Morning Report Vaccination Board Review

You are admitting a newborn in the GCN and as you review the mothers history you note that there is no documentation of her Hepatitis B status. The mothers HBsAg has been drawn and is pending. The infant has a normal physical exam. Your next step should be: A. Continue with routine GCN management while awaiting maternal HBsAg results, administering Hepatitis B vaccine upon discharge B. Administer Hepatitis B vaccine immediately C. Administer Hepatitis B vaccine and HBIG immediately D. Draw stat HBsAg levels in infant

Answer: Administer Hep B vaccine immediately

HepB vaccine: Only vaccine administered at birth 3 shot series
1st dose: Birth, 1 or 2 month visit 2nd dose: <1 mo after 1st dose 3rd dose: <4 mo after 1st dose, not before 6 mo of age

If <2kg, wait 1 month for adequate seroconversion

If mom is HBsAg+ give immediately after birth but do not count as a part of 3 shot series

 Unknown HepB status in mom

HepB vaccine within 12 hours of birth HBIG within 7 days if mothers serologies return as positive

HBsAg+ mother
HepB vaccine and HBIG ASAP Test for anit-HBs and HBsAg in infant at 9-18 mo (after completion of 3 mo series)

What ELSE is in that shot?!?

What allergies should you inquire about before giving vaccines?
(hint: 3 things)

An 18 mo M in your continuity clinic has a severe (anaphylactic) allergy to eggs which vaccine(s) are contraindicated?
A. MMR B. Varicella C. Influenza D. Yellow Fever E. Hib

Answer: Influenza & Yellow Fever

Influenza (including intranasal) Yellow fever (Eggs are Yellow and Bird Flu) MMR is SAFE to use even though incubated with egg

Which have Streptomycin, Neomycin, and Polymyxin B?

P-P-P-POLIO!! IPV OPV

Which 2 Vaccines have Neomycin?

MMR Varicella

Which have Gelatin?

MMR Varicella Yellow Fever

You are in HONC clinic seeing a 30 y/o F with HgbSS. Her last immunizations were at age 18 mo. What additional vaccines will you administer today? (select all that apply) A. B. C. D. E. F. Influenza Tdap Yellow fever PCV 13 PPSV 23 MCV4

Answer: PPSV 23, MCV4 and Influenza

Asplenic children (surgical/functional) should receive PPSV and MCV4 in addition to all routine vaccines due to increased risk with encapsulated organisms. Incidence of and/or mortality from septicemia is 350 times that of an immunocompetent child. They should receive:

MCV4 at age 2 y PPSV 23 at age 2 y and 5 y TdAP

It is October and you are discharging the following infants from the NICU. Who gets synagized? Select all that apply A. 6 mo old FT with tricuspid atresia B. Ex-35 6/7 IDM with feeding intolerance C. 30 month old with CLD, receiving 0.8L NC D. 2 mo old, ex-34 wk healthy M with no chronic disease being discharged to a home with a 4 year old sister

Answer: 6 mo old FT with tricuspid atresia AND 2 mo old, ex-34 wk healthy M with 4 y/o sister

Wait..What is Synagis? Palivizumab: is a monoclonal antibody used to limit the severity of RSV infections in expremies and high-risk infants

You are getting ready to administer vaccinations to a 4 year old patient in your clinic. Which of the following medication regimens would make you hesitate (select all that apply) A. B. 4 y/o with moderate persistent asthma on daily flovent 4 y/o on daily corticosteroids secondary to adrenal insufficiency C. 4 y/o with JIA on a 3 week course of prednisone (dose = 2mg/kg/day) D. 4 y/o severe asthmatic on a 14 day taper of prednisolone (dose = 1mg/kg/day)

Answer: 4 y/o with JIA on a 3 week course

of prednisone (dose = 2mg/kg/day)
Redbook Guidelines for LIVE VACCINES in patients on corticosteroids (not immunosuppressed at baseline)

Do not give if receiving > 2mg/kg/day of prednisone for 14 days or greater (including QOD) Wait until corticosteroid therapy has been discontinued for at least 1 month

Its November and you are seeing a 6 y asthmatic for WCC mom is finally agreeing to the flu vaccine (after 2 years of encouragement) She requests the intranasal influenza vaccine. What regimen would you recommend?

1. 2. 3. 4. 5.

Intransal Influenza x1 dose IM Influenza x1 dose Intranasal x 2 doses IM Influenza x2 doses Influenza is contraindicated in asthmatics

Answer: IM Influenza x2 doses

Children: 9 y should receive 2 doses of influenza separated by 4 weeks when receiving it for the first time (1 dose annually subsequently) Infants 6 mo and older are eligible for influenza vaccination The intranasal formulation is a live vaccine and can only be given to children 2 y and with no underlying chronic medical conditions (heart, lung, renal, DM) or immunocompromised

Rapid Fire. To give or not to give

A previous anaphylaxis to the vaccine or one of its components?

Do not give Consider performing skin testing to determine safety of administering vaccine

Rapid Fire. To give or not to give

Previous mild-to-moderate local reaction to a vaccine (soreness, redness, swelling)

Give Occurs with most vaccines

Rapid Fire. To give or not to give

Concurrent mild, acute illness with or without low-grade fever

Give

Rapid Fire. To give or not to give

Currently on antibiotics/antivirals

Give

Rapid Fire. To give or not to give

History of penicillin or other nonspecific allergy

Give

Rapid Fire. To give or not to give

Moderate-to-severe illness with fever

Do not give Use clinical judgment

Rapid Fire. To give or not to give

Pregnant teenager

Give: HepB, Tdap, Td, inactivated influenza Do not give: MMR, varicella, intranasal influenza, IPV, OPV