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DU PA Peds Hlth Main

Duke PA Pediatric Health Maintenance

What is the most common method of preventing infectious diseases available to practitioners Immunizations
Name the 15 diseases against which US infants and children are vaccinated Diphtheria, tetanus, pertussis, polio, measles, mumps, varicella, rubella, influenza, hepatitis A, hepatitis B, rotavirus, meningococcal meningitis, HPV and pneumococcal disease
What is DTap Diptheria Tetanus and acellular pertussis, this is a vaccine for young children
What is Tdap Tetanus diphtheria and pertussis, older child and adult vaccine
If you give someone a live vaccine how long do you need to wait before doing a TB skin test It is ok if you do them at the same time. If you give the live vaccine first you have to wait 6 weeks for the TB skin test.
Vaccination or Immunization – the actual process of administering agent (toxoid, antitoxin or Ig) Vaccination
Vaccination or Immunization – the process of inducing immunity which is active or passive Immunization
Vaccination results in active or passive immunity Active
What are the 5 types of vaccine Live attenuated, inactivated, subunit, recombinant, conjugated
What is the purpose of an adjuvant (aluminium salts) in a vaccine Enhance host response
How many doses of live attenuated vaccine does it usually take to confer immunity Usually one
What are some examples of inactivated vaccines Influenza (TIV), polio, hep A/B, diphtheria, tetanus, pneumococcal, meningococcal, HIB, HPV
What are some examples of live attenuated vaccines Measles, mumps, rubella, MMR, varicella, yellow fever, rotavirus, influenza (LAIV)
What type of vaccine (recombinant, conjugate, subunit) – genes that code for a specific viral protein are expressed in another microbe (Hep B, HPV) Recombinant
What type of vaccine (recombinant, conjugate, subunit) – vaccines for bacteria with polysaccharide capsules, linked to protein carriers (pneumococcal, HIB, meningococcal) Conjugate
What type of vaccine (recombinant, conjugate, subunit) – produced from specific purified antigens (DTaP, Tdap) Subunit
Most vaccines are administered by which route IM
Currently most children receive __ vaccines between 0-18 years 40
What is the reason children are vaccinated against hep A children often have asymptomatic and or unrecognized infections and therefore play a major role in transmission of disease to adults
Hep A vaccine is recommended for all children at __ of age 12 months
What is the reason children are vaccinated for hep B chronic infection is more likely if infection is acquired early in life, 25% of HBV infected infants will die of related disease, transmission from child to child has been documented
HBV vaccine is recommended for all infants and unvaccinated children by age __ 11-12 years
Reason to vaccinate against pertussis Pertussis infections occur in infants and young children and is highly contagious
The Tdap vaccine is for __ Adolescents/adults
The DTap vaccine is for __ Children up to age 7
Adverse effects generally attributed to whole cell pertussis – have decrease dramatically with D Tap High fever, unusual cry, seizures/rarely acute encephalitis
Reason for the HIB vaccine Before vaccine availability HiB was the #1 cause of bacterial meningitis in children <5 with a high rate of neurologic problems. It was also a big cause of pneumonia, cellulitis, epiglottitis, and septic arthritis
Reason for the polio vaccine Highly infectious, viral meningitis and paralytic polio
When were the Americas declared polio free 1994
Reason for the Measles, Mumps and Rubella (MMR) vaccine Few clinicians recognize measles, measles cause >1million deaths/yr worldwide, fetal rubella can result in devastating sequelae, the combined vaccine is more effective than individual components
Reason for varicella vaccine Highly infectious, before vaccine complications accounted for more than 80% of the 10,000 annual hospital admissions, neonatal infections are particularly severe, infections in young adults can be life threatening
Reason for pneumococcal conjugate vaccine (PCV-7) S. pneumo responsible for many cases of serious, invasive disease in children <5 yrs
Reason for rotavirus vaccine Major cause of severe gastroenteritis in children 0-5 yrs (1/80 US infants hospitalized annually), highly contagious
LAIV is now approved for healthy kids as young as __ 2 years
Do not immunize children <__ of age against influenza 6 months
__ allergy may be a contraindication for influenza vaccine Egg
Do not give LAIV to children <5 years of age with a history of __ Wheezing
Why vaccinate against influenza Highly contagious, 0-2 year olds at increased risk, children have highest attack rate
HPV vaccine (Gardasil) is recommended for __ Females age 11-12 years
HPV vaccine (Gardasil) catch-up is recommended for __ Females 13-26 years of age
Why vaccinate against HPV HPV is now the most common STD in the US, prevalence is highest among sexually active females <25 years of age, infections occur early after onset of sexual activity, infection can lead to cervical cancer
What are the contraindications for vaccination Severe allergic reaction, pregnancy (not all), known severe immunodeficiency, encephalopathy or other serious neurological sequelae after DTP or DTaP, influenza vaccine in patients with severe allergic reaction to eggs
What is the timing for pediatric office visits 2-4 day, 1 month, 2 month, 4 month, 6 month, 9 month, 12 month, 15-18 month, 2 yr, Q yr
Measure head circumference every visit until __ 2 years
When do formal vision tests begin (tumbling E’s, picture tests) 3-4 years
__ month old should fixate on a face with eyes 1
What is the minimally acceptable visual acuity for a 3-5 y/o 20/40
What is the minimally acceptable visual acuity for a 6 y/o 20/30
Ocular malalignment Strabismus
Loss of vision due to disuse Amblyopia
When is the hearing screen performed Before discharge from the hospital
When are children screened for anemia Minimum: 12-24 months, 4-6 yo, & once after onset of menses
When are children screened for lead At least once between 12 and 24 months
Name the 7 disorders/conditions newborns are screened for in NC Amino acid disorders (including PKU), fatty acid disorders, organic acid disorders, biotinidase deficiency, hypothyroidism, congenital adrenal hyperplasia, sickle cell disease
Most common cause of anemia Iron deficiency
What are risk factors for anemia in children Low birth wt, cow’s milk, anemic mother
Lead levels >__micrograms/dL is a medical emergency 70
Lead levels >__micrograms/dL causes colic, nausea, myalgia, seizures, headache, anemia 50
What is an acceptable level of lead <10 micrograms/dL
Consider chelation at lead levels >__micrograms/dL 25
At what age should children be screened for lead Between 12 and 24
TB skin testing can be done as early as __ 3 months
Cholesterol screening can be done as early as __ for those at risk 2 years
What are risk factors for childhood hypercholesterolemia Parent/grandparent with CAD or MI<55yo, parent cholesterol >240, overweight, evidence of insulin resistance
When should you put a child on cholesterol lowering medication (cholestyramine, colestipol) >10 yo with LDL >190 after diet treatment
Children <__lbs should be in rear facing car seats 20
Children __lbs should be in front facing car seats 20-40
Children __lbs should be in booster seats 40-60
Children >__lbs or __ft can be in a regular lap/shoulder belt 60, 4
Vax administered SubQ MMR, IPV, Varicella
Vax administered orally rotavirus
Created by: bwyche