FNP Board Review: Pediatrics: Immunizations
What is the preferred separation time between administering Varicella Vaccine and MMR vaccine?
1 month
What are the indications for an infant born to a hepatitis B antigen (HBsAg) positive mother?
1. Administer Hep B vaccine and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth 2. Test for HBsAg and antibody to HBsAg after 3 or more doses of HebB series (at age 9-18 months)
What are the indications if a mother's HBsAg status is unknown?
1. Determine/check status immediately after birth 2. Administer HepB within 12 hours of birth 3. If the mother tests positive, HBIG should be given no later than 1 week of age
What are the typical administrations for all vaccines?
Administration for all vaccines are typically 0.5 ml, IM or sbucu depending on vaccine with the exception of the influenza vaccine
What do adverse reactions to vaccines involve?
Adverse reactions to vaccines are typically minor involving: local muscle soreness low grade temperature local erythema and tenderness
Before the Hib Conjugate was developed as a vaccine, Hib disease was_________
Before Hib vaccine, Hib disease was the leading cause of bacterial meningitis among children under 5 years old in the United States. Meningitis is an infection of the lining of the brain and spinal cord. It can lead to brain damage and deafness
When is there an increased rate of meningococcal disease?
Between the ages of 16 and 21 years
When is 23PS Pneumovax given?
Children aged 24-59 months who completed PCV 13 series and who are immune compromised should receive an additional one dose of 23PS at 24 months
When is DTap vaccine to be given?
DTaP is a series of 3 (primary) at 2-4-6 months and 2 boosters at 15 months and 6 years.
Is DTaP indicated for an 8 year old child?
DTaP is not indicated for children years of age or older
What vaccines are given at 4 months?
DTap Hib conjugate PCV13 IPV (polio)
When can the first first dose of Hib Conjugate vaccine and be given and at what age is it not recommended?
First dose of Hib can be given as early as 6 weeks of age; not recommended for children 5 years of age or older because it is no longer efficaceous after 5 years old
If there is no reliable history of chicken pox and no evidence of immunity, can varicella be given?
Give 2 doses of varicella after age of 12 months when there is no reliable history of chicken pox and no evidence of immunity is available.
When is human papillomavirus vaccine given? (HPV)?
HPV is a series of 3, given at 11 or 12 years, second dose is given 1 month after first dose, and 3rd dose is given 6 months after the initial dose. It is given to both males and females
Is HPV common?
HPV the virus, is the most common STD
What conditions in a child necessitate receiving an additional dose of 23PS at 24 months?
Hemoglobinopathies asplenia splenic dysfunction HIV infection congenital immunodeficiencies renal failure nephrotic syndrome chronic cardiac disease chronic pulmonary disease diabetes
When is Hepatitis A Vaccine given?
Hepatitis A vaccine is a series of 2 (1 year to 2 years, 6 months apart)
What vaccine is administered to newborns prior to hospital discharge?
Hepatitis B
What vaccines are given at 6 months?
Hepatitis B DTaP Hib conjugate PCV 13 IPV (polio) influenza
What vaccines are given at 2 months?
Hepatitis B DTaP (Diptheria/Tetanus/Pertussis) Hib Conjugate (Haemophilus Influenzae type B) PCV13 (Prevnar pneumococcal vaccine) Polio Vaccine (IPV)
How many are in the Hepatitis B Vaccine series and when is it given?
Hepatitis B vaccine is a series of 3, given at 0-2-6 months The second dose is given 1-2 months of age; monovalent or a combination vaccine containing HepB
What vaccines are given at 12 months?
Hib Booster PCV 13 Booster MMR
When is Hib Conjugate Vaccine given?
Hib Conjugate Vaccine is a series of 3 primary given at 2-4-6 months and one booster at 12 months.
If a child has a history of anaphylaxis to streptomycin what vaccine is contraindicated?
IPV (polio)
When is the Polio vaccine IPV given?
IPV is a series of 4 given at 2-4-6 months and at 6 year IPV is inactivated polio vaccine
If there is a break in immunizations from the recommended schedule how are the immunizations resumed?
If there is a break in immunizations from the recommended schedule resume immunizations according to the child's current age regardless of the vaccines previously missed
What is the dosing for influenza vaccine for children aged 6-35 months, and children 3 years old or greater?
In children aged 6 to 35 months, the dose is 0.25mL IM. Children 3 yrs old or greater, the dose is 0.5 mL IM. Children younger than 9 years receive 2 doses 1 month apart
When is Influenza vaccine given?
Influenza is given as one dose annually, beginning at 6 months
If a person has an egg allergy can they receive the influenza vaccine?
Influenza vaccine may be contraindicated in those with an egg allergy, but can give if the pt is kept there for observation for 90 minutes
What else does the HPV quadrivalent vaccine cover?
It covers types 6 and 11-genital warts, as well as cancerous lesions of cervix, genital warts, anus, penis, oropharyngeal. Gardasil given between 9 to 26 years
What is the recommendations for the Adolescent that receives the HPV vaccine?
It is recommended that adolescents sit for at least 15 minutes after receiving the vaccine due to risk of labile syncope, postural hypotension, and vasovagal responses
When is Live attenuated inactive virus given for influenza vaccine?
Live attenuated inactive virus (LAIV) known as FluMist, may be used as an alternative to trivalent inactivated virus (TIV) in healthy persons aged 2 to 49 years.
What are the meningococcal conjugate vaccines?
MCV4, Menactra, Menveo
When can MMR be given early?
MMR can be given as early as 6 months of age, if exposed to measles or travelling to endemic areas, but the pt will need to continue primary series at an appropriate time.
When is MMR given?
MMR or Measles, Mumps, Rubella vaccine is given as a series of 2 at 1 year and by 12 years.
When should MMR not be given?
MMR should not be given to those who are pregnant or immunosuppressed
When is the meningococcal vaccine given?
Meningococcal Vaccine is a series of 2 given at ages 11-12 years, and a booster at the age of 16 years.
What other circumstances in the age group of 24-59 months would indicate an additional dose of 23PS?
Native american, african american, alaskan descent or attending day care
If an adolescent is receiving their fost dose of Meningococal vaccine at age 16, do they need a booster?
No, a booster isn't necessary
When is OPV given?
OPV or oral polio vaccine is discouraged and only possible for dose number 3 and 4 (at 6 months and 6 years)
When is PCV13, the pneumococcal vaccine given?
PCV13 or Prevnar is a series of 3 given at 2-4-6 months with one booster at 12 months
When is Rotavirus vaccine (Rota) given?
Rota is a series of 3 given from 6 weeks to 32 weeks. The first dose is given at 6-14 weeks and each subsequent dose is at 4 week interval
What can the Rotavirus vaccine cause?
Rotavirus can cause intussusception
When is Tetanus, Dephteria, Acellular Pertussis Vaccine (Tdap) given?
Tdap is a series of 1 given at 11 or 12 years. Subsequent Td boosters are recommended every 10 years
Who provides the Immunization recommendations?
The American Academy of Pediatrics Immunization Chart, it is updated annually in January
What is the HPV bivalent vaccine and when can it be given?
The HPV bivalent vaccine is Cervarix and it is given at 10-25 years.
When is the Rotavirus vaccine to be completed?
The Rotavirus vaccine must be completed before 32 weeks. Do not administer a dose after age of 32 weeks.
When should the final dose of Hepatitis B vaccination be given?
The final dose of Hepatitis B should be given at 6 months of age or later
Should the first dose of vaccine be bivalent or monovalent?
The first dose should be monovalent
How many preparations of the HPV vaccine are there and what do they cover?
There are 2 commercial HPV preparations. Both cover the oncologic strains of HPV (types 16 and 18) for cancerous lesions of cervix, genital warts, anus, penis, oropharyngeal, recurrent papillomatosis.
What are the intervals for vaccine administration?
Vaccine intervals need to be at least 6 weeks
When is Varicella given?
Varicella is a series of 2 given between 12 months and 12 years, minimum of 3 months apart.
When is Varicella contraindicated?
Varicella is contraindicated in pregnant women and immunocompromised persons; it is contraindicated in those with streptomycin allergy
Can MMR can be given simultaneously with PPD?
Yes, but prefer to postpone PPD for 4-6 weeks to avoid possible suppressive response to PPD
As the NP, you are assessing an 8 month old infant in an immunization clinic. You know that by 8 months the child should have had which of the following immunizations? a. Hep B (1st/2nd) all primary DTaP series, 2 doses of polio b. All DTaP, polio series, MMR c. DTaP (1st/2nd), MMR (1st), all Hep B series d. Varicella, DTaP (1st), Hep B (1st)
a. Hep B (1st/2nd), all primary DTap Series, 2 doses of polio
Tommy is in for his 4 month well check. He was born preterm with a birth weight of 2.0 kg. The appropriate immunizations to give him today would be: a. DTap, Hib, IPV, Hep B-3 b. DTap, Hib, IPV, PCV 13 c. DTP, Hib, Hep B-3, PCV 13 d. Hold off on immunizations until he reaches his term due date
b. DTaP, Hib, IPV, PCV 13
In considering client situations, which one requires the use of an inactivated (not live) vaccine? a. history of nonspecific allergies b. immunocompromised client c. concurrent antimicrobial therapy d. mild acute illness
b. immunocompromised client
Mom informs you that she and her 6 month old infant are traveling to a place where measles is endemic. Your best response to her is: a. She should not take her baby with her b. Reassure her that her baby has passive immunity c. Give baby a MMR or monovalent measles injection d. Give baby gamma globulin prior to the trip
c. Give baby a MMR or monovalent measles injection
Johnny, 5 years old, is in your clinic for his initial well check. You note he has not received any immunizations. Which of the following is not necessary at this age? a. MMR B. DTaP c. Hib D. Varicella
c. Hib
What are reportable events with vaccine administration?
reportable events are: Anaphylaxis Encephalitis Death These are reportable to the Vaccine Adverse Events Reporting system