ID Prevention and Immunoprophylaxis- Exam 2 Flashcards
(140 cards)
1
Q
_____ A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops
A
bioterrorism
2
Q
_____ the processing of microbes or toxins in a manner that would ensure a devastating effect following release
A
weaponization
3
Q
What are the categories of bioterrorism agents?
A
Category A-C
4
Q
What is a category A bioterrorism mean? B? C?
A
Easily spread person - person
High mortality and morbidity
Requires special action for public health preparedness
Potential for public panic and social disruption
Moderately easy to spread
Low to moderate morbidity and mortality
Readily available
Could be engineered for mass spread in the future
Potential for major health impact
5
Q
Anthrax -(Bacillus anthracis)
Botulism - (Clostridium botulinum toxin)
Plague - (Yersinia pestis)
Smallpox - (Variola major)
Tularemia - (Francisella tularensis)
What category?
A
Category A
6
Q
Brucellosis (Brucella spp.)
Epsilon toxin of Clostridium perfringens
Food safety threats (e.g., Salmonella spp., Escherichia coli 0157:H7, Shigella)
Glanders (Burkholderia mallei)
Melioidosis (Burkholderia pseudomallei)
Psittacosis (Chlamydophila psittaci)
Q fever (Coxiella burnetii)
Ricin toxin from Ricinus communis (castor beans)
Staphylococcal enterotoxin B
Typhus fever (Rickettsia prowazekii)
Viral encephalitis (alphaviruses [e.g., Venezuelan, eastern, and western equine encephalitis])
Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
What category?
A
B
7
Q
Nipah
hantavirus
SARS
MERS coronavirus
pandemic influenza
What category?
A
C
8
Q
____ is the worst form in term of mass spread for bioterrorism agents
A
anything aerosol
9
Q
Gram + rod
Spore-forming
Found in soil
Can form painless vesicle that turns into necrotic eschar
Fever, fatigue, malaise, N/V, cough, SOB ⇾ pneumonia ⇾ pleural effusions ⇾ death
What am I?
What form is most likely used in bioterrorism?
A
Anthrax
respiratory (aka inhaled) is most common
10
Q
What is the treatment for Anthrax? What about post-exposure? For how long?
A
antitoxin
cipro or clindamycin
vaccination
cipro or doxy
lasts up to 60 days due to persistent spores
11
Q
_____ is the only bioterrorism agent that is non-living. Can it spread person to person?
A
Botulism
does NOT spread person to person
12
Q
T/F: The botulism antitoxin does not work on all the 7 distinct forms
A
False, DOES work on all the different forms
13
Q
What is the pathophys behind botulism?
A
Toxin prevents the release of acetylcholine = flaccid paralysis of muscles
14
Q
Multiple cranial nerve palsies leading to descending flaccid paralysis
Diplopia
dysphagia
dysarthria
dry mouth
ptosis
dilated pupils
fatigue
extreme weakness
What am I?
How do you dx?
A
Botulism
toxin immunoassay
15
Q
What is the treatment for botulism?
A
Intubation, mechanical ventilation, parenteral nutrition
Equine antitoxin if dx early in disease
Weeks to months of regeneration of new motor neuron synapses w/in the muscle cell
16
Q
T/F: There is a good botulism vaccine on the market, recommended for ages 18+
A
FALSE! no approved FDA vaccine
17
Q
Gram - bacillus
Painful LAD w/ necrosis, fever, bacteremia ⇾ septicemia ⇾ death
Nodes called buboes
Extensive ecchymosis and necrosis of digits and nose
either can be from a bite of an infected rat flea or inhalation of the bacteria
Fever, cough, hemoptysis, and GI Sx
What am I?
A
Bubonic plague
18
Q
How do you dx bubonic plague? What is the treatment?
A
Blood cultures and / or cultures of buboes, sputum
Antibodies
gentamicin, streptomycin, doxycycline, fluoroquinolone
19
Q
What is the prophylaxis treatment for bubonic plague? What is the prevention?
A
Doxycycline and ciprofloxacin X 7 day
No vaccine available
20
Q
_____ has been eradication globally. What is the virus called?
A
smallpox
Variola major
21
Q
_____ is a double-stranded DNA virus from Poxviridae family. Virus infects host ⇾ spreads to lymphoid tissue ⇾ localized infection of skin dermis ⇾ 2-14 days later ⇾ fever, malaise, HA, N/V, back pain, rash (maculopapular to face and extreme ⇾ spreading to trunk ⇾ turn to vesicles, then pustules, then scabs), mouth ulcers
A
Smallpox
22
Q
How do you dx smallpox? What is the treatment?
A
Culture, PCR
Antibodies
Strict isolation
Supportive measures only
Antivirals have not really been studied
23
Q
Small, non-motile, gram - coccobacillus
NOT spread person to person
Non-spore forming
rabbit fever or deer fly fever
spread through ticks and fleas that bite an infected host and pass to humans
What am I?
A
Tularemia
24
Q
Pharyngitis, pleuritis, bronchopneumonia
Fever, HA, chills, fatigue, malaise
Conjunctivitis and exanthems also possible
50% will have an infiltrate on CXR; hilar adenopathy w/o infiltrate also possible
What am I?
How do you dx?
A
Tularemia
Gram stain or cultures of infected tissues or blood
25
What is the treatment for tularemia?
Streptomycin, doxycycline, gentamicin, fluoroquinolones
26
What is a very deadly viral hemorrhagic fever used for bioterrorism?
Ebola virus
27
All are enveloped, single-stranded RNA viruses that require a host. Human's contract ____ by being in direct contact with body fluids
viral hemorrhagic fevers
28
Fever, myalgia, prostration, DIC w/ thrombocytopenia and capillary hemorrhage
Viral hemorrhagic fevers
29
When should you suspect a viral hemorrhagic fever?
Should be suspected in any person w/ temp >38.3 ℃ (or 101 ℉) for <3 weeks with at least 2 of the following (in the absence of another cause):
Hemorrhagic or purpuric rash
Epistaxis
Hematemesis
Hemoptysis
Hematochezia
30
What is the dx testing for Viral Hemorrhagic Fevers? What is the treatment?
Serological testing for antigen and antibody; PCR - sent to the CDC
No approved treatment or vaccine
Experimental - antibody cocktails and ribavirin
31
In September 2001 ____ was released through USPS, with 22 infections and 5 fatalities
anthrax
32
____ was the main focus of the pre-1991 Iraqi bioweapons program. Japan produced it in 1930 and used it to poison prisoners
Japanese cult successfully infected civilians in Tokyo on 3 separate occasions
Botulism
33
_____ WWII - Japanese dropped _____ over China causing an outbreak in areas of target
Yersinia pestis aka the plague
plague-infested fleas
34
smallpox has a ____ mortality rate when infected
10-30%
35
____ was possibly used to infect sheep and sent into enemy lines by the Hittites in the 14th century. There was an outbreak among German and Soviet soldiers on the frontline in WWII
Tularemia
36
1992 - a Japanese cult travelled to Africa under false assumptions to aid _____ in an effort to obtain the virus for bioterrorism use. What dz?
Ebola victims
Viral hemorrhagic fever
37
What is the short version of the Universal Precautions?
Treat all human body fluids as if they are infected
38
Includes hand hygiene; PPE based on certain types of exposure; safe injection practices; and safe management of contaminated equipment and other items in the environment. Applies to all patients and all bodily secretions (urine, feces, nasal secretions, sputum, vomit)
Standard Precautions
39
Gown and gloves required for pt or environment contact
Sometimes above needed to even enter patient room
What kind of precautions?
Contact precautions
40
Surgical mask required w/in 3 feet of patient
What kind of precaution?
Droplet precaution
41
Negative pressure isolation room
Respirator must be worn
What kind of precaution?
Airborne infection isolation
42
When in contact w/ blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment
What types of PPE?
Gloves
43
During procedures when contact of clothing, exposed skin w/ blood/body fluids, secretions, excretions, or body fluid is anticipated
What type of PPE?
Gowns
44
Any activity which may result in splashes or sprays of blood, body fluids, secretions, or excretions
What type of PPE?
Mask/Goggles or Face shield
45
_____ induced by vaccines prepared from bacteria or their products
active immunity
46
_____ administration of preformed antibodies in preparations called immunoglobulins
passive immunity
47
An _____ vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable. _____ takes an infectious agent and alters it so that it becomes harmless or less virulent.
attenuated
Attenuation
48
More stable
Safest form
Weaker immune response
often requires multiple doses/boosters
What type of vaccine?
Give some examples
inactivated/dead virus
seasonal influenza, polio
49
Does not cause active disease (typically)
Provides greatest immunity
What type of vaccine?
Give some examples
Live, attenuated - live but weakened virus
MMR
50
Contain only antigens
Less risk of adverse reactions
Very time-consuming to make
What type of vaccine?
Give some examples
Subunit vaccines
Hep B
51
For bacterial infections that secrete toxoids
Inactivated toxoids
What type of vaccine?
Give some examples
toxoid vaccines
tetanus, diphtheria, pertussis
52
Works against bacteria w/ a cell wall
Produce synthetic product containing cell wall similar to the bacteria
What type of vaccine?
Give some examples
conjugate vaccine
HIB type B vaccines, Pneumococcal
53
______ use a live bacteria as a vector
Recombinant vector vaccines
54
**What is the CI for all vaccines? What is a precaution?
Severe allergic reaction - anaphylaxis
Pregnancy and severe immunosuppression - no LIVE vaccines, including live-attenuated vaccines
Acute illness that is moderate to severe - with or without fever
55
_____ is approved for ages 6 weeks ⇾ 7 years of age
Made up of inactivated forms of the toxins produced by these bacteria, as well as acellular antigens of pertussis
DTaP
56
____ lower dose of the toxin components used for booster doses only
Indicated for those 7 years of age and older
What is it called w/o the pertussis component
Tdap
Td
57
Hx of encephalopathy - coma or prolonged seizures w/in 7 days of administration of the vaccine w/ pertussis components
Progressive, unstable neurological d/o, uncontrolled seizures, etc. - hold off on vaccine until controlled
These are the CI of _____
Diphtheria, Tetanus, Pertussis vaccine
58
What type of vaccine is MMR?
live-attenuated vaccine
59
When do you give Td?
Given for a dirty wound if it’s been > 5 years since last tetanus
60
What are the CI of the Diphtheria, Tetanus, Pertussis vaccines?
Hx of encephalopathy - coma or prolonged seizures w/in 7 days of administration of the vaccine w/ pertussis components
Progressive, unstable neurological d/o, uncontrolled seizures, etc. - hold off on vaccine until controlled
61
What pt population should you NOT give the MMR vaccine to? Why?
pregnant women and immunocompromised because it is a LIVE attenuated vaccine
62
What is the dosing schedule for MMR? When do you NOT give the MMRV combo?
2-part series given at WCC:
12 months
4 years - typically combined w/ varicella - ProQuad vaccine
MMRV combo not given under 23 months due to febrile seizure risk
63
What is the timeframe to give MMR prophlaxis?
May be administered w/in six days of exposure
64
What are the CI to MMR vaccine?
Pregnancy
Severe immunodeficiency
Postpone a month if pt has been on long-term (>14 days) of steroids
**Immediate hypersensitivity reaction to gelatin or neomycin - components of the vaccine
65
What type of vaccine is Polio? What is the dosing schedule?
inactivated vaccine
Given IM or SQ
4-dose series given at WCC
2 months
4 months
6 months
4 years
66
What are the CI to the polio vaccine?
Previous reaction to IPV
**Allergy or sensitivities to streptomycin, polymyxin B, and neomycin
caution in pregnancy
67
What type of vaccine is Hep A? What is the dosing schedule? What are the CI?
Inactivated / killed virus
Given IM
2-dose schedule given at WCC
12 months
2 years
No CI
68
____ MOA causes an immune reaction by activating lymphocytes to attack the antigen, engulf it, which releases inflammatory mediators signaling B and T-cells. These cells go on to produce new B and T-cells with specific activity against _____
hepatitis A
hepatitis A antigen
69
What type of vaccine is Hep B? What is the dosing schedule?
Subunit vaccine
Given IM
4-dose vaccine given at WCC
Birth - 1 month
2 months
4 months
6 months
70
____ MOA is ____ proteins in the vaccine are recognized by antigen presenting cells process the antigen and introduce it to the T-helper cells. B-cells now recognize the antigen causing a weak immune response which then produces neutralizing antibodies
Hep B
HBsAg proteins
71
What are the CI to Hep B?
Hypersensitivity to yeast
Severe allergic reaction to latex
72
What type of vaccine is rotavirus? Based on what?
Live-attenuated vaccine
Issue w/ different strains of RV in geographical regions
73
Which type of rotavirus vaccine? _____ live-attenuated G1P human RV vaccine
Rotarix
74
Which type of rotavirus vaccine? _____ live pentavalent bovine-reassortant vaccine containing G1,2,3,4 and P1
RotaTeq
75
Why is rotavirus considered dangerous in kids?
can result in 40 poopy diapers an hour, sever risk of dehydration
76
What is the dosing schedule for rotavirus? (Rotarix)
2-dose vaccine:
2 months
4 months
77
What is the dosing schedule for rotavirus? (RotaTeg)
2 months
4 months
6 months
78
What are the requirements for all Rotavirus vaccines regardless of the brand? Are you able to "catch up" on this vaccine?
Dose of either of the above should be given before 15 weeks of age and all doses given before 8 months of age
NOT able to catch this vaccine up
79
What are the CI of the rotavirus vaccine?
Severe immunodeficiency
Previous h/o intussusception
Severe illness - wait until recovery to give vaccine
80
What type of vaccine is HIB? Haemophilus Influenzae
Polysaccharide conjugate vaccine
81
In the 1980s, prior to the vaccine, ____ was the leading cause of meningitis in children < 5 yo
HIB
82
_____ MOA attaches a polyribosylribitol phosphate (PRP) capsule to a protein, which will recruit T-cells and lead to the formation of sufficient numbers of anti-PRP antibodies
HIB vaccine
83
What is the dosing schedule for HIB?
IM
can be given in combo
2 months
4 months
6 months
12-15 month - booster
84
What are the CI of the HIB vaccine?
Same w/ all other vaccine
Do no give to infants < 6 weeks of age
85
____ vaccine is active against strep pneu, immunity begins in 2-3 weeks and lasts around 5 years. What type of vaccine?
Pneumococcal vaccine
all conjugate polysaccharide vaccines
86
What are the 4 types of pneu vaccines?
PCV13 - Prevnar 13
PPSV23 - Pneumovax 23
PCV 15 - Vaxnuvance
PCV 20 - Prevnar 20
87
What is the dosing schedule for PCV13?
IM
4-dose series given at WCC
2 months
4 months
6 months
12 - 15 months
>6 y/o - single dose
88
What is the dosing schedule for PPSV23?
IM or SQ
1-dose
Indicated in adult population of those >65 y/o who have already received Prevnar 13
89
What is the dosing schedule for PCV15 and PCV20?
1-dose
Indicated in adult population of those >65 who have not received either PCV 13 or PPSV23
90
The flu vaccine types can either be _____ or ______
Inactivated / killed vaccine
or
Live-attenuated vaccine
91
What is the inactived/killed flu vaccine derived from?
Derived from hybrid strain mixed w/ laboratory strain and grown in eggs
92
What is the live-attentuated flu vaccine's target/goal?
Donor virus is mated w/ an anticipated epidemic wild strain
Induces nasal IgA antibodies
93
What are the important points about Fluzone?
6 months and older for standard dose of Fluzone
egg based
quadrivalent
94
What are the important points about Flucelvax?
4 years and older
egg free and grown in cells of mammals
cell culture based
quadrivalent
95
What are the important points about Flublok?
uses recombinant technology and is egg-free as well
18 years and older
quadrivalent
96
The trivalent vaccine of Fluzone high dose, who is it indicated for?
65 and over
Contains 4 times the antigen of the standard vaccine to provide better protection
egg based
97
What are the important points about FLUAD?
formulated with the adjuvant MF59
65 and over
Standard dose
98
What are the CI for the intranasal live attenuated flu vaccine? What age range?
Pregnancy
Children 2-17 receiving ASA therapy
Immunosuppression
Children 2-4 w/ asthma or wheezing in past 12 months
People who have taken influenza antiviral meds in the past 48 hrs
People who care for immunosuppressed individuals
Chronic medical conditions, such as DM, chronic kidney dz, etc.
2-49
99
**What is the dosing schedule for the flu vaccine in children 6 months to 8 years?
should receive 2 doses of influenza vaccine in the same season if they have never had two in one season previously
season is October through March
100
**What is the dosing schedule for the flu vaccine in children 9 years and older?
only need 1 dose regardless of previous vaccination hx
101
**What are the CI for the inactivated flu vaccine?
Severe latex allergy
Precautions
GBS infection w/in 6 wks of previous influenza vaccine
**Egg allergy is NOT a CI
102
What type of vaccine is Varicella? What is the dosing schedule?
Live-attenuated vaccine
Given SQ
2-dose series at WCC
12 month WCC
4 year WCC - usually in combo w/ MMR vaccine
103
____ MOA produces an IgG humoral immune response causing a cell-mediated immune response by varicella-zoster-specific activation of both CD4+ T-helper and CD8+ T-lymphocyte cells
Varicella vaccine
104
What are the CI to the varicella vaccine?
Hx of allergy to neomycin
Blood dyscrasias (leukemia, lymphoma - anything that affects the bone marrow)
Moderate to severe illness
Anyone who has received blood products w/in 3-11 months
Immunocompromised or pregnant
105
What strands of N. meningitidis does the meningococcal vaccine protect against?
A, B, C, W, X, and Y are responsible for majority of invasive disease
106
_____ and ______ are conjugated polysaccharide vaccines - protects against serotypes A,C,W, and Y
Menactra
and
Menveo
107
____ and ____ are recombinant vaccines - protect against serotype B
Bexsero
and
Trumenba
108
What is the dosing schedule for Meningococcal ACWY?
given IM
2-dose series at WCC - required for public schools
11 years
16 years
109
What is the dosing schedule for Meningococcal B?
2-dose series - still optional, but most colleges require
16 years
6 months after 1st dose
110
What are the CI to the meningococcal vaccine?
Severe allergic reaction to latex
111
What type of vaccine is HPV? What is the dosing schedule?
Subunit vaccine
Given IM
Indicated in ages 9-45, but most have no benefit over age 26
2 or 3-dose series dependent upon timing of administration of the vaccine
If administered before age 15 - only 2 doses needed
11 years old
Next dose in 6-12 month
112
____ MOA is recombinant DNA was used to generate virus-like particles capable of mimicking the natural virus and eliciting high-titers of virus neutralizing antibodies
HPV vaccine
113
_____ (name of vaccine) protects against strains 6, 11 (genital warts) and 16, 18 (cervical cancers) and now 31, 33, 45, 52, and 58
Gardasil 9
114
What are the CI to HPV?
Immediate hypersensitivity to yeast
Severe latex allergy
Precaution
Pregnancy
115
Live vaccine is introduced into system and patient produces a low-level viremia
IgM antibodies are produced against __
Virus may be passed through blood products so no blood donations allowed in pts who have received __ vaccine w/in 14 days
What vaccine?
yellow fever
116
What type of vaccine is yellow fever? What is yellow fever spread by? What type of virus is yellow fever?
live-attenuated vaccine
spread by Aedes mosquitoes
Enveloped, single-stranded RNA virus, flavivirus
117
What is the dosing schedule of yellow fever? What age range?
one injection for those traveling to or living in an area that is at risk for yellow fever
9 months - 59 years of age
118
Does yellow fever immunity last a lifetime?
Usually lifelong protection, but given again in 10 years if traveling to high risk areas
119
What are the CI to the yellow fever vaccine?
6 months or younger
Immunocompromised
120
What are the two types of typhoid vaccines?
Capsular, polysaccharide vaccine
Oral, live-attenuated vaccine
121
What type of bacteria does the Typhoid vaccine protect you from?
Protects from gram negative Salmonella enterica serotype typhi (Salmonella typhi)
122
Works by causing lipopolysaccharide biosynthesis inducing a local protective immune response in the intestine
Due to the build up of lipopolysaccharide intermediates, the bacterial cells lyse before causing a virulent infection
What vaccine?
oral, live attenuated typhoid vaccine
123
What is the oral typhoid vaccine dosing schedule?
1 capsule by mouth every other day totaling 4 pills
May travel 1 week after last dose
Given at 6 years of age and older
Booster every 5 years
124
What is the IM injection typhoid vaccine schedule?
One dose
May travel 2 weeks after vaccination
Given at 2 years of age and older
Booster every 2 years
125
What are the CI for the typhoid vaccine?
Oral vaccine:
Pregnancy
Immunocompromised
IM injection:
No real contraindication except as w/ all vaccinations, but best to delay until 2nd trimester of pregnancy
126
Binds to the RV preventing it from invading the CNS
Also builds up antibodies to allow the vaccine to work more proactively
What am I?
Rabies immunoglobulin - passive immunization
127
Inactivated antigen vaccine
Builds antibodies against the RV
What am I?
Rabies vaccine - active immunization
128
Who needs to receive the rabies vaccine?
Used for pre-exposure immunization in high risk individuals as well as those who require post-exposure prophylaxis
infected person need both passive and active immunization
129
What is the dosing schedule for HRIG - Human rabies immunoglobulin?
Injected around the wound up to 7 days after first dose of vaccine
If full amount not used, inject the rest at a different site from rabies vaccine
Is not given to those who have had previous vaccination
130
What is the dosing schedule for the rabies vaccine?
1 mL given IM (deltoid) on days 0, 3, 7 and 14
If previously immunized, it’s given only on days 0 and 3
Immunocompromised persons should receive a fifth dose on day 28
In 2013, the vaccine age indication was dropped to 2 months of age
131
_____ is immunoglobulin only - not an actual vaccine
Synagis / palivizumab: Humanized monoclonal anti-RSV antibody
132
What is the MOA for Synagis?
Bind RSV F protein, which plays a role in virus attachment and mediates fusion
Does not inhibit virus attachment
Does inhibit viral transcription
133
What is the dosing schedule for Synagis?
Must be given monthly to high-risk individuals during respiratory season (Sept - May)
15mg/kg/month IM
55% reduction in RSV admissions in premature infants
134
Antibodies or antibody fragments derived from the plasma of large mammals (generally horses, but also sheep, goats, or rabbits) that have been previously immunized with non-lethal ______. Attaches to and neutralizes the _____ proteins causing it to be released from the receptor site
venomous doses
poisonous venom
135
What is the dosing schedule for antivenoms?
The sooner initiated, the more effective - typically w/in 4 hours of bite
Indicated for progressive local tissue findings, hematologic laboratory abnormalities, and/or evidence of systemic toxicity
Airway swelling, neurological toxicity, cardiovascular collapse
136
What is the proper protocol to administer antivenoms?
Initial dose:
4-6 vials IV over 1 hour
95% of cases control is achieved w/ initial dose
Subsequent doses:
An additional 4-6 vials
Maintenance dose:
2 vials every 6 hours up to 3 doses
This is started 6 hours after control achieved
Decreases recurrence of symptoms
137
What is "control" defined as in antivenom cases?
Systemic symptoms resolved
Hematologic abnormalities are improving
Local effects have begun to improve
138
What are some cautions when using antivenom?
Sensitivity should be tested first by injecting 0.1 mL SQ first and watching for any localized reaction over the next 30 min
Epinephrine and antihistamine should be at the bedside
Serum sickness
139
Can occur days to weeks after administration of antivenom
Hypersensitivity reaction to the alien immunoglobulin
Anaphylactic and pyrogenic reactions
Fever, chills, rigor, headache and tachycardia
Skin rash, generalized allergic reaction
What am I?
Serum sickness in response to antivenom
140
