Columbus: viral infections

Question 0

What vaccine is recommended for HIV-positive pregnant patients?

Answer 0

Pneumococcus

Question 1

What vaccines are contraindicated in pregnancy?

Answer 1

Live attenuated vaccines. Measles, mumps, rubella, polio, varicella, yellow fever

Question 2

How long should people wait for pregnancy after MMR?

Can MMR be given while breast-feeding?

How would you counsel a woman who received MMR during first trimester?

Answer 2

One month

Compatible with breast-feeding; no risk to newborn

No increased risk of anomaly; not indication for termination

Question 3

How soon after influenza vaccination do antibodies present?

How long does passive neonatal protection exist

Answer 3

Two weeks

Six months

Question 4

Who should not receive influenza vaccination?

Answer 4

Egg allergy
Children under 6 months due to Reye syndrome
Children 6 months to 18 years on chronic aspirin
Current illness with fever
History of vaccine reaction or Guillain Barre syndrome

Question 5

When should tetanus, diphtheria, pertussis vaccination be given during pregnancy?

How long does newborn passive immunity persist?

When should other newborn caregivers receive Tdap vaccination?

Answer 5

At any point but best between 27 and 36 weeks

Three months

At least two weeks prior

Question 6

What is the tetanus vaccination schedule for women who have never had the series?

Answer 6

0, 4 weeks, 6-12 months

Question 7

What is thiomerosal?

What is the current status of thimerosal as a vaccination preservative?

Answer 7

Mercury-based preservative in multidose vials; broken down into ethylmercury and thiosalicylate

Remove from childhood vaccinations as of 2001; replaced by more expensive preservatives with less long-term data

Question 8

What are the concerns for the fetus associated with maternal fever during pregnancy?

Answer 8

Risk of neural tube defects double with fever greater than 103.5° during neural tube closure

Risk of encephalopathy, neonatal seizures with increased fever near delivery

Question 9

What type of virus is influenza?

Answer 9

Single-stranded RNA virus; two subtypes: A and B

Question 10

How does influenza typically present?

Answer 10

Fever, chills, headache, myalgia

Question 11

Does pregnancy make women more susceptible to influenza?

Is the fetus at risk for infection?

What complications should be considered?

Answer 11

No

No evidence of in utero infection

Increased risk of bacterial superinfection or pneumonia
Increased risk of preterm labor

Question 12

How should influenza be managed?

Answer 12

Stay home, fluids, acetaminophen, rest, chicken soup

Oseltamivir 75-150 mg twice daily for five days or 75 mg twice daily 7-10 days for prophylaxis (type A only)

Question 13

What type of virus causes rubella?

What are the other names for rubella?

How is it transmitted?

Answer 13

A togavirus, which is a single-stranded RNA virus

“Third disease” or German measles

Hand-to-mouth, droplet with 90% acquisition rate

Question 14

When is rubella contagious?

How long is the incubation period?

Answer 14

Seven days prior to rash and seven days after

16-18 days

Question 15

What are symptoms of rubella infection?

Answer 15

Low fever
Pink, macular rash starting on head, spreads to trunk and limbs
Transient arthritis in adults

Question 16

How is rubella diagnosed?

Answer 16

IgM antibody presents 4 weeks after infection
Four-fold increase in IgG titers
IgG without IgM indicates immunity

Question 17

What is the rate of fetal infection during the first trimester?

What is the rate of fetal infection during the second and third trimesters?

How is fetal infection diagnosed?

Answer 17

90%

30-50%

Culture from amniocentesis; no predictive value for fetal injury; late ultrasound findings

Question 18

What is the risk of congenital rubella syndrome at 10 weeks or less?
11-14 weeks?
Greater than 14 weeks?

What is the mortality rate for infants with congenital rubella syndrome?

Answer 18

50%
10%
0%

10%

Question 19

What is the most common sequela of congenital rubella syndrome?

What are other sequelae?

Answer 19

Cochlear degeneration with deafness 70%

Blindness with retinopathy and Cataracs 20-30%
Microcephaly and retardation 25%
Cardiac anomalies 20%
Hemolytic anemia and thrombocytopenia

Question 20

What viruses are in the herpes family?

What type of viruses are these?

Answer 20

Herpes simplex I and II, varicella zoster, CMV, Epstein-Barr virus

Double-stranded DNA virus

Question 21

How long do symptoms from primary HSV infection persist?

How long does viral shedding occur?

When do antibodies develop?

Answer 21

3 weeks

4-5 weeks

Within 7 days and peek at 3 weeks

Question 22

What percentage of new genital infections are with HSV-1?

Answer 22

80%

Question 23

What is herpetic whitlow?

What is scrum pox?

Answer 23

Herpes found on healthcare workers particularly on the finger or thumb

Herpes on rugby players

Question 24

What is the risk of neonatal HSV infection with a primary maternal infection? Non-primary first episode? Recurrent genital infection? Recurrent oral infection?

Answer 24

50% 33% 3% Nearly 0%

Question 25

How does neonatal HSV infection present?

Answer 25

45% mild and localized to face 30% herpetic encephalitis with 10% mortality and 20% permanent sequela 25% disseminated with 30% mortality

Question 26

What percentage of the US population are anti-HSV-1 positive? HSV-2 positive? Cervical viral shedding of HSV occurs at what percent of deliveries?

Answer 26

50% 30% 0.5%

Question 27

What is the most accurate way to diagnose herpes? What other testing is available?

Answer 27

PCR testing of a vesicle Viral culture of a new vesicle Serologic testing

Question 28

How should primary or non-primary first episodes of HSV infection be treated?

Answer 28

Valacyclovir 1 g twice daily for 7-10 days | Acyclovir 400 mg three times daily for 7-10 days

Question 29

How should recurrent HSV be treated? How does this differ from prophylaxis dosing?

Answer 29

Valacyclovir 500 mg twice daily for three days Acyclovir 400 mg three times daily for five days Same; start at 36 weeks

Question 30

What is the effectiveness of HSV prophylaxis during pregnancy?

Answer 30

75% reduction in recurrence, 40% reduction in C-section rate, 90% reduction in viral shedding

Question 31

When is C-section indicated for delivery in the setting of HSV? If recurrent HSV lesions are distant from the genital hiatus, what mode of delivery is recommended?

Answer 31

Active lesions or prodromal symptoms Cover lesion with occlusive dressing and allow vaginal delivery