835 > Immunizations > Flashcards

Immunizations Flashcards

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1
Q

Vaccines + Media

A
  • Stirred up fear and concern over vaccine safety

- Leading to increased questions from parents and some refusing to innoculate their children

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2
Q

Thimerosal

A
  • Mercury-containing compound that was used as a preservative
  • Thimerosal has largely been removed from vaccines with the exception of inactivated influenza vaccine
  • NEVER contained in MMR vaccine
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3
Q

MMR Vaccine

A
  • Live-attenuated triple viral vaccine against measles, mumps, and rubella
  • Max: 2 doses/lifetime
  • Single antigens are no longer available
  • MMRV with varicella is also available now
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4
Q

Measles

A
  • Vaccine-preventable disease
  • Despite vaccine, still a leading death of children worldwide
  • Highly contagious
  • Symptoms: cough, runny nose, full body rash
  • Complications: pneumonia, encephalitis
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5
Q

Mumps

A
  • Vaccine-preventable viral disease
  • Contagious
  • Symptoms: fever, headache, muscle aches, fatigue, swelling of salivary glands
  • Complications: orchitis, pancreatitis, encephalitis, hearing loss, miscarriage
  • > 99% since vaccine
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6
Q

Rubella

A
  • Vaccine-preventable viral disease
  • Contagious
  • Symptoms: fever, sore throat, rash, arthralgias
  • Complications: birth defects, miscarriage, encephalitis, otitis media
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7
Q

Wakefield Study

A
  • Study that suggested that MMR caused autism
  • Numerous larger studies have shown otherwise
  • Original article ended up retracted
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8
Q

MMR + Autism

A
  • Signs/symptoms have a temporal relationship
  • Autism is both genetic and environmental
  • CDC, Vaccine Injury Compensation Program, and Institute of Medicine don’t support the association
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9
Q

Addressing Parents’ Concerns

A
  • No vaccine is 100% safe/effective, but to do nothing is a higher risk
  • Establish rapport, be open/honest, identify concerns, identify sources of information, respond with evidence-based information, appeal to civic duty and risk
  • If parents refuse, respect decision and broach in the future
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10
Q

Pharmacist Responsibility + Vaccines

A
  • Promote vaccination
  • Ensure proper storage/administration
  • Observe correct timing and appropriate intervals of vaccinations
  • Follow contraindications and precautions
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11
Q

Passive Immunity

A
  • Protection transferred from exogenous source - blood, placenta
  • Wanes with time
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12
Q

Active Immunity

A
  • Produced from person’s own immune system - infections, vaccinations
  • Immunity persists for years
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13
Q

Live Vaccines

A
  • MMR
  • Varicella
  • Influenza
  • Rotavirus
  • Also, yellow fever, vaccinia (smallpox), oral polio (OPV), BCG for tuberculosis, and oral typhoid
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14
Q

Fractional Inactivated Vaccines

A
  • Only portion of virus or bacteria included to enact a response
  • Protein - toxin or subunit
  • Polysaccharide-based
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15
Q

Viral Whole Vaccines

A
  • Polio
  • Hep A
  • Rabies
  • Japanese encephalitis
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16
Q

Viral Fractional Vaccines

A
  • Hep B
  • Influenza
  • HPV
  • Anthrax
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17
Q

Inactive Bacterial Vaccines

A
  • All fractional
  • Tdap
  • Pneumococcal (23/13)
  • Meningococcal
  • Haemophilus influenzae type B
  • Typhoid Vi
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18
Q

Encapsulated Organisms

A
  • Polysaccharide capsules that make them antiphagocytic
  • Target for vaccine protection
  • Patients without spleen are susceptible to these infections
  • EX: S. pneumonia, H. influenzae, N. meningitidis
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19
Q

Pure Polysaccharide Vaccines

A
  • Traditionally adult formulations
  • Not consistently immunogenic in children <2 yrs
  • No booster response and immunogenecity in children improved with conjugation
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20
Q

Polysaccharide Conjugate Vaccines

A
  • Traditionally children formulations
  • Enhanced antibody production, especially in younger kids
  • Repeat doses elicits a booster resposen
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21
Q

Vaccine Precautions

A
  • Severe allergic reaction to vaccine/component
  • Severe illness (delay)
  • DON’T give immunosuppressed and pregnant live vaccines
  • Also don’t give live vaccines to <1 years old or to patients receiving a transfusion or other blood products
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22
Q

Invalid CI

A
  • Mild disease - low fever, URI, otitis media, mild diarrhea
  • Antibiotic therapy
  • Breastfeeding
  • Premature birth
  • Pregnancy/immunosuppression in the house
  • Warfarin
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23
Q

Vaccine Dose Timing/Intervals

A
  • DON’T give before recommended age and interval
  • Increasing the interval DOESN’T diminish the response (DON”T RESTART)
  • Immunosupressed: Administer >= 2 weeks prior to suppression for live vaccines and avoid live vaccines within 2 weeks
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24
Q

Simultaneous Administration

A
  • Okay to give to vaccines together to increase inoculation likelihood
  • DON’T give PCV 13/23 together
  • If LIVE vaccines are not given together, then separate by at least 4 weeks
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25
Adverse Event Reporting
- Use VAERS or Vaccine Injury Compensation Program (childhood vaccines) - Adverse events can be an adverse reaction (side effect)
26
Meningococcal Disease
- Encapsulated organism - 13 serotypes - Vaccines available that cover 5 of the types
27
Meningococcal Risk Factors
- Anatomic or functional asplenia - Terminal complement deficiency - Exposed labratory personnel - Foreign travelers - Military recruits - First year college students in dorm living - HIV
28
Menactra/Menveo
- Conjugate formulations for serotypes A, C, W, Y | - Pure polysaccharide formulation isn't available
29
MenB-4C/MenB-FHbp
- Meningococcal B vaccines - B-4C: 2-dose series - B-FHbp: 2-3 dose series - Vaccines are not interchangeable and have different interval recommendations
30
Pneumococcal Disease
- S. pneumoniae - Encapsulated organism - Invasive diseases: pneumonia, meningitis
31
Pneumococcal Risk Factors
- Young/elderly - Health conditions like asplenia, heart disease, lung disease, asthma, ESRD, cirrhosis, DM, immunosuppression - Smoking - Alcohol abuse
32
PSV23/13
- 23: pure polysaccharide vaccine, doesn't induce response in <2 years old - 13: conjugate vaccine, conugated to protein carrier for better children response, better responses in kids and adults
33
Adults Needing Pneumococcal Vaccination
- Adults >= 65 y.o. (prefer PCV23) - Heart disease - Lung disease/asthma - ESRD - Cirrhosis - DM - Tobacco Use - Alcoholism - Asplenia - Immunosuppression
34
Adults >= 65 + PCV13
- Nursing home/long-term care facilities - Low pediatric PCV13 uptake residences - Traveling to settings with no pediatric PCV13 program - Certain comorbid conditions
35
Diphtheria/Tetanus Toxoids
- Inactivated bacterial toxins - Available in combination: not single antigens - Adult formulations contain [lower] of diphtheria toxoid to prevent local reactions - Local site reactions in higher with each additional dose
36
Pertussis Vaccine
- Acellular vaccine with detoxified pertussis toxin - Better side effect profile than whole cell vaccine with comparable immunity - Precautions: T > 40.5C within past 48 hours without known cause, convulsions within last 3 days - CI: encephalopathy within past 7 days
37
Influenza
- Single stranded RNA virus - Influenza A is responsible for pandemics - Shift variations are major changes causing pandemics, drift variations are minor changes causing epidemics
38
Live Flu Vaccine CI
- Immunosuppression - Anatomical or functional asplenia - Pregnancy - Close contact/caregiver of immunosuppressed - Flu antivirals in last 48 hours - CSF leak or cochlear implant - History of severe allergic reaction to any part of vaccine
39
Varicella
- Primary infection: chickenpox - Highly contagious vesicular rash - Complications: lesion infections, encephalitis, pneumonia, CVS (congenital varicella syndrome)
40
Herpes Zoster
- Shingles - Recurrent infection: herpes zoster - Can occur decades after initial infection/vaccination - Associated with aging/immunosuppression - Post-herpetic neuralgia is a common complication
41
Varicella Vaccine
- Live - Two doses for those who don't have immunity evidence - Can be given as a part of MMR (MMRV) - ADE: rash, infection site reactions, arthralgias/myalgias, respiratory tract infections - Don't give zostavax (live) to preggo/immunosuppressed
42
RZV + HIV Patients
- No recommendation - Optimal timing and duration of immunity is unknown - Appears to be safe - Recommended for >= 50 y.o. with HIV
43
Rotavirus Gastroenteritis
- Almost all kids infected by 5 y.o. - Five strains account for 90% of infections - 1st infection after 3 months of age is most severe with T>102F - GI symptoms usually resolve in 3-7 days - Low mortality but high healthcare burden
44
Rotavirus Vaccine
- Live oral - Start at 2 months old, don't start after 15 weeks old - Complete by 8 months - Two, interchangeable formulations available
45
Poliomyelitis
- Enterovirus with 3 serotypes | - Infection spreads in CNS and causing motor neuron destruction
46
IPV
- Inactivated polio vaccine - Protects against all serotypes - Given to children - Only give to unvaccinated adults if traveling to polio-endemic areas
47
HPV
- Sexually transmitted infections - Most are asymptomatic but some cause warts or cancer - Most clear the infection - Leading cause of cervical cancer - Vaccine covering 9 strains available
48
Hep A Vaccine
- 2 dose series - Child and adult dosing - Single or combination formulations available
49
Hep A + High Risk Factors
- Chronic liver disease - HIV infection - Sexually active gay men - Drug use - Occupational risk - At risk International travelers - Close contact with international adoptee - Pregnancy based on risk
50
Hep B Vaccine
- Single or combination formulations available - Recommended for all children High-Risk Adults: - Chronic liver disease - HIV - Sexual exposure risk - Current/recent drug use - Percutaneous/mucosal risk exposure - Incarcerated persons - Travel to areas of risk - Pregnancy based on risk
51
H. influenzae Type B Vaccine
- Single or combination formulations - All vaccines are interchangeable for primary series/boosters - Children who fall behind may not need remaining doses - Not recommended for 5 y.o.+ unlesss high risk: HSCT, asplenia, sickle-cell disease
52
Target Populations for Travel Evaluations
- Military personnel - Peace Corps volunteers - Travelers to developing countries - Immigrants
53
Other Travel Considerations
- Age - Underlying illness - Medical history - Allergies - CI to meds/vaccines - Pregnancy/breastfeeding
54
Travel Vaccinations
- No schedule - Individual assessment - Good opportunity to review immunization status for scheduled vaccinations - Some vaccines may be mandatory - Patients may need to carry a copy of their vaccination records
55
Typhoid
- Caused by salmonella typhi - Fecal-oral transmission - Worldwide, Africa/South Asia/Indonesia/Peru have higher rates - Manifestation: high fever, gastroenteritis, diarrhea, rash
56
Yellow Fever
- Virus transmitted by mosquitoes - No treatment available - Phase I: flu like symptoms - Phase II: jaundice, arrhythmias, kidney failure, delirium, seizures, coma, usually fatal
57
Japanese Encephalitis
- Leading cause of viral encephalitis in Asia - Mosquito vector - Typically seasonal - Highest rates in rural areas that use flooding irrigation practices - Inactivated vaccine, not that effective
58
Rabies
- Zoonotic viral disease transmitted by bites - Incubation can be several months - Acute encephalitis is usually fatal within days - Vaccinate if wild/domestic animal contact expected, visiting remote areas, stay >1 mo where dog rabies is common
59
Traveler's Diarrhea + Self Treatment
- Bacteria most common cause (E. coli) - Prophylactic antibiotics not recommended routinely - Use pepto bismol - Can use antibiotics to self treat in causes that are moderate to severe - Safe oral hydration is important to avoid traveler's diarrhea
60
Malaria
- Transmitted by mosquitos - Different species - Usually causes death in US from failed prophylaxis, delay in seeking medical care, misdiagnosis - Exo-erythrocytic and erythrocytic cycles
61
Malaria Signs/Symptoms
- Initial presentation is non-specific: fever, chills, myalgias, HA - Erythrocytic phase: fever, hemolysis => anemia, severe pallor, cyanosis, tachycardia, delirium - Can have more severe complications depending on species infected - Diagnosis is usually a blood smear
62
Chemoprophylaxis Counseling Points
- Malaria risk - Personal protective measures to prevent bites - Mild N/V or loose stools shouldn't dissuade from use - Continue for 1-4 weeks after leaving the endemic area - Seek early care/treatment for febrile illness
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