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Preventive Med Quiz 2

Immunity The ability of the human body to tolerate the presence of exogenous material and to eliminate foreign material.
Passive immunity Protection by animal or human products Transferred to another human (injection) Protection WANES
Active immunity Protection produced by a person's own immune system Protection is PERMANENT
Barriers to vaccinating Cost Advanced appointment/planning Lack of insurance/PCP Mistrust Fear
Examples of passive immunity Placenta transfer Post-exposure prophylaxis Immune globin Hyperimmune globulin (vaccine + immune globulin) Heterologous hyperimmune serum/antitoxin Monoclonal antibody products
Immune globulin examples Hep A Measles
Hyperimmune globulin examples Hep B Rabies Tetanus Varicella
Heterologous hyperimmune serum/anti-toxin examples Botulism Diphtheria
Monoclonal antibody products examples RSV exposure
Examples of active immunity Surviving an infection (immunologic memory) Receiving a vaccination
Types of vaccines (4) Live attenuated Inactivated Polysaccharide Recombinant
Live attenuated vaccine "Weakened virus" Virus retains ability to replicate, usually doesn't cause illness - could revert to original disease MMR/MMRV Rotavirus Influenza Yellow fever
Inactivated vaccine Whole or fractions of virus/bacterium Not alive, cannot replicate Requires multiple doses, boosters Polio Hep A Rabies Influenza aPertussis HPV Diphtheria Tetanus
Polysaccharide vaccine Type of inactivated Pure or conjugate Pneumococcal Meningococcal Salmonella typhi Hib
Recombinant vaccine Genetic engineering Insertion of viral gene segment into plasmid Hep B HPV Typhoid Live attenuated influenza
Diphtheria Corynebacterium diphtheriae Involves mucous membranes Exudative pharyngitis
Symptoms and complications of diphtheria Pseudomembrane Respiratory obstruction Myocarditis Neuritis
Diphtheria vaccine Dtap/DT (children), Tdap (adults) 4 doses: 2, 4, 6, and 15-18 months old Boosters: 4-6 (kindergarten) and 11-12 (middle school) years old, then q 10 years
Tetanus Clostridium tetani Bacterium found in soil/animal feces
Symptoms and complications of tetanus Trismus Stiff neck Difficulty swallowing Rigidity Episodes of tachycardia Spasms Interference in breathing Fracture of spine/long bones Arrhythmia
Tetanus vaccine Dtap/DT (children), Tdap (adults) 4 doses: 2, 4, 6, and 15-18 months old Boosters: 4-6 (kindergarten) and 11-12 (middle school) years old, then q 10 years
Pertussis Bordetella pertussis Whooping cough 3 stages Cough lasting >2 weeks --> pertussis
Stages and symptoms of pertussis Catarrhal: runny nose, sneezing, low fever, occasional cough Paroxysmal: bursts of numerous rapid coughs, typical whooping cough sound Convalescent: recovery, 2-3 weeks
Complications of pertussis Pneumonia Seizures Encephalopathy Death
Pertussis vaccine Dtap/DT (children), Tdap (adults) 4 doses: 2, 4, 6, and 15-18 months old Boosters: 4-6 (kindergarten) and 11-12 (middle school) years old, then q 10 years
Haemophilus influenzae type b (Hib) Haemophilus influenzae Colonizes in nasopharynx Can be asymptomatic as carrier
Symptoms and complications in Hib Invasive: Meningitis (50-65% prevaccine era) Epiglottitis Pneumonia Arthritis Cellulitis Hearing loss/neurologic symptoms (15-30%) Fatality (2-5%)
Hib vaccine Hib 3-4 doses: 2, 4, (6), and 12-15 months old
Hepatitis A Spread through fecal-oral transmission
Symptoms and complications of Hep A Fever Malaise Anorexia Nausea Ab. pain Dark urine Jaundice (70% asymptomatic <6 years old) (70% jaundice in older children and adults)
Hep A vaccine HepA 2 doses: 6-12 months apart after 1-year-old
Hepatitis B Blood borne transmission Can live on environmental surfaces for up to 7 days at room temp.
Symptoms and complications of Hep B Acute hepatitis Chronic hepatitis Cirrhosis Cause of 80% of hepatocellular carcinomas
Hep B vaccine HepB 3 doses: birth, 2 months old, and 6 months old
Measles Paramyxovirus Systemic infection Primary site of infection: respiratory epithelium
Symptoms and complications of measles Fever Rash "4 C's": Cough, Coryza, Koplik spots, Conjunctivitis Otitis media (OM) Pneumonia Encephalitis Seizures Death
Measles vaccine MMR, MMRV 2 doses: 12-15 months old and 4-6 years old NOT given during pregnancy
Mumps Paramyxovirus Parotitis (30-40%)
Symptoms and complications of mumps Parotitis Myalgia Malaise Headache Low fever CNS involvement Orchitis Pancreatitis Deafness Death
Mumps vaccine MMR, MMRV 2 doses: 12-15 months old and 4-6 years old NOT given during pregnancy
Rubella German measles, 3-day measles Togavirus
Symptoms and complications of rubella Fever Respiratory symptoms Malaise Rash for 3 days Lymphadenopathy Arthralgia Encephalitis Neuritis Orchitis Congenital Rubella Syndrome (CRS)
Rubella vaccine MMR, MMRV 2 doses: 12-15 months old and 4-6 years old NOT given during pregnancy
Congenital Rubella Syndrome (CRS) Fetal death Premature delivery 85% of infants affected if infection occurs during 1st trimester Deafness Cataracts Heart defects Microcephaly Mental retardation Bone alterations Liver/spleen damage
Varicella Chicken pox Varicella zoster virus
Symptoms and complications of varicella Pruritic rash 3 types of lesions seen: papules, denuded papules, denusions/crusting ... (?) Secondary skin infection Pneumonia CNS manifestations Reye syndrome (aspirin in children) Maternal: 5 days before-2 days after delivery has 30% neonatal fata
Varicella vaccine Varicella, MMRV 2 doses: 12-15 months old and 4-6 years old *Post-exposure prophylaxis: >70% effective if given w/in 3 days of exposure*
Pneumococcal disease Strep. pneumoniae
Symptoms and complications of pneumococcal disease Most common cause of OM Pneumonia: fever, chills, rigor, pleuritic pain, rusty sputum, cough, dyspnea Bacteremia Meningitis
Pneumococcal vaccine PPSV-23: >2 years old (2-6), >65 years old, HIV PCV-13 4 doses: 2, 4, 6, and 15-18 months old Boosters: before school
Poliomyelitis Enterovirus Enters through mouth Hematologic spread to lymphatics and CNS Spreads along nerve fibers Destruction of motor neurons
Symptoms and complications of poliomyelitis Response is highly variable Spinal polio Paralysis Death
Poliomyelitis vaccine IPV: inactivated 4 doses: 2, 4, 6-18 months old, and 4-6 years old
Rotavirus Fecal-oral transmission (Stays in stool ~30 days)
Symptoms and complications of rotavirus Watery diarrhea Severe dehydration (w/fever & vomiting) Fever >103 (1/3 of cases) Electrolyte imbalance Metabolic acidosis
Rotavirus vaccine RV-1 (2 doses) RV-5 (3 doses) 2(or 3) doses: 2, 4, and (6) months old *Contraindicated if hx of intussusception*
HPV Human papilloma virus Most common STD infx in US
Symptoms and complications of HPV Most are asymptomatic STD infx 50% of cervical cancer Anogenital warts
HPV screening Pap test
HPV vaccine HPV-2 HPV-4 (approved in males) 3 doses: as early as 9 (usually 11-12) years old, then 2 and 6 months later *Given before sexually active*
Meningococcal disease Neisseria meningitidis A leading cause bacterial meningitis and sepsis in US Gram(-) diplococci
Symptoms and complications of meningococcal disease Meningococcal meningitis Meningococcemia (fever, rash, hypotension, multi-organ failure)
Meningococcal disease vaccine MCV-4 MPSV-4 (>55 years old) 2 doses: 11-12 years old and 16 years old Boosters: Work/travel in high-risk areas, Military
Herpes zoster Reactivation of latent varicella zoster Shingles
Symptoms and complications of herpes zoster Rash - unilateral, follows dermatome PHN Ramsay-Hunt
Herpes zoster vaccine Herpes zoster (Zostavax) Dosed: >50 years old *Independent of previous hx of shingles*
Influenza Influenza A subtypes (H and N) Influenza B: milder disease Influenza C: rare in humans
Influenza pandemic Antigenic shift Change in subtype
Influenza epidemic Antigenic drift Milder change
Symptoms and complications of influenza Fever Myalgia Sore throat Cough Headache Pneumonia (viral and secondary bacterial) Myocarditis Reye syndrome (aspirin use)
Influenza vaccine Inactivated (TIV): injection Live attenuated (LAIV): nasal spray 2 doses the 1st year given: 6 months old-8 years old After 1st year, give annually (9 years old and older) *No vaccine for <6 months old*
Contraindications for LAIV Pregnancy <2 years old >49 years old Asthma, COPD DM Renal disease Sickle cell, HIV, Immunosuppressed Children taking long-term aspirin Close contact w/immunosuppressed Allergic to eggs
Vaccines required before entering kindergarten Dtap: booster MMR/MMRV: 2nd dose PCV-13: booster
Vaccines required at 2 months old Dtap Hib Heb B: 2nd dose PCV-13 RV-1/RV-5 IPV
Vaccines required at birth Hep B
Vaccines required at 4 months old Dtap: 2nd dose Hib: 2nd dose PCV-13: 2nd dose IPV: 2nd dose RV-1/RV-5: 2nd dose
Vaccines required at 6 months old Dtap: 3rd dose Hib: possible 3rd dose Hep B: 3rd/final dose PCV-13: 3rd dose IPV: may give between 6-18 months old RV-5: 3rd dose Influenza: between 6 months old and 8 years old
Vaccines required at 12-15 months old Hib: 3rd or 4th dose/final Hep A: 2 doses 6-12 months apart MMRV
Vaccines required at 15-18 months old Dtap: 3rd/final dose PCV-13: 4th/final dose
Vaccines/Boosters given at 4-6 years old Dtap MMRV: 2nd/final dose PCV-13/PPSV-23 IPV: 4th/final dose
Vaccines/Boosters required at 11-12 years old Dtap ~HPV MCV-4: 1st dose
Vaccines/Boosters required at 16 years old HPV if not before
Vaccine given at or older than 50 years old Herpes zoster
Vaccines required before school entry DTaP MMR/V IPV Hep B
Vaccines required for childcare/headstart (preschool) Hib PCV Hep A
Vaccine required before college entry MCV
Created by: Carrie D.