Vaccinations (Peds)

  • A little immuno
  • Reactions: Who shouldn't get vacc
  • Usually: if you think they need, give it
  • Vaccines + disease covered
  • Adult & peds medicine
  • ⚠Don't memorize vaccination schedules, they change annually. (is Look it up!)
  • Know about how many they need, and what to do if someone lapses.

Active

Passive

Priming the immune system

  • APC presents antigen, B cells make Ig
  • B cells become Plasma cells (memory) that can make Ig quickly when reexposed.
  • Any antigen can work: emphasis on pieces of or an entire organism.
  • or a toxin/toxoid (tetanus is the theme)
    ✏Dose at which we die from tetanus < immune response dose)
  • So pt will die, even though immune system doesn't detect/mount response.
  • Immunization strategy is to target the toxin, not the bug.

Adult immune system

  • Ig crosses the placenta and cover baby
  • after 6m 📆 they wear off (also when immunodeficiencies appear)
  • IF mom doesn't have immunity, we can give IVIG (to 👶🏼)

Herd Immunity 🐄🐄

How we eradicate disease

  • everyone should (not must) get vaccinated
  • nobody can carry the disease, but some immunocompromised ppl can still get disease.
  • so not everyone has small pox vaccination, but they won't get it because we eradicated it

Bad Rxns

Live attenuated

Egg Allergy 🍳

  • anaphylaxis is worse than getting the virus.

⛔Yellow Fever

✅MMRV (can give, no longer egg based)

(changing) Influenza (will no longer be used w/ egg. For the test, be careful and check to see if our flu vaccine is made w/ egg

  • not a restriction, just need to check

Live organism

  • profound immunocompromised ♿ should not receive.
  • AIDS, CTX, Transplants, or on Biologics
  • Careful w/ 🤰pregnancy

⛔MMRV

✅Influenza IM (not live, safe)

⛔Influenza Nasal

Normal reaction?

✅

  • Temp 🌡 < 104ºF
  • some erythema
  • Baby may cry 😢, but will be consolable

Abnormal reaction

🚫

  • Hi temp 🔥🌡 ≥104ºF
  • inconsolable child 😭
  • frank Anaphylaxis

✏not a contraindication for other vaccines, just contraindicated in that specific vaccine in the future.

✏Sickness is not a contraindication for giving a vaccine.

  • baby sick? give vaccine

✏Fam Hx of a bad reaction to vaccine? Give the vaccine. Irrelevant history.

  • only personal hx, or known allergy is contraindication.

✏Autism?????

  • nope, don't mention it
  • may want to chastise the parent
  • Vaccines are good, end of story.

Table of Vac

Hep B

DTap

  1. 🤰Mom has HBV; infection @ delivery= chronic carrier state
    Tx: HBV IVIG & Vaccine immediately
  1. 🤰🏻 is HBV negative.
    Tx: HBV HAV vaccine series w/in 2mo
  1. 🤰🏼 doesn't know carrier status 🤷🏼
    Tx: HBV vaccine now, test HBsAg
  • DTaP = kids 👦🏻 (5x as child)
  • Tdap = adults 👨🏽 (1x after 11yo, & q10years)
  • Td = tetanus booster; can be given instead of Tdap (preferred).

Hib

  • Give vaccine when pt has epiglotitis
    ⚠Hib infx doesn't give immunity

MMRV

  • everyone gets it
  • 🚫🤰🏻

(Pretest): Pts born before 1957 (62yo now) are considered immune to measles.

Pneumococcal

  • mostly adults, but also kids: 👦🏻
  • sick or asplenic kids 👦🏻

(Pretest)

  • 1 before, 1 after age 65
  • must space out by 5 years

Meningococcal

  • Everyone should get
  • College/military ⚠ must get 🏕👢

HBV/HAV

  • 3x dose for HAV
  • 3x dose for HBV
  • if theres a lapse, continue where you left off.

Flu

  • Everyone
  • HC workers before winter ☃

✏Never miss an opportunity to give a Tdap

  • especially 🤰🏻, every pregnancy
  • Adults >65 👵🏽 (for pertussis)

Pertussis

Diptheria

Tetanus

  • focus on studying this

Pt: Dirty wound 🔨

  • metal puncture w/ rust
  • also muddy swamp 🐊
  • Lock Jaw 🔒
  • Spastic paralysis (every muscle contracts; 10% of people die)

Dx: Clinical

Tx: ABCs

  • intubate & sedate 😴
  • Muscle relaxers & Paralytics (prn) to get thru acute
  • IV ABx (metronidazole is right answer)

What to do w/ the wound?

  • Prevention strategy
  • Tdap/Adult
  • Td/booster
  • Tetanus IVIG (passive immunity)

3 doses as an adult

  • Tdap 1x
  • Td 2x (q10year)

< 3x lifetime doses Vs. ≥ 3x lifetime dose

  • form of Tdap, DTap, Td, TT
  • 1x dose must be in adulthood

<3x lifetime doses = unknown status

  • Vaccine/Td boost?
  • Vaccine & IVIG?

≥3x lifetime doses

  • Td boost?
  • send home?

✅Clean or ❎Dirty?

✅ Clean

  • > 10 years (lapse in shot)
  • Td boost (Tdap ok)

❎Dirty

  • > 3x lifetime doses
  • 5year cutoff

Timing is more important if ≥3x lifetime doses

✅ Clean

  • < 10 years (no lapse)
  • Send home 🏡

❎Dirty

  • > 5yr (lapse)
  • Td boost (Tdap ok)

❎Dirty

  • < 5yr (up to date)
  • Send home 🏡

✏Dirty wound: Dirt, feces 💩, soil, saliva.

✅Clean wound

  • Vaccine

Pt: Fever 🌡🔥

  • Dysphagia
  • Dyspnea (pseudomembrane: see in mouth)
    ⚠don't peel it off, it will bleed/pt dies 💀

Dx: Clinical

Tx: ABCs

  • Secure airway: Intubate
  • Anti-toxin
  • IV Abx

❎Dirty

  • Vaccine & IVIG

✏ immunity wanes in adulthood

Pt:

  1. Cattaral phase: infectious, nonspecific syndrome "cold-like": low grade 🌡 Temp, rhinorrhea 🤧, cough
  2. Paroxysmal (bad for kids 👦🏻) Paroxysms of coughs w/ large inspiratory effort *wheezing
  3. Resolution

Dx: Clinical

Tx: Supportive

  • may need airway support
  • Azithromycin

✏Will not see any of these, IF they get the vaccine!

HPV

  • prevents cancer
  • boys and girls (9-26yo), everyone

(Pretest)

  • Not safe for pregnancy, but ok for immunocompromised ♿

Varicella

  • Part of MMRV
  • no Pox parties (thanks mom/dad 😒)
  • Thinking was, earlier you get VZV, less disfiguring it is (still true, but still disfiguring)
  • MMRV will prevent shingles later in life

(pretest): born before 1980 considered immune (39yo)

Rotavirus

  • PO vaccine contraindicated ⛔ in anyone w/ intussuseption
  • not everyone needs

Low yield vaccines