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Vaccinations (PM) (Individual Vaccine (Tdap (Adults) mostly Tetanus…

- - - - Zoster
        
        Everyone gets >60y, regardless of VZV titer
        
        patients older than 30 all have chickenpox generally.
        
        Live attenuated: Immunosuppression
        
        Influenza
        
        Everybody, every year, no gaps
        
        ±egg allergy :fried_egg: IM (need a strong suspicion before you switch to Flu IN)
        
        Live attenuated: IN
        
        HPV
        
        Everyone 9-26y :female_sign::male_sign:
        
        no contraindications.
        
        prevents cancer, always give
        
        ...doesn't increase sex activity, just protects
        
        Meningococcal
        
        everyone should get it
        
        people who must have it: College dorms, military recruits(lives in barracks)
        
        Hib Vaccine
        
        Prevents Epiglottitis
        
        kids should get vaccine
        
        HAV vaccine
        
        2 more items...
      - once <60y (13 valent: Prevnar) :man::skin-tone-5:
        
        once >65y(23 valent: Pneumovax) :older_man::skin-tone-4:
        
        13 valent should be given to children
        
        and again as adult
        
        indicated for: CHF, COPD, DM (ie a medical patient)
        
        :warning:Don't give 13 and 23 at the same time
    - - test will ask about the wound (clean? covered in peds lecture)
        
        >3 lifetime doses?
        
        :check: Yes
        
        >10 years since last
        
        :check: Yes, (you're good!)
        
        :green_cross: no, <10y
        
        boost w/ Td
        
        opportunity to give Tdap, give it!
        
        :green_cross:no,
        
        give Td booster
        
        <5y: +IVIG
- - - - Live attenuated vaccines
        
        profound immunosuppression (antiimmunologics, HIV, really old :older_man::skin-tone-2:, really young :baby::skin-tone-3:
        
        Flu (IN)
        
        MMR
        
        Zoster
        
        no way to get around this: vaccinate before they become autoimmune, or wait for them to get better 1st.
        
        :pencil2:You want to give a vaccine, so unless they are obviously contraindicated, give the vaccine
      - Dustyn crosses off these flu vaccines, but the point is that there are few contraindications in practice:
        
        Egg allergy :fried_egg: = no Flu (IM) :muscle::skin-tone-3: on shelf!
        
        reflex to Flu (IN)
        
        Anaphylaxis = no Flu (IM) :muscle::skin-tone-3: on shelf!
        
        reflex to Flu (IN)
        
        Pregnant, Ai, HIV = no Flu (IN) :nose::skin-tone-3: on shelf!