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126 Cards in this Set

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  • Back
How long does it take to mobilize DMAT?
44 teams in US. 27 of these can be deployed within 12-24 hours
What is active immunity and passive immunity?
-Active Immunity
Protection produced by a person’s own immune system
Passive Immunity
-Protection transferred from another person or animal as antibody
What is an antigen?
A live or inactivated substance ( e.g., protein, polysaccharide) capable of producing an immune response
What is an antibody?
Protein molecules (immunoglobulin) produced by B lymphocytes to help eliminate an antigen
What are the types of passive immunity?
-Homologous pooled human antibody (immune globulin)
-Homologous human hyperimmune globulin
-Heterologous hyperimmune serum (antitoxin)
What are the characteristics of live attenuated vaccines?
-Derived from “ wild” virus or bacteria
-Attenuated ( weakened)
-Must replicate to be effective
-Immune response similar to natural infection
What are the problems with live attenuated vaccines?
-Severe reactions possible
-Reversion to pathogenic form
-Interference from circulating antibody
-Unstable
What are the live attenuated viral vaccines?
measles, mumps, rubella, oral polio, rotavirus, vaccinia, varicella, yellow fever
What are the live attenuated bacterial vaccines?
BCG, oral typhoid
What are the characteristics of inactivated vaccines?
-Cannot replicate
-Generally not as effective as live vaccines
-Minimal interference from circulating antibody
What are the disadvantages of inactivated vaccines?
-Generally require 3-5 doses
-Immune response mostly humoral
-Antibody titer falls over time
-Principal antigen may not be defined
What are the whole cell, inactivated, viral vaccines?
influenza, polio, rabies, hepatitis A
What are the whole cell, inactivated, bacterial vaccines?
pertussis, typhoid, cholrea, plague
What are some of the subunit, fractional, inactivated vaccines?
hepatitis B, influenza, acellular pertussis, typhoid Vi, Lyme disease
What are some of the toxiod, fractional, inactivated vaccines?
diphtheria, tetanus
What are the pure polysaccharide vaccines?
-pneumococcal
-meningococcal
-Haemmophilus influenzae type b
What are some of the conjugated polysaccharide vaccines?
-Haemophilus influenzae type b
-pneumococcal
What are the characteristics of pure polysaccharide vaccines?
-Not consistently immunogenic in children <2 years of age
-No booster response
-Antibody with less functional activity
-Immunnogenicity improved by conjugation
If live vaccine is given first, how long must you wait to give antibody?
2 weeks
If antibody is given first, how long must you wait to give vaccine?
>3 months
What 2 vaccines are contraindicated to give at the same time?
cholera and yellow fever
Does increasing or decreasing the time period between multidose vaccines affect the effectiveness of the vaccine?
decreasing the time period may, but not increasing it
What is the one vaccine that must be restarted if there is an extended amount of time between multidose vaccines?
oral typhoid
What are the permanent contraindications to giving a vaccine?
-severe allergy to a prior dose of vaccine or to a vaccine component
-encephalopathy following pertussis vaccine
What are the cases in which it is contraindicated to give live vaccine, but ok to give inactivated vaccine?
-pregnancy
-immunosuppression
What is the communicability of influenza?
Maximum 1-2 days before to 4-5 days after onset
What is the incubation period of diptheria?
The incubation period of diphtheria is 2–5 days (range, 1–10
days).
What are the symptoms of pharyngeal and tonsillar diptheria?
Early symptoms include malaise, sore throat, anorexia, and lowgrade
fever. Within 2–3 days, a bluish-white membrane forms and
extends, varying in size from covering a small patch on the tonsils
to covering most of the soft palate.
What are the symptoms of laryngeal diptheria?
Symptoms include fever, hoarseness,
and a barking cough. The membrane can lead to airway obstruction,
coma, and death.
What are the symptoms of cutaneous diptheria?
Skin infections may
be manifested by a scaling rash or by ulcers with clearly demarcated
edges and membrane, but any chronic skin lesion may harbor
C. diphtheriae, along with other organisms.
What are the most common complications of diptheria?
The most frequent complications of diphtheria are myocarditis and
neuritis. Other complications include otitis media and respiratory
insufficiency due to airway obstruction.
What is the fatality rate of diptheria?
The overall case-fatality rate for diphtheria is 5%–10%, with higher
death rates (up to 20%) in persons <5 and >40 years of age.
What are the symptoms of anterior nasal diptheria?
The onset is indistinguishable from that of the common cold and is
usually characterized by a mucopurulent nasal discharge (containing
both mucus and pus) which may become blood-tinged.
What is the reservior for diptheria?
Human carriers are the reservoir for C. diphtheriae, and are usually
asymptomatic. In outbreaks, high percentages of children are
found to be transient carriers.
What is the method of transmission for diptheria?
Human carriers are the reservoir for C. diphtheriae, and are usually
asymptomatic. In outbreaks, high percentages of children are
found to be transient carriers.
What is the temporal pattern for diptheria?
In temperate areas, diphtheria most frequently occurs during
winter and spring.
What is the communicability of diptheria?
Transmission may occur as long as virulent bacilli are present in
discharges and lesions. The time is variable, but organisms usually
persist 2 weeks or less, and seldom more than 4 weeks, without
antibiotics. Chronic carriers may shed organisms for 6 months or
more. Effective antibiotic therapy promptly terminates shedding.
What is the incubation period of tetanus?
The incubation period varies from 3 to 21 days, usually about
8 days. In general the further the injury site is from the central
nervous system, the longer the incubation period. The shorter the
incubation period, the higher the chance of death. In neonatal
tetanus, symptoms usually appear from 4 to 14 days after birth,
averaging about 7 days.
What are the symptoms of localized tetanus?
Local tetanus is an uncommon form of the disease, in which
patients have persistent contraction of muscles in the same
anatomic area as the injury. 1% fatality.
What are the characteristics of cephalic tetanus?
Cephalic tetanus is a rare form of the disease, occasionally
occurring with otitis media (ear infections) in which C. tetani is
present in the flora of the middle ear, or following injuries to the
head. There is involvement of the cranial nerves, especially in the
facial area.
What are the characteristics of generalized tetanus?
The first sign is trismus or lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks. Complete recovery may take months.
What are the characteristics of neonatal tetanus?
-Neonatal tetanus is a form of generalized tetanus that occurs in
newborn infants. Neonatal tetanus occurs in infants born without protective passive immunity, because the mother is not immune.
-It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument.
What are the complications of tetanus?
-laryngospasm
-fractures
-hypertension
-nosocomial infections
-pulmonary embolism
-aspiration pneumonia
-death
What is the fatality rate of tetanus?
In recent years, tetanus has been fatal in approximately 11% of
reported cases.
When should TID be administered as well as Td toxoids?
-Persons with wounds that are neither clean nor minor, and who have had 0–2 prior doses or have an uncertain history of prior doses, should receive TIG as well as Td toxoid.
-This is because early doses of toxoid may not induce immunity, but only prime the immune system. TIG provides temporary immunity by directly providing antitoxin. This ensures that protective levels of antitoxin are achieved even if an immune response has not yet occurred.
What is the reservoir of tetanus?
Organisms are found primarily in the soil and intestinal tracts of
animals and humans.
What is the communicability of tetanus?
Tetanus is not contagious from person to person. It is the only
vaccine-preventable disease that is infectious, but not contagious.
When should a person recieve the adult tetanus immunization?
7 years old
What type of formulation of tetanus toxioid is used in the adult population?
There are two types of toxoid available—adsorbed (aluminum salt
precipitated) toxoid and fluid toxoid. Although the rates of seroconversion are about equal, the adsorbed toxoid is preferred because the antitoxin response reaches higher titers and is longer lasting than following the fluid toxoid.
What is the incubation period of measles?
10-12 days
What are the complications of the measles?
diarrhea, otits media, pneumonia, encephalitis, death
What is the most common complication of the measles leading to death?
pneumonia
What are the risks of the measles during pregnancy?
-Measles illness during pregnancy results in a higher risk of premature
labor, spontaneous abortion, and low-birth-weight infants.
-Birth defects (with no definable pattern of malformation) have been reported rarely, without confirmation that measles was the cause.
What is atypical measles?
Atypical measles occurs only in persons who received inactivated (“killed”) measles vaccine (KMV) and are subsequently exposed to wild-type measles virus. The illness is characterized by fever, pneumonia, pleural effusions, and edema.
What is the fatality rate of measles?
Up to 25%
What is the reservoir for the measles?
Measles is a human disease. There is no known animal reservoir, and an asymptomatic carrier state has not been documented.
What is the temporal pattern for the measles?
In temperate areas, measles disease occurs primarily in the late
winter and spring.
What is the transmission of the measles?
Measles transmission is primarily person to person via large respiratory
droplets. Airborne transmission via aerosolized droplet nuclei has been documented in closed areas (e.g., office examination room) for up to 2 hours after a person with measles occupied the area.
What is the communicability of the measles?
Measles is highly communicable, with >90% secondary attack rates among susceptible persons. Measles may be transmitted from 4 days prior to 4 days after rash onset. Maximum communicability occurs from onset of prodrome through the first 3–4 days of rash.
What are adverse reactions to the MMR vaccine?
-fever
-rash
-joint symptoms
-thrombocytopenia
-rare-parotitis, deafness, encephalopathy
What is the incubation period of the mumps?
14-18
What are the complications of the mumps?
-cns involvement
-orchitis
-pancreatitis
-deafness
-death
What is the fatality rate of the mumps?
1-3 in 10,000
What is the reservoir for the mumps?
Mumps is a human disease. While persons with asymptomatic or nonclassical infection can transmit the virus, no carrier state is known to exist.
What is the mode of transmission for the mumps?
Transmission of mumps occurs through airborne transmission or
direct contact with infected droplet nuclei or saliva.
What is the communicability of the mumps?
Contagiousness is similar to that of influenza and rubella, but less than that for measles or varicella. The infectious period is considered to be from 3 days before to the 4th day of active disease; virus has been isolated from saliva 7 days before to 9 days after onset of parotitis.
What is the incubation period of rubella?
14 days (12-23 days)
What are the complications of rubella?
-Arthralgia or arthritis
-encephalitis
-thrombocytopenic purpura
-neuritis, orchidis
What is the reservoir for rubella?
-Rubella is a human disease. There is no known animal reservoir.
-Although infants with CRS may shed rubella virus for an extended period, a true carrier state has not been described.
What is the transmission of rubella?
Rubella is spread from person-to-person via airborne transmission
or droplets shed from the respiratory secretions of infected persons.
There is no evidence of insect transmission.
What is the communicability of rubella?
Rubella is only moderately contagious. The disease is most contagious
when the rash is erupting, but virus may be shed from 7 days before
to 5–7 days or more after rash onset.
What is the danger of rubella during pregnancy?
Congential rubella syndrome. Many defects.
Where should MMR be stored?
In the refrigerator.
Once reconstituted what is the longest that MMR can be stored prior to use?
8 hours
Who should not recieve MMR?
-A patient with a severe gelatin or neomycin allergy
-A patient who is trying to become pregnant or is pregnant
-A patient who received blood products less than 3 mos ago
According to the Vaccine in Pregnancy (VIP) registry what is the occurrence of CRS secondary to MMR administration during pregnancy?
0 in 321 administrations
What is the incubation period of varicella?
The incubation period is from 14 to 16 days from exposure, with a range of 10 to 21 days.
What are the complications of varicella?
-bacterial infections of lesions
-cns manifestations
-pneumonia
-hospitalization/death
What are the risks associated with varicella during pregnancy?
Primary varicella infection in the first 20 weeks of gestation is occasionally associated with a variety of abnormalities in the newborn, including low birth weight, hypoplasia of an extremity, skin scarring, localized muscular atrophy, encephalitis, cortical atrophy, chorioretinitis, and microcephaly.
What is the fatality rate of varicella?
-Among children 1–14 years of age, the fatality rate is 1 per 100,000 cases.
-Among persons 15–19 years, the fatality rate is 2.7 per 100,000 cases
-Among adults 30–49 years of age, 25.2 per 100,000 cases.
What is the reservior for varicella?
Varicella is a human disease. No animal or insect source or vector is known to exist.
What is the transmission of varicella?
Infection with VZV occurs through the respiratory tract. The most common mode of transmission of VZV is believed to be person-top erson from infected respiratory tract secretions. Transmission may also occur by respiratory contact with airborne droplets, or by direct contact or inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster.
What is the temporal pattern of varicella?
In temperate areas, varicella has a distinct seasonal fluctuation, with the highest incidence occurring in winter–early spring
What are the adverse reactions of the varicella vaccine?
-injection site complaints
-rash
What are the contraindications & precautions of varicella vaccine?
-pregnancy
-immunosuppression
-recent blood product
-severe allergic reaction to vaccine component
-moderate or severe acute illness
What are the risks associated with congenital varicella?
Primary varicella infection in the first 20 weeks of gestation is occasionally associated with a variety of abnormalities in the newborn, including low birth weight, hypoplasia of an extremity, skin scarring, localized muscular atrophy, encephalitis, cortical atrophy, chorioretinitis, and microcephaly. (2%)
Why do breakthrough infections occur with varicella vaccinations?
Breakthrough varicella infection could be a result of several factors, including interference of vaccine virus replication by circulating antibody, impotent vaccine due to storage or handling errors, or inaccurate recordkeeping.
Where should varicella vaccine be stored?
To maintain potency, the lyophilized vaccine must be stored frozen at an average temperature of +5OF (-15OC). Vaccine diluent must be refrigerated and used within 30 minutes.
What is the incubation period of HepA?
The incubation period of hepatitis A is 28 days (range 15–50
days).
What is the fatality rate of HepA?
The case-fatality rate among reported cases of all ages is approximately
0.3%, but can be higher among older persons (approximately 2% among persons 40 years of age and older).
What is the reservoir for HepA?
Humans are the only natural reservoir of the virus. There are no insect or animal vectors. A chronic HAV carrier state has not been reported.
What is the transmission of HepA?
HAV infection is acquired primarily by the fecal-oral route by either person-to-person contact or ingestion of contaminated food or water.
What is the communicability of HepA?
Viral shedding persists for 1 to 3 weeks. Infected persons are most likely to transmit HAV 1 to 2 weeks before the onset of illness, when HAV concentration in stool is highest. The risk then decreases and is minimal the week after the onset of jaundice.
What are adverse rxns to HepA vaccine?
-pain at injection site
-no serious rxns reported
What are the contraindications and precautions for HepA vaccine?
-allergic rxn to component
-serious illness
What is the incubation period of HepB?
The incubation period
ranges from 6 weeks to 6 months (average, 120 days).
What are the complications of HepB?
-fulminant hepatitis
-hospitalization
-cirrhosis
-hepatocellular carcinoma
-death
What is the fatality rate of HepB?
While most acute HBV infections in adults result in complete recovery,
fulminant hepatitis occurs in about 1% to 2% of persons, with mortality rates of 63% to 93%.
What serological test results reflect immunity due to vaccination?
Anti-HBs positive, HBsAg negative, Anti-HBc negative
What is the reservior for HepB?
Although other primates may be infected experimentally, HBV infection affects only humans.
What is the transmission of HepB?
The virus is transmitted by parenteral or mucosal exposure to HBsAg-positive body fluids from persons who are carriers or have acute HBV infection. Sexual contact. Bloodborne.
What is the communicability of HepB?
Persons with either acute or chronic HBV infection should be considered infectious any time that HBsAg is present in the blood. 1-2 months before and after onset of symptoms
What is the duration of immunity of the HepB vaccine?
greater than 15 years
When should a booster be administered after completions of HepB series?
Not recommended.
What are the adverse reactions to the HepB vaccine?
-pain at injection site
-mild systemic complaints (fatigue, HA)
-high temperature
What are the contraindications and precautions to the HepB vaccine?
-allergic rxn to vaccine component
-severe illness
If a patient is a nonresponder after completion of 6 total doses of hepatitis B vaccine they should:
Receive postexposure prophylaxis if exposed.
What is the incubation period for influenza?
The incubation period for influenza is usually 2 days, but can vary
from 1–4 days.
What are the complications of influenza?
-Pneumonia
-primary influenza
-secondary bacterial
-Reye’s syndrome
-Myocarditis
-Death
What is the fatality rate of influenza?
Death is reported in 0.5–1 per 1,000 cases. The majority of deaths occur in persons 65 years of age and older.
What is the reservoir for influenza?
Human, animals (type A only)
What is the communicability of influenza?
Maximum 1-2 days before to 4-5 days after onset
What are the adverse reactions to the trivalent inactivated influenza vaccine (TIV)?
-local reactions
-fever, malaise
-allergic rxns (rare)
-neurological rxns (very rare)
What are the contraindications and precautions for use of this trivalent inactivated influenza vaccine (TIV)?
-allergic rxn to component of vaccine
-severe illness
What are the adverse reactions to the live attenuated influenza vaccine (laiv)
-Significantly increased risk of asthma or reactive airways disease among children 12–59 months of age who received LAIV.
-Among healthy adults, a significantly increased rate of cough, runny nose, nasal congestion, sore throat, and chills.
-No severe adverse rxns.
What are the contraindications and precautions to the live attenuated influenza vaccine (LAIV)?
-less than 5 yo
-older than 50
-underlying medical conditions
-aspirin use (chronic)
-immunosuppression
-pregnancy
-egg allergy
-history of Guillan Barre syndrome
-severe illness
What is the incubation period for pneumococcal?
1-3 days
What are the complications of pneumococcal?
pneumonia, bacteremia, meningitis
What is the fatality rate of pneumococcal?
The mortality rate of pneumococcal meningitis is about 30%, but may be as high as 80% in elderly persons.
What is the reservoir for pneumococcal?
Streptococcus pneumoniae is a human pathogen. The reservoir for pneumococci is presumably the nasopharynx of asymptomatic human carriers. There is no animal or insect vector.
What is the transmission of pneumococcal?
Transmission of Streptococcus pneumoniae occurs as the result of direct person-to-person contact via respiratory droplets, and by autoinoculation in persons carrying the bacteria in their upper respiratory tract.
What is the communicability of pneumococcal?
The period of communicability for pneumococcal disease is unknown, but presumably transmission can occur as long as the organism appears in respiratory secretions.
What are adverse reactions to pneumococcal vaccine?
-local reactions
-fever, myalgia
What are the contraindications to pneumococcal vaccine?
-allergic rxn to component
-severe illness
True or false: If you run out of adult pneumococcal vaccine you can substitute the pediatric vaccine and double the dose.
False.
True or false: If a patient requires vaccination for flu and pneumococcus and is afraid of needles it is okay to combine these two vaccines into one syringe.
False. But the two can be given silmultaneously.