questions 7

Vaccines

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Topic updated on 11/03/17 11:18pm

Snapshot
  • An 85-year-old female is to be admitted to a nursing home. Her last immunization was a tetanus booster given 15 years ago and PPSV23 given three years ago after a bout of pneumonia.
  • A 40-year-old pediatric nurse is starting a new job in October.  He has no complaints. Past medical history includes chickenpox as a child. His last immunization was tetanus-diptheria booster seven years ago.
Vaccination schedule
  • Published by the CDC 
  • Pediatric 
  • Adolescent
  • Adult
  • Contraindications
Types of vaccines
  • Live, attenuated vaccines
    • MMR
      • measles, mumps, and rubella
      • the only live, attenuated vaccine that can be given to HIV+ patients
        • Vaccine may be given to HIV+ patients with CD4+ > 200; CD4+ < 200 is a contraindication to vaccination 
      • egg allergy is not a contraindication
    • Sabin polio
      • given orally
    • chicken pox (VZV)
    • smallpox
    • yellow fever
      • egg allergy is still a contraindication
    • typhoid (oral)
    • rotavirus
    • Franciscella tularensis
    • influenza
      • nasally delievered
      • may be used in healthy adults
      • egg allergy is no longer a contraindication (supervision is necessary)
  • Killed (inactivated) vaccines
    • rabies
    • influenza
    • Salk polio
      • given as an injection
      • now the primary form of polio vaccination in U.S.
      • salK = Killed
    • HAV
    • Vibrio cholerae
    • Japanese encephalitis
  • Recombinant vaccines
    • HBV
      • HBsAg antigen
    • HPV
      • types 6, 11, 16, and 18
    • Borrelia burgdorferi
      • recombinant outer surface protein
  • Toxoid vaccines
    • tetanus
    • diphtheria
    • pertussis
  • Subunit vaccines
    • H. influenza
      • capsular polysaccharide conjugated to diphtheria toxoid
    • N. meningitidis
    • Pneumococcal 
      • adult version is NOT conjugated and does NOT stimulate a helper T cell response
      • the infant version IS conjugated and stimulates a helper T cell response
    • typhoid (injected)
  • Live, pathogenic vaccine
    • adenovirus
      • given in enteric-coated capsules
Contraindications
  • Egg allergic patients
    • yellow fever
  • Immunosuppressed patients
    • live vaccines
      • MMR is OK in HIV+ 
      • do not give oral polio to HIV patients or their contacts
  • Pregnant patients
    • live vaccines


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Qbank (3 Questions)

TAG
(M3.ID.1) A 20-year-old college student is traveling to Senegal with a medical mission. Before receiving the yellow fever vaccine, he should be screened for allergies to which of the following? Topic Review Topic

1. Peanuts
2. Milk
3. Shellfish
4. Soy
5. Eggs

PREFERRED RESPONSE ▶
TAG
(M2.ID.20) A 22-year-old male presents to a primary care physician for a check-up. He reports feeling fatigued but otherwise denies any acute complaints. The patient has a prior history of alcohol abuse. During the preventive health segment of his visit, a vaccine history is obtained. It is determined that he is in need of an MMR vaccination, and he consents to receive this at the current visit. Which of the following is a contraindication to the administration of this vaccine? Topic Review Topic

1. Chronic alcoholism
2. Asplenia secondary to prior splenectomy
3. Hepatitis or other liver disease
4. HIV positive with CD4+ count of 150 cells/uL
5. Administration of other live vaccines on the same day

PREFERRED RESPONSE ▶
TAG
(M2.ID.51) A 47-year-old man presents to your outpatient clinic for a routine checkup. His only medical problem is mild hypertension, for which he takes hydrochlorothiazide. He works as an accountant and lives with his girlfriend; they are mutually monogamous. He drinks a glass of Scotch each evening at dinner, smokes one pack of cigarettes daily, and denies ever using street drugs. Review of his medical records shows that he received a tetanus-diptheria (Td) booster 6 years ago, and the influenza vaccine 3 months previously at a sick visit for an upper respiratory infection. He also received 2 doses each of the measles-mumps-rubella (MMR) previously and had chickenpox as a child. Which of the following vaccines is indicated at this visit? Topic Review Topic

1. Hepatitis A
2. Hepatitis B
3. Zoster
4. Pneumococcal (polysaccharide)
5. Td

PREFERRED RESPONSE ▶
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