DTap/Tdap + Td?

documentation of 2 vaccinations at least 4 weeks apart

born in US before 1980 (exception healthcare workers and pregnant patients)

history of disease

history of herpes zoster

lab evidence of immunity

evidence of immunity against varicella

Varivax

live attenuated vaccine administered SQ

live attenuated

what kind of vaccine is varivax?

immunocompromised, pregnancy, anaphylaxis to gelatin or neomycin

can be considered in pts with HIV if CD4 percentages are > 15% and CD4 count is > 200

contraindications for Varivax

SQ 2 vaccinations at least 4 weeks apart

how is varivax administered

Shingrix

recombinant zoster vaccine; 2 doses 2-6 months apart for adults > 50 years old; IM injection

> 90% effective at reducing shingles and post herpetic neuralgia

2 IM doses 2-6 months apart in adults > 50 y/o

how to administer Shingrix

if there is serologic evidence of varicella suceptibility

when would one recommend that one gets the varicella vaccination before the shingles vaccine

allergic reaction

not studied in pregnancy and nursing mothers

contraindications to Shingrix

recombinant

what type of vaccine is Shingrix?

Gardasil 9

inactivated vaccine that is given to prevent cervical cancer, genital warts, anogenital and oropharyngeal cancers

injection site reaction, fatigue, myalgia, fever

side effects of Shingrix

6, 11, 16, 18, 31, 33, 45, 52, 58

what HPV strains does Gardasil 9 cover?

both males and females aged 9-26

when does the CDC recommend HPV vaccination?

shared decision making

what does the ACIP recommend for HPV vaccination in those 26-45?

2 doses 6 months apart

HPV vaccine schedule for those < 15