immunizations

pertussis transmission

"whooping cough" respiratory droplets -- can get from mom, dad, grandparents

IPV clinical features

*flaccid paralysis* weakness paralysis of certain muscles death (iron lung)

pertussis complications

*pneumonia* seizures encephalopathy death the younger the more likely to be hospitalized and die -- rates high for infants <1 yr -- highest among hispanics

PCV clinical features

ABRUPT onset: -- fever -- chills -- pleuritic chest pain -- productive cough -- dyspnea -- tachypnea -- hypoxia

ACIP

Advisory Committee in Immunization Practices: -- once vaccine found safe a committee looks at all evidence to determine whether it should be a routine vaccination Members: -- 15 voting members -- 14 of 15 have expertise in vaccinology, immunology, pediatrics, internal medicine, nursing, family med, virology, public health, and preventable medicine -- 15th member is a consumer/parent -- 8 additional ex-officio members representing federal agencies also responsible for immunization programs -- 30 additional non-voting members of liaison organizations help bring immunization expertise Meetings: -- 3/year -- work groups broken up by specific vaccine preventable diseases are active all year Determination of recommendations: -- how to use these vaccines to control diseases -- stand as public health advise that will lead to a reduction in incidence of vaccine preventable diseases as well increase in safe use of vaccines

pertussis vaccine

DTap given 2 mo, 4 mo, 6 mo, 15 mo, 4-6 yrs Tdap given 11-12 yrs

diphtheria vaccine

DTap given 2 mo, 4 mo, 6 mo, 15 mo, 4-6 yrs Tdap given 11-12 yrs only given up to age 7 years! Tdap given for ALL PREGNANT women with EACH PREGNANCY at 28 weeks gestation!!!!

tetanus vaccine

DTap given at 2 mo, 4 mo, 6 mo, 15 mo, 4-6 yrs Tdap given 11-12 yrs

vaccine preventable diseases

FOURTEEN: -- diphtheria -- tetanus -- pertussis -- hep B -- hep A -- Hib -- PCV -- rotavirus -- MMR -- IPV (polio) -- varicella -- MCV (meningitis) -- HPV -- Flu

seasonal influenza precautions

GBS within 6 weeks of previous dose

VAERS

Vaccine Adverse Event Reporting System: -- gov relies on this to identify problems after marketing process of vaccines -- national surveillance program sponsored by CDC and FDA -- public database (ANYONE CAN MAKE REPORTS)

VIS

Vaccine Information Statements: -- required to be given PRIOR to receiving each dose of vaccine! -- allows parents to ask questions regarding vaccine before administration -- all part of informed consent when administering a vaccine write down: -- lot number on bottle -- location site administered -- document you gave parent the VIS

VICP

Vaccine Injury Compensation Program -- compensation comes from gov not vaccine companies -- if the court finds the person has a legitimate claim, they'll be awarded compensation all vaccines are covered by this program

varicella transmission

airborne droplet or direct contact with lesions

MCV contraindications

allergy to vaccine component history of GBS

rotavirus precautions

altered immunocompetence moderate to severe acute gastroenteritis moderate to severe febrile illness chronic GI illness intussusception

hep B contraindications

anaphylactic reaction common to baker's yeast (component in vaccine)

IPV contraindications

anaphylactic reaction to neomycin or streptomycin

hep A contraindications

anaphylactic reaction to vaccine moderate to severe illness w/ or w/o fever

diphtheria complications

attributed to the toxin bacteria produces -- neuritis -- myocarditis death can occur in 5-10% of infected

varicella complications

bacterial infection (OPEN lesions) pneumonia CNS manifestations reye's syndrome death amputation

hep B transmission

blood and bodily fluids

MCV complications

brain damage hearing loss hydrocephalis myocarditis seizures

inactivated vaccines

can be produced from whole or fractions of viruses or bacteria Whole- made from entire organism but inactivated Fractional- either protein or polysaccharide based the more similar the vaccine is to the disease the better the immune response is to the vaccine providing greater immunity!!

Hib clinical features

can cause meningitis: - fever - decrease mental status - stiff neck - epiglottitis - cellulitis - septic arthritis - pneumonia - osteomyelitis - pericarditis

special situations to give vaccines

chemotherapy steroid therapy (1 mo after stopping) bone marrow transplant (before and 6 mo after) IgG therapy household/close contacts

hep B complications

cirrhosis, liver cancer, death

tetanus transmission

contaminated wounds, tissue injury, any puncture wound

rotavirus complications

death from dehydration, causing electrolyte imbalance

seasonal influenza transmission

droplet direct or indirect contact

seasonal influenza contraindications

egg allergy severe allergic reaction to previous dose LAIV (live attenuated influenza virus) is nasal -- NOT given to children <2 yrs or >49 yrs -- immunodeficient -- on long-term aspirin therapy -- history of GBS or asthma

DTaP/Tdap contraindications

encephalopathy within 7 days of previous dose allergic reaction to vaccine moderate to severe illness (need to go to ER) GBS <6 weeks after previous dose

hep A transmission

fecal-oral route

rotavirus transmission

fecal-oral route very contagious

MCV clinical features

fever HA stiff neck photophobia altered mental status meningococcal sepsis: -- fever -- petechial or purpuric rash -- hypotension -- leads to organ failure

DTaP/Tdap precautions

fever >105 within 48 hrs of dose collapse or shock like state seizures within 3 days of dose inconsolable crying lasting >3 hrs within 48 hrs of dose

hep A vaccine

given 1 yr and 18 mo MUST have 6 MONTHS interval between doses

MMR vaccine

given at 1 year and 4-6 yrs only time given before one yr as old as 6 months is if they're traveling outside the country to high risk areas

varicella vaccine

given at 1 yr and 4-6 yrs

MCV vaccine

given at 11-12 years and 16-18 years highest risk for disease between 17-21 years

HPV vaccine

given at 11-12 years, plus 2nd dose 2 months after 1st, and 3rd dose 4 months after 2nd dose

rotavirus vaccine

given at 2 mo, 4 mo, 6 mo ONLY vaccine given PO if not received first dose by 4 months they will NOT receive any doses once they turn 8 months they CAN'T get any doses

PCV vaccine

given at 2 mo, 4 mo, 6 mo, 1 yr

IPV vaccine

given at 2 mo, 4 mo, 6 mo, 4-6 yrs

Hib vaccine

given at 2 mo, 4 mo, 6 mo, and 1 yr

hep B vaccine

given at birth, 1 mo, 2 mo, and 6 mo administration 24 hours after birth is 70-90% effective in preventing transmission in exposed infants infants and moms who are hep B positive or don't know their hep B status are given the vaccine and HBIG (hep B immunoglobulin) -- 85-95% effective in preventing transmission

seasonal influenza vaccine

given yearly after 6 mo <9 yrs of age will get 2 doses -- 2nd dose 30 days after 1st the first dose primes their immune system and the second gives them immunity live virus: -- spray given in nostril (NO ONE gets live intranasal right now) -- not given if allergic to eggs, have asthma, or under 2 yrs flu shot= inactivated!

Hib transmission

haemophilus influenza type B gram negative bacteria via respiratory droplet

Hib complications

hearing impairment neurological impairment death

diphtheria clinical features

incubation 2-5 days can involve any mucous membrane -- interior nasal -- pharyngeal -- tonsilar

hep A clinical features

incubation avg 28 days ABRUPT onset: -- fever -- malaise -- anorexia -- nausea -- abdominal discomfort -- dark urine -- jaundice children <6 are usually asymptomatic

hep B clinical features

incubation avg 90 days (3 months) malaise HA fever myalgia icteric phase (jaundice) clay colored stools hepatic tenderness hepatomegaly 50% of cases mainly in children are asymptomatic

MMR clinical features

incubation is 10-14 days fever runny nose cough rash parotiditis HA muscle aches

rotavirus clinical features

incubation is 2 days- spreads QUICKLY can be asymptomatic vomiting severe dehydrating diarrhea fever GI symptoms subsides within 3-7 days

pertussis clinical features

incubation is 7-10 days mild, INSIDIOUS onset: -- runny nose -- fever -- non-specific cough progresses to rapid coughing fits w/ high pitched whooping sound -- vomiting caused by fits of rapid coughing can last up to 10 weeks

tetanus clinical features

incubation is 8 days Local- not common Cephalic- rare Generalized- most common, affects whole body: -- descends from head down -- "lock jaw" aka trismus -- difficulty swallowing -- *muscle rigidity and spasms*

seasonal influenza clinical features

incubation is within 2 days ABRUPT onset: -- high fever (>101) -- fatigue -- sore throat -- non-productive cough -- HA

tetanus complications

laryngospasms HTN contractures PE aspiration pneumonia death

varicella clinical features

lesions "hallmark" vesicles contain fluid (contagious part) rash appears on head, face, and then trunk

hep A complications

liver failure

HPV clinical features and complications

may be asymptomatic anogenital warts recurrent respiratory papillomatosis (papule in esophagus) cervical intraepithelial neoplasia (precursor for cervical cancer) full blown cervical, anal, vaginal, vulvar, penile, or head and neck cancer

PCV precautions

moderate to severe illness w/ or w/o fever PPSV within last 2 months

HPV precautions

none

Hib precautions/contraindications

none

MCV precautions

none

hep A precautions

none

IPV complications

paralysis

vaccine approval process

phase 1: -- initial human studies for safety and immunogenicity (how well ppl are responding) -- small number of ppl closely monitored phase 2: -- dose ranging studies -- several hundred are enrolled phase 3: -- provides documentation of effectiveness and additional safety data that's required for licensing -- thousands of people enrolled apply for licensure through FDA phase 4: -- formal studies on a vaccine once out on the market -- can be administered to anyone -- monitors for ADE

PCV transmission

pneumoccocal respiratory droplet

PCV complications

pneumonia bacteremia meningitis

MMR complications

pneumonia hearing loss encephalitis seizures swelling of the testes (can cause sterilization) pancreatitis arthritis death (esp. in measles or rubella)

seasonal influenza complications

pneumonia reye's syndrome myocarditis death

IPV transmission

polio- occurs in 3rd world countries fecal-oral route or oral-oral route

IPV precautions

pregnancy

HPV contraindications

pregnancy yeast allergy or to any vaccine component

MMR contraindications

pregnancy (LIVE virus vaccine) known altered immunodeficiency

hep B precautions

preterm birth (wait until child >2 kg)

Live attenuated vaccines

produced by modifying a disease producing virus (wild virus) or bacteria in a lab resulting vaccine organism retains the ability to replicate and produce immunity (antibodies) but doesn't cause illness

passive immunity

protection from another -- like antibodies baby get from mother via placenta lasting up to 1 yr after birth -- reason we don't give MMR before 1 yr TEMPORARY- wanes w/ time -- ex. synagis must be given every 30 days

active immunity

protection from our own immune system produces humoral immunity (antibodies) and cellular immunity PERMANENT- confers long-term immunity through memory B cells that rapidly produce antibodies if re-exposed can receive active immunity by: -- surviving infection by disease causing organism -- vaccination that produce an immune response and confer immunologic memory

varicella precautions

recent IgG administration (same rules as MMR)

MMR precautions

recent IgG administration (wait 3-6 mo) if MMR given wait 2 weeks to give IgG thrombocytopenia thrombocytopenic purpura

MCV transmission

respiratory droplet

diphtheria transmission

respiratory droplet or skin-skin

MMR transmission

respiratory or airborne

varicella contraindications

severe allergic reaction after previous dose HIV immunodeficiency pregnancy high dose of corticosteroid use

rotavirus contraindications

severe allergic reaction after previous dose infants born to HIV+ mother known or weakened immune system

PCV contraindications

severe allergic reaction to previous dose

IM sites of vaccination

use 22-25 g needle Newborn: (first 28 days) -- use 5/8" needle -- anterolateral thigh muscle (vastus lateralis) Infants: (1-12 mo) -- use 1" needle -- vastus lateralis Toddlers (1-3) and Children/Teens (4-18): -- 1-1.25" needle in vastus lateralis -- 5/8-1" needle in deltoid

SC sites of vaccination

use 23-25 g needle 5/8" length person <12 mo/infants: -- fatty tissue over vastus lateralis and upper outer triceps if needed person >12 months: -- fatty tissue over vastus lateralis or fatty tissue of upper outer triceps

HPV transmission

usually direct sexual contact