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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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