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Adult Immunizations 2012 Update. Kenneth McCall, BSPharm , PharmD Associate Professor & Dept. Chair. Disclosure. I, Kenneth McCall, do not have an interest in selling a technology, program, product, and/or service to CME/CE professionals. I am a speaker for Merck Vaccines. Objectives.

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adult immunizations 2012 update

Adult Immunizations2012 Update

Kenneth McCall, BSPharm, PharmD

Associate Professor & Dept. Chair

disclosure
Disclosure
  • I, Kenneth McCall, do not have an interest in selling a technology, program, product, and/or service to CME/CE professionals.
  • I am a speaker for Merck Vaccines.
objectives
Objectives
  • Discuss the gap between current rates and Healthy People 2020 goals for vaccinations.
  • Categorize each of the CDC recommended vaccines based upon live/inactivated, route, prep., and storage.
  • Recognize vaccine-preventable pathogens by common name, classification, and transmission.
  • Discuss the influenza vaccines for 2012 including the new High-Dose and Intradermal vaccines.
  • Identify vaccine contraindications and recommend vaccines based upon age and medical history.
  • Apply ACIP recommendations and FDA approved indications for the CDC recommended vaccines.
outline
Outline
  • Background & Principles of Vaccination
  • Influenza
  • Pneumonia
  • Herpes zoster
immunization resources
Immunization Resources
  • The Pink Book

http://www.cdc.gov/vaccines/pubs/pinkbook/index.html

  • Adolescent and Adult Vaccine Quiz

http://www2a.cdc.gov/nip/adultImmSched/

  • Screening Questionnaire

http://www.immunize.org/catg.d/p4065.pdf

  • The Yellow Book

http://wwwnc.cdc.gov/travel/

  • 1-800-CDC-INFO
  • Apps
    • ACP Immunization Advisor
    • CDC Vaccine Schedule for Adults
second regular session 125 th maine legislature
Second Regular Session – 125th Maine Legislature
  • LD 1608 “An Act to Clarify the Laws Governing Pharmacy Interns”
    • Sponsored by Speaker Bob Nutting
    • “…authorized to engage in the practice of pharmacy while under the direct supervision of a licensed pharmacist.”
  • LD 1715 “An Act for Timely Access to Enhanced Administration of All Vaccines”
    • Sponsored by Representative Meredith Strang Burgess
    • “‘Practice of pharmacy’ means…the administration of vaccines licensed by the US FDA that are recommended by the US CDC ACIP for administration to adults…”
    • “A pharmacy may operate a vaccine administration clinic inside, outside, or off the pharmacy’s premises…with one-time board approval”
pharmacist administered vaccines types of vaccines authorized to administer
Pharmacist Administered VaccinesTypes of Vaccines Authorized to Administer

Based upon APhA / NASPA Survey of State IZ Laws/ Rules (updated March 2012)

* Via Rx for some; ** broad list of vaccines

pharmacist administered vaccines may student interns administer vaccines
Pharmacist Administered VaccinesMay student interns administer vaccines?

Based upon APhA / NASPA Survey of State IZ Laws/ Rules (updated March 2012)

principles of vaccination
Principles of Vaccination*
  • Passive immunity
    • Transplacental
    • Breast milk
    • Blood products
  • Active immunity
    • Infection
    • Vaccination

*Epidemiology and Prevention of Vaccine-Preventable Diseases, 12th Edition

classification of vaccines
Classification of Vaccines
  • Live attenuated
    • Weakened form of the “wild” virus or bacteria
  • Inactivated
    • Whole viruses or bacteria
    • Fractions of viruses or bacteria

*Epidemiology and Prevention of Vaccine-Preventable Diseases, 12th Edition

classification of vaccines1
Classification of Vaccines
  • Live attenuated:
    • Measles, mumps, rubella, varicella, zoster, intranasal influenza
  • Inactivated:
    • hepatitis A, hepatitis B, influenza, pneumonia, diphtheria, tetanus, pertussis, HPV, meningicoccal

*Epidemiology and Prevention of Vaccine-Preventable Diseases, 12th Edition

timing spacing of vaccines
Timing & Spacing of Vaccines
  • All vaccines can be administered at the same visit as all other vaccines.
    • Individual vaccines should not be mixed in the same syringe.
  • When live vaccines (MMR, Varicella, Zoster, and Flumist) are not administered at the same visit, they should be separated by at least 4 weeks.
  • All other combinations of two inactivated vaccines, or live and inactivated vaccines may be given at any time before or after each other.
  • Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine.
  • Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection.

*Epidemiology and Prevention of Vaccine-Preventable Diseases, 12th Edition

slide14

A healthcare provider requests a flu shot, MMR, and varicella vaccine. Which of the following statement about the timing of the vaccines is true?

  • All three , separate syringes, same day
  • All three, mix in 1 syringe, same day
  • Must separate MMR and varicella by 4 wks
  • Must separate MMR and varicella by 7 days
slide15

An 12-year-old girl received the first dose of the HPV vaccine six months ago. The recommend HPV series is a second dose 1-2 mos after first and third dose at least 3 mos after second. What would you recommend to the parent?

  • The vaccine is no longer indicated
  • Start the series over and repeat first dose
  • Give 2nd dose today; 3rd dose in 1 month
  • Give 2nd dose today; 3rd dose in 3 mos.
recommended adult immunization schedule by vaccine and age group
Recommended Adult Immunization Schedule, by vaccine and age group

< -------------TIV or LAIV--------- >

TIV or TIV HD

< -----------------------------TIV or TIV ID-------------------------------- >

FDA approved

age 50+ yrs

vaccines that might be indicated for adults based on medical and other indications
Vaccines that might be indicated for adults based on medical and other indications

Smoker

College Dorm / Military Recruit

influenza virus strains
Influenza Virus Strains
  • Influenza A virus
    • Moderate to severe illness
    • All age groups
    • Humans and other animals
  • Influenza B virus
    • Milder disease
    • Primarily affects children
    • Humans only
  • Influenza C virus
    • Rarely reported in humans
    • No epidemics

Seasonal influenza

vaccine contains

2 type-A and 1 type-B

estimated influenza vaccination coverage 2010 11
Estimated Influenza Vaccination Coverage: 2010-11.

†Persons with asthma, diabetes, or heart disease

MMWR / June 10, 2011 / Vol. 60 / No. 22

2011 12 acip cdc who recommendations
2011-12 ACIP/CDC/WHO Recommendations
  • Routine influenza vaccination continues to be recommended for all persons aged ≥6 months.
  • The 2011--12 U.S. seasonal influenza vaccine virus strains are identical to those contained in the 2010--11 vaccine.
  • Persons aged ≥65 years can be administered any of the standard-dose inactivated vaccine or Fluzone High-Dose.
  • A new intradermally administered TIV preparation, Fluzone Intradermal, was licensed in May 2011 for adults 18 to 65.
  • Refer patients with a severe egg allergy to a physician.
  • Persons with a mild egg allergy should receive flu vaccine:
    • TIV rather than LAIV should be used.
    • Observed vaccine recipients for at least 30 minutes
live attenuated influenza vaccine
Live Attenuated Influenza Vaccine
  • Indication
    • Healthy people 2 through 49 years of age
  • Contraindications
    • Pregnant women
    • People who have long-term health problems with:
      • heart disease
      • kidney or liver disease
      • lung disease
      • metabolic disease, such as diabetes
      • asthma
      • anemia, and other blood disorders
    • Anyone with a weakened immune system
    • Severe egg allergy

I pick my nose!

live attenuated influenza vaccine adverse reactions
Live Attenuated Influenza VaccineAdverse Reactions
  • Runny nose or nasal congestion
  • Fever > 100°F in children 2-6 years of age
  • Sore throat in adults
  • Wheezing and hospitalization in children < 2 years old
administration
Administration
  • Flumist®: 0.1-mL dose in each nostril
  • Intranasal
slide31

Methods:

    • Multicenter, randomized, double-blind controlled study
    • HD vaccine (60 mcg of hemagglutinin per strain): N=2,575
    • SD vaccine (15 mcg of hemagglutinin per strain): N=1,262
    • in adults 65 years of age and older.

J Infect Dis. 2009;200(2):172-80

comparison of responses to high dose hd and standard dose sd influenza vaccine
Comparison of responses to high-dose (HD) and standard-dose (SD) influenza vaccine

antibody titer level

J Infect Dis. 2009;200(2):172-80

comparison of systemic side effects to hd and sd influenza vaccine
Comparison of systemic side effects to HD and SD influenza vaccine

Percent

J Infect Dis. 2009;200(2):172-80

administration1
Administration
  • Fluzone HD®: 0.5-mL dose
  • IM - deltoid
  • 1 inch, 25 gauge needle
slide35

A 30-year-old healthy male requests an annual flu shot. He is allergic to eggs (rash/hives). His wife is currently pregnant. Which flu vaccine(s) is/are appropriate?

  • Influenza intradermal vaccine 0.1 ml
  • Influenza SD shot 0.5 ml IM
  • Influenza HD shot 0.5 ml IM
  • Flumist nasal spray 0.1 ml in each nostril
  • Either 1 or 2
  • Either 3 or 4
  • Either 1, 2 or 4
intradermal influenza vaccine
Intradermal Influenza Vaccine
  • Indication
    • Persons 18 through 64 years of age
  • Contraindications
    • Severe egg allergy
slide40

Methods:

    • Multicenter, randomized, double-blind controlled study
    • ID vaccine (9 mcg of hemagglutinin per strain) N=1,803
    • IM vaccine (15 mcg of hemagglutinin per strain): N=452
    • in adults 18 to 60 years of age.

Human Vaccines. 2010;6:346-54.

comparison of responses to intradermal id and intramuscular im influenza vaccine
Comparison of responses to Intradermal (ID) and Intramuscular (IM) influenza vaccine

Seroprotection Rate

Human Vaccines. 2010;6:346-54.

comparison of systemic side effects to id and im influenza vaccine
Comparison of systemic side effects to ID and IM influenza vaccine

Percent

Human Vaccines. 2010;6:346-54.

comparison of local side effects to id and im influenza vaccine
Comparison of local side effects to ID and IM influenza vaccine

Percent

Human Vaccines. 2010;6:346-54.

slide44
Which side effect is more common with the intradermal influenza vaccine than the IM influenza vaccine?
  • Injection site pain
  • Headache
  • Fever
  • Injection site swelling
  • Malaise
slide45

A 35-year-old woman requests an annual flu shot. She has ulcerative colitis and is taking Prednisone 40 mg QD. Which flu vaccine(s) is/are appropriate?

  • Influenza intradermal shot 0.1 ml
  • Influenza SD shot 0.5 ml IM
  • Influenza HD shot 0.5 ml IM
  • Flumist nasal spray 0.2 ml nasal
  • Either 1 or 2
  • Either 2 or 3
  • Either 2 or 4
pneumococcal 23 vaccine
Pneumococcal-23 Vaccine
  • Indication
    • Routine vaccination of persons > 65 years (ACIP)
    • Routine vaccination of persons > 50 years (FDA)
    • Persons > 2 years of age with chronic conditions
    • Chronic illness (diabetes, heart disease, lung disease)
    • Asplenia
    • Immunocompromised / HIV infection
    • Cochlear implant
    • Smokers
  • Contraindications
    • Hypersensitivity to any component of the vaccine
acip recommendations for prevnar 13 in adults 50
ACIP Recommendations for PREVNAR 13 in Adults >50
  • 12/30/11-FDA expanded indication to adults 50+
  • February 2012 ACIP meeting: “At this time, the available evidence is insufficient to recommend routine use of PCV13 among older adults”
    • Critical data elements for the ACIP recommendation to be made are not available at this time
      • –the indirect effects of PCV13 use in children on adult disease incidence
      • –results from the CAPITA trial
    • Clinical relevance of immunogenicity data unclear without defined correlate of protection

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm285431.htm

http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-feb12/02-PCV13.pdf(slide 37)

slide53
Percentage of IPD cases caused by serotypes covered in PCV7, PCV13, and PPSV23 among adults >18 years, by age group – US 20081

78%

76%

66%

53%

49%

44%

1MMWR 2010 59(34);1102-1106

administration2
Administration
  • Pneumovax®: 0.5-mL dose
  • IM - deltoid
  • 1 inch, 25 gauge needle
slide55

JB is a 40-year-old man with diabetes. He has no allergies. His current meds include metformin 500 mg PO BID and lisinopril 20 mg PO QD. Which vaccine(s) is/are appropriate for him?

  • Pneumovax 0.5 ml IM
  • Influenza SD vaccine 0.5 ml IM
  • Influenza HD vaccine 0.5 ml IM
  • Flumist nasal spray 0.2 ml nasal
  • Both 1 and 2
  • Both 2 and 3
  • Both 2 and 4
slide56
Which of the following statements about the administration of influenza and pneumonia vaccines is true?
  • Same day, opposite arm, separate syringe
  • Same day, same arm, mixed in 1 syringe
  • Must be separated by at least 7 days
  • Must be separated by at least 4 weeks
zoster vaccine indication
Zoster Vaccine Indication
  • ACIP recommends routine vaccination of all persons aged >60 years with 1 dose of zoster vaccine.
  • NEW FDA LABELING: “ZOSTAVAXis a live attenuated virus vaccine indicated for prevention of herpes zoster (shingles) in individuals 50 years of age and older.”
  • Persons who report a previous episode of zoster and persons with chronic medical conditions can be vaccinated unless those conditions are contraindications or precautions.
  • Zoster vaccination is not indicated to treat acute zoster.
  • Zostavax® [package insert]. Whitehouse Station, NJ: Merck; April 2011.

Recommendations of the Advisory Committee on Immunization Practices (ACIP)

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5705a1.htm?s_cid=rr5705a1_e

vaccine contraindications
Vaccine Contraindications
  • Allergy to neomycin or any vaccine component
  • Pregnancy
  • Immunocompromised status
    • AIDS or other clinical manifestations of HIV, including persons with CD4+ T-lymphocyte values <200 per mm3
    • malignant neoplasms affecting the bone marrow
    • chemotherapy or radiation within the last 3 months
    • Persons on immunosuppressive therapy, including high-dose corticosteroids (>20 mg/day of prednisone or equivalent) lasting two or more weeks
zest shingles prevention study sps results
ZEST & Shingles Prevention Study (SPS) Results

1

(-29 to 48)

18%

41%

(28 to 52)

1

(56 to 71)

64%

(54 to 81)

70%

1. Oxman et al. New England Journal of Medicine. 2005. 352 (22): 2271

  • 2. Zostavax® [package insert]. Whitehouse Station, NJ: Merck; April 2011.
storage and handling
Storage and Handling
  • zoster vaccine must be stored frozen
  • The vaccine must be discarded if not used within 30 minutes after reconstitution.
  • New labeling: Zostavax may be stored and/or transported at fridge temp for up to 72 hours prior to reconstitution. Any unused vaccine at fridge temp should be discarded.
  • Zostavax® [package insert]. Whitehouse Station, NJ: Merck; April 2011.
administration3
Administration
  • Zostavax: 0.65-mL dose (reconstituted)
  • SQ – upper, outer tricep
  • 5/8 inch, 25 gauge needle
which of the following statements about the administration of influenza and zoster vaccines is true
Which of the following statements about the administration of influenza and zoster vaccines is true?
  • Same day, opposite arm, separate syringe.
  • Same day, same arm, mixed in 1 syringe.
  • Must be separated by at least 7 days.
  • Must be separated by at least 4 weeks.
slide66

RR is a 70-year-old woman with COPD. She has no allergies. Her meds include albuterol, Pulmicort and Spiriva. She has an 80-pack-year history of smoking. She quit smoking 5 years ago. Her last pneumonia shot was 8 years ago. Which vaccine(s) is/are appropriate for her?

  • Pneumovax 0.5 ml IM
  • Influenza SD shot 0.25 ml IM
  • Influenza HD shot 0.5 ml IM
  • Flumist nasal spray 0.1 ml in each nostril
  • Zostavax 0.65 ml SQ
  • Both 1 and 2
  • 1, 2 and 5
  • 1, 3 and 5
  • 1, 4 and 5
varicella vaccination
Varicella Vaccination
  • All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine or a second dose if they have received only 1 dose.
  • Special consideration for vaccination should be given to those who
    • have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or
    • are at high risk for exposure or transmission (e.g., teachers; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
varicella vaccination1
Varicella Vaccination
  • Immunocompromised status is a contraindication.
  • Pregnancy is a contraindication.
  • Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. The second dose should be administered 4–8 weeks after the first dose.
administration4
Administration
  • Varivax: 0.65-mL dose (reconstituted)
  • SQ – upper, outer tricep
  • 5/8 inch, 25 gauge needle
measles mumps rubella vaccination
Measles, Mumps, Rubella Vaccination
  • All adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, laboratory evidence of immunity to each of the three diseases, or documentation of provider-diagnosed measles or mumps disease.
  • A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who
    • are students in postsecondary educational institutions;
    • work in a health-care facility; or
    • plan to travel internationally.
mmr vaccine contraindications
MMR Vaccine Contraindications
  • AIDS or other clinical manifestations of HIV, including persons with CD4+ T-lymphocyte values <200 per mm3
  • Malignant neoplasms affecting the bone marrow
  • Chemotherapy or radiation within the last 3 months
  • Persons on immunosuppressive therapy, including high-dose corticosteroids (>20 mg/day of prednisone or equivalent) lasting two or more weeks
administration5
Administration
  • MMR: 0.65-mL dose (reconstituted)
  • SQ – upper, outer tricep
  • 5/8 inch, 25 gauge needle
which of the following vaccine preventable pathogens is a bacteria
Which of the following vaccine-preventable pathogens is a bacteria?
  • Measles
  • Mumps
  • Rubella
  • Pneumococcus
  • Influenza
  • Varicella
new fda approval july 8 2011
New FDA Approval – July 8, 2011
  • US FDA has approved Boostrix® vaccine to prevent tetanus, diphtheria, and pertussis (whooping cough) in people ages 65 and older.
  • Boostrix® is the first vaccine approved to prevent all three diseases in older people.
  • Adacel® is approved for persons 11 through 64 years.
  • Boostrix® [package insert]. Rixensart, Belgium: GlaxoSmithKline; July 2011.
  • Adacel® [package insert]. Swiftwater, PA: Sanofi Pasteur Inc.; February 2012.
tetanus diphtheria and pertussis td tdap vaccination
Tetanus, diphtheria, and pertussis (Td/Tdap) Vaccination
  • Administer a one-time dose of Tdap to adults younger than age 65 years who have not received Tdap previously or for whom vaccine status is unknown to replace one of the 10-year Td boosters.
  • Tdap is specifically recommended for the following persons:
    • pregnant women more than 20 weeks’ gestation,
    • adults, regardless of age, who are close contacts of infants younger than age 12 months (e.g., parents, grandparents, or child care providers), and
    • health-care personnel.
  • Tdap can be administered regardless of interval since the most recent tetanus or diphtheria containing vaccine.
  • Pregnant women not vaccinated during pregnancy should receive Tdap immediately postpartum.
  • Adults 65 years and older may receive Tdap.
administration6
Administration
  • Boostrix®/Adacel®: 0.5-mL dose
  • IM - deltoid
  • 1 inch, 25 gauge needle
slide84

AB is a 52-year-old woman with hypertension. She has no allergies. Her meds include amlodipine 10 mg PO QD. She smokes 1 PPD. Her newborn grandson lives with her. Which vaccine(s) is/are appropriate for her?

  • Pneumovax 0.5 ml IM
  • Influenza SD shot 0.5 ml IM
  • Influenza HD shot 0.5 ml IM
  • Flumist nasal spray 0.1 ml in each nostril
  • Zostavax 0.65 ml SQ
  • Tdap 0.5 ml IM
  • 1, 2 and 5
  • 1, 3 and 5
  • 1, 2, 5 and 6
human papillomavirus hpv vaccination
Human papillomavirus (HPV) vaccination
  • Two vaccines are licensed for use in females, bivalent HPV vaccine (HPV2) and quadrivalent HPV vaccine (HPV4), and one HPV vaccine for use in males (HPV4).
  • For females, either HPV4 or HPV2 is recommended in a 3-dose series for routine vaccination at 11 or 12 years of age, and for those 13 through 26 years of age, if not previously vaccinated.
  • For males, HPV4 is recommended in a 3-dose series for routine vaccination at 11 or 12 years f age, and for those 13 through 21 years of age, if not previously vaccinated. Males 22 through 26 years of age may be vaccinated.
human papillomavirus hpv vaccination1
Human papillomavirus (HPV) vaccination
  • HPV vaccines are not live vaccines and can be administered to persons who are immuno-compromised as a result of infection (including HIV infection), disease, or medications.
  • HPV vaccine can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test.
administration7
Administration
  • Gardasil®/Cervarix®
  • IM - deltoid
  • 1 inch, 25 gauge needle
the mother of a 12 year old boy requests the hpv vaccination select the correct vaccine and series
The mother of a 12-year-old boy requests the HPV vaccination. Select the correct vaccine and series.
  • Gardasil®: 3 dose series
  • Cervarix®: 3 dose series
  • Gardasil®: 2 dose series
  • Cervarix®: 2 dose series
meningocococcal disease
Meningocococcal Disease
  • Gram – Bacteria
  • Respiratory
  • Invasive disease
meningococcal vaccination
Meningococcal Vaccination
  • Administer 2 doses of meningococcal conjugate vaccine quadrivalent (MCV4) at least 2 months apart to adults with functional aspleniaor persistent complement component deficiencies.
  • HIV-infected persons who are vaccinated should also receive 2 doses.
  • Administer a single dose of meningococcal vaccine to microbiologists routinely exposed to isolates of Neisseriameningitidis, military recruits, and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic.
  • First-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday.
meningococcal vaccination1
Meningococcal Vaccination
  • MCV4 (Menactra or Menveo) is preferred for adults 55 years old and younger; meningococcal polysaccharide vaccine (MPSV4-Menomune) is preferred for adults 56 years and older.
  • Revaccination with MCV4 every 5 years is recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection.
administration8
Administration
  • IM - deltoid
  • 1 inch, 25 gauge needle
hepatits a vaccine havrix vaqta
Hepatits A VaccineHavrix®, Vaqta®

Hepatits B VaccineRecombivax-HB® Engerix-B®

Combined Hep A & B Vaccine

  • Twinrix®
hepatitis a vaccination
Hepatitis A Vaccination
  • Vaccinate any person seeking protection from hepatitis A virus (HAV) infection and persons with any of the following indications:
    • men who have sex with men
    • persons who use injection drugs
    • persons with chronic liver disease
    • persons traveling to high risk countries
  • Single-antigen vaccine formulations should be administered in a 2-dose schedule
hepatitis b vaccination
Hepatitis B Vaccination
  • Vaccinate any person seeking protection
  • Vaccinate any person in the following risk groups for hepatitis B virus (HBV) infection:
    • sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months); persons seeking evaluation or treatment for a STD, current or recent injection-drug users; and men who have sex with men;
    • health-care personnel and public-safety workers who are exposed to blood or other potentially infectious body fluids;
    • persons with diabetes younger than 60 years as soon as feasible after diagnosis; persons with diabetes who are 60 years or older at the discretion of the treating clinician
    • persons with end-stage renal disease, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease;
    • household contacts and sex partners of persons with chronic HBV infection; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate prevalence of chronic HBV infection; and
    • all adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; healthcare settings targeting services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities.
administration9
Administration
  • IM - deltoid
  • 1 inch, 25 gauge needle
slide104

Which vaccines would you recommend for an 19-year-old female college freshman who is living in the dorms. Her prescription profile includes Yaz one tablet QD and a prescription for Metronidazole 2 gm PO x1 two months ago.

  • Hepatitis B: 3 dose series
  • HPV: 3 dose series
  • Meningocococcal
  • Zoster
  • 1 & 3 only
  • 2 & 4 only
  • 1, 2, and 3
slide105

A patient is travelling to an international destination and requests the appropriate immunizations. What is the best reference to find the vaccines that are indicated?

  • The Pink Book
  • The Red Book
  • The Orange Book
  • The Yellow Book
which of the following vaccines is a live vaccine
Which of the following vaccines is a live vaccine?
  • Pneumovax
  • Zostavax
  • Gardasil
  • Havrix
  • Fluzone HD
ad