Vaccines - Adv Pharm 1
What is the yellow fever vaccine?
Yellow Fever Endemic in Sub-Saharan Africa and tropical South America Certification required to enter some countries Vaccinate all persons over 9 months of age traveling to endemic areas Use cautiously in patients over age 60 yrs
What is yellow fever?
Yellow fever is a viral illness spread by some species of mosquitoes in Central and South America and in tropical regions of Africa. Yellow fever is endemic in sub-Saharan Africa and tropical South America (Brunette et al, 2010). The CDC estimates the risk of an unvaccinated traveler contracting yellow fever during a 2-week visit to West Africa as 10 cases per 100,000 and 1 case per 100,000 travelers to South America (Brunette et al, 2010). All travelers should use personal protective measures to avoid mosquito bites to prevent yellow fever transmission. Vaccination is recommended for travel to endemic areas. Certification of yellow fever vaccine may be required for all persons aged 9 months or older to enter certain countries in endemic areas. Current recommendations are listed at the CDC Travel Web site: Yellow Book, Chapter 2: Pre-Travel Consultation.
What is the INACTIVATED flu vaccine?
3 strains of influenza, 2 type A and 1 type B Strains change annually based on predicted circulating strains Contraindications: anaphylaxis to eggs or influenza vaccine, Guillain-Barré syndrome w/in 6 wks of influenza vaccine, febrile illness ADRs: local reaction, mild systemic effects Drug interactions: immunosuppressants, theophylline, phenytion, warfarin Dosing: annual vaccine to all persons 6 months or older Patients younger than 9 yrs get 2 doses the first year High dose flu vaccine for age > 65 years ***Influenza vaccine (Agriflu, Fluogen, FluShield, Fluzone) is multivalent vaccine that contains three different viral subtypes. Each year, the World Health Organization recommends to the FDA's Vaccines and Related Biologic Products Advisory Committee what strains will be included in the following year's vaccine.
What is Antibody opsonization?
Antibody opsonization is the process by which a pathogen is marked for ingestion and eliminated by a phagocyte. Opson in ancient Greece referred to the delicious side-dish of any meal, versus the sitos, or the staple of the meal.
What is the BCG vaccine?
Bacillus Calmette-Guérin Vaccine --> Immune stimulant Most effective in children ADRs: disseminated disease in TB + patients Skin lesions at injection site is normal reaction May cause false positive PPD skin test
What is the Human Papillomavirus Vaccine?
Bivalent HPV (Cervarix) vaccine for females (types 16,18) Quadrivalent HPV (Gardisil) vaccine for females and males (types 6,11,16,18) Contraindications: allergic reaction ADRs: syncope, injection site pain and redness Dosing: 3 doses at 0, 2 and 6 months Gardasil females and males age 9 to 26 yrs Cervarix females age 10 to 25 yrs Both are started at the 11 to 12 yr visit
What is the recommended immunizations schedule? (Summarized)
CDC Advisory Committee on Immunization Practice (ACIP) sets recommended vaccine schedule Children 0-6 years Children 7-18 years Adult schedule Catch-up schedule Guidelines for vaccinating pregnant women
What is the Diphtheria, Tetanus, and acellular Pertussis Vaccine? (TDAP)
DTaP or Tdap or Td Contraindications: anaphylactic reaction, progressive neurologic disease, high temp or seizure after previous DTaP dose (not Tdap) Use DT before age 7 yrs and Tdap after ADRs: pain at injection site, low grade fever, aches, headache Give antipyretics to children with hx of febrile seizures Dosing: DTaP 2m, 4m. 6m. 15-18m and 4 to 6 yrs Tdap age 11 to 12 yrs Adults should receive Tdap or Td every 10 years
What are the inactivated vaccines?
Diphtheria, Tetanus, and Pertussis Vaccine Haemophilus B Conjugate Vaccine Inactivated Poliovirus Vaccine Hepatitis B Virus Vaccine Hepatitis A Virus Vaccine Human Papillomavirus Vaccine Influenza Vaccine Pneumococcal Vaccine Meningococcal Polysaccharide Vaccine Lyme Disease Vaccine Typhoid Vaccine Cholera Vaccine Japanese Encephalitis Virus Vaccine Plague Vaccine Rabies Vaccine
Who is the HPV vaccine used for?
Dosing of the HPV vaccines vary with drug and gender of the patient. HPV4 (Gardasil) is approved for use in girls and women age 9 to 26 years of age to prevent cervical, vulvar, and vaginal cancer caused by HPV types 16 and 18 and genital warts (condyloma acuminata) caused by HPV types 6 and 11. HPV4 is recommended for all girls starting at age 11 to 12 years, but may be started as young as age 9 years. The dosing schedule is three doses of 0.5 mL given IM at 0, 2, and 6 months. HPV4 (Gardasil) is approved for the prevention of genital warts caused by HPV types 6 and 11 in males. The HPV4 vaccine may be given to males ages 9 to 26 years to prevent genital warts (CDC, 2010b). The dosing schedule for HPV4 in males is 0.5 mL given IM at 0, 2, and 6 months.
What is the hepatitis A vaccine?
HAV provides 100% protection with 2 doses HAVrix (0.5 mL for children/adolescents, 1.0 mL for adults) VAQTA (0.5 mL for children/adolescents, 1.0 mL for adults) Twinrix (HAV & HBV) adults only Contraindications: severe reaction to HAV, moderate illness, younger than 12 months ADRs: soreness at injection site Dosing: 2 doses 6 months apart All children at 12 months, dose 2 at 18 to 24 months Travelers to countries with high Hep A rates
What is the inactivated polio virus?
IPV, IPV/DTaP (Pediarix), DTaP/HIB/IPV (Pentacel) Contraindications: allergy to neomycin, streptomycin or polymyxin B Drug interaction: immunosuppressants Dosing: 2m, 4m, 6-18m, 4 to 6 yrs ******IPV is a parenteral noninfectious suspension of three types of inactivated poliovirus. The IPV available in the United States since the late 1980s is of enhanced potency and is highly immunogenic. IPV inhibits pharyngeal acquisition of poliovirus and, to a lesser extent, provides gut immunity. IPV is available in combination with diphtheria, tetanus, pertussis, and hepatitis B (Pediarix) or in combination with DTaP and HIB (Pentacel).
Why is the BCG vaccine given?
Immunization with bacillus Calmette-Guérin (BCG)vaccine lowers the risk of serious complications of primary TB in children. It is not widely used in the United States, but is given to infants and young children in countries where TB is endemic. BCG is an immune stimulant used to produce immunity against TB. Vaccination with BCG stimulates natural infection with Mycobacterium tuberculosis and results in a cell-mediated immune reaction and immunity against TB. Vaccination with BCG causes variable degrees of protection against TB. The protective effect of BCG use in children against military and meningeal TB is about 80 percent. It is less effective in adults.
What is the Japanese Encephalitis Virus Vaccine?
Inactivated Vero cell culture-derived vaccine (IXIARO) Contraindications: pregnancy, children, thimerosal allergy ADRs: local and systemic reactions, urticaria and angioedema of the face, lips, and oropharynx can occur Drug interactions: none Dosing: persons in endemic or epidemic areas, travelers spending > 1 month in rural endemic areas
What are the Inactivated Vaccines General Principles to be considered?
Inactivated vaccines: "killed" virus May be co-administered with other vaccines No need to restart series if patient gets off schedule (use Catch Up schedule)
What is Japanese encephalitis?
Japanese encephalitis (JE) is the most common form of viral encephalitis in Asia and is spread by mosquitoes. An estimated 35,000 to 50,000 cases occur annually. JE is usually severe, resulting in death in 20 to 30 percent of cases, miscarriage in pregnant women, and serious neurological outcomes in 30 to 50 percent of infected patients. The ACIP recommends that JE-VAX be administered to those who plan on residing in areas in which JE is endemic or epidemic. The probability of JE viral infection and illness increases with the duration of the stay in rural endemic areas. Current information on locations of JE virus transmission can be obtained from the CDC Yellow Book or Travel website.
What is important to know about the Live Attenuated Influenza Vaccine?
LAIV (Flumist) Contains 2 strains of influenza A and 1 strain of influenza B Administered intranasally Live vaccine replicates in nasal mucosa Contraindicated: Egg allergy, asthma, immunocompromised, pregnancy Administer to healthy patients age 2 yrs to 49 yrs annually Children age 2 to 8 years need 2 doses 1st year
Which vaccines are considered live (attenuated)?
Live Attenuated Influenza Vaccine ----> Measles, Mumps, and Rubella Vaccine Oral Poliovirus Vaccine Rotavirus Vaccine Varicella Virus Vaccine Herpes Zoster Vaccine Typhoid Yellow Fever Vaccine Bacillus Calmette-Guérin Vaccine
What is important to know about the MMR vaccine?
Measles, Mumps & Rubella 2 doses 99% effective in providing immunity Contraindications: neomycin allergy, pregnancy, immunosuppression, febrile illness Ok to give with egg allergy May give to breastfeeding women ADRs: fever 7 to 12 days after vaccination Drug interactions: Immune globulin, high dose corticosteroids, chemo Administer first dose at age 12 to 15 months 2nd dose at age 4 to 6 years, or at least 4 weeks after the first dose
What is the MMRV vaccine?
Measles, Mumps, Rubella and Varicella (ProQuad) Similar to MMR Contraindications the same as MMR Use caution in patients with a history of cerebral injury, seizures or where physiologic stress due to fever should be avoided ADRs: Fever > 102o (21.5% vs 14.9% with MMR), increased risk of febrile seizures Administer on same schedule as MMR Informed consent includes risk of fever and febrile seizures ***Similar to MMR, the MMRV (ProQuad) vaccine is a live, attenuated virus vaccine that produces a subclinical infection, creating active immunity to measles, mumps, rubella, and varicella viruses.
What is the Meningococcal Vaccine?
Meningococcal polysaccharide vaccine (MPSV) groups A, C, Y and W-135 (Menomune A/C/Y/W-135) is used to prevent meningococcemia and meningitis caused by Neisseria meningitidis serogroups A, C, Y, and W-135. MCV4 (Menactra, Menveo) is a tetravalent meningococcal conjugate vaccine that also provides protection against serogroups A, C, Y, and W-135. Contraindications: febrile illness, see age guidelines for each ADRs: local reaction Drug interactions: none Dosing: MCV4 at age 11 to 12 yrs with booster at age 16 yrs MCV4 functional asplenia, travelers to high risk areas, lab workers MCV4 unvaccinated college freshmen or military recruits MPSV Adults over age 55 years
What are the general principles to receive a live vaccine?
Not administered to immunocompromised patients Usually not given if patient has febrile illness If patient needs two live vaccines: Give both the same day OR Administer at least 4 weeks apart Not administered in pregnancy Pregnancy should be avoided for 1 month after vaccination Drug interaction Antiviral drugs
What is the oral polio vaccine?
Not used in the US since 2000 Effective, easy to administer Virus lives in GI tract for 4 to 6 weeks after administration Rare risk of VAPP Patient and household contacts Still used throughout the world ****Although oral polio vaccine (OPV) is no longer used in the United States, it is still used in other countries because of administration ease and low cost.
What is the oral typhoid vaccine?
Oral Typhoid vaccine ---> Travelers to S or SE Asia, Africa, Caribbean, Central and South America Oral capsule for age 6 yrs and up Revaccinate every 5 years
Explain the reactions of the PPD vaccine and how it is read
PPD is administered intradermally to asymptomatic individuals. Once a person has become sensitized to mycobacterial antigens, a hypersensitivity reaction occurs to the administration of the intradermal PPD. In sensitive people, the reaction includes induration and erythema at the site of administration. A positive reaction to PPD indicates that the person at some time has had a TB infection. A positive test does not indicate an active infection but rather that further testing is indicated.
What is the Hepatitis B Virus Vaccine?
Stimulates antihepatitis B surface antigen antibodies Alone or in combination (Pediarix, Twinrix, Combax) Contraindications: yeast allergy, moderate or severe illness, immunosuppression (give larger doses) ADRs: local reaction, 15% experience systemic complaints of fever, malaise Dosing: all ages, 3 doses over 6 months 4 wks between dose 1 and 2, 2 months between dose 2 and 3, and 4 mo between dose 1 and 3
Who is at risk for hepatitis A infection?
People at increased risk for hepatitis A infection who should be routinely vaccinated include the following: People more than 1 year old who are traveling or working in countries that have high or intermediate endemic infection. All of South America, Africa, Greenland, and Asia have a high incidence of hepatitis A infection. Russia and Eastern Europe are areas of intermediate prevalence. IG is recommended for children under age 1 who are traveling to these areas. Men who have sex with men. Illegal drug users. People who have an occupational risk for infection, including those who work with hepatitis A-infected primates or with hepatitis A in a research laboratory setting. People with clotting factor disorders. People with chronic liver disease.
What is important to know about the Pneumococcal Polysaccharide Vaccine?
Polyvalent pneumococcal polysaccharide vaccine (PPV) contains 23 highly purified capsular polysaccharides from Streptococcus pneumoniae Contraindications: moderate to severe febrile illness, give 10 to 14 days before splenectomy, organ transplant, or chemotherapy. No PPV in children < 2 years ADRs: local reaction, mild systemic effects Drug interactions: immunosuppressants (give 10 to 14 days before) PPV Dosing: All adults over age 65 years Persons 2 yrs to 65 yrs with chronic cardiac or pulmonary disease, chronic liver disease or alcoholism, DM, CSF leaks Persons 2 yrs to 65 yrs with asplenia Immunocompromised persons Smokers age 19 yrs to 65 yrs Asthma patients age 19 to 65 yrs 12 to 24 months after bone marrow transplant PPV is given to children 2 months after last PCV dose
What is the Haemophilus B Conjugate Vaccine?
Protects against invasive H. flu Contraindications: allergy to components of vaccine, moderate to severe illness, only given to children younger than 6 yrs ADRs: injection site pain and redness Dosing: depends on vaccine used ActHib or Pentacel 2m, 4m, 6m, 12-15m (booster dose). PedvaxHIB or Comvax 2m, 4m, 12-15m (booster dose). If first dose given after age 15 months, then child only needs one dose
What is the rabies vaccine?
Rabies vaccine (Imovax, RabAvert) inactivated rabies virus Contraindications: Moderate to severe illness ADRs: mild local and systemic reactions, serum sickness may occur (6%) Drug interactions: chloroquine (Aralen), immunosuppressants, rabies IG Dosing: Pre-exposure vaccine day 0, day 7, and either day 21 or day 28, booster q 2 yrs Post-exposure prophylaxis days 0, 3, 7, and 14, with RIG given on day 0 ***Rabies vaccine can be given for primary or pre-exposure vaccination or as part of post-exposure prophylaxis. Pre-exposure vaccination is recommended to high-risk groups, such as veterinarians, animal handlers, and certain laboratory workers. Post-exposure prophylaxis is recommended if the patient has a bite from a rabid animal that penetrates the skin. Post-exposure vaccine administration should always be accompanied by the use of RIG.
What is the rotavirus vaccine?
RotaTeq and Rotarix Orally administered and replicates in small intestine Contraindicated: immunocompromised, febrile illness ADRs: mild GI, no risk of intussusception in new vaccines Administer to infants with first dose by age 14 weeks 6 days and last dose by 8 months Rotarix (RV1): give at age 2m, 4m. RotaTeq (RV5): give at age 2m, 4m, 6m.
What is rotavirus?
Rotavirus is the leading cause of gastroenteritis in infants and young children worldwide. Almost every child in the United States will become infected with rotavirus by age 5 years, causing 400,000 doctor visits, and 55,000 to 70,000 hospital admissions (CDC,2006b). RotaTeq is is a live oral vaccine that contains five strains of rotavirus (G1, G2,G3, or G4, P7). Rotarix is indicated for the prevention of rotavirus gastroenteritis caused by G1,G3,G4,and G9. Both vaccines are live vaccines that replicate in the small intestine and induce active immunity against rotavirus.
What is the herpes zoster vaccine?
Shingles caused by reactivation of varicella Zoster vaccine (Zostavax) Reduces risk of developing herpes zoster 51.3% Reduces risk of post-herpetic neuralgia by 66.5% (reduced severity in 57%) Contraindications: neomycin or gelatin allergy, immunocompromised, pregnancy, acute illness, age younger than 60 years Drug interactions: high-dose steroids, antivirals Administer one dose for all patients age 60 yrs or older
What are shingles?
Shingles is a localized and painful cutaneous eruption caused by the reactivation of varicella zoster virus, the same virus that causes chickenpox in children. The varicella virus becomes latent in the neuronal cell bodies and becomes reactivated to cause shingles. The triggers for re-activation are not well understood, but it is known that cell-mediated immunity may prevent reactivation. The lifetime incidence of shingles is 1 in 3 and it affects approximately 1 million patients in the United States annually (CDC, 2008).
What patients are at risk at should receive the meningococcal vaccine?
The ACIP (CDC, 2005c) recommends routine vaccination of young adolescents (defined as aged 11 to 12 years) with MCV4 at the preadolescent health care visit or on entering high school (age 15). The ACIP also recommends that the following high-risk groups receive meningococcal vaccine: Patients with deficiencies in late complement components (C3, C5, to C9). Persons with functional or actual asplenia. Research, industrial, and clinical laboratory personnel who routinely are exposed to N. meningitides in solution that may be aerosolized. Travelers to, and residents of, hyper-endemic areas such as sub-Saharan Africa. Epidemics have occurred recently in Saudi Arabia, Kenya, Tanzania, Burundi, and Mongolia. College freshmen living in dorms. Military recruits.
Why do we mass vaccinate?
The immunization schedules may change, but the underlying premise of preventing the spread of infectious disease through mass immunization of susceptible populations does not change. The success of mass vaccination is measured not only in decreased numbers of vaccine-preventable illnesses but also in the resurgence of diseases such as polio and measles when programs are halted.
What is the PPD vaccine?
Tuberculin PPD is used to screen asymptomatic individuals for infection with M. tuberculosis Contraindications: tuberculin-positive reactors, immunodeficiency ADRs: In highly sensitive people, vesiculation, ulceration, and necrosis can occur at the administration site Drug interaction: live virus vaccines, BCG and immunosuppressants Dosing: The test consists of injecting 5 TU of PPD intradermally Reactions are read in 48 to 72 hours Positive reading based on risk category
What is typhoid fever?
Typhoid vaccines are used to increase resistance to enteric fever caused by Salmonella typhi. Typhoid fever is spread by ingesting water contaminated by feces from infected persons. Worldwide, an estimated 22 million cases of typhoid fever occur annually (Brunette, Kozarsky, Magill, & Shtim, 2010). The risk is greatest in travelers to South Asia, although the disease can be seen in East and Southeast Asia, Africa, the Caribbean, and Central and South America (Brunette et al, 2010).
Who is the hepatitis B vaccine recommended for?
Vaccination with HBV is recommended for all ages, particularly patients at high risk of contracting hepatitis B. Those at high risk include IV drug users, infants born to mothers who are Hbs Ag-positive, hemodialysis patients, sexually active people with multiple partners, incarcerated people, international travelers, household contacts of hepatitis B carriers, and sexual contacts of hepatitis B carriers. Patients who are getting tattoos or who share razors, toothbrushes, or body-piercing jewelry are also at risk of contracting hepatitis B. Health-care workers, day-care staff, and other people who may have exposure to body fluids also have a greater risk of contracting hepatitis B.
What are the different types of vaccines?
Vaccines are divided into two different types: those that are made from attenuated ("modified-live") or inactivated ("killed") infective agents.
What is the varicella vaccine?
Varicella virus vaccine (Varivax) 2 doses 98.3% effective against any disease May be administered post-exposure (w/in 3 days) Contraindications: neomycin allergy, febrile illness, immunocompromised, high-dose steroids, pregnancy ADRs: fever, rash, injection site reaction Administer first dose at age 12 to 15 months 2nd dose at age 4 to 6 years Adolescents and adults with no hx of varicella are given 2 doses 4 to 8 weeks apart