Overview of Vaccines

  • Active immunity is provided by both live and killed (inactivated) vaccines
  • Live vaccines are given SUBCUTANEOUSLY (or PO/Nasal) & cause a sub-clinical infection which induces long last immunity in the patient given only 1 or 2 doses usually
    • SE are more systemic than inactivated vaccines
    • Live vaccines are contraindicated in immunocompromised patients   (inactivated vaccines aren’t)
    • Antibodies in the blood can interfere with the body’s response to live vaccines, this is why live vaccines are only given to ppl > 1 yo (maternal antibodies are no longer present)
    • Don’t use live vaccines during prego, unless the risk of the disease is high due to something like a disease breakout in a country
  • Live vaccines on the market:
    • MMR (measles, mumps, rubella)
      • Only given in combo (these vaccines are never given individually)
      • 1st dose at > 1 year old, 2nd dose by kindergarten
        • Lots of adults never received 2nd dose & thus still require it
    • Varicella (chickenpox)/shingles — this is the same vaccine; shingles is for adults though & is given in a large dose
      • Given as 2 doses for everyone
      • Sometimes used in combo w/ MMR (ProQuad)
      • Zoster Vaccine is the same as varicella vaccine but it is given as a larger dose for adults in order to prevent shingles which is a reactivation of chickenpox
        • Effectiveness of this vaccine decreases as adults get older–big difference in effectiveness in ppl getting it in 60s vs. 80s
    • Rotavirus
    • Typhoid (oral), yellow fever
    • Intranasal influenza (given to healthy ppl ages 2-49)
  • Inactivated vaccines are usually given INTRAMUSCULAR and require multiple exposures over months & potential booster doses to maintain immunity.
    • Takes time for inactivated vaccines to work (2 weeks with the flu shot)
    • Usually start giving these at 2 months of age
    • SE are primarily local inflammatory reactions as opposed to live vaccines being systemic
    • Passive antibodies AREN’T an issue with inactivated & in fact ppl on antibody therapies may actually require inactivated vaccines more b/c they are immunocompromised and suspect to these diseases even more
    • The only inactive vaccine that can be given at any time during pregnancy is the flu shot (all other inactive vaccines should only be given during the 2nd or 3rd trimester)
    • Polysaccharide (PS) Vaccines are important inactivated vaccines because they are eliminated via the spleen
      • Pneumococcal pneumonia, HiB (haemophilus influenza B) & meningococcus—if a person has a splenectomy they will be more susceptible to these types of diseases & thus will need these vaccines more frequently
      • These PS antigens can be conjugated to a protein in order to induce longer term immunity
      • All of these result in meningitis (pneumococcal meningitis, HiB meningitis, meningococcal meningitis)
    • Inactivated vaccines should never be heated or frozen because these can denature the vaccine’s proteins (a few live vaccines can/must be frozen)
  • Inactivated vaccines on the market:
    • Pneumococcal
      • Influenza/pneumococcal pneumonia is the most common cause of vaccine-preventable death in the US
      • The Polysaccharide version is given to ppl at a high risk & kids > 2 years old
        • Usually only one dose is needed but severely immunocompromised, asplenics (w/o spleen), adults > 65 years old & other very high risk patients may need a second dose after 5 years
      • The conjugate version (PCV13) should be given any time between infancy through 18 years old
        • Number of doses of the conjugate version depends on the age/conditions of the patient
        • Mainly indicated for high risk conditions (asplenia–w/o spleen) & other high risk patients–meningococcal conjugated vaccine is indicated for all teenagers plus anyone in their first year of college
    • Influenza
      • The inactivated IM vaccine is given to anyone over 6 months of age
      • Ppl at high risk for getting the seasonal flu–immunocompromised (includes ppl w/ chronic diseases like asthma, diabetes, etc), prego, health care workers, ppl  < 18 years old & > 50 years old
      • H1N1 & H3N2 are both part of the 2010-2011 seasonal flu vaccine
    • HiB (Haemophilus influenza B)
    • Meningococcal
    • DTaP (diphtheria, tetanus, pertussis)  & Tdap
      • DTaP:  used for kids < 7 years old
        • Begin at 2 months old; minimum of 3 doses–recommended 5 doses by kindergarten
        • DT (no Pertussis antigen present) is used only when Pertussis is contraindicated in the kid
      • Tdap:  used for adolescents/adults
        • One time dose but waning immunity of vaccines after 5-10 years old
        • The Tdap version is used for ppl over 7 years old in order to reduce local reactions
          • The difference between the Tdap & DTaP is that the DTaP product which is used for children has more D & P antigen than the Tdap booster used for adults
          • At age 11-12 or older it is possible to sub one dose of Tdap for Td
          • Booster doses of Td or Tdap are given every 10 years
    • Hep A & B
      • Twinrix:  a 3-dose Hep A & B combo vaccine
      • Hep B–adolescents & adults are at the highest immediate risk
        • Small infants are at high risk if their mother or other caregiver are carriers
        • Given by itself as a 3 dose series
      • Hep A–given by itself as a 2 dose series
      • Recommended for all kids > 1 year old
    • IPV (injected polio)
    • HPV
      • Gardasil has Types 6, 11, 16 & 18
        • Types 16, 18 are used to prevent cancer (cervical)
          • Cervarix only contains these two & is only used by women
        • Types 6, 11 are used to prevent genital warts  (males may also get the Gardasil shot for this)
        • It’s recommended that the HPV vaccine be received between 9-26 years of age & prior to sexual activity
    • Rabies, Typhoid (injected)
  • Herd immunity may apply to HiB, Pneumococcal, measles, mumps, varicella, influenza, pertussis (pertussis immunity wanes over time)
    • Can’t get herd immunity for tetanus b/c it’s found everywhere
  • Required Vaccines for kids 0-6
    • Hep B, Rotavirus, DTaP (diphtheria, tetanus, pertussis), HiB (haemophilus influenza type B), Pneumococcal, inactivated Poliovirus, influenza, MMR (measles, mumps, rubella), varicella (chickenpox), Hep A, Meningococcal
  • Required Vaccines for kids 7-18
    • Tdap (diphtheria, tetanus, pertussis), HPV, meningococcal, influenza, pneumococcal, Hep A, Hep B, inactivated poliovirus, MMR, varicella
  • Required Vaccines for ppl 19+
    • Tdap (diphtheria, tetanus, pertussis), HPV, varicella, zoster (ages 60+), MMR, influenza
  • NCVIA (national childhood vaccine injury act) mandates that vaccinators report certain adverse events they observe in patients following specific vaccinations
    • Proof of causality isn’t required for reporting to VAERS
  • Required documentation for vaccines: date admin’d or given to patient, date on vaccine, manufacturer, lot number, name/address/title of person administering drug
  • Vaccinators must use the most up-to-date vaccine info statement and record use on the vaccination record
  • The following are invalid (inappropriately considered) contraindications or vaccines:
    • Premature birth, antimicrobial therapy, breastfeeding, minor illnesses, convalescence (recovery) following an illness, diarrhea, fever, seizure history

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