Immunization Training (80 QUESTIONS)
WITH ANSWERS| GRADED A
Ava has arrived at the clinic for her well-child visit. She is 4 months old. Ava's immunization
record reveals that she has received the following vaccines:
2 doses of HepB
1 dose of Hib
1 dose of rotavirus
1 dose of PCV13
1 dose of DTaP
1 dose of IPV
Which vaccines should Ava receive at today's visit? Correct Answer: Upon reviewing the
immunization schedule for children and adolescents, Ava is due for her 2nd dose of Hib,
rotavirus, DTaP, PCV13, and IPV. She is not due for her 3rd hepatitis B dose until 6 months of
age. Even though it may be influenza season, she is too young to receive influenza vaccine. IIV
is not recommended until 6 months of age. MMR and varicella, which are live vaccines, are not
recommended until 1 year of age.
What is the most common complication of pertussis? Correct Answer: Pertussis, which is is
caused by Bordetella pertussis, infects the respiratory tract and produces toxins that interfere
with the function of the respiratory tract, ultimately causing the characteristic symptoms of
pertussis. Symptoms begin as they would for the common cold but then transition to the
paroxysmal (whooping) cough. Given the impact on the respiratory tract, pneumonia is the most
common complication. Poor oxygenation during the coughing episodes can lead to hypoxemia
and seizures, but these are less common. Colic is inconsolable crying, which has been attributed
to abdominal pain. This is unrelated to pertussis.
When looking at the schedule for vaccines that might be indicated for children and adolescents
aged 18 years or younger based on medical indications, what does the orange bar represent?
Correct Answer: The schedule for vaccines that might be indicated for children and adolescents
aged 18 years or younger based on medical indications includes six different color-coded bars.
Yellow indicates that vaccination according to the routine schedule is recommended. Purple is
for vaccines that are recommended for persons with an additional risk factor for which the
vaccine would be indicated. The yellow and black checkered bar indicates that vaccination is
recommended, and additional doses may be necessary based on medical condition. The footnotes
will need to be used for further guidance. A white bar means that there is no recommendation.
,Red means the vaccine is contraindicated and orange indicates there is a precaution for
vaccination.
Herd immunity refers to which of the following situations? Correct Answer: There are instances
in which some individuals are not able to be vaccinated. For example, infants younger than 2
months of age are too you to receive DTaP and a child with a compromised immune system
would not likely receive MMR. It is important to vaccinate those in the community who can
receive the vaccine to avoid outbreaks and the transmission of disease to those unvaccinated.
This is called herd immunity.
Which of the following is the best example of a group with which individual pharmacists can
collaborate to increase immunization rates in their communities? Correct Answer: Pharmacists
often work with their local health departments to provide vaccines and public health services in
their communities. They may collaborate on various public health outreach and emergency
response activities. The Advisory Committee on Immunization Practices (ACIP) is the leading
authority in the U.S. that provides comprehensive vaccination recommendations and guidelines.
These recommendations are reviewed and approved by the CDC. The National Vaccine
Advisory Committee (NVAC) is an entity of the U.S. Department of Health and Human
Services. NVAC has the responsibility of recommending ways to prevent disease through
vaccine development and promoting opportunities to prevent adverse reactions to vaccines.
While pharmacists may work with the ACIP, the CDC, and NVAC on immunization initiatives,
they do not often collaborate on a local level.
Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never experienced any
adverse effects from vaccinations. At his next well-child check-up, Kyle will be receiving the
following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine. Which of
the following tetanus-containing vaccines would be appropriate for him? Correct Answer: DTaP
is a five-dose series given at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. Kyle is
due for his 5th and final dose of DTaP. DTaP is appropriate for children less than 7 years of age.
DT is only reserved for children who have a contraindication to the pertussis component in
DTaP. Children, adolescents, and adults 7 years of age and older who require protection against
tetanus, diphtheria, and pertussis would receive Tdap. Following the one-time dose of Tdap, a Td
booster should be given every 10 years.
Why was the live attenuated influenza vaccine (LAIV) removed from the ACIP's influenza
vaccine recommendations? Correct Answer: When used according to its approved indications,
LAIV has not been shown to cause influenza or serious adverse events. However, based on data
that demonstrated LAIV efficacy was lower than expected in the 2013-2014 and 2015-2016
influenza seasons, the ACIP made the recommendation to avoid its use. This recommendation
began with the 2016-2017 influenza season. Although there have been some production and
supply issues with LAIV in recent years, this had no impact on its removal as a recommended
vaccine for influenza.
Which of the following statements about live attenuated vaccines is true? Correct Answer: Live
attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that
it can cause disease. Inactivated vaccines are produced by killing the virus or bacteria. They
, include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular
vaccines (which can be viruses or bacteria, or fractions of either). Live attenuated vaccines tend
to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated
vaccines must replicate inBarbara is a 60-year-old woman who presents to the pharmacy for two
vaccines: HZV and IIV. Which of the following are the appropriate doses and routes for
administering these vaccines to this patient? order for the body to produce an immune response.
If given to a patient with a compromised immune system, there is a chance they could replicate
in an uncontrolled fashion and cause disease. Circulating antibodies may interfere with a live
attenuated vaccine's ability to replicate.
Barbara is a 60-year-old woman who presents to the pharmacy for two vaccines: HZV and IIV.
Which of the following are the appropriate doses and routes for administering these vaccines to
this patient? Correct Answer: The dose of the herpes zoster vaccine (Zostavax) is 0.65 mL. It is
administered subcutaneously in the outer aspect of the upper arm. Inactivated influenza vaccines
are administered intramuscularly into the deltoid muscle. The dose for individuals aged 3 years
and older is 0.5 mL.
Tom is a 9-year old boy who has never had an influenza vaccine. Tom's mother shows you his
up-to-date immunization record and reports that he has never had any adverse reactions to
vaccinations. What dose and schedule of IIV should be administered to Tom? Correct Answer:
Influenza vaccination is universally recommended beginning at age 6 months. Children aged 6
months through 8 years who have not previously received at least two dose of the influenza
vaccine should receive 2 doses, 4 weeks apart. Beginning at age 9, children only need one dose
during an influenza season. The dose of influenza vaccine is 0.25 mL for children aged 6 months
through 2 years. Children 3 years of age and older would get 0.5 mL.
Which of these vaccines is an inactivated vaccine? Correct Answer: The live attenuated vaccines
include cholera, herpes zoster, live attenuated influenza vaccine (LAIV), MMR, MMRV,
rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox), varicella, and yellow fever.
All other vaccines are inactivated.
Which of the following documents must be given to every patient or patient's caregiver before
administration of a vaccine covered under the National Childhood Vaccine Injury Act (NCVIA)?
Correct Answer: Vaccine information statemetns (VISs) are standardized forms that provide an
overview of the risks and benefits of vaccines. Health care providers who administer vaccines
are required by law to provide patients with the most up-to-date version of the VIS for any
vaccine covered under the National Childhood Vaccine Injury Act (NCVIA). The CMS-1500
and CMS-855B are forms required by the Centers for Medicare and Medicaid Services (CMS)
for billing and enrolling as a Medicare provider, respectively. The PHS-731 is now the CDC 731
form and is the International Certificate of Vaccination or Prophylaxis as Approved by the World
Health Organization (the Yellow Card).
At what point during pregnancy is it recommended to administer the influenza vaccine? Correct
Answer: Influenza vaccination during pregnancy not only decreases the risks for influenza-
related complications during pregnancy, but has also been shown to reduce influenza-related
hospitalizations in newborns. For women pregnant during the influenza season, the ACIP
WITH ANSWERS| GRADED A
Ava has arrived at the clinic for her well-child visit. She is 4 months old. Ava's immunization
record reveals that she has received the following vaccines:
2 doses of HepB
1 dose of Hib
1 dose of rotavirus
1 dose of PCV13
1 dose of DTaP
1 dose of IPV
Which vaccines should Ava receive at today's visit? Correct Answer: Upon reviewing the
immunization schedule for children and adolescents, Ava is due for her 2nd dose of Hib,
rotavirus, DTaP, PCV13, and IPV. She is not due for her 3rd hepatitis B dose until 6 months of
age. Even though it may be influenza season, she is too young to receive influenza vaccine. IIV
is not recommended until 6 months of age. MMR and varicella, which are live vaccines, are not
recommended until 1 year of age.
What is the most common complication of pertussis? Correct Answer: Pertussis, which is is
caused by Bordetella pertussis, infects the respiratory tract and produces toxins that interfere
with the function of the respiratory tract, ultimately causing the characteristic symptoms of
pertussis. Symptoms begin as they would for the common cold but then transition to the
paroxysmal (whooping) cough. Given the impact on the respiratory tract, pneumonia is the most
common complication. Poor oxygenation during the coughing episodes can lead to hypoxemia
and seizures, but these are less common. Colic is inconsolable crying, which has been attributed
to abdominal pain. This is unrelated to pertussis.
When looking at the schedule for vaccines that might be indicated for children and adolescents
aged 18 years or younger based on medical indications, what does the orange bar represent?
Correct Answer: The schedule for vaccines that might be indicated for children and adolescents
aged 18 years or younger based on medical indications includes six different color-coded bars.
Yellow indicates that vaccination according to the routine schedule is recommended. Purple is
for vaccines that are recommended for persons with an additional risk factor for which the
vaccine would be indicated. The yellow and black checkered bar indicates that vaccination is
recommended, and additional doses may be necessary based on medical condition. The footnotes
will need to be used for further guidance. A white bar means that there is no recommendation.
,Red means the vaccine is contraindicated and orange indicates there is a precaution for
vaccination.
Herd immunity refers to which of the following situations? Correct Answer: There are instances
in which some individuals are not able to be vaccinated. For example, infants younger than 2
months of age are too you to receive DTaP and a child with a compromised immune system
would not likely receive MMR. It is important to vaccinate those in the community who can
receive the vaccine to avoid outbreaks and the transmission of disease to those unvaccinated.
This is called herd immunity.
Which of the following is the best example of a group with which individual pharmacists can
collaborate to increase immunization rates in their communities? Correct Answer: Pharmacists
often work with their local health departments to provide vaccines and public health services in
their communities. They may collaborate on various public health outreach and emergency
response activities. The Advisory Committee on Immunization Practices (ACIP) is the leading
authority in the U.S. that provides comprehensive vaccination recommendations and guidelines.
These recommendations are reviewed and approved by the CDC. The National Vaccine
Advisory Committee (NVAC) is an entity of the U.S. Department of Health and Human
Services. NVAC has the responsibility of recommending ways to prevent disease through
vaccine development and promoting opportunities to prevent adverse reactions to vaccines.
While pharmacists may work with the ACIP, the CDC, and NVAC on immunization initiatives,
they do not often collaborate on a local level.
Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never experienced any
adverse effects from vaccinations. At his next well-child check-up, Kyle will be receiving the
following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine. Which of
the following tetanus-containing vaccines would be appropriate for him? Correct Answer: DTaP
is a five-dose series given at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. Kyle is
due for his 5th and final dose of DTaP. DTaP is appropriate for children less than 7 years of age.
DT is only reserved for children who have a contraindication to the pertussis component in
DTaP. Children, adolescents, and adults 7 years of age and older who require protection against
tetanus, diphtheria, and pertussis would receive Tdap. Following the one-time dose of Tdap, a Td
booster should be given every 10 years.
Why was the live attenuated influenza vaccine (LAIV) removed from the ACIP's influenza
vaccine recommendations? Correct Answer: When used according to its approved indications,
LAIV has not been shown to cause influenza or serious adverse events. However, based on data
that demonstrated LAIV efficacy was lower than expected in the 2013-2014 and 2015-2016
influenza seasons, the ACIP made the recommendation to avoid its use. This recommendation
began with the 2016-2017 influenza season. Although there have been some production and
supply issues with LAIV in recent years, this had no impact on its removal as a recommended
vaccine for influenza.
Which of the following statements about live attenuated vaccines is true? Correct Answer: Live
attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that
it can cause disease. Inactivated vaccines are produced by killing the virus or bacteria. They
, include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular
vaccines (which can be viruses or bacteria, or fractions of either). Live attenuated vaccines tend
to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated
vaccines must replicate inBarbara is a 60-year-old woman who presents to the pharmacy for two
vaccines: HZV and IIV. Which of the following are the appropriate doses and routes for
administering these vaccines to this patient? order for the body to produce an immune response.
If given to a patient with a compromised immune system, there is a chance they could replicate
in an uncontrolled fashion and cause disease. Circulating antibodies may interfere with a live
attenuated vaccine's ability to replicate.
Barbara is a 60-year-old woman who presents to the pharmacy for two vaccines: HZV and IIV.
Which of the following are the appropriate doses and routes for administering these vaccines to
this patient? Correct Answer: The dose of the herpes zoster vaccine (Zostavax) is 0.65 mL. It is
administered subcutaneously in the outer aspect of the upper arm. Inactivated influenza vaccines
are administered intramuscularly into the deltoid muscle. The dose for individuals aged 3 years
and older is 0.5 mL.
Tom is a 9-year old boy who has never had an influenza vaccine. Tom's mother shows you his
up-to-date immunization record and reports that he has never had any adverse reactions to
vaccinations. What dose and schedule of IIV should be administered to Tom? Correct Answer:
Influenza vaccination is universally recommended beginning at age 6 months. Children aged 6
months through 8 years who have not previously received at least two dose of the influenza
vaccine should receive 2 doses, 4 weeks apart. Beginning at age 9, children only need one dose
during an influenza season. The dose of influenza vaccine is 0.25 mL for children aged 6 months
through 2 years. Children 3 years of age and older would get 0.5 mL.
Which of these vaccines is an inactivated vaccine? Correct Answer: The live attenuated vaccines
include cholera, herpes zoster, live attenuated influenza vaccine (LAIV), MMR, MMRV,
rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox), varicella, and yellow fever.
All other vaccines are inactivated.
Which of the following documents must be given to every patient or patient's caregiver before
administration of a vaccine covered under the National Childhood Vaccine Injury Act (NCVIA)?
Correct Answer: Vaccine information statemetns (VISs) are standardized forms that provide an
overview of the risks and benefits of vaccines. Health care providers who administer vaccines
are required by law to provide patients with the most up-to-date version of the VIS for any
vaccine covered under the National Childhood Vaccine Injury Act (NCVIA). The CMS-1500
and CMS-855B are forms required by the Centers for Medicare and Medicaid Services (CMS)
for billing and enrolling as a Medicare provider, respectively. The PHS-731 is now the CDC 731
form and is the International Certificate of Vaccination or Prophylaxis as Approved by the World
Health Organization (the Yellow Card).
At what point during pregnancy is it recommended to administer the influenza vaccine? Correct
Answer: Influenza vaccination during pregnancy not only decreases the risks for influenza-
related complications during pregnancy, but has also been shown to reduce influenza-related
hospitalizations in newborns. For women pregnant during the influenza season, the ACIP
