PT 3: Immunizations & Influenza (EXAM 6) *25 EASYGENERATOR QUESTIONS*

Vaccine administration procedures (Oral rotavirus & Nasal influenza):

-re-administration is not required if a vaccine is spitted out (rotavirus) or sneezed (nasal influenza)

*KNOW* People taking chronic acyclovir, famciclovir, or valacyclovir should discontinue the medication ____1___ before administration of the herpes zoster vaccine and should not start them again for ____2_____ *word bank: 1 day, 14 days*

1. 1 day (24 hrs) 2. 14 days (2 weeks)

*EASYGENERATOR Q*

1. 50 2. 65 3. 65

*EASYGENERATOR Q* 1. Antibodies to the influenza vaccine decline at _______ months post vaccination. 2. After receiving the influenza vaccine, it takes about _______ weeks to develop protection to influenza

1. 6 months 2. 2 weeks

*EASYGENERATOR Q* Match the following route of administration for the following vaccines: 1. MMR 2. Td A. SubQ B. IM

1. A 2. B

*EASYGENERATOR Q* Match the following: 1. Antigenic drift 2. Antigenic shift A. Annual changes generally caused by point mutations on surface antigens B. Major change in hemagglutinin or neuraminidase that may cause a pandemic

1. A 2. B

1. Patients who ONLY have hives as a reaction can receive any approved influenza vaccine. A. True B. False 2. Patients who have any other reaction can still receive any vaccine under the supervision of a health care provider who can recognize and manage allergic conditions A. True B. False

1. A 2. B

*KNOW* 1. Zanamavir (Relenza) adult treatment dose? 2. Zanamavir (Relenza) adult prophylaxis dose? A. 2 inhalations BID x5days (first 2 dose separate by at least 2hrs then q12 hrs) B. 2 inhalations (10mg) daily x7 days 3. Zanamavir (Relenza) child treatment age? 4. Zanamavir (Relenza) child prophylaxis age? A. 7 years B. 5 years

1. A 2. B 3. A 4. B *child dose is the same as adults*

*KNOW* 1. Peramivir (Rapivab) adult treatment dose? 2. Baloxavir (Xofluza) adult treatment dose? A. 600 mg IV once B. 40 mg PO (in patients 40-80kg) or 80 mg PO (in patients >80kg) 3. Peramivir (Rapivab) child treatment age? 4. Baloxavir (Xofluza) child treatment age? A. 2 years B. 12 years

1. A 2. B 3. A 4. B *NO prophylaxis dose for either Peramivir or Baloxavir*

*KNOW* 1. Oseltamivir (Tamiflu) adult treatment dose? 2. Oseltamivir (Tamiflu) adult prophylaxis dose? A. 75 mg BID daily x5 days B. 75 mg daily x7 days 3. Oseltamivir (Tamiflu) child treatment age? 4. Oseltamivir (Tamiflu) child prophylaxis age? A. Birth B. 3 months

1. A 2. B 3. A 4. B *child dose is weight based*

Match the following duration between doses for pneumococcal vaccines (PCV13 & PPSV23): 1. Healthy adults 2. In certain immunocompromised patients (ex: HIV, chronic renal failure, nephrotic syndrome, asplenia, CSF leaks, cochlear implants) 3. Patients requiring 2 doses of PPSV23 (ex: asplenia & immunocompromised) A. Wait 1 year B. Wait 8 weeks C. 5 years

1. A 2. B 3. C

Match the following adult vaccinations and their recommended ages. 1. Shingrix 2. Zostavax 3. Pneumococcal A. ≥50 years old B. ≥60 years old C. ≥65 years old

1. A 2. B 3. C *NOTE: there are 2 different pneumococcal vaccines; one is recommended at 65 & the other at 66* *Zostavax is FDA approved for ≥50*

Match the following adverse reactions of influenza with their severity. 1. Redness, muscle soreness 2. Fever, malaise 3. Allergic reaction, Guillain-Barre Syndrome (GBS) A. Local B. Mild C. Severe

1. A 2. B 3. C *intradermal, high-dose, Fluad, and PharmaJet have more local reactions* *Flu-like symptoms more common with LAIV*

*EASYGENERATOR Q* Match the following dosage forms: 1. Baloxavir 2. Zanamavir 3. Peramivir 4. Oseltamivir A. Oral tablet B. Oral inhalation C. IV D. Capsule & suspension

1. A 2. B 3. C 4. D

*KNOW* Match the following influenza treatment dosage forms: 1. Capsule & suspension 2. Oral inhalation 3. IV 4. Oral tablet A. Oseltamivir (Tamiflu®) B. Zanamavir (Relenza®) C. Peramivir (Rapivab®) D. Baloxavir (Xofluza)

1. A 2. B 3. C 4. D

Match the following anaphylactic allergy ingredients to the vaccines to avoid: 1. Eggs 2. Gelatin 3. Neomycin 4. Streptomycin & Polymyxin B A. Yellow fever, Influenza B. MMR, varicella (includes Zostavax) C. MMR, varicella (includes Zostavax), polio D. Polio

1. A 2. B 3. C 4. D

Match the following Influenza vaccine recommendations and their ages. 1. IIV (inactivate influenza vaccine) 2. Intradermal formulation 3. IIV-HD & Fluad 4. LAIV (live vaccine) A. All persons ≥6 months of age B. 18-64 y/o C. ≥65 and older D. Ages 2-49

1. A 2. B 3. C 4. D *Influenza is recommended annually (single dose) except for children <9 y/o receiving it for the 1st time; they should receive 2 doses (4 weeks apart)*

*KNOW* Match the following influenza key points to the correct agent. 1. Take with food, can compound capsules into suspension, adjust dose for renal impairement 2. Avoid in respiratory disease & in patients with milk allergy 3. Adjust dose for renal impairement & infuse over 15-30 minutes 4. Avoid co-administering with polyvalent cation products (laxatives, antacids, supplements, dairy products) A. Oseltamivir (Tamiflu®) B. Zanamavir (Relenza®) C. Peramivir (Rapivab®) D. Baloxavir (Xofluza)

1. A 2. B 3. C 4. D *baloxavir is well tolerated*

*KNOW* Match the following influenza vaccines with their age indications: 1. Fluzone Intradermal (IIV4) 2. Fluzone high dose (IIV3) & Fluad (aIIV3) 3. Flucelax (ccIIV4) 4. FluBlok (IRIV4) 5. FluMist IN Quadrivalent (LAIV4) A. 18-64 years B. ≥65 years C. ≥4 years D. ≥18 years E. 2-49 years

1. A 2. B 3. C 4. D 5. E *Afluria (IIV4) is indicated for patients ≥5 years*

*KNOW* Match the following MMR vaccine adult recommendations: 1. Pregnant women 2. Non-pregnant women 3. HIV infection & CD4 cell count >200 cells/mcL for at least 6 months & no evidence of immunity to measles, mumps or rubella 4. International travelers 5. Health care personnel born in 1957 or later with no evidence of immunity 6. Previous receipt of ≤2 doses of mumps-containing vaccine & identified to be at increased risk for mumps during outbreak A. 1 dose MMR after birth & before discharge B. 1 dose MMR C. 2 doses of MMR at least 28 days apart D. 2 doses of MMR at least 28 days apart or 1 dose if previously received 1 dose E. 2 doses of MMR at least 28 days apart for measles or mumps or 1 dose of MMR for rubella F. 1 dose MMR

1. A 2. B 3. C 4. D 5. E 6. F

*KNOW* 1. Conjugate vaccine is also known as: *select all that apply* A. PCV13 B. Prevnar 13 C. PPSV23 D. Pneumovax 2. Polysaccharide vaccine is also known as: *select all that apply* A. PCV13 B. Prevnar 13 C. PPSV23 D. Pneumovax

1. A & B 2. C & D *Both administered IM* *Polysaccharide is NOT used in children <2 y/o*

Inactivated vaccines include:

1. Diphtheria, tetanus, pertussis 2. Haemophilus influenzae type B 3. Hep A & B 4. Poliovirus 5. Meningococcal 6. Pneumococcal 7. Rabies 8. Influenza (IM & ID) 9. Herpes Zoster (Shingrix)

People considered immunocompromised include:

1. Immunodeficient 2. HIV 3. Chronic renal failure, nephrotic syndrome 4. Leukemia, lymphoma, Hodgkin disease 5. Generalize malignancy 6. Solid organ transplant 7. Multiple myeloma

1. Polysaccharide vaccines stimulate T-cell __________ immunity A. Independent B. Dependent 2. Conjugate polysaccharide vaccines stimulate T-cell ________ immunity. A. Independent B. Dependent

1. Independent 2. Dependent *think pneumococcal vaccine* *conjugated used in children <2y/o; polysaccharide not as useful in children <2y/o* *C*onjugated = *C*hildren

*EASYGENERATOR Q* (True or False)

1. TRUE 2. FALSE 3. TRUE

*EASYGENERATOR Q*

A

*EASYGENERATOR*

A

*EASYGENERATOR* Which pneumococcal vaccine is used for the initial childhood vaccine series? A. Prevnar B. Pneumovax

A

Allergy and encephalopathy seen within _________ are a contraindication for future pertussis vaccine doses. A. 7 days B. 10 days C. 20 days D. 3 days

A

Anaphylactic reactions to vaccine or inactive ingredient (live or inactivated) is an absolute contraindication. A. True B. False

A

For adults aged 60+, which shingles vaccine (herpes zoster vaccine) is recommended? A. Shingrix (RZV) B. Zostavax (ZVL)

A

Influenza is the #1 cause of death of a vaccine-preventable illness. A. True B. False

A

PPD test must wait _______ after live vaccine. A. 4-6 weeks B. 6-8 weeks C. 2-4 weeks D. 10-12 weeks

A

Shingrix is a _________ recombinant subunit vaccine administered as an IM injection. A. Non-live B. Live

A

The inactivated influenza vaccine is available as a 3 strain/trivalent (IIV3) or four strain/quadrivalent (IIV4) vaccine. A. True B. False

A

There are 2 types of antigenic changes; antigenic drift & antigenic shift. -typically caused by point mutations of surface antigens -adaption to human antibodies -occurs yearly A. Antigen drift B. Antigen shift

A

There is no preference for inactive vs live flu vaccine in 2018-2019 season. A. True B. False

A

Treatment for Influenza is MOST effective within _______ of illness onset. A. 48 hrs B. 24 hrs C. 8 hrs D. 12 hrs

A

Trivalent vaccine contains 2 strains of A and 1 strain of B whereas quadrivalent vaccines contain 2 strains of A & B. A. True B. False

A

What is the drug of choice for hospitalized patients with severe or complicated illness? A. Oseltamivir (Tamiflu®) B. Zanamavir (Relenza®) C. Peramivir (Rapivab®) D. Baloxavir (Xofluza)

A

Which of the following pneumococcal vaccine is administered to children 2 months & older? A. PCV13 series B. PPSV23 series

A

With prefilled syringes, you do NOT need to remove air. A. True B. False

A

What is the drug of choice for treating influenza in pregnancy/lactating patients? A. Oseltamivir (Tamiflu®) B. Zanamavir (Relenza®) C. Peramivir (Rapivab®) D. Baloxavir (Xofluza)

A *AVOID Baloxavir due to lack of safety data*

Live vaccines are NOT administered to neonates & infants until maternal antibodies have waned/disappeared. This generally occurs by age? A. 12 months (1 year) B. 6 months C. 24 months (2 years) D. 8 months

A *EXCEPTION to the rule is with Rotavirus*

LAIV should not be used until ________ after antiviral therapy is complete. A. 48 hrs B. 24 hrs C. 12 hrs D. 72 hrs

A *IIV is okay during treatment and chemoprophylaxis*

Patients age 65 y/o and older are recommended to receive both pnemoccocal vaccines. PCV13 (Prevnar) is given as a single dose first at age 65. How long should you wait before administering PPSV23 (Pneumovax)? A. 1 year (12 months) B. 2 years (24 months) C. 6 months D. 8 months E. No need to wait, administer both at the same time

A *If already received PPSV23 first, they should receive PCV13 no sooner than one year after PPSV23* *NOTE: Do not give both at the same visit* *If PCV13 was given before age 65, no additional PCV13 is needed*

*KNOW* Shingrix (shingles vaccine) is administered as 2 doses; 2-6 months apart to adults _________ regardless of past episode of herpes zoster or receipt of ZVL. A. ≥50 years old B. ≥60 years old C. ≥65 years old

A *If pt received ZVL already, wait 2 months before giving shingrix*

With transplant patients, when possible, immunize before transplant. A. True B. False

A *Live vaccines not generally given*

All vaccines can be administered at the same visit as all other vaccines. A. True B. False

A *NOTE: 2 live vaccines MUST be separated by 4 weeks if they are not given at the same time*

Influenza treatments shorten the duration of the flu by? A. 1 day B. 3 days C. 4 days D. 1 week

A *Prophylaxis can prevent symptomatic disease, but does not decrease virus transmission*

When controlling influenza outbreaks, it is important that we use antiviral chemoprophylaxisis for at least? A. 2 weeks B. 4 weeks C. 6 weeks D. 12 weeks

A *Recommend to all residents (regardless of immunization status) & all unvaccinated employees*

There are 3 types of influenza; A, B and C. Which of the 3 is the MAIN cause of Influenza cases? A. Type A B. Type B C. Type C

A *Type C does not cause disease in humans*

The first dose of Influenza is recommended at? A. 6 months B. 12 months C. 1 year D. 5 years E. 12 years

A *annually thereafter* *Indicated for everyone*

How many days "early" are you allowed to give multi-dose vaccine series if previous doses were given before minimum intervals & ages? A. 4 days B. 10 days C. 8 days D. 2 days

A *if a vaccine was given when the child was 5 months and the 1st series is at 6 months, that vaccine does not count BUT if it was given 4 days before the child turned 6 months, then it counts*

Inactivated vaccines typically require multiple doses in order to be effective. A. True B. False

A *no need to know chart*

Which of the following influenza vaccines is also known as "MF59-adjuvanted trivalent inactivated vaccine (aIIV3)" and is the ONLY adjuvanted vaccine in the US? A. Fluad B. Flublok C. Flucelvax D. Fluzone

A *typically used in our elderly population* *adjuvanted vaccine illicit's a stronger immune response in our older population than the regular one*

Varicella is known as chicken pox vaccine & Zoster as shingles vaccine. A. True B. False

A *varicella (chicken pox) is caused by a virus; the virus remains dormant in the dorsal ganglia and can be reactivated as herpes zoster (shingles)*

Which of the following MMR side effect is COMMON in post-pubertal females? A. Joint pain B. Fever C. Rash D. Injection site reactions

A *why? b/c of the rubella component of the vaccine*

*EASYGENERATOR Q* Which vaccines are indicated for adults 65 years and older? *select all that apply* A. Fluad B. Fluzone high dose C. Afluria D. FluMist

A & B

Which of the following are considered "toxoids"? *select all that apply* A. Diphtheria B. Tetanus C. Pertussis D. Measles E. Mumps

A & B

*EASYGENERATOR Q*

A & C

*EASYGENERATOR Q*

A & D

*EASYGENERATOR Q* Which of the following signs and symptoms are more common in influenza than in cold? *select all that apply* A. Fever B. Severe myalgia C. Fatigue D. Sore throat

A, B, C

*EASYGENERATOR Q*

B

*EASYGENERATOR Q* SL has a past history of an anaphylactic reaction to neomycin. Which of the following can SL receive? A. MMR B. Pertussis C. Polio D. Varicella

B

*EASYGENERATOR Q* Which polio vaccine is preferred? A. Oral live-attenuated vaccine B. Inactivated IM vaccine

B

*EASYGENERATOR*

B

Hospitalized patients unable to tolerate Oseltamivir or absorb it due to known or suspected gastric stasis, malabsorption, or GI bleeding should consider: A. Zanamavir (Relenza®) B. Peramivir (Rapivab®) C. Baloxavir (Xofluza)

B

There are 2 types of antigenic changes; antigenic drift & antigenic shift. -drastic change in hemagglutinin (H) or neuraminidase (N) -responsible for pandemics -ex: a subtype previously only in pigs or birds can now infect humans A. Antigen drift B. Antigen shift

B

Which of the following vaccines has efficacy against ALL circulating strains & expires 16 weeks after production? A. Fluad B. Flublok C. Flucelvax D. Fluzone

B

*EASYGENERATOR Q* What is the route of administration of the Shingrix vaccine? A. Intradermal B. Intramuscular C. Intranasal D. Oral E. Subcutaneous

B *Zostavax is SubQ; Shingrix is IM*

*EASYGENERATOR Q*

C

*EASYGENERATOR Q* At what age is the influenza vaccine first routinely recommended? A. Birth B. 2 months C. 6 months D. 12 months

C

*EASYGENERATOR Q* The varicella vaccine should be administered starting age? A. 2 months B. 6 months C. 12 months D. 11 years

C

*EASYGENERATOR Q* Which type of Influenza is LEAST likely to cause symptoms? A. A B. B C. C

C

People with functional or anatomic asplenia include: A. Sickle cell disease or other hemoglobinopathy B. Congenital or acquired asplenia C. Both A & B

C

Influenza A viruses are categorized into subtypes based on two major surface antigens. These include: A. Hemagglutinin (H): H1, H2, H3 B. Neuraminidase (N): N1, N2 C. Both A & B

C *Change the hemagglutinin and neuraminidase surface antigens over time to evade the immune system*

*EASYGENERATOR Q*

D

Adults should receive 1 dose of MMR vaccine if no evidence of immunity to measles, mumps or rubella. Evidence includes: A. Born before 1957 (unless healthcare personnel) B. Documentation of receipt of MMR C. Laboratory evidence of disease D. All the above

D

Which of the following is TRUE regarding treatment of Influenza? A. All high risk patients should be treated B. Non-high risk patients should be treated based on professional judgement C. Initiate treatment as soon as possible (ideally 48 hrs after symptom onset) D. All the above

D

Which of the following patient populations have a temporary contraindication to live vaccinations? A. Immunosuppressed B. Pregnant C. Recent dose of immunoglobulin D. All the above

D

Which of the following signs and symptoms are more common in influenza than in cold? A. Characteristic, high fever (>101°F) lasting 3-4 days B. Myalgia (aches & pains that are often severe) C. Fatigue and weakness that can last up to 2-3 weeks D. All the above

D

Which of the following signs and symptoms are more common in the cold than in influenza? A. Stuffy nose B. Sneezing C. Sore throat D. All the above

D

Which of the following vaccines are "specially" recommended in the "7-18" age group? A. TdaP (tetanus, diphtheria & pertussis) B. HPV C. Pneumococcal polysaccharide (PPSV) D. All the above

D

Patients with ________ require 2 doses of Pneumovax (PPSV23) before age 65. A. Functional asplenia B. Anatomic asplenia C. Immunocompromised D. All the above

D *3rd dose is given when they turn 65 y/o*

Poliomyelitis is a viral infection that can cause acute flaccid paralysis. Vaccines developed against polio include: A. The original inactivated trivalent vaccine B. Inactivated polio vaccine (IPV) C. Oral polio vaccine (OPV) D. All the above

D *Currently in the United States IPV is recommended*

*KNOW* Which of the following is TRUE regarding PharmaJet? A. Its a needle-free injector for flu shots B. Its FDA approved with Afluria influenza vaccine in patients 18-64 y/o C. Tenderness, swelling, pain & redness is more common with PharmaJet than regular needle injection D. All the above

D *PharmaJet = Afluria vaccine*

There are 2 strengths available for Diphtheria; pediatric strength & adult strength. D signifies? d signifies? *Q: which of the 2 has LESS antigen?*

D = pediatric strength d = adult strength *adult strength has less antigen due to increased adverse effects if pediatric strength is used in adults*

Current shift of Influenza vaccines is towards: A. Quadrivalent vaccines B. Non-egg based C. Universal vaccine D. Microneedle patch E. All the above

E

Precautions for pertussis vaccine use includes previous: A. Hypotonic hyporesponsive episode B. Fever of ≥104.9˚F C. Crying lasting more than 3 hrs within 48 hrs of a previous dose D. Seizures within 3 days after a dose E. All the above

E

Which of the following agents have activity against influenza A & B? A. Baloxavir marboxil (Xofluza) B. Oseltamivir (Tamiflu) C. Zanamavir (Relenza) D. Peramivir (Rapivab) E. All the above

E

Which of the following groups of people are MOST important to give the influenza vaccine to? A. Healthcare personnel B. People living in dormitories or in crowded conditions C. Caregivers for high risk persons D. Persons with conditions that increase the risk of influenza complications E. All the above

E

Which of the following is TRUE regarding the flu vaccine? A. It should be administered annually as soon as vaccine is available B. Antibodies decline at 6 months post vaccination C. Protection occurs about 2 weeks after immunization D. Do not vaccinate twice in 1 season E. All the above

E

Which of the following vaccines are "specially" recommended in the "0-6" age group? A. Rotavirus B. DTaP (Diphtheria, tetanus & pertussis) C. Haemophilus influenzae type b (Hib) D. Pneumococcal conjugate (PCV) E. All the above

E

Patients with ________ require an additional dose of Prevnar (PCV13) between the ages of 2-64. A. Functional asplenia B. Anatomic asplenia C. Cochlear implant D. Cerebrospinal fluid leak E. All the above

E *2nd dose is given when they turn 65 y/o*

Which of the following is TRUE regarding the MMR vaccine? A. It should NOT be given to pregnant or immunosuppressed individuals since its a live vaccine B. It may suppress positive PPD test for 6 wks C. Avoid conception for 28 days after receiving vaccine D. Vaccine virus may be excreted via nose & throat secretions after vaccinations but is not contagious E. All the above

E *Exception: HIV patients who have never had the vaccine should receive it unless "severely immunosuppressed"*

Which of the following is TRUE regarding multi-dose vaccine series? A. The minimal interval between most vaccine doses is 4 weeks B. Increasing the interval between doses does NOT diminish effectiveness but does delay the response C. Decreasing the interval between doses may interfere with antibody response & protection D. Delays in immunization do not necessitate restarting series or adding doses E. All the above

E *NOTE if patient delays for years, then restarting the series may be necessary*

MMR vaccine: A. Its a vaccination for measles, mumps & rubella B. Its a live vaccine C. Its administered SubQ D. 1st dose is at 12-15 months & 2nd dose 4-6 years E. All the above

E *NOTE: 2nd dose is NOT a booster*

Which of the following is TRUE regarding vaccines in immunocompromised patients? A. They should NOT receive live vaccines B. Glucocorticoids suppress vaccine response C. Patients receiving Prednisone ≥20mg daily or 2mg/kg daily for at least 2 weeks should wait 1 month before administering live vaccines D. Patients with chronic pulmonary, renal, hepatic or metabolic disease can receive BOTH live & inactive vaccines E. All the above

E *NOTE: Chronic pulmonary, renal, hepatic, or metabolic disease patients often need higher doses & more frequent doses*

*KNOW* Which of the following is TRUE regarding the varicella vaccine (chicken pox vaccine)? A. Its a live vaccine B. It MUST be kept frozen and out of light C. Its administered via SubQ injection within 30 minutes of being reconstituted D. 1st dose is recommended at 12-18 months of age; 2nd dose at 4-6 years of age E. All the above

E *NOTE: It can be used in older adults who have not had the disease and have not been immunized yet*

Which of the following is TRUE regarding the diphtheria vaccine? A. Its an IM injection B. Its normally combined with tetanus & pertussis (DTaP) or Td in adults C. Its a dose series vaccine D. A booster dose is given once every 10 years (normally as Td) E. All the above

E *NOTE: it can also be combined with the Hep B vaccine* *dose series vaccine b/c its inactivated*

*KNOW* Which of the following is TRUE regarding vaccines in pregnancy? A. Most vaccines are category C B. Live vaccines are generally avoided C. Influenza is recommended if pregnant during flu season D. TdaP is given weeks 27 and 36 of gestation (every pregnancy) E. All the above

E *Rubella & varicella are given post-partum if not previously vaccinated*

Which of the following is TRUE regarding the Hib vaccine? A. It helps prevent a variety of conditions including meningitis B. Three products are available but keep in mind to use to same product for initial series C. Should be used only up to 59 months of age unless other health conditions exist (ex: HIV, sickle cell disease) D. Its an IM injection E. All the above

E *use ONLY up to 59 months b/c most people by then have developed natural immunity*

Polio vaccine: A. Adults do not need to be vaccinated unless traveling to a high risk area B. Recommended for all children <18 y/o C. Only given to pregnant women if a clear need exists D. IPV is recommended for immunodeficient patients & their household contacts E. OPV is no longer used F. All the above

F

Which of the following is TRUE regarding the Tetanus vaccine? A. The preferred option is the tetanus toxoid adsorbed B. You receive the tetanus vaccine at the same time as diphtheria & after a wound C. Tetanus is the only vaccine-preventable disease that is NOT contagious D. If 3 dose series never received, you can give tetanus immunoglobulin if a serious wound + tetanus toxoid if different syringes and injection sites are used E. Its okay to use in immunosuppressed individuals if indicated F. All the above

F

Which of the following is TRUE regarding the proper procedures of handling a shingrix shortage? A. Prioritize patients due for their 2nd dose B. Do NOT complete series with Zostavax (not substitutable) C. Recommend to patients to use the vaccine finder online D. Provide clear documentation of immunization to patients in case a 2nd dose is administered elsewhere E. Going beyond 6 months is ok if needed; no need to restart series F. All the above

F

Which of the following vaccines are considered "live" vaccines? A. Herpes Zoster (Zostavax) B. Influenza (Intranasal) C. MMR D. Rotavirus (oral) E. Varicella (chicken pox vaccine) F. All the above

F

Varicella vaccine: A. Is very effective B. Can be used post-exposure if given within 3-5 days C. Contraindicated in pregnant women & immunocompromised individuals D. Avoid using salicylates for 6 weeks after vaccination E. Varicella-like rash may occur F. All the above

F *Exception is children with asymptomatic or mildly symptomatic HIV*

Which of the following is TRUE regarding the pertussis vaccine? A. Pertussis causes coughing spells associated with thick mucus B. The vaccine is commonly given as DTaP (in our younger patients; <6 y/o) C. TdaP in children 11-18 y/o (recommended additional dose) D. Recommended for all pregnant women for every pregnancy E. Don't worry about the amount of time between Td & TdaP F. All the above

F *NOTE: reason for increased cases of pertussis may be due to mutations of the bacteria*

Which of the following is TRUE regarding Zostavax (herpes zoster vaccine)? A. Its a live vaccine B. Indicated for prevention of herpes zoster (shingles) & postherpetic neuralgia (PHN) C. Its FDA approved for ages ≥50 but NOT recommended until ≥60 D. Its administered as a SubQ dose E. Should NOT be used in people who are immunocompromised, pregnant or have untreated TB F. All the above

F *the vaccine is the same strain in varicella vaccine, but much higher dose*

Patients with _________ require an additional dose of Pneumovax (PPSV23) between the ages of 2-64 y/o A. Chronic heart disease B. Chronic lung disease C. Diabetes D. Alcoholism E. Cigarette smoking F. Chronic liver disease or cirrhosis G. All the above

G *2nd dose is given when they turn 65 y/o* *These patients are considered immuno-competent*

Which of the following patient populations are at higher risk for Influenza? A. Adults >50 y/o B. Children 6-59 months old C. Immunosuppressed (including HIV infection) D. Women pregnant during influenza season E. Patients with chronic medical conditions F. Residents of long-term care facilities G. Patients with compromised respiratory function or aspiration risk H. All the above

H

Which of the following are NOT considered contraindications to vaccines? A. Mild-moderate local reactions B. Mild acute illness C. Premature infants D. Family history of adverse effects E. Diarrhea F. Breastfeeding G. Current antibiotic use H. All the above

H *Breastfeeding is only contraindicated with the small pox vaccine*

*KNOW* FluMist is a live attenuated influenza vaccine (LAIV) that is administered intranasally. It is approved for healthy persons aged 2-49 y/o BUT should be avoided in: A. Pregnancy B. Immunocompromised conditions such as HIV C. Anatomic or functional asplenia D. People in close contact or caregiver of severely immunocompromised person in protected environment E. Patients who received influenza medications within past 48hrs F. Patients that have a cerebrospinal fluid leak or cochlear implant G. Children 2-4 with history of wheezing/asthma H. Children receiving ASA or salicylate therapy I. All the above

I *NOTE: Children age 2-8 getting influenza vaccine for the first time should get 2 doses of LAIV*

Pertussis is also known as?

whooping cough