Immunizations *need to update

Which of the following vaccines are recommended for infants and children?

3-dose hepatitis B vaccine started at birth Other vaccine series start at age 2 months, including: Prevnar 13, DTaP, Hib, Polio, Rotavirus Live vaccine series generally start at age ≥ 12 mo, including: MMR, Varicella No polysaccharide vaccines before age 2 years

Which of the following patients should receive the MenB vaccine?

A 10 year old with sickle cell disease A 19 year old on a college campus during a meningitis serogroup B outbreak A 25 year old lab worker exposed to N. Meningitidis

Which of the following statements are true concerning Zoster Virus Vaccine?

ACIP recommends routine vaccination with Shingrix (2 doses given at month 0 and month 2-6) in patients age ≥ 50 years, including those who previously received varicella virus vaccine or Zostavax Vaccinate even if the patient has a history of zoster infection, since recurrence is possible Store vaccine and adjuvant liquid in the refrigerator. Do not freeze Give IM

Influenza Vaccine Tips

Age 6 months to 8 years (not previously vaccinated): Give 2 doses (4 weeks apart). Patients with an egg allergy: Can receive any age-appropriate inactivated influenza vaccine, even if severe allergy symptoms. Flublok (an egg-free product) is approved for age > 18 years only. Flucelvax (egg-free; grown in a cell culture) is approved for age > 4 years. If using an influenza vaccine other than Flublok or Flucelvaxin a patient with a severe egg allergy (i.e., more than hives), the vaccine should be administered in a medical setting under thesupervision of a healthcare provider who is able to recognize and treat severe allergic reactions. Do not administer the live influenza vaccine (FluMist). Pregnant patients: Can receive any age-appropriate inactivated influenza vaccine. Do not administer the live influenza vaccine (FluMist). Indicated only for patients age ~ 65 years: Fluzone High Dose Quadrivalent and Fluad (adjuvanted influenza vaccine)

Vaccinations for healthcare professionals:

Annual influenza is usually required (with proof/documentation of vaccination) Hepatitis B: if there is no evidence of vaccine series completion or a blood test showing immunity Tdap: 1 dose, if not up-to-date, then Td or Tdap every 10 years Varicella: if there is no history of vaccination or chickenpox infection MMR: if there is no history of vaccination or a blood test showing immunity

Which of the following statement are true concerning Varicella Virus Vaccine?

Anyone without evidence of immunity to varicella should receive 2 doses of Varivax Do not use in pregnancy or if immunocompromised Some antivirals (e.g.,acyclovir, valacyclovir, famciclovir) can interfere with Varivax(live vaccine). Stop 24 hours before vaccine administration and do not take for 14 days after vaccination Store vaccine in the freeze Reconstitute immediately upon removal from the freezer and inject Do not give if there is a hypersensitivity to gelatin or neomycin Give SC

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

Bacille Calmette Guerin (BCG)

Meningococcal Vaccines

CV4 (Conjugate Vaccines) Menactra: for age 9 months-55 years MenQuadfi: for age > 2 years Menveo: for age 2 months-55 years MenB (Bexsero, Trumenba): for age 10-25 years

Which of the following statements is correct about Vivotif?

Capsules are stored in the refrigerator Take on an empty stomach (1 hour before a meal) with cold or lukewarm water Take 1 capsule PO on alternative day Complete at least 1 week prior to possible exposure

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

DTaP

Poliovirus-Containing Vaccines:

DTaP-HepB-IPV Pediarix

Diphtheria, Tetanus, toxoids and acellular Pertussis

DTaP-HepB-IPV: Pediarix (DTaP) Tdap: Adacel,Boostrix (Td, Tdap)

Which of the following statements are true concerning Measles, Mumps and Rubella vaccine?

Do not use in pregnancy or if immunocompromised MMR: store in the refrigerator or freezer MMRV: store vaccine in the freezer only due to the varicella component Store diluents at room temperature or in the refrigerator Give SC

Which of the following vaccines contain Hepatitis B only?

Engerix-B Heplisav-B Recombivax HB

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

Epinephrine

Intranasal vaccines:

FluMist Quadrivalent (Live Attenuated Vaccine)

What is Active Immunity?

From the person's own immune system (from vaccines or fighting an infection). Lasts a long time, often a lifetime.

The tuberculin skin test (TST), also called a purified protein derivative (PPD) test, is used to determine if a person has latent tuberculosis (TB). Live vaccines can cause a false- negative result. Options to reduce the risk of a false-negative TST result include:

Give the live vaccine on the same day as the skin test Wait 4 weeks after alive vaccine to perform the skin test Administer the skin test first, wait 48-72 hours to get the result, then give the live vaccine

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

HIV infection Multiple myeloma about the begin treatment A solid organ transplant recipient Chronic renal failure undergoing hemodialysis These patients are immunocompromised and should receive Vaxneuvance followed by one dose of Pneumovax 23 at least eight weeks later

Vaccinations for sickle cell disease & other causes of asplenia:

Haemophilus Influenzae Type B (Hib vaccine) Pneumococcal vaccines Meningococcal vaccines: Meningococcal conjugate vaccine (Menactra, Menveo or MenQuadfi) Serogroup B meningococcal vaccine (Bexsero or Trumenba)

Which of the following vaccines contain Hepatitis A only?

Havrix VAQTA

FluMist could be recommended for which of the following patients?

Healthy patients age 2 - 49 years old

Hepatitis containing vaccines:

Hepatitis A: Havrix, VAQTA Hepatitis B: Engerix-B, Heplisav-B, Recombivax HB DTaP-HepB-IPV: Pediarix

Vaccinations for older adults:

Herpes zoster vaccine (Shingrix): age ~ 50 years, 2 doses, 2-6 months apart Pneumococcal vaccine (age > 65 years) (if never received before): PCV20 x 1 or PCV15 x1 followed by PPSV23 x1 ≥ 12 months later (can be given ≥ 8 weeks later if immunocompromised) Shingrix recommendations have expanded to include adults aged ≥ 19 years if immunosuppressed (or expected to become immunosuppressed)

Typhim Vi, a vaccine for typhoid fever, is available for adults and children > 2 years old. What route is Typhim Vi administered?

IM single dose - given at least 2 weeks prior to expected exposure

What is the regimens for HPV9 (9-Valent): Gardasil9 if started at age 15 or older?

If started at age 15 or older, or if immunocompromised ➔ 3 doses

What is the regimens for HPV9 (9-Valent): Gardasil9 if started before age 15?

If started before age 15 ➔ 2 doses (at month Oand 6-12 months later)

Vaccinations for adults:

Influenza Tdap, Td Shingles Human Papillomavirus (HPV) Pneumococcal Meningococcal Hepatitis B Hepatitis A

Yellow fever is a viral infection transmitted by a bite from infected mosquitoes most commonly found in parts of South America and Africa. Which of the following are True about the yellow fever vaccine YF-VAX? (SATA)

It is a live vaccine It should not be administered to patients with a severe (life threatening) allergy to eggs and gelatin, immunosuppression, age < 6 months or breastfeeding Is give SC one dose > 10 days before travel The booster can be administered every 10 years for those at continued risk of exposure

Vaccinations for pregnancy:

Live vaccines are contraindicated Influenza vaccine, inactivated (not live) can be given in any trimester Tdap x 1 with each pregnancy (weeks 27-36, optimally)*

Vaccinations for immunodeficiency:

Live vaccines are contraindicated Pneumococcal vaccines HIV (CD4 count< 200 cells/mm'): Meningococcal conjugate vaccine (Menactra, Menveo or MenQuadfi) Hepatitis A vaccine Hepatitis B vaccine

List the common live vaccines: (HINT: MICRO-VY)

MMR Intranasal Influenza Cholera Rotavirus Oral Typhoid Varicella Yellow Fever

SC only vaccines:

MMR MMRV Varicella Yellow Fever Dengue Smallpox Monkeypox

Which of the following statements are correct concerning live vaccines and antibody?

MMR and varicella-containing vaccines require separation from antibody-containing products (e.g., blood transfusions, IVIG). The recommended spacing is: Vaccine ➔ 2 weeks ➔ antibody-containing product Antibody-containing product ➔ 3 months or longer ➔ vaccine

Measles, Mumps and Rubella-Containing Vaccines (Live Attenuated):

MMR: M-M-R II MMRV (MMR +Varicella): ProQuad

Which of the following vaccines are recommended for adolescents and young adults?

Meningococcal vaccine (MCV4; Menactra, Menveo or MenQuadfi) 2 doses: 1 dose at age 11-12 years and 1 dose at age 16 years First-year college students in residential housing (if not previously vaccinated): 1 dose Human papillomavirus vaccine: Recommended at age 11-12 years 2 or 3 doses (depending on age at start) Tdap: first dose at age > 11 years

Vaccinations may be given, if indicated, in the following situations:

Mild acute illness (slight fever, mild diarrhea) Current antimicrobial treatment Previous local skin reaction (mild/moderate) from a vaccine Allergies: bird feathers, penicillin, allergies to products not in the vaccine Pregnancy (except live vaccines), breastfeeding, preterm birth Recent tuberculin skin test lmmunosuppressed person in the household, recent exposure to the disease or convalescence Family history of adverse events to the vaccine

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

One dose today, followed by a second dose in 28 days

Pneumococcal vaccines

PCV13 (Prevnar 13) continues to be recommended for routine pneumococcal vaccination in children ≤ 18 years. There are three pneumococcal vaccines recommended for adults: Two conjugate vaccines: PCV15 (Vaxneuvance) and PCV20 (Prevnar 20) One polysaccharide vaccine: PPSV23 (Pneumovax 23) Adults aged 19-64 years with certain underlying medical conditions or age ≥ 65 years (if never received before) :PCV20 x 1 or PCV15 x1 followed by PPSV23 x1 ≥ 12 months later (can be given ≥ 8 weeks later if immunocompromised)

IM or SC vaccines:

PPSV23 IPV(IPOL)

Fluad could be recommended for which of the following patients?

Patients > 65 years old

Fluzone high dose could be recommended for which of the following patients?

Patients > 65 years old

Flublok could be recommended for which of the following patients?

Patients with egg allergy > 18 years old

Flucelvax could be recommended for which of the following patients?

Patients with egg allergy > 4 years old

Vaccinations for diabetic patients:

Pneumococcal vaccine Adults aged 19-64 years with certain underlying medical conditions or age ≥ 65 years (if never received before): PCV20 x 1 or PCV15 x1 followed by PPSV23 x1 ≥ 12 months later (can be given ≥ 8 weeks later if immunocompromised) Hepatitis B: age 19-59 years (or at age > 60 years per healthcare provider discretion)

Diphtheria Toxoid-,Tetanus Toxoid-and acellular Pertussis vaccine is recommended in:

Pregnant or postpartum women, with each pregnancy Close contacts of infants younger than age 12 months (e.g.,father, grandparents and child-care providers), if not up-to-date Healthcare personnel with direct patient contact, if not up-to-date Children age 7-10 years who did not get fully vaccinated with the DTaP series; give a single dose of Tdap instead of DTaP.

Rotavirus Vaccines (LiveAttenuated):

RV1: Rotarix (PO) RVS:RotaTeq (PO)

What is Passive Immunity?

Received from someone else, such as receiving immunoglobulins (lg) that are pooled from other people, or through transfer from a mother to her baby.

How is influenza spread most commonly?

Respiratory droplets, from sneezing or coughing

There are two vaccines available for the prevention of rotavirus gastroenteritis in infants. They are both LIVE and ORAL vaccines:

Rotarix is available as a preservative free ORAL powder for suspension which needs to be reconstituted RotaTeq

True or False: Adverse reactions that require some type of assistance should be reported to the FDA's Vaccine Adverse Event Reporting System (VAERS).

True

True or False: DTaP is for children younger than 7 years of age

True

True or False: Haemophilus influenzae Type B (Hib) is given to adults with asplenia

True

True or False: Human Papillomavirus Vaccine HPV9 (9-Valent): Gardasil9 is recommended in patients 11 - 12 years

True

True or False: MMR is stored either in the refrigerator or freezer.

True

True or False: Minor allergic reactions will resolve quickly and can be treated with diphenhydramine (OTC) or hydroxyzine (prescription).

True

True or False: Most vaccines are stored in the refrigerator (between 36°F and 46°F, or 2°c and 8°C).

True

True or False: Pregnant women should receive Tdap during the third trimester (27 - 36 weeks) of pregnancy for the highest concentration of antibodies to be transferred to the baby

True

True or False: Simultaneous administration of vaccine and antibody (in the form of immunoglobulin) is recommended for post-exposure prophylaxis of certain diseases (e.g.,hepatitis A and B, rabies and tetanus).

True

True or False: The Advisory Committee on Immunization Practices (ACIP) provides the recommendations for vaccine administration in children and adults (i.e., who gets what vaccine and when).

True

True or False: The Centers for Disease Control and Prevention (CDC) approves the ACIP recommendations and publishes them in the CDC's Morbidity and Mortality Weekly Report (MMWR) and The Pink Book (Epidemiology and Prevention of Vaccine-Preventable Diseases).

True

True or False: The FDA approves vaccinations based on the safety and efficacy for the indication.

True

True or False: The Serogroup B (MenB) meningococcal vaccines are indicated for patients 10 - 25 years old. They are recommended for patients with asplenia/sickle disease, lab workers exposed to N. meningitis and during an outbreak situation.

True

True or False: The diluents that come with varicella, MMR and MMRVvaccines can be stored in the refrigerator or at room temperature.

True

True or False: The patient should be monitored for at least 15 minutes after vaccination (to watch for an allergic reaction, syncope, dizziness or falls).

True

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

True

True or False: The recombinant zoster vaccine (Shingrix) is indicated in patients age ≥ 50 years and age 19 years or older who are/ will be immunodeficient or immunosuppressed

True

True or False: Vaccines that should be stored in the freezer (between -58°F and +5°F, or -50°C and -15°C) include: varicella vaccine, MMRV, oral cholera vaccine, ebola vaccine, and smallpox and monkeypox vaccine.

True

Which vaccine containing antigens for both Hepatitis A and B?

Twinrix

PO vaccines:

Typhoid (Vivotifc) capsules Cholera (Vaxchora) and Rotavirus (RotaTeq, Rotarix)

Which of the following statements are true concerning intramuscular (IM) injections?

Use a 22 - 25 gauge needle. Inject at a 90-degree angle. Adults: inject into the deltoid muscle above the level of the armpit and below the shoulder joint Infants: inject in to the anterolateral mid-thigh muscle IM needle length: 1" in adults

Which of the following statements are true concerning Subcutaneous (Subcut) injections?

Use a 23 - 25 gauge, 5/8" needle at a 45-degree angle Adults: inject into the fatty tissue over the triceps Infants: inject into the anterolateral mid-thigh muscle

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

VAERS

Which of the following statements are correct concerning vaccine timing and spacing?

Vaccines can usually be given at the same time (same visit and same day) EXCEPTION: in patients with asplenia, Prevnar and Menactra should be separated by 4 weeks Multiple live vaccines can be given on the same day or (if not given on the same day) spaced 4 weeks apart EXCEPTION: no separation is required for oral rotavirus vaccines If a vaccine series requires > 1 dose, the intervals between doses can be extended without restarting the series, but they cannot be shortened in most cases

Varicella-Containing Vaccines:

Varicella Virus Vaccine:(for chicken pox): Variva MMRV: ProQuad ZosterVirusVaccine (for herpes zoster/ shingles): Shingrix

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

Vaxneuvance today, Pneumovax 23 in 1 year

Which vaccine is contraindicated with a severe (life-threatening) allergy to eggs or gelatin?

Yellow Fever