Section 9 Appendices Newfoundland and Labrador
Newfoundland and Labrador Immunization Manual Section 9 Appendices Appendix A: Vaccine Abbreviations ................................................................................ 2 Appendix B: Coverage Rate Report Forms for Newfoundland Labrador Immunization Programs........................................................................................................................ 3 Appendix C: CRMS Documentation of Immunization ...................................................... 8 Appendix D: Latex Allergies and Immunization ............................................................... 9 Appendix E: Adverse Events Following Immunization Reporting Form ..........................11 Appendix F: User Guide: Report of Adverse Events Following Immunization (AEFI) .....12 Appendix G: Management of Anaphylaxis in the Non-Hospital Setting (Poster).............13 Appendix H: Vaccine Information for Immunization Program .........................................14 Appendix I: Self Directed Learning Module on Immunization ........................................15 Appendix J: Requisition for Biological Preparations .......................................................32 Appendix K: Biological Preparations Return Report (Wastage) .....................................33 Appendix L: Temperature Monitoring Form ...................................................................34 1 Immunization Manual – NL September 2013 Appendix A: Vaccine Abbreviations http://www.phac-aspc.gc.ca/publicat/cig-gci/app-anneng.php Appendices 2 Immunization Manual – NL September 2013 Appendix B: Coverage Rate Report Forms for Newfoundland Labrador Immunization Programs Coverage Rates Report 1 Immunization Status at age 2 years Report due March 31st of each year Region _____________________ Birth Year ___________________ Number of two year olds with active files (Child Health Cards or CRMS and not moved from region) in the region with that birth year ___________________ Date Reported _______________ DTaP/IPV/Hib 4 doses Pneumococcal 4 doses MMR 2 doses 1 dose Varicella 1 dose Men-C 1 dose 2 dose # Children who have received Percentage Birth Year 2010 2011 2012 2013 2014 Immunization status at age 2 Due March 31,2013 Due March 31,2014** Due March 31,2015 Due March 31,2016 Due March 31,2017 ** Need New Coverage form to capture MMRV in 2014 Comments Appendices 3 Immunization Manual – NL September 2013 Coverage Rates Report 2 Immunization status at Kindergarten Report due December 31st of each year Region ___________________________ Kindergarten Enrolment ______________ (includes home schooled children) School Year ________________________ Date Reported_______________________ DTaP/IPV/ Hib 4 doses DTaP/ IPV or TdapIPV Pneumococcal 3 or 4 doses MMR 2 doses st 1 dose Varicella 1 dose Men-C 1 dose nd 2 dose # Children who have received Percentage Comments Appendices 4 Immunization Manual – NL September 2013 Coverage Rates Report 3 Immunization status for Men-C-ACYW135 Grade 4 Report due June 30th of each year Region _______________________ School Year ___________________ (should include home schooled children) Birth Year _____________________ Date Reported___________________ Men-C-ACYW135 # students # children who have eligible** received **Eligible includes children in grade 4 who have not already received a dose of Men-CACYW135 Comments Appendices 5 Immunization Manual – NL September 2013 Coverage Rates Report 4 Immunization status for Human Papillomavirus (HPV) vaccine Grade 6 Females only Report due June 30th of each year Region _______________________ School Year ___________________ (should include home schooled children) Date Reported____________________ HPV Dose # 1 # students eligible * # children who have received HPV Dose # 2 # students eligible* # children who have received HPV Dose # 3 # students eligible* # children who have received Percentage * Eligible includes children in grade 6 who have not already received a series of HPV vaccine. Comments Appendices 6 Immunization Manual – NL September 2013 Coverage Rates Report 5 Immunization status for Tdap Grade 9 Report due June 30th of each year Region_______________________ School Year ___________________ Grade 9 enrolment______________ (should include home schooled children) Date Reported__________________ Tdap # Students eligible # Of students vaccinated Percentage% Comments _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Appendices 7 Immunization Manual – NL September 2013 Appendix C: Client Referral Management System (CRMS) Documentation of Immunization All regional health authorities must use CRMS to capture primary immunizations, school immunizations, adult immunizations and vaccines that have been administered in relation to communicable disease control. Please see the guidelines for documentation in CRMS that have been developed by the regional health authorities where the client resides for specifics. Appendices 8 Immunization Manual – NL September 2013 Appendix D: Latex Allergies and Immunization To address concerns regarding latex allergies and immunization the following documentation has been collected: Documentation from manufacturers Individuals identified as high risk Suggested guidelines for immunizing a person with latex allergies Screening questions to ask when using a product with latex content Individuals identified as high risk for latex allergies: Those with spina bifida Those with myelodysplasia or complex congenital anomalies Those who have frequent contact with natural latex products and have experienced allergy type reactions Those with a history of anaphylactic reactions of “unknown origin” during surgery Those who have food allergies to avocados, kiwi, bananas, chestnuts, tomato or apples Guidelines for immunizing a person with latex allergy: Ampules of vaccine do not contain latex Use an alternate product, latex free if one is available Inject vaccine immediately after drawing up Screening questions to ask when using a latex containing product: Do you have any allergies? Do you have an allergy to avocados, kiwi, bananas, chestnuts, tomato or apples? Do you have spina bifida? Do you have a history of rash, hives, eye irritation, rhinitis (runny nose) or asthmatic symptoms after handing latex gloves, balloons, condoms or other latex items? Do you have any medical problems? Do your lips swell if you blow up a balloon? Have you had surgery, if yes how many? Do you frequently come in contact with rubber products in your workplace? If the answer to any of these questions is yes: Inquire whether allergy testing has been done and did it include latex If status is unknown check with the parent or family doctor If the person is allergic to latex, use latex guidelines If further information is unavailable refer to MOH Appendices 9 Immunization Manual – NL September 2013 Latex Content of commonly used Vaccine Closures Vaccine/product Trade Name Manufacturer DaPT-IPV-Hib DaPT-IPV MMR/diluent Pediacel Quadracel Priorix (vial only) Sanofi Sanofi GSK MMR/diluent MMRV/diluent Pneu-C-10 MMRII Priorix-Tetra Synflorix Merck GSK GSK Pneu-C-13 Varicella Prevnar Varilrix Wyeth GSK No latex No latex Prefilled syringe contains latex, vial does not No latex No latex Varicella Men-C HB HB HPV Flu Flu Pneu-P-23 Varilrix Mengugate C Recombivax Energix Gardasil Fluviral Vaxigrip Pneumovax23 Merck Merck Merck GSK Merck GSK Sanofi Merck No latex No latex Latex No latex No latex No latex No latex No latex Sanofi No latex Twinrix GSK Latex Havrix (vial only) Vaqta Typhium Vi Boostrix GSK No latex Merck Sanofi GSK Latex No latex Latex Men-P-ACWY Men-CACYW 135 Hib Td Menomune Menactra Sanofi Sanofi Latex No Latex ACT-HIB Td Absorbed Sanofi Sanofi No latex No latex IPV Td-IPV Imovax-Polio Td PolioAbsorbed Sanofi Sanofi No latex No latex Tubersol 5TU PPD HAHB HA HA Typh-l Tdap Appendices Closure Content No latex No latex No latex Comments/alternate Diluent in prefilled syringe contains latex Diluent in prefilled syringe contains latex Use Energix Prefilled syringe contains latex Prefilled syringe contains latex Use Havrix Use Adacel as it does not contain latex Multi-dose vial contains latex 10 Immunization Manual – NL September 2013 Appendix E: Adverse Events Following Immunization Reporting Form http://www.phac-aspc.gc.ca/im/aefi-form-eng.php Appendices 11 Immunization Manual – NL September 2013 Appendix F: User Guide: Report of Adverse Events Following Immunization (AEFI) http://www.phac-aspc.gc.ca/im/aefi_guide/index-eng.php Appendices 12 Immunization Manual – NL September 2013 Appendix G: Management of Anaphylaxis in the NonHospital Setting (Poster) 1. Administer epinephrine promptly*, subcutaneously or intramuscularly in the limb opposite the site of injection. Use the arm if both legs have been used as injection sites during the current visit. Table 1 Epinephrine Dose by Age AGE DOSE (1:1000 epinephrine) 2-6 months 0.07 mL 7 months to 11 months Between 0.07 mL. and 0.10 mL 12 to 17 months 0.10 mL 18 months to 4 years 0.15 mL 5 years 0.20 mL 6-9 years 0.30 mL 10-13 years 0.40 mL 14 years and older 0.50 mL 2. Call for assistance - transport to an emergency medical facility 3. Place person in recumbent position with legs elevated. 4. Initiate Cardio Pulmonary Resuscitation (CPR), if required 5. Administer ONE dose diphenhydramine HCl (Benadryl ®) ** as an adjunct to epinephrine immunization. This is given deep IM in a limb not used for initial immunization/injection Table 2 BENADRYL ® Dose by Age 6. AGE Injected 50mg /mL Oral or injected Less than 2 years 0.25 mL 12.5 mg 2 - 4 years 0.50 mL 25 mg 5 - 11 years 0.50-1.00 mL 12 years and over 1.00 mL 25-50 mg 50 mg Repeat epinephrine at 5 minute intervals, if no improvement after initial dose. May be repeated twice (total of 3 doses) Emergency Telephone Number ___________________________ *Speedy intervention with epinephrine is of paramount importance; failure to use epinephrine promptly is more dangerous than using it improperly ** Some RHA may include an oral dose of Benadryl ® for the treatment of the conscious patients. (See CIG for rationale) NOTE: In the event of an anaphylactic type reaction all events must be charted and the nursing manager and Communicable Disease Nurse/Coordinator should be notified as soon as possible Appendices 13 Immunization Manual – NL September 2013 Appendix H: Vaccine Information for Immunization Program http://www.health.gov.nl.ca/health/publichealth/cdc/imm unizations.html Appendices 14 Immunization Manual – NL September 2013 Appendix I: Self Directed Learning Module on Immunization Self Directed Learning Module on Immunization Goal: To provide an ongoing, standardized educational process that will guide health practitioners’ immunization practise in accordance with policies and procedures outlined in the Newfoundland and Labrador Immunization Manual and the Canadian Immunization Guide. Objectives: On completion of the immunization educational process, the participant will be able to: Define terms related to immunization and immunity. 1. Demonstrate proper vaccine handling and storage. 2. Provide adequate information to clients that will enable them to make an informed decision. 3. Demonstrate knowledge of the current Newfoundland and Labrador routine immunization schedule. 4. Demonstrate knowledge of vaccines used in terms of: recommended indication, route, site and dosage common side effects adverse effects contraindications risks/benefits patient education (i.e.: what to do if person being vaccinated experiences an adverse event or common side effect) administration technique Resources: 1. Newfoundland and Labrador Department of Health and Community Services, Immunization Manual. December 2011 2. National Advisory Committee on Immunization.(2012) Canadian Immunization (Evergreen Edition).Ottawa ON http://www.phac-aspc.gc.ca/publicat/ciggci/index-eng.php 3. Control of Communicable Disease Manual.19th ed. 2008 Heymann. APHA. 4. Manufacturers’ product monograph inserts. 5. Your Child’s Best Shot. A Parent’s Guide to Vaccination, 3rd ed. 2006. Gold, R. Canadian Paediatric Society 6. Websites: http://www.immunize.cpha.ca http://www.health.gov.nl.ca/health/publichealth/cdc/health_pro_info.html#immunization Appendices 15 Immunization Manual – NL September 2013 Self-Directed Learning Module on Immunization Guidelines for the Practitioner 1. To become knowledgeable in the field of immunization you will need to successfully complete i) this written self-directed immunization learning module; and ii) a supervised immunization experience; and iii) orientation session with the Communicable Disease Control Nurse (CDCN) 2. You will direct your own learning experience with the goal of reaching or maintaining competence in immunization. Feel free to use any resource: books, journals, colleges, to assist you in completing the module. It is recommended that you refer to the most current edition of the Newfoundland and Labrador Immunization Manual and the Canadian Immunization Guide. All resources will be provided to you by your manager. 3. Complete the module prior to meeting with the Communicable Disease Control Nurse for orientation on immunization. When you are finished, hand in or send your completed module to the CDCN at least two days prior to your scheduled orientation time. 4. The NL Immunization Manual found at http://www.health.gov.nl.ca/health/publichealth/cdc/health_pro_info.html#immuni zation contains the provincial and regional policies and procedures for immunization, therefore, it is important to carefully read and become familiar with this resource. 5. The module will be corrected by the CDCN (or nurse manager) and reviewed with you at the orientation session. 6. Remember, there is no grade or pass/fail designation awarded to this module. Instead, all questions must be answered completely and must follow Newfoundland and Labrador immunization policy. Appendices 16 Immunization Manual – NL September 2013 Self-Directed Learning Module on Immunization Questions Please answer ALL questions in the space provided. If additional space is needed, please write on the back making sure the answer is well indicated. Please be brief but complete with your answers. 1. What are the true contraindications for all vaccines? 2. What is meant by immunization precautions? 3. What are the characteristics of an “ideal vaccine”? 4. What are the five characteristics of a valid consent for immunization? 5. Before administering inactivated vaccines and/or live attenuated vaccines, what would you discuss with the client in terms of benefits, reactions and instructions if a reaction were to occur? Vaccine A. Benefits B. Reactions C. Instructions Inactivated Vaccines Live vaccines Appendices 17 Immunization Manual – NL September 2013 6. What documentation, charting and reporting requirements are needed when an adverse event following immunization occurs? 7. What instructions would you give the parent/guardian for management of common side effects post immunization? 8. Live vaccines are not recommended in which circumstances: A. Pregnancy B. Hypersensitivity to eggs C. Immunocompromised D. Previous anaphylactic reaction to the vaccine E. A C & D. 9. What is the difference in the diphtheria component between DTaP-IPV and Td vaccines? 10. What is the best source for up to date information on vaccines regarding dosage? A. Immunization Manual B. Internet site C. Product monograph supplied with the vaccine 11. The term “cold chain” refers to: A. the distribution for vaccines B. how it is ensured that vaccines arrive at their final destination with their immunogenic properties intact C. storage for vaccines D. maintaining the temperature of vaccines between 2C and 8C E. All of the above 12. Check () the following True (T) or False (F): When a cold chain break has occurred: A. The nurse will notify the vaccine coordinator. ___T ___F B. If it is known that the power outage will last less than two hours, the vaccines can remain in the refrigerator; the door should not be opened. ___T ___F Appendices 18 Immunization Manual – NL September 2013 C. If due to a witnessed power outage, the vaccine coordinator or designate will take the vaccines out of the refrigerator and destroy them. ___T ___F 13. How frequently should one monitor temperature in any vaccine storage unit? 14. Of the following, circle those which are accurate when referring to a refrigerator that is used to store vaccines: A. The temperature within it must be maintained between 0 and 8 degrees Celsius. B. Food and beverages can be stored in the vaccine refrigerator. C. The procedures to be followed in the event of refrigerator failure are posted on it. D. Bottles of water can be placed on any empty shelves and in the door spaces. E. The refrigerator can be located in the coffee room so everyone can use it. F. It must contain a maximum-minimum thermometer. G. The refrigerator is checked regularly to determine if the temperature within it is optimal. H. It meets the approved Provincial Immunization Policy 15. Check () the following True (T) or False (F): Refrigerators used to store vaccines shall: A. be maintained at a temperature between 2 and 8C ___T ___F B. be defrosted when 1 cm. of ice builds up in the freezer section ___T ___F C. contain water bottles in order to maintain a more constant temperature in the event of a power failure ___T ___F 16. When vaccine has been exposed to temperatures outside the recommended range, we should: A. Use the vaccine if it has been exposed for less than two hours B. Consult the appropriate manufacturer(s) and destroy the vaccine C. Place the vaccine in a container labelled “do not use”, place at proper temperature and notify the vaccine coordinator in your region or the provincial Office and await further direction. 17. How can you tell if someone has fainted versus someone who is having an anaphylactic reaction? Appendices 19 Immunization Manual – NL 18. September 2013 Mona, a 16 year old female, has just received a Tdap booster. She states that she is feeling faint, is pale and suddenly collapses. Check () the following True (T) or False (F): A. She is experiencing an anaphylactic reaction. ___T ___F B. You should have her lie down and measure her BP, pulse and respirations. ___T ___F C. The correct dosage of adrenalin to administer in the case of anaphylaxis is 0.5 ml. ___T ___F D. In the event of an anaphylactic reaction, you should never administer CPR. ___T ___F 19. For the vaccines noted below describe the following: administration route; site; dosage and needle size that would be used for infants, children and adults: Answers: Vaccine Infants Children Infants Adults Route Injection Site Dosage NEEDLE Size & Length MMRV DTaP-IPV Pneu-C-13 Influenza 20. What are the key principles of risk communication? 21. All of the following are principles of combination vaccines except? A. Combination vaccines do not need to be tested. B. Ideal combination vaccines are safe and effective as the single antigen. C. They should fit the current schedule, be easily stored & easy to administer. D. Helps to reduce the number of immunization Appendices 20 Immunization Manual – NL September 2013 22 . Give the recommended Newfoundland and Labrador schedule for a child who began immunization at birth . Routine immunization schedule for children beginning immunization in early infancy VACCINE DTaP IPV Hib Age DTaP IPV Or TdapIPV HB HPV MMRV MMR Tdap Inf PneuC-13 Men C ACYW 135 MenC 2 mos. 4 mos. 6 mos. 6-23 mos. 12 mos. 18 mos. 4 to 6 yrs. Grade 4 Grade 6 14 to 16 yrs. Answer: DTaP-IPV-Hib Diphtheria,acellular pertussis, tetanus, polio, Haemophilus influenzae type b DTaP-IPV Diphtheria, acellular pertussis, tetanus, polio vaccine HB Hepatitis B vaccine 2 doses at 0, 4-6 mo beginning in school year 2012 MMR Measles, mumps, rubella vaccine MMRV Measles, mumps, rubella,varicella vaccine Tdap Tetanus, diphtheria, acellular pertussis vaccine Tdap-IPV Tetanus, diphtheria, acellular pertussis vaccine, polio vaccine Inf Influenza Var Varicella vaccine Pneu-C-13 Pneumococcal conjugate 13 valent Men-C Meningococcal type C Men-C-ACYW135 Meningococcal type A, C, Y&W135 HPV Human Papilloma virus Appendices 21 Immunization Manual – NL September 2013 23. In the following 4 scenarios, give the immunization schedule and the vaccines you would use to complete the child’s schedule to school entry. A. A healthy four-year-old child who has never been immunized. Immunization schedule for children < 7 years of age not immunized in early Infancy Timing DTaP-IPV Hib MMRV MMR Pneu-C-13 Men-C TdapIPV First visit 2 months later 2 months later 6-12 months later * 4-6 years * 4-6 years can be omitted if fourth dose was given after the fourth birthday B. A healthy 13-month-old child who has never been immunized. Immunization schedule for children < 7 years of age not immunized in early infancy Timing DTaP-IPV Hib MMRV MMR Pneu-C-13 Men-C TdapIPV First visit 2 months later 2 months later 6-12 months later * 4-6 years * 4-6 years can be omitted if fourth dose was given after the fourth birthday C. A seven-month-old infant who received two doses of DTaP-IPV-Hib and Pneu-C- 13 at two and four months of age Immunization schedule for children < 7 years of age not iimmunized in early infancy Timing DTaP-IPV Hib MMRV MMR Pneu-C-13 Men-C TdapIPV First visit 2 months later 2 months later 6-12 months later * 4-6 years * 4-6 years can be omitted if fourth dose was given after the fourth birthday D. A nine-month-old infant who received two doses of DTaP-IPV and PneuC-13 at two and four months of age. Appendices 22 Immunization Manual – NL September 2013 Immunization schedule for children < 7 years of age not immunized in early Infancy Timing DTaP-IPV Hib MMRV MMR Pneu-C-13 Men-C TdapIPV First visit 2 months later 3 months later 6-12 months later * 4-6 years * 4-6 years can be omitted if fourth dose was given after the fourth birthday 24. Steven is eight months old and is attending a Child Health Clinic. At six months of age, he received one dose of DaPT-IPV-Hib and Pneu-C-13. Steven is being breastfed, and his mother is two months pregnant. He looks well but is taking Amoxil. A) What are the contraindications to Steven receiving his immunization today? a. b. c. d. On antibiotics Household member pregnant Being breastfed None of the above B) What vaccines should be given to Steven today? a. b. c. d. e. DTaP-IPV- Hib, Pneu-C-13 DT, Hib MMRV Var Men-C C) At what age should Steven return for his next immunization appointment? a. 12 months b. c. d. 9 months 10 months 15 months D) What vaccines should Steven receive then? a. DTaP-IPV- Hib b. DT, Hib c. MMR d. Var e. Men-C E) What vaccines will Steven receive at 12 months of age? a. b. c. d. DTaP-IPV-Hib, Pneu-C-13 MMRV, Men-C, Pneu-C-13 DaPT, OPV, Hep. B MMR, Hib F) What vaccines will Steven receive when he is 14-16 years of age? Appendices 23 Immunization Manual – NL a. b. c. September 2013 Tdap Td-P Td 25. A preschool child has arrived at Child Health Clinic having previously received a complete primary series of DTaP-IPV-Hib (in infancy). You are informed that the child is allergic to dust, cats and several foods. What would you do regarding the MMRV injection that is overdue? 26. Katelyn is 12 months old. She has previously received three doses of DTaPIPV-Hib and two doses of Pneu-C-13 at the recommended ages. After the third dose of DTaP-IPV-Hib Katelyn had a fever of 105°F and a febrile seizure. Two months ago, she was exposed to measles and was given immune globulin. A) Does Katelyn have contraindications to any vaccines? a. Yes b. No B) If your answer to A was yes, which vaccine(s) would be contraindicated at this time? a. DTaP-IPV-Hib b. MMRV c. IPV d. Hep B C) What vaccine(s) should Katelyn receive today? a. DTaP-IPV-Hib, MMRV b. Men-C and Pneu-C-13 c. Men-C only D) When should Katelyn return for immunization, and what vaccine(s) should she receive at that time? a. In two months for DT-P, Hib b. In two months for Hep B c. In three to 11 months for MMRV d. In two months for DTaP-IPV-Hib and MMRV 27. A child received MMR two days ago and requires a Tuberculin Skin Test (TST) with PPD. What do you do and why? 28. Elizabeth is seven weeks old and was born one month premature. Mom is breastfeeding her, and her father recently completed radiation and chemotherapy for Hodgkin’s. Her sister has epilepsy. Appendices 24 Immunization Manual – NL September 2013 A. Should Elizabeth be immunized today? a. Yes b. No B. Are there any contraindications? a. Yes, due to prematurity b. Yes, due to family history of epilepsy c. Yes, due to family member receiving chemotherapy d. None of the above e. All of the above C. What vaccines does Elizabeth need at two months of age? a. DTaP-IPV-Hib, Pneu-C 13 b. DTaP-IPV-Hib c. None until three months because she is one month premature d. Not until she weighs 4500gms D. After the first immunization is given, when should she come back and what vaccines should she receive? a. In two months for DTaP-IPV-Hib and Pneu-C-13 b. In two months for DTaP-IPV c. In one month for Hib d. None of the above 29. Austin, Elizabeth’s brother, is three years old and has no documentation of his MMR or his fourth dose of DTaP-IPV-Hib. A. Are there any contraindications? a. No pertussis due to family history of epilepsy b. No MMR due to family member receiving chemotherapy c. No contraindications B. What vaccines does Austin need? a. DTaP-IPV-Hib b. MMRV c. a and b d. DT-P, Hib C. Does he need a booster i.e. DTaP-IPV? a. Yes b. No D. When can he receive this fifth dose of DaPT-IPV? a. One year later b. Two years later c. Three years later d. Any of the above 30. The following questions relate to administering tuberculin skin testing (TST): A. Which biological is used; what strength and dosage? B. What site? Appendices 25 Immunization Manual – NL September 2013 C. Which route? D. What type of syringe and needle? 31. How do you read and record the results of a TST? How do you interpret the readings? 32. It is December and a family with 2 young children (7 months and 2 ½ years) has moved back to Newfoundland and Labrador from Alberta. Paul, had chickenpox at 5 ½mos of age, he is now 7months old and is feeling well. He previously received DTaP-IPV-Hib, Pneu-C-13 and Men-C at two and four months of age. A. What vaccine(s) should Paul receive today? a) DTaP-IPV-Hib, Pneu-C-13, Men C and Influenza b) DTaP-IPV-Hib, Pneu-C-13 and Men C c) DTaP-IPV-Hib, Pneu-C-13 d) DTaP-IPV-Hib and Influenza A. When should Paul return to clinic and what vaccine(s) should he receive? a) In 6 months for MMR, Var and Men C b) In 5 months for MMR and Men C c) In 5 months for MMRV, Men C and Pneu-C-13 d) In 5 months for MMR e) In 6 months for MMR C. What would Paul’s remaining vaccine schedule look like? 33. Paul’s sister Joy is 2 ½ years old; she was born in New Brunswick and moved with her parents to Alberta when she was 5 months old. She previously received: DTaP-IPV-Hib at 2, 4, 6, and 18 months Pneu-C-13 at 2, 4, 6 and 18 months Men C at 6 months HB at birth and 2 months MMR & Var at 12 months and MMR at18 months Influenza at 6 and 18 months D. What vaccine(s) should Joy receive today? a) None b) HB and Men C c) HB d) Men C Appendices 26 Immunization Manual – NL September 2013 e) HB, Men C and Influenza E. What would Joy’s remaining vaccine schedule look like? 34. John has just returned from Halifax where he had a bone marrow transplant, what is the process for immunization? 35. What should be recommended to a 26-year-old woman who is not immune to rubella? 36. Mrs. B is a 60 year old woman with diabetes, she has called the local health unit to inquire about which vaccines she should receive this coming fall. Which immunizations should she offered? 37. Who are the target population for pneumococcal polysaccharide immunization in NL? 38. Who are the target population for inclusion in the high risk children’s pneumococcal conjugate vaccine program; primary series (4 doses versus 3) in NL? 39. The following questions pertain to hepatitis B vaccine. A. Who is the target population for universal hepatitis B immunization? B. What are the current schedules? C. For prevention of hepatitis B in an infant born to a mother known prior to delivery to be a surface antigen carrier (HBsAg+) see CIG for information on HBIG administration. 40. Your co-worker has experienced a needle stick injury. What should be done? Appendices 27 Immunization Manual – NL September 2013 41. The following questions pertain to Human Papillomavirus (HPV) vaccine. A. Who is the target population for universal HPV immunization? B. What is the current schedule? C. From what disease does this vaccine protect? 42. What information should you record after completing immunization, and where would you record it? 43. Hepatitis B infection can cause: A. No symptoms B. Death C. Chronic carrier state D. Cirrhosis and cancer of the liver E. All of the above 44. The most severe complication of pertussis is: A. Death B. Brain damage C. Apnea D. Cough E. Hib 45. Which disease can cause fetal abnormalities if a woman contracts it during the first three months of pregnancy? A. Measles B. Mumps C. Polio D. Rubella E. Hib 46. How is tetanus transmitted? A. By direct, person-to-person contact B. By contact with airborne droplets C. Through a break in the skin D. By an insect bite E. By sexual contact 47. Which of the following diseases is considered to be the most contagious? A. Mumps B. Measles C. Rubella D. Hepatitis B E. Polio Appendices 28 Immunization Manual – NL September 2013 48. Mumps is characterized by: A. Orchitis in postpubertal males B. Respiratory symptoms C. Swelling of one or more salivary glands D. Life-long immunity after lab-confirmed mumps disease E. All of the above 49. Which of the following groups have the best sero-protection rates following immunization with HB? A. Children less than 2 years of age B. Children between the ages of 5 and 15 years C. People aged 20-29 years D. Peoples greater than 60 years of age 50. Children in whom invasive Hib disease develops before 24 months of age should still receive vaccine as recommended. True or False? 51. Pertussis vaccine is recommended for whom? A. Children greater than or equal to 2 months of age B. Adolescents C. Adults D. Persons who have had natural Pertussis infection E. All of the above 52. Diphtheria is seen most often: A. during the summer months in Canada B. in infants of immune mothers C. in non-immunized children under 15 years of age D. in countries where mass immunization is carried out regularly E. All of the above 53. Which of the following diseases can cause meningitis? A. Haemophilus influenzae type b B. Mumps C. Polio D. All of the above E. None of the above 54. Rubella: A. is usually a mild disease B. can be confused with measles C. can occur without a rash D. can be complicated by arthritis E. All of the above 55. People born before 1970 are considered to be immune to which of the following diseases: A. Pertussis B. Mumps C. Measles D. Polio E. None of the above Appendices 29 Immunization Manual – NL September 2013 56. The incubation period for hepatitis B can be: A. 45-180 days B. 60-90 days C. 6-9 months D. 2 weeks E. All of the above 57. If a child has had varicella (chickenpox) prior to their first birthday the varicella immunization is not required. A. True B. False 58. Which of the following are vaccine preventable diseases? A. Chickenpox B. West Nile virus infection C. Influenza D. Invasive Pneumococcal disease 59. Once a vaccine has been drawn up into the syringe when should it be given? A. Within 90 minutes B. Within 24 hours C. As soon as possible 60. The following is true about the Human Papillomavirus (HPV) vaccine: A. HPV vaccine is not licensed for use among males B. Vaccine ideally should be administered before potential exposure to HPV through sexual exposure C. HPV vaccine does not take the place of regular pap screening D. All of the above Appendices 30 Immunization Manual – NL September 2013 Checklist for Supervised Immunization Experience ACTIVITY DATE COMPLETED COMMENTS Completed the Self Directed Learning Module Shared Vaccine Information with Client Assessment Prior to Immunization Discussed Risks and Benefits Obtained Informed Consent Washed Hands Vaccine Preparation - Sections 3 and 4 Checked adrenalin/ benadryl dose and availability Vaccine selection Checked expiry date Dosage Reconstitution as required Choice of syringe, needle and site Sterile/aseptic technique Vaccine storage handling techniques Demonstrated Appropriate Vaccine Administration - Section 4 Inspect vaccine Positioning, holding IM SC ID Disposal of needle and syringe Comfort measures Assessment post immunization Demonstrated Appropriate Documentation Section 1.4 Client=s Record of Immunization Provide post-immunization info Provide record of immunization Completion Date: _______________________ Appendices Signature: ____________________ 31 Immunization Manual – NL September 2013 Appendix J: Requisition for Biological Preparations http://www.health.gov.nl.ca/health/publichealth/cdc/Requisiti ons%20for%20Biological%20Preparations.pdf Appendices 32 Immunization Manual – NL September 2013 Appendix K: Report Form for Biological Products Wastage http://www.health.gov.nl.ca/health/publichealth/cdc/Biol ogical%20Preparations%20Return%20Report.pdf Appendices 33 Immunization Manual – NL September 2013 Appendix L: Temperature Monitoring Form http://www.health.gov.nl.ca/health/publichealth/cdc/Temperat ure%20Monitoring%20Log.pdf Appendices 34
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