Hep A+B, HPV, Mpox, Pneumococcal, RSV

Question 1

Hepatitis B is caused by…

Answer 1

Viral infection (HBV)

Question 2

Duration of hepatitis B is usually…

Answer 2

Short-term; most clear infection after 4-8 weeks

Some people are chronic HB carriers

Question 3

HBV is transmitted via…

Answer 3

Blood or bodily fluids containing HB virus
(sharing injection equipment, sexual contact, vertical transmission)

Question 4

Signs + symptoms of hepatitis B may include…

Answer 4

Fatigue, fever, N/V, decreased appetite
Jaundice

Asymptomatic in 50% of adult cases and majority of children cases

Question 5

Hep B vaccination is given…

Answer 5

Part of primary series (2 doses, grade 6)

Question 6

Is a booster required for HBV?

Answer 6

Not for healthy population - potentially for some special populations based on serology

Question 7

HBV serology presents as:
HBsAg: Negative
Anti-HBc: Negative
Anti-HBs: Negative
This patent would be considered ____ to HBV.

Answer 7

Susceptible

HBsAg = surface antigen
Anti-HBs = surfac antibody
Anti-HBc = virus core

Question 8

HBV serology presents as:
HBsAg: Negative
Anti-HBc: Negative
Anti-HBs: Positive with >10 IU/L
This patent would be considered ____ to HBV.

Answer 8

Immune, from vaccination

Question 9

HBV serology presents as:
HBsAg: Negative
Anti-HBc: Positive
Anti-HBs: Positive
This patent would be considered ____ to HBV.

Answer 9

Immune, from infection

Question 10

If healthy patients have received appropriate immunization series for HBV, they are considered immune/protected for life even if anti-HBs drops below ____, because…

Answer 10

<10: immune memory to HB persists. Therefore another HB vaccine dose NOT required.

Question 11

Another dose may be given if anti-HBs is below 10 for…

Answer 11

Some special populations (immunocompromised, CKD)

Question 12

Hepatitis A is caused by…

Answer 12

Viral infection (HAV)

Question 13

Hepatitis A is transmitted via…

Answer 13

Fecal-oral

Contaminated food, water, drinks

Question 14

Signs + symptoms of hepatitis A include…

Answer 14

Adolescent/adults - anorexia, nausea, fatigue, fever, jaundice

Younger patients are usually asymptomatic

Question 15

Hepatitis A schedule is different from hepatitis B, in that…

Answer 15

It is not routinely given in childhood vaccinations - only recommended for people at increased risk of infection

Ex: Travel, certain living conditions, liver disease, unsafe injection equipment

Question 16

Twinrix contains ____ and is primarily used in SK today for…

Answer 16

Both HA and HB immunization - convenience for travel (someone requires HA for travel and unsure/no documentation for HB series)

If someone does have HB series done, then HA only (cheaper)

Question 17

HPV is caused by…

Answer 17

Viral infection

Question 18

HPV is transmitted…

Answer 18

Sexually - skin-skin contact
Vertically

Most common STI

Question 19

Signs + symptoms of HPV infection may include…

Answer 19

Mostly asymptomatic

Some develop genital warts
Some develop cancer

Question 20

HPV vaccine is available as…

Answer 20

HPV-9 (Gardasil)
HPV-2 (Cervarix) - this one is not commonly used

Question 21

NACI’s new recommendations regarding the HPV vaccine include…

Number of doses? Which vaccine to use?

Answer 21

HPV-9 preferred over HPV-2
9-20: 1 dose
21-26: 2 doses
27+: 2 doses
Immunocompromised: 3 doses

May be offered in pregnancy

As of 2024, SK follows old schedule with 2/3 doses

Question 22

HPV vaccine is approved for women up to age…

Answer 22

45 - consider discussing with unvaccinated adults with new sexual partners

Question 23

The HPV vaccine is ____, so it should be administered….

Answer 23

Adjuvanted - administered last (more painful)

Question 24

The HPV vaccine does not protect against…

Answer 24

Other STI’s

Question 25

HPV vaccine is most effective...

Answer 25

When given at a younger age, before exposure to HPV ## Footnote Vaccine after onset of sexual activity is still recommended - unlikely that vaccine recipient has been infected with all HPV types in vaccine Still indicated with in women with abnormal pap test, cervical cancer, genital warts

Question 26

Mpox is caused by...

Answer 26

Viral infection

Question 27

Mpox is transmitted by...

Answer 27

Skin-skin contact Respiratory droplets Animal to human

Question 28

Most cases of mpox have been diagnosed in...

Answer 28

Men who have sex with men

Question 29

Signs + symptoms of Mpox include...

Answer 29

Systemic illness - fever, chills, headache, myalgias, rash (similar to shingles) Atypical = lesions without systemic illness Cases of mortality in immunocompromised, or those who developed encephalitis

Question 30

Mpox is contagious until...

Answer 30

All lesion scabs have fallen off

Question 31

____ vaccine protects against Mpox.

Answer 31

Smallpox

Question 32

The smallpox vaccine is... | Type?

Answer 32

Live-attenuated, but non-replicating Safe in immunocompromised

Question 33

Smallpox/Mpox immunization scheduling is...

Answer 33

Not routine - based on risk factors (multiple sexual partners, environment) Prophylaxis: 2 doses given 1 month apart Post-exposure - 1 dose, up to 14 days since last exposure

Question 34

Pneumococcal vaccine is related to...

Answer 34

Bacterial infection due to streptococcus pneumonia ## Footnote Many serotypes

Question 35

Streptococcus pneumonia is transmitted via...

Answer 35

Respiratory droplets; direct/indirect contact with oral secretions

Question 36

Streptococcus pneumonia can cause...

Answer 36

Sinusitis, AOM, pneumonia Bacteremia, meningitis

Question 37

Interchangability of pneumococcal vaccines...

Answer 37

Is important to consider - most are not interchangeable due to conjugate and polysaccharide

Question 38

There are many types of pneumococcal vaccines because...

Answer 38

The most common serotypes that cause disease vary across different populations, and tend to change over time

Question 39

Compared to the polysaccharide vaccine, the conjugate vaccine...

Answer 39

Produces longer lasting immunity and has a more robust immune response that involves both B + T cells ## Footnote Polysaccharide is T-cell independent

Question 40

NACI recommends this for pneumococcal routine childhood scheduling...

Answer 40

PCV15 or PCV20 SK = PCV15 x 3 doses

Question 41

NACI recommends this for pneumococcal routine adult scheduling... ## Footnote NO IPD risk factors

Answer 41

65+ regardless of pneumococcal vaccination history with PCV13, 15 or 23: Give 1 dose of PCV 20 or 21. SK = only public funding if patient has not received ANY prior pneumococcal vaccines | Wait 1 year from last pneumococcal dose

Question 42

If someone is at increased risk of IPD, NACI recommends this for pneumococcal vaccine scheduling...

Answer 42

18+ with medical/environmental IPD risk factors, regardless of previous vaccination with PCV 13, 15, or 23: 1 dose of PCV 20 or 21. SK - if IPD risk factors present, potentially eligible for public funding

Question 43

RSV is caused by...

Answer 43

Viral infection

Question 44

RSV is transmitted by...

Answer 44

Respiratory droplets - annual outbreaks + reinfection is common

Question 45

Individuals at high risk of severe RSV include...

Answer 45

Chronic respiratory, cardiac, renal conditions Diabetes Immunosuppressed

Question 46

Signs + symptoms of RSV include...

Answer 46

URTI - mild, cold-like symptoms Lower lung infections Severe cases = oxygen + hospitalization required

Question 47

The three approved RSV vaccines in Canada include...

Answer 47

Arexvy - monovalent, adjuvanted Abrysvo - bivalent Mresvia - monovalent

Question 48

RSV vaccination is recommened for the following individuals who are RSV-vaccine naive (NACI)

Answer 48

Everyone 75+ 60-74 LTC residents, or are at increased risk of severe RSV (chronic diseases) | However, NOT publicly funded in SK yet

Question 49

NACI recommends this dosing schedule for RSV...

Answer 49

Abrexvy or Abrysvo x 1 single dose

Question 50

RSV efficacy studies showed...

Answer 50

A decrease in RSV-lower respiratory tract disease compared to placebo. Better results in those with higher risk factors

Question 51

RSV vaccine AE's include...

Answer 51

Arexvy contains an adjuvant, Abrysvo does not. Injection site rxns - pain, redness, swelling Systemic rxns - fatigue, myalgia, headache Serious AE's relatively similar to placebo; possibility for GBS, AFib