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72 Cards in this Set
- Front
- Back
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types of immunity
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1. Active immunity is protection produced by the body’s own immune system. Usually permanent.
-produced by vaccination or dz 2. Passive immunity is produced by transfer of antibody from immune donor or mother. Temporary. |
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maternal ABs
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-protect infant for first year of life
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factors that impact on immune response to vaccination include
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1. presence of maternal AB
2. nature and dose of antigen 3. handling of vaccine 4. host age, nutrition, coexisting dz |
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live attenuated
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-produced by modifying virus or bacteria
-vaccine organism can replicate and produce immunity but not illness -Virus or bacteria are “weakened” by repeated culturing -Immune response almost identical to that produced by natural infection. ex: MMR, intranasal influenza, BCG oral typhoid |
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inactivated
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-produced from whole or fractions of viruses or bacteria
-Virus or bacteria is grown in culture media and then inactivated with heat or chemicals. -Inactivated vaccines are not live and cannot replicate or cause disease. -May be given when antibody is present in blood. -require multiple doses -ex: polio, hep A, rabies, pertussis |
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polysaccharide vaccines
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-Inactivated subunit vaccines composed of long chains of sugar molecules that make up the capsule of certain bacteria.
-Pure polysaccharide vaccines used for pneumococcal, meningococcal and salmonella vaccines. -<2 yrs old do not always respond |
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conjugate polysaccharide vaccines
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-to give babies immunity
-Haemophilus influenzae type b, Pneumoccus and Meningococcus. |
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recombinent vaccines
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-Hepatitis B vaccine made by inserting Hep B virus gene into gene of yeast cell. Yeast cell produces pure Hep. B surface antigen
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vaccine administration sites
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-<18 mo: anterolateral thigh
-toddlers: anterolateral thigh or deltoid -older kids: deltoid |
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IM route
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-deep into muscle with 22-23 G needle 7/8 inch long (2 cm).
-Pinch muscle and insert needle at 45 degrees in thigh and 90 degrees in deltoid. -Aspirate for blood then inject. |
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subcutaneous
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-inject into pinched skinfold with 25G needle ½ to 7/8 inches long.
-Clean skin with alcohol, insert needle at 45 degrees into skin. Aspirate for blood and inject. |
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invalid C/I to vaccines
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Mild illness
Mild/moderate local reaction or fever after prior dose Antibiotic therapy Disease exposure or convalescence Pregnancy in household Premature birth Breastfeeding Allergies to products not in vaccine |
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Allergic rxns
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-occur in 1 of every 1.5 million doses
-Providers should be prepared for anaphylactic reactions (epinephrine, airways, CPR) |
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adverse effects
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-mild to life threatening
-caregivers should be informed -vaccine informed consent signed by caregiver -Records including vaccine, date administered, lot number, manufacturer, name of provider. -Adverse events must be reported to Vaccine Adverse Events Reporting System. |
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Polio
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-spread from intestinal tract to CNS
-vaccine inactivated administered SC -C/I: allergic rxn to neomycin, streptomycin, polymyxin B or prior polio vaccine -should not be given to a mod or severely ill pts -4 .5ml SC doses give at: 2, 4, 6-18 mo, 4-6 yrs |
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Pertussis
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-acute resp tract infx aka "whooping cough"
-Lax vaccine administration has led to resurgence in cases. -majority of cases July-Oct -extremely contagious -spread by aerosol droplets -toxin mediated -Bacteria attach to respiratory cilia, produce toxins that paralyze cilia causing inflammation which prevents clearing of secretions. |
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pertussis clinical manifestations
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-6 wk disease with 3 stages
1. catarrhal stage: congestion, rhinorrhea, fever, 2. Paroxysmal stage: dry, intermittant hacking cough 3. Convalescent stage: |
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dx of pertussis
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-suspect in pt with cough with no other sxs
-<3 mos may see apnea and cyanosis -CXR mildly abnml with perihlar infiltrate or edema -cx gold standard |
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mgmt of pertussis
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-hospitalize infants <3 mo
-O2, suctioning if needed -mechanical ventilation -erythromycin |
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pertussis vaccine
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-Acellular vaccine combined with diptheria and tetanus toxoids (DTaP) preferred over whole cell pertussis vaccine due to fewer adverse reactions.
-Adverse reactions include: local reactions, high fever, persistant crying (> 3 hrs), hypotonic, hyporesponsive episodes, seizures. -5 doses of .5 ml IM: 2, 4, 6, 15-18 mo, 4-6 yrs |
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pertussis vaccine C/I
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-allergic rxn
-CNS dz -Precautions: temp >105, persistent crying >3 hrs, shock or high fever, seizures w.in 3 days of prior vaccine |
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Tdap
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-for adolescents and adults
-given to 11-12 yo -Td recommended every 10 yrs (adults) |
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Diptheria
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-spread airborne, secretions or skin lesions
-exotoxin causes necrosis -Pseudomembrane of organisms, epithelial cells, fibrin, leukocytes, erythrocytes is greyish-brown and adherent. -difficult to remove-bleeding occurs -toxin may lead to paralysis of palate and hypopharynx |
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clinical manifestations of diptheria
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-tonisl and pharynx most commonly involved
-edema and thick membrane can lead to airway compromise -bull-neck appearance. -tx: antitoxin, PCN G or erythromyxin |
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diptheria vaccine
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-in combo with pertussis and tetanus
-Do not give if moderate to severe illness, life threatening allergic reaction or CNS disease after previous dose -2,4, 6, 15-18 mo, 4-6 yrs -Tdap b/t 11-12 yrs |
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Tetanus
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-acute, spastic paralytic illness caused by tetanus toxin
-2nd most poisonous substance -"lockjaw" -spores in soil intestines and feces of animals -Most non-neonatal cases from puncture wound from dirty object, injection drug use. -Infection from animal bites, piercings, burns, frostbite, gangrene, compound fractures. |
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clinical manifestations of tetanus
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-Masseter muscle spasm (trismus or lockjaw) is presenting symptom in 50% of cases.
-HA, restlessness, irritability early sx. -Then stiffness, difficulty chewing, dysphagia and neck muscle spasm. -risus sardonicus (sardonic smile) -spasms |
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mgmt of tetanus
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-wound debridement
-tetanus immune globulin -metronidazole -muscle relaxants: diazepam -supportive: quiet, dark setting, intubation |
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tetanus vaccine
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-2,4,6,15-18 mo, 4-6 yrs
-Tdap b/t 11-12 yrs -booster Td every 10 yrs -local rxns: pain, erythema, induration -C/I: allergic rxn |
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Measls
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-highly contagious
-spread by droplet spray during prodromal phase -Maternal antibody may interfere with vaccine given before 12 mos. of age. |
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clinical manifestations of measles
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2 stages:
1. incubation: 10-12 days to 1st sx, rash 2-4 days later 2. Prodromal: lasts 3-5 days. Fever, dry cough, coryza and conjunctivities -Koplik spots 3. Maculopapular rash: tem rises as rash appears. Starts as faint macules on neck, behind ears, on harline and cheeks. Becomes maculopap and spread over entire face, neck, upper arms, uper chest within first 24 hrs. Then spreads to back, abdomen, arms , thighs in next 24 hrs -as rash reaches feet it begins to fade on face |
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diagnosis of measles
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-testing for IgM ABs
-tx: supportive, dark room is photophobia present |
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measles vaccine
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-live attenuated virus
-Sc -given at 12-15 mon -4-6 yrs -Should not be given to people with allergic reaction to neomycin, gelatin, prior dose, moderate to severe illness. -C/I: allergy, preg, severe immunosup |
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Rubella
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-in early preg can lead to congenital rubella syndrome
-spread by oral droplet -viremia 5-7 days after exposure -Virus shed in nasopharyngeal secretions, blood, feces, urine. -Patients with subclinical disease are infectious. |
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clinical manifestations of rubella
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-incubation period 14-21 days
-prodrome of mild catarrhal sx -2/3 of infxs subclinical -Retroauricular, posterior cervical and postoccipital lymphadenopathy is characteristic. |
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rrash of rubella
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-exanthema begins on face and spread quickly
-maculopapules in large numbers -Large areas of flushing that spread over body within 24 hours -During 2nd day, rash may become pinpoint lesions (like scarlet fever) on trunk. -Rash usually clears by third day -Forchheimer spots: appear prio to rash, discrete rose colored on soft palate that coalesce onto red blush |
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dx of rubella
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-clinical
-verified with serology or virus cx -spleen may be enlarged -LAD -Tx: supportive |
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Rubella vaccine
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-combined with MMR
-2 doses SC -12-15 mo and 4-6 yrs -C/i: preg, allergy to vaccine, neomycin or gelatin, severe immune compromise -SE: fever, rash, thrombocytopenia, febrile seizures |
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Mumps
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-Acute viral infection with acute painful swelling of parotid glands
-Virus enters respiratory tract and multiplies and becomes bloodborne to many tissues especially salivary glands in 12-25 days. |
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clinical manifestations of mumps
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-Onset characterized by pain and swelling of one or both parotid glands which may occur rapidly. Peaks in 1-3 days.
-Swollen tissues push earlobes outward -Swelling subsides in 3-7 days |
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diagnosis of mumps
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-clinical
-serum amylase may be elevated -confirm dx with serology, viral cx, mumps IgM -tx: supportive |
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mumps vaccine
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-12-15 mo and 4-6 yrs
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H. influenza type B risk factors
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1. childcare outside the home
2. elementary age or younger siblings 3. short duration or lack of breast feeding 4. parental smoking 5. transmitted by direct contact |
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dx of H. flu
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-H&P
-culture and gram stain -imaging as indicated |
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H. influ vaccine
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-HIB vaccine combined with other childhood vaccines: Hep. B, DtaP
-IM -2, 4, 6* (depending on which Hib vaccine used), 12-15 mos -C/I: allergy, infants <6 wks, mod to severe illness -SE: local pain, redness, swelling |
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Hep A
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-transmitted by fecal-oral route
-2/3 of kids asx -Liver involvement includes injury to hepatocytes, necrosis. |
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clinical manifestations of Hep A
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-abrupt onset
-fever -malaise -nausea, V -anorexia -abd discomfort -RUQ pain, jaundice, dark urine -tx: supportive |
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Hep A vaccine
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-2 IM doses for kids 12-23 mo
-2nd dose 6 mo after first -may be given with other vaccines -C/I with allergy -postpone if mod to severely ill -SE: allergic rxn, pain, HA, fatigue |
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Hep B
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-Most important risk factor is perinatal exposure to HBsAg + mother
-Infection in utero and at delivery -Risk of chronic disease inversely related to age at infection. (Higher risk-younger age) |
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clinical manifestations of hep B
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-jaundice ~8wks after exposure lasting 4 wks
-Icteric skin and mucous membranes, enlarged, tender liver, splenomegaly, lymphadenopathy |
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Hep B vaccine
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-recombinent DNA vaccine
-2 doses -infant born to infected mom: dose 1 w/in 12 hrs of life, dose 2 at 1-2 mo, dose 3 ar 6 mo -Hepatitis Immune Globulin also given by 12 hours of life. |
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Hep B vacine: infant born to uninfected mom
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-dose 1 at birth
-2 at 1-4 mo -dose 3 at 6-18 mo |
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Hep B vaccine older child/adult
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-dose 1 at any time
-dose 2 1-2 mo later -dose 3 at 4-6 mo after dose 1 |
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Varicella
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-transmitted by resp secretions and direct contact with fluid or lesiosn
-illness begins ~14 days after exposure -fever, maliase, anorexia, HA, abd pain -tx: acyclovir |
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dx of varicella
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-clinical
-direct flurescent AB |
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rash of varicella
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-Lesions appear first on scalp, face or trunk.
Initially pruritic, erythematous macules Evolve to papules Papules become fluid filled vesicles In 24-48 hours, vesicles become cloudy and umbilicated. Crusting occurs as new crops of lesions form. Lesions in various stages of evolution |
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varicella vaccine
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-live virus
-for susceptible kids 12-18 mo of age and susceptible older kids, adolescents, and adults -SC -1 dose at 12-18 mo -2nd dose at 4-6 yrs -2 doses 4 wks apart in adolescents and adults -C/I: allergy to vaccine, neomycin, gelatin, mod-sever illness, immune deficiencies, preg |
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Influenza
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-RNA viruses causing respiratory illnesses with significant morbidity and mortality in children.
-Infants and young children at high risk for infection. -dz of colder months -transmission by aerosolized droplets |
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clinical manifestations of influenza
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-Abrupt onset of coryza, conjunctivitis, pharyngitis, dry cough.
-Systemic sx include; fever, myalgia, malaise, headache. -Children may be toxic in appearance with high fever. |
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dx of influenza
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-clinical
-viral cx of nasopharyngeal secretions -rapid antigen test for influenza A virus -tx: rest, fluids, acetaminophen or ibuprofen, no salicylates |
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influenza vacine
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-recommended annually for all kids 6mo -18 yrs of age
-live attenuated virus -nasal spray; for healthy kids >2yrs -inactivated- injection; for kids >6 months -do no give to pts with allergy to vaccine, chicken, or eggs -SE: fever, local rxn, guillain barre |
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Strep pneumo
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-causes URI infx and invasive disease
-most infants and children have organism in nasopharynx. Peaks at 2 years of age. -S. pneumoniae is the most common cause of bacteremia, bacterial pneumonia and otitis media. 2nd most common cause of meningitis in children. -ssx related to anatomical site of dz -Diagnosis is made by recovery of organism from site of infection, blood or CSF. Gram stain shows gram + lancet shaped diplococci. |
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tx for s. pneumo
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-PCN
-PCN G (IV) or PCN V (oral) are drugs of choice for PCN sensitive strains. -Vancomycin, cefotaxime or ceftriaxone may be used for PCN resistant strains. |
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Pneumococcal Polysaccharide Vaccine (PPSV) Pneumovax
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-protect against 23 serotypes
-not used in kids <2 -Used in children with: Sickle Cell disease, renal failure, nephrotic syndrome, immunosuppression, HIV infection. -given at 2yo |
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Pneumococcal Conjugate Vaccine (PCV) Prevnar
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-effective against 7 serotypes
-Reduces invasive infection, pneumonia otitis media in infants. -Recommended for all infants at 2 mos, 4 mos, 6 mos. and 12-15 mos. -Children 24-59 mos. who have not had vaccine and are at high risk for pneumococcal disease. |
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RSV
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-major cause of bronchiolitis and PNA <1 yo
-First signs are rhinorrhea and pharyngitis. Cough 1-3 days later with sneezing and low grade fever. -Soon after, child begins to wheeze. -Wheezing, crackles or rhonchi may be heard on auscultation. -CXR may show hyperexpansion, interstitial pneumonia or consolidations. |
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dx of RSV
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-clinical
-Hypoxemia/ hypercapnea/ acidosis -Definitive diagnosis by obtaining virus from nasopharyngeal wash for antigen detection. tx: symptomatic therapy, epi, albuterol, ribavirin if IC |
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RSV immunoprophylaxis
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-Palvizumab (Synagis) ) monoclonal antibody against RSV. Given IM.
-Administered monthly Oct-May (RSV season) -Premies <28 weeks) and infants with lung disease should be prophylaxed for 1-2 RSV seasons. |
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Meningococcal
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-Meningitis in 58% of cases. Also bacteremia.
-Invasive disease common in young children but recently college students in dormitories at increasing risk. -dx: isolate oragnism, gram stain, rapid agglutination tests -tx: PCN G, cefotaxime, ceftriaxone |
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meningococcal vaccine
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-Meningococcal polysaccharide vaccine (MPSV4)
-Meningococcal conjugate vaccine (MCV4) -MCV4 should be given to children with asplenia or complement deficiencies at 2-10 yrs of age and all children at 11-12 yrs. -Unvaccinated college freshman in dorms should be vaccinated with MCV4. |
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Rotavirus vaccine
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-New vaccine, RotaTeq does not have association with intussusception.
-Given at 2 mos., 4 mos., 6 mos. |
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HPV vaccine
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-recombinent vaccine
-Recently recommended for females 11-12 years of age. -3 dose schedule -2nd dose 2 months after first -3rd dose 6 months after first -Administer to females 13-18 years of age if not previously vaccinated. |
