Pregnant & Lactating Women - Bundle of Joy Shots
📌 C/I Live Vaccines: "My Vain Boy Loves Icecream On Yachts" (MMR, Varicella, BCG, LAIV, OPV, Yellow Fever).
| Status | Vaccines | Key Points |
|---|---|---|
| Contraindicated | MMR, Varicella, BCG, Live Influenza (LAIV), OPV (Sabin), Yellow Fever | Live vaccines: Risk to fetus |
| Recommended | Tdap, Inactivated Influenza (IIV) | Tdap: 27-36 wks each pregnancy; IIV: any trimester, protects mother & newborn |
| Special Circumstances | Hepatitis B, Rabies | High-risk exposure; Post-exposure prophylaxis (PEP) for Rabies |
⭐ Tdap vaccine is recommended during each pregnancy (27-36 weeks), irrespective of prior vaccination.
Immunocompromised Hosts - Guarding the Vulnerable
- General Principle: ⚠️ AVOID LIVE VACCINES. Prefer killed, subunit, toxoid, recombinant vaccines.
- HIV Infection:
- CD4 count guides.
- MMR, Varicella if CD4 > 200 cells/µL (no AIDS illness).
- Avoid: BCG, OPV, Yellow Fever, live typhoid.
- Post-Transplant (Solid Organ/HSCT):
- Inactivated: 3-6 months post-transplant.
- Live: Delayed (≥24 months post-HSCT, off immunosuppression, no GVHD).
- Asplenia:
- Risk: Encapsulated bacteria.
- 📌 SHiN vaccines: S. pneumoniae, H. influenzae b, N. meningitidis.
- ⭐ > Patients with asplenia should receive pneumococcal, meningococcal, and Hib vaccines, preferably 2 weeks before elective splenectomy or as soon as possible after.
- Chronic Steroids/DMARDs:
- High-dose steroids (Prednisone ≥20mg/d ≥14d)/DMARDs: AVOID LIVE VACCINES.
- Vaccinate pre-therapy if possible.
Extremes of Age & Others - Cradle to Cane Care
-
Preterm Infants (<37 wks):
- Chronological age; full doses.
- BCG: Defer <2kg (or <2.5kg).
- Hep B (<2kg BW):
- Mom HBsAg (+): Vaccine+HBIG at birth (1st dose).
- Mom HBsAg (-): 1st dose @ 1mo/discharge/>2kg.
- Mom HBsAg (?): Vaccine at birth (+HBIG). Test mom.
⭐ Preterms: full doses by chronological age. BCG deferred <2kg-2.5kg. Hep B (<2kg): if mom HBsAg (+), vaccine+HBIG at birth; if (-), 1st dose >2kg/1mo.
-
Elderly (≥65 years):
- Influenza: Annual.
- Pneumococcal: PCV13 then PPSV23 (1 yr apart; 8 wks if IC).
- Zoster: Recombinant preferred.
-
Chronic Diseases (Key Vaccines):
- Diabetes: Influenza, Pneumococcal, Hep B (19-59y; consider ≥60y).
- CKD: High-dose Hep B, Pneumococcal, Influenza.
- CLD: Hep A, Hep B, Pneumococcal, Influenza.
High‑Yield Points - ⚡ Biggest Takeaways
- Pregnant women: Avoid live vaccines (MMR, Varicella). Give Tdap at 27-36 weeks.
- Immunocompromised: Avoid live vaccines. CD4 count critical in HIV (MMR if CD4 >200).
- Asplenia: Vaccinate against Pneumococcal, Meningococcal, Hib. Give pre-splenectomy or ASAP post-op.
- Premature infants: Use chronological age, not corrected; full doses.
- HIV-infected children: Avoid BCG if symptomatic. MMR/Varicella if CD4% ≥15%.
- High-dose steroids (>20mg/day >14 days): Live vaccines: wait 1 month post-therapy.
Unlock the full lesson and continue reading
Signup to continue reading this lesson and unlimited access questions, flashcards, AI notes, and more
