5111- Immunization Quiz (table)

Measles, Mumps, Rubella (Live) MMR: M-M-R II MMRV (MMR + Varicella): ProQuad ADR

- ADR: injection site reactions, arthralgia, myalgia, Rash

Zoster Virus Vaccines (for herpes zoster/shingles): Shingrix, Zostavax ADR

- ADR: injection site reactions, headache, flu-like symptoms, fever

Measles, Mumps, Rubella (Live) MMR: M-M-R II MMRV (MMR + Varicella): ProQuad Patient info

- Adults born before 1957 are generally considered immune to measles and mumps

Diphtheria Toxoid, Tetanus Toxoid, acellular Pertussis

- DTaP has 3-5 times as much of the diphtheria component than Tdap or Td - Tdap has lower diphtheria and acellular pertussis dose to avoid local reactions in adults - Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid-containing vaccine ADR: Injection site reactions, arthus reactions, swelling, fever

Influenza vaccines patient education

- Preferable to administer before October (might take 2 weeks to work) - Trivalent protect against 3 viruses: two influenza A's and one influenza B - Quadrivalent protect against two influenza A's and two influenza B's - Inactivated are produced using eggs - ADR: fever, malaise, myalgia, injection site reactions

Zoster Virus Vaccines (for herpes zoster/shingles): Shingrix, Zostavax patient education

- Zostavax: live attenuated, higher strength than varicella vaccine - Shingrix: recombinant, adjuvanted zoster

Pneumococcal: 23-valent polysaccharide vaccine (PPSV23) Pneumovax is good for...

-19-64 that have asthma -19-64 who are smokers -2-64 who have chronic illness

What are the populations and schedules for meningococcal vaccines: -MenB (covers serogroup B) -Bexsero: for age 10-25 yrs -Trumenba: for age 10-25 yrs

-2 doses (given 1 mo apart) -2 doses given 6 mo. apart. If high risk of meningococcal disease or during an outbreak: give 3 doses at months 0, 1-2, and 6 -patients age >/= 10 yrs with high risk: asplenia/sickle cell disease, complement component deficiencies or eculzumab use -lab workers with N. meningitidis -during an outbreak -optional for patients age 16-23 yrs. who are not at high risk but want the vaccine (if given the preferred age is 16-19 yrs)

Pneumococcal: 23-valent polysaccharide vaccine (PPSV23) Pneumovax- IM or SC

-2 doses for adults 19-64 yrs with immunocompromising conditions and asplenia -all adults >/=65 yrs: 1 dose

HPV vaccine patient information

-ACIP recommends routine vaccination at age 11 to 12 years (can start at 9 yo.) for patients with any history of sexual abuse or assault, vaccination should be started at 9 yrs. Catch-up vaccination is recommended for all persons through age 26 years - Individuals 27-45 years who are not adequately vaccinated may be vaccinated with shared clinical decision making - Consider recommending to adults >27yo who are more at risk for contracting HPV: new sex partner or multiple partners - Caution for fainting, administer to seated patient and monitor after vaccination - ADR: injection site reactions, headache, fever, fatigue, myalgia - Vaccine is more effective if given before sexual activity begins

Live- Varicella Virus Vaccine (for chickenpox): Varivax ADR

-Injection site reactions -rash -fever -Malaise -Arthralgia

what are the vaccines for live Rotavirus (2)

-RotaTeq (RVS) -Rotarix (RV1)

Influenza vaccines -all IM except for fluzone intradermal and quadrivalent Trivalent Inactivated - Fluvirin: > 4 yrs Quadrivalent Inactivated - Afluria: > 5 yrs - FluLaval: > 6 mos - Fluarix: > 3 yrs - Flucelvax Quadrivalent: ≥ 4 yrs - Flubok Quadrivalent: ≥ 18 yrs - Fluzone Intradermal - Fluzone High Dose: ≥ 65 yrs - Fluad (adjuvanted): ≥ 65 yrs - Quadrivalent: 18-64 yrs Quadrivalent Live Attenuated: - FluMist: Healthy people 2-49 years -intranasal

-Routine annual vaccination recommended for all persons ≥ 6 mo or older -Children 6 mo - 8 yrs receiving influenza vaccination for the first time need 2 doses, administered at least 4 weeks apart

Diphtheria Toxoid, Tetanus Toxoid, acellular Pertussis (dosage and population) DTaP: Dapacel, Infanrix DTaP-IPV: Kinrix, Quadracel DTaP-HepB-IPV: Pediarix DTaP-IPV/Hib: Pentacel DTaP-IPV/Hib/HepB: Vaxelis

-Routine childhood vaccine series: 5 doses given at ages 2,4,6, 15-18 mos and 4-6 yrs -For children younger than 7 years of age

Poliovirus (IPV)

-a routine childhood vaccine series given between the ages 2 months to 6 years -series of 4 vaccines given at 2 months, 4 months, 6-18 months, and 4-6 years -first dose can be given as early as 6 weeks

Rotavirus (live) vaccine populations and schedules

-a routine childhood vaccine series given btw ages 6 weeks-8 months -the first dose must be administered before 15 weeks of age and can be given as early as 6 weeks -the last dose must be administered by 8 months of age

Pneumococcal: 13-valent conjugate vaccine (PCV13) Prevnar 13 population -IM

-all children age 6 wks to 5 years: 4-dose series given at age 2, 4, 6, and 12 to 15 months -adults >/=65 yo with immunocompromising conditions and asplenia: 1 dose

For which adults is Hepatitis B: Engerix-B, Heplisav-B, Recombivax vaccines good for ?

-healthcare workers -patients with ESRD (on dialysis) -chronic liver disease (including HCV) -HIV -diabetes (age 19-59 yrs, or >/=60 yrs at health care provider discretion) -IV drug abusers -men who have sex with men -anyone with multiple sex partners -incarcerated people -some travelers

ADR of Hepatitis A: Havrix, VAQTA

-injection site reactions -fever

HepB vaccines side effects

-injection site reactions -headache -fatigue -fever

Pneumococcal: 13-valent conjugate vaccine (PCV13) Prevnar 13 population ADR

-injection site reactions -headache -fever -fatigue -myagia

What are ADR's of meningococcal vaccines

-injection site reactions -headache -fever -malaise

What is the ADRs of rotavirus (live) vaccine

-irritability or mild, temporary diarrhea or vomiting -risk of intussusception (a type of bowel blockage) usually a week after the 1st or 2nd dose

contraindications for Rotavirus (live)

-severe (life-threatening) allergic reaction to a previous dose of rotavirus vaccine -severe (life-threatening) allergy to any component of rotavirus vaccine -severe combined immunodeficiency (SCID) -previous episode of intussusception

Contraindications for IPV

-severe (life-threatening) allergic reaction to an IPV vaccine -severe (life-threatening) allergy to any component of IPV vaccine

What are the live vaccines?

-zoster (zostavax) -LAIV (FluMist Quadrivalent) -MMR -Rotarix, RotaTeq -Varicella (varivax)

Males are selected to get Human Papillomavirus Vaccines (HPV9: 9-Valent: Gardasil) for:

1) Anal cancer caused by HPV types 2) Genital warts (condyloma acuminata) caused by HPV 3) Precancerous or dysplastic lesions caused by HPV A) Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3 -If started before age 15 or older (15-26yrs), or if immunocompromised (regardless of age)-3 dose (at months 0, 1-2, and 6 -FDA-approved up to age 45, ACIP recommendations have not changed

females are selected to get Human Papillomavirus Vaccines (HPV9: 9-Valent: Gardasil) for

1) cervical, vulvar, vaginal, and anal cancer caused by Human Papillomavirus (HPV) types ... 2) genital warts (condyloma acuminata) caused by HPV types 6 & 11 3) and the following precancerous or dysplastic lesions caused by HPV types... A) cervical intraepithelial neoplasia (CIN) grade 2/3 and cervical adenocarcinoma in situ (AIS) B) cervical intraepithelial neoplasia (CIN) grade 1 C) Vulvar intraepithelial neoplasia (VIN) grade 2 and grade3 D) Vaginal intraepithelial neoplasia (VAIN) grade 2 and grade 3 E) Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3

Anyone without evidence of immunity to varicella should receive -- doses of ----

2 doses of varivax

Quadrivalent meningococcal conjugate vaccines (MCV4) include ...

A, C, W, Y

---vaccine is required by Saudi Arabia for travel to the Hajj and Umrah pilgrimages; proof of vaccination is required

ACWY vaccine (meningococcal)

influenza vaccines CI

Allergy to previous influenza vaccination allergy to eggs (except for Flucelvax) Live, attenuated vaccine CI: severe egg allergy, use of aspirin-containing products, use of influenza antiviral medications in the past 48 hrs, children age 2-4 yrs with asthma or a wheezing episode in the last 12 mos, close contact with an immunosuppressed person

Measles, Mumps, Rubella (Live) MMR: M-M-R II MMRV (MMR + Varicella): ProQuad CI

CI: -Pregnancy or if immunocompromised -Febrile illness

Diphtheria Toxoid, Tetanus Toxoid, acellular Pertussis

CI: For pertussis-containing vaccines: encephalopathy (e.g. coma, decreased level of consciousness, prolonged seizures) that is not attributable to another cause within 7 days of receiving the vaccine

Zoster Virus Vaccines (for herpes zoster/shingles): Shingrix, Zostavax contraindications

CI: Recombinant Zoster Vaccine (Shingrix): lactation Zoster Vaccine Live (Zostavax) hypersensitivity to gelatin or neomycin. Immunosuppression or immunodeficiency Both: pregnancy

Used for routine vaccine series in infants and children < 7yo who have a contraindication to the acellular pertussis antigen in DTaP: 3 doses, 0,1,6-12 M

DT

which HEPB vaccines are a 3 dose series given at month 0, 1, and 6 (can be completed in 4 months if necessary, but requires a booster at 1 year if the series is accelerated

Energix-X and Recombivax HB

-a routine childhood vaccine series given btw 2-15 months -ActHIB and Hiberix: 3-dose primary series (2, 4, & 6 months) followed by booster (15-16 months) what is this vaccine

Haemophilus influenzae type b (Hib) specific vaccines: Hib: ActHIB, Hiberix, PedvaxHIB

which vaccine is given to these specific adults: -men who have sex with men -illicit drug users -chronic liver disease -homeless individuals -clotting factor disorders -travelers to countries with high Hepatitis A incidence or anyone else who wants it

Hepatitis A: Havrix, VAQTA for adults -2 doses at least 6 months apart

which vaccine is a 2-dose series given at month 0 and 1 and should not be used in pregnant women

Hepisav-B (age >/= 18 yrs)

Live- Varicella Virus Vaccine (for chickenpox): Varivax contraindications

Hypersensitivity to gelatin or neomycin immunodeficiency or immunosuppression -active, untreated TB -pregnancy

Diphtheria Toxoid, Tetanus Toxoid, acellular Pertussis administration

IM

Haemophilus influenzae type b (Hib) route of administration

IM

Hepatitis A: Havrix, VAQTA and Hepatitis B: Engerix-B, Heplisav-B, Recombivax HB route of administration

IM

How are meningococcal vaccines administered

IM

administration of IPV (Polio)

IM

Varicella (live) Zoster Virus Vaccines (for herpes zoster/shingles): Shingrix, Zostavax

IM (Shingrix), SC (Zostavax)

most adults do not need this vaccine because they were already vaccinated against the disease as children. some adults are at higher risk and should consider it if traveling to certain parts of the world, laboratory workers who might handle this virus, and health care workers treating these patients

IPV (poliovirus)

contraindication for Hepatitis A: Havrix, VAQTA

Immediately and/or severe allergic or hypersensitivity reaction to hepatitis A containing vaccines or any component of the formulation, including neomycin

Children: routine vaccination series; 2 doses given at age 12-15 mo and 4-6 years ProQuad: Patients age 12 mo - 12 yrs Adults: 1-2 doses if no evidence of immunity 2 doses (4 wks apart): healthcare workers, HIV patients with CD4 count ≥ 200 cells/mm3 for at least 6 mos, nonpregnant women of childbearing age (with no evidence of immunity to rubella), international travels, household contacts of immunocompromised people and students in postsecondary educational institutions.

Measles, Mumps, Rubella (Live) MMR: M-M-R II MMRV (MMR + Varicella): ProQuad

Route of administration for Rotavirus (live)

Oral drops

If vaccinated because of a chronic illness before the age of 65, patients must have 5 years in between ---- doses

Pneumovax23

Diphtheria Toxoid, Tetanus Toxoid, acellular Pertussis

Precaution: Guillain-Barre syndrome within 6 weeks of a previous diphtheria, tetanus and/or pertussis vaccine

Influenza vaccines precautions

Precaution: Guillain-Barre syndrome within 6 wks of a previous influenza vaccination Live, attenuated vaccine: asthma in pts ≥5 yrs, underlying conditions that predispose to influenza complications (e.g. chronic lung, heart, renal, hepatic neurologic, hematologic and metabolic disorders, including diabetes)

Zoster Virus Vaccines (for herpes zoster/shingles): Shingrix, Zostavax precautions

Precaution: Some antivirals (e.g. acyclovir, valacyclovir, etc) can interfere with the live vaccines (varivax and Zostavax). Stop 24 hours before vaccine administration and do not take for 14 days

Quadrivalent Live Attenuated: FluMist: Healthy people 2-49 years

Pregnancy or immunocompromised Hypersensitivity to egg protein

which vaccine gives 3 doses at ages 2, 4, & 6 months

RotaTeq

which vaccine gives 2 doses at ages 2 and 4 months

Rotarix

Live- Varicella Virus Vaccine (for chickenpox): Varivax dosage

Routine childhood vaccine series: 2 doses given at age 12-15 mos and 4-6 yrs

What are the populations and schedules for Meningococcal vaccines: -MenACWY: covers serogroups A, C, W, Y -MCV4 (conjugate vaccines) -Menactra: for age 9 months-55 years -can be used in adults >/=56 yrs if needed

Routine vaccination: -Adolescents: 2 dose series given at 11-12 yrs and at 16 yrs (booster dose) -special populations at high risk: travelers to certain countries such as the meningitis belt in Sun-Saharan Africa -Age >/=2 months with: HIV, asplenia/sickle cell disease, complement component deficiencies or eculizumab use: 2 doses at least 8 wks apart. 1 dose every 5 yrs after completing the 2-dose primary series -lab workers with N. meningitidis exposure -1st year college students (age </=21 yrs) living in resident housing, if not up-to-date -military recruits -the number of doses and timing (intervals) will depend on age and specific risk. People with ongoing risk of meningococcal disease should be revaccinated every 5 yrs.

Live- Varicella Virus Vaccine (for chickenpox): Varivax ROA

SC

Measles, Mumps, Rubella (Live) MMR: M-M-R II MMRV (MMR + Varicella): ProQuad

SC

--- is available in a separate vaccine. Use in addition to the quadrivalent meningococcal conjugate vaccines

Serogroup B (MenB)

Varicella (live) Zoster Virus Vaccines (for herpes zoster/shingles): Shingrix, Zostavax

Shingrix is preferred. ACIP recommends routine vaccination (2 doses given at month 0 and month 2-6) in patients age ≥ 50 years, including those who previously received varicella virus vaccine or Zostavax (wait at least 8 weeks after Zostavax before starting the 2-dose series of Shingrix) If second dose if given less than 4 weeks after the first then it must be repeated If patient is late on receiving the second dose do not restart the series or use Zostavax in its place Second dose can be given late if Shingrix is in short supply without having to repeat the series Vaccinate even if the pt has a history of zoster infection, since recurrence is possible Zostavax (if used) is recommended in patients ≥ 60 yrs (1 dose) In general, it's okay to give these vaccines to patients with low-level immunosuppression, which includes: prednisone less than 20 mg equivalent/day for two weeks or longer methotrexate less than 0.4 mg/kg/week azathioprine less than 3 mg/kg/day 6-mercaptopurine less than 1.5 mg/kg/day

Routine booster given every 10 years in patients ≥7 yrs Wound prophylaxis: for deep or dirty wounds, revaccinate with Td if it has been more than 5 years since the last dose. Tetanus immunoglobulin (TIG) may be required if no previous tetanus vaccines have been given. Can use Tdap x1 if never received

Td: Tenivac

1x booster at age ≥ 11 years (with no previous record of Tdap) Recommended in: 1) Pregnant or postpartum women, with each pregnancy after 20 wks of gestation (27-36 weeks optimal) 2) Close contacts of infants younger than age 12 mo, if not up-to-date 3) Healthcare personnel with direct patient contact, if not up-to-date 4) Children age 7-10 years who did not get fully vaccinated with the DTaP series, give a single dose of Tdap instead of DTap

Tdap: Adacel, Boostrix

Can be used in place of Td for 10yr booster vaccine, tetanus prophylaxis for wounds, or in a Catch-up schedule

Tdap: Adacel, Boostrix

Hepatitis A: Havrix, VAQTA dosing for children

a routine childhood vaccine series: 2 doses given at age 12 mo then 6-18 mos later

ADR of IPV

a sore spot with redness, swelling, or pain where the shot is given can happen after polio vaccine

at what ages can people get Human Papillomavirus Vaccines (HPV9: 9-Valent: Gardasil)

age 9-45 yrs in both genders (for selected patients) -preferred age is 11-12 yrs

Fluzone Quadrivalent 0.5 mL single-dose prefilled syringes are indicated for use in

ages 3 years and older

Fluzone Quadrivalent 0.25 ml single-dose prefilled syringes are indicated for use in

ages 6 months to 35 months

Haemophilus influenzae type b (Hib) contraindications

hypersensitivity to Haemophilus b polysaccharide, tetanus toxoid-containing vaccine (Hiberix and ActHIB only), or any component of the formulation

HepB vaccines contraindications

hypersensitivity to yeast

Haemophilus influenzae type b (Hib) ADR

injection site reactions

Pneumococcal: 23-valent polysaccharide vaccine (PPSV23) Pneumovax shared clinical decision

making with healthy patients age 65 and older when considering PCV13

HBIG vaccine is given at the same time as the first dose---

needs to be in a different limb for best efficacy

Hepatitis B: Engerix-B, Heplisav-B, Recombivax children dosing

routine childhood vaccine series started within 24 hours after birth; 3 doses given at age 0, 1-2 and. 6-18 months

Pneumococcal: 23-valent polysaccharide vaccine (PPSV23) Pneumovax contraindications

severe allergic reaction (e.g. anaphylactic/ anaphylactoid reaction) to pneumococcal vaccine or any component of the formulation

Pneumococcal: 13-valent conjugate vaccine (PCV13) Prevnar 13 population contraindications

severe allergic reaction (e.g. anaphylaxis) to pneumococcal vaccine, any component of the formulation, or any diphtheria toxoid-containing vaccine

Contraindication for meningococcal vaccines: -MenACWY: covers serogroups A, C, W, Y -MCV4 (conjugate vaccines) -Menactra: for age 9 months-55 years -can be used in adults >/=56 yrs if needed

severe hypersensitivity to other meningococcal-containing vaccines or any component of the formulation including diphtheria toxoid or CRM197 (a diphtheria toxin carrier protein)

Contraindications for MenB: Covers serogroup B Bexsero: for age 10-25 yrs Trumenba: for age 10-25 yrs

severe hypersensitivity to the meningococcal group B vaccine or any comment of the formulation

Live- Varicella Virus Vaccine (for chickenpox): Varivax precaution

some antivirals (e.g. acyclovir, valacyclovir, etc) can interfere with the live vaccines (varivax and zostavax). Stop 24 hours before vaccine administration and do not take for 14 days