In a Diseased State
Most common cause of severe gastroenteritis in infants and young children
What is rotavirus?
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Rotavirus is responsible for up to 500,000 diarrheal deaths each year worldwide.
Note: in countries that routinely immunize, gastroenteritis from rotavirus has decreased substantially and norovirus is becoming the leading cause of severe gastroenteritis
Live vaccine that is contraindicated in patients with SCID
What is rotavirus vaccine?
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SCID is the main contraindication to rotavirus
Per the CDC, for patients with altered immunocompetence such as HIV, decisions to vaccinate should be made on a case-by-case risk and benefit basis
The minimum age to start the primary series
What is 6 weeks?
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The primary series is typically started at the 2 month visit, but can be given as early as 6 weeks
These are the components of Pentacel
What is DTaP, ActHib (PRP-T), and IPV?
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ActHib requires 3 doses + a booster, so should be given at 2mo, 4mo, 6mo for the primary series whether given as pentacel or as ActHib alone
The next age for Hib vaccination for a 9 month old who received 2 doses of pedvaxHiB
What is 12-15 months of age?
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PedvaxHib only requires 2 doses with an additional booster at 12-15 months.
ActHib requires 3 doses plus the booster.
If more than one brand is used at 2 or 4 months of age, then patient should receive the 3-dose primary series + booster
Transmission of Haemophilus Influenza type b
What is respiratory droplets?
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Peak transmission is Sept through Dec and March through May
The most common adverse reaction to Hib vaccination
What is localized reaction (i.e. swelling, redness, pain)?
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Systemic and serious adverse reactions are very rare with Hib vaccination
Routine schedule for PCV13 vaccination
What is 4 doses at 2mo, 4mo, 6mo, and 12-15mo?
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Fewer doses are required if the series is started at 7 months or older:
7-11 months: 2 doses + booster at 12-15 months
12-23 months: 2 doses separated by 8 weeks
24-59 months: 1 dose
These are the components of Pediarix
What is HepB, DTaP and IPV?
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Note that Pediarix does NOT include Hib!
If using pediarix during your primary series, you must also give Hib separately (either ActHib - 3 doses, or PedvaxHib - 2 doses)
The maximum age you should vaccinate a healthy patient who never received Hib vaccination
What is 59 months?
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Hib is generally not recommended for healthy patients older than 59 months. Vaccinate high risk older children with asplenia, immunodeficiency, HIV infection, or receiving chemotherapy/radiation therapy
Cochlear implants put patients at a higher risk of this bacterial infection
What is pneumococcus?
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Risk factors for invasive pneumococcal disease include functional or anatomic asplenia (including sickle cell), immunodeficiency, chronic renal disease, nephrotic syndrome, CSF leak, cochlear implant
The #1 contraindication for inactivated vaccines
What is severe allergic reaction?
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If a patient has had an allergic reaction to a vaccine component or following a prior dose of the vaccine, it is an absolute contraindication
The difference between rotateq and rotarix vaccination schedules
What is the number of doses?
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Rotarix (RV1): 2 doses
Rotateq (RV5): 3 doses
Minimum interval between doses is 4 weeks
Max age for first dose is 14 weeks, 6 days
Max age for any dose is 8 months, 0 days
This is the only oral vaccine given in the primary series
What is rotavirus?
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The ACIP recommends that providers do not repeat the dose if the infant spits out or regurgitates the vaccine.
Infants may eat or drink immediately following vaccine administration
The maximum age to vaccinate a patient who is missing doses of rotavirus vaccine
What is 8 months?
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No rotavirus vaccine should be administered to infants older than 8 months, 0 days
The maximum age for the first dose is 14 weeks, 6 days, and there should be a minimum interval of 4 weeks between doses
Formerly the leading cause of bacterial meningitis among children under age 5
What is Haemophilus influenza type b?
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Pre-vaccine era, Hib presented most commonly as meningitis (50%), epiglottitis (17%), pneumonia (15%), arthritis (8%), cellulitis (6%), bacteremia (2%), and osteomyelitis (2%)
A history of this condition is a contraindication for rotavirus
What is intussusception?
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There is a small risk of intussusception from rotavirus vaccination, usually within a week after the first or second dose. Any patient with a history of intussusception should NOT receive rotavirus vaccination.
The Hib vaccine that only requires 2 primary doses
What is PedVax HiB (PRP-OMP)?
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Pedvax Hib: 2 primary doses + one booster dose at 12-15 months
ActHib (PRP-T): 3 primary doses + one booster dose at 12-15 months
This pneumococcal vaccine is a polysaccharide vaccine
What is pneumovax 23 (PPSV23)
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Prevnar 13 (PCV13) is a pneumococcal conjugate vaccine and can be given from 6 weeks to 18 years.
Pneumovax 23 (PPSV23) is a polysaccharide vaccine and can be given >2 years for patients at increased risk for pneumococcal disease.
The number of PCV13 doses needed in a 6 month old who received two doses of PCV7
What is 2?
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Children who received 1 or more doses of PCV7 should complete the series with PCV13 (4 total doses)
Disease that can cause dehydration, electrolyte imbalances, metabolic acidosis, and multiple organ system failure
What is rotavirus?
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Most severe if infection occurs after 3 months old and can be particularly severe in immunocompromised children
This vaccine can cause fever and myalgia in 24-35% of patients
What is PCV13?
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It is important to counsel patients that they may experience local reactions or fever/myalgia after being vaccinated with prevnar. Febrile seizures are rare but can occur.
The minimum age you can give PPSV 23 and the frequency
What is age 2 and every 5 years?
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PPSV23 is recommended for children 2-18 years at increased risk; when both PCV13 and PPSV23 are indicated, always administer PCV13 first and do not administer both at same visit
Candidates for every 5-year revaccination of PPSV23: asplenia, immunosuppression, transplant, chronic renal failure, nephrotic syndrome, malignancy
The difference between conjugate and polysaccharide vaccines
What is improved immunogenicity with conjugate vaccines?
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Conjugated vaccines improve immunogenicity by linking the polysaccharide to a protein which changes the immune response from T cell independent to T cell dependent.
The first conjugated vaccine made was for HiB. Polysaccharide vaccines are not recommended for children under age 2 because of their immature immune systems.
The number of doses of PCV13 a 15 month old patient should receive if they have never been vaccinated
What is 2?
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Patients 12-23 months who have never received PCV13 should have two doses separated by at least 8 weeks
Patients 24-59 months only need 1 dose