Immunizations

Question 1

What vaccine preventable disease kills the most kids annually?

Answer 1

• measles (745,000/1.5 mill total vaccine preventable deaths)

Question 2

What is herd immunity?

Answer 2

• ability of a community to resist epidemic disease
• not every person in a pop has to be immunized in order for a community to be resistant to an epidemic disease
• unvaccinated individuals are indirectly protected by vaccinated individuals, as the latter will not contract and transmit the disease b/t infected and susceptible individuals

Question 3

Active immunizations?

Answer 3

• antigen admin (either live, killed or derivative such as protein polysaccharide of microorganism) or toxoid (deactivated toxin)
• provides long term immunity
• meaningful immunity often not achieved until 2-4 wks after vaccination
• live versions more efficacious and provide longer lasting immunity than nonliving vaccines

Question 4

Passive immunization?

Answer 4

• admin of preformed ab (immunoglobulin)
• results in immediate protective immunity
• short term though (typically lasts only 3-6 months)

Question 5

Times when immunoglobulin therapy (passive immunization) is used?

Answer 5

• mother is HBsAg +, then HBIG is given within 12 hrs of birth
• Palivizumab (Synagis) is RSV immune globulin that is admin to children at risk for severe RSV

Question 6

Live virus immunizations?

Answer 6

• MMR
• Varicella
• Zoster
• Nasal-spray Flu vaccine
• Yellow fever (not std in US)
• Oral polio
• typhoid (not std in US)
• TB (BCG - not std in US

Question 7

Admin more than 1 live vaccine at same time?

Answer 7

• should be done on same day at diff injection site or 4 weeks apart

Question 8

Most common side effects of vaccines in kids?

Answer 8

• mild side effects:

fever and local rxns at site of injection

Question 9

True vaccine CIs?

Answer 9

• previous anaphylactiv rxn to specific vaccine
• hx of anaphylaxis to eggs or egg protein - avoid measeles, mumps, influenza and yellow fever vaccines
• previous anaphylactic rxn to neomycin or streptomycin: avoid MMR
• hx of severe systemic rxns to cholera, typhoid or plague vaccine
• adults who are immunocompromised - avoid live vaccines
• household members of immunocompromised pts have to avoid oral polio vaccine - if vaccine induced disease occurs it could be transmitted to immunocompromised individual
• pregnant women: avoid all live virus vaccines

Question 10

Common misconceptions about vaccine CIs?

Answer 10

• not a CI to admin vaccine in pt with mild respiratory, intestinal, or flu-like illnes, low grade fever or hx of recent illness
• mild or moderate local rxns are not CI
• hx of seizures isn’t a CI
• hx of non-vaccine assoc demyelinating conditions (MS or guillain-barre syndrome) not a CI to vaccine admin)

Question 11

Hep B vaccine infant schedule?

Answer 11

• 3 doses
• 1st: birth
• 2nd: 6-8 wks of age
• 3rd: 4-18 months
• some babies get 4 doses if giving combo vaccine using Hep B is used (Pediarix)

Question 12

What is done for babies born with high risk of getting Hep B?

Answer 12

• for babies born to HBsAg+ mothers, admin HepB vaccine and 0.5 mL of HBIG w/in 12 hrs of birth
• these infants should be tested for HBsAg and ab to HBsAg 1-2 months after completion of HepB series

Question 13

Strep pneumo is leading cause of what? And what else can it cause in young children?

Answer 13

• leading cause of bacterial pneumonia worldwide and principal cause of sepsis and meningitis, especially in kids younger than 2 yo.
• incidence of invasive pbeumococcal disease has declined 60-90% in kids since PCV13 has been added to routine immunization schedule

Question 14

Recommended immunization schedule for PCV13?

Answer 14

• IM 0.5 mL/dose
• primary 1: 6-8 wks
• 2: 4 months
• 3: 6 months
• booster: 12-15 months

Question 15

HIB used to be leading cause of what before HIB vaccine?

Answer 15

• leading cause of childhood meningitis, pneumonia, and epiglottitis
• incidence has fallen more than 99% since prevaccine era

Question 16

Indications to admin HIB vaccine to adults and children older than 5?

Answer 16

• sickle cell disease
• HIV/AIDS
• removal of spleen
• bone marrow transplant
• cancer pts on immunocompromising chemo

Question 17

HIB vaccine schedule?

Answer 17

• 1: 6-8 wks
• 2: 4 months (4 wk interval)
• 3: 6 months (4 wks)
• booster: 15-18 months (6 mos)

Question 18

IPV schedule?

Answer 18

• 6-8 weeks
• 4 months
• 6-18 months
• booster dose at 4-6 years

Question 19

How long is DTaP vaccine effective for?

Answer 19

• approximately 10 yrs

Question 20

DTaP vaccine schedule?

Answer 20

• 1: 6-8 weeks
• 2: 4 months (4 wk interval)
• 3: 6 months (4 wks)
• 4: 15-18 months 6 mos)
• 5: 4-6 yrs (6 mos)

Question 21

Booster doses for Tdap?

Answer 21

• 11 or 12 yrs of age if 5 years since last dose
• every 10 yrs thereafter (Td or Tdap)
• pertussis is making a comeback, recommended that all adults get at least 1 booster from Tdap formulation

Question 22

Admin of rotavirus vaccine (rotarix, rotateq)? Why do we give this?

Answer 22

• admin orally
• rotavirus is single most impt viral cause of severe gastroenteritis in kids worldwide
• severe gastroenteritis affects kids 6mo-2 yrs
• vaccine to be started by 14 wks and is to be completed by 8 months

Question 23

Dosage of RV5 (RotaTeq)?

Answer 23

• more common
• live attenuated
• route: oral 2 ml/dose/ 3 doses
• pentavalent human-bovine rotavirus reassortant vaccine

Question 24

Dosage of RV1 (rotarix)?

Answer 24

• live attenuated vaccine
• route: oral 2 ml/ 2 doses
• monovalent vaccine derived from the most common human serotype

Question 25

Rotavirus vaccines are assoc with an increased risk of?

Answer 25

- intussusception

Question 26

Rotavirus vaccine schedlue (ratateq, rotarix)?

Answer 26

- first dose: 6-8 wks - 2nd: 4 months - 3rd: 6 months (only for rotaTeq)

Question 27

Flu shot is recommended to who? How many doses are reqd when receiving flu vaccine for first time? - How long does before vaccine is effective?

Answer 27

- recommeneded for all kids annually from 6 mo-18 yrs and close contacts of all kids 0-59 mos - for kids aged 6 mos to 8yrs reqr 2 doses (sep by at least 4 wks) to kids who are recieving vaccine for first time - inactivated vaccine protects against 3-4 diff influenza viruses - Takes 2 weeks for protection

Question 28

Intranasal flu vaccine?

Answer 28

- live, only approved for healthy pts 2-49 who are not pregnant - viruses in nasal spray don't cause the flu

Question 29

What is the Hep A vaccine? When is it admin? Typical schedule?

Answer 29

- inactivated whole virus vaccine - ped formulations vaccines approved for 12 months- 18 years - admin with 2 dose series, 1st dose initiated at 12-23 months, 2 doses should be separated by 6-18 months - schedule: 1st dose: 12 months 2nd: 24 months

Question 30

MMR vaccine? Vaccination schedule?

Answer 30

- live virus attenuated vaccine at 0.5 ml dose via subQ route - first dose: 12-18 months - 2nd dose: 4-6 yrs (may be given any time at least 4 weeks after the first dose) - first dose has to be given at exactly 12 months or later

Question 31

Why do we worry about Rubella (german measles) so much?

Answer 31

- rubella virus causes rash, arthritis (mostly in females), and mild fever - rubella in and of itself generally is a mild self-limiting disease but if a woman gets rubella while pregnant - lead to congenital rubella syndrome

Question 32

Varivax? schedule?

Answer 32

- varicella vaccine - live, attenuated - ped dosing: 0.5 ml SubQ - routine childhood vaccination is 2 doses - 1st: 12-15 months - 2nd: 4-6 yrs but may be admin earlier provided 3 or months have elapsed after first dose

Question 33

Meningococcal vaccine?

Answer 33

- MCV4 and Menactra - 2 doses of MCV4 recommend for adolescents 11-18 yrs of age: 1st dose at 11-12 booster: 16

Question 34

HPV vaccine?

Answer 34

- gardisal - ACIP recommends routine vaccination of all adolescents 11-12 yo - can be started at 9 - catch up vaccination recommened for 13-26 yo - routine schedule: 0, 2, 6 months - 3rd dose should follow 1st dose by at least 24 wks - series doesn't need to be restarted if schedule is interrupted - best time to get vaccine is before becoming sexually active

Question 35

What vaccines are in Pediarix? schedule? What age group can get this?

Answer 35

- DTaP, Hep B, IPV combo - min. age: 6 wks - 3 doses at 2, 4, and 6 months - not approved for boosters - for children 6 wks-7 yrs - Child can still get this if received birth dose of HBV vaccine, (4 doses of it in total) - May be used in infants whose mothers are HBsAg + or status unknown

Question 36

What does a typical vaccination schedule look like with combo vaccines?

Answer 36

- birth: HBV - 2 months: prevnar, Hib, pediarix - 4 months: prevnar, Hib, pediarix - 6 months: prevnar, Hib, pediarix - 12 months: prevnar, Hib, HepA - 15-18 months: DTaP, ProQuad (MMRV) - 18-24 months: HepA - 4-6 yrs: Kinrix (DTaP-IPV) and ProQuad

Question 37

If Hexavac gets approved what would the infancy vaccination schedule look like?

Answer 37

- only need to administer Prevnar and Hexavac through first year