Pediatric Vaccination and Infection Quiz
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Questions and Answers

What is the most common cause of severe diarrhea in infants and children?

Rotavirus

What is the most common presentation of Haemophilus influenzae Type B infection in adults?

Meningitis

What is the recommended interval for primary series doses of HiB vaccine?

8 weeks

Which of the following is NOT a contraindication to the administration of Meningococcal conjugate vaccine?

<p>Pregnancy</p> Signup and view all the answers

The inactivated poliovirus vaccine is not preferred over the oral poliovirus vaccine?

<p>False</p> Signup and view all the answers

Which of the following is a characteristic of poliovirus infections?

<p>All of the above</p> Signup and view all the answers

What is the recommended age for the first dose of RotaTeq vaccine?

<p>6 weeks</p> Signup and view all the answers

The Rotashield® vaccine is still available in the U.S.?

<p>False</p> Signup and view all the answers

Which of the following is a contraindication to the administration of Rotavirus vaccine?

<p>History of intussusception</p> Signup and view all the answers

What is the full name of the individual who authored the presentation?

<p>Emily Eddy</p> Signup and view all the answers

What are the four diseases that the learning objectives focus on?

<p>Rotavirus, Polio, HiB, and Meningococcal</p> Signup and view all the answers

Which of the following is NOT a clinical feature of Haemophilus influenzae type B?

<p>Hepatitis</p> Signup and view all the answers

What is the primary mode of transmission for Haemophilus influenzae type B?

<p>Respiratory droplets</p> Signup and view all the answers

The HiB vaccine is considered interchangeable across various brands.

<p>True</p> Signup and view all the answers

What is the minimum age for administering the first dose of the HiB vaccine?

<p>6 weeks</p> Signup and view all the answers

Identify the primary cause of meningitis, sepsis, pneumonia, and arthritis.

<p><em>Neisseria meningitidis</em></p> Signup and view all the answers

What age group is considered most susceptible to meningococcal disease?

<p>People aged 16-21 years</p> Signup and view all the answers

Which of the following is NOT a symptom of meningococcal meningitis?

<p>Swollen lymph nodes</p> Signup and view all the answers

What is the recommended age range for receiving Menveo®?

<p>2 months to 55 years</p> Signup and view all the answers

What is the name of the new meningococcal vaccine approved in October 2023?

<p>Penbraya</p> Signup and view all the answers

What is the minimum interval between doses of Bexsero?

<p>1 month</p> Signup and view all the answers

The Penbraya vaccine is the only vaccine that covers all five meningococcal strains.

<p>True</p> Signup and view all the answers

What was the peak year for paralytic polio cases in the USA?

<p>This demonstrates the historical impact of polio before widespread vaccination efforts.</p> Signup and view all the answers

What type of poliovirus was identified in New York's wastewater in 2022?

<p>Type 2</p> Signup and view all the answers

Which of the following is NOT a possible outcome of a poliovirus infection?

<p>Hepatitis</p> Signup and view all the answers

The mortality rate for paralytic polio is higher in adults than in children.

<p>True</p> Signup and view all the answers

How is poliovirus primarily spread?

<p>Fecal-oral</p> Signup and view all the answers

What is the name of the oral poliovirus vaccine?

<p>OPV</p> Signup and view all the answers

Which type of polio vaccine is routinely administered in the USA?

<p>IPV</p> Signup and view all the answers

What is the recommended age for completing the IPV series for adults?

<p>18 years and older</p> Signup and view all the answers

What is the most common cause of severe diarrhea in infants and children?

<p>Rotavirus</p> Signup and view all the answers

What is the primary mode of transmission for rotavirus?

<p>Fecal-oral</p> Signup and view all the answers

Rotavirus infection can lead to permanent immunity.

<p>False</p> Signup and view all the answers

What is the name of the first rotavirus vaccine that was removed from the market in 1999?

<p>Rotashield</p> Signup and view all the answers

Which is a contraindication for receiving the rotavirus vaccine?

<p>History of intussusception</p> Signup and view all the answers

What is the maximum age for receiving any dose of the rotavirus vaccine?

<p>8 months</p> Signup and view all the answers

The rotavirus vaccine is administered via injection.

<p>False</p> Signup and view all the answers

What is the most common adverse reaction reported after receiving the rotavirus vaccine?

<p>Fever</p> Signup and view all the answers

Study Notes

Vaccine Specifics

  • Rotavirus, HiB, and Meningococcal vaccines are covered.
  • Emily Eddy, PharmD, MSLD, BCACP is the presenter.

Presenter Information

  • Assistant Professor – Dallas
  • Director of Labs and Simulations – Dallas
  • Practice Sites – Dallas VA, BSW Class D

Learning Objectives

  • Describe the pathophysiology and disease course for Rotavirus, Polio, HiB, and Meningococcal.
  • Identify the schedule, dosing, and administration route for the associated vaccines.
  • Name the adverse effects, contraindications, and risks/benefits for the associated vaccines.

Pink Book Chapters

  • Chapter 8: Haemophilus influenzae
  • Chapter 14: Meningococcal Disease
  • Chapter 18: Poliomyelitis
  • Chapter 19: Rotavirus

Haemophilus influenzae Type B (HiB)

  • Bacteria: Gram-negative aerobic coccobacillus
  • Leading cause of bacterial meningitis and invasive bacterial disease before vaccine introduction.
  • Fatality rate: 3-6% even with antibiotic treatment.
  • Majority of infections in children under 5 years old, and 2/3 of cases in children under 18 months.
  • Infection rarely seen after 5 years of age.
  • Clinical Features:
    • Epiglottitis (17%)
    • Pneumonia (15%)
    • Meningitis (50%)
    • Osteomyelitis, arthritis(2%)
    • Bacteremia, Cellulitis - (Not included in Pie Chart)

HiB Epidemiology

  • Occurrence: Worldwide
  • Reservoir: Humans
  • Transmission: Respiratory droplets (neonates- aspiration of amniotic fluid or genital tract secretions)
  • Temporal Pattern: Sept-Dec and then March-May
  • Communicability: Close contact
  • Risk Factors: Exposure factors include crowded/large households, daycare, low socioeconomics, low parental education, school-aged siblings. Host factors: Hispanic/Native American, chronic diseases, male.

HiB Polysaccharide Conjugate Vaccines

  • All products are administered via IM injection.
  • HiB only products (ActHIB, Hiberix, or PedvaxHIB) can be used starting at 6 weeks of age.
  • Combination products are interchangeable. Examples are Pentacel (HiB with DTaP-IPV) and Vaxelis (HiB with DTaP-IPV-HepB).
  • A different HiB vaccine must be used for boosters.

HiB Vaccine Schedule

  • Recommended interval: 8 weeks for primary series doses (minimum of 4 weeks interval).
  • Minimum age for first dose: 6 weeks.
  • Can be given with other vaccinations due at the same time.
    • Schedule is included in table format.

Adverse Reactions and Contraindications (HiB)

  • Adverse Reactions: Swelling, redness, and/or pain in 5-30% of recipients; Systemic reactions infrequent; Serious adverse reactions are rare.
  • Contraindications: Severe allergic reaction to vaccine component and moderate/severe acute illness when given. Age under 6 weeks.

Meningococcal

  • Cause: Neisseria meningitidis, causes meningitis, sepsis, pneumonia, arthritis
  • Transmission: Droplets (aerosol or secretions), cough, sneeze, kissing, slobber.
  • Colonizes: Nasopharynx
  • Most Common In: Infants younger than 1 year of age, and people aged 16-21 years old.
  • Presentation: Sudden onset of fever, headache, stiff neck.
  • Fatality Rates: 10-15% even with antibiotic therapy. Meningococcemia in the blood has a fatality up to 40%. Survivors may have permanent hearing loss, neurological damage, etc.

Meningococcal Epidemiology

  • Occurrence: Worldwide
  • Reservoir: Humans
  • Transmission: Respiratory droplets
  • Temporal Pattern: Late winter and early spring
  • Communicability: Limited, close contact

Meningococcal Conjugate Vaccines

  • Quadrivalent (MenACWY): Menveo, starting at 2 months old; MenQuadfi, starts at 2+ years old.
  • Serogroup B (MenB): Trumenba, 10-25 years old; Bexsero, 10-25 years old; All MenB vaccines are recommended for high risk of serogroup B.
  • Pentivalent (MenABCWY): Penbraya, approved Oct 2023; 10-25 years old.

Meningococcal Conjugate Vaccine Schedule

  • Adolescents 11-12 years of age receive the quadrivalent vaccine, with a booster at 16 years old.
  • Adolescents not at high risk (16-18 years old) can receive a MenB vaccine.
  • Bexsero – 2 doses, at least 1 month apart.
  • Trumenba – 2 doses, at least 6 months apart.
  • Penbraya – 2 dose series at least 6 months apart.
  • Use vaccines on the same day, if necessary.

Adverse Reactions Meningococcal Conjugate Vaccines

  • Contraindications: Severe allergic reaction to the vaccine component.
  • Adverse Reactions: Site reactions, headache, malaise, fever, nausea, vomiting.

Poliovirus

  • Epidemics peaked in 1952 with >21,000 paralytic cases in the USA.
  • Eradication in the USA occurred in 1979.
  • Global eradication is predicted for this decade.
  • Only 62 cases worldwide as of March 2023.

Poliovirus Infections

  • Asymptomatic: 72% of cases (contagious, virus shed in stool).
  • Minor Nonspecific Illness: 24% of cases (full recovery typically within one week, no CNS invasion).
  • Nonparalytic Aseptic Meningitis: 1-5% of cases (stiffness in neck, back, legs; symptoms last 2-10 days, full recovery).
  • Paralysis: <1% of cases (paralytic symptoms can begin within 1-18 days, and last 2-3 days).

Polio Epidemiology

  • Occurrence: Eradication in most countries (limited outbreaks).
  • Reservoir: Humans
  • Transmission: Fecal-oral.
  • Temporal Pattern: Summer months
  • Communicability: Highly infectious (7-10 days before symptoms and remain positive in stool for 3-6 weeks).

Polio Vaccines

  • Oral Poliovirus Vaccine (OPV): Produced more GI immunity, 3 dose series. No longer available in the USA due to risk of vaccine-associated polio.
  • Inactivated Poliovirus Vaccine (IPV): Inactivated with formaldehyde. Single dose pre-filled syringe. 4-dose series at 2, 4, 6-18 months. Can be given intramuscularly or subcutaneously.

Polio Vaccine Efficacy

  • Highly effective in producing immunity to poliovirus (>90% immune after 2 doses, and >99% immune after 3 doses). Duration of immunity unknown.
  • IPV is preferred over OPV. IPV eliminates the possibility of shedding the live vaccine virus.

Polio Vaccine Availability

  • Pediarix (Polio + Diphtheria, Tetanus, Pertussis, Hep B)
  • Kinrix (Polio + Diphtheria, Tetanus, Pertussis)
  • Pentacel (Polio + Diphtheria, Tetanus, Pertussis, Hib)
  • Vaxelis (Polio + Diphtheria, Tetanus, Pertussis, Hib, Hep B)
  • Quadracel (Polio + Diphtheria, Tetanus, Pertussis)

Adult Vaccination

  • Recommendation for adults of 18 years and older to complete a full IPV series.
  • Single lifetime booster for increased risk of exposure.
  • Use standard schedule: 0, 1-2 months, 6-12 month.
  • May separate by 4 weeks if accelerated needed.

Polio Adverse Reactions

  • Adverse Reactions: Site reactions (pain, redness), vaccine-associated paralytic poliomyelitis (VAPP), rare ADR with OPV.
  • One case per 2-3 million doses. Paralysis is the same as wild type; may be permanent.

Contraindications & Precautions

  • Contraindications: Severe allergic reaction to the vaccine or a previous dose. Contains streptomycin, neomycin, polymyxin B.
  • Precautions: Moderate/severe acute illness.

Rotavirus

  • Most common cause of severe diarrhea in infants/children.
  • 95%+ of children infected by the age of 5.
  • Initiated vaccine program with reduction > 400,000 visits to doctors, ERs, and hospitalization. Approx 20-60 deaths occurred per year.

Rotavirus Characteristics

  • Fecal-oral route. Highly communicable (2 days before and 10 days after symptom onset).
  • First infection after 3 months is most severe. Also includes severe diarrhea, nausea, vomiting, and fever.
  • Resolves in 3-7 days.

Rotavirus Immunity

  • Infection doesn't cause permanent immunity.
  • Only 38% protected against subsequent infections.
  • 77% protected from diarrhea, and 87% protected from severe diarrhea.
  • Subsequent infections lead to progressively greater protection and less severe infections. Not a common occurrence before infants reach 3 months old.

Rotavirus Epidemiology

  • Similar incidence worldwide.
  • Reservoir: GI/stool of infected humans; rare cross-infection with mammals.
  • Transmission: Fecal-oral.
  • Common pattern: In the USA: Southwest regions (Nov-Dec) and Northeast regions (April-May).
  • High communicability 2 days before and 10 days after onset of symptoms. Risk factors include: children or elderly in childcare/hospitals, and caretakers/adults of children with immunodeficiencies.

First Rotavirus Vaccine

  • Rotashield® in 1998. Risk of intussusception noted within 3-14 days following the vaccine.
  • First dose risk higher (20-fold increase), second dose held lower risk (5-fold increase). Removed from the market in 1999.

Current Rotavirus Vaccines

  • RV1 (Rotarix®): Contains one live-attenuated human rotavirus strain, liquid formulation, 2 oral doses (1.5 ml) at 2 and 4 months of age.
  • RV5 (RotaTeq®): LIVE reassortant, pentavalent vaccine, developed from human and bovine parent rotavirus strains; 3 oral doses (2ml) at 2,4,6 months of age.

Rotavirus Vaccine Schedule Recommendations

  • Infants can receive the vaccine starting at 6 weeks of age.
  • The same vaccine should be used to complete the full series, when possible.
  • Minimal interval between doses: 4 weeks.
  • First dose by 14 weeks, and 6 days of age. Maximal age for any dose: 8 months.

Rotavirus Vaccine Administration Pearls

  • Oral solution; DO NOT inject.
  • Do not repeat if infant spits out or regurgitates the vaccine.
  • No restrictions on liquid consumption before or after the vaccine.

Rotavirus Vaccine Efficacy and Storage

  • Prevention of any rotavirus diarrhea: 74-87% (95-98% reduced severe diarrhea).
  • Stored: Refrigerate both, RV1 diluent can be stored at room temperature. Administer within 24 hours of reconstitution. Administer RV5 ASAP after removal from refrigeration.

Rotavirus Contraindications and Precautions

  • Contraindications: Intussusception history. Severe allergic reaction to the vaccine component. RV1 applicator contains latex. Severe combined immunodeficiency.
  • Precautions: Acute, moderate or severe gastroenteritis. Other acute illness. Immunocompromised.

Rotavirus Adverse Reactions

  • Common: Fever (40-43%), Vomiting (15-18%), Diarrhea (9-24%), and Irritability (13-62%).
  • No serious adverse reactions reported.

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Description

Test your knowledge on pediatric vaccinations and common infections affecting infants and children. This quiz covers the most prevalent causes of diarrhea, vaccine schedules, and characteristics of viral infections. Understand the important contraindications for various vaccines as well.

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