Refreshing Immunization Knowledge

Catch Up Schedule/Dosing Intervals

100

What is the minimum age to start vaccines?

• 6 weeks of age (Hep B birth dose is the exception)

200

When can you use Kinrix?

• ONLY for age 4-6 (prior to the 7th birthday) as the 5th dose of DTaP and 4th dose of IPV

300

When do you use the catch up schedule?

• On infants or children who are more than 1 month or 1 dose behind schedule should be on an accelerated schedule
• Only use until the patient is caught up.  Once they are back on schedule, use the recommended ages and intervals on the normal/usual childhood schedule

400

Minimum Schedule for Hep B

1st dose to 2nd dose: 4 weeks

2nd dose to 3rd dose: 8 weeks

1st dose to 3rd dose: Must be at least 16 weeks apart

500

Is there a grace period to giving/receiving vaccines ahead min/max intervals/age?  Any exceptions?

• Yes, there is a 4 day grace period.  This allows vaccine doses administered up to four days before the minimum interval or age to be counted as valid.  It should only be used rarely/if patient happens to be in clinic and is not be used routinely and/or for future vaccines.
• NO GRACE PERIOD for 28 day interval between live vaccines
• NO GRACE PERIOD for MMR at age 1 (unless for international travel)
• NO GRACE PERIOD for last dose in the Hep B series for infants (should not receive the last dose in the series earlier than age 24 weeks/if the 3rd dose is given prior to 24 weeks, that dose should not be counted and should be repeated)

Preparing/Administering/Documenting Vaccines

100

If a patient declines a vaccine, tell me where and how you document in the chart

1. Immunization Management Form

2. Click on Correct tab that the vaccine is located

3. Select the "not given today box"

4. From the drop down menu, select the best fitting answer. Can also free type.

5. Press Commit Button

200

Which angle do you administer a Subcutaneous injection?  Angle for Intramuscular?

Explain how you determine proper needle gauge and length

• 45 degree angle into the fat
• 90 degree (perpendicular) into the thickest part of the muscle

_________________________________________

• Based on route, age, injection site and weight for adults
• SQ = 23-25 gauge 5/8 inch, ALL AGES, thigh for infants & upper outer triceps area 12 months +
• IM = 22-25 gauge, use chart for needle length & site

300

When giving more than one injection in the same extremity, how much distance should there be from each injection site?

• 1 inch apart

400

Name the 7 Rights of Vaccine Administration

1. Right patient

2. Right vaccine w/ right diluent (if needed)

3. Right dose

4. Right time (including the correct age, appropriate interval and vaccine/diluent that is not expired)

5. Right route, needle length and technique

6. Right site

7. Right documentation

500

Which of the vaccines we have in stock require reconstitution?  Where is the diluent kept for them? How long after mixing do you have to give them?

• HIB (in the box/fridge) 24 hours
• Menveo (in the box/fridge) 8 hours
• Rotarix (in the box/fridge) 24 hours
• Shingrix (in the box/fridge) 6 hours
• Covid (in the cupboard—only some formulations—SODIUM CHLORIDE 0/9%)  12 hours
• MMR (in the cupboard—STERILE WATER) 8 hours
• Varicella (in the cupboard—STERILE WATER) 30 minutes

VFC/Medicare/Medicaid

100

Who is eligible to receive VFC vaccines?

1. All children birth through 18 years of age who are:

• Enrolled in Medicaid
• Enrolled in CHIP
• Have no health insurance
• American Indian/Alaskan native
• Under insured (insured but no vaccine coverage---send them to FQHC/RHC provider)

200

Who do you notify if there is a wasted VFC Vaccine? 

What do you include in that report?

Natalie, she needs to report it to VFC ASAP and needs to indicate a reason in her report for why it was wasted, the lot, and expiration date. It just takes a quick flag in that patient's chart letting her know of the VFC waste

300

Can we give vaccines to adults with Medicaid insurance?

• Yes, EXCEPT SHINGLES!!

400

Which vaccines can we give patients with Medicare?

1. Flu, Pneumonia, Covid-19

2. Hep B (for individuals at high risk) and/or Tetanus (if related to illness or injury)

3. Send to pharmacy for preventive Tetanus and Shingles

500

What needs to be done if a High Risk Medicare patient decides to get the Hep B vaccine?

The Dx of the disease will need to be attached to the order in centricity

COVID/Refugee Vaccines

100

When do you give a bivalent booster (All ages)?

2 months after completing the primary series

200

For an adult refugee patient, how many Td's/Tdaps do they need?

Three. Preferably starting with the Tdap. We review records to see if they received any doses overseas.

1st dose: Tdap, 2nd dose: Td 4 weeks later, and 3rd dose: Td 6 months after the 2nd dose of tetanus. 

Then it will be a booster of tetanus every 10 years

300

How many polios does an adult refugee patient need?

Three. 

1st dose to 2nd dose: 4 weeks

2nd dose to 3rd dose: 6 months

400

How many Pfizer COVID vaccines do you need to complete a primary series for children ages 6 months – 4 years (recently updated 3/14/23)

3 doses of the pfizer monovalent

500

Name the vaccines that are required for the Greencard

Under the immigration laws of the United States, a noncitizen who applies for an immigrant visa abroad, or who seeks to adjust status to that of a lawful permanent resident while in the United States, is required to receive vaccinations to prevent the following diseases:

• Mumps;
• Measles;
• Rubella;
• Polio;
• Tetanus and Diphtheria Toxoids;
• Pertussis;
• Haemophilus influenzae type B;
• Hepatitis B;
• COVID-19; and
• Any other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices (ACIP).

Pneumococcal/Tdap/Td

100

What is the difference between Dtap, Tdap & TD?

1. TD protects against Tetanus and Diphtheria in adults

2. Tdap protects against Tetanus, Diphtheria AND Pertussis (whopping cough) for adolescents and adults (Age 7 & older)

3. Dtap protects against Diphtheria, Tetanus AND Pertussis (whooping cough)  in babies and children (through age 6)

200

Name some risk factors that a patient would qualify to receive a pneumonia vaccine

e.g. HIV, Cancer, Hep C, DM, Asthma, Smoker, COPD, Liver Disease, Heart Disease (excluding Hypertension), Alcohol, etc.

300

If a Medicare patient wants a Td/Tdap in clinic without an indication of an injury, what form do they have to sign?

An ABN (advanced beneficiary notice)

400

When do you give a Tdap to a pregnant woman?

Between 27-36 weeks of Gestation

500

Name the different pneumococcal vaccines we keep in stock and their recommendations

1. PCV-13.  Give to infants as a 4 dose series (2 months, 4 months, 6 months, and 12-15 months).  Also give to children 2 through 4 years who are unvaccinated or have an incomplete series.

        -And to children 2 through 18 w/ certain medical conditions

2.PCV-20.  Give to all adults age 65 or older who have never received any pneumococcal vaccines or whose previous vaccination history is unknown.  If you give a PCV20, a dose of PPSV23 is NOT indicated.  Go over/see Chart for details

3. PPSV23 (Pneumovax).  Go over/see chart for details