APhA Immunization Exam

Cellular Vaccines

1. Inactivated Vaccines 2. Whole viruses or bacteria 3. Known as Subunits (fractions) 4. DTP/DTaP

Inactivated Vaccines are:

1. Killed virus or bacteria 2. Does not replicate 3. Stimulates humoral immunity (antibodies) 4. May be given to people who have received blood products or live vaccines, regardless of timing. 5. Predominantly given to infants (less than 12 months) because they may have circulating maternal antibodies which could reduce the effectiveness of a live vaccines.

Steps when using Immunization schedules

1. start with patients age, which vaccines should they have and are they behind? 2. If patient has medical condition, check for precautions and contraindications 3. Refer to vaccine notes for types, frequencies, intervals and special considerations

If two live vaccines are given simultaneously sly on the same day, then you must wait _____ minimum interval.

28-day minimum interval so that each vaccine can replicate properly.

PPCP Step 2

ASSESS after collecting information and analyzing the need for vaccines following ACIP recommendations.

ACIP

Advisory Committee on Immunization Practices: -housed within the CDC -15 voting/30 nonvoting medical health experts -7 domains of framework that examines the vaccine

Passive Immunity

Antibodies from an external source

The community pharmacist, while filling discharge orders from the hospital, recognizes a patient's need for receiving the pneumococcal vaccine during a transition of care to a personal care home. This is an example of what part of the patient care process?

Assess

Innate Immunity

Barrier defense mechanism

PPCP Step 1

COLLECT information to determine which vaccine and screen for any contraindications/precautions at every clinical encounter

PPCP Step 2 - Diagnosis Based Screening

Diagnosis Based Screening is when certain medical conditions may be indications for certain vaccines

An electronic prescription for glipizide 10mg is received by a pharmacist for a new patient. The prescription indicates a diagnosis of E11, Type 2 diabetes mellitus. In addition to filling the prescription, the pharmacist could assess the patient for potential immunizations to recommend. What form of assessment is the pharmacist utilizing?

Diagnosis-based screening

LAIV4 is the abbreviation for:

Live Attenuated Influenza Vaccine

When administering measles, mumps, rubella (MMR) and pneumococcal conjugate vaccine (PCV13) to a patient at their 15-month appointment, what must be considered regarding vaccine spacing?

MMR and PCV13 may be administered simultaneously or at any interval between doses.

If patient is pregnant then which vaccines should be avoided?

MMR, VAR, HPV but can be given immediately after she gives birth. Influenza should be inactivated.

MMR is the abbreviation for:

Measles, mumps, rubella

Screening Questions: Live Vaccines, Blood Products

Past year, have you received transfusion of blood/blood products or given Immune (gamma) globulin Blood or blood products may contain antibodies that reduce vaccine efficacy.

Which of the following is one of the five guidelines identified by the APhA Board of Trustees in 2019 to assist pharmacists in incorporating immunization activities into their practice?

Prevention, Partnership, Quality, Documentation and Empowerment

Live Vaccines are:

1. Attenuated 2. Stimulates both humoral and cell-mediated immune response 3. May be interfered with by circulating antibodies 4. Not given to children less than 12 months of age due to presence of maternal antibodies

Screening Questions for All Patients

1. Current Health Status 2. Allergies and Past Reactions 3. Long-term Illness

Toxoid Vaccines

1. Inactivated Vaccine 2. Subunit (fractions) 3. Inactive or biological toxin 4. Tetanus toxoid

What are two broad categories that vaccines are classified as?

1. Live attenuated vaccines 2. Inactivated vaccines

What clinical factors need to be considered before administering a lie attenuated vaccine?

1. Patients who currently are immunocompromised 2. Live attenuated vaccines administered in the previous 28 days.

How long does it take for the immune system to provide protection by producing disease-specific antibodies and memory cells?

14 days

If an 11 year old child never got the hepatitis B vaccine series, what is the minimum amount of time that must occur between dose 1 and dose 3 when getting this child caught up?

16 weeks

Live vaccines followed by blood products (contain antibodies) require ______minimum interval.

2 weeks.

Children less than what age do not mount an adequate immune response to t-cell independent immunity?

2 years.

The herpes zoster vaccine is first recommended what age for immunocompetent adults

50

Based on the adult immunization schedule, at what age is the live attenuated influenza vaccine (LAIV) no longer recommended?

50 years

At what age can the 2-dose schedule of the human papillomavirus (HPV) Vaccine be given?

A 2 dose schedule is recommended for girls and boys who initiate the vaccination series at ages 9 through 14 years.

Which of the following are part of the four steps set by NVAC as the standards for Adult Immunization Practice?

ASSESS, RECOMMEND, ADMINISTER & DOCUMENT

Adaptive Immunity

Also known as acquired

How often are the CDC immunization schedules published?

Annually

Which of the following is found in vaccines to evoke an immune response?

Antigens

In the patient care process, how often should a pharmacist collect information on a patient?

At every clinical encounter

LAIV is contraindicated if child has asthma or wheezing for what age?

Children ages 2-4 with heart disease or chronic disease should still be vaccinated against influenza using INACTIVATED

Why is spacing and timing of vaccines important?

Circulating antibodies may interfere with immune response

Star Pharmacy has been providing influenza vaccines for years and is now implementing a Hepatitis B vaccine program in their pharmacy next month. A crucial step in the Pharmacists' Patient Care Process for this vaccine is:

Create a reminder and recall system.

EUA

Emergency Use Authorizations - allow for medical countermeasures, such as medications or vaccines to be made available during a public health emergency ex: COVID-19

Antigens

Evoke the immune response and bind to specific antibodies

T/F: Vaccines contain antibodies which are recognized by the immune system.

False

PPCP Step 5

Follow-up with Patients, monitor and manage potential adverse events and schedule appt's for follow-up doses

A 10 year-old child received one dose of the hepatitis A vaccine at 1 year of age, but never returned for a second dose. Which of the following is true regarding the need for a second dose of the hepatitis A vaccine for this child?

Give 1 dose now as catch up

Which of the following vaccines is not recommended during pregnancy?

Human papillomavirus vaccine (HPV)

PPCP Step 4

Implement - communicate and collaborate with other providers as part of the immunization neighborhood, VIS form to educate patients about the vaccine they might be getting and counseling patients on risks and benefits to all patients receiving vaccinations.

Pneumococcal polysaccharide vaccine (PPSV23) is best categorized as what type of vaccine?

Inactivated Polysaccharide Vaccine

The National Vaccine Advisory Committee 2013 Standards for Adult Immunization Practice and the 2016 International Pharmaceutical Federation global report identify pharmacists as:

Integral to increasing vaccination rates

Active Immunity

Long-term protection but takes 2 weeks to work

Which of the following vaccines is contraindicated for an adult patient with HIV and a CD4 count <200 mm2?

MMR

Which of the following is TRUE of the emergency use authorization process?

Manufacturers must include a plan for safety monitoring

PPCP Step 2 - Mass Screening

Mass Screening can help identify candidates for vaccines based on a common factor, review child's vaccination status prior to school entry

MMRV is the abbreviation for:

Measles, mumps, rubella, varicella

Opportunities for Advocacy and Collaboration include:

Membership in state Immunization coalition to serve as an expert on policy and practice issues affecting pharmacy

A 9 year-old was just diagnosed with asplenia. This child is up to date on all routinely recommended vaccines. Which additional vaccine does this child need?

MenACWY - Meningococcal ACWY

NVAC

National Vaccine Advisory Committee established standards for adult immunization practice: ASSESS, RECOMMEND, ADMINISTER & DOCUMENT

Can inactivated vaccines replicate?

No. It does not cause disease.

PPCP Step 2 - Occurrence Based Screening

Occurrence-Based Screening is when Patients who may have health conditions that warrant vaccination at a hospital visit

Screening Questions: Live Vaccines, Family history

Parent, brother/sister with immune system problem? Heredity immunodeficiency should be screened

A male patient presents to the pharmacy for a shingles vaccine appointment. The patient is a new patient to the pharmacy. Which of the following information would be most appropriate to collect as part of the patient care process?

Patient's age, current health, vaccine history, and allergies

PPCP

Pharmacist Patient Care Process

EUA Process

Phase 1/2 have to be completed Phase 3 - long term so monitor safety and FDA may allow it to move forward.

PPCP Step 3

Plan - pharmacists creates an individualized patient-centered care plan with clear and strong evidence based recommendations

Screening Questions: Pregnant Women

Pregnant women should receive IIV4 and Tdap vaccinations Some live vaccines may be contraindicated in pregnancy

PPCP Step 2 - Procedure Based Screening

Procedure Based screening is when certain procedures might indicate the need for specific vaccines

Screening Questions: Live Vaccines, Vaccine Timing

Received vaccinations in the last 4 weeks? Vaccines should be given BEFORE initiation of immunosuppressive therapies

RV1, RV5 is the abbreviation for:

Rotavirus

Which of the following diseases have been eradicated worldwide, allowing vaccination to be discontinued?

Smallpox - eradicated in 1980 by WHO

Schedule for Children up to 18 years

Table 1 - Age Table 2 - Catch-up schedule for pts. behind on vaccines Table 3 - Medical indication

T/F: Inactivated vaccines are not affected by live vaccines and visa versa.

True

T/F: Inactivated vaccines do NOT have minimum intervals between administered vaccines

True

What is the name of the document published by the CDC that describes the risks and benefits of a vaccine in lay terms?

VIS - Vaccine Information Statement

VAR is the abbreviation for:

Varicella

When does Active Immunity occur?

When a patient is exposed to an antigen that triggers the body's immune system to produce it's own disease-specific antibodies and memory cells.

CDC Immunization Schedules

age, # of doses, time between doses, indications, precautions - UPDATED ANNUALLY

T/F: MMR is a live attenuated vaccine.

True

Which of the following is an example of passive immunity? a.) Contracting measles b.) Hep B Vaccine c.) Skin Barrier d.) Maternal antibodies

d.) Maternal antibodies

Which of the following vaccines listed is a live attenuated vaccine? a.) Hep B b.) Hep A c.) RZV d.) VAR

d.) VAR

What does attenuated mean?

weakened

What can a pharmacist do to reduce the risk of getting hepatitis B after exposure?

1. Post-exposure prophylaxis is needed right away 2. Give both Hep B immune globulin (HBIG) and Hepatitis B vaccine 3. HBIG contains antibodies that provide immediate protection via passive immunity 4. When a person is fully vaccinated, the hepatitis B vaccine provides long-term protection.

Recombinant Vaccine

1. Produced by genetic engineering 2. May contain no actual virus or a modified strain of a virus 3. HepB, HPV, RZV, RIV4

Which of the following statements best meets the definition of precaution?

A condition that may alter or diminish the patient's response or may increase the patient's risk of a serious reaction to a vaccine.

Which vaccine technol is an ingredient added typically to inactivated vaccines to boost its immune response by targeting pathogen recognition receptors that are expressed on dendritic cells to trigger a pro-inflammatory response? Though this technology creates a more robust immune response, it can also increase local site reactions and systemic reactions, such as fevers, chills, and body aches.

Adjuvants (manufactured to produce a more robust immune response to the vaccine)

If a child is behind on the rotavirus vaccine, what is the interval of time between dose 1 & 2 to start getting the child caught up?

At least 4 weeks

Screening Questions: Live Vaccines in immunocompromised

Immunocompromised - Cancer, Leukemia, AIDS These individuals may be a contraindication for live vaccines such as MMR, VAR, LAIV4

Screening Questions: Live Vaccines, Immunosuppressive Therapy

In the past 3 months, have you taken medications that affect your immune system like Prednisone or other steroids, anticancer drugs or treatment of rheumatoid arthritis, Crohn's disease or psoriasis, or radiation treatments? Immunosuppression may reduce vaccine efficacy or pose a risk for disseminated infection

Under the direction of the U.S. Department of Health and Human Services, the Healthy People initiative has identified the following as a goal for 2030:

Increase the proportion of persons who are vaccinated annually against seasonal influenza

Precautions vs. Contraindications

Precautions - conditions that may diminish response to vaccine and increases risk of serious reaction Contraindications - when a conditions exists that will result in a severe, life-threatnening event if patient receives this vaccine. ex: severe allergy/reaction to previous dose or vaccine component.

Screening Questions: Patients considering tetanus-containing vaccines

Seizure, brain or other nervous system problem Guillain-Barre syndrome (GBS) may be a precaution

Which of the following is true regarding the use of mRNA in vaccine technology? a.) mRNA is extremely stable in a host's body. b.) mRNA is the genetic blueprint that tells your body how to make a particular protein subunit of a virus which, after being produced, will elicit an immune response. c.) mRNA vaccine technology requires replication similar to a live attenuated vaccine. d.) mRNA vaccine technology elicits its immune response and protects the host by altering the host's DNA.

b.) mRNA is the genetic blueprint that tells your body how to make a particular protein subunit of a virus which, after being produced, will elicit an immune response.