Vaccines

Overview

• Do not memorize schedule

• Understand how many vaccines they need and what to do if behind schedule

• When in doubt: give vaccine

Active Vaccine

Antibody against antigens include:

• organism pieces

• toxins

• toxoid: look like toxins (e.g. tetanus toxoid vaccine)

Passive Vaccine

Includes:

• maternal to fetus

• IVIG

Herd immunity

• if enough people get vaccined in the community, disease disappears

Vaccine Reactions

Allergies

Egg Allergies

• Do not give Yellow fever vaccine

  • Safe to give MMRV (MMR, varicella) vaccines

  • Safe to give Flu vaccines now

Vaccines contraindicated in cases of neomycin allergy include:

• IPV

• MMR

• Varicella

• Hepatitis A

The vaccines for rotavirus and meningococcus are contraindicated in cases of latex allergy.

Live attenuated

• Immunocompromised: AIDS, transplants, biologics drugs (Etanercept), pregnant women

• MMRV

• Flu, intranasal

Normal Reaction

• If temp < 104

• Erythema

• Consolable

Abnormal Reaction

• temp > or = 104

• Inconsolable

• frank anaphylaxis

Scenarios

• Sick: give vaccine

• family history: give vaccine

• autism: give vaccine

Individual Vaccines

Hep B

_

• prevent vertical transmission via IVIG and hep B vaccine immediately (both within 12 hours)

• mom -: start Hep B series

• mom unknown: give hep B within 12 hours, test mom, if positive, give HBIG within 7 days

DTaP

_

• DTaP: 5 doses. Big D = bigger dose

• TdaP: 1 dose after 11, every 10 years

• Td: booster, can be given instead of TdaP

HiB

_

• Getting Hib does not give immunity

MMRV

_

Pneumococcal

_

• mostly for adults

• kids: if sickle cell or asplenic

Meningitis

_

• every one gets, especially if shared space (college, military)

HPV

_

Hep A, B

_

Flu

_

Diseases shouldn't see

Tetanus

• cause: dirty wound from rusty metal puncture

• symptoms: lock jaw, spastic paralysis, die

• diagnosis: clinical

• treatment: intubate, sedate, muscle relaxers, paralytics, IV antibiotics (metronidazole)

• prevention: Tdap, Td booster, tetanus IVIG

  • get 3 doses as adult (tdap, dtap, td, tt; 1 must be in adulthood), get every 10 years

_

• dirty wound: metal, dirt, feces, soil, saliva

• if more than 10 years since last dose: give tdap. Can also use Td

Diptheria

• Symptoms: Fever; dysphasia, dyspnea from pseudomembrane (do not try to peel)

• Diagnosis: clinical

• Treatment: secure airway (intubate), anti-toxins,IV antibiotics

Pertussis

• Symptoms: 3 phases

  • Catarrhal: nonspecific symptoms looks like cold, infectious

  • Paroxysmal: coughs followed by wheezing on inspiration (whooping cough)

  • Resolution:

• Diagnosis: clinical

• Treatment: supportive, erythromycin

Rotavirus

• oral vaccine

• CI in anyone with

  • intussuception

  • Immunodeficiencies such as SCID (live, attenuated vaccine)

  • latex allergies