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 recently approved by the ACIP, as of June 2024 for use in adults 19 years and older?
A - PCV15
B - PCV20
C - PCV21
What is C - PCV21
Per 6/27/24 meeting
This recommendation was adopted by the CDC Director on June 27, 2024 and is now official.
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 virus
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 herpesvirus family.
- It stays dormant in the sensory ganglia and can reactivate to cause zoster
- 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, having varicella at younger than 18 months
What is the preferred timing of Tdap vaccination during pregnancy?
A. 3rd trimester
B. 1st trimester
C. 2nd trimester
D. After first confirmed pregnancy test
What is 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%!
- Women should 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 of the following statements about the transmission and prevention of respiratory syncytial virus (RSV) is correct?
A. RSV is primarily spread through blood transfusions and can be prevented by wearing gloves.
B. RSV is spread through respiratory droplets and direct contact with contaminated surfaces; prevention includes frequent hand washing and avoiding close contact with infected individuals.
C. RSV is only spread through airborne particles and can be prevented by using air purifiers.
D. RSV is spread through contaminated food and water, and prevention includes boiling water and cooking food thoroughly.
What is B - RSV is spread through respiratory droplets and direct contact with contaminated surfaces; prevention includes frequent hand washing and avoiding close contact with infected individuals.
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 to influenza
B. 2nd trimester, during the middle of the pregnancy is the ideal time, not to soon, not to late
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. Vaccination during July and August should be avoided, unless there is concern that vaccination later in the season is not possible. 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 the CDC to receive pneumococcal vaccination, a change from the previous age of 65.
What is 50 and older
On October 23, 2024 - CDC and ACIP recommend lowering the age for pneumococcal vaccination with (PCV15, PCV20, or PCV21) from 65 years and older to 50 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, 1-3 months apart
B. 50 years and older, 2-6 months apart
C. 50 years and older, 2 weeks - 4 weeks apart
B. 50 years and older, 2-6 months apart
Which of the following are LIVE vaccines, select ALL that apply.
1. MMR
2. Varicella
3. Shingrix
4. Intranasal influenza (FluMist)
MMR, Varicella and Intranasal influenza (FluMist) are two 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)
According to recommendations from ACIP, which one of the following persons, who has not received an RSV vaccine in the past, should receive one dose of RSV vaccine?
A. 50-year-old person with diabetes and HTN
B. 65-year-old person with no underlying comorbidities and not taking any prescription medications.
C. 60-year-old person with T2DM and asthma.
D. 58-year-old person residing in a nursing home.
C. 60-year-old person with diabetes and asthma
In June 2024, the ACIP updated its recommendations for use of the RSV vaccine for adults. Specifically, the ACIP recommended the following receive RSV vaccination:
- ALL adults 75 years of age and older
- Those 60 to 74 years of age who are at increased risk of severe RSV disease . Those who are 60 to 74 years and not at increased risk of severe RSV disease are NOT recommended to receive RSV vaccine.
Risk Factors Include:
Per the ACIP, what formulation of flu vaccine is recommended for those ≥ 65 years and older?
A. High-dose inactivated influenza vaccine, Fluzone high-dose
B. Recombinant influenza vaccine, Flublok
C. Adjuvanted influenza vaccine, Fluad
D. Any of the above
D - Any of the above
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 HD, recombinant, and adjuvanted vaccines that have been shown to elicit a higher immune response in this population.
MT is a 33-year-old female patient with a history of chronic renal failure. She has received PCV13 (13-valent pneumococcal conjugate vaccine) in the past (i.e., when she was a child). Does she need another pneumo vaccine, if so, what should she receive?
A. MT can receive a dose of PCV13 or PCV15 because at least 1 year has passed since her PCV13 vaccination.
B. MT can receive a dose of PCV20 or PCV21 because at least 1 year has passed since her PCV13 vaccination.
C. MT does not need a dose of any pneumococcal vaccine now and she should be revaccinated when she turns 65 years of age.
B. MT can receive a dose of PCV20, or PCV21 because at least 1 year has passed since her PCV13 vaccination. Regardless of which is used, pneumococcal vaccination is complete. Does not need another dose at 50 and older, at least for now.
The CDC recommends that adults 19 through 64 years of age 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 in Shingrix for reducing the incidence of zoster in those 50 years and older?
A. 32.5-53.6%
B. 91.3-97.4%
C. 63.2-88.7%
B - 91.3-97.4% - 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 adult hepatitis B vaccine is a 2-dose series?
A. Heplisav-B
B. Twinrix
C. Engerix-B
D. Recombivax HB
What is A - Heplisav-B (approved 11/19/2017), which is only approved in those ≥ 18 and is given as 2 doses at 0 and 1 month vs other regimens, which are 3 dose series.
Which one of the following medical conditions was found to have the highest incidence of RSV-associated hospitalizations in adults?
A. Congestive Heart Failure
B. Obesity
C. Diabetes
D. History of thrombotic event
A - Congestive Heart Failure
These high-risk adults include those who:
Estimated incidence rates per 100,000 persons over three RSV seasons were highest for CHF. Adults with CHF had up to 33 times higher (Incidence rate ratio, range 4-33) hospitalization rates than those without CHF.
doi: 10.1093/cid/ciab595
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?
A - Fluzone high-dose
B. Adjuvanted influenza vaccine, Fluad
C. Non high-dose inactivated influenza vaccine (regular flu shot)
D. Any of the above
D - Any of the above
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 female with a cochlear implant, what pneumococcal vaccine(s), if any should she receive? Assume no prior pneumococcal vaccinations.
A. No pneumococcal vaccination needed
B. PCV23
C. PCV20, or PCV21
D. PCV15 alone and vaccination is complete
C. PCV20, or PCV21
For those 19-64 years of age with immunocompromising conditions such as cochlear implants, should receive 1 dose of PCV20, or PCV21 and their series is considered complete. If PCV15 is used, it needs to be followed by 1 dose of PPSV23 at least 1 year later. The minimum interval of 8 weeks can be considered in adults with immunocompromising condition such as cochlear implant, or cerebral spinal leak.
In this patients case, if PCV13 had been given then give PCV20, or PCV21 at least 1 year later and pneumococcal vaccinations are complete.
JW is a 60-year-old male that presents to the pharmacy for routine flu vaccination. When reviewing his USIIS account, you notice JW has never received Shingrix. In addition to the flu shot you also offer the Shingrix. JW reports he never remembers getting chicken pox and doesn't think he needs it. What do you tell him? Is Shingrix still recommended?
A. Yes, he should still receive the Shingrix, as he likely still had chickenpox
B. No, since he does not remember having chickenpox, he is not indicated to receive Shingrix
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, as he likely still had chickenpox.
Those 50 years old older can get Shingrix 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. Based on this, I strongly recommend you receive the Shingrix today and come back in 2-6 months for the 2nd and final dose in the series.
What flu vaccine(s) may be administered to persons with anaphylaxis to egg ingestion?
A - FluMist (LAIV)
B - Fluarix, Flulaval (IIV)
C - Fluad (aIIV)
D - All of the above
What is D, all 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.
Select the most appropriate RSV vaccine and timing recommendation for a pregnant individual, with her first pregnancy.
A. Single dose of a RSV vaccine (Arexvy, Abrysvo, or mRESVIA) immediately after childbirth.
B. Single dose of a RSV vaccine (Arexvy, Abrysvo, or mRESVIA) during weeks 32-36 of pregnancy during the RSV season.
C. Single dose of Arexvy during weeks 32-36 of pregnancy during the RSV season.
D. Single dose of Abrysvo during weeks 32-36 of pregnancy during the RSV season.
D. Single dose of Abrysvo during weeks 32-36 of pregnancy during the RSV season.
Three RSV vaccines are currently licensed for use in the United States: Arexvy (GlaxoSmithKline), mRESVIA (Moderna), and Abrysvo (Pfizer). However, only Abrysvo is FDA approved for use in pregnant individuals.
Abrysvo is indicated for active immunization of pregnant individuals at 32-36 weeks gestational age for the prevention of lower respiratory tract disease (LRTD) and severe LRTD caused by RSV in infants from birth through 6 months of age.
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 yo male that presents to your pharmacy to receive his flu vaccine, stating he would like the FluMist due to fear of needles. You are reviewing BJ's consent form and notice that he checked "YES" for one of the boxes and circled "Cancer." You ask him about this, and he states he is being treated for testicular cancer. What recommendations will you give BJ regarding vaccination with FluMist?
Thank BJ for coming to receive his flu vaccine and let him know you have concerns with use of the FluMist today. 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. I would be happy to give you one of our other vaccines that has shown to be safe and beneficial. Getting a flu vaccine, especially in your case is very important because if you were to get the flu, you may get sicker and or have more health complications as compared to someone who does not have a weakened immune system. Then address any further concerns he has with the needle, etc.
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 67-year-old female that presents to your pharmacy for routine flu vaccination. You are reviewing her USIIS vaccine database and notice CJ received one dose of PPSV23, 13 months ago. In addition to her flu shot, what additional pneumococcal vaccine would you recommend she receive today?
A. PCV13
B. Another dose of PPSV23
C. PCV15, PCV20, or PCV21
C. PCV15, PCV20, or PCV21
Since the patient received the PPSV23, she should also receive the PCV15, PCV20, or PCV21 at least 1 year after the PPSV23. Regardless of which vaccine is used, their pneumococcal vaccinations are complete.
JP 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, or does she need to wait until she is 50 years old?
On July 23, 2021, FDA expanded the indication for Shingrix or RZV, 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. Everyone 11-26 years of age
D. Those 11-26 years and 55 years and older if they are at higher risk for HPV
What is 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.
A 67 yo patient is eligible for the annual flu vaccine, the COVID-19 vaccine, and is a good candidate to receive the RSV vaccine based on underlying risk factors (e.g., age, comorbidities). They agree to receive all three vaccines. Choose the correct action for todays visit.
A. You administer the flu and COVID vaccines today and ask them to return in 4 weeks for the RSV vaccine.
B. You administer all three vaccines today.
C. You 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 Centers for Disease Control and Prevention (CDC) released a statement noting that the influenza, COVID-19, and RSV vaccines can all be administered during the same visit. Additionally, the CDC noted that there is no minimum waiting period between getting each vaccine if they are given at separate visits. There are safety data on the co-administration of the influenza and COVID-19 vaccines, along with safety data on the co-administration of the influenza and RSV vaccines. Patients should consider getting the recommended influenza, COVID-19, and RSV vaccines at the same visit, especially if they are unlikely to return to their provider for additional vaccinations and are at high risk of getting seriously ill from any of these infections.
If multiple vaccines are administered in the same limb, like the deltoid, the injections should be separated by at least 1 inch. Also recommended to administer vaccines that are more likely to cause local reactions (pneumococcal, tetanus, Shingrix) in separate limbs and administer the most painful vaccine last.