Immunization

Question 0

Hepatitis B

For infants born to hepatitis B surface antigen (HBsAg)–positive mothers, what should be given?

Answer 0

HepB vaccine and 0.5 mL of HBIG within 12 hours of birth

test for HBsAg and anti-HBs 1 to 2 months after completion of the HepB series, at age 9 through 18 months (preferably at the next well-child visit)

Question 1

Hepatitis B vaccine

minimum age
routine schedule of immunization

Answer 1

minimum age: at birth
routine: ideally 0, 1 mo, 6 mos
in some cases,
birth (monovalent), [6 wks, 10 wks, 14 wks] (part of combination vaccine DTwP/HepB/Hib 5-in-1) — 4 doses if the 3rd dose is given before 24 wks or if px is preterm and 1st dose was given at birth

primary series is given in 3 doses
1st dose - within 12 hrs, subsequent doses given at least 4 wks apart, 3rd dose preferably given not earlier than 24 wks (6mos)

Question 2

Hepatitis B

If mother’s HBsAg status is unknown, what should be done

Answer 2

regardless of weight, give HBV first within 12 hrs then confirm HBsAg status, if +, give HBIG within 7 days

Question 3

Hepatitis B

Minimum interval between doses

Answer 3

The primary 3-dose series should be at least 4 weeks apart, with the 3rd dose preferably given not earlier than 24 wks (6mos)

A fourth dose is needed if the third dose was given before 24 wks (eg as part of combination vaccines, with a schedule of 6-10-14 wks DTP-HepB-Hib)

Question 4

Hepatitis B

How many doses should be given if HepB was administered as part of combination vaccine after the birth dose?

Answer 4

4 doses

Question 5

Hepatitis B

If patient was previously unvaccinated, what should be the routine catch-up schedule?

Answer 5

follow a 3-dose schedule:

0, 1-2 mos, 6 mos

Question 6

Hepatitis B

For previously unvaccinated children between 7-18 yrs old, what is the catchup sched?

Answer 6

Follow 3-dose series: 0-1-6 mos (PPS)

Question 7

BCG should be given at the earliest possible age within first 2 mos of life. For healthy infants and children >2 mos who are NOT given BCG at birth, PPD is NOT necessary, except in which conditions?

Answer 7

If any of the following are present:

• suspected congenital TB
• hx of close contact to known or suspected infectious cases of TB
• clinical findings suggestive of TB and/or CXR suggestive of TB
• in any of these conditions, induration of >5 mm is (+)

Question 8

HiB

route of administration
minimum age
minimum interval
number of primary doses
routine schedule
booster age

Answer 8

route: IM
minimum age: 6 wks
minimum interval: 4 wks
no of primary doses: 3 
routine schedule: 6-10-14 wks
booster age: 12-15 mos, 6 mos after 3rd dose

Question 9

HiB

for unimmunized children aged 5 yrs and older, what are the conditions that warrant HiB vaccination?

Answer 9

sickle cell disease
leukemia
HIV
post-splenectomy pxs

Question 10

Enumerate the live attenuated vaccines

Answer 10

MMRV, OPV, RV (viral), BCG (bacterial)

• derived from “wild” virus or bacteria
• attenuated
• must replicate to be effective
• immune response similar to natural infection
• potential for reversal to pathogenic form
• interference from circulating antibody
• unstable

Question 11

What are the whole cell inactivated vaccines?

Answer 11

viral: influenza, polio, rabies, hepatitis A
bacterial: pertussis, typhoid

Question 12

What are the types of fractional inactivated vaccines?

Answer 12

Protein-based

• subunit: hepB, influenza, acellular pertussis, typhoid Vi
• toxoid: diphtheria, tetanus

Polysaccharide based

• pure: pneumococcal, meningococcal, Hib (PRP)
• conjugate: Hib (PRP-T, PRP-OMC), pneumococcal

Question 13

What is the minimum interval between 2 live injected vaccines?

Answer 13

4 weeks

• there is no contraindication to simultaneous administration of any vaccine
• injected live vaccines (MMRV) are not believed to have an effect on live vaccines given orally (OPV, rotavirus, oral typhoid)
• live oral vaccines may be given at any time before or after live injected vaccines