Vaccines

perfexion, ASN, RN · Jan 28, 2016

We give tdap and flu shot together right before discharge and if they have a reaction we tell them to see their doctor in the office. Side note: I've never had a patient qualify for pneumonia .

SiwanRN · Jan 28, 2016

Hi there. Not an OB nurse, but I am a public health nurse who gives vaccines to all age groups. It is absolutely fine to give Tdap and influenza vaccines the same day to a postpartum mom (and what shame she wasn't able to get them in her 3rd trimester). You can even give them in the same arm if you wanted to, as long as you had at least an inch between injection sites. You can find some good information about vaccine administration here:

Vaccines: Recs/Vac-Admin/main page

More specific on how to give vaccines (and correct spacing between IM injections in the same arm): http://www.immunize.org/catg.d/p2020A.pdf

More specific information on correct dosages and routes for specific vaccines:

http://www.immunize.org/catg.d/p3084.pdf

If you suspected a vaccine reaction, you can report it to VAERS: Vaccine Adverse Event Reporting System (VAERS) VAERS | Monitoring | Ensuring Safety | Vaccine Safety | CDC But the above poster is right, ultimately their primary care physician will need to do the work to sort it out whether it was a reaction to the vaccine component, an adjuvant, improper administration technique or if it was just a coincidence that she had a problem develop after she was vaccinated.

If your post partum mom wanted and qualified for Tdap, pneumonia, MMR and flu you could give them all at the same time. 2 vaccines per arm, and remember that MMR is a subcutaneous injection and not intramuscular.

OBwonKnewbie · Jan 28, 2016

Hi there. Not an OB nurse, but I am a public health nurse who gives vaccines to all age groups. It is absolutely fine to give Tdap and influenza vaccines the same day to a postpartum mom (and what shame she wasn't able to get them in her 3rd trimester). You can even give them in the same arm if you wanted to, as long as you had at least an inch between injection sites. You can find some good information about vaccine administration here:
Vaccines: Recs/Vac-Admin/main page
More specific on how to give vaccines (and correct spacing between IM injections in the same arm): http://www.immunize.org/catg.d/p2020A.pdf
More specific information on correct dosages and routes for specific vaccines:
http://www.immunize.org/catg.d/p3084.pdf
If you suspected a vaccine reaction, you can report it to VAERS: Vaccine Adverse Event Reporting System (VAERS) VAERS | Monitoring | Ensuring Safety | Vaccine Safety | CDC But the above poster is right, ultimately their primary care physician will need to do the work to sort it out whether it was a reaction to the vaccine component, an adjuvant, improper administration technique or if it was just a coincidence that she had a problem develop after she was vaccinated.
If your post partum mom wanted and qualified for Tdap, pneumonia, MMR and flu you could give them all at the same time. 2 vaccines per arm, and remember that MMR is a subcutaneous injection and not intramuscular.

Thank you so much! That is very helpful. Our patients have been getting a little better about getting their vaccines in the third trimester but the doctors offices don't seen to stress it too hard.

OBwonKnewbie · Jan 28, 2016

We give tdap and flu shot together right before discharge and if they have a reaction we tell them to see their doctor in the office. Side note: I've never had a patient qualify for pneumonia .

Really? We don't give it often, but our screening tool has them receive it if they have a chronic resp. condition (like asthma) or they are a smoker

SiwanRN · Jan 28, 2016

Do you have PPSV23 or PCV13 vaccine OBwonKnewbie? The guidelines are a little different for each of them, but here's the general rules:

"In June 2012, ACIP recommended vaccination of adults with specific risk factors. All PCV13-naÃ¯ve adults 19 years and older with functional or anatomic asplenia (e.g., from sickle cell disease or splenectomy), HIV infection, leukemia, lymphoma, Hodgkin disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome, or other conditions associated with immunosuppression (e.g., organ or bone marrow transplantation) and those receiving immunosuppressive chemotherapy, including long-term corticosteroids, or those with CSF leak or cochlear implants, should receive a dose of PCV13 vaccine. PCV13 should be administered to eligible adults with one of these risk factors prior to PPSV23, the vaccine recommended for these groups of adults since 1997. Eligible adults with one of these risk factors who have not previously received PPSV23 should receive a dose of PCV13 first followed by a dose of PPSV23 at least 8 weeks later. Subsequent doses of PPSV23 should follow PPSV23 recommendations for these adults. Adults 19 years of age or older with the aforementioned conditions who have previously received one or more doses of PPSV23 should be given a dose of PCV13 one or more years after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23."

Pinkbook | Pneumococcal | Epidemiology of Vaccine Preventable Diseases | CDC

cayenne06, MSN, CNM · Jan 29, 2016

Doesn't come up often nowadays, as most women are getting tdap during the 3rd trimester. But yes, we give them both at the same time when needed, postpartum AND during pregnancy. The risk of a reaction beyond a localized one is quite rare, assuming you screened for contraindications.

If I give my postpartum patient oxycodone and motrin at the same time and she has a reaction, I won't know which one caused it either. But we do that all the time, even in patients naive to both meds, and even though reactions to those medications are more common than vaccine reactions.

OBwonKnewbie · Jan 29, 2016

Do you have PPSV23 or PCV13 vaccine OBwonKnewbie? The guidelines are a little different for each of them, but here's the general rules:
"In June 2012, ACIP recommended vaccination of adults with specific risk factors. All PCV13-naÃ¯ve adults 19 years and older with functional or anatomic asplenia (e.g., from sickle cell disease or splenectomy), HIV infection, leukemia, lymphoma, Hodgkin disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome, or other conditions associated with immunosuppression (e.g., organ or bone marrow transplantation) and those receiving immunosuppressive chemotherapy, including long-term corticosteroids, or those with CSF leak or cochlear implants, should receive a dose of PCV13 vaccine. PCV13 should be administered to eligible adults with one of these risk factors prior to PPSV23, the vaccine recommended for these groups of adults since 1997. Eligible adults with one of these risk factors who have not previously received PPSV23 should receive a dose of PCV13 first followed by a dose of PPSV23 at least 8 weeks later. Subsequent doses of PPSV23 should follow PPSV23 recommendations for these adults. Adults 19 years of age or older with the aforementioned conditions who have previously received one or more doses of PPSV23 should be given a dose of PCV13 one or more years after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23."
Pinkbook | Pneumococcal | Epidemiology of Vaccine Preventable Diseases | CDC

I am pretty sure we have the polysaccharide, so I think the PPSV23. I did read the pdfs on the CDC site and it said that if one has never received the pneumonia vaccine before that they should get the conjugate first (and a lot of our patients get it the first time from us if they opt to get it). If we only have the polysaccharide, does this mean we shouldn't be giving that as their first dose?

OBwonKnewbie · Jan 29, 2016

Doesn't come up often nowadays, as most women are getting tdap during the 3rd trimester. But yes, we give them both at the same time when needed, postpartum AND during pregnancy. The risk of a reaction beyond a localized one is quite rare, assuming you screened for contraindications.
If I give my postpartum patient oxycodone and motrin at the same time and she has a reaction, I won't know which one caused it either. But we do that all the time, even in patients naive to both meds, and even though reactions to those medications are more common than vaccine reactions.

Very good point

klone, MSN, RN · Jan 29, 2016

Hi there. Not an OB nurse, but I am a public health nurse who gives vaccines to all age groups. It is absolutely fine to give Tdap and influenza vaccines the same day to a postpartum mom (and what shame she wasn't able to get them in her 3rd trimester).

Exactly my thought! Cocooning!!

OBwonKnewbie · Jan 29, 2016

So you guys are seeing most of your mom's already vaccinated in the third trimester? We see only a small percentage who get vaccinated in the third trimester. Most nurses wait to give the vaccines right before discharge, but if I have patient pp day 1 or 2 I usually get to them and give at least one. Now I can just give them all and get it over with! I wish the doctors office promoted them more. Most of our patients refuse the flu shot but will take the Tdap.

klone, MSN, RN · Jan 29, 2016

I work clinic now, and I can tell you that once they hit 28 weeks, we offer it to EVERY pregnant woman! Flu shot too. When I do their initial intake and history, I also tell them of the importance of getting it, as well as family cocooning.