Immunization Training
Which of the following patients are appropriate candidates for the 2-dose schedule of HPV9?
ACIP recommends a 2-dose series of 9vHPV at ages 11 or 12 years. The doses should be given at 0 and 6 to 12 months. If the 2nd dose is administered sooner than 5 months after the 1st dose, then a 3rd dose is needed. If the series has not been started by age 15, then a 3-dose series is needed. A 3-dose series is also recommended for individuals who are immunocompromised.
HPV vaccine is recommended for which of the following individuals?
According to ACIP, both males and females between ages 9 through 26 years may receive the HPV vaccine. It is routinely recommended at 11 or 12 years of age.
According to the Advisory Committee on Immunization Practices (ACIP), which of the following would be considered adequate evidence of immunity to varicella, indicating that administration of varicella vaccine is unnecessary?
According to ACIP, evidence of immunity to varicella is documentation of 2 doses of varicella vaccine at least 4 weeks apart; history of varicella or herpes zoster diagnosis or verification of varicella or herpes zoster disease by a health care provider; laboratory evidence of immunity or disease; or for women who are not pregnant, immunocompetent individuals, and individuals who are not health care providers, born in the U.S. before 1980. Given the likelihood of false positive reports, self-reporting is no longer considered evidence of immunity.
What is the type of immunity that occurs when a pregnant woman is vaccinated with Tdap to protect the infant from pertussis after birth?
Acquired immunity involves immunological memory. It is something the body develops upon exposure to pathogens or antigens and results in antigen-antibody complex formation. Cell-mediated immunity is a component of acquired immunity and destroys pathogens that have entered cells. Acquired immunity can be active or passive. Active immunity occurs when an antigen from an invading pathogen or a vaccine triggers the immune system to respond. Passive immunity happens when antibodies are provided from another source, such as or upon receipt of blood products or immunoglobulin when maternal antibodies are transferred to the fetus. This is the reason Tdap is given with every pregnancy—the maternal antibodies passed to the fetus protect the newborn from pertussis.
Alex is a 32-year-old man who is scheduled to travel to a country where hepatitis A is endemic. He leaves in 3 weeks and will be gone a month. He received his first dose of hepatitis A vaccine today. Alex should be counseled to return for his second dose of hepatitis A vaccine:
Adults needing protection from the hepatitis A virus should receive a two-dose series. The second dose should be given at least 6 months after the first dose
All Medicare Part B enrollees are covered for which vaccines?
All Medicare Part B enrollees have coverage for both pneumococcal vaccines and the influenza vaccine, while hepatitis B vaccine is covered only for specific high-risk patients. The Td/Tdap and herpes zoster vaccines are covered under a patient's Medicare Part D plan.
Upon giving a VIS to a patient who is to receive a vaccine cover under the National Childhood Vaccine Injury Act, what must be documented?
As outlined within the Vaccine Injury Compensation Program (VICP) within the NCVIA, a copy of the most up-to-date version of the vaccine information statement (VIS) must be given to the patient or the patient's caregiver before administering the vaccine. The provider must document the patient name, date the vaccine was administered, vaccine manufacturer and lot number, name, address, and title of person administering the vaccine, date printed on the VIS, and date the VIS was given to the vaccine recipient or that person's legal representative. A patient's or caregiver's signature for activities and documents pertaining to vaccine administration is not mandated by federal law. However, some states or employers may require signatures.
John is a 46-year-old man with diabetes. He requests a refill of his diabetes testing supplies on October 21st. His immunization record indicates that he has completed the primary series of MMR, DTaP, HepA, and HepB vaccines. John has a documented history of chickenpox, and his last Td booster dose was 19 years ago. Which of the following vaccines should he receive?
Because John has diabetes both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines he needs. Because Tdap is recommended for all adults who have not had that vaccine, he needs Tdap. Influenza vaccine is universally recommended and is important for John because his diabetes places him at high-risk for influenza complications. He is also a candidate for PPSV23, which is recommended for patients with diabetes. PCV13 is recommended for those with immunocompromising conditions, but is not currently recommended for patients with diabetes.
Kate is a 24-year-old woman with asthma. She requests a refill of her albuterol inhaler on November 1st. Kate's immunization record indicates that she completed the primary series of MMR, varicella, DTaP, HepA, and HepB vaccines, and she received a dose of Tdap 2 years ago. For complete coverage, which of the following vaccines should she receive?
Because Kate has asthma, both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines she needs. PPSV23 is recommended for those ages 19 through 64 years of age with asthma. She did not receive HPV as an adolescent and is younger than 27 years of age so she would be a candidate for HPV vaccination. Influenza vaccine is universally recommended and is important for Kate because her asthma places her at high-risk for influenza complications. She will not need Td vaccination for another 8 years. PCV13 is recommended for those with immunocompromising conditions, but not asthma.
Alan is a 47-year-old man who has no documentation of a primary series of tetanus-containing vaccine. Which of the following would be an appropriate primary series for Alan?
DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP. Adults with an unknown or incomplete history of a 3-dose primary series with tetanus and diphtheria toxoid-containing vaccines should complete the primary series. The initial dose in this series should be Tdap. The second dose should be Td given at least 4 weeks later. The third dose, also using Td, should be 6-12 months after the second dose. A booster of Td is then given every 10 years after the third dose.
Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never experienced any adverse effects from vaccinations. At his next well-child check-up, Kyle will be receiving the following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine. Which of the following tetanus-containing vaccines would be appropriate for him?
DTaP is a five-dose series given at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. Kyle is due for his 5th and final dose of DTaP. DTaP is appropriate for children less than 7 years of age. DT is only reserved for children who have a contraindication to the pertussis component in DTaP. Children, adolescents, and adults 7 years of age and older who require protection against tetanus, diphtheria, and pertussis would receive Tdap. Following the one-time dose of Tdap, a Td booster should be given every 10 years.
Which disease is characterized by the development of a membrane on the tonsils, pharynx, or larynx, leading to respiratory obstruction?
Diphtheria is caused by Corynebacterium diphtheriae, which enters the body through the respiratory tract. C. diphtheriae can infect any mucous membrane in the body, with the most common sites being the tonsils, pharynx, larynx, and nasal mucosa. The infection can cause tissue destruction and usually results in the formation of a pseudomembrane, which is a characteristic sign of diphtheria infection. This bluish-white membrane develops on the tonsils and pharynx within 2 to 3 days. As the membrane extends into the airway, it can lead to respiratory obstruction. Bordetella pertussis, infects the respiratory tract and produces toxins that interfere with the function of the respiratory tract, ultimately causing the characteristic symptoms of pertussis. Symptoms begin as they would for the common cold but then transition to a paroxysmal (whooping) cough. Haemophilus influenza type b (Hib) is spread by respiratory transmission and most commonly causes pneumonia, bacteremia, and meningitis. Meningitis is an infection of the brain and spinal cord, which can lead to a variety of complications including brain damage and deafness.
According to ACIP recommendations, HZV is indicated for the prevention of herpes zoster in adults aged:
Even though the herpes zoster vaccine (Zostavax) is FDA approved for individuals aged 50 and older, the ACIP recommends this vaccine for individuals aged 60 and older. There are concerns about waning immunity with this vaccine. If given too soon (before age 60), it may not afford protection in older individuals who are at higher risk of herpes zoster.
Which of the following patients is a candidate for both MenACWY and MenB vaccines?
Even though the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) and the serogroup B meningococcal vaccine both provide protection against meningococcal disease, the risk of infection for the various strains and age indications of vaccines differ. Both are recommended during outbreaks of the respective serogroup(s) as well as for individuals with functional or anatomic asplenia and persistent complement component deficiencies. While MenACWY can be used beginning at age 2 months, MenB is not recommended for use until age 10 years. HIV infection and being in the military are considered risk factors for the serogroups in MenACWY, but not serogroup B.
After completion of a primary vaccine series and documentation of a one-time dose of Tdap, Td booster doses are recommended every:
Following the one-time dose of Tdap that is given after the primary series has been completed, a Td booster should be given every 10 years.
HZV should not be administered to a patient with a history of anaphylaxis to:
Gelatin can be found in the MMR vaccine, rabies vaccine, typhoid vaccine, varicella vaccine, yellow fever vaccine, herpes zoster vaccine (HZV), and any combination vaccines that include these. A patient with a severe allergy to gelatin would have a contraindication to receiving these vaccines. HZV also contains neomycin, but does not contain egg protein, latex, or tree nuts.
A health care provider who has not been vaccinated against hepatitis B is stuck by a contaminated needle after administering an immunization to a hepatitis B-positive patient. In addition to hepatitis B vaccine, the health care provider also should receive hepatitis B Immunoglobulin (HBIG) as postexposure prophylaxis because the HBIG provides:
Giving both the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) allows for active and passive immunity. Active immunity occurs when the antigen from the vaccine triggers the immune system to respond. The vaccine will provide long-term protection but it takes the body about two weeks to develop immunity. Passive immunity happens when antibodies are provided from another source, such as immunoglobulin. Passive immunity is short-live, but it provides protection right away.
What is the time interval for which the development of Guillain-Barré syndrome following influenza vaccination would result in a precaution for future influenza vaccines?
Guillain-Barré Syndrome (GBS) is an autoimmune, neuromuscular disease. Although rare, it can occur following viral infections and, in some instances, receipt of influenza and tetanus-containing vaccines. If GBS has occurred within 6 weeks of receipt of either of these vaccines, this would be considered a precaution for future vaccination with the associated vaccine. Such individuals should not be vaccinated unless the benefits of vaccination and preventing disease outweigh the risks of GBS recurring. If GBS occurred greater than 6 weeks following vaccination, then it is not likely that the occurrence of GBS was associated with the vaccine.
Prior to the introduction of a vaccine, what was the leading cause of bacterial meningitis in children younger than 5 years of age?
H. influenzae type b (Hib) is an aerobic gram-negative coccobacillus spread by respiratory transmission from asymptomatic carriers.Before the availability of vaccines, Hib affected 1 of every 200 children in the United States, accounting for more than 20,000 cases each year.It was the leading cause of bacterial meningitis in children younger than 5 years of age. Hib vaccines have been highly effective—disease incidence was reduced from 20,000 cases in 1985 to 17 cases reported in 2010.
Robert is a 48-year-old pharmacist who is preparing to provide immunizations in his pharmacy for the first time next fall. He has no documentation of receiving the hepatitis B vaccine and would like to be vaccinated before administering vaccines in his practice. What is the recommended routine schedule for vaccination against hepatitis B?
Hepatitis B vaccine is routinely given as a 3-dose series. For adults seeking protection against the hepatitis B virus, the routine schedule is 0, 1, and 6 months.
Which of the following statements is true regarding varicella-containing vaccines?
Herpes zoster vaccine (Zostavax) contains 14 times more antigen than varicella vaccine. This greater potency is necessary to elicit an adequate immune response in older patients who have immunity to varicella because they previously had chicken pox.
For a patient who needs to receive IIV and HZV, which of the following best describes appropriate administration of these vaccines?
IIV is the inactivated influenza vaccine and HZV is the live, attenuated herpes zoster vaccine. Inactivated vaccines do not interfere with the immune response to other vaccines, live or inactivated. There is no need to observe any minimum interval between doses of two different inactivated vaccines, nor between combinations of inactivated and live vaccines. The concern is when two live vaccines are not administered at the same clinic visit. If two live vaccines are not given simultaneously, at least 4 weeks must pass before giving the other live vaccine.
Which of the following immunization strategies is preferred for adults under the age of 65 years with immunocompromising conditions who require both PCV13 and PPSV23?
Ideally, when individuals require both PCV13 and PPSV23, PCV13 should be given first. For those with immunocompromising conditions at high-risk for pneumococcal disease, the interval between PCV13 and PPSV23 is at least 8 weeks. This 8-week interval also applies to those with asplenia, cochlear implants, and cerebrospinal fluid leaks. All others would wait at least one year between the two vaccines.
If a patient received the first dose of HepB but did not return for the remaining doses in the series, under what circumstances should the HepB series be restarted?
If patients fall behind with vaccinations given in a multi-dose series, it usually is not necessary to start the series over; oral typhoid is the one exception. Increasing the interval between doses of a multi-dose vaccine series does not diminish the ultimate effectiveness of the vaccine, but it does delay protection for the patient.
When Mary turned 64, she was diagnosed with type 2 diabetes. At that time, she received PPSV23. Which of the following represents appropriate pneumococcal coverage for Mary
Immunocompetent adults aged 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after PCV13. However, if an individual is a candidate for PPSV23 prior to age 65 due to high-risk conditions (in this case diabetes), then another dose of PPSV23 would be recommended after the individual turns 65, but should be given 5 years after the 1st dose. Since Mary received PPSV23 prior to PCV13, then PCV13 should be administered at least one year after PPSV23.
According to ACIP recommendations, what is the maximum number of doses of PPSV23 a patient should receive in his or her lifetime?
Immunocompromised individuals and those with asplenia should receive two doses of PPSV23 five years apart. If the second dose was administered prior to age 65, then a third dose would be given after the individual turns 65 (and five years after the previous dose). It is possible for these individuals to receive up to three doses of PPSV23. However, there are no circumstances in which more than three doses would be recommended.
Jackie is a 34-year-old woman who received an influenza vaccine from you today. She wants to know how long it will take for the vaccine to begin working to protect her from getting the flu. What would be the most appropriate response to this patient?
Immunologic Memory.
If a patient is a candidate for revaccination with PPSV23, what is the ACIP-recommended interval between doses of this vaccine?
Individuals at high-risk for pneumococcal disease may require one to three doses of PPSV23, depending on age and condition. When multiple doses are required, the interval between doses should be 5 years. For example, individuals under the age of 65 who are immunocompromised or have asplenia should receive two doses of PPSV23 five years apart. If the second dose was administered prior to age 65, then a third dose would be given after the individual turns 65 (and five years after the previous dose).
Which of the following is most likely to result in an influenza pandemic?
Influenza A is the main contributor to pandemic and epidemic outbreaks of disease. A pandemic is a worldwide outbreak. In the case of influenza, this is often due to an antigenic shift in which one or both of the surface antigens on the influenza A virus change. A new strain is created that can result in widespread infection. Antigenic drift occurs continuously and leads to minor changes in the structure of the virus, but does not result in new strains.
At what point during pregnancy is it recommended to administer the influenza vaccine?
Influenza vaccination during pregnancy not only decreases the risks for influenza-related complications during pregnancy, but has also been shown to reduce influenza-related hospitalizations in newborns. For women pregnant during the influenza season, the ACIP recommends that the influenza vaccine be given during any trimester. While there may be some vaccines that are more effective when given during a specific trimester (e.g., Tdap) or others that may be safer to administer prior to or after pregnancy (e.g., live vaccines), the influenza vaccine does not have these issues and can be given at any time.
Tom is a 9-year old boy who has never had an influenza vaccine. Tom's mother shows you his up-to-date immunization record and reports that he has never had any adverse reactions to vaccinations. What dose and schedule of IIV should be administered to Tom?
Influenza vaccination is universally recommended beginning at age 6 months. Children aged 6 months through 8 years who have not previously received at least two dose of the influenza vaccine should receive 2 doses, 4 weeks apart. Beginning at age 9, children only need one dose during an influenza season. The dose of influenza vaccine is 0.25 mL for children aged 6 months through 2 years. Children 3 years of age and older would get 0.5 mL.
the past with no reported adverse reactions. Aiden's father asks about having his son vaccinated against influenza. The most appropriate response would be to inform the father that Aiden:
Influenza vaccination is universally recommended beginning at age 6 months. Children aged 6 months through 8 years who have not previously received at least two dose of the influenza vaccine should receive 2 doses, 4 weeks apart. Children aged 6 months can be given either the trivalent or quadrivalent inactivated influenza vaccine (IIV3 or IIV4), so long as the age indications for the product are appropriate. It is not recommended that LAIV be used for the current influenza season. Furthermore, LAIV is approved for healthy individuals 2 through 49 years of age. Even if it was recommended, Aiden would be too young.
Which of the following statements about live attenuated vaccines is true?
Live attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that it can cause disease. Inactivated vaccines are produced by killing the virus or bacteria. They include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular vaccines (which can be viruses or bacteria, or fractions of either). Live attenuated vaccines tend to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated vaccines must replicate inBarbara is a 60-year-old woman who presents to the pharmacy for two vaccines: HZV and IIV. Which of the following are the appropriate doses and routes for administering these vaccines to this patient? order for the body to produce an immune response. If given to a patient with a compromised immune system, there is a chance they could replicate in an uncontrolled fashion and cause disease. Circulating antibodies may interfere with a live attenuated vaccine's ability to replicate.
If pharmacists are called upon to assist with vaccination efforts following a natural disaster, which vaccine is likely to be needed by many of the victims?
Natural disasters, such as hurricanes, earthquakes, and floods, may increase the risk for tetanus infections due to environmental microbes, such as the contamination of wounds from bacteria in the soil. Therefore, it is important to provide Td or Tdap vaccination for victims in disaster-affected areas. Natural disasters have not been found to increase risk for pneumococcal disease, measles, mumps, rubella, or meningococcal B.
A history of anaphylaxis caused by neomycin would be a contraindication to receiving which of the following vaccines?
Neomycin can be found in hepatitis A vaccine, inactivated polio vaccine (IPV), MMR, rabies vaccine, smallpox vaccine, varicella vaccine, zoster vaccine, several influenza vaccines, and any combination vaccines that include these. A patient with a severe allergy to neomycin would have a contraindication to receiving these vaccines.
After reconstitution, within what time frame must HZV be administered?
Once reconstituted, the herpes zoster vaccine (Zostavax) must be administered within 30 minutes. Although this vaccine should be stored in the freezer, prior to reconstitution, it is stable at refrigerator temperatures of 2°C to 8°C (36°F to 46°F) for up to 72 hours.
Which of the following tetanus booster vaccines would be most appropriate for administration to a 12-year-old boy who has completed a primary series with DTaP and has no known allergies?
One dose of Tdap is routinely recommended for all adolescents who have completed the primary series of DTaP. This should be given at 11 to 12 years of age. DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Following the one-time dose of Tdap, a Td booster should be given every 10 years. DT, which has a higher amount of diphtheria toxin is only reserved for children who have a contraindication to the pertussis component in DTaP.
What is the most common complication of pertussis?
Pertussis, which is is caused by Bordetella pertussis, infects the respiratory tract and produces toxins that interfere with the function of the respiratory tract, ultimately causing the characteristic symptoms of pertussis. Symptoms begin as they would for the common cold but then transition to the paroxysmal (whooping) cough. Given the impact on the respiratory tract, pneumonia is the most common complication. Poor oxygenation during the coughing episodes can lead to hypoxemia and seizures, but these are less common. Colic is inconsolable crying, which has been attributed to abdominal pain. This is unrelated to pertussis.
Which of the following is the best example of a group with which individual pharmacists can collaborate to increase immunization rates in their communities?
Pharmacists often work with their local health departments to provide vaccines and public health services in their communities. They may collaborate on various public health outreach and emergency response activities. The Advisory Committee on Immunization Practices (ACIP) is the leading authority in the U.S. that provides comprehensive vaccination recommendations and guidelines. These recommendations are reviewed and approved by the CDC. The National Vaccine Advisory Committee (NVAC) is an entity of the U.S. Department of Health and Human Services. NVAC has the responsibility of recommending ways to prevent disease through vaccine development and promoting opportunities to prevent adverse reactions to vaccines. While pharmacists may work with the ACIP, the CDC, and NVAC on immunization initiatives, they do not often collaborate on a local level.
What is the standard dose of epinephrine for managing anaphylaxis?
Preferably, epinephrine is dosed on the basis of the patient's body weight. Aqueous epinephrine (1 mg/mL preparation) should be administered at a dose of 0.01 mg/kg/dose, up to a maximum of 0.5 mg per dose. The dose of epinephrine can be repeated every 5-15 minutes (according to the patient's response), up to three doses.
Federal law makes offering an annual influenza vaccination a requirement for continued federal funding in which setting?
Resident of long-term care facilities are at high-risk for influenza and pneumococcal disease. If a long-term care facility receives funding from Medicare, it must offer influenza vaccine annually to its residents. Pneumococcal vaccine must also be offered at least once during the resident's stay. The Centers for Medicare and Medicaid Services (CMS) began requiring this in 2005 as a condition of participation. This is not mandated for patient-centered medical homes, accountable care organizations, or home health care.
Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living in dormitories, who have not been previously vaccinated?
Routine vaccination with the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) is one dose at ages 11 to 12 years and a booster dose at age 16 years. A first-year college student aged 21 years or younger living in residential housing who has not been previously vaccinated with MCV4 is considered high-risk for meningococcal disease. One dose should be administered. Living in dormitories on a college campus is not considered a risk factor for pneumococcal disease, HPV, or varicella.
Adolescents should be routinely vaccinated with MCV4 on the following schedule:
Routine vaccination with the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) is one dose at ages 11 to 12 years and a booster dose at age 16 years. According to ACIP, adding this booster dose substantially reduces the number of cases and deaths due to meningococcal disease while the initial dose serves to protect the younger adolescents.
Which of the following is recognized by sociologists as a factor in a patient's decision whether to be vaccinated?
Sociologists have identified five key factors in a person's decision to be vaccinated: 1) perceived susceptibility to a disease, 2) perceived seriousness of a disease, 3) perceived vaccine benefits, 4) perceived vaccine barriers (e.g., adverse effects, access), and 5) social influence (e.g., recommendation from a health care provider
In which publication does the CDC initially publish new or updated vaccine recommendations?
The Advisory Committee on Immunization Practices (ACIP) develops vaccine recommendations and guidelines. These are reviewed and approved by the CDC Director and the U.S. Department of Health and Human Services. Once approved, they are published in the CDC's Morbidity and Mortality Weekly Report (MMWR). The Epidemiology and Prevention of Vaccine-Preventable Diseases (commonly referred to as the Pink Book) provides comprehensive information about vaccines and the diseases they prevent. Content published in the MMWR regarding vaccines is often incorporated into this resource. Needle Tips is a newsletter published multiple times throughout the year by the Immunization Action Coalition. It provides timely updates and answers to frequently asked questions. Vaccine is a journal affiliated with the Edward Jenner Society and The Japanese Society for Vaccinology. It is a forum for the publication of research, reviews, and commentaries related to vaccines.
The childhood/adolescent and adult immunization schedules are updated and published annually during which months?
The Advisory Committee on Immunization Practices (ACIP) meets at least three times a year to discuss vaccine recommendations and guidelines. Although new recommendations may result from these meetings, the comprehensive schedules for children, adolescents, and adults are published once per year. These are typically made available at the end of January or early February.
Which of the following best describes how to administer MMR vaccine to an adult patient weighing 210 lb?
The MMR vaccine is administered subcutaneously at a 45 degree angle into the outer aspect of the upper arm. Vaccines that are given intramuscularly are administered into the deltoid muscle at a 90 degree angle. The weight of the patient does not matter with regard to route of administration.
Which of the following is a requirement of the Occupational Safety and Health Administration's (OSHA's) Bloodborne Pathogens Standard?
The Needlestick Safety and Prevention Act of 2000 directed OSHA to redesign its Bloodborne Pathogens Standard to provide more detail in the OSHA guidelines for employers to identify, evaluate, and implement safer medical devices.This Act mandates the use of safety devices and health care employers must provide safety devices to employees to reduce the risk of occupational exposure to bloodborne pathogens. Following injection, the safety device on the syringe should be immediately activated. Used needles should never be clipped nor recapped. Preexposure vaccination with hepatitis B vaccine must be offered by the employer to all employees with job responsibilities with potential exposure to bloodborne pathogens. There is no such requirement for hepatitis A since this is not considered a bloodborne pathogen. The OSHA Bloodborne Pathogens Standard requires the employer to provide training for all personnel with potential exposure to bloodborne pathogens. OSHA training must be repeated at least annually.
During which step of the Pharmacists' Patient Care Process would a pharmacist analyze a patient's need for certain vaccines?
The Pharmacists' Patient Care Process incorporates five steps to providing patient-centered care (collect, assess, plan, implement, and follow-up). Each of these can be applied to immunization services. Collect: the pharmacist collects the information that is necessary to determine which vaccinations may be indicated. Assess: the pharmacist assesses the information collected and analyzes the need for vaccines in accordance with the ACIP recommendations. Plan: the plan should include an offer to immunize, as appropriate, as well as pertinent areas of education for the patient, including education about vaccine-preventable diseases, vaccines, and how vaccines can help the patient. Implement: The pharmacist implements the care plan in collaboration with a patient or caregiver and physician or other health care professional, as appropriate. Follow-up: includes appropriate monitoring and management of possible adverse reactions, which may range from injection-site reactions to more severe reactions such as syncope and anaphylaxis. A follow-up plan should be created for patients who initially decline a vaccine recommendation, who may have temporary contraindications, or precautions, or those referred to another immunization provider. In addition, follow-up plans are required for patients who require additional immunizations to complete a vaccine series.
Which of the following best describes how to administer Tdap vaccine to an adult patient weighing 185 lb?
The Tdap vaccine is administered intramuscularly into the deltoid muscle. Intramuscular injections should be administered at a 90 degree angle. Vaccines that are given subcutaneously are administered at a 45 degree angle into the outer aspect of the upper arm. The weight of the patient does not matter with regard to route of administration.
The monitoring system that health care providers should use to report serious adverse events after vaccination is:
The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine post-marketing safety surveillance program of the CDC and the FDA. This monitoring system collects information about adverse events that occur after the administration of vaccines in the United States to identify potential vaccine safety concerns. All immunization providers have a professional responsibility to report any serious, rare, or unexpected adverse events to VAERS. The CMS-1500 form is required by the Centers for Medicare and Medicaid Services (CMS) for billing. OSHA is the Occupational Safety and Health Administration, which has the responsibility to ensure working conditions are safe for employees. VICP is the National Vaccine Injury Compensation Program and provides a no-fault insurance fund that covers vaccine-related injuries listed in the Vaccine Injury Table (VIT).
The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic of which of the following diseases?
The classic symptoms of measles include fever, cough, coryza (runny nose), conjunctivitis, Koplik spots (a bluish-white rash on mucous membranes, especially the mouth), followed by the development of a maculopapular rash approximately 14 days after exposure. Individuals infected with mumps may not have symptoms. Others may have nonspecific symptoms, such as headache, fever, myalgia, and malaise. About 30% to 40% of individuals may experience inflammation of the parotid glands. Rubella symptoms tend to be relatively mild and may present as a maculopapular rash that occurs approximately 14 days after exposure. Others may experience arthritis and arthralgia. Varicella presents as a generalized vesicular rash.
Barbara is a 60-year-old woman who presents to the pharmacy for two vaccines: HZV and IIV. Which of the following are the appropriate doses and routes for administering these vaccines to this patient?
The dose of the herpes zoster vaccine (Zostavax) is 0.65 mL. It is administered subcutaneously in the outer aspect of the upper arm. Inactivated influenza vaccines are administered intramuscularly into the deltoid muscle. The dose for individuals aged 3 years and older is 0.5 mL.
What is the minimum needle length recommended for administering HepB vaccine to an adult patient weighing 130 lb?
The hepatitis B vaccine is administered intramuscularly into the deltoid muscle in individuals three years of age and older. The needle must be long enough to reach deep into the muscle. Fixed 1-inch needles are acceptable for patients weighing 60 kg (132 lb) or less.
According to ACIP, which of the following is a contraindication to receiving HZV?
The herpes zoster vaccine (Zostavax) is a live vaccine. It is contraindicated in individuals who are pregnant and those with compromised immune systems. This includes those with HIV and a CD4+ count less than 200, those receiving chemotherapy or radiation or other immunocompromising medications (e.g., corticosteroids), and cancer affecting the bone or lymphatic system (e.g., leukemia, lymphoma). It is also contraindicated in individuals who have experienced a severe allergic reaction to the vaccine components (e.g., gelatin, neomycin). Individuals with a history of a herpes zoster infection and those who have not received the varicella vaccine may still receive HZV. Although HZV can be administered to individuals younger than 60 years of age, this is not recommended by ACIP.
What is meant by the term "immunization neighborhood"?
The immunization neighborhood is a term coined by the American Pharmacists Association to describe the "collaboration, coordination, and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases."
The incubation period for influenza can range from:
The incubation period for influenza can range from 1 to 4 days. The onset of symptoms is usually abrupt. People infected with influenza virus may be contagious beginning 1 day before their symptoms develop and up to 5 to 7 days after becoming sick. Uncomplicated influenza usually resolves after 3 to 7 days for the majority of patients.
Which of these vaccines is a live attenuated vaccine?
The live attenuated vaccines include cholera, herpes zoster, live attenuated influenza vaccine (LAIV), MMR, MMRV, rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox), varicella, and yellow fever. All other vaccines are inactivated.
Which of these vaccines is an inactivated vaccine?
The live attenuated vaccines include cholera, herpes zoster, live attenuated influenza vaccine (LAIV), MMR, MMRV, rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox), varicella, and yellow fever. All other vaccines are inactivated.
How is the live, cholera vaccine administered?
The live cholera vaccine is administered as a single oral dose at least 10 days prior to potential exposure to V. cholera.Individuals should not eat or drink for 60 minutes before or after receipt of the vaccine.
There should be a flat hard surface in the area where vaccines will be administered to ensure:
The location for vaccine administration should have space for the patient to faint without being injured, and a flat surface for the patient to lie on if fainting occurs or if the pharmacist needs to perform CPR.
With the exception of rotavirus, the routinely recommended live vaccines are contraindicated in a patient who:
The majority of live vaccines are contraindicated in patients who are immunocompromised. Immunosuppression may reduce vaccine efficacy as well as pose a risk for disseminated infection with the normally attenuated pathogen in the live vaccine. However, some exceptions have been made depending on the level of immunosuppression. In the case of the rotavirus vaccine, severe combined immunodeficiency (SCID) is a contraindication but other immunocompromising conditions are precautions. The interval that should be observed between one or more live vaccines is four weeks. Ppsv2 Antibiotics can interfere with the oral typhoid and cholera vaccines but should be fine with all other vaccines.
Arthus reactions, which are exaggerated local reactions that can occur if a patient is vaccinated too frequently, are most commonly reported after which vaccine?
The most common adverse reactions associated with tetanus and diphtheria toxoids-containing vaccines are local injection-site reactions. These injection-site reactions are usually mild and self-limiting. However, Arthus reactions have been reported after administration of these vaccines. An Arthus reaction after vaccination with tetanus and diphtheria toxoids is not an allergic reaction and is not common. However, these reactions may occur if a patient is immunized with tetanus or diphtheria toxoids too frequently. Patients with a history of Arthus reactions after vaccination should not receive doses of Td or Tdap any more frequently than every 10 years. Arthus-type reactions have not been associated with other types of vaccines.
Which of the following vaccines is recommended for infants to receive within 24 hours of birth?
The only vaccine routinely recommended to be given at birth is the hepatitis B vaccine. This dose, when given within 24 hours of birth, is critical for reducing maternal transmission of the virus. Following the first dose, two additional doses are needed (one at age one to two months and the third dose at ages 6 through 18 months).
When looking at the schedule for vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications, what does the orange bar represent?
The schedule for vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications includes six different color-coded bars. Yellow indicates that vaccination according to the routine schedule is recommended. Purple is for vaccines that are recommended for persons with an additional risk factor for which the vaccine would be indicated. The yellow and black checkered bar indicates that vaccination is recommended, and additional doses may be necessary based on medical condition. The footnotes will need to be used for further guidance. A white bar means that there is no recommendation. Red means the vaccine is contraindicated and orange indicates there is a precaution for vaccination.
A history of anaphylaxis caused by gelatin would be a contraindication to receiving which of the following vaccines?
The vaccines that contain gelatin include live attenuated influenza vaccine (Flumist), MMR, MMRV, rabies (RabAvert), typhoid (Vivotif Ty21a), varicella, yellow fever, and zoster (Zostavax). Appendix B (Vaccine Excipient & Media Summary) of CDC's Epidemiology and Prevention of Vaccine-Preventable Diseases is a great resource to identify the various components in each vaccine.
Which of the following statements about pharmacy-based vaccination programs is true?
The vaccines that pharmacists are permitted to administer vary from state to state. Some states allow pharmacists to administer vaccines under protocol or collaborative practice agreement, while others require a prescription to administer a vaccine. Many pharmacists have initially implemented immunization services with influenza vaccine, due in part to the general high demand for the vaccine, as well as state laws that have supported this approach. Because pharmacists have the infrastructure to bill Medicare Part D prescription drug plans, it may be easier for them to offer these services for older patients and pharmacists could partner with other providers to increase immunization rates.
Herd immunity refers to which of the following situations?
There are instances in which some individuals are not able to be vaccinated. For example, infants younger than 2 months of age are too you to receive DTaP and a child with a compromised immune system would not likely receive MMR. It is important to vaccinate those in the community who can receive the vaccine to avoid outbreaks and the transmission of disease to those unvaccinated. This is called herd immunity.
Which of the following best describes an opportunity for pharmacists to use diagnosis-based screening to identify people at risk for vaccine-preventable diseases?
There are two main approaches for determining who needs a vaccine: universal immunization and high-risk targeting. Three screening strategies can be used to identify people at high-risk: diagnosis-based screening, procedure-based screening, and occurrence-based screening. Diagnosis-based screening identifies patients in need of vaccines based on the presence of a particular diagnosis (in this case, diabetes). Procedure-based screening involves assessing vaccine needs based on a patient's receipt of a surgical, medical, or pharmacy-based procedure (in this case, a splenectomy). Occurrence-based screening takes advantage of an event, such as a hospital admission, clinic visit, or emergency department visit to identify people who need to be vaccinated (in this case, discharge counseling).
Ava has arrived at the clinic for her well-child visit. She is 4 months old. Ava's immunization record reveals that she has received the following vaccines: 2 doses of HepB 1 dose of Hib 1 dose of rotavirus 1 dose of PCV13 1 dose of DTaP 1 dose of IPV Which vaccines should Ava receive at today's visit?
Upon reviewing the immunization schedule for children and adolescents, Ava is due for her 2nd dose of Hib, rotavirus, DTaP, PCV13, and IPV. She is not due for her 3rd hepatitis B dose until 6 months of age. Even though it may be influenza season, she is too young to receive influenza vaccine. IIV is not recommended until 6 months of age. MMR and varicella, which are live vaccines, are not recommended until 1 year of age.
David is a healthy 5-year-old boy who is scheduled to see his pediatrician for a checkup in July prior to starting kindergarten. David's immunization record reveals that he has received the following vaccines: 3 doses of HepB 4 doses of PCV13 2 doses of HepA 3 doses of IPV 2 doses of rotavirus 1 dose of MMRV 4 doses of DTaP 4 doses of Hib Which vaccines should David receive at this visit?
Upon reviewing the immunization schedule for children and adolescents, David will need his 5th dose of DTaP, 4th dose of IPV, 2nd dose of MMR, and 2nd dose of varicella. His PCV13, Hib, hepatitis A and B series are complete. Depending on the rotavirus vaccine used, two doses may have completed the series. Regardless, David is too old to receive any additional rotavirus vaccine doses. He does not require the meningococcal vaccine (MCV4) until he is 11 to 12 years of age. Because he needs both MMR and varicella, he may receive the MMRV combination vaccine again.
Emily is a 16-year-old high-school student with no chronic medical conditions. Emily's immunization record shows that she completed the primary series for IPV, HepA, Hib, DTaP, and MMR, and she had a physician-diagnosed case of chickenpox at 2 years of age. Which of the following would be the most appropriate recommendation for her today?
Upon reviewing the immunization schedule for children and adolescents, Emily was supposed to receive Tdap, MCV4, and HPV at ages 11 to 12. It also appears she did not receive her hepatitis B vaccines as an infant. Emily will need to get caught up on these four vaccines. Since influenza vaccine is universally recommended on an annual basis, she should receive that as well if it is during influenza season. We would refer to the catch-up schedule for dosing interval guidance.
Which of the following documents must be given to every patient or patient's caregiver before administration of a vaccine covered under the National Childhood Vaccine Injury Act (NCVIA)?
Vaccine information statemetns (VISs) are standardized forms that provide an overview of the risks and benefits of vaccines. Health care providers who administer vaccines are required by law to provide patients with the most up-to-date version of the VIS for any vaccine covered under the National Childhood Vaccine Injury Act (NCVIA). The CMS-1500 and CMS-855B are forms required by the Centers for Medicare and Medicaid Services (CMS) for billing and enrolling as a Medicare provider, respectively. The PHS-731 is now the CDC 731 form and is the International Certificate of Vaccination or Prophylaxis as Approved by the World Health Organization (the Yellow Card).
Which of the following statements is true regarding how vaccines evoke an immune response?
Vaccines contain antigens that stimulate an immune response and result in immunologic memory. B cells are activated in this process. Except for pure polysaccharide vaccines, T cells are also activated and are able to generate additional B cells. B cells express unique receptors that recognize and bind to only one particular antigen. B cells are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph. This is referred to as humoral immunity. B cells mature to plasma cells and antibodies that help the body eliminate the antigen are formed.
Why should refrigerated vaccines be stored in the middle of the refrigerator?
Vaccines should be stored in the middle of the refrigerator, not in the door or on the bottom shelf, because the temperature in the middle does not fluctuate as much
Why are adjuvants added to vaccines?
When an adjuvant is added to a vaccine, this results in an inflammatory response. This, in turn, strengthens the response to the antigen and the immune response is much greater. For instance, adjuvants are added to recombinant vaccines. When used alone, recombinant vaccines evoke a weak immune response. When adjuvants are added, the immune response is strong.
Why was the live attenuated influenza vaccine (LAIV) removed from the ACIP's influenza vaccine recommendations?
When used according to its approved indications, LAIV has not been shown to cause influenza or serious adverse events. However, based on data that demonstrated LAIV efficacy was lower than expected in the 2013-2014 and 2015-2016 influenza seasons, the ACIP made the recommendation to avoid its use. This recommendation began with the 2016-2017 influenza season. Although there have been some production and supply issues with LAIV in recent years, this had no impact on its removal as a recommended vaccine for influenza.
Which of the following statements about establishing clinics for administering vaccines is true?
Year-round vaccine programs more readily lend themselves to being managed as prescriptions within the usual pharmacy workflow, whereas seasonal or high-demand vaccines may be better suited for clinics during which additional resources and time can be devoted. Immunization clinics can be held in pharmacies as well as other venues, such as businesses (including health care organizations which have a need to immunize providers), schools, houses of worship, community centers, and other community gathering areas. Pharmacy technicians can serve an important role during clinics to help manage workflow, such as providing paperwork (e.g., VISs, screening questionnaires). Each state dictates the duties a student pharmacist may perform, which may or may not include vaccine administration.
In the event that a young child is fussy following the receipt of a vaccine, pharmacists should advise parents to:
Young children may experience drowsiness, fretfulness, or poor appetite following vaccination. Parents should be advised to plan quiet activities and comfort their children as needed. Children's formulations of acetaminophen or ibuprofen can be used to relieve local discomfort, if needed. Aspirin is not recommended for use in children. If more serious adverse reactions occur, parents should be instructed to seek emergency care and to follow up with the pediatrician as necessary.
Which of the following statements would be accurate when responding to a patient's concerns about the safety of vaccines?
cause influenza. The intranasal influenza vaccine is a live vaccine, but the virus has been modified so that it cannot cause disease. No vaccine is 100% effective and efficacy varies depending on the vaccine. Furthermore, if illness does occur in someone vaccinated, it is often less severe. Thimerosal is a mercury-containing compound that has been used for decades as a preservative in vaccines to prevent bacterial contamination. There is no scientific evidence showing any short- or long-term harm from exposure to thimerosal in vaccines. One myth that has circulated about vaccines is that some manufacturer lots are associated with higher incidences of adverse events reported to VAERS (i.e., hot lots). To date, no vaccine lot in the modern era has been found to be unsafe on the basis of VAERS reports. There is a misperception that giving several vaccines on the same day overloads the patient's immune system. In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person's immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines.
