Immunizations


Varicella has the number II (2) in it - remember 2 vaccinations of varicella.

Update on immunizations in adults. REF

If an otherwise healthy patient receives pneumococcal vaccine at age 65 or later, a second dose is not needed. If a healthy patient receives the vaccine before age 65, a second dose should be given after age 65 if at least 5 years have elapsed since the first dose. REF

In a 1-year-old, pneumococcal 7-valent conjugate vaccine (Prevnar) is preferred rather than polyvalent pneumococcal vaccine (Pneumovax) because it is more immunogenic. REF
Pneumococcal 7-valent vaccine produces a satisfactory immune response in a 1-year-old, while polyvalent vaccine does not cause a good antibody response in children under the age of 2. 

According to the most recent guidelines from the Centers for Disease Control, pneumococcal vaccine should be given to ALL persons 65 or over, including both previously unvaccinated persons and those who received the vaccine before age 65 but were vaccinated over 5 years ago. This patient was age 62 when he received the vaccine, indicating he should be revaccinated at the time of the health maintenance visit. Data from a single epidemiologic study suggest that the vaccine may provide protection for at least 9 years after receipt of the initial dose; however, data to support the need for subsequent doses of pneumococcal vaccine are not available, and because there is insufficient data concerning the safety of pneumococcal vaccine when administered three or more times, revaccination following a second dose is not routinely recommended. REF

The live, attenuated influenza vaccine  is an option for vaccinating healthy, nonpregnant individuals age 5-49 years.  The vaccine is administered intranasally. 
https://nf.aafp.org/Assessment/Take/1560/c/6648197a-343a-4650-a0a0-6ab844c39f18

Patients with chronic illness, diabetes mellitus, cerebrospinal fluid leaks, chronic bronchopulmonary dysplasia, cyanotic congenital heart disease, or cochlear implants should receive one dose of pneumococcal polysaccharide vaccine after 2 years of age, and at least 2 months after the last dose of pneumococcal conjugate vaccine (Prevnar 13).  Revaccination with polysaccharide vaccine is not recommended for these patients.  Individuals with sickle cell disease, those with anatomic or functional asplenia, immunocompromised persons with renal failure or leukemia, and HIV-infected persons should receive polysaccharide vaccine on this schedule and should be revaccinated at least 5 years after the first dose. Ref: Zimmerman RK, Middleton DB: Vaccines for persons at high risk, 2007. J Fam Pract 2007;56(2 Suppl Vaccines):S38-S46, C4-C5. REF


The Advisory Committee on Immunization Practices (ACIP) recommends routine pneumococcal vaccination for healthy patients starting at age 65 years. One-time revaccination after 5 years is recommended only for persons with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising conditions. For persons aged >65 years, one-time revaccination is recommended if they were vaccinated >5 years previously and were aged <65 years at the time of primary vaccination. Patients over 2 years of age with various chronic diseases and patients who are immunocompromised also should be vaccinated (SOR A). Children less than 2 years of age should receive the 13-valent conjugate vaccine as a part of their routine well child vaccinations at 2, 4, 6, and 12 to 15 months of age. These guidelines are ridiculous. REF

Vaccine-based immunity to tetanus, diphtheria, polio, and measles wanes over time, and that these diseases are highly prevalent abroad. REF

Which immunization for college students going to live in a dorm ? REF

Which bites get RPEP ? REF

HIV and HTLV-1 (human T-cell lymphotropic virus) infections are the only infectious diseases that are considered absolute contraindications to breastfeeding in developed countries such as the U.S. REF


Asplenic and functionally asplenic patients are susceptible to overwhelming infection from encapsulated organisms, and should be immunized with pneumococcal, meningococcal, and Hib vaccines. REF 


Birth = Hep B in the hospital (3 dose series)

2 months
- Pentacel (Dtap, IPV, Hib) (5 dose series skipping 12 mo and 18-24 vaccinations)
- Prevnar 13 (pneumococcal) (4 dose series).
- Hep B 2.
- Rotarix (2 dose series) (1st dose betw 6 wks & 14 wks, 6 days, 4 weeks between, must be completed by 8 months).

4 months
- Pentacel (Dtap, IPV, Hib) 2.
- Prevnar 13 (pneumococcal) 2.
- Rotarix 2.

6 months
- Pentacel (Dtap, IPV, Hib) 3.
- Prevnar 13 (pneumococcal) 3.
- Hep B 3.
The rotavirus vaccine is an oral vaccine recommended for infants in a 3-dose schedule at ages 2, 4, and 6 months. . REF

12 months
- Prevnar 13 (pneumococcal) 4.
- MMR (2 dose series)
- Hep A (2 dose series).

15 months
- Pentacel (Dtap, IPV, Hib) 4.
- Varicella (3 dose series).

18-24 months
- Hep A 2.

4 years old
Pentacel (Dtap, IPV, Hib) or Kimrix (Dtap, IPV) 5.
- Varicella 2
- MMR 2

Younger than 7 yo needs pertussis vaccine - give DTaP, not Td or Tdap.
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11 years old
- Varicella 3
- Adacel (Tdap)
- Meningococcal
- can start HPV

50 years old:
- zostavax

65 years old
- pneumovax
If a healthy patient receives pneumococcal vaccine at age 65 or later, a 2nd dose is not needed. 
If a healthy patient receives the vaccine before age 65 give a 2nd after 65 when > 5 yrs from first. REF

2 - 49 yo
- influenza for influenza A&B
- in 2-8 yo getting first shot, 2 doses should be given 4 weeks apart before December.
- live influenza vaccine should not be administered with 4 weeks of other live vaccines.

- Which unimmunized group should get 2 doses of influenza vaccine ? REF

- Live vaccinations and Tdap/MCV4 must be separated by 28 days if not given simultaneously.

- Hib is not recommend for children older than 60 months.

- HPV is not recommended before the age of 9. (9-26 yo).
-- quadrivalent HPV 6,11,16,18 - DNA virus - direct contact or fomites.
-- 6,11 - warts, 16,18 - cervical cancer
-- IM 3 dose series, 2 (min 1 month), 4 (min 3 months) months apart. 
-- Preg category B (no specific teratogenic effects).

- Children who have had chicken pox don't need varicella.

- Varicella is contraindicated in kiddos getting salicylates for Kawasaki ds (Reye syndrome).

- Breast feeding is not a contraindication to receiving vaccinations, but babies don't seroconvert.

- In 1998 4-valent rotavirus vaccination (RotaShield) was pulled 2/2 associate with intussusception.
-- RotaTeq and Rotarix are not associated with intussusception.

- At 9 yo 1 dose of influenza is indicated in children who haven't had it previously (vs 2 doses if younger).

- MMR must be given subqutaneously rather than IM.

- 4 yo pt with asplenia. 1 dose PCV13, 2nd PCV13 at 8 wks, 1 PPSV23 at 8wks, 2nd PPSV23 at 5 yrs.
-- PPSV23 is recommended only in at-risk children, most of whom will have had 4*PCV13 by 2 yo.

- Varicella must be shipped in an insulated container with dry ice at 5F (-15C).

Pneumococcal vaccination: In October 2008 the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention recommended adding cigarette smoking to the list of high-risk conditions that are indications for the 23-valent pneumococcal polysaccharide vaccine. All persons between the ages of 19 and 64 who smoke should receive this vaccine. One-time revaccination after 5 years is recommended for persons with chronic renal failure, asplenia (functional or anatomic), or other immunocompromising conditions. The patient with chronic renal failure in this question has already received two immunizations. The diabetic patient and the nursing-home resident have both received one immunization and should not receive a second dose until age 65. The 71-year-old has already been immunized after age 65, and a repeat immunization is not recommended. REF
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