CB

Vaccines Through the Lifespan

Why Vaccinate?

  • Vaccines are the best way to prevent specific diseases, targeting approximately 25 bacterial and viral pathogens.

Types of Vaccines

  • Killed or Inactivated Vaccines: Hepatitis A, Flu, Polio.
  • Live Attenuated Vaccines: MMR, Varicella, Rotavirus.
  • Conjugate/Subunit/PS Vaccines: Pneumococcal, HIB, Meningococcal, Hepatitis B, HPV, Shingles, Pertussis.
  • Toxoid Vaccines: Tetanus, Diphtheria.
  • mRNA Vaccines: COVID-$19$.
  • Viral-Vector Vaccines: COVID-$19$.

General Vaccine Administration

  • Intramuscular (90 degree angle): Vastus Lateralis (for < 3 years) or Deltoid (for > 3 years).
  • Subcutaneous (45 degree angle): Fatty tissue of thigh (infants < 12 months) or upper outer triceps area (> 12 months).

Hepatitis B (HepB)

  • Disease: DNA virus causing acute/chronic hepatitis, cirrhosis, hepatocellular carcinoma. Transmitted by blood/body fluids.
  • Administration: Monovalent HepB for all newborns within 24 hours of birth; 2^{nd} dose at 1 or 2 months. Total 3-4 doses.
  • Effectiveness: >90\% effective.
  • Contraindications: Hypersensitivity to yeast or HepB vaccine.
  • Adult Recommendations: All adults up to 59 years, pregnant women, immunocompromised (e.g., HIV), chronic liver disease.

Rotavirus (RV)

  • Disease: Intestinal virus, common cause of diarrhea in children.
  • Administration: Oral live attenuated vaccine; 2 or 3 dose series for infants by 8 months of age.
  • Effectiveness: 85-96\% effective.
  • Adverse Effects: Mild, temporary diarrhea/vomiting.
  • Contraindications: Past life-threatening reactions, severe allergy to latex (for Rotarix).

Diphtheria, Tetanus, and Pertussis (DTaP/Tdap)

  • Diseases: Diphtheria (pharyngitis, cardiac/nerve damage), Tetanus (nervous system effects, respiratory compromise), Pertussis (whooping cough, apnea/pneumonia in infants).
  • Administration:
    • DTaP: 5-dose series (2, 4, 6, 15-18 months, and 4-6 years).
    • Tdap: 1 dose for adolescents aged 11-12 years.
  • Effectiveness: Diphtheria vaccine 97\% effective, Tetanus vaccine 100\% effective, Pertussis (new formulation) 98\% effective.
  • Adult Recommendations: Tdap booster every 10 years. Pregnant women (27-36 weeks gestation, with every pregnancy), immunocompromised (e.g., HIV), chronic liver disease.

Haemophilus Influenzae Type B (HIB)

  • Disease: Leading cause of purulent meningitis, epiglottitis, pneumonia, and septic arthritis in children.
  • Administration: 2 or 3-dose primary series and a booster dose at 12-15 months.
  • Effectiveness: Cases are < 1\% of pre-vaccine rates.

Pneumococcal

  • Disease: Common infection causing otitis media, pneumonia, and invasive bloodstream infections, including meningitis.
  • Vaccine Types: PCV ($15, 20$) and PPSV ($23$).
  • Administration (Pediatric): All children < 5 years; 4-dose series of PCV20 or PCV15 at 2, 4, 6 months and at 12-15 months.
  • Adult Recommendations: PCV15 or PCV20 for all adults 65 years or older. Patients with chronic health conditions (asplenia, diabetes, HIV, lung/liver disease) should be vaccinated.

Poliomyelitis (Polio)

  • Disease: Highly contagious poliovirus, can cause paralytic disease.
  • Administration: IPV (4-dose series) at 2, 4, 6-18 months, and 4-6 years. Final dose on/after 4^{th} birthday and at least 6 months after previous dose.
  • Effectiveness: 99-100\% develop serum antibody; protection is considered lifelong.
  • Contraindications: Allergic reaction to previous dose, or to streptomycin, polymyxin B, or neomycin B.

Influenza (Flu)

  • Administration: 1 dose annually. Live attenuated influenza vaccine (LAIV) is a nasal spray for non-pregnant people 2-49 years (limited use).
  • Contraindications (LAIV): History of severe allergic reaction, children (2-17 years) on aspirin, children (2-4 years) with asthma/wheezing in past 12 months, immunocompromised, splenectomy, recent antiviral medications, pregnancy, cochlear implants, cerebral fluid leak.

Measles, Mumps, and Rubella (MMR)

  • Diseases: Measles (highly contagious, can lead to encephalitis), Mumps (complications include orchitis, deafness), Rubella (can cause congenital rubella syndrome in pregnancy).
  • Administration: Live attenuated vaccine. First dose at 12-15 months; second dose at 18 months or school entry (interval not shorter than 28 days).
  • Effectiveness: Measles 99\% (after 2 doses), Mumps >95\%, Rubella 90\% (after 1 dose).
  • Contraindications: Allergic to gelatin, pregnant (or becoming pregnant within 1 month), immunocompromised.
  • Adult Recommendations: All adults aged 19-49, and all persons born after 1957. HIV patients with CD4 count above 200 can consider. Women of childbearing age must be vaccinated against rubella before pregnancy and wait 4 weeks after MMR before conception.

Varicella (VAR) & Zoster (Shingles)

  • Diseases: Varicella (chickenpox) caused by VZV. Shingles is a reactivation of latent VZV, potentially leading to eye complications, pneumonia, encephalitis.
  • Administration (VAR): Weakened live vaccine. 2-dose series at 12-15 months and 4-6 years.
  • Effectiveness (VAR): 85-90\% effective in preventing disease, 100\% in preventing severe disease.
  • Adult Recommendations:
    • Varicella: All adults born in 1980 or later.
    • Zoster (Shingrix): 2 doses for adults 50 years and older, and adults 19 years and older with weakened immune systems. 90\% effective.

Hepatitis A (HepA)

  • Disease: Acute hepatitis, spread via fecal route.
  • Administration: 2-dose series for children at 12-23 months, separated by 6-18 months.
  • Effectiveness: 94\% highly effective.
  • Adult Recommendations: Adults with chronic conditions (e.g., HIV, liver disease), those traveling to high-risk areas, or living in areas with high HepA rates.

Meningococcal

  • Disease: Life-threatening sepsis and/or meningitis.
  • Vaccine Types: Meningococcal Conjugate (MenACWY), Serogroup B (MenB), Pentavalent (MenABCWY).
  • Administration:
    • MenACWY: Pediatric patients at 11-12 years with a booster at 16 years.
    • MenB: Patients 10 years or older at increased risk.
    • MenABCWY: Option when receiving both MenACWY and MenB at the same visit.

Human Papillomaviruses (HPV)

  • Disease: Sexually transmitted, causes 50\% of anogenital cancers and 20\% of throat/mouth cancers (types 16, 18); genital warts (types 6, 11).
  • Administration: For preteens (boys/girls) at 11-12 years (can start at 9 years), up to age 26 if not vaccinated.
    • Initiating before age 15: 2 doses (0, 6-12 months).
    • Initiating at age 15 or older: 3 doses (0, 1-2, 6 months).
  • Effectiveness: 100\% effective in preventing targeted HPV-related precancerous changes.
  • Adverse Effects: Site reactions, fainting (patient should sit/lie down for 15 minutes post-vaccine).

Respiratory Syncytial Virus (RSV)

  • Disease: Leading cause of respiratory disease, hospitalization in infants, and severe disease in older adults.
  • Pediatric Recommendations:
    • Nirsevimab (Beyfortus - antibody): Single dose for infants < 8 months during first RSV season, or older infants in second season with increased risk. Reduces severe RSV by ~80\%, protects for ~5 months.
    • Palivizumab (Synagis - antibody): Once a month during RSV season for infants/children < 24 months at increased risk. Reduces hospitalization by ~50\%.
  • Adult Recommendations:
    • Maternal Vaccine (Abrysvo): Administered at 32-36 weeks gestation during RSV season to confer protection to young infants.
    • Adults 60 years or older (Arexvy, Abrysvo): 1 dose, especially for those at increased risk for severe RSV disease. These vaccines provide >80\% effectiveness in the first RSV season.

COVID-$19$

  • Vaccine Types: mRNA (Pfizer-BioNTech, Moderna), Protein Subunit (Novavax).
  • Pediatric Administration:
    • 6 months-4 years: Multiple doses of updated vaccine.
    • 5-11 years: Updated Pfizer-BioNTech or Moderna.
    • 12 years and older: 1 updated Pfizer-BioNTech, Moderna, or Novavax. Unvaccinated choosing Novavax requires 2 doses, 3-8 weeks apart.
  • Adult Recommendations: All adults recommended to receive an updated COVID-$19$ vaccine. Immunocompromised individuals may need additional doses.

Mpox

  • Disease: Caused by a virus related to smallpox, spread via skin contact with infected individuals/materials.
  • Vaccine: JYNNEOS (live attenuated).
  • Administration: For patients 18 years and older at risk. 2 doses needed for optimal effectiveness.
  • Effectiveness: 70\% effective in preventing illness with 2 doses.
  • Adverse Effects: Redness/swelling at injection site, fatigue, headache, muscle pain.