Immunizations

Which of the following could interfere with the effectiveness of a dose of Varivax? (Select ALL that apply.)

A. Acyclovir C. Valtrex D. MMR given 2 weeks prior to Varivax Systemic antivirals with activity against the herpes virus can inactivate the vaccine strain and should not be used within 24 hours before or 14 days after giving the vaccine. Famciclovir (Famvir) would be problematic as well. If not administered simultaneously, live vaccines should be separated by 28 days (4 weeks) to avoid antibody interference. Denavir (penciclovir) is a topical medication and for this reason, is unlikely to interfere.

A 67-year-old patient at your pharmacy has diabetes and heart disease. Which of the following vaccines is the patient eligible to receive today?

A. Prevnar 20 One dose of Prevnar 20 (or Vaxneuvance in series with Pneumovax 23) is recommended for all patients ≥ 65 years of age.

Which of the following statements concerning intramuscular injection is correct?

B. The injection site is above the level of the armpit and below the acromion process. Administration of vaccines at the proper anatomical site via approved routes is important to vaccine efficacy. Subcutaneous injections are given using a 5/8-inch needle, whereas intramuscular injections are given using a 1-inch needle in most adults. A 5/8-inch needle is used in IM injections if the patient is less than 130 pounds.

A 64-year-old female is in the pharmacy on September 10 to pick up her meloxicam prescription. The pharmacist notices that she is congested, with sneezing and she mentions a sore throat. Upon questioning, she states that she has not received her influenza vaccine yet this season. Which of the following is correct?

C. She can receive the influenza vaccine today since mild acute illness is not a contraindication. Vaccination should be deferred if the patient has a moderate or severe illness but can be administered to patients with mild acute illness (e.g., slight fever, mild diarrhea). If a patient is well enough to walk into the pharmacy, they are likely a candidate for vaccination. The CDC recommends giving the influenza vaccine as soon as it is available rather than deferring it until later in the season.

PR is a 45-year-old male who presents to the pharmacy on November 3rd to pick up a prescription. He has a history of asthma, hypertension, anxiety and intermittent depressive episodes. He was involved in a motor vehicle accident the previous summer, which resulted in a punctured lung, two fractured ribs and a lacerated spleen with subsequent splenectomy. He reports that he has not received any vaccines since he was an infant. Which of the following best represents the list of vaccines that are indicated for PR today?

E. Prevnar 20, Menveo, Hiberix, and Fluzone Due to PR's asplenia, he needs to receive H. influenza type b (Hiberix), meningococcal (Menveo) and pneumococcal (Prevnar 20) vaccines. Annual influenza vaccines are recommended for everyone six months and older during influenza season. Fluad and Fluzone High-Dose are indicated for use in patients ≥ 65 years old.

A pharmacist is working in a hospital that requires hepatitis B vaccination. She received the first dose of a 3-dose series. She did not return for the second dose, which was due one month later. It is now four months after the first dose. Select the correct recommendation:

E. She should get the second dose now and return for the third dose at the proper time. Increasing the interval between doses of vaccine given in a series does not diminish the effectiveness of the vaccine after completion of the series, but it may delay complete protection.

HS is a healthy 67-year-old female who presents to her PCP in October. Which vaccine should the pharmacist recommend for HS today?

E. Shingrix The high-dose influenza vaccine (e.g., Fluzone High Dose) produces a more robust immune response than FluMist and may better protect against influenza in adults ≥ 65 years of age. Prevnar 13 is no longer part of a recommended pneumococcal vaccine series in otherwise healthy adults 65 years and older.

Significant adverse reactions that occur after administration of a vaccine should be reported to the following:

E. VAERS Adverse reactions to vaccinations should be reported to the patient's primary care provider and the FDA's Vaccine and Adverse Event Reporting System (VAERS).

Choose the correct statements regarding SC administration of vaccines. (Select ALL that apply.)

A. Varivax, yellow fever and MMR are administered subcutaneously B. SC injections are administered into the fatty tissue over the triceps. D. SC injections are administered at a 45-degree angle. E. SC injections are administered using a needle that is 5/8 inch long. The upper outer arm (the fatty tissue over the triceps) is the preferred site for a SC vaccine injection in adults. SC injections should be administered at a 45-degree angle with a 5/8 inch needle. The shorter needle and angle of administration prevent accidental injection into the muscle.

What is the correct route of administration for Rotarix?

C. Oral Rotarix (RV1) is a live attenuated vaccine used for the prevention of rotavirus gastroenteritis that is administered orally to infants.

The Shingrix vaccine is recommended for which of the following patients?

B. A 52-year-old adult with hypertension The recombinant zoster vaccine (Shingrix) is indicated in patients age ≥ 50 years and patients age 19 years or older who are/will be immunodeficient or immunosuppressed.

Which of the following vaccines can be given in the time interval as stated below?

C. Varivax and Flumist separated by 28 days Live vaccines should be administered on the same day or separated by at least 28 days (4 weeks). There is not a minimum time interval required between an inactivated and a live vaccine.

Which of the following vaccine names is NOT correctly matched?

E. Engerix-B= Haemophilus influenzae type B (HiB) vaccine Engerix-B is a hepatitis B vaccine.

A 20-year-old female has no evidence of immunity to varicella and is being vaccinated to prevent chickenpox. Which screening question must be asked before administering Varivax?

E. Have you ever had a severe reaction to gelatin? Varivax vaccines should not be administered to anyone with a true allergy to neomycin or gelatin (components of the vaccine). Varivax is a live vaccine and cannot be administered to severely immunocompromised patients. The steroid dose indicated here is not high enough to cause immunosuppression.

What does the "a" in DTaP stand for?

A. Acellular The "a" in DTaP and Tdap stands for acellular, meaning that the pertussis component contains only a part of the pertussis organism. Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) in the vaccine. Lower-case "d" and "p" denote reduced doses of diphtheria and pertussis used in the adolescent/adult formulations.

A community pharmacist who runs a vaccination clinic wants to review current vaccine administration recommendations. What source is best to obtain the current vaccine recommendations and other essential immunization information?

A. Centers for Disease Control and Prevention (CDC) website The vaccine recommendations are developed by the Advisory Committee on Immunization Practices (ACIP) and published in the Morbidity and Mortality Weekly Report (MMWR). All of this information, including the full vaccination schedules, is available on the CDC website.

Which of the following is not correct regarding vaccine storage?

A. Cholera vaccine must be stored in the refrigerator. The oral cholera vaccine (Vaxchora) must be stored in the freezer prior to reconstitution with water.

Which tetanus-containing vaccine requires five doses to be given as a part of the routine childhood vaccine series?

A. DTaP Children should get five doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. DT does not contain pertussis and is used only as a substitute for DTaP in children who cannot tolerate pertussis vaccine.

One dose of Prevnar 20 is recommended before age 65 years in patients with which of the following medical conditions? (Select ALL that apply)

A. Diabetes B. Asthma C. Smokes cigarettes D. Heart failure These patients should receive one dose of PCV20 before age 65. Patients with these conditions are immunocompetent but have a higher risk of pneumococcal disease.

Which of the following vaccines contain hepatitis B only? (Select ALL that apply.)

A. Engerix-B E. Recombivax HB Engerix-B and Recombivax HB contain only hepatitis B.

A pharmacy administering vaccines must be prepared to administer the following medication in the event of an anaphylactic reaction:

A. Epinephrine All pharmacies administering vaccines must have emergency protocols in place for treating anaphylaxis. For severe symptoms, the emergency medical system (EMS) should be called and care provided until they arrive, including administration of epinephrine to open the patient's airways. Diphenhydramine can be given to reduce swelling and pruritus. Steroids may be administered after arrival in the emergency department.

Patients aged 19-64 years can receive Vaxneuvance followed by Pneumovax 23 at least eight weeks later if they have which of the following conditions? (Select ALL that apply)

A. HIV infection B. Chronic renal failure on hemodialysis C. Solid organ transplant E. Multiple myeloma treated with chemotherapy Vaxneuvance (PCV15), followed by one dose of Pneumovax 23 (PPSV23) at least eight weeks later, is indicated for immunocompromised patients.

During a routine well-visit, a pediatrician recommends the HPV vaccine for a 13-year-old female. The mother is not sure if this vaccine is appropriate for her daughter. Which of the following statements should be included in the patient education? (Select ALL that apply.)

A. It prevents cervical, vaginal and oropharyngeal cancers, as well as genital warts. B. If the patient receives the vaccine today, only two doses are required. The HPV vaccine (Gardasil 9) is indicated in both males and females. The recommended age for administration is 11-12 years but can be given as early as 9 years. If started before age 15, only two (not three) doses are required.

KP is a 45-year-old man presenting to the clinic for a routine checkup with vaccination. His height is 5 feet 11 inches and his weight today is 88 kg. Which of the following statements is correct about vaccine administration?

A. Pneumovax 23 can be given subcutaneously at a 45-degree angle into the fatty tissue over the triceps using a 5/8-inch needle. Pneumovax 23 can be administered either SC or IM. For vaccines given SC, administration should occur at a 45-degree angle into the fatty tissue over the triceps using a 5/8-inch needle. Most vaccines, including Fluzone, Shingrix and Boostrix, are administered IM. IM administration should occur at a 90-degree angle into the deltoid muscle with a 1-inch needle (if weight is < 260 pounds for males).

A child with sickle cell disease has not been vaccinated for meningococcal disease. Which of the following is true regarding meningococcal disease/vaccine? (Select ALL that apply.)

A. Quadrivalent meningococcal vaccines include Menactra and Menveo B. The damage to the spleen caused by sickle cell disease puts this patient at risk for meningococcal disease. C. This patient should receive the MenB vaccine one he turns 10 years old D. High-risk populations can be vaccinated starting at 2 months of age. Patients with sickle cell disease are considered functionally asplenic (their spleen does not function), and both the quadrivalent (ACWY) and serogroup B vaccines are recommended.

LM, a 29-year-old female, is starting her first job as a hospital pharmacist in September. She completed the hepatitis B vaccine series during pharmacy school but states that she did not receive most childhood vaccines and cannot recall any other vaccinations during adulthood. What vaccines should LM receive today? (Select ALL that apply.)

A. Seasonal influenza vaccine B. Tdap C. Varivax Healthcare professionals should receive the varicella vaccine if there is no history of vaccination or chickenpox infection. Tdap should be administered at least once, if not up-to-date, with a booster of Td or Tdap every 10 years. Hepatitis B and MMR should be administered if there is no evidence of vaccination or blood test showing immunity. Annual influenza vaccine is usually required for all healthcare professionals.

A 62-year-old female patient came into the pharmacy to get an influenza shot. It was her first time receiving the annual vaccine. Three days later, she came back complaining of a hacking cough, mild weakness, stuffy nose and a sore throat. She is afebrile and reports no muscle aches or pains. She states the shot gave her the flu. What is the most likely reason for the patient's illness?

A. She has a cold. The patient has classic symptoms of a cold (cough, mild weakness, stuffy nose and sore throat, without fever). Symptoms of influenza include a sudden onset, high fever (usually 3-4 days duration), dry cough, prominent headache, muscle aches and pains (myalgia), weakness, fatigue (which can last for weeks), with an occasional stuffy nose and sore throat. The influenza shot is inactivated and cannot cause influenza; it may cause a mild illness for a day or two afterward.

AD is a 12-month-old female with sickle cell disease who is at the clinic for a routine visit. She will receive her fourth dose of pneumococcal vaccine. Which of the following statements are accurate regarding the vaccine she will receive today? (Select ALL that apply.)

A. She will receive Prevnar 13 C. She will receive pneumococcal conjugate vaccine, 13-valent When administered as part of the childhood vaccination schedule, Prevnar 13 is a 4-dose series. Pneumovax 23 is a polysaccharide vaccine, which does not elicit an antibody response in children age < 2 years old.

Which of the following statements are correct concerning the prevention of typhoid? (Select ALL that apply.)

A. The oral formulation is a live vaccine and must be stored in the refrigerator. C. The typhoid vaccine is available as oral capsules or an IM injection. Oral typhoid vaccine (Vivotif) is a live vaccine supplied as four capsules that require refrigeration. The injectable vaccine (Typhim Vi) is inactivated and administered intramuscularly. Vaccination should be completed at least 1-2 weeks before travel. Typhoid is transmitted via contaminated food and water ingestion and is common in most parts of the worl

When at the health clinic to get influenza vaccines for herself and her 13-month-old daughter, a mother noted on the screening form that her daughter received VAQTA earlier that month. Which of the following statements is true?

A. VAQTA is a hepatitis A vaccine The hepatitis A vaccine (VAQTA, Havrix) is part of the childhood vaccination schedule.

Which of the following patients should receive the MenB vaccine? (Select ALL that apply.)

B. A 19-year-old on a college campus during a meningitis serogroup B outbreak C. A 25-year-old lab worker exposed to N. Meningitidis D. A 10-year-old with sickle cell disease The serogroup B meningococcal vaccines are indicated for patients 10-25 years old. They are recommended for patients with asplenia/sickle cell disease, lab workers exposed to N. meningitidis and during an outbreak situation. The MenACWY vaccine, but not the MenB vaccine, is recommended for travelers to the meningitis belt in Sub-Saharan Africa.

In which of the following patients is the measles-mumps-rubella vaccine contraindicated?

B. A 31-year-old female who is 31 weeks pregnant Live vaccines, such as MMR, should not be given to pregnant patients. A patient with HIV and a CD4+ count < 200 should not receive live vaccines. The other answers do not represent contraindications to vaccination.

Referring to the figure, which choice best represents the appropriate location for administering the Tdap vaccine?

B. Choice B The Tdap vaccine should be administered intramuscularly into the deltoid muscle.

Which of the following statements concerning the recombinant vaccine Flublok are correct? (Select ALL that apply.)

B. Flubok is an egg-free vaccine E. Flubok is approved for use in patients 18 years and older Flublok is an egg-free influenza vaccine approved for patients 18 years and older. Patients with egg allergies can receive any age-appropriate influenza vaccine. If using an influenza vaccine other than Flublok or Flucelvax in a patient with a severe egg allergy, the vaccine should be administered in a medical office where severe allergic reactions can be adequately treated.

Ropinirole 0.5 mg PO dailyAcetaminophen 650 mg PO Q6HDiovan 160 mg PO dailyCalcitriol 0.5 mg PO dailyProcrit 8,000 units 3x/week during hemodialysisFerric gluconate 125 mg IV with each dialysis sessionNephro-Vite 1 tablet PO dailySynthroid 125 mcg PO dailyRenvela 1,600 mg PO TID with mealsSensipar 60 mg PO dailyTamiflu 30 mg PO daily x 5 days (started 2 days prior to admission)Tums TID PRN dyspepsia (uses daily) Allergies: levofloxacin (dizziness, confusion), captopril (cough), peanuts (hives, stopped breathing) Vital Signs:Height: 5'6", Weight: 178 lbsBP: 105/61 mmHg, HR: 101 BPM, RR: 22 BPM, Temp: 100.4ºF, Pain: 2/10 Diagnostic Tests:Chest x-ray: cardiac enlargement, thin bilateral pleural effusionsECG: peaked T-waves, widened QRS interval Laboratory Tests (2/5):Sodium 141 mEq/LPotassium 6.7 mEq/LChloride 100 mEq/LBicarbonate 20 mEq/LBlood urea nitrogen 56 mg/dLSerum creatinine 12.1 mg/dLGlucose 112 mg/dLMagnesium 1.9 mEq/LPhosphorus 6.2 mg/dLCalcium 11.5 mg/dLAST 48 units/LALT 42 units/LWhite blood cells 9,100 cells/mm3Hemoglobin 9.8 g/dLHematocrit 30.2%Platelets 290,000 cells/mm3Albumin 2.9 g/dL Assessment and Plan: hemodialysis x 4 hours today and tomorrow for fluid/electrolyte balance. A review of outpatient labs from January 2nd shows a hemoglobin of 9.4 g/dL. According to current recommendations, once he is stabilized, which vaccines should this patient receive if his immunizations are not up to date? (Select ALL that apply)

B. Inactivated influenza vaccine C. Tdap E. PCV20 Patients with end-stage renal disease (ESRD) should be vaccinated against Hepatitis B. ESRD patients are considered to have altered immunocompetence, which means that PCV20 (Prevnar 20) or PCV15 (Vaxneuvance) followed by PPSV23 (Pneumovax 23) x 1 in eight weeks is recommended. Everyone age six months and older should receive a flu vaccine annually. Anyone age > 11 who has not received a pertussis booster should receive a dose of Tdap followed by a booster (Td or Tdap) every 10 years.

A patient is undergoing a pre-operative evaluation for a splenectomy. Which vaccine is specifically indicated in a patient without a spleen?

B. Menactra A damaged or missing spleen causes a type of immunodeficiency. For this reason, splenectomy patients should receive pneumococcal, meningococcal and Hib vaccines. These vaccines can be given at least two weeks before an elective surgery or within two weeks after an emergent procedure.

Which of the following vaccines must be stored in the freezer and require reconstitution with a diluent prior to administration? (Select ALL that apply.)

B. ProQuad E. Varivax Varicella-containing vaccines (ProQuad, Varivax) and the oral cholera vaccine require storage in the freezer. Varicella, MMR and MMRV vaccines require reconstitution with a diluent before use.

JB is a 72-year-old male who is due for his tetanus vaccine. He lives in an apartment with his daughter, a 3-month-old granddaughter and a 2-year-old grandson. He does not know if he ever received the pertussis vaccine. Which vaccine should JB receive?

B. Tdap As part of the routine childhood vaccination schedule, children receive five doses of DTaP. Children ≥ 7 years old, adolescents and adults receive Tdap. Although a Td booster is available, Tdap is recommended to protect against transmission of pertussis to children and infants at the highest risk of severe illness and death.

VR is 20 weeks pregnant with her second child. She is unsure what childhood vaccines she received and is certain that she has not been vaccinated for anything in at least fifteen years. Which vaccines are recommended for VR during her pregnancy? (Select ALL that apply.)

B. Tdap E. Afluria (during flu season) Inactivated influenza vaccine is recommended during flu season for all stages of pregnancy. One dose of Tdap is recommended with every pregnancy, ideally between 27-36 weeks gestation. Live vaccines are contraindicated during pregnancy.

Select the correct statement concerning active and passive immunity.

B. The MMR vaccine provides active immunity. Active immunity is produced by a person's own immune system and is usually permanent. Active immunity (antibody production) occurs when a person becomes infected with the organism and recovers or receives a vaccination. Passive immunity is acquired when antibodies are provided by someone else. The most common forms of passive immunity include a pregnant mother sharing antibodies with her baby shortly before birth and through breast milk during breastfeeding. Antibodies contained in intravenous immunoglobulins are an example of passive immunity.

The manager at a pharmacy ordered 100 single-dose vials of Afluria. He found them stored in the pharmacy's freezer. Choose the correct course of action:

B. The vaccine cannot be used; it must be safely discarded. Vaccines that require refrigeration cannot be stored in the freezer. If it has been frozen in error, the vaccine must not be used.

Choose the correct statements concerning the HPV vaccine: (Select ALL that apply.)

B. Three doses are required for a 24-year-old male with HIV receiving his first dose. C. Two doses are required for 12-year-old female receiving her first dose. D. Three doses are required for 1 16-year-old female receiving her first dose. The HPV vaccine is recommended for people ages 9-26 years. It is preferred to give at age 11-12. The 2-dose series can be used for immunocompetent patients when vaccination begins before age 15 years.

Which of the following is an inactivated vaccine?

B. Typhoid vaccine given intramuscularly The polysaccharide typhoid vaccine (TyphimVi) administered IM is inactivated. The oral typhoid vaccine (Vivotif) is a live vaccine. Both rotavirus vaccines (RotaTeq and Rotarix), the cholera vaccine (Vaxchora) and the yellow fever vaccine (YF-VAX) are all live vaccines.

A small community pharmacy just received a delivery of influenza vaccines. The pharmacist tells the staff to place the FluMist in the refrigerator door to keep it separate from the influenza injections. Which of the following statements regarding vaccine storage is correct?

B. Vaccines should not be stored in the doors of a refrigerator. Vaccines should be stored in the center of the refrigerator, away from the walls. Vaccines should never be stored in the doors of a refrigerator or freezer as the temperature there is unstable.

Select the correct name for the chickenpox vaccine:

B. Varivax Look-alike drug names contribute to the most common error pharmacists make, which is dispensing the wrong medication.

Which of the following patients are eligible to receive the pneumococcal conjugate vaccinePrevnar 20? (Select ALL that apply)

C. 50-year-old male with COPD D. 68-year-old female with hypertension Prevnar 20 is a 20-valent pneumococcal conjugate vaccine that is approved for use in all adults aged ≥ 65 years and for adults aged 19 - 64 years with certain underlying medical conditions (e.g., COPD). It is not approved for use in pediatric patients.

Fluad could be recommended for which of the following patients?

C. A 67-year-old female with a history of hyperthyroidism Fluad, a trivalent flu vaccine approved for patients ≥ 65 years old, contains an adjuvant to improve the antibody response. It is not an egg-free formulation. A severe reaction following a dose of vaccine is a contraindication to any subsequent dose of that vaccine. A patient who experiences Guillain-Barre within six weeks of a prior influenza vaccine should be referred to their healthcare provider.

Which vaccine can cause a false-positive reaction to the Tuberculin Skin Test (TST)?

C. Bacille Calmette-Guerin (BCG) Previous vaccination with Bacille Calmette-Guerin (BCG) can cause a false-positive reaction to a TB skin test. Though not often used in the United States, BCG is given to infants and small children in countries with a higher TB incidence.

Which of the following, if taken, would qualify as steroid-induced immunosuppression? (Select ALL that apply.)

C. Dexamethasone 4mg PO daily for three weeks. D. Prednisone 30mg PO daily for 22 days in an 11.8kg child To consider a patient immunocompromised due to steroid use, systemic steroids must be taken for at least 14 days at a dose of at least 20 mg or 2 mg/kg of prednisone daily (or equivalent). Steroids taken by inhaled, topical and intraarticular routes are not considered to be immunosuppressive. Equivalent steroid doses are covered in the Systemic Steroids & Autoimmune Conditions chapter of the RxPrep Course Book.

(same as above) When questioned, TH states that he declined the influenza vaccine offered at his dialysis center in the fall because he felt like he was getting a cold. Which of the following is true regarding the influenza vaccine in this patient?

C. He should receive a dose of inactivated influenza vaccine prior to discharge. Fluzone High-Dose and Fluad are indicated for patients age 65 and older. He may have developed immunity to the one strain of influenza that made him ill, but there is typically more than one strain circulating, and vaccination will help protect him from the other strains. Tamiflu will not impact the efficacy of the inactivated influenza vaccine.

KH approaches the pharmacist in January and asks if her 7-year-old daughter should receive the seasonal influenza vaccination. She notes that her daughter has a severe allergy to eggs. Which statement regarding the administration of an influenza vaccine for KH's daughter is correct?

C. If she has not been previously vaccinated for influenza, she should receive two doses spaced four weeks apart. Patients between the ages of six months and eight years, who have not been previously vaccinated for influenza, should receive two doses spaced four weeks apart. Patients with egg allergies can receive any age-appropriate inactivated influenza vaccine, even with severe reactions. FluMist should not be administered in patients with egg allergies. No additional observation period is recommended beyond the required 15 minutes.

Which of the following statements about the Shingrix vaccine is correct?

C. It should be administered even if the patient has a history of shingles. Shingrix is a recombinant (non-live vaccine) administered to prevent shingles outbreaks caused by the herpes zoster virus, even in patients with a history of shingles. It is administered IM into the deltoid muscle.

A 12-month-old child was hospitalized two months ago and received immune globulin for Kawasaki disease. Which vaccine/s would be adversely affected by this treatment if administered today? (Select ALL that apply.)

C. Measles, mumps, and rubella vaccine E. Varicella vaccine Antibodies, found in some blood products and intravenous immunoglobulins (IVIG), can interfere with live vaccine replication.

A 14-month-old child was hospitalized two months ago for a dog bite injury. She was not on schedule with her tetanus vaccine series, so tetanus immune globulin was given. Which vaccine would be affected by this treatment?

C. Measles-mumps-rubella-varicella (MMRV) MMR and varicella-containing vaccines are live vaccines that require replication to produce an immune response. If antibody-containing products (e.g., immunoglobulins) have recently been administered, live vaccines should not be given for at least three months (the recommended separation time varies depending on the product received). If an MMR or varicella-containing vaccine has recently been given, antibody-containing products should be avoided for at least two weeks after vaccination to prevent interference with vaccine efficacy.

PJ is a 13-month-old male who presents to the pediatrician for a routine check-up. He has never received an influenza vaccine. Which of the following is required?

C. One dose today, followed by a second dose in 28 days Children ages six months to eight years who are receiving an influenza vaccine for the first time require two doses, separated by four weeks.

JK is a 21-year-old male who presents to the urgent care clinic on June 22 with a puncture wound in his left foot after stepping on a nail when he walked outside barefoot. He remembers getting a tetanus shot at age 14 (it made his arm very sore) but has only gotten a flu shot every year since then. Which of these vaccines would be an appropriate selection to administer at this time? (Select ALL that apply.

C. Td D. Boostrix He has a dirty wound, and his last tetanus vaccine was > 5 years ago, so he should receive a tetanus booster with either Td or Tdap (Adacel or Boostrix). DT and DTaP are used in children age < 7 years. The uppercase D and P correlate to the higher antigen content of the childhood vaccines. The adult boosters contain less diphtheria and pertussis antigen because the immune system is already primed.

A community pharmacist who runs a vaccination clinic has run out of Vaccine Information Statements (VISs) for one of the vaccines being administered today. The pharmacist can use which of the following websites to obtain a copy of the VIS to provide to patients? (Select ALL that apply.)

C. The Immunization Action Coalition D. The Centers for Disease Control and Prevention (CDC) The CDC prepares Vaccine Information Statements (VISs) for each vaccine to explain the benefits and risks. Federal law requires that the VIS be handed to the patient before the vaccination is given. VISs can be found on the CDC and Immunization Action Coalition websites.

MP is a 29-year-old female who recently finished nursing school and is ready to start her new job. Her employer requires that she complete a tuberculosis screening. The TST was placed on Monday and read as negative by the Employee Health nurse on Wednesday. MP tells the nurse that she received the varicella vaccine last week since she did not have chickenpox as a child and is required to have documented immunity to varicella. What information should the Employee Health nurse communicate to MP?

C. The TST will have to be repeated four weeks after the Varivax; live vaccines can cause false-negative results. Live vaccines (e.g., varicella, MMR, ProQuad or FluMist) can be given on the same day as the TST or after the TST results are obtained (48-72 hours). If given before the TST, a false-negative result can occur, leading to untreated tuberculosis. It is recommended to wait four weeks after a live vaccine to administer the TST.

A small community pharmacy just received a delivery of influenza vaccines. The pharmacy owner needs to instruct the staff on storage requirements. He should include the following information:

C. The stock should be rotated so that the oldest vaccines (earliest expiration dates) are in the front. When new vaccines are received, the stock should be rotated, so vaccines and diluents with the earliest expiration date are used first. Refrigerator and freezer temperatures must be recorded in a temperature log twice each workday. The log should be kept for at least three years.

DV is a healthy 66-year-old female. Her PCP believes that she would benefit from receiving both Vaxneuvance and Pneumovax 23. How should the vaccines be sequenced?

C. Vaxneuvance today, Pneumovax 23 in 1 year When both Vaxneuvance and Pneumovax 23 are given to a healthy patient ≥ 65 years old, Vaxneuvance is given first. Wait at least one year before administering Pneumovax 23.

LB is a 45-year-old female with no significant past medical history who is at the pharmacy today to get her annual flu vaccine and specifically requests Flumist. LB asks the pharmacist about the outbreaks of measles and hepatitis A which have been on the local news in the past few months. LB admits she has not been vaccinated against either of these diseases but asks the pharmacist if she can be vaccinated today. Can the patient receive all three vaccines (Flumist, measles and hepatitis A) today?

C. Yes, she can get all three vaccines today. Simultaneous administration (administration on the same day) is recommended whenever possible to increase immunization rates. Although all the indicated vaccines for the patient can each be given, the individual vaccines cannot be mixed in the same syringe unless they are licensed for mixing by the FDA. If live parenteral (injected) vaccines (e.g., measles - MMR or MMRV, varicella, and yellow fever) and the live intranasal influenza vaccine (Flumist) are not administered at the same visit, they should be separated by at least 4 weeks. If more than one injection is given in the same limb, separate the injection sites by at least 1-2 inches. This way, any individual reactions can be observed.

HY is a 77-year-old female with diabetes, heart failure and rheumatoid arthritis. She would like to get a flu vaccine while her prescriptions are filled. Which of the following formulations would not be appropriate for her?

D. FluMist FluMist (the live attenuated influenza vaccine) is indicated for healthy patients age 2-49 years, so it would be inappropriate for this 77-year-old patient.

Select the correct information for the Varivax vaccine.

D. Once drawn up in a syringe, the vaccine must be used quickly. Live vaccines should not be given during pregnancy. The vaccine is stored in the freezer, and the diluent is stored at room temperature or in the refrigerator. Varivax should be reconstituted immediately when removed from the freezer and administered by SC injection right away.

How is influenza spread most commonly?

D. Respiratory droplets, from sneezing or coughing Influenza spreads primarily through respiratory droplet transmission, such as when an infected person coughs or sneezes near an uninfected person. The infection can also spread if a person touches something contaminated with the virus and then touches their mouth, eyes or nose.

EG is a 50-year-old male who approaches the counter to ask for the best option to treat a cut he received on his foot while working in his garden. EG does not believe he received many childhood vaccines. Which vaccine is preferable?

D. Tdap For anyone with deep or dirty wounds, revaccination with Td or Tdap is recommended if it has been more than five years since the last dose. Tdap should be given to anyone who has not received a pertussis-containing vaccine previously.

A mother asks if her 11-month-old son will receive thimerosal from vaccines. She is concerned that this mercury-containing preservative might increase the risk of autism in her son. Select the correct statements. (Select ALL that apply.)

D. Thimerosal may be present in multi-dose influenza vaccines and can be avoided upon request. A link between vaccines and autism has been well-studied and has not been shown in legitimate medical literature. Thimerosal is a preservative that contains a small amount of mercury and has been removed from most childhood vaccines. Some of the multi-dose (but not single-dose) influenza shot vials contain thimerosal; the patient can request an injection without thimerosal, and the pharmacy should have this option available. Herd immunity results from high vaccination rates and can help protect patients who cannot be vaccinated (e.g., patients with contraindications).

Which vaccine is contraindicated in patients with a severe allergy to eggs or gelatin?

D. Yellow fever The yellow fever vaccine should be avoided in patients with severe (life-threatening) allergies to eggs or gelatin.

Exposure to which of the following commonly requires administration of immune globulin at the time of vaccination?

E. Rabies The rabies vaccine (RabAvert) is most commonly administered after possible rabies exposure. Unless a patient has received a rabies vaccine previously, immune globulin should be administered with the first vaccine dose to help the patient fight the organism right away.

Which vaccine contains antigens for both Hepatitis A and B?

E. Twinrix The name Twinrix is a clue ("twin") that two vaccines are included.