Skin test prior to administration of this/these vaccines in egg allergic patients. yellow fever influenza (only if mild reaction to eggs. If severe anaphylactic reaction to eggs, vaccine is contraindicated and skin testing should not be done. Chemoprophylaxis indicated.) What do you do/not do in an egg allergic patient who needs the MMR vaccine? Do NOT skin test (not enough egg antigen to make test reliable) Do NOT withhold vaccine Do give vaccine consider monitoring for 90 minutes after administration Which childhood vaccines are subQ Which are oral SubQ: MMR, varicella, IPV Oral: rotavirus Which vaccines are live MMR Varicella Rotavirus nasal flu oral typhoid yellow fever This vaccine is contraindicated in immunocompromised children and those with immunocompromised people at home oral polio vaccine (OPV) caution with this/these vaccine/s in patients allergic to eggs influenza (both kinds) yellow fever caution with this/these vaccine/s in patients allergic to stretomycin, neomycin, polymixin B IPV OPV caution with this/these vaccine/s in patients allergic to neomycin MMR varicella caution with this/these vaccine/s in patients allergic to gelatin MMR varicella yellow fever avoid these vaccines in pregnant patients MMR Varicella intranasal flu IPV OPV avoid these vaccines in patients who are breastfeeding none ;-) absolute contraindications to DTaP encephalopathy within 7 days of previous dosing anaphylaxis with previous dose Relative contraindications to DTaP temp >40.5 w/in 48hrs of previous dose with no other cause collapse/shock like state w/in 48hrs of previous dose seizures w/in 3 days of previous dose persistent inconsolable crying within last 48 hours absolute contraindications to MMR anaphylaxis to neomycin or gelatin pregnancy (no cases of vaccine induced congenital rubella syndrome; no need to teminate pregnancy if MMR given to pregnant woman) immunodeficiency (except most HIV infected children can receive MMR) Relative contraindications to MMR recent IgG (give 2 weeks before or 3-12 months after IgG) thrombocytopenia with first dose high dose (2mg/kg/day or >20mg/day) oral corticosteroids for 14 days or more (wait 1 month from steroid discontinuation) Why is OPV no longer recommended vaccine associated paralysis IPV does not cause this Other than normal vaccination when shoule Hib be given or not given do not give to normal child after age 5 give to child <24 months with invasive H. influenzae infection as natural immunity may not develop give to all with functional/anatomic asplenia (sickle cell, other hemoglobiopathy, AIDS) What do you give to a newborn with a HBsAg+ mother HepB vaccine within 12 hours of delivery HepB immunoglobulin within 12 hours of delivery at a different site What do you give to a newborn whose mother's HBsAg status is unknown? HepB vaccine within 12 hours of delivery If testing shows mom is positive, give immunoglobulin to child within 1 week from delivery but preferrably ASAP side effects of varicella vaccine 3-5% develop localized varicella-like rash w/in 1 month 3-5% develop generalized varicella-like rash w/in 1 month if rash develops, keep children away from immunocompromised individuals contraindications (and non-contraindications) for varicella vaccine avoid immunocompromised patients (but HIV, hypogammaglobulinemia, dysgammaglobulinemia, oral steroids <2mg/kg/day and <20mg/day are ok) Do not vaccinate pregnant women (but ok to give to child if mom is pregnant) types and timing of pneumococcal vaccines 7-valent (PCV) at 2,4,6,12-15 months give series to 24-59 unvaccinated month olds if high risk or moderate risk high risk: SSD, asplenia, HIV, chronic cardio-pulm dz (not asthma), diabetes moderate risk: daycare, native americans/alaskans, african americans 23 valent (PPSV) for children with immunodeficieny, asplenia, chronic disease now give after PCV series completed, ideally at ages 2 and 5. Who get meningococcal vaccine universal recommendation for 11-12 year olds 2-10 year olds with terminal complement deficiency, asplenia, other high risk groups those going into crowded living environments (college dorms, military barracks) when do you give rotavirus vaccine must start by 15 weeks must complete before 8 months RotaTeq 2,4,6 months Rotarix 2,4 months Remeber intussusception with old vaccine, not with new ones What HPV serotypes does HPV vaccine prevent 6,11 cause >90% of genital warts 16,18 cause ~70% of cervical CA Who get HPV vaccine and when females age 9-26 (recently approved in males of same ages) most start at 11-12 years give a 0,2,6 months Still give if history of HPV infection vaccine at birth HepB vaccine at 1 month Hep B vaccines at 2 months HepB (if not at 1 month) DTaP Hib IPV PCV Rota vaccines at 4 months DTaP Hib IPV PCV Rota Maybe HepB vaccines at 6 months DTaP Hib IPV PCV Rota Maybe HepB Maybe Influenza vaccines at 12-15 months MMR Varicella HepA (with 2nd dose 6-12 months later) Hib PCV DTaP (15 months) Maybe HepB Maybe influenza vaccines at 4-6 years DTaP (not after age 7, switch to Tdap) IPV MMR (2nd dose can be given 1mo after first) Varicella (2nd dose can be given 3mo after first) Vaccines at 11-12 years Tdap (then Td boosters q10yr or with injury) HPV MCV4 remeber to catch up on MMR, varicella, HepB When is HepB vaccine given 1st dose as early as birth, at least by 2mo 2nd dose at least 1mo after 1st 3rd dose at least 4mo after 1st and 2mo after 2nd, not before 6mo of age When is DTaP given 2,4,6,12-15,4-6yrs switch to Tdap after 7 years When is Hib given 2,4,6,12-15mo some formulations do not require 6 mo dose When is PCV given 2,4,6,12-15mo when is IPV given 2,4,6mo 4-6yr