Health Promo & Disease Prevention

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Primary prevention:

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activities to prevent the onset of a disease

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Secondary prevention:

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activities to ID and tx asx persons with RF's for a disease; "secondary = screening"

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Goal of primary prevention:

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spare individuals the suffering, burden, and cost of the condition

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Examples of primary prevention:

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immunization, chemoprophylaxis

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active immunity is:

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resistance developed in response to an Ag

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tertiary prevention:

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management of a person with an established disease

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goal of tertiary prevention:

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minimize disease-associated complications

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examples of tertiary prevention:

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meds & lifestyle changes to moderate BG in DM

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Problems with using amantadine or rimantadine for influenza:

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some influenza strains are resistant

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Zanamivir (Relenza) or oseltamivir (Tamiflu) in care of pt's with or at risk of influenza:

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these d's can minimize severity if used early in acute illness

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Does influenza nasal spray contain LAVV?

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Yes, nasal spray influenza vaccine is live and attenuated.

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% of HCP's receive influ vaccination annually

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40% receive the influ vaccination

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For nml adult, length of inoculation for influ is:

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1-4 d

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children with influ present with:

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AOM, n/v

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influ sx resolve within

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1 week, but cough and malaise often last 2 w

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influ largely spread via:

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respiratory droplets (cough or sneeze)

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adults with influ remain contagious for how many days after onset of sx?

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5 days

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children with influ remain contagious for how many days after onset of sx?

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10 days

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immunocompromised with influ remain contagious for how many days after onset of sx?

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3 weeks

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influ vaccines are _% effective in preventing influ.

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70-80%

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who should not receive FluMist?

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(good for 2-49y/o)

NOT for <2y/o, >50y/o, pt with a medical condition like CHD, lung disease, DM, renal disease, and immunosuppression; children / adolescents on LT ASA, pt with hx of GBS, pregnancy, allergy to eggs

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Influ vaccinate when?

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1 month prior to season, usually in October or November

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Influ Special considerations for < 9y/o:

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if initial dose of influ vaccine, need two doses

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MMR vaccine:

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live, attenuated; 2 doses, 1 month apart; typically causes mild 3-5 d illness; teratogenic if contracted during pregnancy; DON'T give in pregnancy; Not for allergy to neomycin or gelatin, safe during lactation

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pneumococcal disease:

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G+ streptococcus pneumoniae (leading CoD from CAP in US); also - atypical: M. Pneumo, Chlamydophila, Legionella; G-: H. Influ, Moraxella catarrhalis, and Klebsiella pneumo

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pneumococcal vaccine

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vaccine with 23-valent polysaccharide (ineffective against M. Pneumo, Chlamydophila, Legionella; G-: H. Influ, Moraxella catarrhalis, and Klebsiella pneumo)

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indications for pneumo vaccine

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chronic lung disease, CVD, chronic liver disease, splenectomy, immunocompromised, cochlear implants, CSF leak, HIV; residents of nursing homes, smokers, adults >65y/o

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indications for repeat pneumo vaccine, after 5 years:

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chronic renal failure, asplenia, immunocompromised; OR if >65y/o and was 5 years or more previously AND younger than 65 y/o at time of primary vaccination

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HBV vaccine contraindication:

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hx of reaction to baker's yeast

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Risks associated with chronic HBV:

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hepatocellular carcinoma, cirrhosis, continued infectivity

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structure of HBV:

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double-stranded DNA virus with inner core protein of HBV core Ag and an outer surface of HBsAg

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transmission of HBV

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blood or body fluids

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% of acute HBV that becomes chronic:

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5%

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HBV vaccine

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non-live vaccine, 3 doses required, 95% of those receiving it develop HBsAb

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high risk people needing HBsAb testing:

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HC, injection drug users, sex workers, dialysis pt's, immunosupressed

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when to admin booster of HBV vaccine:

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when HBsAb levels decline to < 10mIU/mL

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post exposure prophylaxis for HBV (and many other potential infections):

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HBIG ASAP - preferred within 24 hours - and HBV vaccine; also offer testing for HIV, HAV, HCV

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if allergic to neomycin, avoid which vaccines?

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IPV, MMR, varicella

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if allergy to streptomycin, polymyxin B, neomycin, avoid which vaccines?

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IPV, smallpox

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if allergy to Baker's yeast, avoid which vaccine?

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HBV

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if allergy to egg, avoid which vaccine?

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influenza - either form

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if allergy to gelatin, avoid which vaccine

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MMR, varicella

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smallpox spread:

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direct deposit of infective droplets

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smallpox virus name:

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variola; variola major is m/c and most severe (fatality 30%)

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smallpox characteristics:

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incubation: 7-17d without sx and not contagious; rash starts on tongue and spreads to face, arms, legs, hands, feet within 24 hours (all at the same time); contagious until all crusts have fallen off

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varicella (AKA chickenpox or VZV) characteristics:

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lesions erupt over several days, old and new lesions

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smallpox vaccination:

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in anticipation of bioterrorism: give within 3 d of exposure; if given 3-7d post-exposure, some benefit; made from LIVE smallpox relative called "vaccinia"; vaccination itself WILL cause large draining pustule / scar

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% who develop shingles after primary infection with VZV:

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15%; markedly reduced in those with vaccination; should confirm VZV immunity via titers in HCP

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varicella vaccine schedule:

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1-1year
2-4-6y/o

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if older adult w/o hx of varicella or VZV vaccine, vaccine schedule:

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2 doses, 4-8w apart

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partum pt w/o hx of VZV immunity receives:

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dose one of VZV vaccine prior to hospital discharge

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VZV vaccine characteristics:

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live, attenuated; can cause mild chickenpox

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LAVV precautions:

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MMR - pregnancy
VZV (chick) - immunosuppression (except HIV); if HIV, don't give if CD4 <200 cell/uL
FluMist

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tetanus characteristics:

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clostridium tetani - anaerobe, G+, found in soil

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diptheria characteristics:

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corynebacterium diphtheriae, G- bacillus; causes severe resp. tract infection - pseudomembranous pharyngitis; transmission person-to-person or contaminated liquids

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tetanus booster?

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q 10 y

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Tdap given in adulthood

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covers tetanus for 10 years and pertussis

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m/c source of HAV infection:

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contaminated drinking water

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characteristics of HAV:

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small RNA virus; fecal-oral transmit, self-limiting infection; in developing countries, most children develop it by 5y/o; in N. America, 50% of cases are 20-39y/o

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HAV immunization schedule:

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2 doses 6-12 m apart; not live virus

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poliovirus:

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transmit fecal-oral, highly contagious: rates of household contact infection are up to 96%!

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poliovirus vaccine:

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live (oral, small stool shedding with possible infection consequence; no longer used in USA) or inactive (IM)

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recommended screening for a 55 y/o woman:

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breast, skin, colorectal

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Br CA screening:

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>20y/o BSE
20-30y/o CBE q 3 y; asx pt's >= 40y/o q y

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Mammography screening guidelines:

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>=40y/o q year; with high risk both mammo and MRI q y

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colorectal screening guidelines:

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men and women >=50y/o -> FOBT at Home! (2 samples from 3 consecutive specimens; NOT toilet-bowl specimens); if any +, go with colonoscopy; OR stool DNA test

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colorectal imaging guidelines:

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flexible sigmoidoscopy q 5y at 50y/o OR
DCBE q 5y at 50y/o OR
colonoscopy q 10y at 50y/o

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RF's for colorectal cancer (warranting increased screening):

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hx of CR CA, Crohn's / UC, family hx of <60y/o of CR CA or polyps, fix of hereditary colorectal CA syndromes

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prostate screening:

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>=50y/o; OFFER DRE and PSA annually for men with life expectancy greater than 10 y

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higher risk for prostate CA - increase screening:

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AA, fhx of dx <65y/o -> start at 45y/o with screening; if multiple 1st degree male relatives, start screening at 40y/o

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cervical CA screening:

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PAP
start 3 y after first sex - not later than 21y/o; q y with PAP;
at 30y/o women with 3 nml PAPs screen q 2-3y; >70y/o with 3 or more nml PAPs and no abnl in past 10 y can STOP cervical CA screening

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components of intervention for treating tobacco use:

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ask, advise assess, assist, arrange - the "Five A's"
use in ALL cases of tobacco use and at all encounters

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varenicline used for and SE's:

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smoking cessation depressed mood, agitation, changes in behavior, suicidal ideation, and suicide; ask about suicideality at every visit

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corneal reflex from CN:

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V

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vision and visual fields CN:

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III

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Mnemonic for the CN's:

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On Old Olympus Towering Tops, A Finn And German Viewed Some Hops

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trochlear n innervates what:

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it is CN IV: innervates the Superior oblique muscle

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normal corneal reflexes are innervated by:

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the afferent limb of CN V and the effect limb of CN VII

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what are effects from CN IX and X:

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Glossopharyngeal: swallowing, palate elevation, gustation

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CN X does:

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parasympathetic regulation of multiple organs: sensing aortic pressure and regulating BP, slowing HR, regulating taste and digestive tract

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decreased facial tonus - including eyelid drooping - caused by which affected CN?

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CN VII; if suspected, perform a Lyme Ab titer; if treating Bell's Palsy, use prednisone PO ASAP (this tx is useless after > 10d from onset)

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Bell's Palsy etiology?

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could be Lyme; possibly HHV or Varicella-zoster; tx: supportive care, keep the eye protected and moist