Flu
How long does it take for antibodies to develop after the flu vaccine is given?
A. 7 days
B. 14 days
c. 21 days
B. 14 days.
Its best to receive the flu vaccination end of September, and in October to allow time for immunity to develop and to last throughout the end of the flu season.
What new pneumococcal conjugate vaccine was approved by the ACIP in June 2024 for use in adults 19 years and older?
A - PPSV23
B - PCV15
C - PCV21
What is C - PCV21
Per 6/27/24 meeting
This vaccine was specifically designed to help protect against 8 additional serotypes not included in other vaccines, which accounts for ~30% of invasive disease in those 50 years and older.
What virus causes herpes zoster (shingles)?
A. Varicella zoster
B. Shingella virus
C. Streptococcus virus
A - Varicella zoster virus (VZV), which is the same virus that causes chicken pox and is a member of the herpes virus family.
- It stays dormant in the sensory ganglia and can reactivate to cause shingles
- Anyone who has had varicella (chicken pox) or received the varicella vaccine can develop herpes zoster (shingles)
- Risk factors for reactivation include - aging, immunosuppression, intrauterine exposure to VZV/chickenpox, having varicella at age <18 months
What is the preferred timing of the Tdap with each pregnancy?
A. 3rd trimester
B. 1st trimester
C. 2nd trimester
D. After first confirmed pregnancy test
A - 3rd trimester, or between 27-36 weeks of gestation. It is recommended to receive the Tdap early in the 3rd trimester to allow time for antibodies to be passed to the infant.
- Getting the Tdap between 27-36 weeks of pregnancy lowers the risk of whooping cough in babies younger than 2 months old by 78%!
- Receive with each pregnancy
- Close contacts should receive the Tdap if they haven't received a booster in the last 10 years, ideally 2 weeks prior to contact
Which statement correctly describes RSV transmission and prevention?
A. Spread through blood
B. Spread via respiratory droplets and surface contact; prevented by handwashing and avoiding close contact
C. Only airborne; prevented with air purifiers
D. Spread through food and water
What is B. Spread via respiratory droplets and surface contact; prevented by handwashing and avoiding close contact
Incubation period is 2 to 8 days, with symptoms starting around 4-6 days after exposure. Infants and those with weakened immune systems can shed the virus for up to 4 weeks.
During which trimester should pregnant women receive the flu vaccine?
A. 1st trimester, so the baby can have an extended amount of time to develop immunity
B. 2nd trimester, during the middle of the pregnancy is the ideal time
C. 3rd trimester, this is the ideal time for the flu vaccine and provides optimal immunity for the baby
D. Any trimester. It does not matter which trimester the flu vaccine is given
D - During any trimester, with preference during September and October. If the pregnant person is in their 3rd trimester during July and August, vaccination with influenza can be considered because this may reduce the risk of flu for the infant during the first months of birth, when they are too young to receive vaccination. However, waiting until September and October is preferable, unless there is concern that this later vaccination is not possible.
FluMist - Must NOT be given during pregnancy due to the risk of the live vaccine crossing the placenta and infecting the fetus.
This age group is now recommended by ACIP to receive routine pneumococcal vaccination, a change from the previous age of 65.
A. 40 years and older
B. 50 years and older
C. 60 years and older
What is B - 50 years and older
On October 23, 2024, ACIP updated recommendations for routine pneumococcal vaccinations with (PCV15, PCV20, or PCV21) to now include those 50 years and older (previously 65 years and older). This gives more adults the opportunity to protect themselves from pneumococcal disease at the age when when risk of infection increases.
The CDC recommends routine vaccination with Shingrix for what age group, and what is the interval for the 2-dose series?
A. 19 years and older, 1 to 3 months apart
B. 50 years and older, 2 to 6 months apart
C. 50 years and older, 2 to 4 weeks apart
B. 50 years and older, 2 to 6 months apart
Which of the following are LIVE vaccines, select ALL that apply.
A. MMR
B. Varicella
C. Shingrix
D. FluMist
MMR, Varicella and FluMist are three examples of live vaccines. Others include:
- Rotavirus
- Yellow fever (not routine)
- Typhoid (not routine, used in the military)
- Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (TB) disease (not routine, used in the military and other countries)
Based on the latest ACIP recommendations, which RSV‑vaccine–naïve patient should receive RSV vaccination?
A. 40-year-old person with diabetes and HTN
B. 60-year-old person with no underlying comorbidities and not taking any prescription medications.
C. 58-year-old person with T2DM and asthma.
C. 58-year-old person with diabetes and asthma
In April 2025, the ACIP updated its recommendations for use of the RSV vaccine for adults. Specifically, the ACIP recommended the following patient groups to receive RSV vaccination:
- ALL adults 75 years of age and older
- Those 50 to 74 years of age (used to be 60-74 years) who are at increased risk of severe RSV disease.
- Abrysvo and Arexvy are approved for 50 years and older.
Risk Factors Include:
Per the ACIP, what formulation of flu vaccine is preferred for those ≥ 65 years and older?
A. Fluzone High-dose
B. Fluarix
C. Flumist
D. Standard-dose Fluzone
A - Fluzone high-dose
Older adults (aged ≥65 years) are at increased risk for severe influenza-associated illness, hospitalization, and death compared with younger persons. Influenza vaccines are often less effective in this population, thus the use of fluzone high-dose has been shown to elicit a higher immune response in this population.
MT is a 33‑year‑old woman with chronic renal failure and no history of pneumococcal vaccination.
Which of the following is the most appropriate pneumococcal vaccination recommendation for this patient?
A. Administer PCV15
B. Administer PCV20 or PCV21
C. No pneumococcal vaccination is indicated until age 50 years
B. Administer PCV20 or PCV21
Regardless of which is used, pneumococcal vaccination is complete.
The CDC recommends that adults 19 through 49 years old with specific immunocompromising conditions or risk factors receive pneumococcal vaccination. These immunocompromising conditions include, but are not limited to, chronic renal failure, congenital or acquired asplenia, select malignancies, HIV infection, nephrotic syndrome, sickle cell disease, and individuals who have undergone solid organ transplant.
What is the efficacy of the Shingrix vaccine for reducing the incidence of zoster in those 50 years and older?
A. 32.5 to 53.6%
B. 91.3 to 97.4%
C. 63.2 to 88.7%
B - 91.3 to 97.4%. The Shingrix vaccine reduced the overall incidence of zoster by 96.6% in those 50-69, 97.4% for those 60-69, and 91.3% in ≥ 70 years of age.
Also reduced the incidence of postherpetic neuralgia by 91.2% for those 50-69 and 88.8% for those 70 years and older
As a comparison the efficacy for the previous shingles vaccine (Zostavax) was 51% reduction of zoster and only lasts about 5 years.
What is the minimum time interval required between two different injectable or nasally administered live vaccinations, if the are not administered on the same day.
A. No minimum interval required
B. 7 days
C. 14 days
D. 28 days
What is D 28 days.
If not administered simultaneously, injectable or nasally administered live vaccines should be administered at intervals of ≥28 days as this impairs the immune response to the second live vaccine administered. If 2 live vaccines are administered <28 days apart, the second vaccine is invalid and should be readministered 28 or more days after the invalid dose.
A 67‑year‑old patient with risk factors for severe RSV disease presents for vaccination. They are eligible for the annual influenza vaccine, a COVID‑19 vaccine, and RSV vaccination and agree to receive all recommended vaccines today. What is the most appropriate action at today’s visit?
A. Administer the flu and COVID vaccines today and ask them to return in 4 weeks for the RSV vaccine.
B. Administer all three vaccines today.
C. Administer the flu and RSV vaccines today and ask them to return in 28 days for the COVID vaccine.
B. You administer all three vaccines today.
In November 2023, the CDC announced that influenza, COVID‑19, and RSV vaccines may be safely given during the same visit. There is no required waiting period between them if they are administered separately. Safety data support coadministration of the influenza and COVID‑19 vaccines, as well as the influenza and RSV vaccines. Giving all recommended vaccines at the same visit is especially important for patients who may not return for additional doses and who are at higher risk for severe illness.
When administering multiple vaccines in the same limb (e.g., the deltoid), injections should be spaced at least 1 inch apart. Vaccines more likely to cause local reactions (such as pneumococcal, tetanus, or Shingrix) should be given in different limbs, and the most painful vaccine should be administered last.
JD is a 35 year old male who has a history of renal transplant 5 years ago and is taking immunosuppressant medications chronically. It is October and he presents to the pharmacy for a flu vaccination. What flu vaccine can JD receive? Choose most correct answer
A. Fluzone high-dose
B. Fluzone regular dose
C. Either of the above is appropriate
C - Either of the above is appropriate
For solid organ transplant recipients aged 18 through 64 years who are taking immunosuppressive medication regimens, ACIP now recommends high-dose (HD-IIV3) and adjuvanted (aIIV3) inactivated influenza vaccines as an acceptable options for influenza vaccination, without a preference over other age-appropriate inactivated or recombinant influenza vaccines.
LA is a 20‑year‑old woman with a cochlear implant and no previous pneumococcal vaccinations.
Which of the following is the most appropriate pneumococcal vaccination recommendation for this patient?
A. No pneumococcal vaccination is indicated
B. Administer PCV20 or PCV21
C. Administer PCV15 alone, and pneumococcal vaccination is complete
B. Administer PCV20 or PCV21
For those 19-49 years of age with immunocompromising conditions such as cochlear implants, should receive 1 dose of PCV20, or PCV21 and their series is considered complete.
JW is a 60‑year‑old man who presents to the pharmacy for his annual flu shot. During a review of his immunization history, you note that he has never received the Shingrix. In addition to administering the flu vaccine, you recommend Shingrix. JW states that he does not remember ever having chickenpox and questions whether he needs the shingles vaccine.
What is the most appropriate response? Is Shingrix still recommended?
A. Yes, he should still receive the Shingrix
vaccine series
B. No, since he does not remember having chickenpox, Shingrix is not indicated
C. No, he should first receive the varicella vaccine and then receive Shingrix at least 4 weeks later
A. Yes, he should still receive the Shingrix vaccine series
Those 50 years old older should receive the Shingrix series whether or not they remember having chickenpox in the past. Studies show that more than 99% of Americans 40 years and older have had chickenpox, even if they don’t remember having the disease. Chickenpox and shingles are related because they are caused by the same virus. After a person recovers from chickenpox, the virus stays dormant in the body. It can reactivate years later and cause shingles. Shingles can be very debilitating and, in some cases cause lasting nerve pain.
What flu vaccine may be administered to persons with anaphylaxis to egg ingestion? Choose most correct answer.
A - FluMist
B - Flucelvax
C - Flublok
D - Fluad (aIIV)
E - Any of the above
What is E, any of the above.
People with egg allergy may receive any vaccine (egg-based or non-egg-based) that is otherwise appropriate for their age and health status. Beginning with the 2023-2024 season, additional safety measures are no longer recommended for flu vaccination of people who are allergic to eggs beyond those recommended for receipt of any vaccine, regardless of severity, or previous reaction to egg.
Why?
Most flu shots and the nasal spray flu vaccine are manufactured using egg-based technology. Because of this, they contain a small amount of egg proteins, such as ovalbumin. However, studies that have examined the use of both the nasal spray vaccine and flu shots in egg-allergic and non-egg-allergic patients indicate that severe allergic reactions in people with egg allergies are unlikely. This only applies to those with an egg allergy and not other allergies to vaccine components.
Flucelvax and Flublock are cell based and do not use egg protein in production.
According to current ACIP recommendations, which RSV vaccination strategy is most appropriate for a 30‑year‑old pregnant patient in her first pregnancy?
A. Administer a single dose of an RSV vaccine (Arexvy®, Abrysvo®, or mRESVIA™) immediately postpartum.
B. Administer a single dose of an RSV vaccine (Arexvy®, Abrysvo®, or mRESVIA™) at 32–36 weeks’ gestation during RSV season.
C. Administer a single dose of Arexvy® at 32–36 weeks’ gestation during RSV season.
D. Administer a single dose of Abrysvo® at 32–36 weeks’ gestation during RSV season.
D. Administer a single dose of Abrysvo® at 32–36 weeks’ gestation during RSV season.
Three RSV vaccines that are currently licensed for use in adults in the United States are: Arexvy (GlaxoSmithKline), mRESVIA (Moderna), and Abrysvo (Pfizer). However, only Abrysvo is FDA approved for use in pregnant individuals.
The CDC recommends the use of a single dose of Abrysvo during weeks 32-36 of pregnancy during the RSV season, which is September through January.
There is currently no ACIP recommendation for RSV vaccination in subsequent pregnancies (data not yet available)
BJ is a 48‑year‑old man who presents to the pharmacy requesting an flu vaccination. He states he would prefer FluMist because he has a fear of needles. While reviewing his vaccination consent form, you note that he indicated a history of cancer. BJ reports that he is currently undergoing treatment for testicular cancer.
Which of the following is the most appropriate recommendation regarding flu vaccination for this patient?
A. FluMist is appropriate because BJ is younger than 49 years
B. FluMist is contraindicated, and BJ should receive an inactivated influenza vaccine
C. FluMist may be administered if BJ is not experiencing systemic symptoms
D. No influenza vaccination is recommended while BJ is receiving cancer treatment
B. FluMist is contraindicated, and BJ should receive an inactivated influenza vaccine
FluMist is a live vaccine and is NOT recommended in those with immune deficiency, or weakened immune systems due to either medication or health conditions such as cancer. Experts provide this recommendation because live vaccines may cause the disease they are trying to prevent. Recommend getting the regular flu vaccine.
FluMist is approved for ages 2-49
**Added in 2023 - FluMist should NOT be given to close contacts of immunosuppressed persons who require a protected environment**
CJ is a 68‑year‑old woman who presents to the pharmacy for routine influenza vaccination. Her immunization record shows she received one dose of PPSV23 three years ago and has never received a pneumococcal conjugate vaccine.
Which of the following is the most appropriate pneumococcal vaccination recommendation at this time?
A. Administer another dose of PPSV23 today because at least 3 years have passed since the previous dose
B. Administer PCV15 today and schedule PPSV23 at least 1 year later
C. Administer PCV20 or PCV21 today with no additional pneumococcal vaccines needed
D. Defer pneumococcal vaccination until at least 5 years have passed since the prior PPSV23 dose
C. Administer PCV20 or PCV21 today with no additional pneumococcal vaccines needed
Since the patient received the PPSV23, she should also receive the PCV20, or PCV21 at least 1 year after the PPSV23. Regardless of which vaccine is used, their pneumococcal vaccination is complete.
❌ PCV15 + PPSV23 later
CP is a 25-year-old female with rheumatoid arthritis on Humira, who presents to the pharmacy asking to get a shingles vaccination.
Can she receive the Shingrix vaccine series, or does she need to wait until she is older?
A. No, she must get the varicella vaccine first, then Shingrix at least 4 weeks later
B. Yes, she can get start the Shingrix series
C. No, she must wait until she is 50 years and older to get the Shingrix series
B. Yes, she can start the Shingrix series
On July 23, 2021, FDA expanded the indication for Shingrix, to include adults aged ≥18 years who are, or will be at increased risk for shingles because of immunodeficiency or immunosuppression. On October 20, 2021, ACIP recommended two dose Shingrix in adults ≥19 years, for the same indication above.
Immunocompromising conditions include:
- Autoimmune and inflammatory conditions -vaccination should not occur during flares and if possible, prior to immunosuppressive therapy
- Those with HIV
- Those with cancer - if possible, administer prior to chemotherapy or radiation
- Solid organ transplant recipients - If possible, administer prior to transplant, or at least 6-12 months after transplantation
- Hematopoietic cell transplant (HCT) patients
**The series can be shortened, with the 2nd dose given 1-2 months, if it will facilitate avoiding vaccination during periods of more intense immunosuppression**
According to the CDC, what age groups should receive the human papillomavirus (HPV) vaccine? Choose the MOST correct response
A. Children aged 5-10 years
B. Children aged 11-12 years
C. Routine vaccination at ages 11-26
D. Those 11-26 years and 55 years and older if they are at higher risk for HPV
C - Everyone 11 to 26 years of age (can start series as early as age 9, ideally between ages 11 and 12)
2 or 3 dose series depending on age at initial vaccination or condition
Age 9 –14 years at initial vaccination: 2-dose series at 0, 6–12 months (minimum interval: 5 months; repeat dose if administered too soon)
Ages 15 - 26, 27-45 at initial vaccination: 3-dose series at 0, 1–2 months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon)
No additional dose recommended when any HPV vaccine series has been completed using the recommended dosing intervals.
Some adults 27-45 years, if not vaccinated with HPV, may decide to get HPV after discussing with their healthcare provider to determine if they are at high risk for HPV and if vaccination would be beneficial.
Which one of the following medical conditions was found to have the highest incidence of RSV-associated hospitalizations in adults?
A. Cardiovascular disease
B. Obesity
C. Diabetes
D. History of thrombotic event
A - Cardiovascular disease
ACIP surveillance data and epidemiologic analyses consistently demonstrate that chronic cardiovascular disease (particularly congestive heart failure and coronary artery disease) is associated with the highest incidence rates of RSV‑associated hospitalization in adults, especially those aged ≥60 years.
MMWR, July 21, 2023; 72(29):793–801 [cdc.gov]