Vaccine Specifics 7 2024 - Student PDF

Vaccine Specifics 7 Rotavirus, Polio, HiB, and Meningococcal Emily Eddy, PharmD, MSLD,BCACP  Who am I?! Assistant Professor – Dallas Director of Labs and Simulations – Dallas Practice Sites – Dallas VA, BSW Class D  Learning Objectives Fo...

Vaccine Specifics 7 Rotavirus, Polio, HiB, and Meningococcal Emily Eddy, PharmD, MSLD,BCACP  Who am I?! Assistant Professor – Dallas Director of Labs and Simulations – Dallas Practice Sites – Dallas VA, BSW Class D  Learning Objectives For Rotavirus, Polio, HiB, and Meningococcal: 01 02 Describe Identify The pathophysiology and Schedule, dosing, and disease course. administration route for the 03 associated vaccines. Name Adverse effects, contraindications, and risks/benefits for the associated vaccines.  Pink Book Chapters Chapter 8 Chapter 14 Haemophilus Meningococcal influenzae Disease Chapter 18 Chapter 19 Poliomyelitis Rotavirus Available at https://www.cdc.gov/vaccines/pubs/pinkbook/index.html  01 Haemophilus influenzae Type B (HiB) Haemophilus influenzae Type B (HiB) o Bacteria o Gram-negative aerobic coccobacillus o Before vaccine introduction o Leading cause of bacterial meningitis and other invasive bacterial disease o Fatality of 3-6% even with antibiotic therapy o Majority of infections in children < 5 years old o 2/3 cases in children < 18 months o Infection rarely seen after 5 years of age Hemophilus influenza Type B Clinical Features Epiglotitis 17% Pneumonia Meningitis 15% 50% Osteomyelitis 2%Arthritis 8%Cellulitis Bacteremia 6% 2% Meningitis Bacteremia Cellulitis Arthritis Osteomyelitis Pneumonia Epiglotitis  Epidemiology Occurrence World wide 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 -crowded/large household, daycare, low socioeconomics, low parental education, school-aged siblings Host factors -Hispanic/Native American, chronic diseases, male HiB Polysaccharide Conjugate Vaccines o All products delivered via IM injection o HiB only products o ActHIB, Hiberix or PedvaxHIB o Use as young as 6 weeks of age o Vaccines are interchangeable o Combination products o Pentacel (HiB with DTaP-IPV) o Vaxelis (HiB with DTaP-IPV-HepB o Must use different HiB vaccine for booster  HiB Vaccine Schedule Recommended interval of 8 weeks for primary series doses (minimum of 4 week interval) Minimum 6 weeks of age for first dose Vaccination younger than 6 weeks of age may induce immunologic tolerance to HiB antigen May be given with other vaccinations that are due at the same time Vaccine 2 months 4 months 6 months 12-15 months ActHIB X X X X Pentacel X X X X Hiberix X X X X PedvaxHIB X X -- X Vaxelis X X X See previous slide  Adverse Reactions and Contraindications o Adverse Reactions o Swelling, redness and/or pain in 5-30% of recipients o Systemic reactions infrequent o Serious adverse reactions are rare o Contraindications o Severe allergic reaction to vaccine component o moderate or severe acute illness o Age < 6 weeks  02 Meningococcal  Meningitis o Neisseria meningitidis o Cause of meningitis, sepsis, pneumonia, arthritis o Transmitted by droplets – aerosol or secretions o Cough, sneeze, kissing, slobber o Colonizes nasopharynx o Most common in: o Infants < 1 year of age o People aged 16-21 years  Meningitis o Presentation o Sudden onset of fever o Headache o Stiff neck o Fatality rate 10-15% o Even WITH appropriate antibiotic therapy o Meningococcemia (in the blood) fatality up to 40% o Up to 20% of survivors have permanent hearing loss, neurological damage, etc.  Epidemiology Occurrence World wide Reservoir Humans Transmission Respiratory droplets Temporal Pattern Late winter and early spring Communicability Limited, close contact  Meningococcal conjugate vaccine Quadrivalent (MenACWY) IM Serogroup B (MenB) IM vaccines vaccines Menveo® Trumenba® 2 months – 55 years old 10 – 25 years old MenQuadfi® Bexsero® 2+ years old 10 – 25 years old All MenB vaccines are only recommended for patients at high risk of serogroup B  Meningococcal conjugate vaccine Pentivalent (MenABCWY) IM vaccine ○ Penbraya™ Approved October 2023 10-25 years old Two 0.5ml doses 6 months apart Only vaccine to include all 5 strains  Vaccine Schedule o Routine vaccination with MenACWY for all adolescents 11-12 years of age with a booster at 16 years old o Menveo or MenQuadfi or Penbraya* o Adolescents not at an increased risk age 16-23 (preferred 16-18 years) can receive MenB vaccine based on shared clinical decision making o Bexsero – 2 dose series at least 1 month apart o Trumenba – 2 dose series at least 6 months apart o Penbraya – 2 dose series at least 6 months apart o Only use if both MenACWY and MenB vaccine would be given on the same clinic day Contraindications and Adverse Effects o Contraindications o Severe allergic reaction to previous dose or vaccine component o Adverse effects o Injection site reaction – 48% o Headache and malaise up to 60% and begin within 7 days o Fever (100-103oF) within 7 days o Nausea and vomiting 03 Polio  Poliovirus o Once numerous epidemics o Peaked in 1952 with more than 21,000 paralytic cases in USA o Ended in US in 1979 o Global eradication within this decade (fingers crossed) o Only 62 cases worldwide as of March 2023 o https://www.cdc.gov/mmwr/volumes/72/wr/ mm7219a3.htm#T1_down  Poliovirus Infections Asymptomatic, Nonparalytic aseptic 72% meningitis, 1-5% Stiffness in neck/back/legs Contagious Symptoms last 2-10 days with full Virus shed in stool recovery Paralysis, 90% immune after 2 doses ○ >99% immune after 3 doses ○ Duration of immunity not known with certainty IPV is preferred over OPV ○ IPV eliminates the possibility of shedding the live vaccine virus Availability of Polio Vaccines Combination vaccines with polio ○ 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 2023 Recommendation: all adults 18 years and older to complete IPV series if unknown or suspected to be unvaccinated/incompletely vaccinated ○ Due to 2022 New York poliovirus case – poliovirus type 2 identified in young adult and detected in wastewater linked to 6 New York counties during April-October 2022 Single lifetime booster with IPV if increased risk of exposure who have completed primary series of OPV or IPV Consider giving IPV if traveling to polio-endemic areas ○ Use standard 0, 1-2 month, 6-12 month schedule ○ May separate by 4 weeks if accelerated schedule needed  Adverse Reactions Adverse Reactions: ○ Site reactions: pain, redness ○ VAPP, vaccine associated paralytic poliomyelitis Rare ADR with OPV 1 case for every 2-3 million doses Paralysis is the same as one cause by a wild type May be permanent  Contraindications & Precautions Contraindications: ○ Severe allergic reaction to a vaccine component or following a prior dose of vaccine ○ Contains streptomycin, neomycin, polymyxin B Precaution: ○ Moderate or severe acute illness 04 Rotavirus  Rotavirus o Most common cause of severe diarrhea in infants and children o 95%+ of children infected at least once before age 5 o Before initiation of the rotavirus vaccine program in the US (2006) o >400,000 young children had to see a doctor, visit an emergency room or were hospitalized o 20 to 60 died (500,000 worldwide)  Rotavirus o Fecal oral route o Highly communicable o Spans 2 days before to 10 days after onset of symptoms o First infection after 3 months of age is the most severe o Severe diarrhea, nausea, vomiting, febrile o Resolves in 3-7 days  Rotavirus Immunity o Infection does not lead to permanent immunity o Only 38% protected against ANY subsequent rotavirus infections o 77% protected from diarrhea o 87% protected from severe diarrhea o Subsequent infections lead to progressively greater protection and are less severe in nature o Not common for infants < 3 months of age o Mother’s immunity  Epidemiology Occurrence Incidence similar throughout the world Reservoir GI/stool of infected humans (rare cross infection with mammals) Transmission Fecal-oral Temporal In USA: Pattern Southwest regions: Nov-Dec Northeast regions: April-May Communicability HIGHLY infectious 2 days BEFORE and 10 days AFTER symptoms Risk Factors Children or elderly in child care centers Children in hospital wards Caretakers and parents of above children Children, adults with immunodeficiency related diseases  First Rotavirus Vaccine o Rotashield® in 1998 o Risk of intussusception o Occurred in 1 out of 10,000 vaccines o Within 3 to 14 days after the vaccine o First dose held a higher risk, 20-fold increase o Second dose held smaller risk, 5-fold increase o Removed from market in 1999  Current Rotavirus Vaccines RV1 (Rotarix®) RV5 (RotaTeq®) Contains one strain of LIVE attenuated LIVE reassortant, pentavalent vaccine human rotavirus developed from human and bovine parent Liquid formulation  2 oral doses (1.5ml) at 2 rotavirus strains months and 4 months of age No reconstitution Lyophilized formulation  2 oral doses (1 ml) 3 oral doses (2 ml) at 2, 4 and 6 months of at 2 and 4 months of age (must be age reconstituted) Schedule Recommendations All infants without contraindication Use same vaccine to complete series, if possible May be started as early as 6 weeks of age ○ Minimal interval between doses = 4 weeks First dose must be given by 14 weeks 6 days of age Max age for any dose = 8 months https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6304a4.htm  Rotavirus Vaccine Administration Pearls o Given as an ORAL solution  DO NOT INJECT! o Do not repeat the dose if an infant spits out or regurgitates the vaccine o No restrictions on the infant’s liquid consumption before or after the vaccination Rotavirus Vaccine Efficacy and Storage o Prevention of any rotavirus diarrhea  74-87% o Severe diarrhea  95-98% o Both vaccines significantly reduced physician visits for diarrhea and reduced rotavirus-related hospitalizations o Storage: o Refrigerate both vaccines o RV1 diluent may be stored at room temperature o Should be administered within 24 hours of reconstitution o Administer RV5 as soon as possible after being removed from refrigeration Rotavirus CI and Precautions o Contraindications o History of intussception o Severe allergic reaction to vaccine component o RV1 applicator contains latex o Infants diagnosed with severe combined immunodeficiency o Precautions o Acute, moderate or severe gastroenteritis or other acute illness o Immunocompromised  Rotavirus Adverse Reactions o Common o Fever (40-43%) o Vomiting (15-18%) o Diarrhea (9-24%) o Irritability (13-62%) o No serious adverse reactions reported  Thanks Do you have any questions? 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