Immunizations

Question 1

Polysaccharide Vaccine

Answer 1

• Inactivated vaccine made from outside layer of encapsulated bacteria
• Inadequate immune response in children <2 yo
• Ex: PPSV 23 (Pneumovax)

Question 2

Conjugate Vaccine

Answer 2

• Use polysaccharide molecules from outside layer of bacteria and join them to carrier proteins
• Increased immune response in infants
• Ex: PCV 13 (Prevnar)

Question 3

Common Live Vaccines

Answer 3

MICRO-VY

• MMR
• Intranasal Influenza (FluMist)
• Cholera
• Rotavirus
• Oral Typhoid
• Varicella
• Yellow Fever

Question 4

TST

Answer 4

• Tuberculin skin test, aka purified protein derivative (PPD)
• If live vaccine given, must wait 4 weeks to administer skin test
• Recommend to give TST first, wait 48-72 hours to get result, then give vaccine

Question 5

Vaccines for Infants/Chilren

Answer 5

• 3 dose Hep B at birth (within 24 hours)
• Prevnar 13, DTaP, Hib, polio, rotavirus at 2 months
• Live vaccines start at 12 mo old or older: MMR, varicella
• No polysaccharide =< 2 yo

Question 6

Vaccines for HCP

Answer 6

• Annual influenza
• Hep B if no evidence of series completion or blood test showing insufficient immunity
• Tdap: 1 dose every 10 years
• Varicella if no vaccination or previous chickenpox infection
• MMR if no history of vaccine or insufficient immunity

Question 7

Vaccines for Adolescents/Young Adults

Answer 7

• Meningococcal (MCV4: Menactra, Menveo): 1 dose at 11-12, 1 dose at 16, 1 dose if first-year college students in group housing
• HPV: recommended for 11-12 years old (with age, number of doses increases from 2 to 3)
• Tdap: first dose at >11 yo

Question 8

Vaccines for Sickle Cell Disease/Asplenia

Answer 8

• H.influenzae type b (Hib)
• Pneumococcal (13 and 23): <65 yo - give 13 first, wait 8 weeks, then 2 doses of 23 (5 years apart)
• Meningococcal vaccines: 4 serogroups and serogroup B (Bexsero or Trumenba)

Question 9

Vaccines for Preggos

Answer 9

• NO LIVE VACCINES (CI)
• Inactivated flu vaccine at any trimester
• 1 Tdap with each pregnancy (weeks 27-36 optimally)

Question 10

Vaccines for Older Adults

Answer 10

• Shingrix for 50 yo+, 2 doses given 2-6 mo apart
• Pneumococcal for 65 yo+: 23 given once or 13 given once beforehand if immunocompromised (timing between depends on immunocompromised)

Question 11

Vaccines for Immunodeficiency

Answer 11

• NO LIVE VACCINES (CI)
• Pneumococcal: Before 65 - give 13 once, wait 8 weeks, then give 23 twice (5 years between)
• If HIV CD4 < 200: Meningococcal conjugate (Menactra or Menveo), Hep A and B vaccines

Question 12

Influenza

Answer 12

• Recommended annually for all patients >= 6 mo
• Trivalent (Fluad): recommended for 65 yo+-
• Quadrivalent: Afluria/Fluarix/FluLoval/Fluzone (approved for various ages), Flucelvax (approved 4yo+, egg-free), Flublok (approved 18 yo+, egg-free), Fluzone High-dose (approved 65 yo+)
• FluMist: Quadrivalent, live nasal mist, approved for health patients 2-49 yo, divided between two nostrils
• Give vaccine as soon as available
• Store in fridge

Question 13

Shingles

Answer 13

• Vaccinate all adults over 50 yo even if they had shingles/chickenpox or Zostavax previously
• 2 dose series, 2nd dose given 2-6 mo after the first
• Shingrix, do not freeze, given IM

Question 14

HPV

Answer 14

• Give to adults =< 26 yo if they didn’t complete series (indicated up to 45 yo)
• Recommended for 11-12 yo (may start as young as 9 if history of sexual abuse)
• <15: 2 doses, >15: 3 doses
• Store in fridge, given IM, shake before administration
• Caution for fainting, give to seated patients

Question 15

Pneumococcal

Answer 15

• Give PPSV 23 to all adults 65 yo+, 1 dose 2-64 yo (need heart, lung, or liver disease, diabetes, alcohol abuse, or smoke), 2 doses 2-64 yo if immunocompromised
• Give PCV13 in 6 yo+ immunocompromised patients (if not received before, optional for adults 65 yo+
• Store in fridge, shake prior to use, PPSV can be given IM or SQ

Question 16

Meningococcal

Answer 16

• Serogroup B (Bexsero, Trumenba) - give with asplenia, exposure to N. meningitidis, taking certain biologics (given for 10-25 yo)
• Conjugate vaccines (Menactra, Menveo) - same groups as above, HIV, travelers/residents to countries where disease is common (Sub-Saharan meningitis belt in Africa), military recruits, first year college students living in dorms
• For menveo, both vial and liquid contain vaccine, must use those supplied
• Vaccination required in Saudi Arabia during Hajj and Umrah pilgrimage time periods
• Store in fridge, give IM

Question 17

Hep B Vaccines

Answer 17

• Sexually active adult if not in long-term monogamous relationship, diabetics 19-59 yo (possibly 60 yo+ with doctor recommendation), household contact with infected person, IV drug abusers, patients with HIV or chronic liver disease
• Can give alone (Engerix-B, Recombivax HB, Heplisav-B) or with Hep A (Twinrix)
• Store in fridge, given IM, shake before administration
• *Heplisav-B only approve for 18 yo+**

Question 18

Hep A Vaccine

Answer 18

• Adults traveling to underdeveloped countries outside the US, household with newly adopted children from moderate to high-risk countries, liver disease, hemophilia, MSM, IVDA, homeless, HIV
• Given alone (VAQTA, Havrix) or with Hep B (Twinrix)
• Store in fridge, given IM, shake before administration

Question 19

DTaP

Answer 19

• With HepB/IPV: Pediarix
• For children <7 yo
• Store in fridge, given IM, shake before administration

Question 20

Tdap

Answer 20

• Adacel or Boostrix
• Wound prophylaxis: for deep/dirty wounds, revaccinate if >5 years since last dose
• Give if never given previously as an adult, then Q10y as routine booster
• Recommended for each pregnancy and those in close contact with infants <12 mo if not given in past 5 years
• Store in fridge, given IM, shake before administration

Question 21

Hib Vaccines

Answer 21

• ActHIB, Hiberix
• Given to those with asplenia
• Store in fridge, given IM, shake before administration

Question 22

MMR-Containing Vaccines

Answer 22

• ProQuad contains varicella
• Give 2 doses to healthcare workers, HIV patients with CDC =<200 at least 6 months, international travelers
• Live vaccine therefore DON’T use in preggo/immunocompromised
• Store in freezer if contains varicella, diluents go in fridge or room temp, give SQ

Question 23

RotaVirus

Answer 23

• Rotarix or RotaTeq
• Number of doses depends on vaccine used
• Store in fridge
• Given orally

Question 24

Varicella-Containing Vaccines

Answer 24

• Varicella alone = Varivax; MMRV = ProQuad
• Live, so don’t give in preggos/immunocompromised
• CI in allergies to gelatin or neomycin
• For chickenpox
• Give 2 doses to anyone without immunity
• Stop antivirals (valacyclovir, acyclovir, famiciclovir) 24 hours before vaccine administration and stay off for 2 weeeks
• Store in freezer, reconstitute immediately upon removing and inject ASAP (within 30 minutes), give SQ

Question 25

Rabies Vaccines

Answer 25

- RabAvert - Given preventatively for high risk of exposure (3 doses) or post exposure with rabies immunoglobulin (4 doses total) - Store in fridge, reconstistute with diluent, give IM