Vaccines

• CDC/ACIP Immunization Schedules

  • Influenza
  • COVID-19
  • Pneumococcal
  • Tetanus, Diphtheria, and Pertussis

  
• Influenza vaccine types


  IIV4; HD-IIV4 (Fluzone High-Dose®); ccIIV4 (Flucelvax®); RIV4 (Flublok®); aIIV4 (Fluad adjuvanted®); LAIV4 (FluMist®)

  
• Influenza vaccine products


  Multi-dose vials, single-dose vials, prefilled syringes

  
• Influenza vaccine


  • Inactivated vaccine (IIV4); Recombinant vaccine (RIV4); Live-attenuated vaccine (LAIV4)

  
• Influenza vaccine recommended age

  Age > 6 months (vaccine approvals vary by brand)

  
• Influenza vaccine storage


  Refrigerate (2 to 8°C) / Protect LAIV from light

  
• Influenza vaccine dosing/route


  Inactivated vaccine: 0.25-0.5 mL IM / Live-attenuated vaccine: 0.1 mL each nostril

  
• Influenza vaccine dosing for children 6 months through 8 years


  Who have only received 1 lifetime dose, require 2 doses > 4 weeks apart

  
• Influenza vaccine timing


  Vaccinate annually, ideally during September/October (may vaccinate throughout season)

  
• Influenza vaccine efficacy

  Median 47% (dependent on age, co-morbidities, and match) – vaccination reduces symptomatic illness, medical visits, hospitalization, and death. Note: immunity delayed ~ 2 weeks after vaccination

  
• Influenza vaccine contraindications

  • IIV4 and LAIV4: h/o anaphylaxis to the influenza vaccine (ccIIV and RIV may be used with caution if previous reaction was to IIV or LAIV). Egg allergy no longer considered a contraindication.
  • LAIV4 only: Pregnancy, immunocompromise, children aged 2-4 y w/ asthma, children/adolescents treated w/ aspirin/salicylates – risk of Reye syndrome, treatment w/ influenza antivirals w/in past 48 h (see CDC* for other C/Is)

  
• Influenza vaccine common ADRs

  • IIV4/ccIIV4/RIV4/HD-IIV4/aIIV4: Transient injection site reactions predominate (e.g., pain lasting 1-2 d up to 65%)
  • LAIV4: Rhinorrhea and nasal congestion, fever (children aged 2-6 years), sore throat

  
• Influenza vaccine rare but serious ADRs

  • IIV: Febrile seizures in young children; increased risk if given on the same day as PCV13 and DTaP vaccines.

  
• Influenza vaccine special considerations

  IIV4 is recommended for use during pregnancy; HD-IIV4, RIV4, aIIV4 ACIP preferred among patients aged > 65 years

  
• Influenza vaccine age indications by product

  • > 6 months: Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent, Flucelvax Quadrivalent
  • > 18 years: Flublok Quadrivalent
  • > 65 years: Fluzone High-Dose Quadrivalent, Fluad adjuvanted Quadrivalent
  • 2 to 49 years: FluMist

  
• Cell-cultured and recombinant influenza vaccines no longer contain egg protein because they are not produced by growing flu viruses in eggs, unlike other IIV4 vaccines.

  
• COVID-19 vaccines

  • Pfizer-BioNTech (COMIRNATY® 2023-24 version); Moderna (SPIKEVAX® 2023-24 version); Novavax (2023-24 version)

  
• COVID-19 vaccine products

  COMIRNATY® and SPIKEVAX®: Suspension for injection (single dose) / COMIRNATY®: Single dose prefilled syringes

  
• COVID-19 vaccine types

  • Pfizer and Moderna: mRNA vaccines / Novavax: Protein subunit recombinant vaccine (spike protein plus adjuvant)

  
• COVID-19 vaccine recommended age

  Pfizer and Moderna: Age > 6 months / Novavax: Age > 12 years

  
• COVID-19 vaccine storage

  • Pfizer*: Ultra-cold freezer until expiration; refrigerator x 10 w; room temp x 12 h
  • Moderna*: Freezer until expiration; refrigerator x 30 d; room temp x 24 h; Stable 12 h once punctured
  • Novavax: Refrigerator; Protect from light; Stable 12 h at 2 to 25°C once punctured

  
• COVID-19 vaccine dosing/route

  • Pfizer: Age 6 mo-4 y = 0.3mL (yellow cap/label); 5-11 y = 0.3mL (blue cap/label); 12+ y = 0.3mL (gray cap/label) / IM
  • Moderna: Age 6 mo–11 y = 0.25mL (dark blue cap + green label); 12+ y = 0.5mL (dark blue cap/label) / IM
  • Novavax: Age > 12 y: 0.5mL IM x 1 (previously vaccinated w/ COVID vaccine) or x 2 doses 3 w apart (vaccine naïve)

  
• COVID-19 vaccine efficacy

  SPIKEVAX = 93% (preliminary data) / COMIRNATY 95% (preliminary data) / Novavax 90%

  
• COVID-19 vaccine contraindications

  • Pfizer and Moderna: h/o anaphylaxis or an immediate allergic reaction (e.g., hives, swelling, wheezing), even if not severe, to any ingredient in an mRNA COVID-19 vaccine – includes PEG (Novavax vaccines does not contain PEG)

  
• COVID-19 vaccine common ADRs

  • Local injection site reactions up to 90% (pain, erythema, swelling), fatigue up to 60-80%, fever up to 20-25%, chills up to 40-50%, headache up to 60-75%, myalgia up to 45-60%, arthralgia up to 20-50%, axillary lymphadenopathy (swelling and tenderness) up to 30% (data only with SPIKEVAX)

  
• COVID-19 vaccine rare but serious ADRs

  • Myocarditis and pericarditis: Chest pain, shortness of breath, feelings of a rapid/fluttering/pounding heart – rare, most common among adolescents and young adult males

  
• Pneumococcal vaccines

  • PCV15 (Vaxneuvance™); PCV20 (Prevnar 20®); PPSV23 (Pneumovax 23®)

  
• Pneumococcal vaccine products

  Vaxneuvance™, Prevnar-20®, Pneumovax-23®: Suspension for injection (0.5 mL dose), single-dose prefilled syringe

  
• Pneumococcal vaccine types

  • Conjugate vaccine (PCV) – Conjugated to a diphtheria toxoid protein and contains aluminum as an adjuvant
  • Polysaccharide vaccine (PPSV)

  
• Pneumococcal vaccine recommended age

  • PCV13, PCV15, PCV20: Age > 6 weeks (note: PCV13 no longer recommended, to be discontinued)
  • PPSV23: Age > 2 years

  
• Pneumococcal vaccine storage

  Refrigerate (2 to 8°C)

  
• Pneumococcal vaccine dosing/route

  • PCV15/20: 0.5 mL IM – Refer to CDC/ACIP recommendations, with attention to high-risk conditions/dose spacing
  • PPSV23: 0.5 mL IM or SC – Refer to CDC/ACIP recommendations, with attention to high-risk conditions/dose spacing

  
• Pneumococcal vaccine efficacy

  Pediatric: Since approval of PCV, invasive disease in children caused by serotypes in PCV7 and PCV13 declined 99% and 90%, respectively / Adult: PCV13 – 46% efficacy against vaccine-type pneumonia and 75% efficacy against invasive pneumococcal disease (note: immunogenicity of PCV20 comparable to PCV13)

  
• Pneumococcal vaccine contraindications

  • h/o anaphylaxis to the vaccine/components

  
• Pneumococcal vaccine common ADRs

  • Injection site reactions predominate (pain, tenderness, swelling, erythema), decreased appetite, fatigue, headache, muscle pain, fever

  
• Pneumococcal vaccine rare but serious ADRs

  • Febrile seizures in young children if given on the same day as IIV.

  
• Pneumococcal vaccine special considerations

  Patients with functional or anatomic asplenia are at very high risk (up to 50X risk) for invasive pneumococcal disease and therefore require vaccination; Patients with a high-risk medical condition may receive either PCV20 or PCV15 followed by PPSV23 – when both PCV and PPSV are indicated, always administer PCV first.

  
• Tetanus, Diphtheria, and Pertussis vaccines

  • DTaP (Daptocel®, Infanrix®); DT (various); Tdap (Adacel®, Boostrix®); Td (Tenivac®, Tdvax®)

  
• Tetanus, Diphtheria, and Pertussis combination vaccines

  • DTaP-IPV (Kinrix®, Quadracel®); DTaP-IPV-Hib (Pentacel®); DTaP-IPV-HepB (Pediarix®); DTaP-IPV-Hib-HepB (Vaxelis®)

  
• Tetanus, Diphtheria, and Pertussis vaccine products

  Single-dose vials: Daptocel®, Tdvax® / Single-dose, prefilled syringes: Infanrix® / Both: Adacel®, Boostrix®, Tenivac®