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Rules about steroids and giving vaccines

If a course of steroids is given for less than 14 days, then REGARDLESS OF THE DOSE given, ANY vacci­na­tion is allowed (including all live vaccines).




If > 20 mg/day, or > 2 mg/kg/day of prednisone is prescribed for > 14 days, then vaccinations should be held for one month after the course is over.

Hep B Vaccine schedule

3 dose series




Must wait at least one month after dose #1 to give dose #2.


Must wait at least four months after dose #2 to give dose #3.


Dose #3 must NOT be given before the age of 24 weeks (6 months).




So these are all ok:


0,1,6 months


0,2,6 months


0,2,4,6 months (4 months was a combo vaccine)

Hep B vaccination in premies weighing < 2kg and HBsAg negative mother

Give Hep B vaccine within 30 days or prior to discharge (whichever is first)

Hep B vaccination in PREMIE <2kg and HBsAg unknown mother

give the Hep B vaccine + Hep B immunoglobulin within 12 hours of birth




**Does NOT count toward normal series

Hep B vaccination in FULL term and HBsAg unknown mother

give the Hepatitis B vaccine within 12 hours of birth




figure out mom’s status, and if she is HBsAg POSITIVE, give the immunoglobulin (HBIG) no later than the 7th day of life

Hep B vaccination in premies/full term and HBsAg positive mother





**what else is important to remember??

Give Hep B vaccine AND Hep B Immunoglobulin within 12 hours of delivery




**this DOES NOT COUNT towards normal completion of the series

When to test an infant for Hep B if mother was positive?

Test for HBsAg and antibody to HBsAg 1–2 mos after completion of>3 doses of series (typically ~9 months of age)




Testing should not be performedbefore age 9 months nor within 4 wks of the most recent vaccine dose.

Live Vaccines (6)

MMR, VZV, Adenovirus, Yellow Fever, inhaled Influenza, and Rotavirus




(also OPV although not used anymore)

MMR and PPD rule

Can be placed on the same day




If MMR already given, must wait 6 weeks before placing PPD

Rotavirus vaccine schedule


-typical schedule


-first dose must be given after and before what age?


-can it be given if immunocompromised family member at home?

2, 4, 6 months if 3-dose series


2, 4 months if 2-dose series




first dose must be given AFTER 6 weeks and BEFORE 15 weeks




CAN be given if immunocompromised family member at home

FluMist can be given to?

>2yo


not an asthmatic


not pregnant


not immunocompromised

Influenza vaccine schedule

starts at 6 months (need 2 doses to start) then yearly

Hep A Vaccine schedule

1 year then 6 months after

HPV Vaccine schedule

starts at 11 years


3 dose series: 0, 1-2, 6 months

MCV4 Vaccine schedule (normal)

starts at 11 years


booster given at 16 years


*if unimmunized and living in a dorm, give one dose only

MCV4 Vaccine schedule (if needed earlier)


-who are high risk?

minimum age is 2 months




high risk groups:


asplenic (sickle cell), having complement deficiency, generally immunocompromised, or traveling to an endemic area

Prophylaxis for meningitis

-who?


-treatment?



CLOSE INTIMATE contact:


1) household members


2) child-care center contacts


3) persons directly exposed to the patient’s oral secretions (e.g., by kissing,mouth-to-mouth resuscitation, endotracheal intubation)


4) sat next to patient on plane for >8 hours




give rifampin or ceftriaxone within 24 hours

Most meningitis in infants is caused by what serotype?

serotype B (not in the vaccine)

Pertussis prophylaxis


-who?


-treatment?

All household contacts and all exposed people who are at high risk (including infants, pregnant women in their third trimester, those with a pre-existing illness like asthma, and those with contact with infants and pregnant women)




Azithromycin for kids < 6 weeks of age due to concern for pyloric stenosis.




For those > 6 weeks of age, give erythromycin. If the patient is unimmunized, also give the vaccine.

Hep A prophylaxis


-who?


-treatment?

unimmunized family members only




immunoglobulin

Hep B needle sticks



CHECK FOR IMMUNITY.




if antibody negative or known unimmunized: give the immunoglobulin (HBIG) and also start the full vaccination series

Measles prophylaxis


-72 hour rule

For an exposure less than 72 hours ago, give the vaccine to unimmunized patients who are at least 6 months old.




For exposures greater than 72 hours ago, give the immunoglobulin (MIG) and then DO NOT GIVE THE MMR for at least 5 months after that.

DTaP and Tdap vaccine schedules


DTaP: 2, 4, 6, 15 months, and 5 years




Tdap booster is given around 11–12 years




Boosters then continue every 10 years after that

Tetanus and clean wounds

if last shot was >10 years ago, give booster

Tetanus and dirty wounds

if last shot was >5 years ago, give booster




if immunization status is unknown or incomplete, give immunoglobulin + booster

If a tetanus booster is needed after age 7 years?

Give Tdap

How many vaccines at 2 months?

Six


DTap, IPV, Hep B, Hib, PCV, Rota

How many vaccines at 4 months?

Five


DTap, IPV, Hib, PCV, Rota

How many vaccines at 6 months?

Six


DTap, IPV, Hep B, Hib, PCV, Rota

How many vaccines at 12 months?

Five


MMR #1, VZV #1, Hep A #1, Hib #4, PCV

How many vaccines at 15 months?

One


DTap

How many vaccines at 4 years?

Four


MMR #2, Varicella #2, DTaP, IPV

Severe allergic reaction to eggs or chickens should not receive what vaccines?

Live-attenuated influenza vaccine (FluMist)




Yellow Fever

Severe allergic reactions to gelatin should not receive which vaccines?

MMR, varicella, influenza, and yellow fever

DTaP contraindications

1. Encephalopathy or prolonged seizure within 1 week of vaccine - DO NOT give the pertussis component in future vaccines (only give DT) and DO NOT order allergy testing (may cause seizure)




2. Severe allergic reaction

DTaP relative precautions

progressive neuro or seizure disorder NOT under control




having a brief seizure within 3 days


having a high fever (>105) or shock-like state within 48 hours


having persistent, inconsolable crying for >3 hours within 48 hours




**so if these happen AFTER 4 days you're fine to give it!

Rotavirus Contraindications

SCID


History of intussusception

MMR and Varicella are contraindicated in who?

Pregnancy


Severely immunocompromised (severe AIDS, bone marrow/solid organ transplants)




**family members ok!

Severe allergic reactions to neomycin and polymyxin should not receive what vaccines?

IPV, Varicella, MMR

Severe allergic reaction to streptomycin should not receive what vaccine?

IPV