5111 Vaccines Table

Tdap: Adacel, Boostrix**

1x booster at age >/= 11 yrs (with no previous record of Tdap) Recommended in: 1) PREGNANT or POSTPARTUM women w each pregnancy after 20 wks of gestation (27-36 wks optimal) --3RD TRIMESTER is protect the baby 2) close contacts of infant younger than age 12 mo, if not up-to-date 3) HEALTHCARE PERSONAL w direct pt contact, if not up-to-date 4) children age 7-10 yrs. who did not get fully vaccinated w the DTaP series, give a SINGLE dose of Tdap instead of DTap administration: IM **can be used in place of Td for 10 yr booster vaccine, tetanus prophylaxis for wounds, or in a Catch up schedule

Pneumococcal Vaccines

23- Valent Polysaccharide Vaccine (PPSV23): Pneumovax 23 13- Valent Conjugated Baccine (PCV13) : Prevnar 13

What is refrigerated temperature?

2C to 8C (36-46 F)

RotaTeq (RV5) Rotarix (RV1)

A ROUTINE childhood vaccine series given between AGES 6 WKS. TO 8 MOS The FIRST dose must be administered BEFORE 15 wks. of age and can be given as early as 6 wks. The LAST dose must be administered by 8 MONTHS of age RotaTeq: 3 DOSES at age 2 mos, 4 mos, and 6 mos Rotarix: 2 DOSES at ages 2 mos and 4 mos administration: ORAL drops Cl: -SEVERE (LIFE-THREATING) ALLERGIC RXN to previous dose of rotavirus vaccine and to any component of rotavirus vaccine - severe combined immunodeficiency (SCID) - the previous episode of intussusception ADR: IRRITABILITY OR MILD, TEMPORARY DIARRHEA OR VOMITING - risk intussusception (a type of bowel blockage) usually a week after the 1st or 2nd dose

23- Valent Polysaccharide Vaccine (PPSV23): Pneumovax 23

ADULT Pts 19-64 yrs who have ASTHMA, SMOKERS (RESPIRATORY PROBLEM) Pts 2-64 yrs. who have CHRONIC ILLNESS 2 doses for adults 19-64 yrs. with immunocompromising conditions and asplenia All ADULTS >/= 65 yrs: 1 DOSE If vaccinated because of chronic illness before the age of 65, pt must have 5 yrs. in between Pneumovax23 doses. administration: IM or SC CI: Severe ALLERGIC RXN (eg. anaphylactive/anaphylactoid rxn) to pneumococcal vaccine or any component of the formulation ADR: INJECTION SITE RXNS, HEADACHE, FEVER, FATIGUE, MYALGIA shared clinical decision making w healthy pt age 65 and older when consider PCV13

Measles, Mumps, Rubella (LIVE): Pearls/ Pt education

Adults born before 1957 are generally considered IMMUNE to measles and mumps ADR: INJECTION SITE RXN, ARTHRALGIA, MYALGIA, RASH

Influenza Vaccines: Quadrivalent Inactivated

Afluria >/= 5 yrs. FluLaval: >/= 6 mos Fluarix: >/= 3 yrs. Flucelvax Quadrivalent: >/= 4 yrs. Flubok Quadrivalent: >/= 18 yrs. Fluzone Intradermal Quadrivalent: 18-64 yrs.--(probably be out of the market) Fluzone High Dose: >/= 65 yrs. Fluad (adjuvanted) >/= 65 yrs.

What vaccines are refrigerated?

All except Zoster and Varicella (MMR and be both frozen and refrigerated)

Describe appropriate documentation and follow up after vaccine administration?

As pt prepare to leave the pharmacy, the pharmacist should provide them an updated vaccination record and remind them to report any usually events that occurs. The pharmacist also should inform pt when there is a need for future doses of the vaccine. If appropriate, make return appointments for administration of multi dose vaccines while pt are still in the pharmacy and give them a written reminder of the follow-up date.

Hepatitis A: Havrix, VAQTA

CHILDREN: a ROUTINE childhood vaccine series: 2 DOSES given at age 12 mo and then 6-18 mos LATER ADULTS: men who have sex w men, illicit drug users, chronic liver disease, homeless individuals, clotting factor disorders, travelers to countries w high HepA incidence, or anyone else who wants it 2 DOSES AT LEAST 6 MO APART administration: IM CI: immediate and/or severe allergic or hypersensitivity rxn to HepA contains vaccines or any component of the formulation, including neomycin ADR: INJECTION SITE RXN, FEVER

Hepatitis B: Engerix-B, Heplisav- B, Recombivax HB

CHILDREN: routine childhood vaccine series started w 24 hrs. after birth ; 3 DOSES GIVEN AT AGE 0,1-2, AND 6-18 MOS **HBIG vaccine given at the same time as the first dose needs to be in a different limb for best efficacy ADULTS: HEALTHCARE WORKERS**, Pt w ESRD (on dialysis), chronic liver disease (HCV), HIV, DIABETES** (age 19-59 yrs, or >/= 60 yrs. at health care provider discretion), IV drug abusers, men who have sex w men, anyone w multiple sex partner, incarcerated people, some travelers Engerix-B and Recombivax HB: 3 DOSE SERIES give at MONTH 0,1, AND 6 (can be completed in 4 months if necessary, but requires a booster at 1 yr if the series is accelerated) Hepisav-B (age >/= 18 yrs.): 2 DOSE series given at MONTH 0 and 1. Do NOT use in pregnant women administration: IM CI: hypersensitivity to yeast ADR: INJECTION SITE RXN, HEADACHE, FATIGUE, FEVER

Influenza: Precautions/CI

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 OF 2-4 YRS. W ASTHMA or a wheezing episode in the last 12 mos, close contact w IMMUNOSUPPRESSED PERSON PRECAUTIONS: GUILLAIN-BARRE SYNDROME w/thin 6 wks. of a previous influenza vaccination Live, attenuated vaccine: ASTHMA in pts >/= 5yrs. underlying condition that predispose to influenza complications (e.g. chronic lung, heart, renal, hepatic neurologic, hematologic, and metabolic disorder, including diabetes)

Diptheria, Toxoid, Tetanus Toxoid, acellular Pertussis vaccines: PRECAUTION/CI

CI: For pertussis-containing vaccines: encephalopathy (e.g. coma, decreased level of consciousness, prolong seizures) that is not attributable to another cause within 7 days of receiving the vaccine PRECAUTION: Guillain-Barre syndrome, within 6 wks of a previous diphtheria, tetanus, and/or pertussis vaccine

Measles, Mumps, Rubella (LIVE): Population and Schedule

Children: ROUTINE vaccination SERIES; 2 DOSES given at AGE 12-15 MO and 4-6 YRS ProQuad: Pt age 12 MO- 12 YRS Adults: 1-2 doses if NO evidence of immunity 2 dose (4 wks apart): HEALTHCARE WORKERS, HIV pt with CD4 count >/= 200 for at least 6 mos, NON PREGNANT women of childbearing age ( no evidence of immunity of rubella), INTERNATIONAL TRAVELS, house contacts of immunocompromised people, and student in POSTSECONDARY EDUCATION INSTITUTIONS.

Diptheria, Toxoid, Tetanus Toxoid, acellular Pertussis: Pearls/Pt education

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 rxn in adults Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid-containing vaccine ADR: INJECTION SITE RXN, ARTHUS RXN, SWELLING, FEVER

Diptheria Toxoid ,Tetanus Toxoid, acellular Pertussis: Vaccines

DTaP: Dapacel, Infanrix DTaP-IPV: Kinrix, Quaidracel DTaP- HepB-IPV: Pediarix DTaP-IPV/Hib: Pentacel DTaP-IPV/Hib/HepB: Vaxelis DT Td: Tenviac Tdap: Adacel, Boostrix

Influenza Vaccines: Quadrivalent LIVE Attenuated

FluMist: Healthy People 2-49 yrs.

Influenza Vaccines: Trivalent Inactive

Fluvirin: >/= 4 yrs.

Human Papillomavirus Vaccine

HPV9 (9-Valent): Gardasil 9

Hepatitis Vaccines

Hepatitis A: Havrix, VAQTA Hepatitis B: Engerix-B, Hepatitis B, Recombivax HB

Influenza: Administration

IM (intramuscular) (EXCEPT for INTRADERMAL QUADRIVALENT ; though probably will be out of the market)

Poliovirus vaccine

IPV

Gardasil 9: Pearls/PT education

Individuals 27-45 yrs who are NOT ADEQUATELY VACCINATED may be vaccinated w shared clinical decision making: - Considered recommending to adults > 27 yo who are more at risk for contract HPV: new sex partner or multiple partners (share clinical decision) ** ACIP recommends ROUTINE vaccination at the 11 to 12 yrs (can start at 9 yo) for Pt with any history of sexual abuse or assault, vaccination should be started at 9 years. Catch up vaccination recommended for all persons through age 26 CAUTION for fainting administer to seated pt and monitor after vaccination ADR: INJECTION SITE RXN, HEADACHE, FEVER, FATIGUE, MYALGIA vaccine is more effective given BEFORE sexual activity begins

When does the immunization recommendation SCHEDULE published?

Jan-Feb

Measles, Mumps, Rubella (LIVE) vaccines

MMR: M-M-R II MMRV (MMR + Varicella): ProQuad

Meningicoccal vaccines

MenACWY- MCV4** (Conjugated vaccines) MenB

MenB-covers serogroup B Trumenba**: for age 10-25 yrs.

NOT ROUTINE 2 DOSES given 6 mo apart. If HIGH RISK of meningococcal disease or during an outbreak: give 3 DOSES at month 0, 1-2, and 6 Pts age >/= 10 yrs with high risk: Asplenia/sickle cell disease, component deficiencies or eculizumab use (weak immune system)-- WEAK IMMUNE SYSTEM During an OUTBREAK HIV PATIENT* Optional for pt age 16- 23 yrs. who are NOT at high risk but want the vaccine (if given the preferred age is 16-19 yrs.) Cl: Severe hypersensitivity to the meningococcal group B vaccine or any component of the formulation Serogroup B (MenB) is available in a separate vaccine. Use in addition to the quadrivalent meningococcal conjugate vaccines. ADR; INJECTION SITE RXN, HEADACHE, FEVER, MALAISE

What is frozen temperature?

15°C (5°F) to -50°C (-58°F)

What are the steps to perform a SC injection?

Organize supplies, wash hands, and wear gloves certify the correct vaccine and check expiration dates load dose into the syringe using aseptic technique select 5/8 inch, 23-25 gauge needle select the POSTEROLATERAL aspect of the UPPER ARM. exposed the entire injection target area to permit unobstructed access to the injection. wipe the site w alcohol swab to clean oils and direct from the injection site and allow the alcohol to dry pinch the skin and insert the needle at a 45 ANGLE Depressed the plunger at a slow to moderate rate Remove the needle at the same angle 45 ANGLE that entered the skin. activated the safety device. Discard used needles and syringe into a biohazard sharps container. Do not take your eyes off the used needle until it is safely inside the sharps container. Never recap the needle after it has been exposed to the Pt. apply sleigh pressure to the injection site w cotton ball to discourage bleeding place bandaged wash hands give pt appropriate education and document that vaccination (immunization record card) , and provide info about future doses

Describe the signs and symptoms of ADR to vaccines and procedures that pharmacists should follow to manage various ADR?

Report are require for the following events: anaphylaxis, brachial neuritis, encephalopathy, encephalitis, chronic arthritis, thrombocytopenia purple, vaccine-strain measles infection in an immunodeficient recipient, or paralytic polio-myelitis.

Rotavirus (LIVE) vaccines

RotaTeq (RV5) Rotarix (RV1)

Measles, Mumps, Rubella (LIVE): Administration

SC (subcutaneously)

Shingrix, Zostavax: Pearls/PT education

Shingrix: recombinant adjuvanted zoster ADR: INJECTION RXN, HEADACHE, FLU-LIKE SYMPTOMS FEVER

DT

Used for ROUTINE vaccines series in INFANTS and CHILDREN < 7yo who have a contraindication to the acellular pertussis antigen in DTaP: 3 DOSES 0,1,6-12 M Administration: IM

HPV9 (9-Valent): Gardasil 9

VACCINE THAT PREVENTS and PROTECT FROM CANCER Age 9-45 yrs. in both gendered; PREFERRED age to vaccinate is 11-12 yrs. (IDEAL bec of better immune response) FEMALES: 1) CERVICAL, vulvar, VAGINAL, and ANAL cancer caused by Human Papillomavirus (HPV) 2) Genital warts (condyloma acuminata) caused by HPV type 6 and 11 MALE: 1) Anal cancer by HPV types 16, 18, 31,33,45,and 58 2) Genital warts (condyloma acuminata) caused by HPV type 6 and 11 If started BEFORE age 15 --> 2 Dose (at month 0 and 6-12 mos later) (IT HURTS) If start AFTER at age 15 or older (15-26 yrs.) or if immunocompromised (regardless of age) --> 3 dose (at months 0, 1-2 months, and 6 ) IM (intramuscular) CI: hypersensitivity to any component of the vaccine or to a previous dose of the vaccine

Varivax

Varicella Virus Vaccine (for chickenpox) ROUTINE childhood vaccine series: 2 doses given at age 12-15 mos and 4-6 yrs. AND THOSE WHO IS NOT IMMUNE Administration: SC CI: Hypersensitivity to gelatin or neomycin Immunodeficiency or immunosuppression Active, untreated tuberculosis PREGNANY PRECAUTION: some ANTIVIRALS (a.g. acyclovir, valacyclovir, etc.) can interfere w the live vaccine (Variax, and Zostavax). STOP 24 hrs. BEFORE vaccine administration and do NOT take for 14 DAYS ADR: INJECTION SITE RXN, RASH, FEVER, MALAISE, ARTHRALGIA

Varicella: Vaccines

Varicella Virus Vaccine (for chickenpox) LIVE: Varivax Zoster Virus Vaccine (for herpes zoster/shingles): Shringrix**, Zostavax LIVE (but not common anymore)

What the LIVE vaccine?

Zoster (Zostavax) ---(for zoster/shingles/herpes) LAIV (FluMist Quadrivalent) MMR Rotarix, RotaTeq---(Rotavirus) Varicella (Varivax) **(MMRV)

How to perform a Intranasal?

with the Pt's head tilted slightly backwards - the pharmacist should remove the rubber tip and insert the nasal apparatus just inside one nostril and push the plunger until it stops - dose separating clip should be removed and the second spray should then be administered in the opposite nostril in the same manner -both spray must be administered to the pt to ensure complete protection - the pt should be instructed not to inhale or strongly "sniff" the vaccine back into the nasal passage, which is the natural tendency for many pat using nasal inhalers

What should you tell your pt about the LIVE vaccines ADR?

you can feel MORE pain shows little episodes of what the vaccine is fighting off

What are the steps to do IM INJECTION?

Organize supplies, wash hands, and wear gloves certify the correct vaccine and check expiration dates load dose into the syringe using aseptic technique select 5/8-1 1/2 inch, 22-25 gauge needle as appropriate for the individual pt. located the thickest and central portion of the DELTOID. Expose the entire injection target area to permit unobstructed access to the injection site wipe the site w alcohol swab to clean oils and direct from the injection site and allow the alcohol to dry insert the needle at a 90 ANGLE in one smooth, controlled motion. Depressed the plunger at a slow to moderate rate Remove the needle at the same angle 90 ANGLE that entered the skin. activated the safety device. Discard used needles and syringe into a biohazard sharps container. Do not take your eyes off the used needle until it is safely inside the sharps container. Never recap the needle after it has been exposed to the Pt. apply sleigh pressure to the injection site w cotton ball to discourage bleeding place bandaged wash hands give pt appropriate education and document that vaccination (immunization record card) , and provide info about future doses

13-Valent Conjugated Baccine (PCV13) : Prevnar 13

PEDATRIC All children age 6 wks to 5 years: 4 DOSE series given at age 2,4,6, and 12 to 15 mos Adult >/= 65 yo w immunocompromising conditions and asplenia: 1 DOSE administration: IM CI: Severe ALLERGIC rxn (e.g. anaphylaxis) to the pneumococcal vaccine, any component of the formulation or any diphtheria toxoid containing vaccine ADR: INJECTION SITE RXNS, HEADACHE, FEVER, FATIGUE,MYALGIA

Measles, Mumps, Rubella (LIVE): Precautions/CI

PREGNANCY or if IMMUNOCOMPROMISED Febrile illness (Fever)

Influenza: Population and Schedule

ROUTINE ANNUAL vaccination RECOMMENDED for all person >/= 6 MO OR OLDER Children 6 mo-8 yrs receiving influenza vaccination for the first time NEED 2 DOSES, administered at least 4 WKS APART (try to come on Sep, then back on Oct.)

MenACWY- Covers serogroups A,C,W,Y MCV4** (CONJUGATED vaccines): Menactra: for age 9 mos- 55 yrs. Can be used in adults >/= 56 yrs, if needed

ROUTINE VACCINATION: Adolescents: 2 DOSE series given at age 11-12 yrs. and at AGE 16 yrs. (BOOSTER DOSE)-- if children don't get a Booster dose at 16 yrs does NOT get enough PROTECTION Special populations at high risk: travelers to certain countries such as the meningitis belt in Sun-Saharan Africa AGE >/= 2 mos w: 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 w N. meningitides exposure 1st YEAR COLLEGE STUDENT (age </= 21 yrs.) living in resident housing, if not up-to-date MILITARY RECRUITS the # of doses and timing (intervals) will depend on age and specific risk. People w the ongoing risk of meningococcal disease should be revaccinated every 5 yrs. administration: IM CI: severe hypersensitivity to other meningococcal containing vaccines or any component of the formulation including diphtheria toxoid or CRM197 (a diphtheria toxin carrier protein) Quadrivalent meningococcal conjugate vaccines (MCV4) includes A, C, W, and Y ACWY vaccine required by Saudi Arabia for travel to the Hajj and Umrah pilgrimages proof vaccination is required ADR: INJECTION SITE RXN, HEADACHE, FEVER, MALAISE

Td: Tenviac

ROUTINE booster is given every 10 YRS in pt >/= 7 yrs. WOUND PROPHYLAXIS: for DEEP or DIRTY wounds, revaccinated w Td if it has been more than 5 yrs. 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 Administration: IM

IPV

ROUTINE childhood vaccine series given between the age 2 mos to 6 yrs. series of 4 VACCINES GIVE AT 2 MOS, 4 MOS, 6-18 MOS, AND 4-6 YRS. FIRST dose can be given as EARLY as 6 wks. Most adults do NOT need polio vaccination because they were already vaccinated against polio as children. Some adults are at HIGH RISK and should consider polio vaccination, including: - people traveling to certain parts of the world - laboratory workers who might handle poliovirus - healthcare workers treating pt who could have polio administration: IM CI: -SEVERE (LIFE- THREATENING) ALLERGIC RXN to IPV vaccine ADR: SORE SPOT w REDNESS, SWELLING, or PAIN where the shot is given can happen after polio vaccine

DTaP

ROUTINE childhood vaccine series: 5 DOSES given at age 2,4,6,15-18 MOS, and 4-6 YRS --- Stronger than Tdap (dont give to adults cause local systemic rxn) 3-5 TIMES as MUCH of diphtheria component than Tdap or Td Administration: IM

Shingrix**, Zostavax

Zoster Virus Vaccines (for herpes zoster/shingles) PREFERRED over Zostavax ACIP recommends routine vaccination (2 doses given at month 0 and month 2-6) in pt. age >/= 50 yrs. including those who previously received varicella virus vaccine or Zostavax (wait at least 8 wks. after Zostavax before starting the 2 dose series of Shingrix) **If second dose if given LESS than 4 wks after the first then it must be REPEATED ** If pt 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 w/o 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 pt >/= 60 yrs (1 dose) In general, its okay to these to pt 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 IM (Shingrix) SC (Zostavax) CI: Recombinant Zoster Vaccine (Shingrix): lactation PREGNANCY PRECAUTION: some antivirals (a.g. acyclovir, valacyclovir, etc.) can interfere w the live vaccine (Variax, and Zostavax). STOP 24 hrs. BEFORE vaccine administration and do NOT take for 14 DAYS

influenza: Pearls/Pt education

preferable to administer BEFORE OCTOBER (might take 2 WKS to work) Trivalent protect against 3 viruses: two influenza A's and one influenza B Quadrivalent protects against two influenza A's and two influenza B INACTIVATED are produced using EGGS ADR: FEVER, MALAISE, MYALGIA, INJECTION SITE RXN

who should NOT be given a LIVE vaccine?

pregnant women