Preventable Diseases Cumulative Exam 2024.pdf

PHM 180 – PT of Vaccine-Preventable Diseases Cumulative Exam 2024 The exam will consist of 30 questions in multiple choice or True/False format based on the slides and content that were reviewed in class and/or posted in Canvas on the Modules page. There will be some case scenarios that will have yo...

PHM 180 – PT of Vaccine-Preventable Diseases Cumulative Exam 2024 The exam will consist of 30 questions in multiple choice or True/False format based on the slides and content that were reviewed in class and/or posted in Canvas on the Modules page. There will be some case scenarios that will have you answer multiple questions based on that scenario. You will have access to both childhood and adult immunization schedules. Vaccines and Diseases: Know the risk groups and types of vaccines Influenza ○ Disease: flu ○ Risk groups: Adults age ≥ 50 years Children age 6 to 59 months Persons with chronic medical conditions Pregnant women ○ Types of vaccines: IIV4s: Quadrivalent Inactivated influenza vaccine Adjuvanted inactivated [aIIV4] Adjuvant added Fluad Quadrivalent High-dose inactivated [HD-IIV4] RIV4: Quadrivalent Recombinant influenza vaccine Recombinant [RIV4] LAIV4: Quadrivalent Live Attenuated influenza vaccine COVID-19 ○ Disease: COVID-19 ○ Risk groups: Moderately or severely Immunocompromised Individuals recovering from acute COVID-19 illness; may wait up to 90 days after infection to be vaccinated ○ Types of vaccines: Virus; Inactivated mRNA: Pfizer and Moderna Protein-based: Novavax RSV ○ Disease: Respiratory Syncytial Virus ○ Risk groups: Infants and young children Premature ≤6 months of age 2 years with certain underlying conditions Adults aged > 65 years or > 18 years with certain underlying conditions ○ Types of vaccines: PCV 13 (no longer preferred) PCV20 PCV15 → PCV23 Better serotype 3 immunogenicity in PCV15 than PCV20 Varicella, Zoster [RZV] ○ Disease: Varicella ○ Risk groups: Immunocompetent adults age 50 years and older, Immunocompromised adults > 19 years of age ○ Types of vaccines: Varivax: Live attenuated virus Shingrix: Recombinant, adjuvanted zoster vaccine Hepatitis A ○ Disease:Hepatitis A ○ Risk groups: For all children 1 to 2 years old Adults if risk factors are present or for any person for whom immunity against hepatitis A is desired ○ Types of vaccines: Havrix or Vaqta: Brands interchangeable Give 2-dose series at least 6 months apart Twinrix: Hep A & B; for Adults Hepatitis B ○ Disease: Hepatitis B ○ Risk groups: All infants All adolescents who have not been previously vaccinated All adults 19 to 59 years All adults > 60 years of age with risk factors Any adult over age 60 who wishes to protect themselves against Hepatitis B ○ Types of vaccines: Engerix-B: rDNA yeast with alum adjuvant Recombivax HB: rDNA yeast w/alum adjuvant Heplisav-B: rDNA yeast with CpG Adjuvant (adults only) PreHevbrio: Recombinant 3 antigen with alum adjuvant (adults only) Tdap ○ Disease: Tetanus, Diphtheria, & Pertussis ○ Risk groups: Age 6 weeks through 6 years Use DTaP to complete the primary series Age 7 years through 10 years who are not fully vaccinated against pertussis Age 11 years and older If no record of a Tdap dose, Age 65 years and older Health care providers Pregnant women (every pregnancy) Wound Management ○ Types of vaccines: Bacteria; Inactivated Protect against tetanus, diphtheria, and pertussis DTaP Tdap: Boostrix & Adacel Protect against tetanus and diphtheria DT Td HPV ○ Disease: Human Papillomavirus (HPV) types(more than 100) High risk types: 16*, 18*, 31, 33, 39, 45, 51, 52, 58 ○ Cancers Low risk types: 6*, 11*, 40, 42, 43, 44, 54 ○ Low grade Pap smear abnormalities, warts *Most common types ○ Risk groups: ○ Immunocompetent age 9–14 years Age 15 – 26 years Age 27-45 years Types of vaccines: 9vHPV: Inactivated Recombinant MMR ○ Disease: Measles, Mumps, & Rubella ○ Risk groups: All children All susceptible people at high risk: Health care personnel, college students, international travelers, nonpregnant women of childbearing age without evidence of immunity to rubella, patients with HIV if CD4 count adequate or if given before antiretroviral therapy Adults born in 1957 or later who have not been vaccinated with MMR ○ Types of vaccines: M-M-R II: Live, attenuated vaccine Priorix: Live, attenuated vaccine Meningococcal ○ Disease: Meningococcal ○ Risk groups: All adolescents Adults with certain medical conditions (i.e., persistent complement component deficiency, anatomical or functional asplenia, HIV) Routine use of MenB vaccines in persons at increased risk for serogroup B meningococcal disease, including: During outbreaks of serogroup B meningococcal disease. College campuses that have recently experienced an outbreak of serogroup B meningococcal Meningococcal B vaccines recommended for high-risk patients age 10 years or older* Persons with complement deficiencies Persons who are asplenic Microbiologist Those exposed during outbreaks of disease ○ Types of vaccines: Bacteria; Inactivated MenQuadfi: Men ACWY Menveo: Men ACWY Trumenba: Men B Bexsero: Men B Penbraya: All Men ACWYB The remaining questions will cover the following areas: PREP Act What is the PREP Act? ○ Public Readiness and Emergency Preparedness (PREP) Act Allow Secretary of Health and Human Services to make declarations in time of emergency Declarations provide immunity from liability Earlier declarations authorized pharmacists, pharmacy interns, and pharmacy technicians to provide several COVID-19 countermeasures and routine childhood vaccinations HHS requirements ○ Coverage for COVID-19 vaccines ○ Seasonal influenza vaccines ○ COVID-19 tests and other COVID-19 countermeasures ○ Ending soon (expires in December 2024) ○ COVID-19 vaccines by retired providers across state lines ○ Routine childhood vaccinations Who can you immunize? ○ Can administer any vaccines under immunization- certified pharmacist preceptor guidance and authorities ○ Pharmacists, pharmacist interns/students, pharmacy technicians Intro and Basic Immunology: Immune response process in lay terms ○ Immune response Acquired (adaptive) immunity-active(infection or flu vaccine) or passive(breast milk antibodies, antivenom, immune globulin infusion) Cell-mediated immune response Humoral immune response(b cells): mature to antibody-producing cells(plasma cells to produce antigen-specific antibody and make memory cells ○ T-cell dependent immune response ○ T-cell independent immune response Innate immunity Physical barriers Physiological features Processes Cells of immune system ○ Immune response from vaccine Vaccines (contain antigens) Antigens are recognized by immune system and evoke an immune response ○ T-cells activated(also activate b cells) ○ B cells activated Results in production of antibodies Antibodies attack and destroy antigen ○ Antigen eliminated; memory b cells and t cells are formed Types of vaccines – Live versus inactivated, what are their differences? ○ Live Attenuated Vaccines Made from viruses or bacteria Must replicate to work Replication mimics natural infection to stimulate immune response ○ Inactivated Vaccines Made from viruses or bacteria, or virus-like particles Do not replicate because they are not live May contain adjuvants to enhance immune response Adjuvants and their role ○ Adjuvants are added to help the body build a stronger immunity against the antigen in the vaccine, essentially helping vaccines work better. Dosing intervals ○ Vaccines Minimum interval 2 inactivated vaccines No minimum Inactivated and live vaccines No minimum 2 live vaccines, if not simultaneous 28 day minimum interval Inactivated vaccines and antibodies No minimum Live vaccines followed by blood products 2 weeks Blood product given before live vaccine Minimum interval varies (look up) Live vaccine followed by PPD skin test 28 day minimum interval PPD skin test followed by live vaccine Administer vaccine after PPD skin test has been read Grace period – what is it, what types of vaccines it applies to and how to determine a grace period for any vaccine ○ Refers to the period inside of the stated “minimum interval” ○ ○ ACIP counts “on time” as within 4 days of the minimum interval; some states do not allow a grace period Live vaccines – there is no grace period Stick to the stated interval Grace periods and minimum intervals in the COVID-19 vaccine-era have become more complex Screening Patients: Contraindications vs precautions – what is the difference? ○ A contraindication means that a vaccine should not be administered. A precaution identifies a situation in which a vaccine may be administered if the benefit from the vaccine is judged to outweigh the risk. Medical management of reactions ○ If a Reaction Occurs Evaluate severity, and call 911 if necessary Take blood pressure, pulse, and respiration every 5 minutes Administer epinephrine if necessary Monitor closely Be prepared for CPR Document events Texas exemption laws – who do they apply to? ○ Three conditions for exemption Healthcare provider determines it is not safe for student to get a certain vaccine. Requires documentation from physician. Valid for one year. In the United States military Religious or personal belief that goes against getting immunized ○ These only apply to students in Texas. These do not apply to employees who need an exemption from immunization required by their employer. Vaccine Schedules: Types of schedules and how to use them Documentation and Record Keeping: Consent forms – What needs to be on them and why. Review the examples provided from Walgreens and H-E-B ○ Screening questions to Identify Contraindications and Precautions Patient Information Contact Information Vaccine Information Vaccine Name Date of Administration Dose Manufacturer Benefits of the Vaccine Risks and Side Effects Acknowledgment of Understanding Contact Information etc ○ Why Each Element is Important: Informed Consent Legal Protection Safety Communication ImmTrac2 – What is it and who does it keep track of? ○ ImmTrac2 is a secure and confidential immunization registry system used in Texas to keep track of individuals/families vaccinations ○ Used for children, automatically deletes at 26 if no file is placed by the pt. Managing a Program: Requirements to immunize, including student intern rules ○ Receive specialized training ○ Identify what is allowed/required by state laws and regulations Standing orders, OSHA, etc. ○ Plan your service Program offerings Workflow considerations Prepare to manage vaccines appropriately Storage requirements Have an emergency response plan ○ Address reimbursement and compensation ○ Have a plan to stay up to date ○ Student Interns: Student must be trained (complete Certificate Training Program) Operating under supervision of immunization-certified pharmacist When to use protocols vs prescriptions ○ Does a patient need a prescription for a pharmacist to administer a vaccine on the adult immunization schedule? Texas: no, pharmacist can administer vaccine via prescriber-approved protocol or nonpatient specific order ○ Can pharmacists administer all vaccines on the CDC recommended immunization schedule for children 7-18 years old? Texas: yes, all vaccines ○ ** can only give flu vaccine to 7 years and up and rest of vaccines 14 years and up?? Can pharmacy technicians administer vaccines: Texas: no PREP Act has authorized Certified pharmacy techs to administer flu and covid vaccines until december 2024 Requirements for protocols or prescriptions ○ Physician authorization ○ Qualifications of person(s) administering vaccines ○ Vaccine(s) covered in the standing order/protocol ○ Policies Screening patients for indications and contraindications Information to provide to patients (e.g., VIS) How to administer vaccine (e.g., dose, route, anatomic location) Documentation requirements Communication to physician and reporting requirements ○ Emergency precautions including specific protocol OSHA Bloodborne pathogen requirements ○ Requires training with annual updates* ○ Requires use of universal precautions ○ Requires an exposure control plan (ECP) ○ Requires employer to provide hepatitis B vaccine to employees with potential risk ○ Mandates use of safer devices (safety needles) ○ Requires documentation of safety device evaluation ○ Requires documentation of injuries Example Case and Associated Questions: Let’s take Rachel, who was a patient case in the February 28th slides. Rachel is a healthy 8-year-old who completed her entire pediatric vaccination series, but did not get any vaccines recommended for kindergarten. Refer back to Slides #2-4 on how to determine what vaccines Rachel needs. Some questions may be asked concerning what Rachel needs. In addition, the following may be asked that relate to Rachel’s case: 1. What Hepatitis B vaccines are appropriate to give to Rachel based on her age? a. Engerix B b. Recombivax HB c. Heplisav-B d. PreHevbrio e. Answer would be A or B. Engerix and Recombivax are the only ones that can be used in patients under the age of 18. Heplisav and PreHevbrio are only approved for ages 18 an above. 2. If you are working under normal Texas law and the PREP Act is no longer in existence, you can give this Hepatitis B vaccine to Rachel under a physician’s protocol. a. True b. False c. Answer would be False. Normal Texas law does not allow us to give any vaccine except for flu to anyone under the age of 14 under a physician’s protocol. We would need a physician’s prescription giving us authority to administer the Hepatitis B vaccine to Rachel. 3. You give Rachel her second dose of MMR. How long do you need to keep the record of that vaccination? a. Three years b. Five years c. Until the patient reaches the age of 19 years d. For the lifetime of the patient e. Answer is for the lifetime of the patient. Vaccination records must be easily and readily retrievable for the life of the patient. You do not have to keep the paper copy for the lifetime of the patient if it is entered into the computer filling system. 4. Rachel’s mother would like to have Rachel receive the MMR and Varicella vaccines today. You can give both of these today. a. True b. False c. Answer is True. They are both live vaccines and can be given on the same day. If Rachel needs both of these and they decide to only get one today, Rachel would need 5. True or False: If you have had a severe anaphylactic reaction to any vaccine (not just the flu vaccine), then you should not receive that specific vaccine again. 6.