Immunizations 2018

Live attenuated, 2-49 yo

6+ months (multidose), 36+ months (prefilled syr)

Fluarix, FluLaval

4+ years, LATEX ALLERGY

9+ years (needle), 18-64 years (jet injector)

Flucelvax LATEX ALLERGY, FluBlok (recombinant)

18-64 yo

Fluzone High-dose, Fluad (MF59 adjuvant which + immunity)

• mild fever, soreness, swelling at injection site.
• other: h/a, loss of appetite, dizziness

act as stabilizer in some vaccines - ok in Muslims, Jews, and Seventh Day Adventists

Vaccine Information Statement  (VIS): risk vs benefits, purpose, who, SE

MMR, MMRV, varicella, zoster, yellow fever, influenza intranasal (Flumist), rotavirus, cholera, typhoid (Vivotif)

Conjugated with a protein molecule improves antibody response (ex. Prevnar 13)

pink

yes!

no! - antibody + MMR/Varicella = 2 weeks before antibody or 3 months after antibody

yes!

yes! - wait 4 weeks if before PPD to avoid false negative TB test result, also or wait until after PPD 48-72 hours

emergency protocols, epinephrine immediately, need at least 3 0.3 mg autoinjectors

with each pregnancy to allow protection of pertussis before child old enough to be fully vaccinated, if none: 3 dose - tdap, td at 1-2 months and another at 6 months

H influenza type B (HiB), penumo both, meningococcal (Menactra/Menveo + Bexsero/Trumenba)

hep B, influenza, MMR, Varicella, Tdap/Td every 10 years

<7 yo

DTaP (Daptacel, Infanrix), DTaP-IPV (Kinrix, Quadracel), DTaP-HepB-IPV (Pediarix), DTaP-IPV/Hib (Pentacel)

childhood

• ActHIB, Hiberix, PedvaxHIB
• MenCY-Hib = Menhibrix (meningoccoal serogroups C and Y, Hib), DTaP-IPV/Hib (Pentacel), 
• after splenectomy
• NEED TO RECONSTITUTE

• Havrix, Vaqta
• routine at 1 year (2 doses)
• high risk adults

• Engerix-B, Recombivax HB
• High-dose 40 mcg/mL = dialysis
• routine within 24 hours after birth (3 doses)
• high risk adults (3 doses - 0, 1, 6 months)

• Twinrix
• 3 doses 0, 1, 6 months

• IM
• Afluria, Fluvirin
• 65+ = Fluzone, Fluad

• IM
• Fluarix Quadrivalent, Fluzone Quadrivalent, Afluria Quadrivalent, Flulaval Quadrivalent
• 4+ = Flucelvax Quadrivalent (cell culture)
• 18+ = Flublok Quadrivalent (egg free)
• Intradermally
• 18-64 yo = Fluzone Intradermal Quadrivalent

• Intranasally
• FluMist Quadrivalent
• 2-49 yo

• LIVE vaccine
• SubQ
• M-M-R II (Store in fridge or freezer)
• MMRV = MMR + varicella (ProQuad) - store in freezer, diluents in room temp/fridge
• 12 months to 12 years, after 1957
• otherwise 2 doses 4 weeks apart

• intramuscular
• Menactra = 9 mo-55yo
• Menveo = 2 mo-55 yo (Reconstitute!)
• 1 dose 11-12 yo, booster 16 yo
• meningitis belt in Sub-Saharan Africa
• 2 mo + high risk
• ongoing risk - every 5 years

• intramuscular
• Bexsero = 10-25 yo (2 dose, 0 and 1 month)
• Trumenba = 10-25 yo (same) (2 dose (0 and 6 month), high risk outbreak (3 dose (0, 1-2, 6 month)

• 1 dose <5 yo
• 1 dose 65+
• 1 dose 6-64 immunocompromised (asplenia, sickle cell, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs including steroids)

• 1 dose 65+ regardless if below EVERYONE!
• 1 dose <65 - immunocompetent - 2-64 DM, heart/lung/liver disease, alcohol abuse, smokers
• 2 doses <65 - immunocompromised - 2-64 sickle cell, asplenia, HIV, chronic renal failure, malignancy, transplant, immunosuppressive drugs including steroids

• Diphtheria and tetanus toxoid
• <7 with contradindication for acellular pertusis antigen

• Tenivac
• 7+ yo - every 10 years

• Adacel, Boostrix
• 11 yo booster without previous Tdap
• pregnant or postpartum women, close contacts of infants <12 months, healthcare with direct patient contact

• LIVE = subq, freezer, diluent in fridge/room
• Varivax
• 2 doses at 12-15 months, and again at 4-6 years
• NO if hypersensitivity to gelatin or neomycin
• Stop 24 hours of antivirals before or wait to take 14 days days after vaccination

• LIVE = subq, freezer, diluent in fridge/room
• Zostavax, Shingrix (recombinant = NOT live - 2 dose 2-6 months after 1st, even with Zostavax already, 50+ yo)
• ACIP 60+, FDA 50+, recurrence prevention
• NO if hypersensitivity to gelatin or neomycin
• Stop 24 hours of antivirals before or wait to take 14 days days after vaccination

• fridge: 36-46 F (2-8 C)
• freezer: -58 - +5 F (-50 - -15)
• Read and document twice a day

• deltoid muscle
• 1" needle (1.5" woman > 200 lbs, men > 260 lbs)
• 22-25 gauge at 90 degrees

• fatty tissue over triceps
• 5/8" needle
• 23-25 gauge at 45 degrees