Immunizations

Minimum Intervals between Varicella Vaccines

12 mo - 12 years: 3 months 13 years or older: 4 weeks

Varicella Vaccine Recommendations Older Children and Adults

2 doses recommended for all persons older than 4 to 6 years who do not evidence of varicella immunity Second dose recommended for persons of any age only received one dose

HIB Vaccine: PedVaxHIb Primary series

2, 4, 6 months and 12-15 mo booster Alone or in combination w/ hepatitis b as Comvax

HIB Vaccine: ActHIB (PRP-T) Primary series

2, 4, 6, months and 12-15 mo booster

HIB Vaccine: Pentacel Primary series

2, 4, 6, months and booster 15-18 months

Interval Between immune Globulin administration and Measles vaccine

3 months: - Hep A prophylaxis of IgG, Hep B prophylaxis as HBIG, and tetanus prophylaxis as TIG, RBCs w/ saline added 5 months: - Varicella prophylaxis as VariZIP and Measles prophylaxis as IG/packed RBC 6 months: - Botulinum immune globulin IF and whole blood transfusion

Pentacel Vaccine: Primary Series Scedule

4 doses at 2, 4, 6, and 15 though 18 months Each of the first 3 doses should be separated by a minimum of 4 weeks 4th dose may be administered as early as 12 months of age if at least 6 months have elapsed since the 3rd dose of DTaP

DTaP, Tdap, & Td Minimum Age and Route

6 weeks IM

Trivalent Inactivated Influenza Vaccine (TIV) Schedule

6-35 months: - dose: 0.25 ml - 1 or 2 doses 3-8 years: - dose: 0.5 ml - 1 or 2 doses 9 years or older - dose: 0.5 ml - 1 dose

2016 Schedule: IPV Catch-Up Information

A 4th dose is not needed if the third dose was administered after 4 IPV is not routinely recommended for US residents aged 18 years or older

Recombinant Vector Vaccine

A carrier "vector" used which is similar to the DNA vaccine

Rotavirus Vaccine Recommendations

ACIP did not define a maximum interval between doses If the interval between doses is prolonged, the child can till receive the vaccine as long as it can be given on or before the child's 8 month bday It is not necessary to restart the series or add doses because of a prolonged interval between does

Routine HPV Vaccination Recommendations

ACIP recommends routine vaccination of females 11-12 years The vaccination series can be started as young as 9 years of age at the clinician's discretion "Catch-up" Vaccination recommended for females 13-18 years of age

Rotavirus Vaccine and Preterm Infants

ACIP supports vaccination of a preterm infant if: - chronological age is at least 6 weeks - Clinically stable - Administered at the time of discharge or after discharge from the neonatal intensive care unit or nursery

Hepatitis A Vaccine

Adult: - 1 dose - booster dose 6-18 months after first dose Children and adolescents - 1 dose - booster dose 6-18 months after first dose

MCV revaccination recommendations

All 11-12 year olds should be vaccinated with MCV4 A booster dose should be given at age 16 years For adolescents who receive the first dost at age 13-15, a one-time booster dose should be administered, preferably at age 16-18 years, before the peak in increased risk Adolescents who receive their first dose of MCV4 at or after age 16 years do not need booster Other vaccines may be administered during same visit, but at a different anatomic site if feasible

Influenza Vaccine Recommendations

All persons aged >6months should be vaccinated annually Vaccinate by October, if possible Vaccination should continue to be offered as long as influenza viruses are circulating *First Dose Only: Children aged 6 months though 8 years who require 2 doses - first dose as son as possible after vaccine becomes available - Second dose > 4 weeks later

Syncope Following HPV Vaccination

An increase in the # of reports of syncope has been detected by the Vaccine Adverse Event Reporting System 11-18 year old females have contributed most of the increase Serious injuries have resulted Providers should strongly consider observing patients for 15 mins after they are vaccinated

Rotavirus Vaccine Effectiveness

Any rotavirus diarrhea: 74-87% Severe diarrhea: 95-98% Both vaccines significantly reduce physician visits for diarrhea, and reduce rotavirus related hospitalizations

Clinical Manifestations of Polio

Asymptomatic (most infections) to symptomatic, including acute flaccid paralysis of a single limb to quadriplegia, respiratory failure, and rarely death

HIB Vaccine: Hiberix Primary series

Attached to tetanus toxoid 2, 4, 6 months and 12-15 mo booster

Meningococcal Vaccine for Serogroup B

Bexsero and Trumenba 16-23 years of age Not required It means it will not be covered by Vaccine for Children Act

HPV Vaccination in males

Can prevent: - genital warts - anal cancers - penile cancers - oropharyngeal and oral cavity cancers - recurrent respiratory papillomatosis Syncope is chief complaint

Tetanus

Caused by neurotoxin produced by Clostridium tentani in contaminated wound Generalized form is lock jaw with gradual onset over 1-7 days with severe spasms and autonomic dysfunction Local tetanus, local muscle spasms next to a wound Cephalic can present with cranial nerve dysfunction secondary to wound in head or neck

HPV Vaccine Types

Cervarix - Bivalent: 16, 18 - adjuvant: aluminum Gardasil - Quadrivalent: 6, 11, 16, 18 - adjuvant: aluminum Gardasil 9 - 9-valent: 6, 11, 16, 18, 31, 33, 45, 52, 58

Meningococcal Immunization Schedule: At Risk Children 2 to 23 months

Children w/ persistent complement deficiencies, functional or anatomic asplenia or are residents of countries where meningococcal disease is hyperendemic or epidemic or who are at risk to community outbreaks - 4 doses of Menveo (Men ACWY-CRM) at 2, 4, 6, and 12 months

Meningococcal Immunization Schedule: At Risk Children 2 to 18 months

Children w/ persistent complement deficiencies, functional or anatomic asplenia or who are at risk to community outbreaks - four doses of HIBMEnCY-TT (MenHibrix) - 2, 4, 6, and 12-15 months

Meningococcal Immunization Schedule: At Risk Children 9 - 23 months

Children w/ persistent complement deficiencies, travel or are residents of countries where meningococcal disease is hyperendemic or epidemic or who are at risk to community outbreaks - 2 doses of MenACWY (Menactra) 12 weeks apart

Who get vaccinate w/ meningococcal vaccine aside from adolescents?

College students and military recruits People present during outbreaks causes by a vaccine serogroup Other people w/ prolonged increase risk for exposure (travelers or residents of countries where meningococcal disease is hyperendemic or epidemic and microbiologists routinely working with Neisseria meningitidis)

Indications for Meningococcal Vaccine: At Risk Children

Complement component deficiences: C3, C5-C9, properdin, factor H, factor D Functional or anatomic aspleenia: includes infants w/ sick cell disease Infants who are in defined risk group for a community or institutional outbreak Infants traveling to an area where meningococcal disease is hyperendemic: travel to Haji, living in the Meningitis Belt

Live Attenuated Vaccine

Contain a version of the living microbe Ex: MMR, Polio (TOPV)

Pentacel Vaccine (DTaP, IPV, HIB) Contains

Contains lyophilzed Hib (ActHIB) vaccine that is reconstituted with a liquid DTaP-IPV solution The DTaP-IPV solution should not be used separately (i.e. only use to reconstitute the Hib component)

DTaP Protects against

Corynbacterium Diphtheria Tetanus Pertussis

Pertussis

Cough illness Fatalities and brain damage in young children Adolescent and adults are reservoir Zithromax is standard treatment

Pertussis Containing Vaccines

DTaP (pediatric) - approved for children 6 weeks through 6 years (to age 7) Tdap (adolescent and adult) - approved for persons 10 years to 65 (Boostrix & Adacel) - Tdap can be given regardless of the last interval between the last tetanus and diphtheria vaccine - One dose in every pregnancy (between 27-36 wks) - Can give from 7-10 if no record of receiving pertussis vaccine

Pediarix Vaccine

DTaP, Hep B, IPV Minimum age - 6 weeks Approved for 3 doses at 2, 4, and 6 months NOT APPROVED FOR BOOSTER DOSES (4TH & 5TH DOSE) Licensed for children 6 weeks to 7 years May be used interchangeably w/ other pertussis-containing vaccines if necessary Can be used at 2, 4, & 6 mo in infants who received the Hep B vaccine at birth (total of 4 hep b doses) May be used in infants whose mothers are HBsAg positive or status unknown

Pentacel Vaccine

DTaP, IPV, HIB Licensed by FDA for dose 1-4 of the DTaP series among children 6 weeks through 4 years Should not use as 5th dose of DTaP series, or for children 5 years or older

KINRIX Vaccine

DTaP/IPV combo Only approved for 2 booster - 5th dose in DTaP series, & - 4th dose in the IPV series Children 4-6 years Prior DTaP vaccine doses were Infanrix and/or Pediarix for the first 3 doses and Infanrix for the 4th dose

Risk Factors for Invasive Pneumococcal Disease (IPD)

Decreased immune function Splenii (functional or anatomic) Chronic heart, pulmonary (asthmatics being tx w/ high dose steroids), liver or renal disease Cerebrospinal fluid leak Cochlear implant *Give PCV-23 after age 2

Varicella Vaccine Immunogenicity and Efficacy

Detectable antibody - 97% of children 12 mo- 12 yr following 1 dose - 99% of persons 12 years and older after 2 doses 70-90% effective against any varicella disease 95-100% effective against severe varicella disease

Adverse Reactions following MMRV and MMR+V

During the 7-10 days after vaccination about one additional febrile seizure would be expected to occur for every 2,000 children who receive MMRV vaccine rather than separate MMR and varicella vaccines Unless parent prefers, MMR+V recommended for first dose

HIB Vaccine Side Effects

Few symptoms occur 5-30% have local irritation at injection site 1 out of 20 have fever > 102 F

Rotavirus Vaccine Dosing

First dose - 6 weeks through 14 weeks and 6 days - No first dosages can be initiated after 15 weeks and 0 days The minimum interval dose is 4 weeks All doses must be administered by 8 months and 0 days Any infant w/ an allergy to latex cannot receive the vaccine (Rotarix) since cap contains latex *Never give after 8 months of life

Rotavirus

First identified as cause of diarrhea in 1973 Most common cause of severe diarrhea in infants and children Nearly universal infection by 5 years of age Responsible for 500,000 diarrheal deaths each year worldwide Winter time diarrhea

MenHibRix

For children 6 wks of age through 18 months of age w/ functional asplenia, persistent complement deficiencies, or during a community outbreak 4 doses (0.5 ml each) IM at 2, 4, 6, and 12-15 months of age Neisseria meningitis serogroups C & Y Haemophilus influenzae type b

Hepatitis B+ Mothers

For infant born to hep B surface antigen (HBsAg) - positive mothers, administer Hep B and 0.5 ml of hepatitis b immune globulin w/in 12 hours of birth Test for HBsAg and antibody to HBsAg (anti-HBs) at age 9 months through 18 months or at 1-2 months after completion of the Hep B series (preferably at next well-child visit)

MMR Vaccine

Given as a live attenuated strain of virus Cannot catch the virus from the vaccine MMR or MMRV - Delivered as subq injection - Licenses for use in persons 12 mo through 12 years of age - Give first dose at 12-15 months, second at 4-6 years - In unimmunized children, give one dose at first visit and second dose 4 weeks later - After 1 dose, 95-98% immunity; after 2 doses, 99%

DTaP School Entry (5th) Dose

Given between 4 -6 years 5th dose recommended when 4th dose given before 4 years All DTaP vaccines are licensed for 5th dose after DTaP primary series

Hep V Vaccine Series

Given in 3 dose series for children, and in 2 or 3-dose at age > 24 weeks - 1st dose at birth in nursery, 2nd dose 1-2 months later, 3rd dose at age > 24 weeks - HBIG given to infants born to Hep B+ mothers or, if status is unknown give hep b vaccine w/in 12 hours of birth and HBIG within one week of life

Hepatits A Vaccine Efficacy

HAVRIX - 40,000 Thai children 1-16 years - vaccine efficacy 94% VAQTA - 1,000 New York children 2-16 years 0 vaccine efficacy 100%

Comvax

HIB and Hepatitis B Indicated for vaccination against invasive disease caused by Haemophilus influenzae type b and against infection caused by all known subtypes of hepatitis B virus in infants 6 weeks to 15 months of age born of HBsAg negative mothers

Aluminum is used in:

Hep A Hep B DTaP, Tdap Hib HPV Pneumococcus infection

Rotavirus Contraindications

Hypersensitivity Gastrointestinal Tract Congenital Malformation Hx of intussusception Severe combined immunodeficiency disease (SCID) Latex allergy (Rotarix)

Varicella Breakthrough Infection

Immunity appears to be long-lasting for most recipients Breakthrough disease much milder than in unvaccinated persons (looks like mosquito bites) No consistent evidence that risk of breakthrough increases with time since vaccinations

POLIO Vaccine Travel Recommendations

Inactivated polio vaccine booster is not recommended for more than 4 weeks of travel to effected countries

HIB Vaccine

Inactivated vaccine, contains part of the bacterium so cannot cause disease Recommended for all children under 5 years 3 (PedVacHib) to 4 (ActHIB) doses depending on which HIB vaccine and age at first dose Given as an injection into the muscle More than 95% effective if given 2 or 3 doses

Timing of Influenza Vaccine

Influenza activity can occur as early as Oct In more than 80% of influenza seasons peak activity has not occurred until Jan or later In more than 60% of seasons the peak was in Feb or later Immunization providers should begin offering the vaccine as soon as it becomes available through March

HPV Vaccination during Pregnancy

Initiation of the vaccine series should be delayed until after completion of pregnancy If a women is found to be pregnant after initiating the vaccine series, remaining doses should be delayed until after the pregnancy If a vaccine dose has been administered during pregnancy, there is no indication for intervention Women vaccinated during pregnancy should be reported to the Merck registry

Meningococcal Vaccine for Serogroup B: ACIP Recommendations

Left up to individual clinical decision making for the following reasons: - Breadth of coverage of these vaccines against serogroup B strains circulating in the US - Vaccine effectiveness and duration of effectiveness - Impact of these vaccines on carriage and herd community - Safety of these vaccines post-licensure - Current burden of disease is low, which means that the # of adolescents that need to be vaccinated to prevent a case and death is high

Conjugate Vaccine

Linkage of an "unrecognizable" polysaccharide to one that is recognized and can help boost immunity Ex: HIB, Pneumoccal-13

Types of Vaccines

Live attenuated Inactivated or "killed"" Subunit Toxoid Conjugate DNA Recombinant Vector

Polio Vaccine

Live attenuated TOPV only in developing countries Four dose series of IPV Ages 2, 4, 6-18 month and 4-6 years Final dose in series should be administered on or after the 4th birth and at least 6 months after the previous dose Must be 6 weeks at start of series

Pneumococcal Vaccine Adverse Reactions

Local - polysaccharide: 30-50% - conjugate: 10-20% Fever, myalgia - polysaccharide: <1% - conjugate: 15-24% Severe adverse reactions - rare

Adverse Reactions Following 4th & 5th DTaP Dose

Local adverse reactions and fever increased with 4th and 5th doses of DTaP Reports of swelling of entire limb Extensive swelling after 4th dose NOT contraindicate 5th dose Give in thigh to reduce whole limb swelling

Varicella Vaccine Adverse Reactions

Local reactions (pain, erythema) - 19% children - 24% adolescents and adults Rash - 3-4% - may be maculopapular rather than vesicular - average 5 lesions Systemic reactions not common Adverse reactions similar for MMRV

HPV Vaccine Adverse Reactions

Local reactions (pain, swelling) - 84% Fever - 10% No serious adverse reactions reported

DTaP Adverse reactions

Local reactions - 20-40% - pain, redness, swelling Temp of 101 F or higher - 3-5% More severe adverse reactions not common - Exaggerated local reactions (Arthus-type) Local reactions more common following the 4th and 5th dose

Tdap Side Effects

Local redness and swelling at injection site are common, w/ nodules and even abscesses occurring frequently More severe reactions include peripheral neuropathy, Guillian Barre and urticaria Fever and systemic symptoms are uncommon Rare risk of seizure somewhat related to genetics - SNCA1 Dravets syndrome

MMRV Vaccine

MMR + Varicella Approved for children 12 months through 12 years of age (to 13 years) Do not use for persons 13 and older May be used for both first and second doses of MMR varicella vaccines Minimum interval between doses is 3 months *Higher incidence of fever, high risk of side effects (seizures)

CorynbacteriUm Diphtheria

Membranous nasopharyngitis Low grade fever obstructive laryngotracheitis and bull neck Can lead to airway obstruction *gray exudate membrane on throat - thick

Types of Meningococcal Vaccine

Menactra (Men ACWY-D) - Diptheria toxoid - 2 dose series starting at 9 months; 12 weeks between doses MenHibrix (HibmenCY) - Tentanus toxid - Doses at 2, 4, 6 and 12 months Menveo (MenACWY-CRM) - CMR - Doses at 2, 4, 6, and 12 months

Meningococcal Conjugate Vaccine (MCV 4)

Menactra (sanofi pasteur) Quadrivalent polysaccharide vaccine (A, C, Y, W-135) conjugated to diphtheria toxoid IM injection Single dose vials do not contain preservation

Meningococcal Polysaccharide Vaccine (MPSV)

Menomune (sanofi pasteur) Quadrivalent polysaccharide vaccine (A, C, Y, W-135) Subq injection 10 dose vial contains thimerosal as a preservative Adults aged 56 and older

Side Effects of MMR

Mild Problems - Fever (up to 1 person out of 6) - Mild rash (about 1 person out of 20) - Swelling of glands in the cheeks or neck (about 1 person out of 75) Moderate Problems - Seizure (jerking or staring) caused by fever (~1 out of 3,000 doses) - Temporary pain and stiffness in joints, mostly in teenage or adult women (up to 1 out of 4) - Temporary low platelet count, which can cause a bleeding disorder (~1 out of 30,000 doses) Severe Problems (very rare) - Serious allergic reaction (less than 1 in a million) - Several other severe problems have been reported after a child gets MMR vaccine, including: deafness, long-term seizures, coma or lowered consciousness

Side Effects of Varicella Vaccine

Mild Problems - Soreness or swelling where the shot was given (~ 1 out of 5 children and up to 1 to 3 adolescents and adults) - Fever (1 person out of 10, or less) - Mild rash, up to a month after vaccination (1 person out of 25). It is possible for these people to infect other members of their household, but this is extremely rare Moderate problems - Seizure (jerking or starting) caused by fever (very rare) Severe Problems - pneumonia (very rare)

Protection of Rotavirus Vaccine

Mild gastrenteritis: 74-87% Severe gastroenteritis: 85-98%

Varicella Vaccine Minimum Age and Interval

Minimum Age: 12 months Minimum Interval: 3 months From 1-12 years age

Hepatitis A Vaccine: Minimum Age an Interval

Minimum Age: 12 months Minimum Interval: 6 months

Rotavirus Vaccine: Rotateq and Rotarix Minimum Age and Maximum Age

Minimum Age: 6 weeks Maximum Age for first dose in series is 14 weeks, 6 days Maximum Age for any dose is 8 months

PCV 13 Minimum Age & Interval

Minimum Age: 6 weeks Minimum Interval: 8 weeks

POLIO Vaccine Minimum Age and Interval

Minimum Age: 6 weeks Minimum Interval: 8 weeks

Hepatitis B Vaccine Minimum Age and Interval

Minimum Age: birth Minimum Interval: 4 weeks

HIV Vaccine Minimum Age and Minimum Interval

Minimum age: 6 weeks Minimum interval: 8 weeks

HPV Vaccine Minimum Age and Interval

Minimum age: 9 years Minimum Interval: must have 4 weeks between first and 2nd dose w/ the third dose 24 weeks after the first dose and 16 weeks after the 2nd dose

DTaP Precautions

Moderate or severe acute illness Temperature > 105 F or higher within 48 hours w/ no identifiable cause Collapse or shock-like state (hypotonic hyporespontsive episode) w/in 48 hours Persistent, inconsolable crying lasting > 3 hours, occurring within 48 hours Convulsions with or without fever occurring within 3 days

HPV Precautions

Moderate or severe acute illnesses (defer until symptoms improve)

Influenza Vaccine Precautions

Moderate to severe acute illness w/ or without fever Hx of Guillian-Barre syndrome w/in 6 weeks of receipt of influenza vaccine

Provider and Vaccine: Malpractive

Must give Vaccine Information Sheets Must review them w/ families and document in chart Make sure the medical assistant knows how to give shots They are practicing under your license!

DNA Vaccine

Naked DNA vaccine - experimental Ex: Malaria, Herpes, HIV

Clinical Manifestations of Hepatitis A

No chronic carriage Pediatric patient is less likely to be symptomatic Adult will give away diagnosis

Influenza Vaccine New Recommendations

No live attenuated influenza vaccine in 2016 Everyone gets IM For children aged 6 mo - 8 years - Do not give a 2nd dose if they have the influenza vaccine later year - If they did not receive the vaccine last year, need 2 doses separated by 1 month

Rotavirus Precaustions

Other disease the affect immune competence, spina bifida, bladder exotrophy, gastro of moderate to severe No repeating for spitting up or vomiting - infants in households w/ persons who have or are suspected of having immumodeficiency disorder or impaired immune status can be vaccinated

Influenze Minimum Age

Over 6 months

Combination Vaccines that Contain DTaP Disadvantages

Potential for increased adverse events Extra dose of antigen Reduced immunogenicity at certain ages

Rotavirus Vaccine - Conditions that are NOT Precautions

Pre-existing chronic gastrointestinal conditions - no data available - ACIP considers the benefits of vaccination to outweigh theoretical risk Recent receipt of an antibody containing blood product - Not data available - ACIP recommends that rotavirus vaccine may be administered at any time before, concurrent w/, or after administration of any blood product

MMR Contraindications

Pregnancy, or plans to become pregnant within 4 weeks of vaccine Severe allergic reaction to previous vaccine Immunocompromised Not contraindicated if allergic to eggs Not contraindicated if breastfeeding

Clinical manifestations of HIB Disease

Present as a Serious Bacterial Illness (SBI) - Meningitis - Pneumonia - Bacteremia and Sepsis Other bacterial illnesses - Osteomyelitis and septic arthritis - Some include: - UTI (Pyelonephritis) - Bacterial enteritis

Tdap Contraindications

Previous severe allergic reaction to Tetanus or a component of the vaccine Severe or moderate illness - If unable to received tetanus vaccine, individuals will need tetanus immunoglobulin (TIG) w/ invasive, high risk injuries

ACIP Recommendations for PCV 13

Prevnar (PCV 13) - All children 2 to 59 months - 4 doses starting at age 2, 4, 6, and 12-15 months Starting after 24 through 59 months: only need one dose if they have no received the vaccine - fewer doses if series started at 7 months - Children who received one or more dose of PCV 7 should complete w/ PCV 13 - Approved by FDA through age 17

DTaP Primary Vaccination Schedule

Primary 1: 2 months Primary 2: 4 months (4 wk minimum interval) Primary 3: 6 months (4 wk minimum interval) Primary 4: 15-18 months (6 month minimum interval)

Prevnar Series: 1st dose 24-59 months (healthy children)

Primary Series: 1 dose No booster

Prevnar Series: 1st dose at 12-23 months

Primary Series: 2 doses No booster

Prevnar Series: 1st dose 7-11 months

Primary series: 2 doses Booster dose: 1 dose at 12-15 months

Prevnar Series: 1st dose 14-71 months (children w/ chronic diseases or immunocompromised)

Primary series: 2 doses No booster

Prevnar Series: 1st dose 2-6 months

Primary series: 3 doses Booster dose: 1 dose 12-15 months

Pertussis Containing Vaccines: Use in Children w/ underlying neurological disorders

Prior seizure: delay and assess Suspected neurologic disorder: delay and assess Neurological even between doses: Delay and assess Stable/resolved neurological condition: Vaccinate

Inactivated Vaccine

Produced by killing the microbe with heat, chemicals or radiation Ex: Cholera, Influenze, Rabies

Pertussis Among Adolescents and Adults

Prolonged cough (3 months or over) Post-tussive vomiting Multiple medical visits and extensive medical evaluations Complications Hospitalizations Medical costs Missed school and work Impact on public health system

Influenza Vaccine Types

Quadrivalent vaccine, including additional B strain Inactivated subunit (TIV) - IM - Trivalent - Contains egg protein Live attenuated vaccine (LAIV) - not being used this year - intranasal - trivalent - contains egg protein

Rotavirus Vaccines

RV5 (Rotateq) - Contains 5 reassortant rotaviruses developed from human and bovine parent rotavirus strains - Vaccine viruses suspended in a buffer solution - Contains no preservative or thimerosal Rotarix - Administered first dose to infants beginning at 6 weeks age - Administer 2nd dose after an interval of at least 4 weeks and prior to 24 weeks of age

Hep B Vaccine

Recombivax HB (1982) Engerix (1986) - Recombinant DNA vaccines - All varieties contain one of these vaccines in combination w/ others - Administered into the thigh of children < 12 months, deltoid or thigh of older children and adults - Studies indicate that once immune, incurs lifelong immunity in 90% of individuals receiving 3 doses - Given in 3 dose series for children, and in 2 or 3-dose at age > 24 weeks Pediarix Comvax

Varicella Vaccination Healthcare Personnel

Recommended all susceptible healthcare workers Prevaccination serologic screening probably cost effective Post vaccination testing not necessary or recommended

DTaP Fourth Dose

Recommended at 15-18 months May give as early as 12 months if: - child is 12 months of age, and - 6 months since DTaP3, and - unlikely to return at 15-18 months

Combination Vaccines that Contain DTaP Advantages

Reduced the # of injections Improved vaccination timeliness and coverage Reduce shipping and storage costs

Rotavirus Clinical Manifestations

Reovirus (RNA) Initial symptoms of watery diarrhea follow fever and vomiting for 24-48 hours 1-3 day incubation period 5 predominant strains in the US (G1-G4, G9) and account for 90% of isolates G1 strain accounts for 75% of infections Very stable and may remain viable for weeks or months if not disinfected

HPV Vaccination Schedule

Routine schedule is 0, 2, 6 months Minimum Intervals - 4 weeks between 1 & 2 - 12 weeks between 2&3 - 24 weeks between 1 &3 Do not restart the series if the schedule is interrupted Administer at same visit as other age-appropriate vaccines

Varicella Vaccine Recommendations

Routine vaccination at 12-15 months of age Routine second dose at 4-6 years of age 12 months to 12 years of age (3 month minimum interval)

Clinical Manifestations of Pneumococcal Diseae

Serious bacterial illness similar to HIB Otitis Media (#2 cause) Sinusitis Conjunctivitis Occasionally causes mastoiditis, periorbital cellulitis, endocarditis, osteomyelitis, soft tissue infections, neonatal sepsis (rare)

HIB Vaccine Contraindications

Severe allergic reaction after previous vaccine or vaccine component Age younger than 6 weeks Severe illness w/ fevere

Pneumococcal Vaccine Contraindications

Severe allergic reaction to a previous PCV vaccine Mild or moderate illness Safety in pregnancy not determined

HPV Contraindications

Severe allergic reaction to a vaccine component or following a prior dose

Influenza Vaccine Contraindications

Severe allergic reaction to any vaccine component, including egg protein, or after previous dose of any influenza vaccine

Polio Vaccine Contraindications

Severe allergic reaction to neomycin, polymixin B, streptomycin, the vaccine contains trace amounts of these antibiotics Severe allergic reaction to a previous polio vaccine Moderate Illness

Hepatitis B vaccine contraindications

Severe allergic reaction to previous HBV or one of its components in the past Moderate or severe illness Infant weighing less than 2000g (or 4.4 lbs)

DTaP Contraindications

Severe allergic reaction to vaccine component or following a prior dose Encephalopathy not due to another identifiable cause occurring within 7 days after vaccination

Varicella Containing Vaccine Contraindications and Precautions

Severe allergic reaction to vaccine component or following a prior dose Immunosuppression Pregnancy Moderate or severe acute illness Recent blood product (except herpes zoster vaccine)

Hepatitis A Vaccine Contraindications

Severe allergic reaction to vaccine or its components in the past Moderate illness Safety in pregnancy not studied

Clinical Manifestations of Meningococcal Bacteria

Severe disease, including meningitis, bacteremia, and septicemia, resulting in permanent disabilities and even death

Human Papillomavirus (HPV)

Small DNA virus More than 100 types identified based on the genetic sequence of the outer capsid protein L1 40 types infect the mucosal epithelium

Hepatitis B Vaccine side effects

Soreness at the injection site Low grade fever

Hepatitis A Vaccine Side Effects

Soreness at the injection site, common Fever, fatigue, malaise, headache, less common Rare anaphylaxis

Polio Vaccine Side Effects

Soreness at the site of the infection

Clinical Manifestations of Influenza

Sudden onset of fever, w/ chills Headache and malaise Myalgia and cough Followed by upper respiratory symptoms and conjunctival injection, abdominal pain w/ vomiting and diarrhea are less common Death can occur and is associated with myocarditis, secondary bacterial illness and neurological complications

Hepatitis B

Symptomatic or asymptomatic Subacute illness w/ nonspecific symptoms Full blown jaundice as well as GI symptoms Extrahepatic manifestations - Arthralgia - Arthritis - Macular rash - Thrombocytopenia

Tetanus Containing Vaccines

Tdap for one dose is the vaccine for choice for children over 7 year through adulthood every 10 years - If previously unvaccinated, 3-shot series, first two doses separated by 4 wks, 2nd and 3rd by 6-12 months - One of these should be the Tdap - Then booster every 10 years Tetanus vaccine is 100% effective for 10 years after full series - Deep IM injection in thigh of infants - Deltoid of older children and adults

MMR Vaccine: 2015 Schedule Footnote

The 2nd dose may be administered before age 4 years, provided at least 4 weeks have elapsed since the first dose Administer MMR vaccine to infants aged 6 through 11 months who are traveling internationally - this dose should be repeated at 12 months or older and then receive a third dose 4 weeks later Recommended interval between catch up doses is 4 weeks

2016 Schedule: IPV for 7-18 year olds

The final dose in the series should be administered at least 6 months following the previous dose If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child's current age

Tetanus containing vaccine

The vaccine of choice for children 6 weeks to 7 years is DTaP in a 4-dose primary series - Administered at 2m, 4m, 6m, and a booster at 15-18 mo, at least 6 mo afters the 3rd Secondary series - if the 4th dose is given before the 4th bday, another would be given at 4-6 yo (would be 5th dose) - The next booster dose should be given as Tday, ages 11-12 and a booster Td every 10 years there after

Subunit Vaccine

Use of the only antigen that best stimulates the immune system Ex: Hepatitis B, Pertussis, Pneumoccocal

Varicella Containing Vaccines

Varicella Vaccine (Varivax) - approved for persons 12 months and older Measles-mumps-rubella-varicella vaccine (ProQuad) - approved for 12 months to 12 years Herpes Zoster Vaccine (Zostavax) - approved for persons 50 years and older

Why give Varicella Vaccine

Varicella is associated with superinfection w/ strep The disease can lead to scarring It makes parents lose work time

Rotavirus Vaccine Adverse Reactions

Vomiting: 15-18% Diarrhea: 9-24% Irritability: 13-62% Fever: 40-43% Serious adverse reaction: none

Toxoid vaccine

When the toxin is the main cause of the disease Ex: Diphtheria, Tetanus

Kinrix: Inadvertently administered

if Kinrix is inadvertently administered as an earlier dose in the series, the dose may be counted as valid and does not need to be repeated if the minimum age and minimum interval since the prior dose were met

Adjuvants

used to prevent a vaccine from going bad