Pediatrics Board Review: Immunizations

Front 1

Rules about steroids and giving vaccines

Back 1

If a course of steroids is given for less than 14 days, then REGARDLESS OF THE DOSE given, ANY vacci­na­tion is allowed (including all live vaccines).

If > 20 mg/day, or > 2 mg/kg/day of prednisone is prescribed for > 14 days, then vaccinations should be held for one month after the course is over.

Front 2

Hep B Vaccine schedule

Back 2

3 dose series

Must wait at least one month after dose #1 to give dose #2.

Must wait at least four months after dose #2 to give dose #3.

Dose #3 must NOT be given before the age of 24 weeks (6 months).

So these are all ok:

0,1,6 months

0,2,6 months

0,2,4,6 months (4 months was a combo vaccine)

Front 3

Hep B vaccination in premies weighing < 2kg and HBsAg negative mother

Back 3

Give Hep B vaccine within 30 days or prior to discharge (whichever is first)

Front 4

Hep B vaccination in PREMIE <2kg and HBsAg unknown mother

Back 4

give the Hep B vaccine + Hep B immunoglobulin within 12 hours of birth

**Does NOT count toward normal series

Front 5

Hep B vaccination in FULL term and HBsAg unknown mother

Back 5

give the Hepatitis B vaccine within 12 hours of birth

figure out mom’s status, and if she is HBsAg POSITIVE, give the immunoglobulin (HBIG) no later than the 7th day of life

Front 6

Hep B vaccination in premies/full term and HBsAg positive mother

**what else is important to remember??

Back 6

Give Hep B vaccine AND Hep B Immunoglobulin within 12 hours of delivery

**this DOES NOT COUNT towards normal completion of the series

Front 7

When to test an infant for Hep B if mother was positive?

Back 7

Test for HBsAg and antibody to HBsAg 1–2 mos after completion of>3 doses of series (typically ~9 months of age)

Testing should not be performedbefore age 9 months nor within 4 wks of the most recent vaccine dose.

Front 8

Live Vaccines (6)

Back 8

MMR, VZV, Adenovirus, Yellow Fever, inhaled Influenza, and Rotavirus

(also OPV although not used anymore)

Front 9

MMR and PPD rule

Back 9

Can be placed on the same day

If MMR already given, must wait 6 weeks before placing PPD

Front 10

Rotavirus vaccine schedule

-typical schedule

-first dose must be given after and before what age?

-can it be given if immunocompromised family member at home?

Back 10

2, 4, 6 months if 3-dose series

2, 4 months if 2-dose series

first dose must be given AFTER 6 weeks and BEFORE 15 weeks

CAN be given if immunocompromised family member at home

Front 11

FluMist can be given to?

Back 11

>2yo

not an asthmatic

not pregnant

not immunocompromised

Front 12

Influenza vaccine schedule

Back 12

starts at 6 months (need 2 doses to start) then yearly

Front 13

Hep A Vaccine schedule

Back 13

1 year then 6 months after

Front 14

HPV Vaccine schedule

Back 14

starts at 11 years

3 dose series: 0, 1-2, 6 months

Front 15

MCV4 Vaccine schedule (normal)

Back 15

starts at 11 years

booster given at 16 years

*if unimmunized and living in a dorm, give one dose only

Front 16

MCV4 Vaccine schedule (if needed earlier)

-who are high risk?

Back 16

minimum age is 2 months

high risk groups:

asplenic (sickle cell), having complement deficiency, generally immunocompromised, or traveling to an endemic area

Front 17

Prophylaxis for meningitis

-who?

-treatment?

Back 17

CLOSE INTIMATE contact:

1) household members

2) child-care center contacts

3) persons directly exposed to the patient’s oral secretions (e.g., by kissing,mouth-to-mouth resuscitation, endotracheal intubation)

4) sat next to patient on plane for >8 hours

give rifampin or ceftriaxone within 24 hours

Front 18

Most meningitis in infants is caused by what serotype?

Back 18

serotype B (not in the vaccine)

Front 19

Pertussis prophylaxis

-who?

-treatment?

Back 19

All household contacts and all exposed people who are at high risk (including infants, pregnant women in their third trimester, those with a pre-existing illness like asthma, and those with contact with infants and pregnant women)

Azithromycin for kids < 6 weeks of age due to concern for pyloric stenosis.

For those > 6 weeks of age, give erythromycin. If the patient is unimmunized, also give the vaccine.

Front 20

Hep A prophylaxis

-who?

-treatment?

Back 20

unimmunized family members only

immunoglobulin

Front 21

Hep B needle sticks

Back 21

CHECK FOR IMMUNITY.

if antibody negative or known unimmunized: give the immunoglobulin (HBIG) and also start the full vaccination series

Front 22

Measles prophylaxis

-72 hour rule

Back 22

For an exposure less than 72 hours ago, give the vaccine to unimmunized patients who are at least 6 months old.

For exposures greater than 72 hours ago, give the immunoglobulin (MIG) and then DO NOT GIVE THE MMR for at least 5 months after that.

Front 23

DTaP and Tdap vaccine schedules

Back 23

DTaP: 2, 4, 6, 15 months, and 5 years

Tdap booster is given around 11–12 years

Boosters then continue every 10 years after that

Front 24

Tetanus and clean wounds

Back 24

if last shot was >10 years ago, give booster

Front 25

Tetanus and dirty wounds

Back 25

if last shot was >5 years ago, give booster

if immunization status is unknown or incomplete, give immunoglobulin + booster

Front 26

If a tetanus booster is needed after age 7 years?

Back 26

Give Tdap

Front 27

How many vaccines at 2 months?

Back 27

Six

DTap, IPV, Hep B, Hib, PCV, Rota

Front 28

How many vaccines at 4 months?

Back 28

Five

DTap, IPV, Hib, PCV, Rota

Front 29

How many vaccines at 6 months?

Back 29

Six

DTap, IPV, Hep B, Hib, PCV, Rota

Front 30

How many vaccines at 12 months?

Back 30

Five

MMR #1, VZV #1, Hep A #1, Hib #4, PCV

Front 31

How many vaccines at 15 months?

Back 31

One

DTap

Front 32

How many vaccines at 4 years?

Back 32

Four

MMR #2, Varicella #2, DTaP, IPV

Front 33

Severe allergic reaction to eggs or chickens should not receive what vaccines?

Back 33

Live-attenuated influenza vaccine (FluMist)

Yellow Fever

Front 34

Severe allergic reactions to gelatin should not receive which vaccines?

Back 34

MMR, varicella, influenza, and yellow fever

Front 35

DTaP contraindications

Back 35

1. Encephalopathy or prolonged seizure within 1 week of vaccine - DO NOT give the pertussis component in future vaccines (only give DT) and DO NOT order allergy testing (may cause seizure)

2. Severe allergic reaction

Front 36

DTaP relative precautions

Back 36

progressive neuro or seizure disorder NOT under control

having a brief seizure within 3 days

having a high fever (>105) or shock-like state within 48 hours

having persistent, inconsolable crying for >3 hours within 48 hours

**so if these happen AFTER 4 days you're fine to give it!

Front 37

Rotavirus Contraindications

Back 37

SCID

History of intussusception

Front 38

MMR and Varicella are contraindicated in who?

Back 38

Pregnancy

Severely immunocompromised (severe AIDS, bone marrow/solid organ transplants)

**family members ok!

Front 39

Severe allergic reactions to neomycin and polymyxin should not receive what vaccines?

Back 39

IPV, Varicella, MMR

Front 40

Severe allergic reaction to streptomycin should not receive what vaccine?

Back 40

IPV