VFC
Hepatitis Vaccines
What organ is affected?
Is HepA an acute or chronic infection? What about HepB?
What are the two approved HepA vaccines? What are the dosages for pediatric patients? Adult patients?
What are 2 of the 3 approved HepB vaccines? Doses for peds vs adults?
When should the first HepB vaccine be given?
What age can receive Twinrix?
-Route?
-Liver
-HepA: acute; HepB: chronic (can cause fulminant liver failure)
-Havrix and VAQTA, 0.5mL, 1mL
-Recombivax HB, Engerix-B; 10mcg/0.5mL for kids, 20mcg/1mL for adults
-At birth (within 24 hours)
-18 and older
*IM injection
DTaP vs Tdap... what ages for which vaccine?
Why would a pregnant woman be given Tdap?
How often should you get Tdap?
DTaP: ages 6weeks - 6 years old
Tdap: older than 6 years old
Given to pregnant women to protect baby from pertussis (aka whooping cough)
Every 10 years unless there is a skin puncture
What size syringe should be used when drawing up vaccines from single dose or multidose vials?
1 or 3 mL syringe
What can Hib infection cause?
Can infants under 6 weeks old receive the Hib vaccine? Why or why not?
Hib can cause bacterial meningitis.
No, it can cause immunologic tolerance (meaning the immune response may be decreased and not produce antibodies for the Hib bacteria)
Should you inject air into a multidose vial?
No. Not unless the manufacturer says to do so. This can lead to loss of a dose.
Who is eligible for VFC?
-Medicaid managed care
-Uninsured
-Native American
-Alaska Native
-Underinsured (those who have insurance but insurance doesn't include vaccine coverage) (Meeting this criteria is rare)
MMR: what does it protect you against?
Is this a live vaccine?
Which combo vaccine includes MMR? What ages is it approved for?
Can this be given in the same location as another vaccine?
Which route to administer?
Measles, mumps, and rubella
-Yes, live attenuated (weakened viruses are used which are not strong enough to cause disease but are strong enough to stimulate immunity)
-Proquad ; 12 mo - 12 years
-No, you must use a different anatomic location
-SQ
What site is recommended for vaccination of younger children? What are the landmarks of the location?
-Vastus lateralis
-Outer middle third of the thigh
What is the rotavirus disease? What route is it spread? How many doses in the series? What is a rare but possible adverse effect? What age is it first given and subsequent doses need to be separated by how long? Where should the vaccine be administered?
What should you do if the vaccine is spit out? Regive?
-Virus causing severe, watery diarrhea and vomiting that can cause dehydration and death.
-Fecal-oral route
-3
-Intussusception
-First given at 6 weeks and separated by a minimum of 4 weeks for future doses (2, 4, and 6 months; cannot be given on or after age 8 months and 0 days)
-Orally into the cheek
-Nothing, it is not recommended to replace the dose
Should you wipe the top of the multidose vial with alcohol before withdrawing the vaccine? Single dose vial?
What should you do to the top of the vial after wiping with alcohol while gathering supplies to draw the vaccine up?
Yes! For both.
The single dose caps only act as a dust stopper; they do not ensure the unused vial is sterile.
After cleaning the top of the vial, you should leave the alcohol pad on the diaphragm. Why? Theoretically, dust, germs, etc. can get onto the vial if left uncovered in the period of waiting.
HPV:
What can HPV cause?
Who is this vaccine recommended for?
How early can it be given?
I am older than 45 and wanted to catch up, can I?
-Cervical cancers and genital warts
-Males and females ages 11 and 12
-Can be as early as 9 years old
-No, only 27-45 can be vaccinated but must be educated about likelihood of it not mattering (assuming pt has been sexually active at some point in past 45 years)
POLIO:
-Do we use a live or inactivated polio vaccine in the US?
-Names of combo vaccines
-Dose
-IM or SQ?
-Inactivated (IPV) is the only approved form
-Pediarix, pentacel, kinrix, and quadravel are the combo vaccines
-0.5mL
-IM
What site is generally recommended for older children and adults? What is the landmark of the location?
-Deltoid
-Two finger tips below the acromion process in the middle of the imaginary triangle
Varicella can cause _____ later in life.
What is the only monovalent varicella vaccine? What age is it approved for?
What is the only combo vaccine approved and what age is it approved for?
What route is this given?
Shingles
Varivax, 12mo+
ProQuad, 12mo-12 years
SQ
Which vaccines are painful to some when injected?
What order should you give vaccines?
MMR, Prevnar, and HPV vaccines
Administer most painful vaccine last
When giving multiple vaccines in the same limb, how far apart should they be given?
Separate by one inch
MENINGOCOCCAL:
What does it protect against?
Does menactra require reconstitution?
What age is it indicated for?
Route and dose?
-The 5 most common serogroups (A, B, C, W, Y) aka MenACWY
-No
-At ages 11 or 12 with a booster at age 16
-IM, 0.5mL
Correct terminology must be used for the following:
What angle are IM injections given? Acceptable site(s)?
What angle are SQ injections given? Acceptable site(s)?
What angle is an ID injection given? Acceptable site(s)?
1. 90 degrees. Deltoid, vastus lateralis, ventrogluteal.
2. 45 degrees. Back of arm, anterolateral thigh.
3. 10 degrees. Forearm
DTaP vaccine is combo of what?
What age is this vaccine indicated for?
What are the two brands?
How many doses in the series? Can you mix and match brands to complete the series?
-Diphtheria, tetanus, pertussis
-6 weeks to 6 years old
-Infanrix and daptacel
-5. No, they should be the same brand.
What site is NOT recommended?
Dorsogluteal
What are the current 5 FDA-approved combo vaccines? What are they combos of?
Pediarix: DTaP, HepB, IPV (MIN AGE IS 6 WEEKS)
Pentacel: DTaP, IPV, Hib (CAN BE USED UNTIL AGE 4)
Kinrix: DTaP, IPV (CAN ONLY BE GIVEN 4-6 YEARS OLD)
Twinrix: HepA, HepB
Proquad: MMRV
Vaxelis: DTaP, IPV, Hib, HepB
INFLUENZA:
-Do we give an inactivated or activated vaccine?
-What are added to flu vaccines to inhibit bacterial growth?
-What other component is in Fluad Quadravalent?
-What age can you begin recieving the flu vaccine?
What questions must be asked before giving flu vaccine?
You are vaccinating a 6 month old. What must the parent be aware of about dosing?
-Inactivated. Live vaccine is intranasal.
-Antibiotics. Thimerosal is a mercury containing antibacterial compound added.
-Egg
-6 months old
-Have you ever had a reaction before? Are you allergic to egg or thimerosal? Have you ever been diagnosed with Guillian Barre?
-For the first vaccination of children 6mo-8yrs old, they require two doses.
What are the appropriate needle lengths, gauge, and injection site per age group?
Neonate, 28 days or younger
Infants, 1-12 months
Toddlers, 1-2 years
Children, 3-10 years
Children 11-18 years
1. 5/8 in. 22-25g. Vastus lateralis
2. 1 in. 22-25g. Vastus lateralis
3. 1-1.25 in. 22-25g. Vastus lateralis. OR 5/8-1 in. 22-25g. Deltoid
4. 5/8-1 in. 22-25g. Deltoid. (PREFERRED SITE) or 1-1.25 in. 22-25g. Vastus lateralis.
5. 5/8-1 in. 22-25g. Deltoid.
PNEUMOCOCCAL:
What are the two different types? What age groups are indicated for both?
How many serotypes are in the pediatric version?
Dose for peds? Route?
Can you give PCV13 and other vaccines together?
-PPSV23 (65 and up; rec'd for 19-64 cigarette smokers) and PCV13 (6wks-5yrs as series)
-13 hence the name Prevnar 13
-0.5mL, IM
-Yes and no. Cannot be given with Menactra (separate by 4 weeks)
How should you have your hands for an IM injection?
Skin should be spread, not bunched in all populations except geriatric patients. In these patients, it is acceptable to grasp the skin and bunch the muscle.