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What consecutive days and what dose of steroids is it a contraindication to give steroids?
Hold live vaccines for:
14 days of steroids at 2 mg/kg/day or 20 mg/day
Killed vaccines allowed
When can premature babies receive vaccines?
2 months chronological age.
Hep B can be given 1 month chronological age
Rotavirus can't be given in the hospital because it's shed in the stool
What are the live vaccines?
MMR, Varicella, Yellow fever, Adenovirus (usually military only), Rotavirus
Who are live vaccines contraindicated against?
Pregnant women and the immunocompromised including HIV patients with low CD4 counts, patient receiving chemo, those with congenital immune deficiency disorders (e.g. SCIDS)
They are not contraindicated in family members
What is a complication of the MMR and how long do you have to wait to place a PPD after the MMR is given?
Joint pain of the hands and knees is a complication up to a month.
Can give PPD same day as the MMR but cannot place PPD until 4 weeks
How early can the rotavirus vaccine be given?
What's the latest you can give the first dose?
What's the latest you can give the 3rd dose?
Earliest is 6 weeks
Latest is 15 weeks (so that means if you miss the 2 month dose, child is not eligible for 4 month vaccine)
3rd dose can't be given after 8 months
NOTE: There is a 2 shot and 3 shot series
What is the age range where you have to receive 2 doses of influenzae?
If you're between 6 months and 8 years and you're getting the flu for the first time you need 2 doses
When do you get the Hep A vaccine?
Starting at 1 year and 2nd dose is 6 months after
A mom's Hep B status is unknown. What should the baby receive?
Give Hep B within first 12 hours. Test mom and if she is Hep B positive then give Hep B immunoglobulin (HBIG).
NOTE: If child's birth weight is <2 kg then wait till 1 month of age or hospital discharge before giving Hep B. If mom is Hep B pos and baby is <2kg give HBIG and Hep B vaccine at birth but you need to still give 3 shot series.
NOTE: Hep B is a 3 shot series given usually at 0, 4, 6 months
When should HPV be given?
At age 11 with 2 shots 6 months apart
Who should receive the meningogoccal vaccine?
Is given at 11 with booster at 16 years. For unimmunized freshman given meningococcal vaccine (not booster).
If immunocompromized (compliment deficiency) or asplenic can give at 2 months. Booster 3 years after first dose.
NOTE: Serogroup B meningococcal vaccine should be given to susceptible patients starting age 10. Not approved for babies and serogroup B meningococcus is the most common cause of meningitis in babies.
When do you give prophylaxis for N. mening and H. infl meningitis and with what?
Household members or those who have come in contacts with respiratory secretions.
Treat with Rifampin
NOTE: If immunization status is unknown also give Hib vaccine
NOTE: warn about red/orange tears or urine
Who do you prophylactically treat for pertussis and with what?
High risk people like infants, pregnant women, asthmatics.
Treat with macrolide (azithromycin, erythromycin, clarithormycin).
Why do you not give oral erythromycin in children < 6 weeks
Pyloric stenosis. Give azithromycin instead.
What are the prophylaxis standards for Hep B exposure like from a needle stick?
Immunized and unknown: Check titers
Uimmunized: Give HBIG and also start Hep B vaccination series
What is the standard for varicella prophylaxes?
Give Varicella immunoglobulins for high risk patients (immunocompromised, pregnant).
What are the guidelines for measles immunoglobulin prophylaxis?
If less than 6 months give measles immunoglobulin
If older than 6 months give and exposure is within 72 hours give vaccine. If between 72 hours and 6 days give immunoglublin. If greater than 6 days nothing needed. For the immunocompramised give immunoglobulin.
NOTE: Don't give immunoglobulin and vaccine at same time. Wait 5 months after giving immunoglobulin before giving vaccine.
NOTE: If measles vaccines given less than 12 months need to give regular series
When do you give Tdap vs DTaP?
When to immunize clean vs dirty wounds?
When > 7 yrs of age give Tdap (booster given at 11 and 10 yrs after that)
When < 7 yrs of age give DTaP
CLEAN: If < 10 yrs no need and if > 10 yrs than need a booster anyways
DIRTY: If > 5 yrs give booster. If dirty and immunization status is unknown give immunoglobulin + booster
What are the contraindication for DTaP
If a patient has encephalopathy or prolonged seizure w/in 1 week of receiving the DTaP the aP (acellular Pertussis) component part of the vaccine is contraindicated in the future.
NOTE: If a patient has a progressive neuro disorder or seizure disorder the aP vaccine is relatively contraindicated
What are general contraindications for vaccines
High fever (> 105 F) or a seizure within 3 days.
What vaccines have gelatin?
MMR, Varicella, Influenza, and yellow fever vaccine.
If a person has a true gelatin allergy they should be cleared by an allergist before giving.
If a patient has an allergy to neomycin (topical Ab), polymixin (aka colistin), or streptomycin, which vaccines should you hold before getting clearance from an allergist?
MMR, Varicella, IPV
If a patient has an anaphylaxictic reaction to a vaccine component what should you do?
Get allergy testing to each component of the vaccine.
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