Peds Pharm - Vaccines

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Live attenuated vaccines

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Weakened form of the virus is injected; causes few symtoms, but evokes the natural immune response

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Inactivated vaccine

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Dead virus is injected and evokes the immune response, usually no symptoms, but it is less robust as with live vaccines

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Subunit/conjugate vaccine

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Protin/carb from virus is isolated and used o evoke immune response

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Immunizations

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Refers to the production of both passive and active immunity

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Active immunity

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• develops in response to infection or administration of a vaccine or toxoid
• the result is the production of antibodies
•takes weeks to months to develop and is long lasting

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Passive immunity

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• give a patient pre-formed antibodies
• protect immediately, but last as long as the antibodies remain in the body
• specific immune globulins

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Immunization record

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➢Date of Vaccine
➢Manufacturer information
➢Dosage administered
➢Vaccine type, lot #, expiration date
➢Name and title of the person administering the vaccine and address of the clinic or facility where the permanent record will reside
➢Vaccine Information Statement (VIS)
➢Date printed on the VIS
➢Date VIS was given to the patient or parent

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MMR vaccine

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Measles/Mumps/Rubella
Attenuated live virus
Given as a series of 2 doses at 12- 15 months and then again at 4-6 years

All 3 are a weakened live virus and provide life long immunity

Given as subQ on outer upper arm

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Measles

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• Virus
• S/S- fever, conjunctivitis, red pinpoint rash starts on the face
• COMPLICATIONS: pneumonia, otitis media, encephalitis
•Side Effects: soreness at injection site, low grade fever; Rare: fever 5-12 days after injection
• made of chick embryo’s but OK if have an egg allergies Watch for allergies to gelatin, neomycin

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Mumps

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• Virus causing swelling of the parotid gland
• COMPLICATIONS: meningitis, orchitis, if pregnant can cause fetal death
• Side Effects: soreness, occasional low grade fever.. Made from eggs

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Rubella (German measles)

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• Virus- cause light mild rash of face, mild lymph node involvement, occasional swelling of the joints (arthritis)
• COMPLICATIONS: Blindness in a developing fetus, arthritis, miscarriage, congenital defects (especially in the 1st trimester) cataracts heart disease, mental retardation and deafness
• Contraindicated during pregnancy – advised not to get pregnant for 3 months following immunization

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Diptheria, tetanus, pertusis

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Conjugate vaccine
Series of 5 shots: At - 2, 4, 6, 15-18 months then again between 4-6 years old
TD=<7years
TDAP=>7years

Need boster Q 10years

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Diptheria

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• Inaactivated toxin released by corynebacterium diphtheria
• S/S: causes SOB and difficulty swallowing- also can effect the heart, kidney and nervous system
• Side Effects: local reactions :mild- pain, soreness, swelling and redness; and low grade fever

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Tetanus

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• Toxin releasing bacteria Clostridium tetani
• Bacteria lives in soil and enters the body through a puncture
• S/S: muscle spasm, “lockjaw” - can damage the heart
• Made with a toxin
• Side Effects: rare- soreness & pain at site, low grade fever RARE: anaphylaxis reaction

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Pertussis (whooping cough)

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• Very contagious, caused by toxin-relesing bacteria bordetella pertussis
• S/S: uncontrollable coughing, pneumonia, seizures
• new version since 1996
• Side Effects: Mild- pain, fever, drowsiness
• Rare but severe complication includes - Encephalopathy – good neuro assessment prior to immunization
•IM deltoid or thigh

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Polio

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Inactivated vaccine
• Highly contagious virus
• The virus attacks the neurons of the CNS and causes skeletal muscle paralysis
• To prevent vaccine-induced polio, OPV (Oral Polio Vaccine) has been removed from market
• Inactivated polio vaccine – safe and effective
• Watch for allergies to streptomycin, neomycin, or bacitracin

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Streptococcus Pneumoniae

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• Most Common: pneumonia, others include meningitis, and sepsis
• Infants and small children under the age of 2 years are at the greatest risk
• Side Effects: pain/swelling at the site – fever occurs in 21%
• Give to adults over age 65 years, and those who have heart, lung, liver, ETOH, diabetes, and cancer
• The vaccine is a suspension – shake before use

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Hib vaccine

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• Bacteria Haemophilus influenza type B
• COMPLICATIONS: meningitis, sepsis, epiglottis, and pneumonia
• Side Effects: pain, soreness at injection site, low grade fever

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Meningococcus

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• Bacteria caused by Neisseria meningitidis
• MPSV4 only given to children over 2 years
• WHO GETS IT? Children and adults without spleens, college freshman, persons exposed to meningitis
• Common reactions are local pain, headache and fatigue Local redness, swelling, and induration are also common

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Hepatitis A

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• Can lead to a serious liver infection
•Contracted through-
•Contaminated food / water
•Sexual contact / international travelers
• Given in a series of 2 shots- 12 months old, and the 2nd 6-12 months later
• S/S: inflammation of the liver
• Side Effects; Pain/soreness at site, low grade fever

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Hepatitis B

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●Given in a series of 3 injections: birth-2 months, then 1-2 months after the 1st injection- then in between 6-18 months
●Hep B is considered the silent epidemic
●It’s the only vaccine that can prevent CANCER (liver)

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Varicella (chicken pox)

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●first dose between 12 and 15 months, and the second dose between 4 and 6 years of age
●Made from a weakened virus
●Avoid aspirin or other salicylates or 6 weeks
●Contraindicated during pregnancy
●Watch for hypersensitivity to neomycin or gelatin

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Influenza

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Recommended for children 6 to 23 mo
Do not give live vaccine to pregnant woman
Given to kids with asthma, sickle cell, weakened immunity

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Rotavirus

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●Infects intestinal mucosa – most common diarrheal pathogen
●RotaShield withdrawn in 1999 due to intussusception
●A live oral vaccine
● requires reconstitution prior to oral administration
●Single 2 ml dose X 3 doses

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Human Papillomavirus (HPV)

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●Protects again cervical cancer
●Protects again genital warts
●Neutralizing antibodies to HPV
●Adverse effects is h/a & Discomfort at injection site
●Ages 9 -26 (11-12 years)
●Gardasil for boys/girls, Cervarix for girls only
●Series of 3 shots: Initial, 2 months, 6 months

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Comfort measures

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Antipyretics - Non aspirin pain reliever
Tactile stimulation
Topical analgesics
Rapidly inject, no aspiration

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Vaccine pearls of wisdom

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●Consider using the deltoid at 18 months of age
● Always administer vaccine with person sitting down (fainting has occurred up to 15 minutes following vaccination)
●Anterolateral thigh is the preferred site for multiple IM injections
●Separate injection sites by 1 – 2 inches
●All inactivated vaccines, with the exception of meningococcal polysaccharide vaccine (MPSV4) are administered by the IM route

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Vaccine Adverse Event Reporting System (VAERS

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The National Childhood Vaccine Injury Act requires health care providers to report adverse events (possible side effects) that occur following vaccination

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Timeline

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**Focus on timeline for earlier vaccinations, know general timeline for children, not adults**