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231 Cards in this Set
- Front
- Back
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Define Bioterrorism
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The intentional release, or threatened release, of disease producing living organisms or biologically active substances derived from living organisms for the purpose of causing death, illness, incapacity of a population, economic damage or fear
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Define Category A
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-Easy to disseminate and/or easily transmitted person-to-person
-High mortality rate and a major public health impact -Might cause public panic or social disruption -Required special action for public health preparedness |
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Category A Includes:
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-Plague
-Smallpox -Viral hemorrhagic fever -Botulism -Tularemia -Anthrax |
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Define Category B
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-Moderately easy to disseminate
-Causes moderate mortality and morbidity -Requires specific enhancements of the CDC's diagnosis capacities, must enhance disease surveillance |
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Category B Includes:
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-Brucellosis
-Q-fever -Ricin -T-2 mycotoxins -Staphylococcus entertoxin B |
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Define Category C
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-Includes pathogens that could be engineered for mass dissemination because of availability
-Ease of production and dissemination has the potential to increase morbidity and mortality |
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Category C Includes:
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-Hantavirus
-MDR-TB -Yellow Fever |
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Inhalation Anthrax
Category Clinical Presentation |
-Category A
*Initially with cold or flu-like symptoms: sore throat, mild fever, and muscle aches *Followed by non-productive cough, chest discomfort, SOB, fatigue and muscle aches *These symptoms may improve for a short period of time (hours to 2 days) - this is also known as "anthrax holiday", but are followed by an abrupt development of severe respiratory distress with dyspnea, diaphoresis, and cyanosis *Septicemia, shock, and death usually occur within 24-36 hours after the onset of respiratory distress |
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Inhalation Anthrax
Labs |
Chest x-ray may show mediastinal widening (hallmark), pleural effusion, and infiltrates may be present
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Inhalation Anthrax
Causative agent |
Bacillus anthracis
-gram positive -spore forming -nonmotile bacillus |
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Inhalation Anthrax
Treatment |
Ciprofloxacin 400mg IV Q12; or
Doxycycline 100mg IV Q12 Plus one or two of the following: -Rifampin 600mg PO QD -Clindamycin 900mg IV Q8 -Imipenem 500mg IM or IV Q6 -Ampicillin 500mg IV Q6 (requires sensitivity test) -Clarithromycin 500mg PO Q12 |
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Inhalation Anthrax
Children Tx |
-Cipro not recommended for children <18 years but the benefit outweighs the risk for inhalation anthrax
-FYI pedi doses |
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Inhalation Anthrax
Incubation period |
1-6 days depending on the number of spores inhaled
Cases have been reported with incubation periods up to 42 days |
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Inhalation Anthrax
Prophylaxis Treatment |
-Ciprofloxacin 500mg PO Q12 x 60 days; or
-Doxycycline 100mg PO Q12 x 60 days |
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Anthrax vaccine
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-Acellular vaccine 0.5ml SQ at time of exposure
-Repeat at 2 and 4 weeks -Repeat again at 6, 12, and 18 months |
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Cutaneous Anthrax
Causative agent |
Bacillus Anthracis
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Cutaneous Anthrax
Clinical Presentation |
-Most frequently occurs on the hands and forearms of people working with infected livestock
-Infection starts with a papule followed by the formation of a fluid-filled vesicle -The vesicle will dry up and form a scab that is "coal-black in color" |
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Treatment of Cutaneous anthrax
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Ciprofloxacin 500mg PO Q12 x 60 days
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Counseling for Cutaneous anthrax
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-Finish entire course of therapy
-Photooxicity -best on empy stomach but can take with food to reduce nausea -remain upright for 30 minutes after taking medication -maintain adequate hydration to avoid urine concentration and crystal formation -take the drug 2 hours before or 6 hours after magnesium, aluminum, iron, zinc and calcium containing products -try to limit caffeine intake because cipro decreases the clearance of caffeine so you can have increase caffeine concentrations -if miss a dose then skip and tack it onto the end of therapy |
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Alternative Treatment of Cutaneous anthrax
2 counseling points |
Doxycycline 100mg PO Q12 hours x 60 days
Avoid milk/dairy products Phototoxicity |
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Gastrointestinal Anthrax
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-Rarest form
-Transmitted by ingesting insufficiently cooked meat from an infected animal -Incubation period is 3-5 days |
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What is plague?
How is it transmitted? What are the two types? What are the incubation periods? What category? |
-Category A
-Caused by Yersinia pestis -Transmitted to humans by fleas that live on wwild rodents (rats, mice, squirrels) -Bubonic plague (2-10 days) -Pneumonic plague (1-6 days) |
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Clinical presentation for Bubonic plague
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-One more more enlarged tender lymph nodes often in the inguinal area
-May experience malaise, HA, and high fever -Can progress to pneumonic plague |
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Clinical presenation for Pneumonic plague
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-High fever
-Chills -HA -extreme malaise and myalgias -within 24 hours, the patient will have bloody sputum, nausea, vomiting, and abdominal pain -Rapid progression to dyspnea, cyanosis, respiratory failure, and circulatory collapse |
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Treatment of Plague Basics:
Initition Duration CI |
-Must be started within 24 hours of the onset of pneumonia to be effective
-Treatment duration is 10-14 days -Benefits outweight the risks = so do not withhold doxycycline or cipro from children or pregnant women |
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1st line agents for Plague
(include SE and counseling) |
Streptomycin 50mg/kg IM Q12 hours
-HA, neurotoxicity, otooxicity -Maintain hydration Gentamycin 5mg/kg IM or IV QD -Neprotoxicity, ototoxicity -Maintain hydration |
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2nd line agents for Plauge
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Doxycline 100mg IV BID or 200mg IV QD
Ciprofloxacin 400mg IV BID Chloramphenical 25mg/kg QID |
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Chloramphenical ADR and Counseling
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-Confusion
-HA -Aplastic anemia -Bone marrow suppression -Gray syndrome -Rash -Nausea -Vomiting -Diarrhea Report any rash, sore throat or unusual bleeding or bruising = bleeding dyscrasias) |
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Post-Exposure Therapy for Plague
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Doxycycline 100mg PO BID x 7 days
Ciprofloxacin 500 mg PO BID x 7 days No vaccines are available |
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Tularemia:
Causative agent? Endemic Area? Transmission? Incubation period? |
-Caused by Franciella tularensis
-Endemic in Nantucket -Transmitte by direct contact with body fluids of an infected animal, inhalation of dust, ingestion of meats and bites from infected arthropods (ticks, mosquitos, deerflies) -Average incubation 3-5 days, varies from 1-21 days |
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Tularemia Clinical Presentation
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-flu-like symptoms
-many infiltrates present on chest x=ray -widened mediastinum |
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1st line agents for treatment of Tularemia
(dose and duration) |
-Streptomycin 7.5-10mg/kg Q12 x 7 days
-Gentamycin 1-1.7mg/kg Q8 or 4-7 mg/kg QD for 10-14 days |
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Alternative agents for treatment of Tularemia
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-Ciprofloxacin 400mg IV or 750 mg PO Q12 for 10-14 days
-Doxycycline 100 mg Q12 hours for 3-4 weeks -Tetracycline 500 mg PO QID for 3-4 weeks |
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Post Exposure Prophylaxis for Tularemia
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-Cipro 500 mg PO BID x 14 days
-Doxycycline 100 mg PO BID x 14 days -Tetracycline 500mg PO Q6 x 14 days |
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Why is it important to discard expired tetracycline meds?
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Can cause Fanconi's syndrome which is an impairment of the proximal tubules of the kidney
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Small Pox:
Causative agent? Transmission? Incubation period? Treatment? |
-Variola major or minor
-Humans are the only carriers so if one person in the world has it, then its considered a world public health problem because the disease was eradicated in the 1980s -Incubation period is 10-14 days but can range from 7-19 days -Treatment consists of supportive care |
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The Small Pox vaccine require special training b/c:
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-A scab is formed that is infectious and will need to be covered and cared for properly
-requires specific administration techniques -Patients are required to come back in 3 days to see if the vaccine "took" or not |
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How do you know if the small pox vaccine took?
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The scab that is present 3 days after administration will be a certain size
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How do you adminster the small pox vaccine?
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-Use a bifurcated needle
-Dip needle into the vaccine -Pt is poked 15 times in a 5cm area on the back of the arm -Injection site is covered -Patient returns in 3 days for evaluation |
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What are the four different subtypes of the Ebola virus?
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-Ebola-Zaire = most severe
-Ebola-Sudan -Ebola-Ivory coast -Ebola-Reston = primate only |
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What family of virus is the Ebola virus found in?
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Filoviridae family
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What are the modes of infection for the Ebola virus?
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-Unsterilized needles
-Hospital contagion -Person-to-person -Airborne -Dead bodies are contagious |
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What is the clinical presentation for Ebola virus?
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-Red eyes
-Bleeding |
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What is the treatment for the Ebola virus?
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-Supprotive care only
-Avoid aspirin and IM injections b/c of bleeding |
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Define Immunization
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Process of inducing or providing immunity artificially by administering an immunobiologic agent
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List Immunobiologic agents
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-Vaccines
-Toxoids -Immunoglobulins |
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Definte Antibodies
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Glycoprotein molecules that produce the effect of humoral or circulating immunity (synonymous with immunoglobulins)
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Describe Immunoglobulins
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-Derived from donor pools of blood plasma and are processed in order to inactivate any potentially infecting agent
-Indicated for induction of passive immunity |
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Describe Vaccine
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Formulation of whole or fractional microorganisms or portions of them
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Describe Toxoids
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Modefied bacterial toxin that are usually combined with aluminum salts to enhance their antigenicity by prolonging antigen absorption and exposure, and are nontoxic yet retain their ability to stimulate antitoxin formation
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Describe Killed Vaccine
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Consist of whole microbes or isolated microbial components
Also called inactivated |
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Describe Live Vaccine
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Altered weakened avirulent microorganisms, which can be dangerous in immunocompromised
Also called attenuated |
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Benefit of Live over Killed vaccine
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Often more immunogenic and may induce serum antibody protection of longer duration
Both can induce active immunity |
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Describe polysaccharide vaccine
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Contain sugar fragments purified from the capsules of certain bacteria
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Describe conjugated vaccines
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Contain whole or fragmented bacteria or virus
Also called protein vaccines |
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Benefit of conjugated versus polysaccharide vaccines
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Generally induce immunity of longer duration than polysaccharide
Polysaccharide vaccines tend to be poorly immunogenic in children younger than 2 years of age |
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Immunization for children and adolescents
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-Is recommended as described in the schedule
-Schedule is updated and reviewed annually |
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Immunization for Adults with and without medical conditions
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Schedule is updated and reviewed annually
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Immunization for Premature Infants
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-Dose and schedule should be similar to those of full-term infants regardless of age or birth weight
-Exception: Hep B vaccine in infant <2kg should be held until infant is 2 months of age |
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Hep B Vaccine in infant <2kg
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Hold dose until the infant is 2 months of age
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Immunization of Pregnant Women
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-Live attenuated vaccines should NOT be administered drring pregnancy
-Inactivated vaccines should not be given until the second trimester except influenza virus -Inactivated vaccines have not been shown to be teratogenic earlier in pregnancy |
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Immunocompromised hosts that should receive both live attenuated and killed vaccines
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-People who have limited immune deficiency as a result of renal disease, diabetes mellitus, liver disease, or asplenia who are NOT receiving immunosuppressant drugs
***May require a higher dose or more frequent dosing to induce immunity |
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Immunocompromised hosts that should receive only killed vaccines
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People with severe immune deficiency such as congenital immunodeficiency, antimetabolite therapy radiation therapy, or a high dose, prolonged course of corticosteroids
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MMR, varicella, and Rotavirus vaccines for close contacts of immunocompromised patients
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Should be given to susceptible individuals who are close contracts
*Good hand-washing with Rotavirus for 1 week after vaccination *Close contacts should not be given OPV and Small Pox |
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Situation where live vaccines can be given to cancer patients
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Patients are in remission and have have at least 3 months since the last chemotherapy
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Individuals on corticosteriods for < 2 weeks at a dose of <20mg/day should wait how long before live vaccination?
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Patients do not have a contraindication for live vaccination
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Individuals on corticosteriods for > 2 weeks at a dose of >20mg/day should wait how long before live vaccination?
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Wait at least 1-month before live vaccination
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Individuals on long term, alternate dosing steroids with short acting agent
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Have no contraindications to live vaccines
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Individuals on immunosuppressive drugs besides steroids should wait how long before live vaccines
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At least 3 months after d/c
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Vaccination for patients with asplenia
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They should receive live vaccines and should receive pneumococcal, meningococcal, and Hib vaccination to protect against encapsulated bacteria
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Special vaccine considerations for patients receiving human stem cell transplants
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Patients need to be revaccinated with inactivated vaccines 12 months after HSCT and with MMR 24 months after HSCT
*6 months for influenza |
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Vaccination for HIV postive Childrens up to age 16
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*Standard immunization schedule is recommended for Hep B, DaTP, HIB, IPV, and influenza
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Vaccination for HIV postive Childrens up to age 16
MMR |
MMR NOT recommended for chldren with < 200 CD4 count but is acceptable for asymptomatic/mildly symptomatic and CD4 stable
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Vaccination for HIV postive Childrens up to age 16
Varicella |
Varicella is only recommended in children with asmptomatic or mildly symptomatic HIV, >15% effective
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Vaccination for HIV postive Childrens up to age 16
Pneumococcal |
Recommended for children > 2 yeas old
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Vaccination for HIV postive Childrens up to age 16
Other Vaccines |
Avoid all other live vaccines beside Hep B, DaTP, HIB, IPV, influenza, MMR, Varicella, and pneumococcal
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Vaccination for HIV postive Childrens up to age 16
Yellow Fever |
Only if ASBOLUTELY necessary because of theoretical risk of encephalopathy
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Source of Diptheria Toxoid
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Corynebacterium diphtheriae
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Indication for Diptheria Toxoid
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Children >6 weeks of age
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Immunization schedule for Diptheria Toxoid
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2, 4, 6 months, 12-18 months, and 4-6 years of age
*Admin Tdap at age 11-12 to complete series if they didn't receive the Td booster *Ages 13-18 who missed 11-12 Tdap or received Td are encourage to receive 1 dose Tdap 5 years after last Td/DTaP dose |
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Diphteria Toxoid Dosage Forms
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D = pediatric dose
d = adult dose -Less antigen is contained in adult form because of increased adverse effects when pediatric dose given to adults |
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What other vaccines are given with the Diptheria Toxoid
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Tetanus toxoids and acellular Pertussis
DTaP |
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Boosters for Diptheria Toxoid
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Required every 10 years and is given Td
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Diptheria Toxoid for pts < 65 years who have not yet received a dose of Tdap
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Tdap should replace a single dose of Td
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Diptheria Toxoid for nonimmunized adults
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Series of 3 doses of Td
**Wait at least 4 weeks between 1st and 2nd dose **Wait at least 6-12 months bewteen the 2nd and 3rd **One dose can be given as Tdap for protection against pertussis |
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Adverse effects of Diptheria
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mild-moderate tenderness, erythema, and induration at the injection site
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Source of Tetanus
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Clostridium tetani
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Dosage forms of Tetanus
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tetanus toxoids or tetanus toxoid absorbed (T)
**(T) is preferred because of higher immunogenicity and fewer adverse effects Usually given with diphtheria and Pertussis |
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What vaccine is required for a traumatic wound with risk of Tetanus
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additional dose should be given as Td if patient has not received a dose for > 5 years
*Not required if wound is clean and minor *Definetely required for patients with unknown history of tetanus immunization |
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What cuases Pertussis?
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Bordetella Pertussis (bacterial infection)
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What is the classis symptom of Pertussis?
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Paroxysm of coughing to expel thick mucus (whooping cough)
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Adverse effects of Pertussis vaccine
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Erythema and swelling at injection site, moderate fever (3-5%), high fever, seizure, persistent crying spell, and hypotonic hyporesponsive episodes are very rare
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Contraindication to the Pertussis vaccination
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allergy to vaccine componeents, encephalopahty without known cause after 7 days of vaccination
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Is Hepatitis B inactivated or live vaccine
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Inactivated vaccine consisting of hepatitis B surface antigen subunit particles (HBsAg)
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Response rates for Hepatitis B vaccination
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90%. 10% are categorized as hypo- or non-responders.
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Factors associated with lack of immune response to the Hep B vaccine
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-increasing age (>50yrs)
-increased BMI -male gender -hemodialysis patients -immunocompromised patients |
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Which patients should received higher doses of the Hep B vaccine
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-Hemodialysis
-Immunocompromised |
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Medical Indications for Hepatitis B
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-end stage renal disease
-at risk for or presence of STD or HIV -Chronic liver disease |
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Occupational Indication for Hepatitis B
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health care workers and public safety workers exposed to blood or body fluids
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Behavioral indications for Hepatitis B
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*Sexually active but not in mutually monogamous relationship
*Current or recent IVDA *Gay men |
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Random people that should received Hepatitis B vaccine
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-household contacts and sex partners of pts with Hepatitis B
-clients and staff of institutions for developmental disabilities -international travelers -any adult seeking protection against Hep B |
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Schedule for Hepatitis B Vaccine for Newborns
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-1st dose given soon after birth (before discharge)
-2nd dose at age 1-2 months -3rd dose at 6-18 months **3rd dose must be given after age 24 weeks **4th dose is given for hypo- or non-responders |
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How many doses are given in the Hepatitis B series
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-3 doses are given
-4 doses for hypo- or non-responders |
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Schedule for Hepatitis B Vaccine for nonimmunized persons
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-3 dose series at 0, 1, and 6 months
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What is Recombivax HB
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Hepatitis B vaccine that is given in 2 doses that is good for 11-15 year olds
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What is the postexposure vaccination for Hepatitis B
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-Same as primary immunization in addition to HbIg
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What is the primary indication for Haemophilus Influenzae Type B (Hib)
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All infants and children < 2 years of age
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At what age is the Hib vaccine no longer appropriate
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Older than 5 years
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What are the three Hib vaccines?
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-HibTITER, OmniHIB
-PedvaxHIB, Comvax -TriHiBit |
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What is the HibTITER, OmniHIB
What is the schedule |
-Vaccine for Hib
-Series of 3 doses at 2, 4, 6 months of age with a booster at 12-15 months |
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What is the booster dose for Hib?
When should it be given? What age group can it be used? |
TriHiBit (DTap-Hib)
12-15 months Can only be used in children > 12 months |
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What is the PedvaxHIB, Comvax
What is the schedule |
-Vaccine for Hib
-Series of 2 doses at 2 and 4 months of age |
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What is the adverse effects of Hib vaccination
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erythema, and induration at the injection site (lasts 24 hours), fever, diarrhea, and vomiting
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Characteristics of Measles
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Highly contagious viral illness characterized by rash and high fever
Will be eradicated in the US in the next few years due to widespread vaccination |
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Complications of Measles
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severe diarrhea, otitis media, pneumonia, encephalitis
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What is mortality of the measles?
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1-2/1000 cases but higher rates seen in developing countries
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What type of vaccine is used for measles?
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Live attenuated viruse dervied from chicken embryo fibroblasts
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With what other vaccines is the Measles vaccine given
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Mumps and Rubella
Known as MMR |
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What is the immunization series for MMR
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2 doses at 12-15 months and 4-6 years of age
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Catch up schedule for MMR for children (<18yrs)
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Series of 2 spaced out by 4 weeks apart
Must take second dose of incomplete series by 11-18 yrs |
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Catch up schedule for MMR for adults (>18yrs)
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Born before 1957 = immune
After 1957 = need 1 dose Second dose is recommended if exposed to measles, previously vaccinated with killed measles vaccine, vaccinated between 1963-1967, students in postsecondary educational institution, healthcare, or travel internationally |
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Contraindications for MMR
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-pregnancy
-severe hypersensitivity to Neomycin -immunocompromised hosts |
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Interactions with the MMR
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-Can give other live vaccines on the same day or have to wait at least 30 days
-Can suppress positive response to TB test for up to 6 months so need to delay PPD screening for at least 4 weeks |
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Clinical presentation of Mumps
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Bilateral parotitis, usually 16-18 days after exposure
Fever, HA, myalgia, and anorexia usually seen preceding parotitis |
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What type of vaccine is Mumps
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Live, attenuated vaccine prepared from chick embryo cultures
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What is Rubella also known as
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German Measles
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Clinical presentation of Rubella
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Rash, lymphadenopathy, arthralgia, and low grade fever
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Most severe consequence of Rubella infection
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Occurs during pregnancy because it is associated with auditory, cardianc and neurologic defects
Possible miscarriage and stillbirth |
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What type of vaccine is available for Rubella
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Live attenuated vaccine from human cell culture
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Pregnancy and Rubella vaccination
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All women of childbearing age should have documentation of receiving at least 1 or more doses of rubella vaccine
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Adverse effects of Rubella vaccination
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*Increase with age
*lympadenopathy, rash, urticaria, fever, malaise, sore throat, HA, myalgias, and paresthesias of extremities *Usually occur 7-12 days post vaccination and last for 1-5 days. |
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Arthalgia associated with MMR is seen more commonly in?
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Females (25%)
10% of recipients will have arthritis ike syndrome beginning 1-3 weeks after vaccination and lasts for 1 day to 5 weeks |
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What type of infection is Polio
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It is a viral infection that is usually asymptomatic but in serious form causes acute flaccid paralysis
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How is Polio transmitted
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Fecal oral route
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When was the last case of polymyelitis in the US reported
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1979
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What type of vaccine is Polio
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2 kinds but only one availabe now
IPV - inactivated poliovirus vaccine OPV - live attenuated oral - no longer available due to cass of vaccine associated paralytic polio (VAPP) |
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What is the indication for Polio vaccination
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Primary immunization in all children up to 18 years of age
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What is the series for Polio vaccinations
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3 doses at 2, 4, 6-18 months, and 4-6 years of age
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Contraindications for Polio vaccine
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History of allergy to any components of IPV including streptomycin, polymixin B, and neomycin
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Adverse effects associated with Polio vaccine
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Induration and erythema at injection site, fever of >100.4 degrees F (10-19%)
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What type of infections does the Pneumococcus vaccine protect against?
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Invasive infections caused by S. pneumoniae such as bacteremia, and meningitis
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What are the available products for pneumococcus vaccination
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Prevnar (conjugated vaccine for children)(PVC7)
Pneumovax-23 (polysaccharide vaccine primarily for adults)(PPV23) |
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Indications for PVC7
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*Prevnar
Primary immunization for children 2, 4, 6, 12-15 months of age |
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Age group for PPV23
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*Pneumococcal vaccine
Ages 2-64 Give 1 dose |
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Indications for PPV23
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Chronic pulmonary disease (excluding asthma), chronic CV disease, DM, chronic liver disease, chronic alcoholism, chronic renal failure or nephrotic syndrome, asplenia, immunosuppression, cochlear implants, CSF leaks, HIV
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Revaccination with PPV23
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Indicated for a one time revaccination after 5 years for persons with chronic renal failure or nephrotic syndrome, asplenia, or immunosuppression
Patients are >65 years and were vaccinated more than 5 years ago when they were less than 65 |
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Adverse effects of Pneumococcus vaccination
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Erythema, swelling, tenderness at injection site, fever
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Dosing of PPV23
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Single dose in pts >2 years
Brand name = Pneumovax 23 |
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Effectiveness of of PPV23
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60-70% in preventing invasive disease
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Special considerations for PPV23
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May revaccinate in 5 years
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Vaccine components of PPV23
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Purified capsular polysaccharide antigens from 23 serotypes causing 88% of invasive disease
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Dosing for PCV7
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One or two doses depending on age
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Effectiveness of PCV7
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>90% effective against invasive disease in children
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Special considerations for PCV7
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Vaccine generally not recommended for children >5 years
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Vaccine components for PCV7
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Pneumococcal polysaccharide conjugated to nontoxic diphtheria toxin (7 serotypes) causing 86% of bacteremia dn 83% of meningitis among children <6 years
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Characteristics of Varicella
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Highly contagious condition caused by Varicella-zoster virus
Known as chicken pox |
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Symptoms of varicella
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Pruritic vesicles that rapidly crust over, malaise and fever lasting 2-3 days, viruses remain dormant and reactivate as herpes zoster (shingles)
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What type of vaccine is available for Varicella
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Live attenuated vaccine containing neomycin, fetal bovine serum, and residual component from cell culture
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What product is available for Varicella
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Varivax
For children >12 months of age |
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How many doses for Varicella vaccine
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2 doses for children and adults
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Post-exposure prophylaxis of Varicella
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Effective if given within 3 days of exposure
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Contraindications for Varicella vaccine
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Pregnancy, immunocompromised state, history of anaphylactic reaction to neomycin or other components, persons receiving blood, plasma, or immune globulin products within the past 5 months, no salicylates for 6 weeks after vaccination
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How long must you go salicylate free following Varicella vaccine?
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6 weeks
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Adverse effects of Varicella vaccine
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Pain, local swelling, and erythema at injection site, fever, Varicella like rash that may be generalized or localized with 2-10 papular lesions
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Hepatitis A causes what type of illness
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Asymptomatic or symptomatic infection with abrupt onset
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Symptoms of Hep A
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Fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice
Last < 3 months but can occur for longer periods |
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Transmission of Hep A
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Fecal/oral route by either person to person contact or ingestion of infected food/water
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Vaccine products available for Hep A
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Havrix
Vaqta |
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Indications for Hep A vaccination
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-Travelers to areas that are not developed
-Gay men -Persons with clotting factor disorder -Injectable drug users -Patients with chronic liver disease -Children and adolescents in highly endemic areas -Food handlers where vaccine is cost effective -Work with infected primates or with Hep A in the lab -Anyone seeking protection against Hep A |
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Dosing for Hep A
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2 doses at least 6 months apart
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Adverse effects of Hep A vaccine
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Soreness, redness, and pain at injection site, HA
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What type of illness does Influenza cause
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Respiratory viral illness with an abrupt onset of fever, myalgias, HA, severe malaise, sore throat, rhinitis, and non-productive cough
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What are the possible outcomes of Influenza infection
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-Resolve in several days
-Exacerbate a chronic condition -Lead to a secondary bacterial pneumonia |
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How is influenza transmitted?
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Through coughing and sneezing of infected persons
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What products are available for Influenza vaccination
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Fluzone - Trivalent inactivated influenza vaccine = inactivated
Flumist = live, attenuated influenza vaccine (LAIV) (intranasal) |
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Efficacy of Influenza vaccine
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70-90% protection in healthy adults < 65 years old
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Pediatric indications for Influenza vaccine
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-Admin to children 6-59 months as 2 doses separated by > 4 weeks
-Admin annualy to children 5 years and older w/ risk factors or wanting vaccine (1 dose) |
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Adult medical indications for Influenza vaccine
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-age over 50, chronic disorders of CV or pulmonary systems, chronic metabolic disease, immunosuppression, conditions that compromise respiratory function, those with increased risk of aspiration (cognitive dysfxn, spinal cord injury, seizures) or pregnancy during flu season
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Adult occupational indications for Influenza vaccine
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Health care workers and employees of LTC facilities
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Other indications for Influenza vaccine
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-Residents of nursing homes/LTC facilities, contacts/caregivers of children 0-59 months or high risk persons, anyone who would like to be vaccinated
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When to use LAIV or TIV
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Nonpregnant healthy persons without underlying medical conditions aged 2-49 years can receive either vaccine
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Optimal time of vaccination for Influenza
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October to November
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Precautions for Influenza vaccine
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-Egg allergy
-Hypersensitivity to thimerosal |
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Adverse effects of Influenza vaccination
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Soreness at injection site lasting for two days, local pain and swelling, fever, malaise, and myalgias occurring 6-12 hours after vaccine and lasting for 1-2 days
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What causes Meningococcus
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Neisseria meningitides
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What is the leading cause of meningitis and sepsis in children and young adults
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Neisseria meningitides
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Risk factors for Meningococcus
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Being an infant/teenager, asplenia, terminal complement deficiencies, military recruits, international travelers, microbiologists exposed to isolates
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What are the products available for Meningococcus
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Menomune
and Menactra |
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What are the basics of Menomune
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MPSV4 - polysaccharide
Quadrivalent vaccine containing capsular polysaccharides for 4 serotypes |
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What are the basics of Menactra
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MCV4
Polysaccharides are conjugated with diphtheria toxoid |
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Advantages of Menactra over Menomune
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-Booster response after 2nd dose
-Longer duration of immunity -Effective against most common strains |
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Which product to choose if Pt has history of GBS and needs Meningococcus vaccine
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Use MPSV4
Menomune GBS = Guillain-Barre syndrome |
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Pediatric indications for Meningococcus vaccine
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Admin MCV4 (menactra) to children 2-10 years who are going to areas that are endemic, have terminal complement component deficiencies, and/or asplenia
MPSV4 (menomune) is acceptable but not preferred |
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Young adolescent indications for Meningococcus vaccine
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Give MCV4 if not previously vaccinated, unvaccinated college freshman living in dormitories
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Revaccination with Meningococcus vaccines
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Do not revaccinate with MCV4
Revaccinate Q3-5 years with MPSV4 - can switch to MCV4 if pt remains at high risk |
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Adverse effects of Meningococcus vaccine
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Fever, erythema at injection sites lasting for 1-2 days, questionable GBS with MCV4
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Which Meningococcus vaccine contains thimerosol
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MPSV4 = Menomune
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How are the Meningococcus vaccines given
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MPSV4 = SC
MCV4 = IM |
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What can HPV cause
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Cancer and genital warts
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How is HPV spread
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Sexual contact
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What is the most commonly transmitted STD
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HPV
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What does HPV stand for
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Human papillomavirus
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What products are available for HPV
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Gardasil
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What type of vaccine is Gardasil
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A quadrivalent vaccine containing four types of HPV
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What does Gardasil target
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HPY types that cause 70% of cervical cancer and 90% of genital warts
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Effectiveness of Gardasil
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Nearly 100% but will not treat existing HPV infections
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Side effects of Gardasil
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No serious side effects but most common is injection site pain
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How long does Gardasil offer protection?
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5 years
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Do women still need regular cervical cancer screening
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Yes because the vaccine will NOT provide protection against all type sof HPV that cause cervial cancer, some women may not get all required doses of the vaccine, and women may also not get the vaccine's full benefits if they have already acquired a vaccine HPV type
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Indications for HPV vaccine
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Girls 11-12 years of age, but can give at age 9
Females age 13-26 who are not previously vaccinated |
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HPV vaccine series consists of
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3 injection at 0, 2, and 6 months
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Contraindications to Gardasil
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Prengnacy, severea acute illness, hypersensitivity to yeast
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What is Shingles
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It is a reactivation of the varicella zoster virus and can happen in anyone who has had chicken pox.
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In what age group of does Shingles occur and what is the most common age group
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It can occur in all age groups but is most common in those over 60 years of age and risk increases as we age
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What is the presentation for Shingles
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Rash or blisters appear on the skin; usually unilateral
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What causes pain in Shingles
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The virus that is dormant in the nerve cells has become reactivated and traveled down the nerve cells to the skin. As the virus travels, it causes inflammation of the nerve cell
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What is post herpetic neuralgia (PHN)
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Pain that lasts for months after the rash has healed (Shingles)
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What are the products available for Shingles?
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Zostavax
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What type of vaccine is Zostavax
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Live attenuated vaccine for Shingles
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How effective is Zostavax
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Reduces incidence of Shingles by approximately 50%
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What are the indications for Shingles vaccination
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Patients age 60 years and older
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What are the contraindications for Shingles vaccination
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Anaphylaxis to gelatin and/or neomycin; history of immunodeficiency states; high dose steroid therapy; active/untx TB/ pregnancy; children
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What is the dose schedule for Shingles immunization
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Single SC dose, no repeat dosing necessary
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What type of disease does Rotavirus cause
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GI disease
Most common cause of gastroenteritis-related hospitalization in US |
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What age group experiences the worst symptoms of rotavirus infection?
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3-35 months
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When does rotavirus infection peak
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Winter months
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What type of vaccine is available for Rotavirus
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Live, oral vaccine with 5 reassortant viruses from human and bovine strains that are given as a 3 dose series
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At what age is it too late to start the rotavirus vaccination
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Child > 12 weeks of age
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Immunization schedule for Rotavirus vaccination
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All children at 2, 4, 6 months of age
Do not start later than 12 weeks of age Finish series by no later than 32 weeks of age |
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How is the rotavirus vaccine given
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Administer complete vial orally, do not need to repeat if some is spit out
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Contraindications for rotavirus vaccination
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Severe illness wiht or without fever, allergy to vaccine componenets, previous intussuscpetion, current acute gastroenteritis
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