(2) childhood & adult vaccines (149-278)

tdap, mmr, varicella/zoster, hpv, hepA, hepB, polio, meningococcal, mpox, haemophilus influenza, rotavirus

what is another name for varicella and another name for zoster? how are they related?

• varicella = chicken pox

• zoster = shingles

• both diseases caused by same virus strain, so after chicken pox is cleared, strain could stay dormant until older in basal ganglion and reactivates into shingles

what does tdap stand for?

tetanus, diphtheria, pertussis

what is the difference between DTaP and Tdap?

• DTap has higher concentration of diphtheria antigen and pertussis antigen (capital D and P)

  • for kids because pertussis is more concerned for kids

• Tdap has lower dose of pertussis antigen, it is a toxoid vaccine combined with acellular bacterial vaccine, aluminum adjuvant'

  • for adults

what is the recommendation for tetanus, diphtheria, and pertussis vaccines for pt 7-10 not fully vaccinated against pertussis?

single dose of tdap

what is the recommendation for tetanus, diphtheria, and pertussis vaccines for pt 11 and older

if no record of tdap dose, give single dose of tdap followed by 1 dose of Td or Tdap q 10 years

what is the recommendation for tetanus, diphtheria, and pertussis vaccines for pregnant persons

• give for EVERY pregnancy? (not just 1st one like RSV)

• give one dose of Tdap, in early part of gestational weeks 27-36

how does tdap affect fetus

vaccination of pregnant parent transfer antibodies to fetus and protects until first few doses of DTaP

what is cocooing

when family members get TDap shot so they won’t be disease carriers to affect the baby, because babies younger than 6 months can’t get TDap.

what is the recommended interval between a dose of Tdap and the last Td booster

none

A 60-year-old female patient with type 2 diabetes mellitus, hypertension, chronic heart disease, and chronic kidney disease stage III. The patient has a new grandchild and was advised that her last Td vaccine was 12 years ago. What are your recommendations?

get a TDap (cocooning)

what is the vaccine type of MMR?

live attenuated vaccine

what is a precaution of the MMR vaccine relating to allergy?

• alpha-gal allergy

  • a carbohydrate in mammalian meat from tic bites, meaning you’re allergic to red meat

• consult with physician because the gelatin of drug could be from pig

what is the MMR vaccine routine for children, minimum age for dose 1, and minimum interval between doses?

• routine: 2 dose series at age 12 through 15 months and at age 4-6 years

• min age for dose 1L 12 months

• minimum between dose 1 and 2: 4 weeks for MMR and 3 months for MMRV

what is the MMR vaccine recommendation for adults

• one dose

  • for adults born in 1957 or later who are at low risk and have no documented vaccination with live measles vaccine & no lab evidence of immunity or prior measles infection

• two doses

  • high risk adults without prior documented live measles vaccination & no lab evidence of immunity or prior infection

    • healthcare personnel, international travelers born 1957 or later, ppl attending college

what is the interval for MMR vaccines

2 doses at least 4 weeks apart

what are the target groups for MMR vaccination?

high risk groups, children, adults with no prior vaccination history born 1957 or later

should a pt with provider-diagnosed MMR be considered immune

no, they’re not immune so they must get the vaccine

what is the recommended dose and route of administration for MMR?

2 doses SQ or IM

how are MMR vaccines given during a measles outbreak

• vaccine can be given to children as young as 6 months who are high risk of exposure

  • doses given before 12 months of age aren’t counted towards 2-dose series

• those who had 2 doses identified at increased risk can get 3rd dose of mumps

what kind of vaccine is varicella

live attenuated vaccine, 0.5mL SQ or IM

what is a contraindication of live vaccines

pregnancy

what is the varicella vaccine recommendation for children/adults

• children: 1st dose 12-15 months, 2nd dose 4-6 years

• age 7-12 yr without evidence of immunity: 2 doses, 3 months apart

• age 13+ yr without evidence of immunity: 2 doses, 4-8 weeks apart

should a pt who provides a verbal history of chicken pox be considered immune

no, you need lab diagnosis/proof of immunity/titers

what is mmrv vaccine recommendation

no preference between mmr + monovalent varicella vaccine or MMRV for toddlers getting first dose, but for 2nd dose at 4-6 years, MMRV is preferred to reduce number of injections

what kind of vaccine is zoster

recombinant adjuvanted (AS01B)

what is zoster vaccine recommendation

2 doses of the recombinant zoster vaccine for healthy adults aged 50 years and older, and for immunocompromised adults aged 19 years and older

A 52-year-old individual who is post-solid-organ transplant x 10 years on a stable regimen of anti-rejection medications and prednisone 20 mg PO daily inquires about the RZV. What is your recommendation for this patient

• Get the zoster vaccine 2 doses series with the 2nd shot given in 2-6 months for highest lvl of efficacy

• immune response won’t be as strong bc pt is immunocompromised (organ transplant taking prednisone which is immunosuppresant)

what does the human papillomavirus (HPV) vaccine prevent

• prevents cervical cancer in women

• men can carry strain and get genital wart/cancers

what is the vaccine recommendation for HPV

immunocompetent age 9-14 yr

• 2 dose series: 0, 6-12 months

• immunocompromised should get 3 dose series

age 15-18

• 3 dose series: 0, 1-2, 6 months

age 19-26

• 3 dose series

age 27-45

• shared clinical decision making w/ 3 dose series

MN is 19 years old and has no significant medical history. • She states, “I haven’t received the HPV vaccine. Is that something I should get?” • What is your recommendation

Yes, get the 3 dose series

what does it mean for hepatitis A to be self-limiting

body clears the virus on its own without specific medical treatment, and it does not become a chronic or long-term infection, and you get immunity

what is dosing schedule for hepatitis A vaccine

• Havrix (GSK) and Vaqta (Merck) have 2 dose series at least 6 months apart

• Twinrix (GSK) for adults have multiple dosing schedules

  • standard is 3 dose = 0, 1, 6 months

  • accelerated is 4 dose = 0, 1 week, 3 weeks, then 1 year

what is the hepatitis A vaccine recommendation for children/adolescents

all children 1-2 yr old get 2 dose series (0, 6 month) and catch up by age 18, where unvaccinated people through 18 yr should complete 2 dose series with min 6 month interval

what are the 2 types of hepatitis B vaccines

1. recombinant aluminum adjuvant: causes stronger immune rxn

2. recombinant synthetic adjuvant

what is the dose of hepatits B vaccines

1 mL IM for 20 yr and older

what is the hepatitis B vaccine recommendation for children/adolescents

all infants should get one at BIRTH, 1-2, 6-18 months

• hepB is the only vaccine given at birth because it’s transmitted during child birth

what is the hepatitis B vaccine recommendation for adults

• all adults 19-59 who haven’t gotten - 2 or 3 dose series

• adults 60+ with risk factors

what type of vaccine is poliomyelitis

inactivated vaccine containing serotype 1, 2, 3wh

what is the polio vaccine recommendation for children

4 shot series at 2, 4, 6-18 months, 4-6 years

what is the polio vaccine recommendation for adults

adults 18 up who are unvaccinated should get primary vaccination series with inactivated poliovirus vaccine (IPV)

what are the types of meningococcal vaccines?

• conjugated vaccine (MenACWY)-where A, C, W, Y, B are the serotypes

• protein-based vaccine with aluminum adjuvant (MenB)

• Combination vaccine (MenABCWY)

what is the meningococcal ACWY vaccine recommendation for adolescents

• 1 dose of MenACWY age 11-12

• 1 booster dose of MenACWY at age 16 if 1st dose is before 16th bday; if after, then only 1 dose of MenACWY

• those 19-21 who haven’t gotten 16 can catch up with single MenACWY dose

what is the meningococcal ACWY vaccine recommendation for adults with certain conditions

2 doses of MenACWY at least 8 weeks apart

what population is Men B vaccines for

college kids who want extra protection

what are the types of mpox vaccines

• live, replication deficient viral vaccine (preferred)

• live replicating

what are the precaution for mpox vaccine

allergy to chicken/egg protein, ciprofloxacin, gentamicin

what is the mpox vaccine recommendation

2 doses vaccine series for those 18 and older at risk for mpox (std)

what kind of vaccine is the haemophilus influenzae type b?

conjugated vaccine - conjugation is T-cell dependent antigen that is better for immunogenicity

what are the 2 contraindication for haemophilus influenza type b vaccine

• severe hypersensitivity to a component

• children less than 6 weeks of age

what is the haemophilus influenza vaccine recommendation

ActHIB, Hiberix, Pentacel, Vaxelis

• 4 dose series = 2, 4, 6, 12-15 months

PedvaxHIB:

• 3 dose series = 2, 4, 12-15 months

who usually gets rotavirus vaccines

young children 3-5 years old, once they age out, they don’t need to get it

what kind of vaccine is the rotavirus vaccine

live attenuated vaccine

what are 2 precautions for rotavirus vaccine

• moderate-severe gastrointestinal problems

  • kids w/ diarrhea can have severe dehydration/life threatening bc vaccine is LIVE and affect guts

• altered immunocompetence

what is the rotavirus vaccine recommendation

3 dose or 2 dose series = 2, 4, 6 months

what are the ages for administration of rotavirus vaccine (min age for first, max age for first, max age for final)

• minimum age for 1st dose: 6 weeks

• maximum age for 1st dose: 14 weeks 6 days

• maximum age for final dose: 8 months

what are the two Tdap vaccine brands

• Adacel (Sanofi)

• Boostrix (GSK)