Peds: Immunization Recommendations

Question 1

Inactivated attenuated vaccine

Answer 1

• inactivated pathogen;
• cannot replicate;
• can revert to disease form;
• short length of protection (requires booster for long term protection);
  ex. polio injection

Question 2

Live attenuated vaccine

Answer 2

• provokes immune response;
• not sufficient enough to cause illness except immune compromised states (varicella & MMR not given in preg);
  ex. rotavirus, influenza, MMR, varicella, oral polio

Question 3

Toxoid

Answer 3

• toxin produced by the ;
• inactivated toxin;
  ex. DTap, Tdap

Question 4

Conjugate

Answer 4

• contains percentage of pathogen to initiate immune response;
  ex. HIb, PCV 13 (prevnar), HPV

Question 5

Hepatitis B vaccination:

- series of 3 (0-2-6 mos)

Answer 5

• *all newborns vaccinated prior to hospital d/c;
• *2nd dose @ 1-2 mos of age (monovalent);
• *infants born to HBsAg (Hep B antigen) + mothers:
• — given Hep B vac (Hep B) + 0.5 ml Hep B immune globulin (HBIG) within 12 hours;
• — test for HBsAg (antigen and antibody) after 3+ series (commonly @ 9 - 18 mos of age);
• *if HBsAg status of mother is unknown:
• –immediately check newborn after birth;
• – administer HepB within 12 hours of birth;
• — if mother tested pos., given HepB within 1 week;
• *FINAL DOSE given @ 6 mos of age

Question 6

Rotavirus vaccine (Rota):
- series of 3 (between 6 - 32 weeks)

Answer 6

**administer 1st dose 6 to 14 weeks;
(subsequent doses given @ 4 week intervals);
**complete series before 32 weeks;
** not recommended for infants > 32 weeks = decrease efficacy

Question 7

Diphtheria/Tetanus/Pertussis vaccine (DTaP):

• series of 3 primary (2-4-6 mos)
• 2 boosters (15 mos & 6 years)

Answer 7

• *toxoid;

* *not indicated for children > 7 yrs of age

Question 8

Tetanus/Diphtheria/Acellular Pertussis vaccine (Tdap):

• series of 1 (11 or 12 yrs of age)
• subsequent Td boosters recommended q 10 yrs

Answer 8

**recommended due to return of acellular pertussis in adolescents & adults

Question 9

Hib Conjugate (H. Influenza) vaccine:

• series of 3 primary (2-4-6 mos)
• 1 booster (12 mos)

Answer 9

• *1st dose of Hib can be given as early as 6 weeks of age;

* * not recommended for children > 5 yrs of age

Question 10

Pneumococcal vaccine:
PCV13 or Prevnar
- series of 3 primary (2-4-6 mos)
- 1 booster (12 mos)
PS23
-1 dose (24 mos)

Answer 10

• • PCV13 (Prevnar) not recommended for children > 5 us of age;
• • children 24 to 59 mos who completed PCV13 yet are immune compromised should receive additional dose of 23PS at 24 mos;
    (ex. DM, HIV, Sickle Cell, Renal Failure, Heart Disease, Pulmonary Disease)

Question 11

Polio vaccine (IPV):
- series of 4 (2-4-6 mos & 6 yrs)

Answer 11

• • inactivated polio vaccine (IPV) given for series;
• • oral polio (live attenuated) discourage and possible for doses 3 & 4 ;
• *not recommended for children with hx of streptomycin allergy

Question 12

Influenza vaccine (annually):
- 1 dose

Answer 12

• • can be given as early as 6 mos of age
• • < 3 yrs given 0.25 ml IM
• • > 3 yrs given 0.5 ml IM
• • live attenuated inactive virus (LAIV): Flumist can also be given as alternative to trivalent inactivated virus (TIV) in healthy persons ages 2 to 49 yrs of age;
• • contraindicated in those with egg allergy;
• *caution with latex allergy (monitor 90 min after given)

Question 13

Measles, Mumps, & Rubella (MMR) vaccine;

- series of 2 (1 yr& 12 yrs)

Answer 13

• *given as early as 6 mos if expected travel to endemic area in addition to primary series;
• • may be given simultaneously with TB test (PPD - purified protein derivative);
• • preference is to postpone PPD for 4-6 weeks to avoid possible suppressive response of PPD;
• *contraindicated for pregnant & immune suppressed pts

Question 14

Varicella (chicken pox) vaccine:

• series of 2 ( between 12 mos & 12 yrs)
• doses given 3 mos apart

Answer 14

• *give 2 doses after 12 mos of age when no hx of chicken pox or evidence of immunity noted;
• *prefer to give 1 mos from MMR vaccination;
• *contraindicated for pregnant, immune compromised, and hx of streptomycin allergy

Question 15

Hepatitis A vaccine:

• series of 2 (1 to 2 yrs)
• doses given 6 mos apart

Answer 15

• *Hep A source: oral/fecal contamination (food/water);

* * given with expected exposure such as foreign travel

Question 16

Meningococcal vaccine:

• series of 2 (11 or 12 yrs)
• 1 booster (16 yrs)

Answer 16

• • preventive measure as increase rate of meningococcal disease between ages 16 and 21 has been noted;
• *adolescents receiving 1st dose at/after 16 yrs do NOT require booster

Question 17

Human Papillomavirus vaccine (HPV):

- series of 3 (may begin @ 11 or 12 yrs of age)

Answer 17

• *1st dose may be given at 11 to 12 yrs of age;
• • 2nd dose given 1 mos after 1st dose;
• • 3rd dose given 6 mos after 1st dose;
• • HPV is the most common STD;
• *vaccine given to males & females;
• • 2 preparations: Gardasil ( females/males ages 9 to 26 yrs females) and covers oncologic strains 18 & 16 in addition to wart strains 6 & 11; Cervarix (females only- ages 10 to 25 yrs) bivalent vac only covers oncologic strains 16 & 18;

Question 18

Considerations with vaccinations:

Answer 18

• • adolescents should sit for 15 min after HPV vac due to risk of labile syncope (rapid fluctuation in pressure, postural hypotension, & vasovagal responses;
• *adverse rxns reported as localized soreness, low grade temp, and localized erythema

Question 19

Reportable events: Vaccine Adverse Events Reporting System (VAERS)

Answer 19

• *anaphylaxis
• *encephalitis
• *death