final quiz Flashcards
final quiz studying (135 cards)
Seven rules of vaccination:
The more similar a vaccine is to the natural disease, the better the immune response to the vaccine.
Circulating antibody has more effect on the immune response to live attenuated vaccines than on the immune response to inactivated vaccines.
All vaccines can be administered at the same visit as all other vaccines.
Live attenuated vaccines generally produce long-lasting immunity with one or two doses. Inactivated vaccines generally require three or more doses and may require periodic boosting to maintain immunity.
Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine. Decreasing the interval between doses of a multidose vaccine may interfere with the antibody response and protection.
Adverse reactions following live attenuated vaccines are similar to a mild form of the natural disease. Adverse reactions following inactivated vaccines are mostly local, and may occur with or without fever.
two permanent contraindications to vaccination
Severe allergic reaction to a vaccine component or following a prior dose of vaccine. (Do not give another dose of that vaccine.) Encephalopathy without a known cause occurring within 7 days of a dose of a pertussis-containing vaccine. (Do not give another dose of a pertussis-containing vaccine.)
Temporary Contraindications to Vaccines
- Pregnancy (live)
- Moderate/severe illness (all)
- Immunosuppression (live)
- Antibody containing products (live)
Influenza
annually for life, two types of vaccine available – inactivated influenza vaccines (TIV) IM and live attenuated influenza vaccine (LAIV) intranasally.
Can use intranasal LAIV if less than 50, healthy, non pregnant and not high risk.
Over 65 use standard seasonal or high dose.
OK for women in their second/third trimester.
Do not give to those on chemotherapy, not within three days of pertussis vaccine, not during febrile illness, if using LAIV do not administer when nasal congestion is present.
LAIV should not be given to pts with chronic pulmonary, cardiovascular, renal, hepatic, neurologic/neuromuscular, hematologic or metabolic disorders, immune suppression, HIV/AIDs, children up to 18 years old receiving aspirin or other salicylates, or pregnant women.
TD/Tdap
Tetanus, diphtheria, pertussis - first dose to infants with boosters before age of 2. Then booster Td every 10 years for life substituting 1 Td booster with Tdap in adulthood (12, 22, 32, etc.)
All pregnant women receive Tdap regardless of history.
Uncertain history – give 3 dose primary series of Td with Tdap as one of the doses.
Adults 65 and older in close contact with children 12 months and younger, who have not already received Tdap or whose pertussis status is unknown SHOULD get single dose Tdap. All adults 65 and over MAY get single dose Tdap.
In wounds, if no completion of series may require passive immunity with Human TIG especially if wound is contaminated with soil containing animal excreta.
Varicella Vaccine
contains cell-free live attenuated varicella-zoster virus.
Breakthrough disease is common about 42 days or longer after vaccination.
When immunized in early childhood, a single dose is very effective, with an age related decreased in effectiveness.
All adults who do not have evidence of immunity should receive 2 doses 4 weeks apart. Pregnant women should be immunized if no immunity evidence once the child has been born but before leaving the hospital.
Special considerations to HCP, family contacts of persons with immune compromise and those at high risk for exposure or transmission
Zoster vaccination
live attenuated form of the varicella-zoster virus approved for use in adults older than 60, it is the same as the varicella vaccine but contains 14 fold higher concentration of the strain.
It prevents zoster in 50% of recipients and prevents neuralgia in 2/3 of the recipients.
Do not give to severely immune compromised patients (AIDS, immunosuppressive TX, corticosteroid use, ALL, active TB, blood dyscrasias, bone marrow malignancy and lymph malignancy. Hold dose if received IGG treatment in the last 5 months.
Do not give to pt with Hx of anaphylaxis to neomycin.
Contraindicated in those with anaphylactic reaction to gelatin, neomycin or any other component.
MMR
a live attenuated vaccine,
All children receive this at 12-15 months with a booster at 6years.
Adult health care workers without history of vaccination or evidence of immunity should received 2 doses.
severely immune compromised ppl should avoid,
pts on high dose oral corticosteroids should wait 1 month after cessation to be vaccinated, women should wait 1 mos after vaccination to get pregnant,
if receiving IgG must wait 3 months after end to get MMR,
TB skin test should postpone until 4-6 wks after MMR.
HPV vaccine
HPV4 (6,11,16,18) and HPV 2 (6,18).
HPV2 not indicated for males.
Gardasil given to both males and females. Cervarix only for females.
administer 3 doses after age 11 and before age 26 in women, through age 21 unless not previously immunized in males
Could be given as young as 9 yrs old
MSM between 21-26 years.
Second dose should be administered 1-2 months after first, the third dose should be 6 months only longer after the first.
Do not administer to pregnant women, ok for lactation, ok for immune compromised.
Pneumococcal
PPSV23 (pneumovax) is polyvalent mixture from the 23 most prevalent or invasive types. Recommended for all adults over 64, and for those 2- 64 years who have a chronic medical problem, immune suppression, or immunosuppressive therapyl smoker, asthma, or resident of a LTC or SN facility.
If first given before age 65, give one dose at age 65 or 5 years after first dose, whichever is later. No booster after age 65. Max 2 doses per lifetime.
PCV13 (Prevnar 13) was approved for use in children up to 10 years, should also be used in adults older than 19 with immune compromise, cochlear implants, CSF leaks or asplenia. In these adults never previously immunized, PCV13 is given and then followed by PPSV23 no sooner than 8 weeks later.
If previously immunized adult, if received PPSV23, then give PCV13 1 year after most recent dose. For those needing more PPSV23, it should not be administered until 8 weeks after PCV13 and 5 years after most recent PPSV23 dose.
Meningococcal vaccine
MCV4 (Menactra) Single dose should be administered at 11 years or prior to high school. Anyone at risk for meningococcal dz should be immunized – including college dorm living, military recruits, living in endemic areas, asplenia, or complement component deficiency.
MCV4 for age 55 and under. MPSV4 (Menomune) for those older than 55 years.
Do not use in patients with Hx of Gillian Barre!
Hepatitis A vaccine
administer routinely to children older than 1 year, with a second dose given 6-12 months later. Indicated for high risk individuals: IVDU, MSM, HIV, high risk work settings, those at risk for fulminant liver disease , recipients of clotting factors, HCPs, or those travelling to areas endemic.
Hepatitis B vaccine
Recommended for all infants, and children if not administered in infancy.
Adult with the following conditions should be vaccinated: diabetes, chronic liver disease, ESRD, household contact or sexual partner of HBV +, high risk individuals HIV, MSM, prisoners, IVDU, etc. individuals who receive blood products, hemodialysis patients, residents and staff of LTC and correctional Institutions, and immigrants/adoptees/family members where it is endemic. Some travel indication. Health care personnel and public safety staff
Under 20 dose at 0.5ml, over 20 dose at 1ml IM, 3 total doses, 2nd dose 1-2 mos after 1st, 3rd within 6 mos of 1st dose.
Polio vaccine
an inactivated, killed virus (IPV) given as .5ml IM, initial series should be done in early childhood. Offers lifetime immunity.
Should be offered to adults who travel to endemic areas, for lab workers handling virus, or healthcare workers in close contact with patients.
IPV dose can be given to adults who previously received OPV (oral polio virus – administered orally not in the states)
Avoid giving to pregnant women unless immediate protection is needed.
Rabies vaccine
give to those at high risk for animal bites, given as a series and started immediately after any bite. Rabies immunoglobulin gives passive protection when started after exposure to rabies.
Yellow fever
a live attenuated virus preparation which gives 10 years immunity for travelers and lab personnel with exposure risk.
Do not give to children younger than 9 months, do not give during pregnancy unless high risk of exposure.Do not give to those with immune disorders.
Avoid during lactation.
Typhoid vaccine
live attenuated product taken orally (Ty21a) or polysaccharide prep IM (ViCPS).
Give to those travelling to areas where endemic, India, Middle East and central Africa, those who expect contact with infected individuals, and in lab workers who handle it.
Do not give oral formulation to immunocompromised individuals.
Antimalarial drug proquanil should not be stared until 10 days after the oral dose.
Do not administer during acute gastroenteritis.
Primary prevention
is the promotion of well being and is targeted toward the well population. In primary prevention we are trying to prevent a person’s development of risk. This is the classic health promotion phase. Education on both an individual and community basis is key.
EG flouride treatments, folic aacid, immunizations, legal drinking age, condoms
Secondary prevention
is the early intervention phase, targeting those at risk or who have developed risk of illness. Interventions that occur when there is already disease but before there are symptoms, such as in pap, colonoscopy and mammography screening. In this phase we are trying to prevent progression to established disease and hospitalization/chronic management/acute processes.
Tertiary prevention
is essentially disease management. A person has an established disease, is rehabilitating to restore or maximize function, or is in continuing care for disease management. Goals include prevention for complications, reduction of disability. (ie support groups, chronic pain management, PT)
Positive predictive value
the proportion of people with a positive test result who have the target disease
Negative predictive value
the proportion of people with a negative test result who do not have the target disease
Prostate CA screening
second leading cause of cancer death in men over 50. PSA has a poor balance of specificity and sensitivity, identifies trends well.
Screen starting at age 50 for those without risk factors.
Discuss starting at 45 years for those that are African American or first degree relative with prostate CA before age 65, if multiple first degree relatives with Dx start at age 40.
Combine PSA and DRE in screening conversation.
Focus on prevention – maintain healthy weight, 30 min of vigorous exercise 5 or more times a week, eat at least 5 servings of vegies and fruits, 3 servings of whole grains, cut back on red meats, especially processed ones. Red flags include difficulty starting stream, erectile dysfunction.
Colorectal CA screening
Start at age 50 and stop at 75 if low risk
Start at age 40 if high risk.
Risk factors include personal history of cancer or polyps, strong family history, personal history of chronic inflammatory bowled dz, familial adenomatous polyposis, hereditary non-polyposis colon CA in family, African American, Ashkenazi Jews. If IBD, start 8-10 years after dz.
fecal occult blood test (FOBT) and fecal immunochemical test (FIT) every year, and
stool DNA test (sDNA) at uncertain interval. Colonoscopy should be done for any positive.
FOBT and FIT should be conducted with take home multiple sample. Do not do in office with rectal exam.
OR Tests that find polyps and cancer include flexible sigmoidoscopy (every 5 years), colonoscopy every 10 years, double contrast barium enema every 5 years, or CT colonography every 5 years.
