Exam 3: Pediatric Vaccinations

T/F: a child with mild/moderate local reactions to a previous dose of vaccines is a contraindication to receive vaccines

false

name some possible pain management options for children receiving vaccines

oral sucrose 2 minutes before immunizations for infants up to 4 months of age, vapocoolant spray (Pain Ease), counterirritation (Shot Blocker), comfort positioning, distraction, topicals (EMLA/LMX4)

T/F: if a vaccine interval exceeds the recommended interval, the final antibody concentrations after the complete series should not be reduced, there is no need to restart the series

true

T/F: people who are allergic to eggs who have experienced hives after eating eggs or egg-containing foods can and should receive the influenza vaccine with some additional safety measures

true

T/F: vaccines are recommended for youngest age at risk for the disease for which safety and efficacy have been shown

true

as far as spacing of multiple doses of the same antigen go, follow the recommended schedule as close as possible, do NOT administer at _____ than minimum age or ____ than minimum interval

younger, faster

T/F: a child with an immunosuppressed family member is a contraindication for the child to receive vaccines

false

FYI: corticosteroids are usually not a contraindication to live vaccines if treatment is short term, long-term alternate day treatment with short-acting preps, maintenance physiologic doses, topical, inhaled, or intraarticular, bursal or tendon injection - only systemic steroids are of possible concern

...

Ben is 14 months old, he has nasal congestion with discharge, his mother is 3 months pregnant and his father is receiving chemotherapy for lymphoma, immunization record shows: DTaP at 2,4,6 mo, Hib at 2,4,6 mo, Hep B at birth, 2 mo, IPV at 4,6 mo 1. What vaccines are needed today? 2. Does she have any contraindications to the vaccines needed today? 3. When does she need to return and what vaccines will be needed at that time?

1. DTaP (generally given at 15 mos but can give as soon as 12 mos), Hib, Hep B, IPV, PCV, influenza (2 doses b/c <9 yo), MMR, varicella (VAR), Hep A (no rotavirus b/c first dose has to be in by 14 weeks and 6 days, CAN'T give doses later than 8 months) 2. no contraindications (just no nasal influenza b/c too young) 3. return in 4 weeks for 2nd influenza and 8 weeks for 2nd PCV

Jamal is 5 years old and about to enter kindergarten, he has 3 younger siblings, allergic to PCN and milk, immunization record shows: IPV at 2,5,11,14 mo, DTaP 2,5,14,24 mo, MMR at 11,24 mo Var at 24 mo, Hib at 2,5,11 mo, Hep B at birth, 2,5 mo, PCV13 at 5,11 mo 1. What vaccines are needed today? 2. Does she have any contraindications to the vaccines needed today? 3. When does she need to return and what vaccines will be needed at that time?

1. DTaP, Hep B (last dose given at 5 mos, must be given at 6 mos or older so last one was invalid), Hib, PCV, IPV (last dose was invalid, has to be given at age 4 or older), influenza (2 doses b/c <9 yo and never had), MMR (got first dose too young), varicella, Hep A (too old for rotavirus) 2. no contraindications 3. return in 4 weeks for 2nd dose of influenza and in 6 months for Hep A

Sara is 2 months old, Well developed, full term infant, Has documentation of 1st dose of hepatitis B vaccine administered at birth in the hospital 1. What vaccines are needed today? 2. Does she have any contraindications to the vaccines needed today? 3. When does she need to return and what vaccines will be needed at that time?

1. Hep B, DTaP, IPV, Hib, PCV13, RV (not meningococcoal - only for kids at high risk) 2. no contraindications 3. needs to return at 4 months of age to get DTaP, IPV, Hib, PCV13, RV

Jill is 11 years old and entering 6th grade, no history of chickenpox, immunization record shows: Hep B at birth, 2,6 mo, Hib 2,4,6 mo, DTaP 2,6,24 mo 3 yr, 5 yr, IPV 2,6,14 mo and 5 yr, MMR at 14 mo, 5 yr 1. What vaccines are needed today? 2. Does she have any contraindications to the vaccines needed today? 3. When does she need to return and what vaccines will be needed at that time?

1. Tdap, influezna (1 dose b/c >9 yo), varicella, Hep A, HPV, MCV 2. no contraindications 3. return in 2 months for 2nd HPV dose, return in 3 months for varicella

live injectable vaccines must be given at the SAME visit or separated by ______ days

28

the last dose of Hep B has to be given after a child is ______ old, otherwise it is invalid

6 months

The temperature of a refrigerator where vaccines are stored must be monitored (on a daily basis) to make sure the refrigerator temperature stays in the recommended range. a) True b) False

A

If a combination vaccine is not commercially available, it is okay to mix the vaccines you have available into 1 syringe to minimize the number of injections a child may need to receive. a) True b) False

B

Dawn is a 4-month-old brought to the doctor for her regular healthy infant visit. She received all the recommended vaccines at birth and 2 months of age according to the 2012 schedule. Dad is having a bad time with asthma and is currently taking 25 mg prednisone/day in addition to his inhaled medications. Should Dawn receive and immunizations today, and if so, which ones (choose the most correct answer)? a) No- she must wait until Dad is off prednisone b) Yes- she should receive DTaP, Hib, PCV13, IPV c) Yes- she should receive DTaP, Hib, PCV13, IPV, rotavirus, and could receive an invalid dose of hep B if it is part of a combination vaccine d) Yes- she should receive DTaP, Hib, PCV13, hep B

C

Mom brought Pat to the doctor in October for a runny nose. He will be 12-months-old in 1 week. Here is his previous immunization history: DTaP/IPV/Hib (Pentacel) at 2 and 5 months of age Hep B (Engerix) at birth at 2 and 5 months of age, RV5 (Rotateq) at 2 and 5 months of age, PCV13 (Prevnar) at 2 and months of age What is the most complete list of needed vaccines that can be given today? a) DTaP/IPV/Hib, PCV 13, influenza b) DTaP/IPV/Hib, Hep B, RV5, PCV 13 c) DTaP/IPV/Hib, Hep B, PCV 13, influenza d) DTaP, Heb B, PCV 13, Hep A, MMR, varicella, influenza

C

Which of the following is a valid contraindication to the administration of an unspecified vaccine to a 2 year old child? a) The patient is running a mild fever with a runny nose, but is running around the doctors office b) The patient's mother is pregnant c) The patient had a severe allergic reaction to a previous dose of vaccine d) The patient's grandmother is receiving chemotherapy for breast cancer

C

this is the only vaccine started at birth

Hep B

these are the 4 live vaccines routinely used in children

MMR, intranasal influenza, varicella, rotavirus

T/F: a child on current antimicrobial therapy is a contraindication for the child to receive vaccines

false

this is the ONLY contraindication for all vaccines

history of anaphylactic reaction

avoid ____ vaccines in pregnant women

live

severely immunocompromised persons generally should not receive ____ vaccines

live (MMR, rotavirus, intranasal influenza, varicella)

for pregnancy - avoid ____ vaccines, give ____ vaccine, and also give ____ with EACH pregnancy at 27-35 weeks

live, influenza, Tdap (Tdap protects the fetus, prior to pregnancy a woman should have MMR but it's live so can't be given during pregnancy)

are there any time restrictions between inactivated vaccines?

no (can give same day or next day or 28 days from now)

are there any time restrictions between live and inactivated vaccines?

no (can give same day or next day or 28 days from now)