PNN- Vaccinations
Adult Pneumococcal Vaccine - ✔️✔️- Pneumococcal PolySaccharide Vaccine 23-
valent (PPSV23) (Pneumovax) capsular vaccine
Indication: Children ≥ 2 years
Dose: IM, SQ: 0.5 mL as a single dose
Who should receive the 23-valent vaccine?
* ≥ 65 y/o (5 yrs after the last dose if received in the past)
* Smokers / Asthma on oral corticosteroids/ COPD
* Chronic diseases (CHF, DM, Liver disease, alcoholism), heart dz, lung dz
* Cochlear implant, cerebrospinal fluid leak
2 doses of PCV23
* Immunocompromised / HIV / asplenia/ sickle cell
-PCV15 or PCV20. If PCV 20 is used, then PPSV23 is not needed. If PCV15 is
administered, it is followed with a single dose of PPSV23 ≥1 year later
Influenza Vaccine Information - ✔️✔️*Formulation changes annually
*Optimal administration: NO later than the end of October
*Antibodies develop in about 2 weeks
Influenza IM Injection - ✔️✔️Kids 6 m/o - 8 y/o if previously unvaccinated, should
receive 2 doses separated by ≥ 4 weeks, and then once yearly.* Adults & kids > 8 y/o:
0.5 mL IM once yearly
Influenza FluMist nasal spray - ✔️✔️* 2-8 y/o: 0.2 mL dose (repeat in 4 weeks if
previously unvaccinated)* 9-49 y/o: one 0.2 mL dose (0.1 mL/nostril)
Who is "high priority" for the influenza vaccine? - ✔️✔️Assume everyon efor thi
* ≥ 50 or older & nursing home residents
* Chronic disease (respiratory, cardiovascular, renal)
* Health care workers (if receiving the live vaccine, cannot work with
immunosuppressed for 7 days)
* Pregnant women
* Children 6 m/o - 4 y/o OR 6 m/o - 18 y/o on aspirin
Contraindications of Influenza - ✔️✔️* Guillain-Barre Syndrome (GBS)
,* Allergy to thimerosal or severe allergic reaction to the flu vaccine, regardless of the
component
* Patients w/egg allergy can get ANY influenza vaccine
Avoid the live vaccine in asthmatics 2-4 y/o, pregnancy, and immuno-compromised
patients
Influenza Vaccine (Pediatric) - Has the child 6 months through 8 years of age received ≥
2 doses of influenza vaccine? - ✔️✔️NO: Administer TWO doses separated by ≥ 4 wks
YES: Administer ONE dose
Pediatric Pneumococcal Vaccine - ✔️✔️Pneumococcal Conjugated Vaccine 13 valent
(PCV13) (Prevnar 13):
* Prevention of pneumonia, meningitis, and otitis media
* It is conjugated to Diphtheria protein which ↑ the effectiveness of the vaccine during
the first 2 years of life
Indications: ≥ 6 weeks; high-risk patients
Dose: Shake suspension vigorously prior to administration
* 0.5 mL IM 6-8 wks apart at 2, 4, 6 months; followed by the 4th dose at 12-15 months
(4 doses total)
* Catch-up vaccination: ONE dose for healthy kids 24-59 months w/any incomplete
PCV13 vaccination
* Adults ≥ 65 yrs: "shared clinical decision making"
Quick Info regarding Vaccines - ✔️✔️1) Vaccines should be deferred in times of acute
illness2) All vaccines can be given together at the same time but at separate injection
sites3) Acetaminophen seems to reduce the immune response slightly. Giving Tylenol
to children before vaccinations is NOT recommended
Pediatric pneumococcal Vaccines - ✔️✔️Pneumococcal Conjugated Vaccine 13 Valent
(PCV13 - Prevnar 13)
Pneumococcal Conjugated Vaccine 15 Valent
(PCV15 - Vaxneuvance)
Pneumococcal Conjugated Vaccine 20 Valent
(PCV20- Prevnar 20)
Pneumococcal Conjugated Vaccine 13 Valent
(PCV23 - Pneumovax) capsular vaccicine
, Pediatric Pneumococcal Vaccine - ✔️✔️Pneumococcal Conjugate Vaccine 15 - Valent
(PCV15) - Vaxneuvance
Indication: ≥ 6 weeks and children </- 15 months
Pneumococcal Conjugate Vaccine 20 - Valent (PCV20) - Prevnar 20
Indication: ≥ 6 weeks and children </- 15 months
Conjugate Vaccine: may lead to longer lasting and better immunity compared to
polysacc vaccines such as Pneumovax 23
Pneumococcal Guidelines UPDATE - ✔️✔️Adults ≥ 65 y/o who have not previously
received a pneumococcal conjugate vaccine or whose previous vaccination history is
unknown should receive a pneumococcal conjugate vaccine: PCV20 alone or PCV15
followed by a dose of PPSV23
Adults 19-64 y/o with certain risk factors who have not previously received a
pneumococcal conjugate vaccine or whose previous vaccination history is unknown
should receive a pneumococcal conjugate vaccine: PCV20 alone or PCV15 followed by
a dose of PPSV23
Adult >65 who has not previously received a vaccine.
PCV20 alone or PCV 15 followed by PPSV 23
What to pneumo vaccine to give? - ✔️✔️if >19 years old best option is PCV 20.
- if greater than 19 never give PCV 20 alone.
If not available give PCV15 then PPSV23 1 year later
-Can give 8 weeks later if immunocompromised
Pt. high risk of Pna.
Can do 15 then 23 later
or just give PCV 20 and done.
Who gets the Hep B vaccine? - ✔️✔️Transmitted by blood and bodily fluids (semen,
IVDU, mom etc. )
1) All neonates at birth before hospital discharge, 0d, 1m, 6m
2) Unvaccinated person < 60 years and >60 and at risk of HepB virus infection
3) Healthcare workers
4) DM patients 19-59 y/o
5) IVDA, inmates, HIV, liver disease
6) Hemodialysis patients
Adult Pneumococcal Vaccine - ✔️✔️- Pneumococcal PolySaccharide Vaccine 23-
valent (PPSV23) (Pneumovax) capsular vaccine
Indication: Children ≥ 2 years
Dose: IM, SQ: 0.5 mL as a single dose
Who should receive the 23-valent vaccine?
* ≥ 65 y/o (5 yrs after the last dose if received in the past)
* Smokers / Asthma on oral corticosteroids/ COPD
* Chronic diseases (CHF, DM, Liver disease, alcoholism), heart dz, lung dz
* Cochlear implant, cerebrospinal fluid leak
2 doses of PCV23
* Immunocompromised / HIV / asplenia/ sickle cell
-PCV15 or PCV20. If PCV 20 is used, then PPSV23 is not needed. If PCV15 is
administered, it is followed with a single dose of PPSV23 ≥1 year later
Influenza Vaccine Information - ✔️✔️*Formulation changes annually
*Optimal administration: NO later than the end of October
*Antibodies develop in about 2 weeks
Influenza IM Injection - ✔️✔️Kids 6 m/o - 8 y/o if previously unvaccinated, should
receive 2 doses separated by ≥ 4 weeks, and then once yearly.* Adults & kids > 8 y/o:
0.5 mL IM once yearly
Influenza FluMist nasal spray - ✔️✔️* 2-8 y/o: 0.2 mL dose (repeat in 4 weeks if
previously unvaccinated)* 9-49 y/o: one 0.2 mL dose (0.1 mL/nostril)
Who is "high priority" for the influenza vaccine? - ✔️✔️Assume everyon efor thi
* ≥ 50 or older & nursing home residents
* Chronic disease (respiratory, cardiovascular, renal)
* Health care workers (if receiving the live vaccine, cannot work with
immunosuppressed for 7 days)
* Pregnant women
* Children 6 m/o - 4 y/o OR 6 m/o - 18 y/o on aspirin
Contraindications of Influenza - ✔️✔️* Guillain-Barre Syndrome (GBS)
,* Allergy to thimerosal or severe allergic reaction to the flu vaccine, regardless of the
component
* Patients w/egg allergy can get ANY influenza vaccine
Avoid the live vaccine in asthmatics 2-4 y/o, pregnancy, and immuno-compromised
patients
Influenza Vaccine (Pediatric) - Has the child 6 months through 8 years of age received ≥
2 doses of influenza vaccine? - ✔️✔️NO: Administer TWO doses separated by ≥ 4 wks
YES: Administer ONE dose
Pediatric Pneumococcal Vaccine - ✔️✔️Pneumococcal Conjugated Vaccine 13 valent
(PCV13) (Prevnar 13):
* Prevention of pneumonia, meningitis, and otitis media
* It is conjugated to Diphtheria protein which ↑ the effectiveness of the vaccine during
the first 2 years of life
Indications: ≥ 6 weeks; high-risk patients
Dose: Shake suspension vigorously prior to administration
* 0.5 mL IM 6-8 wks apart at 2, 4, 6 months; followed by the 4th dose at 12-15 months
(4 doses total)
* Catch-up vaccination: ONE dose for healthy kids 24-59 months w/any incomplete
PCV13 vaccination
* Adults ≥ 65 yrs: "shared clinical decision making"
Quick Info regarding Vaccines - ✔️✔️1) Vaccines should be deferred in times of acute
illness2) All vaccines can be given together at the same time but at separate injection
sites3) Acetaminophen seems to reduce the immune response slightly. Giving Tylenol
to children before vaccinations is NOT recommended
Pediatric pneumococcal Vaccines - ✔️✔️Pneumococcal Conjugated Vaccine 13 Valent
(PCV13 - Prevnar 13)
Pneumococcal Conjugated Vaccine 15 Valent
(PCV15 - Vaxneuvance)
Pneumococcal Conjugated Vaccine 20 Valent
(PCV20- Prevnar 20)
Pneumococcal Conjugated Vaccine 13 Valent
(PCV23 - Pneumovax) capsular vaccicine
, Pediatric Pneumococcal Vaccine - ✔️✔️Pneumococcal Conjugate Vaccine 15 - Valent
(PCV15) - Vaxneuvance
Indication: ≥ 6 weeks and children </- 15 months
Pneumococcal Conjugate Vaccine 20 - Valent (PCV20) - Prevnar 20
Indication: ≥ 6 weeks and children </- 15 months
Conjugate Vaccine: may lead to longer lasting and better immunity compared to
polysacc vaccines such as Pneumovax 23
Pneumococcal Guidelines UPDATE - ✔️✔️Adults ≥ 65 y/o who have not previously
received a pneumococcal conjugate vaccine or whose previous vaccination history is
unknown should receive a pneumococcal conjugate vaccine: PCV20 alone or PCV15
followed by a dose of PPSV23
Adults 19-64 y/o with certain risk factors who have not previously received a
pneumococcal conjugate vaccine or whose previous vaccination history is unknown
should receive a pneumococcal conjugate vaccine: PCV20 alone or PCV15 followed by
a dose of PPSV23
Adult >65 who has not previously received a vaccine.
PCV20 alone or PCV 15 followed by PPSV 23
What to pneumo vaccine to give? - ✔️✔️if >19 years old best option is PCV 20.
- if greater than 19 never give PCV 20 alone.
If not available give PCV15 then PPSV23 1 year later
-Can give 8 weeks later if immunocompromised
Pt. high risk of Pna.
Can do 15 then 23 later
or just give PCV 20 and done.
Who gets the Hep B vaccine? - ✔️✔️Transmitted by blood and bodily fluids (semen,
IVDU, mom etc. )
1) All neonates at birth before hospital discharge, 0d, 1m, 6m
2) Unvaccinated person < 60 years and >60 and at risk of HepB virus infection
3) Healthcare workers
4) DM patients 19-59 y/o
5) IVDA, inmates, HIV, liver disease
6) Hemodialysis patients
