chapter 6- vaccines

what is the difference between Tdap and DTaP?

- DTaP is for <7 yrs old. while Tdap is for >7 yrs old and for the adolescent booster shot at age 10-11. - Tdap, has a reduced dose of the diphtheria and pertussis vaccines, is approved for adolescents starting at age 11 and adults ages 19 to 64. It is often called a booster dose because it boosts the immunity that wanes from vaccines given at ages 4 to 6.

reactions to vaccines

- can be reaction to the preservatives in the vaccine mixture and not the vaccine itself. -hepB Vaccine- yeast allergy contraindication. -influenza vaccine- egg allergy. thimoresal- contains mecury- was present in some vaccines. some related this to cause autism. - inactivated viruses reactions- usually are mild local tenderness, erythema and swelling at injection site and low grade fever.

varicella (chicken pox)

- single dose of live attenuated form, 0.5ml SubQ. -1st dose- 12-18 months -2nd dose- 4-6 yrs - minimum age to receive vaccine - 12 months -second dose may be given before age 4 as long as atleast 3 months have passed from the first dose. - minimum interval is 3 months but 4 weeks can be accepted as valid. - the 2nd dose is to ensure immunity. but breakthrough illness can occur but there are reduced vesicles and shorter illness. -var can be given with mmr as long as different injection sites and syringes are used but if not given at the same time, you must wait 3 months. -var can also be given with DTap, IPV, HepB or HIB.

polio vaccine

- the vaccination is an inactivated poliovirus vaccine (IPV). - all children should receive 4 doses of IPV at 2months, 4months, 6-18months and 4-6yrs of age.

Tetanus

- there are 3 forms of the tetanus vaccine: tetanus toxoid, tetanus immunoglobulin, and tetanus antitoxin (no longer available in the US). -tetanus toxoid is used for routine vaccination, and it provides protective antitoxin levels for 10yrs. -for wound management TIG can be given. Td boosters should be given to children after 10yrs if Tdap was received in adolescence.

Hib vaccine schedule

-2 or 3 dose series with a final booster dose (so 3 or for shots total). at 12-15 months. Acthib, menhibrix, pentacel- 3 doses at 2,4,6 months, booster 12-15. -pedvaxhib, comvax- 2 doses at 2months and 4 months. hiberex- should only be used as the booster shot for children who have recieved at least 1 shot. it should be given between 12months and 4yrs. booster shot- should be given between 12-15 months.

HepB vaccination schedule

-At birth: give monovalent HepB vaccine to all newborns before hospital discharge. -For infants born to hepatitis B surface antigen (HBsAg)-positive mothers, administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. -These infants should be tested for HBsAg and antibody to HBsAg (anti-HBs) 1 to 2 months after completion of the HepB series, at age 9 through 18 months (preferably at the next well-child visit). -If mother's HBsAg status is unknown, within 12 hours of birth administer HepB vaccine regardless of birth weight. For infants weighing less than 2,000 grams, administer HBIG in addition to HepB vaccine within 12 hours of birth. - Determine mother's HBsAg status as soon as possible and, if mother is HBsAgpositive, also administer HBIG for infants weighing 2,000 grams or more as soon as possible, but no later than age 7 days. - Doses following the birth dose: The second dose should be administered at age 1 or 2 months. -Monovalent HepB vaccine should be used for doses administered before age 6 weeks. -Infants who did not receive a birth dose should receive 3 doses of a HepB-containing vaccine on a schedule of 0, 1 to 2 months, and 6 months starting as soon as feasible

Human Papilloma Virus (HPV) vaccine

-Gardiasil and ceravix- for females to prevent cervical cancer. - given IM in 3 separate doses. 1st dose- 11-12yrs (minimum age to get 9 yrs) 2nd dose- 2 months after the 1st dose. 3rd dose- 6 months after the 1st dose. HPV4- boys- 9-26 yrs in 3 doses to prevent genital warts.

Measles (Rubeola)

-MMR vaccine- minimum age 12 months for routine vaccination. -2 dose series- 12-15 months and 4-6 yrs. -second dose can be given <4yrs as long as 4 weeks as passed between 1st dose. -give 1 dose of MMR to infants 6-11monthd if they are travelling outside the US. - children given dose before 12 months should be revaccinated with the 2 dose series at 12-15 months and 2nd dose at least 4weeks later. -minimum interval between the 2 doses is 4 weeks. -for prophylaxis one dose of MMR can be given within 72 hrs of exposure 12months> -revaccination should be given to those born after 1956 who have not been immunized.

hepatitis B virus

-can lead to fatal consequences from cirrhosis or liver cancer during adulthood. -recommended that newborns recieve HepB before discharge if the mother is hepatitis B surface antigen negative. -monovalant HepB should be given at the birth dose and combination can be given for the rest of the doses. -full time and preterm babies born to mothers who are HepB positive or unknown, should recieve HepB and hepatitis immunoglobulin (HBIG) 0.5ml within 12hrs of birth at two different injection sites. -newborns weighing less than 2000 g (4.4lb), should receive hepB at 1 month instead as long as the mother is HepB negative. -if a preterm infant is given a HepB shot at birth, the full series should be given (3 additional doses) at 1month, 2 and 6 months. -immunization should be done by age 11. -administration site is the vastus lateralis in newborns or the deltoid in older infants and children.

Meningococcal disease

-high risk for infants and adolescents (highest fatality in adolescents) - riks of meningococcal disease is high in freshman living in college dormitories - the meningococcal infection results in limb or digit amputation, skin scarring, hearing loss and neurological disabilities. - neiserria meningitidis is the leading cause of bacterial meningitis in the US. schedule: 1st dose- 11-12yrs 16-18 (booster shot) HIV adolescents: should get 2 doses 8 weeks apart. children with sickle cell (asplenia) and HIV should receive the vaccine younger than 11.

MMRV vaccine

-measles, mumps, rubella and varicella -it is a live attenuated vaccine that can be given to children 12-15 months or 4-6 yrs. -children with HIV should not receive MMRV. -risk of febrile fever at 5-12 days in children 12-23 months is low but should be explained to parents. -MMR or MMRV is given as first dose in children 12-47 months. MMRV is recommended for 48months and up to reduce the number of injections.

Rubella (German Measles)

-presents serious risk to fetus in pregnant women. so goal of vaccination is to protect unborn child. -recommended at 12-15 months and 4-6 yrs - women of childbearing age and adolescents should be vaccinated. -rubella vaccine is contraindicated in pregnancy because it can cross the placenta. - women should be counseled not to get pregnant for 28 days after receiving the rubella vaccine.

Haemophilus influenzae type B

-protects against many diseases caused by Hib- bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis and sepsis. -Hib is a conjugated vaccine that is attached to a nontoxic form of another organism such as the tetanus toxoid, or diptheria protein, which increases the antibody response especially in infants. -hiberex- conjugate vaccine for the booster (final) dose of the Hib vaccine series for children aged 12 months to 4yrs. -injection is given via intramuscular site using a separate site and syringe from the other vaccines.

diptheria

-rare in the US but can result in severe morbidity. -has respiratory manifestations: respiratory nasopharyngitis or obstructive laryngotracheitis with upper airway obstruction. -cutaneous manifestations: vaginal, otic, conjuctival lesions. -give a single dose of equine antitoxin to a child with clinical symptoms due to fulminant progression of the disease. -vaccine can be given combined with tetanus and pertussis or dTaP with HIB. -diptheria vaccine does not produce absolute immunity, the protection lasts for 10 years, booster shots should be given every 10 yrs.

Mumps

-recommended at 12-15 months. -should not be given to infants younger than 12months because maternal antibodies will interfere with the immune response. -mumps immunization is recommended for all individuals born after 1957 who may be suseptible to mumps.

hepatitis A vaccine

-spread by fecal oral route. -illness is abrupt onset with fever, malaise, anorexia, nausea, abdominal discomfort, jaundice. - 1st dose at 12months. 2 dose series, separate each dose by 6-18 months. -the minimum interval is 6 months between the 2 doses. for catch up. dose range- 12-23 months.

pneumococcal disease

-streptococcal pneumococci is responsible for many bacterial infections in children under 2 that can cause severe morbidity and mortality- septicemia, meningitis, otitis media, sinusitis and pneumonia. - problematic for children attending daycare facillities and those who are immunocompromised. schedule: 1st dose: 2months 2nd dose: 4 months 3rd dose: 6 months 4th dose: 12-15 months PV13 and 23- recommended for children with high risk conditions.

pertussis

-vaccine is recommended for all children 6weeks to 6 years of age. -cooconing: vaccinating all of the individuals that come in close contact with an infant against pertussis.- health care workers, fathers, and adults especially those over 65. -accelullar pertussis vaccine produces less reactions than whole cell pertussis vaccine, and is recommended for the first 3 immunizations at 2, 4 and 6. - it is recommended that the 1st 3 DTaP vaccines be from the same manufacturer. -s/s in infants = respiratory distress and apnea without the typical cough.

what are some pain reduction techniques for vaccinations?

1. Apply topical anesthetic EMLA (lidocaine, prilocaine) to the injection site and cover for at least 1 hr. 2. apply topical anesthetic LMX4 (4% lidocaine) to the injection site 30min before the injection. 3. apply a vapocoolant spray (e.g. ethyl chloride or fluorimethane) directly to the skin or to a cotton ball, and place on the skin for 15 seconds before the injection. 4. concentrated sucrose (24%) and non nutritive sucking in neonates. 5. breast feeding during immunization 6. distraction techniques in preschool children (ie. telling the child to blow) 7. administer vaccines simultaneously. 8. dose of acetaminophen 45 mins before vaccination

what should be documented on the MAR for vaccines?

1. day, month and year of administration. 2. manufacturer and lot number of vaccine. 3. name, address and title of person administering the vaccine. 4. site and route of administration. 5. evidence of consent- VIS recieval, document publication date of the VIs.

Vaccine Administration

1. dtap can cause local irritation, inflammation nd abcess formation. good IM technique must be used. 2. provide immunization records to families. 3. provide Vaccine Information sheet for each vaccine. 4. fully inform the risk and benefits for each vaccine

what are the contraindications of vaccines

1. febrile illness. (presence of a minor illness such as common cold is not a contraindication). 2. live virus vaccines should not be given to anyone who is immunocompromised. (varicella and MMR) 3. presence of passive immunity through blood transfusions, immunoglobulins or maternal antibodies is a contraindication to live virus vaccines. 4. administration of mmr or var should be postponed for a min of 3 months after passive immunoglobulins or blood transfusion. 5. allergy to a vaccine or component of the vaccine. mmr- allergy to neomycin or gelatin. 6. pregnancy: contraindicated to mmr vaccine. 7. history of intusseption is contraindicated for the rotavirus vaccine.

combination vaccines

1. pediarix- contains DTaP, hep B and IPV. this can be used as primary immunization beginning at 2 months of age. 2. kinrix- contains DTaP and IPV- may be used as the 5th dose in the DTaP series and the 4th dose in the IPV series.

Tdap vaccine schedule?

11-12 years, then every 10 years -Tdap should be given regardless of the interval between the last DTaP dose. -give 1 dose of Tdap to pregnant adolescents during 27-36 weeks gestation. catch up: -persons age 7 and older who did not complete DTaP series should get 1 dose of Tdap followed by just td if other doses are needed. - if Tdap is recieved as catch up between age 7-10, ,adolescent Tdap dose should not be given. Td should be given 10yrs after the Tdap dose.

Hep B doses interval

1st dose at birth. 2nd dose 1-2 months: minimum interval of 4 weeks between 1st and second dose. 3rd dose: at least 8 weeks after the 2nd dose and 16weeks after the 1st dose (6-18 months). if combination vaccine is used, 4 doses are given. final dose should be given no earlier than 24 weeks.

what is the DTaP dosing schedule?

1st dose-2months 2nd dose-4 months 3rd dose- 6 months 4th dose- 15-18 months (can be given as early as 12months as long as atleast 6 months have passed between the 3rd dose) 5th dose- 4-6 years (fifth dose is not necessary if the 4th dose was given at age 4 or older).

IPV dosing schedule

1st dose: 2 months 2nd dose: 4 months 3rd dose: 6-18 months 4th dos3: 4-6 yrs (on or after 4th birthday atleast 6 months from the 3rd dose). -a 4th dose is not necessary if the 3rd dose was given at age 4 or older and atleast 6 months apart from the 3rd dose. -if both OPV and IPV were administered as part of a series, all 4 doses most be given regardless of the child's age. - IPV is not recommended for U.S residents aged 18 or older.

influenza

6-18 months (inactivated influenza vaccine only) from age 2 up- LAIV (intranasal, live attenuated) or iiv - vaccine should be received in the early fall annually for ongoing protection. - intradermal iiv- 18-64yrs - assess history of egg allergy before giving the vaccine. - LIAV- intranasal live attenuated vaccine can be given to 2-49yrs. it is given in 2 doses 28 days apart. not recommended for children 2-4 with wheezing in the last 12 months, children with asthma, and other underlying medical conditions.

what should be done when there is doubt that a child will return for immunization?

HBV (HepB), DTaP, IPV (poliovirus), MMR, varicella and hib vaccines can be given simultaneously at separate injection sites.

Cocooning

Strategy of protecting infants from pertussis by vaccinating all persons who come in close contact with the infant, including the mother, grandparents, and healthcare workers

polyvalent vaccine

a vaccine that immunizes against more than one disease

natural immunity

acquired as part of normal life experiences

combination vaccine

combination of multiple vaccines into one parenteral form

children who began primary immunization at the recommended age but fail to receive all doses

do not need to begin the immunization series again and they only need to receive the missed doses.

the use of meningococcal and diphtheria proteins in combination vaccines

does not mean the child has received adequate immunization for meningococcal or diptheria illnesses. the child must be given vaccines for those diseases.

emergency management of anaphylaxis

drug: epinepherine 0.01 mg/kg up to a max of 0.3kg. epipen observe for adverse reactions: tachycardia, hypertension, irritability, headaches, nausea and tremors.

what is the importance of needle length in vaccination?

fewer reactions to immunization is observed when it is given deep into the intramuscular tissue rather than subcutaneous tissue.

acquired immunity

immunity that the body develops after it overcomes a disease, or through inoculation (such as vaccination)

what is the recommended needle size for different age groups?

newborn- 2 months: 16mm (5/8 inches) infants: 25mm (1inch) toddlers and older children: 16-25 mm (5/8- 1inch) for deltoid and 25-32mm (1-1.2 inches) for vastus lateralis. use deltoid in children 18 months or older.

why was the use of oral polio vaccine changed to the use of IPV?

oral polio vaccine is related to the risk of vaccine associated polio paralysis (VAPP). the use of IPV has removed this risk.

rotavirus vaccine

rotavirus is one of the leading causes of severe diarrhea in infants and young children. schedule: rotarix- 2 and 4 months rotateq- 2, 4 and 6 months. - infants must receive the first dose before 15 months. - infants must receive the 2nd dose before 8 months. minimum age to receive the first dose is 6 weeks. - vaccine is administered orally.

passive immunity

the short-term immunity that results from the introduction of antibodies from another person or animal. ie antibody transfusion and to fetus via placenta or breastmilk.

conjugate vaccine

vaccine composed of a polysaccharide antigen covalently attached to a large protein molecule, to produce a greater immune response (ie. HIb vaccine).

Monovalent vaccine

vaccine designed to vaccinate against a single antigen or organism

active immunity

when antibodies are formed by the body against specific antigens that have been introduced either naturally or artificially.