Wee Ones
Teens n Tweens
Preggos
Boomers
Hodge Podge
100
You see a 5 month old for a cough, URI symptoms and he has a temp of 100.5. You realize he has not received any vaccines and you doubt he will come back. Should you vaccine today?
Yes. Vaccines should only be delayed for "Moderate or severe illness"
100
Can Menactra (ACWY) be given on the same day as Bexsero (Men B)?
Yes!
100
When is the ideal time to vaccinate pregnant women with Tdap?
Early part of the third trimester of every pregnancy
100
Name two differences between Zostavax (ZVL) and Shingrix (RZV)
Zostavax is live, Shingrix is not
Zostavax is 1 dose, Shingrix is 2
Zostavax is recommended age 60 or over, Shingrix is 50 and over
Zostavax is subQ, Shingrix is IM
Zostavax's efficacy is around 50%, Shingrix is 85-97% efficacious
100
Name 5 live vaccines
MMR
Varicella
FluMist (nasal)
Oral Typhoid
Rotavirus vaccines
Zostavax
200
A patient needs an MMR and Varicella vaccine but the clinic is out of Varicella. You give the MMR today, when should the patient return for Varicella?
The same day or in 4 weeks (must separate live virus vaccines by 4 weeks)
200
An 20 year old is seeing your for a physical. He got his first dose of Gardasil 9 at age 11. How many more doses does he need?
One - Patients need TWO doses as long as the first dose is prior to the 15th birthday AND no immuno-compromising conditions
Three doses if you start at age 15 or later, or cancer, HIV, immunosuppressant drugs
You Do NOT need to restart, even if it is 9 years later
200
How long should a woman wait after getting MMR or Varivax to conceive?
CDC says At least 1 month, Package insert for Varivax says 3 months
200
A 55 year-old patient is seeing you for an acute Shingles outbreak and asks if he should get the Shingrix vaccine and if so, when? How do you respond?
According to the CDC, patients with history of shingles should still received Shingrix but should wait until all symptoms have resolved.
200
Your patient is here for a PPD and marks on her form she had MMR two weeks ago. How should you proceed?
Wait at least 2 more weeks before PPD or Quantiferon -- MMR causes false negative PPD and Quantiferon
300
By what age must you begin the Rotavirus vaccine series?
15 weeks - if a child hasn't gotten first dose by 14 weeks 6 days of age, don't start
(Max age to complete series 8 months 0 days)
300
What commonly used non-travel vaccine for teens is NOT listed in CAIR and why?
It is not ROUTINELY recommended (it is a Category B recommendation)ACIP recommends it for people at increased risk (complement deficiency, asplenia, microbiologists, those exposed)
There is a Category B recommendation for adolescents age 16-23 who "may be vaccinated"
300
What NON-LIVE vaccine is not recommended during pregnancy?
HPV (Gardasil) - probably not teratogenic or any risk but hasn't been studied..
(Also Shingrix but only approved over age 50)
300
Why is the shingles shot given at the pharmacy and not in the office similar to Prevnar in patients with Medicare?
Medicare A (hospital) and Medicare B (outpatient), does NOT cover any shingles vaccine. Medicare D (pharmacy plan) may cover this so it is given at pharmacies.
Medicare only covers:
Flu, Covid, Hep B, Prevnar
(will cover Tdap for injury but not health maintenance)
300
Per law, what are you required to give patients before giving Prevnar20?
VIS (for ALL vaccines)
Realize comes in 20+ languages
400
What vaccines are required for Kindergarten admittance by California law?
4 Polio, 5 Dtap, 3 Hep B, 2 MMR, 2 Varicella
(ie HPV, Hib, Hep A, Rota, Prevnar not required)
[Need Tdap for 7th grade]
400
What is the difference between the ingredients in DTaP and TdaP?
DTaP has about 3-5x the amount of diphtheria ag as Tdap Both have the same amount of Tetanus toxoid DTaP is only for children age 7 and under;
Tdap is for age 7and up (The "big" D = more Diphtheria)
If you give Tdap to a kid under 7, it is not harmful but doesn't "count"
400
Which vaccines are recommended to be given postpartum to mothers of newborns before hospital discharge?
Tdap if not given during pregnancy
Influenza if not given in pregnancy and birth is during flu season (October to March)
MMR for those with negative rubella testing
Varicella if non immune (and second dose in 1-2 months)
400
If a patient got Prevnar 20 at age 55 because he is a smoker, does he need a 2nd dose? If so, when?
No
400
What 4 vaccines are needed for a 30 year old post-splenectomy patient in addition to the routine recommended vaccines?
At discharge:
Prevnar20, Hib, MenACWY, Men B
8 weeks later:
MenACWY, Men B
MenACWY booster every 5 years
500
How does the vaccination schedule for a pre-term infant differ from a full-term infant?
Hep B should be given to pre-term infants born to Hep B negative moms at age 1 month if they weigh less than 2,000 g at birth (ie not at 24-48hrs) (if Hep B + or unknown, give within 12hrs)
Rota delayed if baby still in the hospital at 6 weeks (given it is live - risk of transmission to others)
Synagis only for preemies (although now Beyfortus for all)
500
A 16-year old comes into UC after falling off his motorcycle and has severe dirt-covered abrasions; he is unsure if he had any tetanus vaccines as he was home schooled and his parents are "anti-vax". How will you prevent tetanus in this patient?
He should receive:
TIG (immunoglobulin)
Tdap or Td today (not DTAP) and TWO MORE doses (dose #2 at week 4 and dose 3 at 6-12 months)
(If clean wound still give 3 doses of Tdap but no TIG)
500
What two vaccines should be avoided in a mother who is breastfeeding?
Smallpox
Yellow fever (can be given if traveling to endemic country but ideally should be avoided) - infants of mothers given the vaccine are at risk of encephalitis from the vaccine
500
If a patient had Prevnar 13 at age 65, Pneumovax 23 at age 66 and is now 71, does she need any further pneumococcal vaccines? if so, when?
CAN give (after SCDM) Prevnar 20
5 years after the last pneumococcal vaccine - ie can get now
500
Name four vaccines NOT given via the IM route?
1) MMR - subQ
2) Varicella - subQ
3) Flumist - nasal
4) Rota - oral
5) Typhim (typhoid) - oral