Vaccinations and Organisms which are Vaccine Preventable

Management of Varicella Exposure in healthy person (NO PROPHYLAXIS OR VARICELLA VACCINE)

1. < 12 month old--> NO PROPHYLAXIS 2. >=12 months --> within 5 days of exposure--> VZ vaccine --> >5 days exposure--> NO PROPHYLAXIS (routine vaccinations; if outbreak, give 2 doses >28 days apart for pre-school)

Indications for BCG in US

1. Continual exposure to contagious pulmonary TB, resistant to INH and rifampin (and child cannot be removed from exposure) 2. Continual exposure to people ineffectively treated infectious pulmonary TB, and child cannot be removed from exposure or given Anti TB therapy

'dirty wounds' definition

Contamination by feces, dirt, or saliva or resulting in severe injuries from burns, frostbite or crush injuries If < 3 doses DTaP, then needs booster +TIG if > 3 doses or more than 5 years since last booster--> TdaP

Rabies vaccine-Rhabdoviridae/Lyssavirus genus

Reservoir: bats>>>raccoons, foxes, skunks, coyotes, bobcats, Contact with contaminated saliva

MMR vaccines given before 12 months of age do not count toward the 2 dose series (True or False)

True.

True or False. >6 years - 18 years of age who has received PPS V23 dose previously, should receive PCV 13.

True. a Single dose PCV 13 (even if they had received PCV7 previously) **Can give another PPS V 23 dose, 8 weeks later and then repeat in 5 years. No more than 2 PPSV23 until 65 years of age.

Haemophilus Influenza Type B

pleomorphic gram negative coccobacillus encapsulated strain (strains a-f) nonencapsulated=non typeable

Typhoid vaccines (2)-50-80% efficacy against S. serovar Typhi

(1) Ty21a - live attenuated; oral 4 doses (every other day), every 5 years, (starting at age 6 years old) **complete at least 1 week before possible exposure **Cannot give in immune suppressed or gi illness Vaccine does not express Vi Antigen **can be given simultaneously with mefloquine or chloroquine; if mefloquine given, then delay Ty21a 24 hours; if proquanil given, wait 10 days AFTER last dose of Ty21 a; Atovaquone - give 3 days BEFORE or wait 7 days AFTER last dose. (2) ViCPS, polysaccharide, IM, 1 dose, every 2 years (starting at age 2 years). **complete at least 2 weeks before travel T-cell independent antigen, so no immunologic memory No protection against Salmonella serovar Paratyphi A (?Ty21a may have some cross protection to Paratyphi B)

What is the minimum antitoxin needed to confer protection in the tetanux toxoid vaccine?

0.01 IU/ml usually achievable after 3 doses in children greater than 7 years, and 4 doses in children < 7 years of age levels diminish with time and >10 years, some diminish to less than 0.01 IU/ml --> Booster at 10 years --> Booster at 5 years if any wound that is other than 'minor' and 'clean'.

How many HIB vaccine doses for: 5 years or older -->unimmunized* who have anatomic or functional asplenia (including sickle cell disease) and unimmunized* with with HIV infection. * Patients who have not received a primary series and booster dose or at least 1 dose of Hib vaccine after 14 months of age are considered unimmunized.

1 dose of HIB vaccine

Recommendation for potential exposure to polio by HCW who has been fully immunized

1 dose of IPV No further doses are required. Who else? 1. Travelers to countries where polio is epidemic or endemic 2. Lab workers who cultivate polio 3. HCW in contact with patients excreting WT polio 4. Incompletely immunized should just complete out the required doses, regardless of lapsed interval

For 24-59 months of age, incomplete schedule of 0,1,2 doses

1 dose of PCV 13, >=2 months after the most recent dose If Children with underlying medication conditions**, 2 doses, >=2 months after most recent dose and another >= 2 months later. (unless had incomplete schedule with 3 doses, then just 1 dose). **Medical conditions= 1. Asplenia, SCD 2. Chronic heart or lung disease 3. Diabetes mellitus 4. CSF leak 5. Cochlear implants, 6. HIV or other immune suppressive/compromising conditions

Chemoprophylaxis for children with functional/anatomic asplenia against invasive pneumococcal disease

1. < 3years of age: PCN VK - 125 mg/PO/BID-every day 2. >= 3years of age: PCN VK- 250 mg/PO/BID-every day Duration -'empiric'--for some, if SCD--> stop after 5 years of age; for others, throughout childhood or longer. **Erythromycin for penicillin allergy

Healthcare workers who should get PEP

1. All HCP (even if immunized with Tdap) with unprotected exposure to pertussis + are likely to expose other high risk patients get PEP or observe for 21 days after exposure (treated at the onset of symptoms)

Post exposure Prophylaxis for HBV-- Indications for both HBV vaccine + HBIG

1. Bite/ non intact skin/needlestick to HBs-Ag positive (Example of day care,HBV non immunized boy bites girl (HBV carrier) and draws small amount of blood) 2. Sexual contact/needle sharing; Victim of sexual assault by known HBsAg perpetrator 3. Infants (<2000gm) born to mother's with unknown status within 12 hours of birth (HBV dose #1 does not count towards the 3 dose series for completion) 4. Infants born to mothers known HBsAg positive 5. Full term infants born to mother's unknown status initially and then positive should first receive HBV #1 vaccine dose within 12 hours; and then HBIG within 7 days of birth (once mother's + status identified). Also complete HBV vaccine series

Post Exposure Prophylaxis Indications

1. Bitten, scratched by wild animal 2. Open wound, scratch, or mucous membrane that has been contaminated with saliva or other potentially infectious material from a rabid animal 3. In a room with bat, deeply asleep or sedated, (especially infant or toddler) Contact with feces/blood (noninfectious tissues, or fluid) alone or 'casual contact' with infected persondoes not constitute exposure and is NOT indication for prophylaxis.

Management of animal suspected of 'rabies' and has bitten human

1. Capture, confine, euthanize, and test for rabies 2. Observe by veterinarian for 10 days (and if symptoms, ship 'head' refrigerated to proper facility for testing) Diagnose: DFA of brain material (rapid test)

Congenital Rubella Syndrome

1. Cataracts, pigmentary retinopathy,microphthalmos, glaucoma 2. Cardiac (PDA, PPArtery Stenosis) 3. Auditory( sensorineural hearing impairment) 4. Neuro (behavioral, meningoenceph, microcephaly, and mental retardation) Also: neonatal HSM, thrmobocytopenia, dermal erythropoiesis (blueberry muffin lesions) -85% of first trimester infections **'Natural rubella infection in pregnancy is one of the few known causes of autism' Droplet and contact isolation

Bordetalla pertussis symptoms

1. Catarrhal -only antibiotics given within this period will shorten duration of illness 2. Paroxysmal- antibiotics given this period only decreases risk of communicability 3. Convalescent/Recovery Symptoms: 1. WBC 20-40K with increased lymphocytes 2. Cough or infants- gasping/gagging/ apneic 3. Duration is 10 weeks Diagnosis: PCR (not DFA or culture)

Demonstrated immunity to Varicella includes

1. Documented 2 doses of vaccine, at least 28 days apart 2. Serology evidence of immunity 3. Diagnosis or verification of history of VZ or zoster by healthcare provider

Local wound care of animal bite (suspected of rabies)

1. Flush, soap and water 2. Do not close with sutures 3. Administer RIG directly to wound 4. Administer vaccine (and Rabies-IG with 1st vaccine dose, unless previously vaccinated, then only give rabies vaccine) within 24 hours A. Previously unimmunized, give 4 dose (0, 3, 7, and 14) + RIG Note: If immunocompromised, give 5 dose (0,3,7,14, and 28 days) + RIG B. Previously immunized, give 2 doses (0 and 3 days)--NO RIG

If 7 month old exposed to measles, what should you do?

1. Give MMR within 72 hours of exposure, then still offer some protection (can give down to 6 months of age). 2. If > 72 hours and < 6 days since exposure--> give measles Immunoglobulin

Post exposure Prophylaxis for HBV-- Indications for only HBV vaccine

1. HBsAg status of the source is unknown (sexual, bite, needlestick) 2. Household contact of HBsAg positive 3.

Who gets chemoprophylaxis for H. flu?

1. Household contacts where contact <12 months of age 2. Household contacts, where there is a member < 4 years of age who is partially immunized 3. Household contacts, where immunocompromised (even if fully immunized) 4. Child care or preschool where 2 cases or more occurred within 60 days. Rifampin (20 mg/kg/day X 4 days) Note: do not give to child care contacts or preschool if 1 index case or pregnant women

Who should receive meningococcal exposure chemoprophylaxis--> during the 7 days before onset of illness--HIGH Risk

1. Household contacts; shared toothbrush or other eating utensils during 7 days prior to illness onset or slept in same dwelling during 7 days prior to onset 2. HCW with emergent intubation or exposure to secretions without PPE 3. sitting next to someone on a flight >=8 hours 4. Daycare or preschool contact during 7 days prior to illness onset. No chemoprophylaxis recommended for: 1. Casual contact through school or work 2. Indirect contact ( contact with high risk contact) 3. HCW without direct exposure to oral secretions In outbreak or cluster setting: other than high risk, consult local public health

If lapsed in # of doses of HIB vaccine for primary series, how many doses are needed?

1. If 2 doses before 12 months, or If 15 months -59 months--> single dose 2. If given 0 or 1 dose 7-11 months--> 2 doses, 2 months apart

Management of Measles Exposed unimmunized or immunized (<1 dose)

1. If given within 72 hr of exposure, MMR can ameliorate course of disease in underimmunized or unimmunized 2. Immunoglobulin NEVER indicated in healthy children who have received 1 dose MMR 3. 9 month old should receive Immunologlobulin G (250 mg/dL) IM --> IF IN OUTBREAK SETTING, THEN GIVE MMR IF >= 6 MONTHS OF AGE Then 5 months later, given MMR vaccine

Management of Varicella Exposure in IMMUNE SUPPRESSED person within 10 days of Exposure (VZIG/IG)

1. Immune compromised children (all HIV regardless of CD4; all bone marrow transplant regardless of pre-tx status; congenital or acquired T-lymphocyte immunodeficiency - leukemia,lymphoma, and prednisone for >14 days) 2. Pregnant women 3. Newborn whose mother had VZ disease within 5 days of delivery or 48 hours post delivery 4. Hospitalized preterm whose mother lacks evidence of VZ immunity (>=28 weeks GA) 5. Hospitalized preterm (< 28 weeks GA) regardless of mother's VZ immunity Tx: 1. VariZig, 125 u/10 kg body weight (62.5 u if <= 2kg) up to max of 625 units 2. IVIG 400 mg/kg if you cannot give VariZig or IVIG: Acyclovir/Valcyclovir beginning 7-10 days AFTER exposure for 7 days

What are the other ingredients of IPV which you need to be aware of in case of allergy develops?

1. Neomycin 2. streptomycin 3. Polymyxin B 3 serotypes in IPV; with 1000% seroconversion

What condition has been totally excluded as a causal relationship with MMR? What condition(s) have been as inadequate to accept/reject causal relationship? What condition associated with MMR?

1. No causal -Diabetes mellitus (Type 1) 2. No evidence either way to accept/reject= GBS, ataxia, afebrile seizures 3. Favors acceptance of causal= transient arthralgia

Contraindications to Live Attenuated Influenza Vaccine

1. Preterm infants, 2. HIV 3. Chronic diseases- asthma, chronic pulmonary disease; hemodynamically significant cardiac disease; chronic renal; chronic metabolic disease (diabetes mellitus); hemoglobinapthies; conditions compromising respiratory function (neurodevelopmental disorders, seizure d/o, neuromusc d/o) 4. Long term aspirin therapy 5. Immunodeficiences receiving immunosuppressive therapy 6. Pregnant adolescent and women in any trimester

The most frequent reaction post Varicella Vaccine administration is

1. Rash (usually < 21 days after vaccine)-- general or localized- 32% 2. Fever (21% of reactions) 3. Injection site reaction (13%-- pain, erythema, swelling)

Scarlet Fever Symptoms

1. Rash- sparing face 2. Pastia lines 3. Perioral Pallor 4. sandpaper rash Treatment is for prevention of rheumatic fever NOT post streptococcal glomerulonephritis Note: The rash of scarlet fever is a delayed-type hypersensitivity to an exotoxin and therefore occurs in persons who have had a previous exposure to Streptococcus pyogenes.

Chemoprophylaxis for exposed person to meningococcal disease includes

1. Rifampin- infants to adolescents, adults. **Rifampin and ciprofloxacin are not recommended for pregnant women 2. Azithromycin- use where ciprofloxacin resistant occurs; eradicates carriage; as a single dose; not recommended routinely 3. Ceftriaxone- drug of choice for pregnant women as a single dose 4. Cipro- as a single dose (unless in area where resistant is high).

Children with SCD--> what is recommendations for pneumococcal protection

1. Routine PCV-13 dosing [4 doses: 2,4, 6, 12-15 months] 2. PPS V23 at 2 years of age and then again at 5 years of age. 3. 2nd PPS V23 at 5 years of age.

These are not contraindications for DTaP

1. extensive limb swelling 2. Stable seizures and Cerebral palsy 3. Brachial neuritis 4. Contact allergy to latex gloves 5. Pregnancy/bf 6. Immunosuppression 7. Minor illness including antibiotics

Who gets Pertussis PEP? [Pertussis vaccine + Chemoprophylaxis]

1. face to face contact (within 3 feet) 2. Household and other close contacts 3. in the same proximity for >=1 hour of index pt Note: limited value of PEP if > 21 days have lapsed since exposure to index pt. (but should be still given to households with high risk contacts)

Inactivated pertussis vaccine contains what elements of B. pertussis

1. inactivated pertussis toxin 2. filamentous hemagglutinin 3. fimbrial prteins 4. pertactin (outer membrane)

Not a contraindication for MMR

1. mild or asymptomatic HIV 2. Positive TB test 3. Concurrent TB skin testing 4. Pregnancy/breastfeeding 5. Allergy to egg or non threatening reaction to neomycin 6. History of seizure

Contraindications for pertussis vaccinations

1. progressive neurologic disorder 2. experienced encephalopathy within 7 days after dose of DTP, DTaP or Tdap that cannot be attributed to another identifiable cause.

BCG adverse effects

1. subcutaneous abscess and local regional lymphadenitis 2. Disseminated disease and osteitis--> immune suppressed; needs therapy Note: 80% effective against meningeal and miliary TB 50% effective against pulmonary TB Skin testing later, can cause booster effect that can be potentially confusing

Risk factors for FATAL pertussis infection

1. young age (<7months) 2. birth weight < 2500 grams 3. Female 4. Apgar scores low <8 5. Hispanic/maternal education < 12 years; 6. No vaccination against B. pertussis 7. Leukocytosis high

Rotavirus vaccine dose #1 has to be administered by what age?

15 weeks, 0 days (both term and preterm)

Which non vaccine serotype(s) have caused the most severe disease in the post PCV-7 vaccine era?

19A and 6 C Why? 1. No cross protection from PCV 7 serotypes (19F) 2. Presence of multiple drug resistance in replacement serotype

12 through 59 months who are at increased risk for Hib disease, 1. chemotherapy 2. anatomic or functional asplenia (including sickle cell disease), 3. human immunodeficiency virus (HIV) infection, immunoglobulin deficiency, or early component complement deficiency, who have received either no doses or only 1 dose of Hib vaccine before 12 months of age, How many doses of HIB vaccine?

2 additional doses of Hib vaccine, 8 weeks apart; If already had 2 or more doses of Hib vaccine before age 12 months --> then just 1 additional dose.

Meningococcal vaccine (conjugated)

2 meningococcal quadrivalent polysaccharide protein conjugate vaccines licensed for young children that offer protection against serogroups A, C, W, and Y. Bivalent conjugate vaccine combined with Haemophilus influenzae vaccine protects against serogroups C and Y. Since 2005, vaccination has been routinely recommended in adolescents. (first dose: 10-11 years and follow-up at 16-18 years). In 2010, the recommendation for a booster dose at 16 years of age was made. Although 60% of meningococcal disease occurs in children younger than 5 years of age, 2 licensed novel meningococcal serogroup B-specific vaccines available in the US are approved for use in persons 10 to 25 years of age. Serogroup B-specific vaccines have been used successfully in outbreak settings. Meningococcal vaccination is recommended for travelers to endemic regions, such as the "meningitis belt" in sub-Saharan Africa or during the Hajj in Saudi Arabia. For children younger than 9 months of age who are travelling to endemic areas, a 3-dose primary series of conjugate vaccine at 2, 4, and 6 months of age should be completed prior to travel. Children 9 months to 23 months of age require 2 doses and those 24 months or older require a single dose. In the United States, one of the commercially available quadrivalent vaccines is licensed for persons as young as 2 months of age and the bivalent vaccine that is combined with Haemophilus influenzae is licensed for infants starting at 6 weeks of age.

Meningococcal vaccinations Indications-Special Populations

2 months of age: Groups considered to have increased risk include those with anatomic or functional asplenia, or those with complement component deficiencies. For travel or residence in a hyperendemic region, meningococcal vaccination can begin at 2 months of age. Of note, HIV infection is not an indication for infant immunization.

Salmonella typhi vaccine

2 types Ty21a=oral attenuated vaccine ViCPS=intramusc protein

HBV vaccine -How many doses given in preterm infant?

4 doses if preterm infant was <2000 grams at birth **Decreased Antibody response at this age, **Final dose cannot be given before 24 weeks (164 days) after birth.

Treatment of Pertussis

5-day course of Azithromycin Caution: < 6 months--> watch for infantile hypertrophic pyloric stenosis (FDA not approved azithromycin for pertussis in < 6 months) In severe disease (refractory pulmonary hypertension, marked incr leukocytosis)--> 1. exchange transfusion or 2. leukopheresis may be lifesaving Standard + Droplet (for 5 days after treatment started or 3 weeks after onset of cough)

Influenza vaccine

6 months --> 6 months to 8 years: 2 doses, 4 weeks apart for first dose then once a year thereafter >=9 years: just one dose

Dosing for influenza vaccine

6 months to 9 years: 2 doses, 1 month apart if never received; otherwise once a year (if only receives 1 dose during the season, the following needs to receive 2 doses)

Time between giving live attenuated vaccine and placement of TST

6 weeks (this is because the TST or IGRA response may be affected by vaccine response of host)

Post exposure Prophylaxis Indications for Pertussis

ANYONE exposed (preschool, household, daycare) regardless of immunization status

When should PAP screening begin? [Regardless of sexual activity]

Age 21 years For HIV females, 2 times in Year 1 and then yearly thereafter

If HIB invasive disease occurs < 24 months of age, what is the vaccination recommendations for HIB

Beginning 1 month after disease, vaccinate as if patient had been unimmunized.

A PPS V 23 valent is given (but not PCV 13) to which group at risk for pneumococcal diseae

Chronic heart and lung disease; diabetes mellitus

BCG suppurative adenitis- live vaccine, attenuated (M. bovis)

Clinical symptoms: BCG scar with ipsilateral, fluctuant adenitis with minimal signs of inflammation Treatment: 1. Small or Non suppurative- expectant watching [regress without interventions] 2. Suppurative lesions- spontaneous drain/discharge and sinus formation with healing [need large needle aspiration to prevent scarring and hasten resolution] 3. Lesions are matted/multiloculated- surgical intervention [not I&D--> fistula formation and poor wound healing]

Meningococcal serogroup B Disease and Vaccine

Commercially available serogroup B-specific vaccines are licensed for persons 10 to 25 years of age Serogroup B is responsible for most infections in young children.

HPV type of disease, incubation period; most common strains --> cancer and anogenital warts

Cutaneous and anogenital warts. Incubation period is from 3 months to several years. Most common types causing cervical cancer is Types 16 and 18 Types 6 and 11 account for 90% of anogenital warts.

Pre-Exposure Prophylaxis (HDCV, PCECV)

Dose at 0, 7, 21 or 28 days (IM) Minimal Rabies neutralizing antibody titers should be 1:5 or 0.5 iu/ml Continuous exposure to rabies, need to check titers very 6 months At risk for exposure to rabies, need to check titers after 2years of vaccination. Booster: 1 single dose of Rabies vaccine, IM

True or False: Menactra is not licensed for use in children less than 2 years of age

False. MenACWY-D (Menactra, Sanofi Pasteur) is recommended for use in children aged 9 through 23 months who are at increased risk for meningococcal disease The conjugated vaccines (Hib-MenCY-TT and MenACWY-CRM) can be given at 2, 4, 6 and 12-15 months of age for high risk children. Booster @3 year primary series and repeated every 5 years thereafter.

T or F: Measles vaccination should be given to pregnant woman exposed to measles

False. Pregnant women should receive Ig 250 mg/dl, IM

When is a HIB booster vaccine indicated after the routine 3 or 4 dose routine regimen before age 15 months?

For children undergoing scheduled splenectomy, an additional dose of Hib vaccine is recommended 7-10 days before surgery IRRESPECTIVE OF AGE.

A booster for PPSV 23 is given 5 years after for which people at risk?

Functional asplenia, sickle cell, HIV, immunodeficiency; malignancy, transplant Those with chronic lung, heart disease or diabetes or with CSF leaks/cochlear implants do NOt GET BOOSTER.

Contraindication for MMRV

HIV infection (MMRV is more likely tied to febrile seizure than to give MMR separately from Varicella).

What are the types of HPV vaccines?

HPV2 (Cevarix) HPV4 and HPV9 (6,11,16,18 + 31,33, 45, 52, and 58) Dosing: 0, 1, 6 months (or 2 dose schedule 0, 6-12 months), beginning at age 13 years (although licenesed for down to 9 years)

Bordetella pertussis - gram negative pleomorphic baciluus

Human-only host Contagiousness- catarrhal through 3rd week after onset of paroxysmal Pertussis toxin (PT) mediates cytotoxicity and lymphocytosis (thrombus formation, inflammatory cascades, )--> hypoxemia--> increased pulmonary vascular resistance--> cardiopulmonary failure Diagnosis: 1. Gold standard- culture (calcium alginate or dacron-->Regan Lowe media) 2. PCR- NP wash or dacron swab; insertion element IS481 or Pertussis toxin S1 promoter NO DFA TESTS Signs/Symptoms: 1. Increased WBC with absolute lymphocytosis [associated with poor prognosis in infants/children] 2. Refractory pulmonary hypertension (evidence of RV-dilatation] is most ominous complication

Chemoprophylaxis for index case is indicated in what situation?

If patient received treatment with antibiotic OTHER Than CEFTRIAXONE OR CEFOTAXIME, then should receive rifampin (usually) 4 doses across 2 days

Quarantine of animal who has been vaccinated against rabies and bitten by rabid animal

If vaccinated within 1-3 years, quarantine for 45 days after re-vaccinated. (Note: if unvaccinated pet is bitten by rabid animal and owners refuse euthanasia--> quarantine for 6 months and vaccinate 1 month prior to release)

Conjugation (covalent coupliing) of polysaccharide to Protein Carrier (contains T-cell epitopes)

Immune response to the polysaccharide to change from T-cell-independent to T cell-dependent. This leads to a substantial primary response among infants and a strong anamnestic response at reexposure.

Yellow Fever Vaccine

Live virus vaccine produced in embryonic chicken eggs Good for 10 years for those >9 months of age !. contraindicated if egg allergy 2. Caution about breastfeeding Adverse effects: 1. headaches, myalgias, and low-grade fever 2. anaphylaxis, 3. yellow fever vaccine-associated viscerotropic disease (YEL-AVD)-fever, malaise, headache, myalgia, vomiting, and diarrhea--> hepatic, renal, or respiratory insufficiency or failure; hypotension; thrombocytopenia; and coagulopathy. and 4. yellow fever vaccine-associated neurologic disease (YEL-AND)-meningoencephalitis and Guillain-Barré syndrome and acute disseminated encephalomyelitis. (The latter two manifestations are believed to be autoimmune mediated, in which antibodies produced in response to the vaccine cause either peripheral or central demyelination.)

Management of Varicella Exposure in IMMUNE SUPPRESSED person if >10 days of Exposure (VZIG/IG)

NO PROPHYLAXIS

Can Rabies vaccine or Rabies Immune Globulin treat Rabies infection once symptoms develop?

NO. Rare cases of children surviving rabies infection (3, non immunized); 10-partially immunized.

Who is considered 'Exposed' to VZ

Non transient contact or 5 or more minutes Household member residing in same house Playmate with face to face indoor play Hospital room 2-4 bed with face to face contact with infectious staff member Zoster: intimate contact Newborn: onset of varicellz in mother 5 days or less before delivery or within 48 h after delivery (No VZIg if mother just had zoster)

Influenza -VIRUS DESCRIPTION AND EPI

Orthomyxovirus (A,B, C) Influenza A (H3N2)--> higher mortality Influenza A (H1N1)--> pandemic 2009--> 4x pediatric deaths than other seasons Antigenic Drifts- minor antigenic changes in Influenza A or B. Associated with SEASONAL EPIDEMICS Antigenic Shifts-major antigenic changes in Influenza A ONLY-> pandemic Note: H5N1 and H7N9 (Influenza 1)--> associated with avian flu

Adverse reactions from Rabies vaccine (HDCV)

Primary series: 1. Local site pain, erythema, swelling Booster dose: [Immune mediated reaction can occur 21 days after vaccine dose] 1. Edema, urticaria -generalized 2. Arthritis, arthralgia 3. H/A, vomiting, nausea

Hypersensitivity to allergen in vaccine is usually due to what component

Protein. Most often implicated = ovalbumin, other egg white protein, or gelatin

Interval between Immunoglobulin and MMR /MMRV vaccine administration

RSV prophy-(Palivizumab monoclonal)- 0 Months Tetanus Ig/HAV Ig/HBIg - 3 months Rabies prophylaxis (RIG) - 4 months VariZig or Measles Ig- ***5 months*** (If immunocompromised needs Measles Ig, then give measles vaccine 6 months later) Botulinium Ig- 6 months Replacement IGIV (immune deficiencies)- 8 months Varicella Prophylaxis- IGIV- 8 months ITP- (IGIV)- 10 months Kawasaki (IGIV) - 11 months Blood products: pRBCs - 5 months plasma or platelets- 7 months

How many HIB vaccine doses for < 5 years - chemotherapy or radiation treatment who received a Hib vaccine dose(s) within 14 days of starting therapy or during therapy,

Repeat the dose(s) at least 3 months following therapy completion.

How many HIB vaccine doses for Recipients of hematopoietic stem cell transplant (HSCT)

Revaccinated with a 3-dose regimen of Hib vaccine -->starting 6 to 12 months after successful transplant, regardless of vaccination history; doses should be administered at least 4 weeks apart.

Contraindication for rotavirus vaccination

SCID and intussusception

What are the additional 6 serotypes in PCV-13 not in PCV-7?

Serotypes 1,3,5,6A, 7F, 19A PCV-7 had: 4, 6B, 9V, 14, 18C, 19F, and 23F Immunization with PPS V23 DOES NOT induce immunologic memory or boosting with subsequent doses AND has not effects on NP carriage or indirection protection of unimmunized groups.

Tetanus vaccination is comprised of

Tetanus toxoid vaccine consists of a formaldehyde-treated toxin, standardized for potency according to federal regulations. Tetanus toxoid is adsorbed with an aluminum salt, which serves as an adjuvant to induce an adequate immune response.

Side effect of too frequent booster of Tetanus Vaccine

Tetanus toxoid= formaldehyde formulation (adsorbed with aluminum salt) Local reactions, such as pain and tenderness at the injection site, occur in 50% to 85% of recipients, while 25% to 30% experience edema and erythema. Severe local reactions (marked swelling) occur in <2% of recipients. Increased rates and severity of local reactions, including massive swelling from the elbow to the shoulder-->primarily to high levels of pre-existing antitoxin, and have occurred primarily in persons with a history of multiple booster doses of toxoid. **severe local reactions can be prevented by avoiding unnecessary booster doses of tetanus toxoid vaccine**

Immune correlate to measure protection against rubella infection

Total antibody measurement >10 IU (compared to measuring neutralizing antibodies, which is not widely used). Current MMR vaccine= MMRII composed of 1. Rubella- RA27/3 -from 1965 single fetus infected with rubella, cultured fluid, passaged and cold adaptation to get attenuated virus for vaccine 2. Moraten-attenuated virus 3. Jeryl Lynn Mumps virus Formed separately and then combined to make MMR II

Rubella component of MMR most likely associated with what side effect?

Transient arthralgia (small joints)--usually 6-21 days post vaccine; Acute arthropathy (25%); mild rubella like illness (fever, rash, lymphadenopathy), transient peripheral paresthesias. Measles component most associated with fever and febrile seizures MMRV more likely to cause febrile seizures than MMR and Vz given as separate.

All children < 5 years of age should receive the CONJUGATED pneumococcal vaccine not pneumovax

True

True or False. Neonates exposed to maternal vz should remain in contact/airborne isolation between 21 and 28 days after birth

True

True or False: Children with egg allergy may be given MMR or MMRV vaccines without special precautions

True

Varicella exposure requires airborne and contact isolation of exposed patieng, beginning at 7 days after exposure through 28 days after exposure

True

True/False: Infants born to HBsAg positive mothers should have their post vaccination status verified by serologic testing at 9-12 months of age

True Also true for HCWs, prostitutes, hemodialyses, immunocompromised.

True or False: Inactivated Influenza Vaccine in a single, age -appropriate dose is well tolerated by most recipients with a history of egg allergy. No longer need the 2 step graded challenge.

True Note: No data is published on LAIV to egg allergic recipients Approx 1% of children have IgE mediated sensitivity to egg and only a rare minority have a severe allergy. Only consider alternative strategy if severe anaphylactic reaction

T or F: If patient routinely receives IVIG, then IG or varizig does not need to be given for VZ exposure if within 3 weeks of routine dose

True Subsequent vaccination given 5 months after last dose of immunoglobulin

True/False: Birth vaccine for infants < 2kg, need to make

True.

True or False. The Vaccine Safety Committee of the Institute of Medicine has concluded that the available evidence favors a causal relationship between tetanus toxoid, brachial neuritis, and Guillain-Barré syndrome.

True. No 'causal' relationship with seizure or encephalopathy (only temporal).

Systemic reaction to eggs should NOT receive influenza vaccine (True or False)

True. Should be referred to allergist for skin testing or immunization under allergist/ If hives only with flu vax, then give vax and observe in office for 30 minutes. **Inactivated flu vax do not contain enough egg to trigger an allergic reaction in most children with egg allergy**

For adolescents and adults (not true for children), collapse or sock like state <= 48 hours after receiving a previous dose of a pertussis containing vaccine IS NOT precaution or CONTRAINDICATION for use of Tdap

True. Neither are 1. Seizure <= 3 days after prior dose; 2. Brachial neuritis 3. Nonanaphylactic latex allergy 4. Persistent, inconsolable crying >=3 hours within 48 hours of previous dose 5. Temperature >104.9 (40.5) for <= 48 hours after receipts of previous dose

True or False: There is a 'causal' relationship between TETANUS toxoid and Brachial neuritis and Guillain-Barre' Syndrome

True. (there is not a causal relationship with seizures or encephalopathy)

If more than 3 years since last dose, children between 2-10 years should get booster MCV4 (True or False)

True. Booster doses for MCV4 if more than 3 years since last dose (for children 2-10 years who received/required meningococcal vaccine).

First dose of rotavirus vaccine should NOT be given after 15 weeks of age

True. Once series started, need to complete series by 8 months of age. Note: if 1st dose administered after 15 weeks, then still need to complete the series on schedule

PPD can be given at same time as MMR but NOT within 4-6 week period AFTER MMR has been given

True. PPD can be given at same time as MMR if after MMR, wait 4-6 weeks

An additional PCV13 given to all those > 6 years with high risk (functional asplenia, HIV, malignancy, transplant and congenital deficiency. Also, those with CSF leaks and cochlear implants).

True; also give PPS V23 (given 8 weeks apart)

Empiric Treatment of Pneumococcus Meningitis

Vancomycin +Ceftriaxone (Cefotaxime) OR VANCO + RIFAMPIN (IF ALLERGY TO CEPH)

When should PEP occur for Meningococcal exposure?

Within 24 hours after ndex patient identified. (Chemoprophylaxis given after 2 weeks since exposure has little value).

Should a 6 month old be given Measles vaccine prior to travel to area where Measles is a risk?

Yes. Measles should be given >=6 months of age in preparation for travel. Measles immunoglobulin should be given only if exposed to measles within 6 days. Vitamin A given after infected with measles to decrease morbidity and mortality--but no indication for prophylaxis.

Japanese encephalitis vaccine -inactivated (vero culture) vaccine for > 2 months of age or older

spending more than 1 month in area endemic for Japanese encephalitis vaccine or in area high risk No adverse effects 2 doses at least 28 days apart.

Protein carriers added to polysaccharide vaccines

tetanus toxoid, nontoxic variant of diphtheria toxin, meningococcal outer membrane protein complex improves immune response in <18 month old

Erysipelas- Group A Streptococcus

upper dermis that characteristically extends into the superficial cutaneous lymphatics. rapidly invades and spreads through the lymphatic vessels. This can produce overlying skin "streaking" and regional lymph node swelling and tenderness.

If giving VariZIG (indicated) for VZ/ Zoster exposure

within 10 days after exposure (as soon as possible)