Finally VACCINE ( UW + MTB )

By : Araki
----------------------------------------All patients undergoing Splenectomy should vaccinated against encapsulated
organisms.
either prior to or immediately following surgery
S.pneumonia - N.meningifidis - H.influenza
.
Vaccination against meningococcus :asplenia, those living in dormitories or barracks,
people traveling to or living in areas where meningococcal infection is endemic, and
for college-bound individuals. traveling to some Asian countries and to sub-Saharan
Africa. make the Haj to Mecca, Saudi Arabia.
.
pneumococcal vaccine be given to all healthy adults once at age 65.
Patients under the age of 65 with chronic medical conditions
(chronic lung disease, chronic cardiovascular diseases, DM, chronic liver disease,
chronic renal disease, asplenia, and immunosuppression Alcoholism - CSF leak Cochlear implants )
may be vaccinated once followed by a booster 5 years later
# polyvalent pneumococcal - individuals over age 65
polysaccharides of the 23 most prevalent types of pneumococcus , polysaccharides
cannot be presented to T-cells. Thus, polysaccharide vaccines yield a B-cell only, Tcell-independent response
T-cell-independent 8-cell response
# heptavalent pneumococcal vaccine - use in children
is conjugated with protein and induces active immunity via a T-cell-dependent B-cell
response
T-cell-dependent 8-cell response
.
Hepatitis A Vaccination : All children + high risk adults : Chronic liver D - traveling to
endemic areas - sewer workers IV drug users - food handlers - homosexual men
.

Salmonella typhi vaccinations

pt traveling to endemic countries for a prolonged period of time.
pt with SCD are at increased risk for Salmonella osteomyelitis.
.
The Td vaccine : should be given at least every 10 years.
it is recommending a one-time TdaP booster for adults aged > 18 years due to
waning immunity against pertussis.
.
Influenza vaccination : is recommended for all adults every year , Either intranasal or
injected
All adults aged >50 years with comorbid conditions should receive the intramuscular
vaccine.
.
HPV vaccine (Grdasil) : males 9-26 y and females aged 8-26 years
.
For those traveling to North Africa : give hepatitis A ( 2 dose ) - hepatitis B - typhoid
vaccines as well as a polio booster vaccine
.
Yellow fever : it is a mosquito-borne viral hemorrhagic fever , Vaccination is in
general recommended for those traveling to sub-Saharan African and equatorial
South American countries
.
Patients exposed to hepatitis B
# patient has documented immunity against hepatitis B , ( HBsAb-positive) ,
Reassurance
# pt not develop immunity with the first two doses of HB vaccine. give second
vaccination course
# unknown vaccination history should receive both passive and active immunity.
Passive immunity (HBIG) shortly after exposure (e.g. within 24 hours).
Active immunity is provided by administering the hepatitis B vaccine
.

Vaccines for chronic liver disease

Td/Tdap : Tdap once as substitute for Td booster, then Td every 10 y
Influenza : Every year
Pneumococcal vaccine : 1 dose with repeat 5 years later
Hepatitis A : 2 doses 6 months apart in patients with initial negative serology
Hepatitis B : 3 doses at 0 months, 1 month, and 4 months with initial negative
serologies
.
# Certain vaccines induce a predominantly lgA response. The best known example is
the oral polio
vaccine, which promotes the development of anti-poliovirus lgA antibodies in the Gl
tract
.
any baby from mother with +ve HBsAg ...take 1st dose of HBV vaccine +IG , 2nd dose
after the 1st dose by one ms , (only vaccine) , 3rd dose >> after 1st dose by 6ms
(vaccine) ##
.
if.baby.is less than.2 kg, and mom is HBV.neg. U should delay dose up to one month
or discharge
If less than 2 kg, but mom is sero positive or status unknown, give.vaccine.plus.IG
within 12 hrs. And total of 4 doses are given
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This part by : Ahmed Zaghloul

obligatory vaccines for children in USA is 15 ( 9 viral + 6 bacterial )
the 9 viral is three three MMR (measles mumps rubella) HHV ( hep A Hep B varicella
) IIR (IPV Inactivated infuenza Rota )
the 6 bacterial DTap + 3 capsulated (meningio + pnemo + H flu B )
.
live viral vaccines like MMR and varicella are contraindicated in immune suppresion
with some exceptions like HIV with CD4 and Bruton x linked agammaglobulinemia
they can be given
.
HIV we give live Vac if CD more than 200

MMR - Varicella - Zoster

.
live bacterial vaccine are contraindicated in Chronic granulomatous disease
.
complement def is not contraindication to any vaccine
.
reaction to DTap of fever less than 105 is not contraindication to DTap
if suizer stop pertussus and give only DT ?
.
egg allergy : contra to infuenza and yellow fever
neomycin anaphylaxis : contra MMR and IPV
.
pregnant female can only take 3 vaccines DT and inactivated influenza vaccine in the
2nd and 3rd trimester
.
if the patient take IVIG dont give live viral vaccine for the next 3 months
.
Mild acute illness - antibiotic intake - family history of seizure -family history of
Sudden infant death _ prematurity are not contraindication to vaccines and are
distractors