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162 Cards in this Set
- Front
- Back
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What is considered a fever? And when does cellular damage occurs? |
-Rectal temperature of 100.4 degrees or greater -Cellular damage occurs with temperature >105.8 F |
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Why is a fever beneficial? |
-Fevers are part of the body defense mechanism -Enhances immunological responses -Increases phagocytosis and leukocyte migration -Interferes with viral replication with virulence of some microbes |
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What are some associated symptoms with fever? And what are some signs and symptoms seen in children? |
-Headache, Malaise, Anorexia, Irritability -Irritability, inconsolability, poor perfusion, poor tone, and decreased activity or lethargy |
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What are signs and symptoms of bacterial meningitis? |
Altered sleep pattern, decreased oral intake, hyperthermia, hypothermia, paradoxical irritability |
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What kinds of infectious diseases should you consider when a patient says they refuse to walk? |
Can be a manifestation of deep tissue infection (Pyomyositis, osteomyelitis, septic arthritis, and meningitis) Or arthralgia (Parvovirus B19, Rubella, Hep B, dengue) |
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What kinds of infectious diseases should you consider with skin or mucous membrane changes? |
-Exanthema (wide spread rash) (measles, rubella, chicken pox) -Enanthema (Rash on mucous membrane)-enterovirus, kawasaki -Slapped cheek appearance (5th's disease) -Common with viral illness and characteristic rashes are typically associated with specific illnesses |
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What kinds of infectious disease should you consider with abnormal vital signs? |
-Pulse ox/Respiratory rate (fever, tachypnea) -Low blood pressure (Dehydration, septic shock) -Almost all viruses are associated with fever |
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What kinds of infectious disease should you consider with abnormal general exam, head, neck, and new heart murmur? |
General: Irritability (meningitis, kawasaki) Lethargy: (Dehydration, meningitis) Head: Bulging fontanel (meningitis) Neck: Stiff/painful (meningitis), swollen parotid glands (Mumps) New heart murmur: Endocarditis, rheumatic fever |
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What is the most common cause of fever in young adults? |
Virus Neonates and young infants are more likely to experience morbidity from a viral infection |
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What is a drug fever? |
Hypersensitivity reaction -Fever that coincides with a medication and disappears when the medicine is stopped |
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What are viruses that can cause serious illness in febrile young infants in <3 months? |
Herpes simplex, varicella, enteroviruses, influenza virus, some adenoviruses, and respiratoy syncytial virus |
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What are some viruses that are associated with rash? |
Enterovirus (Hand, foot, mouth disease) Adenovirus (common cold) Rubella (german measles) Varicella (chicken pox) Paravirus B 19 (5th's disease) Epstein-Barr Virus (Mononucleosis) |
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What can a CBC look like during an infection? |
Elevated leukocytosis in bacterial infection Decreased leukopenia in bacterial/viral infection Neutrophils: Increased with bacterial infection Bands: Increased left shift ratio of immature to mature neutrophils with infection |
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What results on the urine dipstick will indicate a UTI? |
Presence of leukocytes, and nitrites |
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When should a urine culture be performed? |
-Should be performed on all febrile children <6 months -All uncircumcised males <12 months -All females <24 months who present with fever of greater than 101F for more than 2 days without another source |
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What is C reactive protein? |
-Inflammatory markers -Increased in bacterial infections -May be slightly increased with viral infections -CRP levels do not increase until 12 hours after the onset of fever and can rise in both viral and bacterial infections |
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What is procalcitonin? |
Biomarker for differentiating viral infections from bacterial infections Will rise and fall more quickly than CRP during onset and control of bacterial infections |
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What is erythrocyte sedimentation rate? |
-Not a specific test for infection -ESR is useful marker to evaluate the effectiveness of therapy when long term antibiotics are needed |
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What does the presence of IgM mean? What does the presence of IgG mean? |
IgM: Active infection IgG: Past infection |
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When should you treat a fever? |
If temperature >101F. Treat for the purpose of providing comfort of the child. |
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How do you manage a fever? |
-Provide adequate hydration -Provide reassurance to parents and advice that not all fevers need to be treated -Provide clothing (Do not bundle in additional clothing) -Provide ambient environment 72F -Sponge with tepid water for temperatures greater than 104F -No ice water baths and alcohol sponging -Encourage child to drink extra fluids (Pedylite) |
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When should parents call the primary care provider for infants <3 months? |
-Lethargic or appears limp and unresponsive -Poor color -Refuses to eat 3 to 4 times in a row -Has repeated bouts of diarrhea or vomiting -Labored, wheezing or grunting breathing pattern that last longer than a half hour -Illness associated with rash that looks like bleeding under skin -Baby's eyes, hands or feet have yellow jaundiced color or pumpkin colored |
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When should parents call the primary care provider older children? |
-Seemsunresponsive, does not make eye contact with you, or has cold and clammy skinthat is not associated with vomiting -Looksmuch sicker than usual with a routine illness -Hasan illness with a rash that looks like bleeding under the skin (purple blotchesor spots) -Hasany symptoms that you believe to be unusual or frightening: trouble breathing,stiff neck, severe headache, or very high fever |
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What is the difference between fever of undetermined origin (FUO) vs. Fever without source (FWS)? |
-FUO: Fever> 101F persisting for 1) 3weeks without a cause, that includes 3weeks of outpatient visits, extensive diagnostics, and continued fevers andeluding 1week of intensive diagnostic testing of 2) Noetiology after 1 week of evaluation in the hospital -FWS: Unexplainedfever >100.4 rectal of brief duration or lasting < 5-7 days, withoutapparent source of illness |
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What are considered high risk fevers? |
-FebrileInfant younger than 1 month of age -Anytoxic appearing neonate, infant, or child regardless of age, risk factor ordegree of fever -Aninfant 1 to 3 months with a rectal fever of 100.4 degrees F |
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What are signs of a toxic infant and child? |
-Altered level of consciousness -Abnormal breathing -Rapid pulse -Fever -Skin abnormalities -Head bobbing -Delayed capillary refill -Poor muscle tone |
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When should you consider hospitalization in an infant or child? |
-Evidence of systemic illness or failure to thrive -If a child is very young -If the parent is anxious -If fever with petechiae in any age child who is ill appearing is high risk for a life threatening bacterial infection (immediate hospitalization and work up) |
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Parents need detailed instructions on signs and symptoms that may indicate a worsening of their infant's illness such as: |
-Changein rash or new rash: duskiness, cyanosis, or mottling, coolness of extremities,poor feeding or vomiting, irritability, cries w/ positional changes -difficultyin comforting or arousing, seizure activity, bulging anterior fontanel |
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When can you use acetaminophen and ibuprofen in infants and children? |
-Acetaminophen less than 6 months -Acetaminophen or ibuprofen greater than 6 months |
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What is the difference between active and passive immunization? |
-Active: Vaccine or toxoid (inactivated toxin) -Passive: Exogenous antibody, immunoglobulin, administering preexisting antibodies to prevent or amend an infectious disease (Hep B immunoglobulin) |
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What are Vaccines for Children Program? (VFC) |
Vaccines are provided free to children younger than 19 years of age. |
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What is true about acetaminophen prophylaxis after a vaccine? |
-Decreases antibody response after vaccination in infants and children. -Do not recommend giving Tylenol after immunizations |
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What are contraindications to vaccines? |
Live vaccine (Varicella, Zoster, MMR, Influenza)- Do not give to immunodeficiency and pregnancy -HPV: Pregnancy Influenza (History of guillan-barre syndrome |
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Why are vaccines generally not given to infants younger than 6 weeks of age? |
-Little safety data exist on doses given before 6 weeks of age and the vaccines aren't licensed for this use. -response is poor and could be detimental to the infant by reducing the immune response to subsequent doses of Hib conjugate vaccine |
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What vaccine is safe for infants when the are first born? |
Infants can respond to the hepatitis B vaccine as early as the day of birth and early receipt of this vaccine is necessary to protect infants born to HBsAg-positive mothers |
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Is it necessary to start a vaccine series over if a patient does no come back for a dose at the recommended time, even if there's been a year or more delay? |
-For routine administered vaccines, no vaccine series needs to be restarted because of an interval that is longer than recommended
-In certain circumstances, oral typhoid vaccine (which may be given for international travel) needs to be restarted if the vaccine series isn't completed within the recommended time frame |
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If 2 live virus vaccines are inadvertently given less than 4 weeks apart, what should be done? |
-If2live virus vaccines are administered >4 weeks apart and not on thesame day, the vaccine given second should be considered invalid and repeated -Therepeatdose should be administered at least 4 weeks after the invalid dose. -Ifgiven too close-impairs the immune response |
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What is the rule for vaccinations to people with acute illnesses? |
-Every opportunity should be taken to provide needed vaccinations -Minor illnesses are not contraindications to vaccination (diarrhea, mild URIs with or without low grade fever) -People with moderate or severe acute illness, with or without fever, should be vaccinated as soon as the condition improves |
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How is measles (rubeola) transmitted? |
-1 of the most contagious infectious diseases -Etiology: Measles virus -Transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, and sneezes |
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What are the signs and symptoms of measles (rubeola)? |
-Initially: fever, malaise and 3 C's: Cough, coryza, and conjunctivitis **Koplik spots** -Diagnostic of measles -Rash usually appears about 14 days after exposure and spreads from head to trunk to lower extremities -Contagious from 4 days before to 4 days after the rash appears |
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What are complications of Measles (rubeola)? |
Otitis media, pneumonia, laryngotracheobronchitis and diarrhea -High risk for complications: Infants and children <5 years old and pregnant women, and the immuno compromised |
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How can you diagnose measles (Rubeola)? |
-Febrile rash -Measles serology: IgM antibody and Measles RNA are most common methods for confirming measles |
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What are some acceptable presumptive evidence of immunity for measles (rubeola)? |
-1 or more doses of measles containing vaccine administered on or after the 1st birthday for preschool age children and adults not at high risk -2 doses of measles containing vaccines for school age children and adults at high risk, including college students, healthcare personnel and international travelers |
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When do children receive the measles (rubeola) vaccination? |
-First dose at 12 to 15 months -Second dose at 4 to 6 yeas or at least 28 days following the first dose |
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What is rubella (German measles) and how is it transmitted? |
-Contagious disease caused by virus and is transmitted by cough and sneeze -Also known as the 3 day measles |
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What are symptoms of rubella (German measles)? |
-Rash that starts on face and spreads to the body -Low fever (>101 degrees) -Symptoms last 2 to 3 days -Swollen glands and URI like symptoms before rash appears -Will have pinkish-red maculopapular eruption and the presence of red palatal lesions (Forschheimer spots) -Measles enanthema |
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How is rubella (German measles) diagnosed? |
Serology is the most common method to confirm rubella -Will a significant rise in rubella antibody titer (rubella IgM) -Obtain a sample within 7-10 days after onset of symptoms -Repeat 14 to 21 days later (to rule out false positives in persons with parovirus infections, mono, or positive rheumatoid factor) -Viral cultures are labor intensive and not usually done |
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How is the rubella vaccine given? |
2 dose series given with the MMR vaccine -First dose at 12 to 15 months -Second dose at 4 to 6 years of age |
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What are mumps and how are they transmitted? |
Viral illness caused by paramyxovirus Transmitted by direct contact with respiratory secretions, saliva, or fomites |
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What are signs and symptoms of mumps? |
-Pain, tenderness, and swelling on one or both parotid salivary glands -Swelling is first visible in front of the lower part of the ear -Peaks in 1 to 3 days -As the swelling worsens, the angle of the jawbone below the ear is no longer visible -Prodromal symptoms (Appears first before parotitis): Low grade fever, myalgia, anorexia, malaise, headache, parotitis (may last up to 10 days) |
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What are complications for mumps? |
Orchitis, pancreatitis, deafness, meningitis, and encephalitis -Pregnant women may be at risk for complications during the first trimester: risk for spontaneous abortion or IU fetal death |
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How do you diagnose mumps?
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Gold standard: Viral culture! (Buccal and oral swab virus cultures) -Mumps virus can be detected by RT-PCR -Vaccinated people may shed virus for a shorter period and might shed smaller amounts of virus |
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What are the vaccines for mumps? |
MMR Live vaccine Two doses of MMR are given |
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What are some contraindications for MMR? |
-Moderate to severe illness -Pregnant women should not get it and should wait until after giving birth (wait 1 month to get pregnant after getting vaccine) -Immunocompromised (HIV/AIDS, cancer, blood disorder) -If they have a received another vaccine within the past 4 weeks |
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What is Fifth's disease (Erythema infectiosum)? |
Mild viral disease with erythematous eruptions. Caused by parvovirus B19. -Most communicable before the onset of rash |
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Describe the signs and symptoms of Fifth's disease during the incubation and prodome period?
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Incubation: 4 to 14 days with rash and joint symptoms 2 to 3 weeks after infection. Prodrome: Mild fever, myalgia, headache, malaise, URI symptoms |
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Describe the rash that develops 7 to 10 days after the prodromal stage? |
-Bright red rash to cheeks and forehead "slapped cheek" with/without mild fever, headache and cold symptoms -Rash will spread to trunk and distal extremities with lace like appearance -Rash becomes transient with heat/cold -Exposure during pregnancy means risk of fetal death |
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How can you diagnose Fifth's disease? |
-Can be made clinically -Serum B 19 specific IgM confirms presence of infection and persists for 6 to 8 weeks -Anti B19 IgG confirms past infection |
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How do you treat Fifth's disease? |
No specific antiviral treatment -No vaccine to prevent it -IGIV offers help for the immunocompromised -Those with hemolytic anemia or who are immunocompromised should be considered for hospitalization -Children can attended school while in the rash stage |
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What are some complications to Fifth's disease? |
-Arthritis of hands, wrists, knees, and ankles occur 2 to 3 weeks after onset of symptoms -Chronic infection (immunodeficient) -Aplastic crisis -Fetal hydrops and death or IU growth retardation is exposed in utero |
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What is fetal hydrops? |
Complication of Fifth's disease -Abnormal accumulation of fluid in 2 or more fetal compartments -Ascites, pleural effusion, pericardial effusion, and skin edema |
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What is true regarding the immunity status after you recover from fifth's disease? |
Once you recover, you develop immunity that generally protects you from parovirus B 19 infection in the future |
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What is roseola infantum (exanthem sibitum) or sixth disease? |
Acute viral infection that primarily affects children <3 years old -Caused by herpes virus 6 |
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What is the incubation period of roseola infantum (exanthem subitum) (6th disease) and when are they most communicable? |
Incubation is 5 to 15 days and they are most communicable during the febrile stage |
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What are signs and symptoms of roseola? |
-Acute fever 101-103 for 3 to 7 days -Signs of URI -Lymphadenopathy in cervical and posterior occipital areas -Lethargy -Infected palpebral conjunctiva, eyelid edema -GI complaints -Reddened tympanic membranes -Occasional febrile seizures -As fever breaks, rash develops |
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Describe the rash associated with roseola. |
As the fever breaks, a rash develops Pinkish, maculopapular rash Starts on trunk Spreads to face and extremities Rash lasts hours to 3 days |
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How do you diagnose roseola? |
-CBC: WBC will be decreased until after the 4th day then returns to normal range -Serologic testing: HHV-6 titers are serial titers 2 to 3 weeks apart and are more reliable -Rapid HHV-6 rapid culture is available -Reverse transcriptase PCR assay |
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How do you treat roseola and what are complications? |
Treat: Supportive care
Complications: Rare (febrile seizures, meningoencephalitis, encephalitis, and hemiplegia) |
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What is chickenpox (varicella)? |
-Acute infectious disease -Caused by varicella-zoster virus (herpesvirus group) -After infection, the virus will stay in the sensory nerve ganglia as a latent infection -Primary infection = Varicella -Reactivation of latent infection = Herpes Zoster (Shingles) |
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What is the incubation period for varicella? |
Incubation period for varicella is 14 to 16 days after exposure to a varicella or herpes zoster rash (range of 10 to 21 days) |
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Describe varicella in an unvaccinated person? |
-Mild prodrome: fever, malaise may occur 1 to 2 days before rash -Rash could be first symptom and is generalized and pruritic -Progresses form macules to papules to vesicular lesions then crusts -First appears on head, chest and back then spreads to the body -Varicella is usually mild with itchy rash, malaise, and fever for 2 to 3 days |
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Describe varicella in a vaccinated person (breakthrough varicella) |
Infection with wild type varicella occurring in a vaccinated person more than 42 days after varicella vaccination -Symptoms are usually mild -Typically afebrile or have low grade fever -Usually few than 50 skin lesions -Usually have shorter illness -Rash is more maculopapular than vesicular -Happens in 25-30% of persons |
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What are complications of varicella? |
Bacterial infection of the skin in children Pneumonia in adults |
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How is varicella transmitted? |
-Highly contagious -Spreads through air when infected person coughs or sneezes -Can be spread by touching or breathing aerosolized virus from varicella lesions -Person is contagious from 1 to 2 days before rash onset until the lesions have crusted -Takes from 10 to 21 days after exposure to the virus to develop varicella |
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Who should receive the live varicella vaccine? |
-Children who never had chicken pox should get 2 doses (1st dose at 12 to 15 months of age and 2nd dose at 4 to 6 years of age) |
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If you are 13 years old and have never gotten the chicken pox or the vaccine, when should you get vaccinated? |
They should get two doses, 28 days apart |
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What are contraindications to the live varicella vaccine? |
-History of allergies to gelatin and neomycin -Blood disorders, immunocompromised -Moderate or severe concurrent illness -Currently pregnant -Received blood products |
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What is the MMRV and when do you receive it? |
Measles, Mumps, Rubella vaccine 1st dose at 12 to 15 months 2nd dose at 4 to 6 years of age -In children less than 2 years old: MMRV is associated with more adverse events compared to separate administration of MMR and varicella |
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What is DTAP? |
Diphtheria Tetanus Acellular Pertusis |
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Who gets diphtheria? |
-Everyoneneeds protection from diphtheria. -Severalthousandcases of diphtheria occur around the world every year -TheUnitedStates averaged more than 175,000 cases of diphtheria each year beforevaccines. -Sincevaccineshave been available, diphtheria cases have fallen by over 99.9%. |
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What are the signs and symptoms of diphtheria? |
-Causes a thick covering in the back of the throat -Can lead to breathing problems, paralysis, heart failure and even death -Spreads form person to person by coughing and sneezing -Symptoms: Gradual onset of sore throat and low grade fever |
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What is tetanus and what can it cause? |
-An infection caused by bacteria that can cause painful muscle contractions -Mainly affects the neck and abdomen -"Lockjaw" because it can cause a person's neck and jaw muscles to lock making it hard to open the mouth or swallow -Can cause breathing problems, severe muscle spasms, seizures, and paralysis |
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How is tetanus transmitted? |
It does not spread from person to person -Bacteria are usually found in soil, dust, and manure and enters the body through breaks in the skin (usually cuts or puncture wounds) |
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What is pertussis (whooping cough) and how is it transmitted? |
-A respiratory illness commonly known as whopping cough -Very contagious disease caused by bacteria -Found only in humans and spread person to person -Usually spreads the disease by coughing or sneezing while in close contact with others who then breathe in the pertussis bacteria |
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What are pertussis signs and symptoms? |
-Develops 7 to 10 days afters being exposed, can occur up to 6 weeks later -Causes severe coughing spells, vomiting, and disturbed sleep -leads to weight loss, incontinence, rib fractures, and passing out from violent coughing -Can occur more at night -Illness can be milder in those vaccinated |
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What are the symptoms of pertussis? |
Early symptoms: Last for 1 to 2 weeks and includes: runny nose, low grade fever, mild, occasional cough, and apnea Traditional Symptoms: fits (paroxysms) of many rapid coughs follow by high-pitched "whoop", vomiting, exhaustion after coughing fits -Coughing fits can last up to 10 weeks or more |
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Who is at risk for pertusis and what are common complications? |
-Everyone is at risk for pertussis, but it is most severe for infants -Of the infants who are hospitalized with pertussis get pneumonia -can also have decreased eating, drinking, and breathing with infants due to coughing spells -Most common complications: weight loss, loss of bladder control, passing out, and rib fractures from severe coughing -Can lead to pneumonia, seizures, brain damage, and death |
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Who should get vaccinated for pertusis? |
Pregnant women should get Tdap every 3rd trimester of their pregnancy -to create antibodies and pass protection before birth -These antibodies will help protect infants at birth and until they are old enough to get their own vaccine at 2 months -Anyone around infants should also get vaccinated |
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Who should get DTap? |
(Diphtheria, tetanus, and aceullar pertussis vaccine) -Children get 6 doses at: 2 months, 4 months, 6 months, 15-18 months, and 4 to 6 years -Can give this vaccine with other vaccines |
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Who should get DT? |
Diphtheria and tetanus vaccine -Does not contain pertussis -Used as a substitute for DTap in children who cannot tolerate pertussis vaccine |
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Who should get vaccinated with Td? |
Tetanus and diphtheria vaccine -Given to preteens, teens, and adults as booster shot every 10 years or after an exposure to tetanus under some circumstances |
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Who should get vaccinated with Tdap? |
Similar to Td but also contains protection against pertussis -Should be given as a 1 time booster in place of Td -Important for those in close contact with infants |
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Who should not get DTap or should wait? |
-Children with moderate to severe illness -Any life threatening allergies to DTaP -Any child who suffered brain or nervous system disease within 7 days of DTaP -Seizure, fever of 105F, or cried nonstop for 3 hours after dose of DTaP should not receive dtap |
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What is polio and how is it transmitted? |
Crippling and deadly disease caused by poliovirus -Spreads person to person contact -The virus lives in an infected person's throat and intestines -Spreads through contact with feces and respiratory droplets -can invade an infected person's brain and spinal cord -72% do not show any signs/symptoms |
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What are signs and symptoms of polio? |
Flu like symptoms that lasts 2 to 5 days then goes away (sore throat, fever, tired, nausea, headache, stomach pains) -Can have more serious symptoms that affect the brain and spinal cord (paresthesia, meningitis, paralysis, weakness in arms and legs, and paralysis that can affect respiratory muscles) |
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How long is a person considered contagious with polio? |
Immediately before symptoms appear and about 1 to 2 weeks after symptoms appear |
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What is post polio syndrome? |
15 to 40 years after the initial infection (and fully recovered), the person can develop new muscle pains, weakness, or paralysis as adults |
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What is the vaccine schedule for polio? |
Inactivated Poliovirus (IPV) Schedule: 2 months, 4 months, and 6 to 18 months. Booster dose at age 4 through 6 years old |
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What is rotavirus? |
Causes acute gastroenteritis -Causes severe watery diarrhea with vomiting, fever, and abdominal pain -Can lead to dehydration in infants and young children -Most common in infants and young children |
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What are the symptoms of rotavirus and incubation period? |
Incubation is about 2 days -Symptoms: severe watery diarrhea, vomiting, fever and abdominal pain. Diarrhea can last form 3 to 8 days -Additional symptoms: loss of appetite and dehydration, decreased urination, dry mouth and throat, feeling dizzy when standing up, and crying without tears |
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How is rotavirus transmitted? |
-Spread easily among infants and young children through stool. -Sheds the virus the most when they are sick and during the first 3 days after recovery -Can be spread by contaminated hands, objects, food, and water -More common in the winter and spring |
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How do you prevent rotavirus? |
Good hygiene and cleanliness |
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What are the two kinds of rotavirus vaccines you can give? |
RotaTeq (RV5) 3 doses: 2 months, 4 months, and 6 months Rotarix (RV1) 2 doses: 2 months and 4 months |
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What is true regarding the vaccination of rotavirus? |
-Vaccinated and unvaccinated children may develop rotavirus disease more than once -Immunity usually lasts 2 years -Neither vaccine nor natural infection provide full immunity from future infections -Usually a person's first infection with rotavirus causes the most severe symptoms |
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What are complications of rotavirus? |
-Intussusception -CDC still recommends that infants receive rotavirus vaccine -Dramatic decrease in hospitalizations and ER visits for rotavirus illness |
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What are contraindications for rotavirus vaccines? |
-Infants who have severe allergic reaction to rotavirus vaccine -Allergy to latex (due to tubing in RV1-can receive RV5) -History of intussusception -Immunocompromised -Acute, moderate or severe illness or gastroenteritis |
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What are types of meningitis vaccines? |
-Haemophilus influenzae (Type B conjugate) (Hib) -Meningococcal polysaccharide -Pneumococcal polysaccharide (pneumovax) -Pneumococcal conjugate (prevnar) |
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What is Haemophilius influenzae Type B, how is it spread, and what can haemophilius influenzae cause? |
-Serious disease caused by bacteria -Usually affects children under 5 years of age -Spreadfrom person to person, nasal secretions, respiratory droplets during close or lengthy contact especially if living int he same household. -Can cause bacterial meningitis, pneumonia, epiglottitis, infections of the blood, joint, bones, and covering of the heart |
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What is the Hib vaccine schedule? |
First dose: 2 months of age Second dose: 4 months Third dose: 6 months Final/booster dose: 12 to 15 months of age May be given as part of a combination vaccine |
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When should Hib vaccine not be given? |
-Toinfants younger than 6 weeks of age
-Aperson who has ever had a life threatening allergic reaction after a previousdose of Hib vaccine -Peoplewho are mildly ill can get Hib vaccine -Peoplewho are moderately or severely ill should wait until they recover. |
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How many total Hib vaccines should a child receive before their first birthday and are they interchangeable? |
The child should receive a total of 3 doses of any combination of Hib vaccines before their first birthday -Hib conjugate vaccines for infants are interchangeable |
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Who should be given haemophilius influenzae Type b (Hib) vaccine? |
-Universal immunization for children less than 5 years old -High risk indications for persons older than 5 -If the person is present in community settings where infectious diseases tend to spread where large groups of people gather -Medical conditions such as not having a spleen or complete deficiency -Traveling near the sub Saharan Africa |
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What does it mean to be a carrier of bacterium neisseria meningitidis? |
1 out of 10 people have this type of bacteria in the back of their nose and throat with no signs or symptoms of disease |
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What are signs and symptoms of meningitis? |
Fever, headache, stiff neck, nausea, vomiting, photophobia, and altered mental status |
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What is meningococcal septicemia (also known as meningococcemia)? |
-Bacteria that damages the walls of the blood vessels which also damages the skin and organs -Can lead to death in a few hours, non fatal cases, permanent disabilities include amputation of toes, fingers, and limbs |
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What happens if a person comes in contact with a patient who has meningococcal disease? |
-People who are close contact with a person w/ meningococcal disease should receiveantibiotics to prevent them from getting the disease
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When vaccinating with the meningococcal vaccine, who should you vaccinate with menactra or Menveo? |
All 11 to 12 year old should be vaccinated with meactra or menveo |
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When is a booster dose given? |
-A booster dose is recommended at age 16 years -For teens who receive the first dose at age 13 to 15 years, a booster should be given at age 16 to 18 years -If the first dose was given at or after the age of 15--no booster is needed |
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What are contraindications to the meningococcal vaccine? |
-H/Osevere(life-threatening) allergic reaction to a previous dose of MenACWY*or MPSV4 -moderatelyorseverely ill at the time the shot is scheduled -Peoplewitha mild illness can usually get the vaccine -Meningococcalvaccines may be given to pregnant women. MenACWY is a fairly new vaccine and has not beenstudied in pregnant women as much as MPSV4 has. It should be used only if clearly needed |
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What is the pneumococcal disease and how is it transmitted? |
-An infection caused by streptococcus pneumoniae bacteria, pneumococcus -Causes ear infections, sinus infections, meningitis, bacteremia -Previous pneumococcal infection will not protect you from future infection -Person to person by direct contact with respiratory secretions like saliva or mucus -People may carry the bacteria in their nose or throat without becoming ill |
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Who is at risk for pneumococcal disease? |
Children at risk: -Younger than 2 years old -In group child care -Who have certain illnesses (sick cell, HIV infection or chronic heart or lung conditions) -With cochlear implants or cerebrospinal fluid leaks |
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Who is the pneumococal vaccination recommended for? |
-PCV13 is recommended for all children 2,4,6, and 12-15 months
-PCV13 is recommended for adults 19 years or older with certain medical conditionsand in all adults 65 years or older |
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Who should not receive the PCV 13 pneumococcal conjugate vaccine? |
-Anyonewho has ever had a life-threatening allergic reaction to a dose of thisvaccine, to an earlier pneumococcal vaccine called PCV7, or to any vaccinecontaining diphtheria toxoid (for example, DTaP), should not get PCV13.
•If the personscheduled for vaccination is not feeling well, your healthcare provider mightdecide to reschedule the shot on another day.2T1 |
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Who should not receive PPSV23 (Pneumococcal polysaccharide) vaccine)? |
-Children less than 2 years old -No evidence that PPSV23 is harmful to pregnant woman or fetus, but can withhold vaccine as a precaution |
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What is hepatitis B and how is it transmitted? |
-Liver infection caused by Hepatitis B -Transmitted by blood, semen, or another body fluid by someone who is not infected -Can transmit from mother to baby |
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What is the highest rate of Hepatitis B infections? |
Men 24-44 years old |
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What is concerning about chronic hepatitis B? |
-Silent killer -May people don't know they have it -LFT and other lab work appear normal -Late signs/symptoms are jaundice, painful or swollen belly |
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What is the typical presentation of someone with Hepatitis B? |
Gradual onset -Low grade fever, nausea, vomiting, minimal hepatomegaly -Arthralgia, myalgia, fatigue, aversion to food and cigarettes, urticaria, rashes -Papular acrodermatitis in infants -Liver is enlarged and tender -Hepatic encephalopathy -Sleep pattern disturbances |
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What HBV serological test will demonstrate current infection and active infection? |
Hepatitis B Surface antigen (HBsAg) Hepatitis B e Antigen (HBeAg) |
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What lab work will show recovery from hepatitis B? |
-Hepatitis B Surface antigen (HBsAg negative) -Hepatitis B Surface antibody (HBsAb positive) This can take up to 6 months to see. |
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What is the treatment and monitoring for hepatitis B? |
-Supportive therapy -Referral to a specialist -Interferon alpha and lamivudine -Annual LFTs, alpha fetoprotein -Liver biopsy |
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When is the Hepatitis B vaccine given in children? |
-Given at birth, 1-2 months, and 6-18 months. -There is no need to booster after the third shot unless they are immunocompromised |
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How do you check for immunity against hepatitis B? |
Check Anti-HBs titers -If they are <10, need to revaccinate -If they are >10, you do not need to revaccinate |
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Are there any contraindications to receiving the hepatitis B vaccine while pregnant? |
No, per the CDC, it may be given to pregnant women |
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What is respiratory syncytial virus infection? |
-RSV causes upper and lower respiratory infections -This is the most common cause of bronchiolitis and pneumonia -Very common. |
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What are symptoms of RSV and the treatment? |
-Illness begins 4 to 6 days after exposure. -Runny nose, decreased appetite, cough, fever, wheezing, irritability, decreased activity, breathing difficulties -There is no specific treatment, just supportive care |
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What prophylactic drug can be given to high risk infants to prevent severe RSV? |
Palivizumab (Synagis) |
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What are signs and symptoms of influenza? |
Abrupt onset of fever, malaise, myalgia, headache, rhinitis, and nonproductive cough
-Cough and malaise may last for 1 to 2 weeks |
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What medication can you give if a child is diagnosed with influenza? |
Osletavir or amantadine if the child is more than 1 year old and is started within 48 hours of onset of symptoms. -Continue this medication until the child is asymptomatic for 24 to 48 hours |
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When should you give the influenza vaccine? |
-Children aged 6 months to 8 years that need 2 doses should receive their second dose 4 weeks after the first dose -Routine annual influenza vaccine starting at 6 months |
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Who are persons at risk for medical complications due to severe influenza? |
-Women who are or will be pregnant during the influenza season -Children and adolescents who are receiving long term aspirin therapy and who might be at risk for experiencing Reye's syndrome after influenza virus infections |
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Who should not receive the live attenuated influenza vaccine? |
-Child less than 2 years old -Children receiving aspirin or aspirin containing products -Pregnant women |
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What is streptococcal disease? |
Spherical gram positive bacteria that causes Group A (beta hemolytic) streptococcal infections (GABHS) -Cause of pharyngitis and impetigo |
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Aside from strep throat, what kind of similar infection can GABHS cause? |
-Scarlet fever |
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What are the signs and symptoms of scarlet fever? |
-Abrupt fever, sore throat, vomiting, headache, chills and malaise -Fever can reach 104F -Tonsils are erythematous with exudate -Tongue coated red with desquamation of the coating -Prominent papillae (strawberry tongue) |
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Describe the rash with scarlet fever. |
Appears 1 to 5 days following onset of symptoms
-Sandpaper, erythematous rash -Begins in axilla, groin and neck and spread centripetally within 24 hours |
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What is the diagnostic test for strep? |
Throat culture (gold standard) -If the rapid strep is positive, you do not need a throat culture. But if the rapid strep is negative, a throat culture is needed to rule out strep |
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What is the treatment of strep? |
Amoxicillin or penicillin (Amoxicillin is frequently used for young children because it tastes better) |
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If you have an allergy to penicillin, what other medication can you use to treat strep? |
10 day course of cephalosporin (Keflex) |
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What causes tuberculosis and who is most susceptible? |
Caused by mycobacterium tuberculosis -Leading cause of death in the world -Children younger than 3 years are most susceptible |
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What is the most common risk factor in children regarding TB? |
Exposure to an infected adult is the most common risk factor in children |
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How do you diagnose tuberculosis? |
Mantoux test -An induration of more than 5-15mm is considered a positive result (Test the whole household if you suspect TB) |
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What population would that be considered a positive result If the Mantoux test shows an induration of 5mm or more? |
-HIV positive person -Recent contacts of TB case -Persons with nodular or fibrotic changes on CXR consistent with old TB -Patients with organ transplant -Immunosuppressed |
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What population would that be considered a positive result If the Mantoux test shows an induration of 10mm or more? |
-Recent arrival from high prevalent country -IV drug users -Homeless shelters, nursing homes, prisons, hospitals workers/residents -Immunosuppressed -Children <4 years old or older exposed to adults in high risk categories |
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What population would that be considered a positive result If the Mantoux test shows an induration of 15mm or more? |
-Person with no known risk factors for TB -Person with an increase of 10mm or more within a 2 year period, regardless of age |
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How do you diagnose TB and what will it show? |
-Chest x ray (Get xray in all children with suspicion or positive skin test)
-Pleural effusion is often seen with primary infection |
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What is the prevention treatment for TB? |
-Isoniazid 10mg/kg/day for 2 months -If the Mantoux test becomes positive at the end of 2 months, therapy should be continued for another 7 months |
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What does it mean if a child has latent TB and how do you treat it? |
-Children with positive skin test without symptoms and a normal chest xray -Treat with 9 months of Isoniazid |
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What is the treatment for active pulmonary TB? |
6 months of Isoniazid 2 months of pyrazinamid Followed by isoniazid plus rifampin for 4 months |
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What is the treatment for active miliary or CNS infection of TB? |
Duration is increased to 12 months or more and a fourth drug (Steptomycin or ethmabutol) is added for the first 2 months |
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What lab work should you follow while on treatment for TB? |
Need to monitor liver enzymes -Isoniazid can be hepatotoxic -What for elevation of AST/ALT |
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What is the precaution with pyridoxine? |
Peripheral neuropathy -Rare in children, but this is not necessary to add pyridoxine unless a child is malnourished |
