Afluria
Fluarix
FluLaval
Fluvirin
Fluzone
Influenza virus
- Recommended for ages > 6mo ANNUALLY
Fluzone
Thimerosal-FREE
6 MO and OLDER
Flucelvax
Influenza
Flucelvax (> 18 yrs)
Flucelvax Quadrivalent (> 4 yrs) ———————————————
Cell-Culture-based
Starter strain originally grown in EGG. Minuscule amounts of ovalbumin; the package insert DOES NOT mention EGG allergy as a contraindication or precaution
Flubok
(18-49 YRS)
- Produced with INSECT VIRUS AND RECOMBINANT DNA
- DOESNT USE EGG IN ITS PRODUCT
FluMIST
Quadrivalent, LiVE attenuated
- NASAL SPRAY
- Formulation changes ANNUALLY
(2-49 yrs OLD)
- *PRESERVATIVE FREE**
- *Thimerosal FREE**
Fluzone HD
SENIORS > 65 y/o
- HIGH DOSE
4x’s as much ANTiGEN as STANDARD adult vaccine to help BOOST iMMUNITY.
- 60mcg of EAch virus strain (INSTEAD of 15mcg w/ STANDARD)
Fluzone INTRADERMAL
(18-64 y/o)
- AVOIDS POSSIBLE MUSCLE SORENESS
- PRESERVATIVE FREE
Afluria
NEEDLE-FREE formulation
- (18-64 Y/O)
- JET INJECTOR
Fluad
Adjuvanted TRIVALENT vaccine
> 65 Y/O
ADJUVANT- enhances bodys IMMUNE RESPONSE
PneumoVAX
- PPSV23
Dose: > 2 Y/O
0.5 mL IM/SUBQ
Indication: children > 2 yo
Who should receive:?
> 65yo (5 years after last dose)
Smokers/Asthma/ COPD
chronic diseases (CHF; DM; liver/ alcoholism)
Cochlear implants
CSF LEAKS
IMMUNOCOMP: HIV/ asplenia/ sickle cell
Who should receive PNEUMOCOCCAL VACCINE??
> 65 Y/O
- Smokers > 18 Y/O
- Asthma/ COPD
- CHRONIC DISEASE
(CHF, DM, LIVER, Alcoholism) - Cochlear IMPLANT
- CSF LEAK
- Immunocompromised
- asplenia**
- sickle cell (Revaccinated)
** Asplenic/ immuno-comp patients < 65 Y/O should be revaccinated once 5 yrs after the initial dose, and AGAIN after 65 y/O (5 yrs apart) (TOTAL OF 3 DOSES)**
PREVNAR 13
Pneumococcal 13- VALENT
- Prevention of PNA, Meningitis, OTITIS MEDIA
- conjugated to DIPTHERIA
Indication: > 6 wks; high-risk pts; > 65 yo
SHAKE VIGOROUSLY PRIOR TO ADMIN
Peds dose: 2 mo, 4MO, 6MO, 1 yeAr(4 TOTAL DOSE)
IM ONLY**
Pneumococcal DUAL VACCINATION
- Asplenia, SC, CSF Leak, Cochlear IMPLANT, or IMMUNO-COMP (HIV, ESRD, CANCER)
—> If Naive: Give PCV-13 followed by PPSV23 > 8 wks LATER
—> If vaccinated 1st w/ PPSV23 in < 19 Y/O pt, give PCV-13, 8 WEEKS later
—> if vaccinated 1st w/ PPSV23 in > 19 g/O pt, then give single DOSE of PCV13 > 1 yr LATER
Engerix-B; RecombiVAX HB (L/C)
Hep B
- IM (NOT LIVE)
** Refrigerate**
May interchange products
CONTRAINDICATED IN YEAST ALLERGY!!
Dose: THREE DOSES!!
**4 wks between 1-2 doses
8 wks between 2-3
6 wks between 1-3**
Who should get HEP-B VACCINATION?
- Health care WORKERS
- IV drug users, inmates, HIV PTS, CHRONIC LIVER Dx
- UNVACCINATED KIDS
- HEMODIALYSIS
- sexually ACTIVE (>1 partner in 6mo; M2M, STD TREATMENT)
- DIABETES (< 60 yo; 19-59)
- ALL NEONATES BEFORE LEAVING HOSPITAL
CONTRAINDICATED IN YEAST ALLERGY
Infants born w/ HEPB and people exposed should receive what?
HBIG (Hepatitis B immune globulin)
Hep B vaccine
HAVRIX; Vaqta
HEP-A vaccine
Trans: FECAL/ ORAL
DOSE: TWO DOSES
ATLEAST 6 months BETWEEN DOSES
Admin: IM
Who should help HAVRIX VACCINE?
> 12-23 MONTHS Y/O
TRAVELING OUTSIDE US
- Chronic Liver disease
- IVDA
- HIV pts
- M2M
- clotting factor disorders
Tetanus; Diphtheria; Pertussis
Tetanus - Clostridium tetani
(RUSTY NAIL; LOCK JAW; MS)
- Tetanus IMMUNOGLOBIN (TIG)
————————————————-
Diphtheria - Corneybacterium Diphtheriae
- Throat and nasal passage ————————————————-
Pertussis - Bordetella Pertussis
- Whooping cough (High Pitch)
DTaP
Tetanus/ Diphtheri/ Pertussis
- ALL infants, NOT CHD > 7 Y/o
Dose: 0.5mL IM: 2,4,6,18 months PLUS
4-6 yrs (5 doses)
**BOOSTER Tdap should be given at 11-12 yrs who have completed a childhood DTaP
- CAPITAL LETTERS MEAN THAT THE VACCINE CONTAINS A LARGER DOSE OF ANTIGENS
Td
Tetanus toxoid
- For pts previously NOT immunized
- BOOSTER DOSE EVERY 10 yrs
(ACIP PREFERS Tdap)
DAPTACEL
DTaP
(Diphtheria/ Tetanus/ acellular Pertussis)
KIDS: 6 WEEKS —-> 6 YEARS
- PRIOR TO 7th BIRTHDAY
ADACEL/ Boostrix
Tdap (0.5mL IM) - Deltoid
Indication: ACTIVE BOOSTER
ADULTS —-> 11-64 y/o
> 65 y/o who have CLOSE CONTACT W/ children should receive a ONE-TIME dose to PROTECT INFANTS
- Pregnant women in 3rd TRIMESTER
- Active BOOSTER is needed because immunity CHILDHOOD vaccine WEARS OFF IN 5-10 yrs
DTaP is contraindicated in which patients??
- Encephalopathy w/ PRIOR DTaP
———————————————— - Use w/ CAUTION in kids w/ progressive or unstable NEUROLOGIC PROBLEMS*
MMR
Measles, Mumps, Rubella
- LIVE VACCINE
- FREEZE OR REFRIGERATE
- SUBQ
- Dose: 2 SERIES. 1 yr old + 5 yrs old
—————————————————-
Measles: Koplik’s spots (rash around mouth), cough, Fever
Mumps: Salivary gland enlargement (PAINFUL)
Rubella: German measles.
Cause abortion/still birth/ birth defects
Who should receive MMR?
- Health care workers, College students, International travelers
- All women of child bearing age, but NOT DURING PREGNANCY!!
MMR CONTRAINDICATIONS
- Pregnancy
- ImmunoCOMP (CD4 < 200)
- neomycin allergy, gelatin
- SEVERE THROMBOCYTOPENIA (Measles)
Proquad
MMR + Varicella
- STORE IN FREEZER(MUST)
- Do not FREEZE diluent
Dose: 2 SERIES (1 yr + 5 yrs old)
Varivax
Varicella
- LIVE VACCINES*
Dose: 2 SERIES (1 yr + 5 yrs)
Admin: SUBQ
Storage: FREEZER
Varizig
Varicella Zoster Immune Globulin
- Decrease severity of chk pox when given FOUR DAYS AFTER EXPOSURE
IPV(IPOL)
POLIO - Breathing muscle PARALYSIS
OPV LIVE not available in USA
————————————————-
- Use in infants/ chd < 5 yrs old
- NOT RECOMMENDED FOT ADULTS UNLESS TRAVELING TO ENDEMIC AREAS*
Dose: 0.5mL IM/SUBQ @ 2,4,6-18 m and 4th Dose at 4-6 yrs old (FOUR TOTAL DOSES)
————————————————
Contains trace of: streptomycin, neomycin, polymyxin B
Kinrix/ Quadracel: DTaP- Polio combo
- IM children 4-6 yrs old: 0.5mL SINGLE DOSE
Kinrix/ Quadracel
DTaP- Polio combo
Dose: 0.5mL as SINGLE DOSE
ActiHIB; Hiberix; PedvaxHIB
H. influenza type B (Hib)
Admin: (2 mo- 5 y/o)
- ALL CHD < 5 y/o
Dose: 0.5mL @ 2,4,6, 12-18 mo (4 DOSES)
ADULTS W/
Asplenia, Sickle Cell, stem cell transplant, planned splenectomy
- MENINGITIS
- Pneumonia
- Epiglottitis
Menactra; MenVEO (MCV—4)
Conjugated MENINGOCOCCAL
- QUADRIVALENT
Menactra——> 9mo-55yo**
MenVEO—> 2mo-55yo**
———————————————
Dose: 0.5mL IM/SQ (MCV-4 given IM)
First DOSE 11-12YO + BOOSTER @ 16YO
MenoMune
Polysaccharide Meningococcal
- SUBCUTANEOUSLY, even THOUGH IT IS NOT LIVE**
> 2YO
Trumenba; Bexsero
MENINGITIS B
- HIGH RISK PTS (asplenia; sickle cell)
- NOT A REPLACEMENT FOR MENACTRA OR MENVEO
Pneumococcal Risk
Average risk: >65 yo with no conditions
PCV13 followed by PPSV23 ONE yr LATER
Pneumococcal Risk
Elevated Risk: chronic HEART DISEASE, chronic LUNG DISEASE (COPD, emphysema, asthma), cigarette smoking, DIABETES, alcoholism, CHRONIC LIVER DISEASE, Cirrhosis, Cigarette smoking
PPSV23
Pneumococcal risk:
High Risk: Cerebrospinal fluid leak
Cochlear Implant
PCV13, eight weeks PPSV23
Pneumococcal RISK
Very high risk:
IMMUNOCOMPROMISED
(HIV, RENAL FAILURE, Functional ASPLENIA (sickle-cell)
CANCER PATIENTS
PCV 13 followed by PPSV23 8 WEEKS later followed by PPSV23 5 years LATER
Heplisav B
Hepatitis B VACCINE
> 18 YEARS OLD
TWO DOSES OF 0.5mL IM ONE MONTH APART
Who gets meninococcal VACCINE
- All adults aged 11-18 yrs
- ^ Risk children
First dose 11-12 y/o + booster at 16 y/o
High risk: asplenia, sickle cell, HIV, taking eculizumab (solaris), traveling to endemic area.
REPEAT IN 5 years for at risk patients
- College freshman living in dorms
- U.S Military
- Travelers to endemic areas; Hajj pilgrimage to MECCA;
- Patients with damaged spleen or splenectomy
- HIV infection
- evulizumab use (Solaris)
- Laboratory personnel who are EXPOSED
- Exposure to meningitis during an outbreak
REPEAT IN 5 YEARS IF REMAINING AT RISK
Human papillomavirus 9-valent vaccine
GARDASIL 9
Cervical cancer is a common female cancer world-wide
Gardasil 9: 9-valent HPV vaccine covers
- 6,11,16,18, 31,33,45,52,58
INDICATED FOR FEMALES AND MALES for the prevention of cervical cancer/ anal cancer/ genital warts**
- FEMALES/ MALES AGE 9-45 y/o
- Starting at 11-12 y/o
- IM
Cervical and anal cancers caused by: all except 6/11
Genital warts are caused bu: 6; 11
Zostavax
LIVE- SUBQ
ZOSTAVAX FDA APPROVED > 50 y/o
CDC Recommends it for patients > 60
Contraindications
1) Gelatin or neomycin allergy
2) Immunocomp (inc. STEROIDS)
FREEZER LIKE VARICELLA
Shingrix
NOT LIVE
- 2 DOSES (2nd dose in 2-6 MO)
- REFRIGERATE
Indicated for > 50yo to PREVENT SHINGLES
administer immediately upon reconstitution or STORE refrigerated and use within 6 HOURS
Which vaccines are oral?
- Vivotif Berna
- Rotavirus
Which vaccines are IM or SC?
- Polio
- Pneumovax
Which vaccines are given SC ONLY?
- Varicella
- MMR/MMRV
- Zostavax
- Yellow fever
Rotavirus vaccine for infants
Rotarix (LIVE): 2 DOSES
-started at 6 WEEKS; second dose 1 MONTH later
RotaTeq (LIVE; ORAL): 3 DOSES; given at 2,4,6 MONTHS
Ixiaro
Japanese encephalitis vaccine
-2 DOSES IM 28 days apart > 2 months old
JE-VC is NOT recommended for short-term travelers whose visit will be restricted to urban areas
Typhim Vi
Typhoid Vaccine
- KILLED (inactivated)
- IM x 1 (0.5mL 2 wks prior)
VivoTIF Berna
Typhoid Vaccine
- ORAL 4 DOSES EOD
- For patients > 6 y/o
- 1 wk prior to exposure
- *REFRIGERATE CAPSULES**
- *AVOID ALCOHOL**
Yellow Fever
-South America & Africa
- LIVE
- 0.5mL SC for > 9 MO
——————————–
Cautions/Contraindications: Egg allergy & Pregnant women, immunosuppressed, or THYMUS disease
Rabvert; Imovax Rabies
-For caver’s, bat handlers, and veterinarians
IM: 3 doses, 1 mL on days 0,7,21,28.
Post exposure PPX for rabies?
- Give Rabies Immune Globulin (HRIG) * kedRAB*
- Vaccinate w/ 5 doses over 28 days
TwinRix
Hep A + Hep B
> 18 y/o
Proquad
MMR + Varicella
FREEZER ONLY
Kinrix / Quadracel
DTaP + IPV
-IM 4-6 y/o
PediaRix
DTaP + Hepatitis B + IPV
Pentacel
DTaP + IPV + Hib (H.influ)
Contraindicated in pregnancy?
- MMR
- Varicella
- Zostavax
- Vivotif BERNA
- Meningococcal (ONLY one thats NOT live)
Thimerosal (preservative)
Influenza (Fluzone is thimerosal FREE)
Contraindicated in AIDS (not HIV)
Varicella** (HIV) can give MMR** (HIV) can give Zoster Flumist Yellow Fever ** (HIV) Cn gv VivoTIF Berna
Use with caution in Neomycin allergy
MMR
Varicella
Zostavax
Polio
Vaccines prepared in Egg?
Yellow Fever
Post-splenectomy/ Asplenia/ Sickle cell disease
Capsular polysaccharide bacteria are cleared by the spleen
- Streptococcus PNA
- H. flu (Hib)
- Neisseria meningitidis
What immunizations for TRAVELORS?
YELLOW BOOK
- Hep A
- Hep B
- Meningococcal
- Typhoid
- Yellow fever
- Japanese encephalitis (Ixiaro)