Immunizations

FDA vs. ACIP vs. CDC vs. Pink book

FDA approves the indication

ACIP recommends vaccines

CDC approves and publishes them in the morbidity and mortality weekly report

Pink book provides vaccine information and education material for healthcare professionals

SC only vaccines (4) (mneumonic)

Yes Sir My Dude

Yellow fever

Smallpox

Monkeypox

Dengue

IM or SC vaccines (4)

Make Me Push Vaccines

MMR II

MMRV

PPSV23

Varicella

Intranasal vaccines (1)

Flumist

Live vaccines (7)

MICRO-VY

MMRII

Intranasal influenza (flumist)

Cholera

Rotavirus

Oral typhoid

Varicella

Yellow fever

Oral vaccines (3)

Vivotif (typhoid)

Rotavirus

Cholera

What vaccines should be kept in freezer? (3)

Varicella containing

Smallpox

Monkeypox

How should vaccines be stored in the fridge? (5)

Keep in OG packaging

Dont put in the door

Measure temp at least twice daily & keep logs for 3 yrs

Use a buffered temp probe

Rotate stock

IM vaccine administration (5)

22-25 gauge

90 deg angle

1 inch unless >260 lb (M) or >200 lb (F) then 1.5 inch

Adults into deltoid

Infants into anterolateral mid thigh

SC vaccine administration (5)

23-35 gauge

5/8 inch needle

45 deg angle

Adults into fatty tissue over tricep

Infants into thigh

RSV indication

pregnant weeks 32-36 weeks (Abrysvo)

adults >75yo
nirsevimab - neonates/infants born during or entering first RSV season

Herpes Zoster (shingles) indication

Adults ≥50yo

19-49 immunocompromised (HCT, SOT, cancer, HIV, etc)

2 doses --> month 0 and month 2-6

Pneumococcal indications

children: 4 doses of PCV15 or PCV20

All pts >50 yo

Pts 19-49 yo at increased risk

3 different regimens:

- PCV20 x 1 dose

- PCV21 x 1 dose

- PCV15 x 1 dose, then >12 months later PPSV23 (8 weeks if immunocompromised)

Tdap administration adults is every ___ years

10

At birth (2) + 2 months (5) + 1 year (3) vaccinations (mneumonic)

At Birth:

• Hep B

• RSV antibody if mother was not vaxed during preg

2 months:

• DTap

• Hib

• Pneumococcal

• Poliovirus

• Rotavirus

1 year

• Hep A

• MMR

• Varicella

- or MMRV (Proquad) which is MMR + varicella

He Ran

Down Her Pretty Pretty Road

He Made Vaxed

Pregnancy recommendations (3)

Flu

Tdap

RSV

Live vax contraindicated

In what patients are live vaccines contraindicated? (2)

Immunocompromised

Pregnancy

Immunocompromised conditions/meds to know (7)

Chronic renal failure

Cancer

HIV infection

Chemo

TNF-alpha inhibitors

Anti-rejection medications

≥20 mg prednisone QD x ≥14 days

COVID indication

All pts ≥6 months

Age ≥65 then 2 doses

Who needs Tdap booster every 10 years? (3)

Each pregnancy

Contact with infants

Wound ppx

HPV indications

All pts 9-26 years old

< 15 yo --> 2 doses

≥ 15 yo --> 3 doses

What vaccine is contraindicated if severe allergy to egg or gelatin?

Yellow fever vaccine

Live vaccines can cause a false _____ with TB skin testing

A. Negative

B. Positive

A. Negative

Live vaccine separation (4) KNOW

Live to live: 4 weeks

Live to antibody: 2 weeks

Antibody to live: 3-11 months

Live to TST (TB skin test): 4 weeks

Where should you report adverse events with vaccinations?

VAERS (vaccine adverse effects reporting system)

T/F: You can give Shingrix even if patient has a history of shingles

True

Antivirals like acyclovir can interact with what vaccines?

Live vaccines

Flu indications

all patients ≥6 months every year

<8 yo need 2 doses if the first time getting flu vaccine (now, then in 4 weeks)

Pregnancy - any inactivated vaccine

≥ 65 yo: fluzone, high dose fluad, flublok

Vaccines for healthcare personnel (3)

Hep B

Varicella

MMR

Flumist (live) is indicated in patients ___-____ years old

2-49