Beruflich Dokumente
Kultur Dokumente
FEBRUARY 5, 2008
STORAGE AND HANDLING
35°F--46°F (2°C--8°C)
Avoid freezing temperatures
aluminum adjuvant precipitates at <32°F (<0°C)
live-attenuated influenza
vaccine:discarded after 60 hours at ref.
temp.
MMR vaccine: give within 8 hours after
reconstitution; ref.temp.
Doses of expired vaccines are invalid,
repeat.
Multidose Vials
DT, Td, Typhoid Vi, meningococcal
polysaccharide vaccine [MPSV], TIV, JE,
MMR, IPV, and yellow fever
Multidose vials that do not require
reconstitution: until the expiration date ;the
vaccine is not visibly contaminated
Vaccines for immunocompromised
patients
Live vaccines generally should be
deferred until immune function has
improved
Vaccines for immunocompromised
patients
Inactivated vaccines might need to be
repeated after immune function has
improved
Vaccines for immunocompromised
patients
increased risk for an adverse reaction
after administration of live-attenuated
vaccines
reduced ability to mount an effective
immune response.
TEST FIRST FOR IMMUNE
STATUS
immunoglobulin (and immunoglobulin subset)
levels
specific antibody levels (tetanus, diphtheria, and
response to pneumococcal vaccine).
lymphocyte numbers (i.e., a complete blood
count with differential
B and T-lymphocytes
CD4+ versus CD8+ lymphocytes
lymphocyte proliferation assays
VACCINES REQUIRED FOR
IMMUNOCOMPROMISED PATIENTS
TIV (INFLUENZA VACCINE)
PCV(PNEUMOCOCCAL VACCINE,
<2Y/O)
PPV(PNEUMOCOCCAL VACCINE, >2
Y/O)
MCV4(MENINGOCOCCAL VACCINE)
PSV (MENINGOCOCCAL VACCINE)
Hib (H.influenzae vaccine)
VACCINATION OF CONTACTS OF
PERSONS WITH ALTERED
IMMUNOCOMPETENCE
Household and other close contacts must
receive all age-appropriate vaccines
EXCEMPTION: live OPV and smallpox
vaccine
varicella vaccine recipient: Avoid contact if
with rash after vaccination
rotavirus-vaccinated infant: frequent
handwashing for at least 1 week
LAIV required
Vaccination with Inactivated
Vaccines
for Immunocompromised
patients
All inactivated vaccines safe
Suboptimal effectiveness
Avoid during chemotherapy or radiation therapy,
but not contraindicated
vaccinated within 2 weeks before starting
immunosuppressive therapy or while receiving
immunosuppressive therapy: invalid
revaccinated at least 3 months after therapy is
discontinued if immune competence has been
restored.
Vaccination with Live-Attenuated
Vaccines for IC patients
are immunocompromised
received the vaccine in the buttock
are infants born to HBsAg (+) mothers
are healthcare workers, contact with blood
are sex partners with chronic hepatitis B
virus infection
NEED FOR BOOASTER DOSES
In the CDC Prevention Guidelines: A Guide to
Action (1997), the CDC states "The duration of
protection of hepatitis B vaccine and need for
booster doses are not yet fully defined. Between
30% and 50% of persons who develop adequate
antibody after three doses of vaccine will lose
detectable antibody within 7 years but protection
against viremic infection and clinical disease
appears to persist." If immunity only lasts 7
years, babies vaccinated with hepatitis B
vaccine may be candidates for more shots at
age seven.
NORMAL LIVER
LIVER HEPATITIS
HEPATOCELLULAR CA
DPT
There are four combination vaccines used to
prevent diphtheria, tetanus and pertussis:
DTaP (CHILDREN < 7 YEARS OLD)
Tdap
DT (CHILDREN < 7 YEARS OLD)
Td.
DOSES: 5 doses of DTaP
2, 4, 6, and 15-18 months and 4-6 years
DPT VACCINE
Td: booster shot every 10 years years
exposure to tetanus
Tdap is similar to Td, contains
pertussis
single dose of Tdap:
adolescents 11 or 12 y/o
booster in older adolescents, adults
19-64 YRS OLD
DPT FOR HCP
Give all HCP a Td booster dose every 10
years, following the completion of the
primary 3-dose series.
Give a 1-time dose of Tdap to all HCP
younger than age 65 years with direct
patient contact
INFLUENZA VACCINE
Inactivated, killed vaccine(TIV)
> 6 months of age
healthy people
chronic medical conditions
pregnant patients
LAIV vaccine
healthy people 2-49 years of age
nonpregnant
INFLUENZA VACCINE
October or November is the best time
to get vaccinated
Flu season: October - May
INFLUENZA VACCINE AND HCP
Give 1 dose of TIV or LAIV annually
LAIV : INTRANASAL
TIV: IM
INFLUENZA VACCINE CAN BE
GIVEN YEARLY TO EVERYONE
People at high risk for complications
from the flu
Children aged 6 months until their 5th
birthday,
Pregnant women
>50 YEARS OLD
chronic medical conditions;
nursing homes,long term care facilities.
People who live with or care for those
at high risk for complications from flu
Household contacts of persons at high
risk for complications from the flu
Household contacts and out of home
caregivers of children less than 6 months
of age (these children are too young to be
vaccinated)
Healthcare workers
MMR VACCINE
DOSE(SQ)
12 – 15 MONTHS OF AGE
REPEAT AFTER 3-5 YEARS
About 2%-5% of persons do not
develop measles immunity after the
first dose of vaccine.
The second dose:another chance to
develop measles immunity for persons
who did not respond to the first dose.
MEASLES VACCINE AND HCP
For healthcare personnel (HCP) born in
1957 or later without serologic evidence of
immunity or prior vaccination:
2 doses of MMR
4 weeks apart.
For HCP born prior to 1957:
RECOMMEND 2 doses, but not
mandatory
VARICELLA VACCINE
ALL HEALTHY SUSCEPTIBLE
PERSONS SHOULD BE VACCINATED
DOSE(SQ)
GIVE AT 12-15 MONTHS OF AGE
NEXT DOSE AFTER 3-5 YEARS
VARICELLA VACCINE AND HCP
GIVE 2 DOSES, 1 MONTH APART
UNLESS:
PRIOR HISTORY OF VARICELLA
LAB EVIDENCE OF IMMUNITY
LAB CONFIRMATION OF THE
DISEASE
MENNGOCOCCAL VACCINE
Give 1 dose to microbiologists who are
routinely exposed to isolates of N.
meningitidis
HPV VACCINE
The HPV vaccine is routinely recommended
for girls 11 and 12 years of age
DOSE (IM)
FIRST DOSE:11-12 YEARS OLD
SECOND DOSE AFTER 2 MONTHS
THIRD DOSE AFTER 4 MONTHS
also recommended for girls and women 13
through 26 years of age who did not receive
it when they were younger
HPV vaccine may be given at the same time
as other vaccines.
HPV VACCINE
Gardasil: first vaccine developed
prevent cervical cancer
precancerous genital lesions
genital warts due to HPV.
four HPV types, which together cause
70% of cervical cancers and 90% of
genital warts.
HPV 6, 11, 16, 18
NORMAL CERVIX
CERVICAL CA
CERVICAL CA
GENITAL WARTS
GENITAL WARTS