Therapeutics: Immunizations/Vaccines

Recombinant vaccine (RIV3): - name? - dose? - only in ages ___ and older - for people with severe ___ allergy. - Produced using ___ ___ cells

- Flublock - 0.5mL - 18 and older - egg - army worm cells

Cell Cultured (ccIIV3): - Name? - Dose? - Indicated only if ___ yrs or older. - Produced in cultured _____ cells instead of ____ ____.

- Flucelvax - 0.5mL - 18 and older - animal cells, hen eggs

Intradermal (ID) version of quadrivalent vaccine (IIV4): - Brand name: F______ Intradermal - needle is 90% _____ than IM needle - Indicated for ages ___ to____. - Dose is ___mL - more or less injection site reactions than IM?

- Fluzone Intradermal - shorter - 18-64 - 0.1mL - more reactions

T/D/P Contraindications: - Hx of severe ____ ____ - Hx of e________ that is idiopathic and within ___ days of a vaccine with pertussis. - unstable _____ conditions or _____ disorders

- allergic reaction - encephalopathy, 7 days - neurologic - neurologic

MMR Contraindications: - severe ______ to vaccine, n____, or g____ - deter if _____, ______, or recent ____ products - ____/____ acute illness - If PPD not given on same day, delay for __ - __ weeks after MMR - verbal screening for pregnancy - pregnant or planning to be pregnant within the next ___ weeks. 1. Adverse Reactions: - f_____/r_____

- allergy - neomycin - gelatin - blood products - moderate/severe - 4-6 weeks - 4 weeks 1. fever/rash

Bioterrorism Vaccines: - a______ - s_____ Other Threats: - b_____ - p____ - t_____ - viral ____ fevers - r____ - many others

- anthrax - smallpox - botulism - plaque - tularemia - hemorrhagic - Ricin

High Dose Version of Trivalent (IIV3): - contains slightly more vaccine _____. - Indicated only if ____ yrs or older.

- antigen - 65 and older

Other Special Groups to Consider When Vaccinating: - ___ ___ workers - ____ _____ - a______ - etc.

- health care - college students - adoptions

- What group/affiliation/committee should you always follow for vaccination recommendations? - Why not FDA? - ALWAYS read the _________ on the guidelines.

- ACIP (brand of the CDC) = advisory committee on immunization practices - ACIP recommendations are more in-depth than FDA. - Footnotes

T/D/P & Pregnancy: - Since 2012, recommendations say to administer to pregnant women how often? - Ideally at what stage of pregnancy? - Why not wait until the first dose in infants at 2 months old?

- EVERY pregnancy - 27-36 weeks gestation - highest risk for infants is during first 3 months of life, so you don't want to wait until 3 months. Give vaccine to mom to "Cocoon" the baby.

Administration Routes: - _____ is critical - _ _ vs _ _ - D_____ - ______ vaccines - S______

- technique - IM vs SC - Diluents (when you have to mix them up with something else before administering) - shaking (many settle during storage) - storage

Live Attenuated vs. Inactivated Vaccines: 1. Live: - made from ____ or _____ - Must _______ to work. Replication mimics ______ _____ by stimulating an ____ response. 2. Inactivated: - Made from various ______ of viruses or bacteria (i.e. suborns, subunits, polysaccharides, toxoids, etc.). - Do they replicate? - Why/why not? - aka "_____" vaccines 3. Most vaccines are live or killed?

1. - viruses or bacteria - replicate - natural infection - immune 2. - fractions - no - because they're killed - "killed" vaccines 3. Most vaccines are Inactivated/killed.

MMR Children Dosing: 1. Dose 1 at __ months 2. Dose 2 at __ - ___ years or at least __ weeks from the last dose. 3. what is MMRV?

1. 12 months 2. 4-6 yrs, 4 weeks 3. MMR + Varicella called ProQuad

Varicella Vaccine for Children: 1. First dose given at what age? ___ - ___ months 2. Second dose given when? ___ - ____ years old 3. If you miss that schedule but the child is under ___ years old, give ___ doses at least ___ months apart to catch them up.

1. 12-15 months 2. 4-6 years 3. 13 years old, - 2 doses - 3 months apart

Varicella Vaccine for Adults: 1. Persons ___ years or older without Hx of varicella, especially those who may be at high risk: _____ of young children, m______, women of ____ age, health care workers, family of _______ patients. 2. Dosing: - _____ doses given IM/SC/ID? how many weeks apart?

1. 13 or older - teachers - military - childbearing - immunocompromised 2: - two doses - given SC - 4-8 weeks apart

Meningococcal B Serotype Vaccine: 1. Trumenba: __ dose series 2. Bexsero: __ dose series - both are licensed by FDA for ages ___ - ____ yrs. ACIP recommends only for high-risk patients age __ or older: ____ deficiencies, a_____, m______, those exposed during outbreaks of disease.

1. 3 dose 2. 2 dose - 10-25yrs - 10 yrs - complement - asplenia - microbiologists

Vaccine Timing: 1. ___ day grace period for inactivated vaccines. 2. If you go too long between doses, do you need to re-start the series?

1. 4-day 2. no

Pneumococcal Vaccines & Elderly: 1. Everyone ___ yrs and older should receive _____ AND ____, however ____ is not needed if a dose was given before age of ___. 2. PCV13 and PPSV23 should or should not be administered on the same day? 3. PCV13 ---> wait how long? ----> PPSV23 4. PPSV23 ---> wait how long ---> PCV13 5. Revaccinate ONE time with PPSV23 if: - people 65 and older received initial dose when <__ years old due to medical indication AND >____ years ago. 6. What other situations should you wait at least 8 weeks before giving either of the pneumococcal vaccines? - _ _ _ leak, ______ implant, a_____ or i_____.

1. 65 - PPSV23 and PCV13 - PCV13 - 65 2. should NOT be same day 3. wait one year 4. wait one year 5. <65 years and > 5 years ago. 6: - CSF leak - cochlear implant - asplenia - immunocompromised

Hep B Vaccine: 1. Efficacy = ___ - ___% effective in preventing ______ with complete course. 2. Adverse Reactions: - _____ at injection site - f_____, h_____ - Temp > ______C (1%)

1. 80-100% - hepatitis 2: - pain - fatigue, HA - 37.7C

Hep A: Who to Immunize: 1. Children > ____ months old 2. _______ 3. People with chronic ____ disease 4. Men who______? 5. D_____ a_____ 6. Risk of ______ ______

1. >12 months 2. travelers (outside U.S.) 3. liver 4. have sex with men 5. Drug abusers 6. occupation exposure

Pregnancy and Vaccines: 1. Ideally, get fully immunized before/during pregnancy? 2. During Pregnancy: - I_____ (live or inactivated?) - T_____ - Defer ___ vaccines

1. BEFORE 2: - influenza (inactivated) - Tdap - live

IPV combo vaccines: 1. Pediarix = _ _ _ _ + IPV + Hep _ - approved for kids __ weeks to __ years - 3 doses at __, __, and __ months - not for ___ doses - should still administer birth dose of ___ __ 2. KINRIX = _ _ _ _ + IPV 3. Pentacel (_ _ _ _ + IPV + _ _ _)

1. DTaP + IPV + HepB - 6 weeks to 7 years - 2, 4, and 6 months - booster - Hep B 2. DTaP + IPV 3. DTaP + IPV + HIB

Inactivated Vaccines List: 1. D___, t____, p______ 2. H _ _ 3. Hep __ 4. Hep __ 5. H____ p_____ 6. Inactivated p______ 7. M_______ 8. P_________ 9. R_______ 10. Inactivated i______ 11. T_____ injection

1. Diptheria, tetanus, pertussis 2. HIB 3. Hep A 4. Hep B 5. Human papillomavirus 6. Inactivated poliovirus 7. Meningococcal 8. Pneumococcal 9. Rabies 10. Inactivated influenza 11. Typhoid injection

Live Attenuated Influenza Vaccine (LAIV4): 1. brand name? 2. Dose: - given in one or both nostrils? 3. Indicated only for healthy people ages ___ - ___ yrs. 4. Contraindications: - p______ - i_______ - ____ allergy - children ___ - ___ yrs old with a____ or w_____ - If pt has taken influenza antivirals within ____ hrs - People who care for severely ________ people 5. Precautions: - a____ in persons __ or older - other ____ diseases - ____ congestion

1. FluMist 2. 0.2mL - divided between both nostrils 3. 2-49 4: - pregnant - immunosuppressed - egg - 2-4 yrs with asthma or wheezing - 48 hrs - immunosuppressed 5: - asthma, 5 or older - chronic (pulmonary, CV, renal, hepatic, neuro, hematologic, metabolic, etc.) - NASAL congestion

Live Attenuated Vaccines List: 1. H_____ _____ 2. V_______ 3. Live attenuated ________ 4. M_____, M_____, ______ 5. Oral t________ capsules 6. R_________ 7. Y____ F_____

1. Herpes zoster 2. Varicella 3. Live attenuated influenza 4. Measles, mumps, rubella 5. Oral typhoid capsules 6. Rotavirus 7. Yellow Fever

MMR Vaccine: 1. Live or dead? 2. Adult Dosing: - ___ or ___ doses given IM? SC? - adults born before 19__ are considered immune - __ doses separated by no less than ___ weeks - Target population includes: health care workers, c____, c____ s____, t_______. If person does not fall into one of those groups, they need at least ___ dose(s).

1. Live 2. 1 or 2 given SC - 1957 - 2 doses, 4 weeks apart or more - children - college students - travelers - one

Random Influenza: 1. Flu season is generally ____ - ____ and peaks in ____ or ____. 2. It takes ___ weeks for the flu vaccine to work. 3. ACIP recommends all people ___ _____ and older should get an annual flu vaccine. 4. Some children __ months through their ____th year may need __ doses which should be administered at least __ weeks apart (see image). 5. Things that are NOT contraindications for the flu vaccine include: - ______ (except for live vaccine) - mild ____ or intolerance to ____ - ____ illness - I______ (except for live vaccine)

1. October to May - peaks January or February 2. 2 weeks 3. 6 months and older 4. 6-months through 8th year (<9 yrs) - 2 doses - 4 weeks apart 5: - pregnancy - allergy/intolerance to egg - mild illness - immunosuppressed

Rotavirus Vaccine: 1. Rota____: - Live or dead? - __ doses via ____ at __, __, __ months old 2. Rota___: - live or dead? - contains ____ in applicator - __ doses via ____ at __ and __ months old 3: *Pick one and stick with it*

1. RotaTeq - live - 3 doses, via mouth, 2, 4, 6 months old 2. Rotarix: - live - latex - 2 doses via mouth at 2 and 4 months old

Human Papillomavirus (HPV): 1. most common ____ in the U.S. 2. Transmission: - through _____ contact 3. Sx: - most people have ___ Sx 4. Complications: - ____ warts - _____ cancer - other cancers

1. STD 2. sexual 3. no Sx 4. genital, cervical

Herpes Zoster Vaccine: 1. Name? 2. more ____ than the varicella vaccine, but same formula. 3. Given to all adults ___ yrs and older via ____ dose(s) SC/IM/ID? 4. Adverse Reactions: - ____ at injection site - small ____ 5. contraindications: - anaphylactic reaction to _____, n_____ or other vaccine components - Primary or acquired _____ - active untreated _ _ - p________

1. Zostavax 2. potent 3. 65 yrs, SC 4. pain - rash 5. gelatin - neomycin - immunodeficiency - TB - pregnancy

Live vs. Inactivated cont'd: 1. Which group has more storage requirements? 2. Live vaccine doses should be separated by how long if not given on the same day? 3. Which group has longer duration of protection? - why? 4. Which groups has more adverse effects? 5. Which group has more contraindications/precautions?

1. live 2. 4 weeks 3. live - greater immune response 4. live 5. live

Varicella Vaccine: 1. live or dead? 2. Adverse Reactions: - ___ reactions - r____

1. live attenuated 2. - local - rash

Things to record/include on patient records regarding vaccinations? 1. patient's _______ 2. vaccination ____ 3. Name, address, and title of who? 4. ______, _____, _____ number and _ _ _ number of the vaccine. 5. Signed ______ forms. 6. Any ______ reactions to vaccine. - also report these to who?

1. name 2. date 3. the practitioner administering the vaccine 4. name (trade or generic), manufacturer, lot number, and NDC number 5. consent 6. adverse reactions - report to VAERS (Vaccine Adverse Event Reporting System).

Influenza FAQs and Myths: 1. "I always get sick after the flu shot." 2. Can you get the flu from the flu shot?

1. normal immune response. Remind pt that it takes 2 weeks to be active and that the shot does not guarantee immunity or 100% effectiveness.

Travel Immunizations: 1. Recommendations for travel are complex... much more than just vaccines. 2. Variety of diseases to consider: - t___ - y___ _____ - Japanese ____- - m_____ - p_______ 3. Refer to _ _ _'s Yellow Book

1.---- 2: - typhoid - yellow fever - encephalitis - malaria - parasites 3. CDC's

1. DTap vs Tdap: - DTaP has higher amounts of _ and _ (children < __ yrs) - Tdap has lower amounts to minimize ____ ____ in adults. 2. Two Tdap Vaccines: - B______: > __ yrs - A____: __ - __ yrs

1: - D and P (<7yrs) - adverse effects 2. Boostrix: >10yrs - Adacel: 11-64 yrs

Different Vaccine Combonations for Tetanus, diphtheria, and pertussis: 1. Tetanus and diphtheria only: - _ _ - _ _ (adult?) 2. Tetanus, diphtheria, and pertussis: - DTaP = diphtheria and tetanus toxoids absorbed, and _____ pertussis absorbed. - Tdap = tetanus toxoid, ______ diphtheria toxoid, and _____ pertussis absorbed.

1: - DT - Td 2: - acellular - reduced, acellular

Hepatitis A Vaccine: 1. Brand names: - H_____ and V_____ (the two are interchangeable). 2. Efficacy: - ____% seropositive after 2 doses. 3. Dosing: ___ IM doses with a minimum ___ month interval between. 4. Adverse Reactions: - ____ at injection site. 5. Contraindications: - previous ___ _____ - ____/____ acute illness

1: - Havrix and Vaqta 2: - 100% 3: 2 IM doses - 6 months 4: - pain 5: - allergic reaction - moderate/severe

Inactivated Influenza Vaccines (IIV): 1. Dosing: - 6 months to 3 yrs = __mL - 3 years and older = __mL 2. Contraindications: - severe _______ to any component of the vaccine, including ____ ____. 3. Precautions: - ___ to ___ illness with or without _____. - Hx of _____ - ____ syndrome within __ week of receipt of flu vaccine.

1: - 0.25mL - 0.5mL 2: - allergy - egg protein 3: - moderate to severe - fever - Guillain-Barre syndrome, 6 weeks

HPV Vaccines: 1. Indications: - recommended to vaccinate all boys and girls __ - __ years - goal to vaccinate __ through __ 2. Catch-up Vaccines: - recommended if patients didn't get vaccinated when younger - for males __ through __ - for females __ through __. - for men who do what? or have what? through age what? - HPV9 approved females 9-__, and males 9-___. ACIP says still offer to males through what age?

1: - 11-12 - 9-26 2: - 9-21 - 9-26 - men who have sex with men - those who have compromised immune systems - through age 26 - females 9-26 - males 9-15 - 26

Meningococcal ACYW Vaccine: 1. For Adolescents: - give one dose at age __ - __ years and a booster at age __. - If first dose given after age __, generally no booster needed. - not routinely recommended after age ___ unless high risk. 2. For persons high-risk (a___, _ _ _, military basic training, c____ s____, ____ workers, travelers to parts of ____/____): - give __ doses at least __ weeks apart (asplenia and HIV only) - Revaccinate every __ years if ongoing high risk

1: - 11-12 years old - 16 - 16 - 19 2. asplenia, HIV, college students, lab workers, Africa/Asia: - 2 doses, at leat 8 weeks apart - 5 years

HIB Vaccine: 1. Dosing: - given at __, __, __ months and __ - __ month booster. 2. Target patients: - infants and ___ ___ - people without _____ - ______ ____ disease - h____ disease - solid organ _____ - severe _______ - _ _ _ 3. Brands: - A____, H_____ - P_____ - Tri______ (only for booster) - Com____, Ped_____: if these are administered at __ and ___ months, a dose at 6 months is not required.

1: - 2, 4, 6, and 12-15 month booster 2: - young children - spleens - sickle cell - hodgkin's - transplant - immunosuppression - HIV 3: - ActHib, Hiberix - Pentacel - TriHIBIt - ComVax, PedVax

Inactivated Polio Vaccine: 1. Dosing: - __, __, __ - __ months, and booster at __ - ___ years. - can be given _ _ or _ _ - only given to adults doing what? 2. Adverse Reactions: - minimal with IPV 3. Contraindications: - allergy to n_____, s_____, p____.

1: - 2, 4, 6-18 months, booster at 4-6 years - IM or SC - traveling to polio endemic areas, or healthcare/lab workers. 2. ----- 3: - neomycin, streptomycin, polymixin

Pneumococcal Vaccines & Medical Conditions: Intervals between PPSV23 and PCV13. 1. 2-18 years old: - wait how long between either vaccine? 2. 19-64 years old: - PCV13 ----> wait how long? -----> PPSV23 - PPSV23 -----> wait how long? -----> PCV13 3. Revaccinate ONE time with PPSV23 if patient is ____ or older, are i____ or a_____, and it's been ___ years or more since they had one.

1: - 8 weeks 2: - 8 weeks - 1 year 3: - 65 or older, is immunocompromised or asplenic, and it's been 5 years or more since last PPSV23.

Tetanus, Diphtheria, and Pertussis: 1. Tetanus: - organism? - found in? - Basic mechanism of infection? - Sx - Transmission 2. Diphtheria: - organism? - complications from toxin: - epidemic in what country in 1990's? 3. Pertussis: - organism? - common disease caused by this organism? - Sx: - Complications: - Population at highest risk:

1: - Clostridium tetani - dust, soil, feces - toxin binds to nervous system and prevents mm. relaxation - lockjaw, mm. rigidity/spasm, - wounds, abrasions, piercings 2: - Cornyebacterium diptheriae - thick coating in throat, prevents breathing, myocarditis, neuritis, death - Russia 3: - Bordatella pertussis - Whooping Cough - minimal fever, severe cough with URI Sx, persistent cough, may last up to 6 weeks. - pneumonia, seizure, encephalopathy, hypoxia, death - infants

Hepatitis A: 1. Sx: - similar to _____ - children are usually ____, disease is better/worse in adults? - Sx include: j_______, f_____, n_____, v____, ____ urine 2. Transmission: - _____ - ______ (contaminated food/water) 3: Incubation period: - ___ - ___ days - Communicability = __ weeks prior to 1 week after symptom onset.

1: - Hep B - asymptomatic - worse in adults - jaundice, fever, nausea, vomiting, dark urine 2: - fecal-oral 3: - 15-20 - 2 weeks (same thing as 1 week prior to symptom onset?)

Influenza Vaccines: 1. Inactivated Influenza Vaccines (IIV): - Trivalent vaccine (IIV3): given via _ _, also has a ___ dose for pts >___ yrs old. - Quadrivalent vaccine (IIV4): given via _ _ OR _ _. - ____ - cultured inactivated influenza vaccine (ccIIV3): produced in cultured ___ cells instead of _____. - R______ inactivated influenza vaccine (RIV3): only in ages ____ and older 2. Live Attenuated Influenza Vaccine (LAIV4): - administration route? - Brand name? - Age group?

1: - IM - high dose, 65yrs and older - IM or ID - Cell-cultured: - animal cells instead of eggs - Recombinant: - 18 years and older 2: - intranasal mist - FluMist - 2-49 and healthy

HPV Vaccine: 1. Dosing: - 0.5mL IM? SC? at __, __ - __, and __ months. 2. Name: G___ (HPV__): - covers most common types. - approved for prevention of _____, ____, and ____ cancers in female patients, and ____ cancer and genital ____ in both male/female patients. 3. Name: C____ (HPV__): - covers female only 4. HPV__:

1: - IM at 0, 1-2, and 6 months old 2. Gardasil (HPV4) - cervical, vaginal, and vulvar - anal - genital warts 3: Cervaris: (HPV2) 4. HPV9

Pneumovax/Prevnar Routine Administrations: 1. Regular Schedule is as follows: - Children should receive _____ vaccine at _, _, _, and again between __ - __ months of age. - Adults age ___ and older should receive ____ (AND ____ if they have not received it before). 2. Acceptions to these routines: - just know general rules of thumb, don't memorize specific schedules for each medical condition.

1: - Prevnar (PCV13) at 2, 4, 6, and 12-15 months. - 65 and older, pneumovax (PPSV23) - Prevnar (PCV13) 2. New recommendations say that patients 2 years of age and older may require either Pneumovax and/or Prevnar if they have certain medical conditions (see image on this slide and next slide).

Pneumococcal Disease/Vaccines: 1. Pneumococcal disease includes: - S. _____ - S_____ - M______ - P_____ - O___ M_____ - seasonal? - Has _____ resistance 2. Pneumonia transmitted via ____ _____. Incubation period is __ - __ days until onset. Sx include abrupt onset of ____ and r_____, _____ chest pain, _____ cough with "_____" sputum, m____, _____cardia. - Pneumococcal disease has highest fatality rates in very ___ and very ___ ages, and with chronic __ - _____s. 3. There are two pneumococcal vaccines, both are live or inactivated? 4. Contraindications: - severe ____ ____ to prior pneumo vaccine - ___ to ___ acute illness 5. Adverse Effects: - local _____ (30-50%) - f____/m____ (<1%)

1: - Strep. pneumoniae - sepsis - meningitis - pneumonia - otitis media - no, it's a threat year-round - antibiotic resistance 2. - resp. droplets - 1-3 days - fever and rigors, - pleuritic chest pain - productive cough - rusty sputum - malaise - tachycardia - very old and very young - chronic co-morbidities 3. both are inactivated 4: - allergic reaction - moderate to severe 5: - local reactions - fever/myalgias

Hep B: 1. Contraindications: - previous _____ _____ - ______/______ acute illness - don't give a child less than 6 weeks old _____. Which is _____ + ______ combo vaccine. 2. Hep B Vaccine Types: - R_______ HB - E_____-B 3. In general, how many doses of the Hep B vaccine are there?

1: - allergic reaction - moderate/severe - Comvax = hepatitis + HIB vaccine combo 2: - Recombivax HB - Energix - B 3: - 3 doses (2 doses of Recombivax HB in 11-15 yr olds, and 4 doses of Energix-B in adults on dialysis).

Vaccination Screening Questions: 1. For ALL vaccines: - severe _____? - other ____? - Are you currently ____? What Sx doesn't count? - If the pt is moderate - severely ill, do you vaccinate? - any ___ diseases? 2. For LIVE vaccines: - is the patient _______ or ______?

1: - allergy - allergies - ill? Fever doesn't count. - NO - chronic 2: - immunosuppressed or pregnant.

Varicella Vaccine: 1. Contraindications: - severe _____ - p______ - I______ - ___/____ acute illness - recent ____ _____ administration 2. Storage: - VERY ______ - store ______, diluents at ___ _____ - discard if not used within _____ minutes of reconstitution

1: - allergy to vaccine - pregnancy - immunosuppressed - moderate/severe - blood products 2: - fragile - frozen - room temp - 30 minutes

Rubella: - Mild disease in children and young adults 1. Complications: - a_______ 2. Goal is to prevent congenital rubella syndrome which includes: - c____ - ___ defects - d_____ - r_____ - m______

1: - arthritis 2: - cataracts - heart defects - deafness - retardation - miscarriage

Rotavirus: 1. Tranmission: - ____ - ___ route 2. Sx: - leading cause of viral _____ - highly prevalent - severe _____, f____, _____. 3. Complications: - d____ 4. Contraindications: - Hx of ________ (part of intestine folds into another section)

1: - fecal - oral 2: - gastroenteritis - diarrhea, fever, vomiting 3: - dehydration 4: - intussusception

MMR: Measles 1. Transmission: - contagious? - transmitted via _____ 2. Sx: - c_______ - c_______ - r______ - fevers >____F 3. Complications: - p_____ - e_____ - death - d_____ - o___ m_____

1: - highly contagious - respiratory 2: - cough - conjunctivitis - rash - 101F or higher 3: - pneumonia - encephalitis - death - diarrhea - otitis media

1. Sx of Anaphylaxis: - Sudden OR gradual onset of generalized ____ - E____ - H_____ (urticaria) - A_____ - Severe _______ (w____) - S_____ of ____ - ______ cramping - S_____ - Cardiovascular _____ 2. Two recommendations to monitor/control allergic responses to vaccines: 3. 80% of fainting (vasovagal syncope) occurs within ____ minutes of administration.

1: - itching - erythema - hives - angioedema - severe bronchospam (wheezing) - SOB - abdominal cramping - shock - cardiovascular collapse 2: - have pts wait after being vaccinated to watch them. - Have a plan ready for action: training, protocols, supplies ready, etc. 3. 15 minutes

Hepatitis B: 1. Sx: - j_____ - ____ eyes - ____ urine 2. Complications: - h_______ - c______ - liver _____ - death 3. Transmission: - ______ transmitted - _____ natal - b______ 4. Incubation: - _____ - ___ days - ___% infected are asymptomatic - Infectious for __ - __ months before and after symptom onset

1: - jaundice - yellow eyes - dark urine 2: - hepatitis - cirrhosis - liver cancer - death 3: - sexually transmitted - perinatal - blood 4: - 45-160 days - 50% - 1-2 months

Polio: 1. Transmission: - virus enters via ____, replicates in ____, spread to via blood to ____/_ _ _, destroys ____ ____, paralysis. 2. Complications: - _____ that can lead to permanent _____ and death.

1: - mouth - gut, - lymph - motor neurons 2: - paralysis - disability

HPV: 1. Adverse Reactions: - injection site ____ - abnormal rates of _____. Suggestion to remain seated for __ minutes after administration. 2. Contraindications: - Immediate hypersensitivity to ____ or any vaccine component. - Only ___% finish all 3 doses!

1: - pain - syncope - 15 minutes 2. yeast - 30%

Shingles: 1. Complications: - ______ neuralgia - s______ - _____ infection - ______ abnormalities

1: - postherpatic - scarring - bacterial - ocular

Mumps: 1. Sx: - r_____ - h_____ - f_____ - m______ - P______ in 30% 2. Complications: - _ _ _ involvement - O____itis (swelling of testicles) - d_____ - d______

1: - rash - HA - fever - malaise - parotitis 2: - CNS - orchitis - deafness - death

HIB: 1. Transmission: - person to person via ___ ____ like by coughing and _____. - usually spread by people who have the bacteria in their ___ and ___ but are ______. 2. Complications: - m_____ - *e_______ - ____ arthritis - c_______ - p_______

1: - respiratory droplets - sneezing - noses and throats - asymptomatic 2: - meningitis - *epiglotitis* - septic - cellulitis - pneumonia

Meningococcal Disease: 1. Neisseria meningitides: - transmitted via __ ____. Many people carry it in their _____. - Sx of Meningitis: p_____, h_____, neck _____ - Sx of Bacteremia: s____ and rash

1: - respiratory droplets - throats - pain, HA, neck stiffness - sepsis and rash

Varicella: 1. Transmission: - ______ ______ or contact with _____ - contagious? 2. Complications: - secondary ____ ____ - E_________ - P_______ - Zoster: associated with _____ and ______ 3. Incubation and Sx: - ___ - ___ days from exposure - Prodrome of f____/m_____ for 1-2 days - Pruritic vessels first on _____, concentrated on ____ - Malaise, pruritis for __ - ___ days - communicable __ - __ days prior to onset through crusting of vesicles.

1: - respiratory droplets or contact with lesions - very contagious 2: - bacterial infection - encephalitis - pneumonia - aging and immunosuppression 3: - 14-16 days - fever/malaise - head, trunk - 2-3 days - 1-2 days

Hep B Vaccine Regimen: 1. Kids: - all infants should get 1st dose when? - Three doses at __, __, and __ months. - Must be at least ___ weeks between dose 1 and 2, and at least __ weeks between dose 2 and 3. - If delayed, do you start over? 2. Adolescents: - if not previously vaccinated __ years old or older 3. High-Risk Adults: - multiple ____ partners, patients seeking Tx for ____, patients with ___ infection, patients on ______, patients with _____ ____ disease, _____ _____ providers, unvaccinated adults with _____ _____ who are aged 19-59 years old.

1: - soon after birth, before they are discharged from hospital - 0, 1, and 6 months - 4 weeks - 8 weeks - no 2: - 11 or older 3: - sex - STD's - HIV - dialysis - chronic liver disease - health care providers - DM

HIB: 1. Adverse Reactions: - s____, r_____, or ____ at injection site - f_____ - i______ 2. Contraindications: - previous ____ ____ to vaccine - children with ____/____ acute illness

1: - swelling, redness, pain - fever - irritability 2: - allergic reaction - moderate/severe

Meningococcal ACYW Vaccine: 1. Menactra: ___ months old to ___ years old 2. Menveo: __ years old to ___ years old

1: 9 months - 55 yrs 2: 2 -55 yrs

Routines for T/D/P: 1. Ages 6 weeks to 6 years: use _______ for primary series. - _, _, _ months, __ - __ month booster, __ - __ year booster - Use _ _ only if patient cannot tolerate pertussis in DTaP - Fully Vaccinated = __ doses of DTaP or __ doses of DTaP if the fourth dose was administered on or after the ______ birthday. 2. 7-11yrs old: Single boost of _____ (if didn't complete _____ series) 3. 11+ yrs old: if no record of Tdap yet, give _____ once, then a booster of ___ every __ years.

1: DTap - 2, 4, 6, months, 12-18 months, 4-6 yr booster - DT - 5 doses, or 4 doses if on/after 4th birthday 2. Tdap, pertussis 3: - Tdap once, then Td every 10 years

Twinrix: 1. what is it? 2. Indicated for what age group/range? 3. ___ doses over ___ months. - new accelerated schedule requires ___ doses total.

1: combination of HepA/HepB vaccines 2. 18 and older 3. 3 doses over 6 months (0, 1, and 6 months) - 4 doses