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Skin test prior to administration of this/these vaccines in egg allergic patients.
- yellow fever
- influenza (only if mild reaction to eggs. If severe anaphylactic reaction to eggs, vaccine is contraindicated and skin testing should not be done. Chemoprophylaxis indicated.)
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What do you do/not do in an egg allergic patient who needs the MMR vaccine?
- Do NOT skin test (not enough egg antigen to make test reliable)
- Do NOT withhold vaccine
- Do give vaccine
- consider monitoring for 90 minutes after administration
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Which childhood vaccines are subQ
Which are oral
SubQ: MMR, varicella, IPV
Oral: rotavirus
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Which vaccines are live
- MMR
- Varicella
- Rotavirus
- nasal flu
- oral typhoid
- yellow fever
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This vaccine is contraindicated in immunocompromised children and those with immunocompromised people at home
oral polio vaccine (OPV)
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caution with this/these vaccine/s in patients allergic to eggs
- influenza (both kinds)
- yellow fever
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caution with this/these vaccine/s in patients allergic to stretomycin, neomycin, polymixin B
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caution with this/these vaccine/s in patients allergic to neomycin
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caution with this/these vaccine/s in patients allergic to gelatin
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avoid these vaccines in pregnant patients
- MMR
- Varicella
- intranasal flu
- IPV
- OPV
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avoid these vaccines in patients who are breastfeeding
none ;-)
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absolute contraindications to DTaP
- encephalopathy within 7 days of previous dosing
- anaphylaxis with previous dose
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Relative contraindications to DTaP
- temp >40.5 w/in 48hrs of previous dose with no other cause
- collapse/shock like state w/in 48hrs of previous dose
- seizures w/in 3 days of previous dose
- persistent inconsolable crying within last 48 hours
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absolute contraindications to MMR
- anaphylaxis to neomycin or gelatin
- pregnancy (no cases of vaccine induced congenital rubella syndrome; no need to teminate pregnancy if MMR given to pregnant woman)
- immunodeficiency (except most HIV infected children can receive MMR)
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Relative contraindications to MMR
- recent IgG (give 2 weeks before or 3-12 months after IgG)
- thrombocytopenia with first dose
- high dose (2mg/kg/day or >20mg/day) oral corticosteroids for 14 days or more (wait 1 month from steroid discontinuation)
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Why is OPV no longer recommended
vaccine associated paralysis
IPV does not cause this
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Other than normal vaccination when shoule Hib be given or not given
- do not give to normal child after age 5
- give to child <24 months with invasive H. influenzae infection as natural immunity may not develop
- give to all with functional/anatomic asplenia (sickle cell, other hemoglobiopathy, AIDS)
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What do you give to a newborn with a HBsAg+ mother
HepB vaccine within 12 hours of delivery
HepB immunoglobulin within 12 hours of delivery at a different site
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What do you give to a newborn whose mother's HBsAg status is unknown?
HepB vaccine within 12 hours of delivery
If testing shows mom is positive, give immunoglobulin to child within 1 week from delivery but preferrably ASAP
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side effects of varicella vaccine
- 3-5% develop localized varicella-like rash w/in 1 month
- 3-5% develop generalized varicella-like rash w/in 1 month
- if rash develops, keep children away from immunocompromised individuals
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contraindications (and non-contraindications) for varicella vaccine
- avoid immunocompromised patients (but HIV, hypogammaglobulinemia, dysgammaglobulinemia, oral steroids <2mg/kg/day and <20mg/day are ok)
- Do not vaccinate pregnant women (but ok to give to child if mom is pregnant)
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types and timing of pneumococcal vaccines
- 7-valent (PCV) at 2,4,6,12-15 months
- give series to 24-59 unvaccinated month olds if high risk or moderate risk
- high risk: SSD, asplenia, HIV, chronic cardio-pulm dz (not asthma), diabetes
- moderate risk: daycare, native americans/alaskans, african americans
- 23 valent (PPSV) for children with immunodeficieny, asplenia, chronic disease
- now give after PCV series completed, ideally at ages 2 and 5.
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Who get meningococcal vaccine
- universal recommendation for 11-12 year olds
- 2-10 year olds with terminal complement deficiency, asplenia, other high risk groups
- those going into crowded living environments (college dorms, military barracks)
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when do you give rotavirus vaccine
- must start by 15 weeks
- must complete before 8 months
- RotaTeq 2,4,6 months
- Rotarix 2,4 months
Remeber intussusception with old vaccine, not with new ones
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What HPV serotypes does HPV vaccine prevent
- 6,11 cause >90% of genital warts
- 16,18 cause ~70% of cervical CA
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Who get HPV vaccine and when
females age 9-26 (recently approved in males of same ages)
- most start at 11-12 years
- give a 0,2,6 months
Still give if history of HPV infection
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vaccines at 2 months
- HepB (if not at 1 month)
- DTaP
- Hib
- IPV
- PCV
- Rota
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vaccines at 4 months
- DTaP
- Hib
- IPV
- PCV
- Rota
- Maybe HepB
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vaccines at 6 months
- DTaP
- Hib
- IPV
- PCV
- Rota
- Maybe HepB
- Maybe Influenza
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vaccines at 12-15 months
- MMR
- Varicella
- HepA (with 2nd dose 6-12 months later)
- Hib
- PCV
- DTaP (15 months)
- Maybe HepB
- Maybe influenza
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vaccines at 4-6 years
- DTaP (not after age 7, switch to Tdap)
- IPV
- MMR (2nd dose can be given 1mo after first)
- Varicella (2nd dose can be given 3mo after first)
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Vaccines at 11-12 years
- Tdap (then Td boosters q10yr or with injury)
- HPV
- MCV4
- remeber to catch up on MMR, varicella, HepB
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When is HepB vaccine given
- 1st dose as early as birth, at least by 2mo
- 2nd dose at least 1mo after 1st
- 3rd dose at least 4mo after 1st and 2mo after 2nd, not before 6mo of age
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When is DTaP given
- 2,4,6,12-15,4-6yrs
- switch to Tdap after 7 years
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When is Hib given
- 2,4,6,12-15mo
- some formulations do not require 6 mo dose
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When is PCV given
2,4,6,12-15mo
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