E2: Pediatric Vaccines Study Guide

protection from infection

immunity

lifelong protection by the immune system

active immunity

protection transferred by another person or animal that wanes with time

passive immunity

live or inactivated substance that produces immune response

antigen

protein molecule produced by B lymphocytes whose function is to eliminate antigens

antibodies

what type of immunity do you get from vaccines?

active

type of vaccine made of a toxin that has been treated to destroy to toxic property but retain its antigenicity

toxoid

what type of vaccine:

- attenuated form of wild type virus or bacteria

- must replicate to be effective

- immune response similar to natural infection

- usually effective with one dose

- interference from circulating antibodies

- unstable

live vaccine

what are examples of live vaccines?***

MMR

OPV

varicella

yellow fever

rotavirus

nasal flu

smallpox

BCG

oral typhoid

what can occur between 2 live vaccines if they are given < 28 days apart?

interference

what type of vaccine:

- cannot replicate

- not as effective

- minimal interference from circulating antibodies

- immune response mostly humoral

antibody titer falls over time

- requires 3-5 doses

inactivated vaccine

what are inactivate viral vaccines?

polio

hep A

rabies

influenza

what is an inactivated bacterial vaccine?

pertussis

what are subunit inactivated vaccines?

Hep B

Hib

DTaP (acellar pertussis)

HPV

anthrax

what are toxoid inactivated vaccines?

diphtheria

DTaP (tetanus)

can you give multiple vaccinations at one time?

yes

does increasing the interval between doses of multi-dose vaccines diminish efficacy? do you need to restart the series?

no and no

what may happen if you decrease the interval between multi-dose vaccines?

interference with antibody response and immune protection

how early can you give another vaccine dose in a series?

4 days prior to the minimal interval or age

adverse reaction or adverse event:

- extraneous effect caused by vaccine

- side effect

adverse reaction

adverse reaction or adverse effect:

- may be coincidental or a true adverse reaction

adverse event

what symptoms suggest a local reaction to a vaccine?

pain, swelling, mild/self-limited

common with inactivated vaccines

what symptoms suggest a systemic reaction to a vaccine?

fever, malaise, HA, fussiness, crying, sleepiness in newborn/infant

what is used to test vaccines before being licensed and allowed on the market?

prelicensure human studies → 3 phases, common rxns identified

what are contraindications for live vaccines?

allergic response

encephalopathy

pregnancy

immunosuppression

what are contraindication for inactivated vaccines?

allergy

encephalopathy

is the vaccine schedule affected in a preterm infant?

no! vaccines are given according to chronological age not gestational age

contraindication or precaution:

condition in a recipient that might increase the chance or severity of an adverse reaction that might compromise the ability of the vaccine to produce immunity

precaution

contraindication or precaution:

great increase in chance of a serious adverse event

contraindication

what vaccines can you NOT give pregnant women?

live vaccines

HPV

what vaccine is recommended to be given during pregnancy between 27-36 weeks?

Tdap → it ↓ infant risk of whooping cough by 78%

can persons with isolated B-cell deficiency receive the varicella vaccine?

yes

should you use live or inactivated vaccines in immunosuppressed pts?

inactivated → their response may be decreased

what diseases are considered a special exception for vaccines?

congenital immunodeficiency

leukemia or lymphoma

generalize malignancy

a patient presents to you office for a flu shot. she is currently treating atopic dermatitis with prednisone and has been taking 25 mg for the past 16 days. can you give this patient the flu shot?

NO! she is immunosuppressed due to the steroids

*you shouldn't give a pt a vaccine if they are taking steroids >20mg x 14 days or longer or if 2mg/kg or more of daily prednisone

if your younger sister is immunosuppressed and you live with her, what vaccines should you receive to help protect her?

MMR, varicella and annual flu

does an acute illness reduce vaccine efficacy or increase adverse reactions?

no

You work in a pediatrics office and are seeing a 12 month old boy presents with his mother for his 12 month wellness visit. Upon completing you annual physical exam, you note the patient has a red, bulging TM in his right ear and suspect he has otitis media. According to the vaccine schedule, you should give the first doses of the MMR and varicella vaccine at this appointment to stay on schedule. Do you delay the vaccine until the child's AOM is resolved or do you give the vaccine today?

give the vaccine! a mild illness is not a contraindication to delay vaccines

how do you track a patient's immunizations in Florida?

Florida SHOTS

what should be given to the parent/guardian before each dose of a vaccine?

vaccine information sheet (IVS)

when should DTaP be administered?

2, 4, 6, 15-18 months, 4-6 years

*the first 3 doses must e given 4 weeks apart

*the 3rd and 4th dose are given 6 months apart

*if the 4th dose is given on/after 4th bday, 5th dose is not necessary

if a Tdap dose is given to a person < 7 y/o in place of DTaP doses 1, 2 or 3, is it considered valid?

no, you must give DTaP

if a Tdap dose is given to persons < 7 y/o in place of DTaP dose 4 or 5, is it considered valid?

yes

what are precautions for DTaP and DT?

- temp of 105 or high w/in 48 hrs of previous dose

- crying for 3 or more hrs w/in 48 hrs of prev dose

- collapse or shock like state w/in 48 hrs or prev dose

- seizure w/in 3 days

- progressive neuro disorder

what is the purpose of Tdap?

to prevent transmission of pertussis

when is Tdap administered?

11-12 y/o + booster every 10 years after

pregnant women 27-36 wks

*min age to receive is 10

what are precautions with Tdap?

- progressive neuro disorder

- mod-sev acute illness

- h/o arthrus rxn following prior dose

- GBS w/in 6 wks after prev dose

can you give MMR to those with egg allergies?

yes!

when is MMR administered?

12-15 months and 4-6 y/o (2 doses)

*2nd dose may be given >4 wks after first dose

*MMR given prior to 12 months is invalid

what is a precaution in the MMRV vaccine?

personal or fam history of seizures

what are precautions for MMR?

- mod/sev illness

- blood, plasma, or IG given in past

- h/o thrombocytopenia/ITP

can you give the MMR vaccine in asx HIV patients?

yes

what are contraindications to the MMR vaccine?

allergy, pregnancy immunosuppression, mod/sev illness, recent blood products

if you are getting the MMR vaccine and a PPD test dose at the same time, what is done first?

PPD test → give MMR with skin test is read

what is the MMRV vaccine?

MMR + varicella → given to 2-12 y/o

if you are giving a MMRV vaccine, what is the interval between doses?

3 months

do you give MMR and varicella in the same arm/site?

NO!!!

who is the Hip vaccine NOT recommended in?

5 y/o and older

when is Hib administered?

2, 4, 6, 12-15 months

*final dose cannot be given earlier than 12 months and minimum 8 weeks after previous dose

what are the exceptions to giving Hib vaccine after age 5?

- child has anatomic or functional asplenia (sickle cell)

- not received primary series and booster dose (they are considered unimmunized)

- unvaccinated person ages 5-18 with HIV

if a patient is < 5 y/o and undergoing chemo or radiation and received Hib vaccine dose within 14 days of starting therapy, what should you do?

repeat the dose 3 months following therapy completion

what are contraindications to the Hib vaccine?

previous severe allergic rxn

age < 6 wks

who is the PPSV23 (purified pneumococcal polysaccharide 23 serotypes) vaccine recommended in?

adults > 64

HIV pts

high risk children > 2 (sickle cell, asplenia)

*not effective in < 2 y/o

when is Prevnar (PCV13) administered?

2, 4, 6, 12-15 months

*heptavalent vaccine

what is the recommended revaccination of PPSV23?

5 years after first dose

what is the duration of immunity for Hep B vaccine?

13 years

what is the schedule of Hep B vaccine?

dose 1 and 2 given min 4 wks apart

dose 2 and 3 given min 8 wks apart

dose 1 and 3 should be min 16 wks apart

do you need to restart the Hep B series if the interval between doses were delayed?

NO!!

if the mothers HBsAg is unknown and the infant is < 2 kg, what do you give them?

HBIG within 12 hrs of birth

if the mothers HBsAg is negative and the infant is < 2 kg, when is Hep B vaccine given?

1 month of age

if the mothers HBsAg is positive, what is given to the newborn?

Hep B vaccine PLUS HBIG within 12 hrs of birth

*also need to be tested for antibodies btw 9-12 months

who is post vaccine testing recommended in?

- infants born to HBsAg+ women

- hemodialysis pts

- immunodeficient pts

- sex partners of persons w chronic HBV infection

- healthcare personnel

the Hep A vaccine is recommended for who?

- international travelers

- MSM

- illegal drug users

- those w occupational risk

- chronic liver disease

what is the schedule for Hep A vaccine?

2 doses 6-18 months apart for pts > 1

When is the polio (IPV) vaccine given?

2, 4, 6-18 months, 4-6 years

*dose 1 as early as 6 wks

*final dose given on/after 4th bday (at least 6 months after prev dose)

what is the exception to vaccinating someone > 18 yrs with the polio vaccine?

if they are traveling to polio endemic countries

- use standard schedule is possible, can separate doses by 4 wks

- do not need to restart series if pt is previous vaccinate but incomplete series

what is the duration of immunity of the varicella vaccine?

> 7 yrs

what is the schedule of the varicella vaccine?

2 doses → 12-15 months then 4-6 yrs

*can be admin simultaneously w MMR

what is the interval between varicella doses for unvaccinated children?

< 13 = 2 doses separated 3 months

> 13 = 2 doses separated 4 weeks

true or false:

if varicella, MMR, LAIV and/or yellow fever are not given on the same day you MUST space them at least 28 days apart

true

what is a common adverse reaction to the varicella vaccine?

rash 5-26 days after injection

when is the rotavirus vaccine given?

Rotarix (RV1) → 2 and 4 months

RotaTeq (RV5) → 2, 4, 6 months

*interval btw doses can be as short as 4 wks

*give final dose no later than 8 months/0days

should you begin the rotavirus vaccine series if an infant is older than 14 weeks/6days?

NO

what are precautions to the Rotarix (RV1) vaccine?

spina bifida or bladder exstrophy

what are contraindications to the rotavirus vaccine?

prev severe allergic rxn

latex allergy → use RV5

h/o intussuception

diagnosis of SCID

what is the schedule for the MenB vaccine?

Bexsero → 2 doses 1 month apart

Trumenba → 2 doses 6 months apart

*use same brand for all doses!

who is the anti-neisseria meningitidis (ACY-W135) vaccine indicated for?

at risk children → persistent complement component deficiency, anatomic/functional asplenia

when can you start receiving the flu vaccine?

6 months

what is the schedule of the flu vaccine (LAIV) if it is your first time dose?

series of 2 + booster 1 month after

if a patient if > 18 and allergic to eggs, what flu vaccine can they receive?

recombinant influenza vaccine (RIV3)

what are contraindications to the flu vaccine (LAIV)?

pregnancy

immunosuppression

age < 2 yrs

recipient of specific antivirals 48 hrs prior to vaccination

wheezing/asthma w/in last 12 months

what is the only HPV vaccine available in the US and what does it cover?

Gardisil 9 → HPV 9, 11, 16, 18, 31, 45, 52 and 58

if the first HPV dose is administered prior to age 15, what is the dosing series?

2 doses → 0 and 6-12 months apart

if the first HPV dose is administered after age 15, what is the dosing series?

3 doses → 0, 2 and 6 months apart

what is the Pediarix vaccine?

DTaP-HepB-IPV combo

3 doses → 2, 4, 6 months

*not approved for booster doses

what is the Twinrix vaccine?

combo of Hep A and Hep B

given > 18 y/o

3 doses → 0, 1, and 6 months apart