Immunizations

Rubella

Also known as "German Measles", this virus causes a rash, fever, and arthritis often in women. It also has the potential to cause a miscarriage in pregnant women. - The vaccine for this is NOT currently given to pregnant women, due to the live vaccines ability to cross the placenta and harm the fetus. It is considered as having an aim in the protection of an unborn child, by vaccinated women of child-bearing age groups.

4th Dose of Hib

Children with Respiratory Problems are given this dose of Hib, at around 12-15 months.

Hepatitis B Immunization CONTRAINDICATIONS

Here, there is an anaphylactic reaction to common *BAKERS YEAST* and liver abnormalities.

PRP-OMP (PedVaxHib or ComVax)

If this part of the Hib Vaccine is administered at the ages 2 and 4 months, the 3rd dose is not necessary.

DTaP Administration w/ A History of Seizures

In this situation, give Tylenol Q4H for 24 hours prior to the vaccine.

Infants Being Breast Fed/Any children with mild illness or fever

Rotovirus can be given to these types of children.

Varicella Vaccine Dose

The dose of this vaccine is: 1st Dose: 12-15 months 2nd Dose: 4 - 6 Years old

PCV Side Effects

These Include: *Polysaccharide Vaccine:* - Redness - Pain - Fever - Muscle Aches *Conjugate Vaccine:* - Redness - Tenderness - Swelling - Decreased Appetite - N/V/D

PCV Considerations

These considerations include: - May be given to children w/ mild illness w/w/out fever - May be given to children w/ mild upper respiratory tract infections and to children with allergic rhinitis - May be given to children w/ *Sickle Cell, HIV, or anything immunocomprimising*

Varicella Vaccine Contraindications

These contraindications include: - Pregnancy - Children with TB - Immunocomprimised Children (Because it is a LIVE vaccine)

MMR Vaccine Doses

These doses include: 1st - 12-15 months 2nd - 4-6 years 3rd - (A high risk or catch up dose) 7-18 years

Alaskans and American Indians

These groups are encouraged to receive the PCV vaccine.

Hib Side Effects

These include (In 25% of children/mild): - Redness - Swelling - Warmth - Fever

PCV Doses

These include 3 separate doses given at 2, 4, and 6 months, which can be given with the Hib Vaccine. 4th Dose - given at 12 - 15 months 5th Dose - given at 2 - 4 years old or older *ONLY IF THERE IS A HIGH RISK FOR INFECTION*

PCV Contraindications

These include: *Allergic to Neomycin and Gelatin*

MMR Vaccine Side Effects

These include: *Mild:*Fever, Rash, Swelling of glands in cheeks or neck *Moderate:* Seizures *Serious:* Deafness, Long term seizures, Coma, Brain Damage

DTaP Contraindication

These include: - Encephalopathy w/in 7 days of administration of a previous DTaP

Varicella Vaccine Side Effects

These include: - Fever - Rash at the injection site

HPV Vaccine Contraindications

These include: - Pregnancy and sensitivity to yeast or any vaccine component. Reportable conditions include: Inconsolable crying, fever of 104, profuse rash if allergic to eggs or gelatin.

DTaP Side Effects

These include: - Redness - Swelling - Soreness at the side - Fussiness - Tiredness - Pain - Poor appetite - Vomiting - Nodule appears - Anaphalaytic Reaction - Fever above 102 F

Hepatitis A Immunization Side Effects

These include: - Severe allergic reaction - Soreness at the Injection site - Headache - Loss of appetite - Tiredness

Rotovirus Vaccine Side Effects

These include: - Severe allergic reactions - N/V/D - Fever - Runny Nose - Soar Throat - Wheezing - Coughing - Ear Infections

Hepatitis B Common Side Effects

These include: - Sorness/Pain/Redness at the injection site - Photophobia - Fever - Headache

IVP Side Effects

These include: - Tiredness - Irritability - Soreness at the injection site

Meningococcal Vaccine Side Effects

These include: 1.) ? 2.) Guillain-Barre Syndrome (EBP says we continue to give the vaccine)

DTap Doses

These include: 1st Dose: at 2 months 2nd Dose: at 4 months 3rd Dose: at 6 months 4th Dose: Given btwn 15-18 months (*At least 6 months has to elapse since the 3rd dose*) 5th Dose: Given btwn 4 - 6 years old 6th Dose: Given at 11-12 years, w/ a catch up dose at 13-18 years old. *At this dose, Tetanus comes first, making it TDaP*

Hepatitis B: Fourth Dose

This HepB dose is considered a catch-up dose from 9 months to 6years old.

Hepatitis B: Second Dose

This HepB dose is given between 1-2 months old - (This also may be the first dose if the mother was HBsAg Negative or if the vaccine wasn't given in the hospital)

Hepatitis B: Third Dose

This HepB dose is given between 6 - 18 months

Dorsalgluteal Site (w/ regard to Hepatitis B)

This IM site is avoided due to poor antibody seroconversion rates, indicating a reduced immune response.

Polysaccharide Vaccine

This PCV vaccine is given to the older population over 5 years of age, and is recommended for anyone over 65 years old due to the increased risk of pneumonia.

Meningococcal Disease

This disease can occur as meningitis or septicemia; Neisseria meningitis is the leading cause of bacterial meningitis. It results in a loss of limbs, deafness, CNS problems, and stroke.

Pneumococcal Disease

This disease is the leading cause of meningitis in children. It can cause pneumonia, otitis media, deafness, brain damage, and a number of bacterial infections such as septicemia and meningitis. These illness are particularly problematic in children who attend daycare.

Hepatitis A

This immunization is spread through the fecal-oral route as well as person to person contact. It is given at late infancy (12 months to 23 months) This requires two doses, and the second must be given 6 months apart from the first. - *UNDER 18 YEARS: Gets 0.5 mL IM Injection* - *ABOVE 19 YEARS: Gets 1.0 mL IM Injection* Infants receive IM through the Vastus Lateralis Toddlers, Children, and Adults receive IM through the Deltoid

Adverse Reaction to DTaP

This is *INCONSOLABLE CRYING* - If this happens up to 3 hours after giving the first dose, notify the physician and realize this is a serious side affect and it should not be given again.

Adolescents Needle Length

This is 1 to 2 inches

Infant Needle Length (Newborn to 2 Months)

This is 5/8 of an inch

Toddler and School age Needle Length

This is 5/8 to 1 Inch in length

MMR Vaccine

This is a LIVE combination vaccine that includes Measles, Mumps,and Rubella. Given at a minimum age of 12 months. Route: SubQ Dose: 0.5mL - Some college students receive this vaccine due to decreased immunity

Diptheria

This is a bacterial infection that leads to respiratory difficulties. If a child is immuno-compromised,you give the vaccine to this 1 month after their treatment. To ascertain this illness, we need a *nose and throat culture*

DTaP Vaccine

This is a combination vaccination that includes: - *Diptheria, Tetanus, and Pertusis* It is given at the minimum of 6 weeks, through the IM route *DOSE = 0.5mL*

TriHIBit (DTaPHib)

This is a combination vaccine that should not be given as a primary immunization. (2,4,6) It can, however, be given as a booster following any Hib vaccine in children ages 12 months and older.

IVP (Inactivated Poliovirus)

This is a disease pf the CNS that can result in paralysis. This vaccine for this should be *CLEAR and COLORLESS* Discard it if it is cloudy.

Measles

This is a highly contagious respiratory disease that causes a total body, skin rash and flu-like symptoms.

ELMA (w/ Occlusive Dressing)

This is a topical anesthetic placed on a child before administration of an injection to minimize pain. It is placed on at least 1 hour before administration of the injection.

VZIG

This is a varicella immunoglobulin given to a child who is immunocomprimised or exposed to chicken pox.

HPV

This is a viral infection spread through skin to skin contact. It is in a group of over 100 different viruses, with at least 30 known to cause some type of cancer. There is currently no cure. The vaccine for this is now approved for males.

Mumps

This is a viral infection that is spread through saliva.

Varicella

This is also known as "Chicken Pox." It causes blister like capsules on the face and the trunk, and swelling of the brain.

Needle Length

This is an important factor when giving IM injections as proper administration into deep muscle tissue provides less pain and fewer reactions. It is important to think critical when determining this, as each child is different. You must look at the child, not just the age of the child.

Tetanus

This is commonly called "lock-jaw", producing a rigid neck and facial spasms. It affects the nervous system and causes muscle spasms.

Pertussis

This is considered *HIGHLY CONTAGIOUS*, and is also known as "Whooping Cough." It produces paroxysmal coughing, pneumonia, encephalopathy and seizures. This patients gasp for air and get rib fractures from coughing.

Administration Of an IM Injection

This is done at a 45-60 degree angle to the skin, toward the knee, at a depth of 16-25 mm skin to needle tip depth.

HPV Vaccine Route

This is done through IM injections, 0.5mL - The first dose is done between 9 - 12 years old - Second dose is 2 months after the first dose - Third dose is given 6 months after the second

Rotovirus Doses

This is given in 3 doses - 2 Months - 4 Months - 6 Months The minimum age to give the first dose is 6 weeks, but no later than 14 weeks. All 3 doses must be given no later than 32 weeks of age, due to insufficient date to support safety and efficiency of vaccines after 32 weeks.

MCV4

This meningococcal vaccine: - Begins at 11 - 12 years old - IM/ Deltoid 0.5mL

MPSV4

This meningococcal vaccine: - Begins at 2 - 10 years old - SubQ/ Anterolateral fat of the thigh or Upper arm, 0.5mL

Hepatitis B

This pediatric disease can lead to fatal consequences like cirrhosis of the liver and liver cancer in adulthood, if left untreated. The minimum age of receiving this immunization is at Birth, WITHIN THE FIRST 12 HOURS. INFANTS - IM injection given in the Vastus Lateralis TODDLERS/CHILDREN/ADULTS - Deltoid *DOSE = 0.5mL*

Rotovirus Major Consideration

This should not be given to children born to HIV positive mothers, as well as to known or suspected weakened immune systems caused by radiation, drugs, or conditions such as leukemia, blood disorders, and cancer.

Meningococcal (MCV, MPSV)

This vaccine involve two vaccines in one, and cannot be mixed with any other vaccine. These two can be given at the same time as other vaccines, but at a different site and with a different syringe.

Varicella Vaccine

This vaccine is given SubQ at a dose of 0.5mL. It is given in conjunction with MMR Vaccine, but with a separate syringe at a separate site.

Hib (Haemophilus Influenze type b Conjugate Vaccine)

This vaccine is given to prevent pneumonia and bacterial meningitis/epiglottis.The route for this vaccine is IM at a dose of 0.5mL. The vastus lateralus is the preferred site for infants, and the deltiod is preferred for toddlers, children and adults.

Influenza

This vaccine is given to prevent the flu/ infection of respiratory tract. It is given annually. The minimum age for trivalent inactivated vaccine is: *6 months (TIV)* Which is given 0.25 mL (up to 35 months) If the patient is age 3 or older, give 0.5mL IM in the Vastus Lateralis. - After 2 years of age, children can receive the Live Attenuated Vaccine (LAIV) in the *Intranasal Route*

Meningococcal Vaccine Contraindications

This vaccine may be given while pregnant, however: - Avoid those with allergies to rubber latex and diptheria toxiod

PCV (Pneumococcal Conjugate Vaccine)

This vaccine prevents the disease Pneumococcal. - The minimum age to administer this is 6 weeks *Dose = 0.5mL via IM Route\

Influenza Vaccine Contraindications (LAIV Version)

This vaccine should not be given to anyone who is allergic to EGGS, Saliylates, known immunodeficiency or a history of GBS.

Rotovirus (Viral Infection)

This viral infection causes severe diarrhea, vomiting, and fever in infants, young children, and Health Care Workers *(WASH HANDS!!)* - *This is the ONLY vaccine that is given PO*

MMR Contraindications

With this vaccine, avoid giving in pregant patients, immunocomprimised children. - Advise girls of child bearing age to delay pregnancy for 3 months. - DON'T give if patients are allergic to *EGGS* *NEOMYCIN* *GELATIN* - Give this vaccine to children with HIV but NOT to those with Cancer

IVP IMPORTANT CONSIDERATION

With this vaccine, it is important to check for the sensitivity to *Neomycin or Streptomycin* prior to administering.

IVP Route and Doses

With this, the routes and dose include: - SubQ and IM at a dose of *0.5mL* This is given at 2 and 4 months; 3rd Dose: 6 - 18 months 4th Dose: 4 - 6 years

HepB Negative Mother and a Delayed Vaccination

With this, the vaccine may be given up to 1 month, but only with an MD's order. Newborns weighing LESS than 2000g (4.4lbs) at birth are GIVEN HepB at 1 month of age.

HepB Positive Mother or Status Unknown

With this, the vaccine must be given to both pre-term and full term born infants ASAP along with Hepatitis Immunoglobulin (HBIG). Here, you MUST have consent documented.

Hib Cautionary Administration

You must be cautious when administering this vaccine to immunocomprimsed patients. The effects of it may be altered.