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Flashcards in IDMM Week 5 Lectures Deck (50):
1

Provincial level health bodies in Canada

Ministry of health
BC CDC
Provincial Lab

2

Regional health bodies in Canada

5 Regional Health Authorities
First Nations Health Authority
Provincial Health Services Authority

3

Describe a paradigm for infection control

Agent-Host-Environment triangle as methods for prevention and control

4

Targets for improved Public Health at the host level

1. immunobiologics (vaccines)
2. Passive antibody treatment--rabies immune globin
3. improving general health--nutrition, rest
4. chemoprophylaxis--antimalarial drugs
5. treatment to prevent progression to active disease--HIV Tx
6. Prevention behaviours--sexual, drug use, eating
7. Measures for infected persons--isolation, quarantine, activity, etc.

5

Targets for inactivation of infectious agent

1. Physical methods: heat, cold, radiation, cleaning
2. Chemical methods--chlorination, disinfection, sterilization

6

Targets for Public Health in the environment

1. Sanitation--water, food, feces
2. Engineering measures--design of facilities, bed nets
3. Administrative measures--cleaning protocols

7

What is primary prevention

prevention before acquisition of disease/illness/infection (immunization)

8

What is secondary prevention

prevention for those who have the disease/illness/infection but before apparent/aware of illness (i.e screening for Hep B in pregnancy)

9

What is tertiary prevention

prevention of those with known disease to prevent complications/progression/spread (ie HAART in HIV)

10

INfectivity

#infected/#exposed

11

Pathogenicity

#clinical cases/#infected

12

Virulence

#severe/fatal / #clinical cases

13

Case fatality ratio

#deaths/#clinical cases

14

Attack rate

#new cases in time 'x'/population exposed

15

Reproductive rate

average number of secondary cases (in a susceptible population) that will be generated from each contagious disease

a function of:
1. duration of contagiousness
2. number of contacts in that period
3. probability of transmission given exposure

16

What virus appears characteristically as "dew drop on a rose petal"

Varicella

17

Control measures for varicella

-report to public health
-isolation of cases while infectious (until rash has crusted over)
-quarantine of exposed susceptibles if in high risk environment
-protect contacts: immunoprophylazis--vaccine within 3 days of exposure, varicella zoster immune globin (VZIG) within 4 days--can prevent or lessen symptoms

18

List some reportable diseases

AIDS
Campylobacteriosis
Anthrax
Botulism
Chlamydia
Cholera
C. difficile associated diarrhea
Cryptosporidiosis
Diptheria
Giardiasis
Gonorrhea
Group B Strep
Hep A, B, C
HIV
Influenza, lab confirmed
Listeriosis
Lyme disease
malaria
Measles
Mumps
Norovirus
Pertussis
Polio
Rabies
Rubella
Tetanus
TB
Typhoid fever
West Nile

19

What infection accounts for 60-80% of primary liver cancer globally?

Hepatitis B

20

Primary prevention of Hep B

immunization, education on risks of transmission, infection control

21

Secondary prevention of Hep B

routine screening for HBV in pregnancy
perinatal HBimmunoglobin and vaccination at time of delivery if mom is HBV +
Post exposure prophylaxis for exposed individuals

22

Tertiary prevention for HBV

screening for complications (cirrhosis, HCC)

23

Discuss HBV immunization

-routine childhood immunizations at 2, 4, 6 months (catch up grade 6)
-adult indications for vaccine: IVDU, infected partner, multiple sex partners, Hx of STIs, travel, healthcare workers, chronic liver disease, end stage renal disease, HIV

24

What accounts for 40% of all chronic liver disease

Hep C--most common reason for a liver transplant

25

Passive immunity

short-term, Igs introduced (can be from mom, human donors)

26

Active immunity

long term
your own immune system stimulation to produce Igs

27

What is a live attenuated vaccine

"weakened" live agent produces an immune response

28

Benefits to live attenuated vaccines

closer to natural infection, fewer doses required

29

Considerations regarding live attenuated vaccines

can have sever reaction in immunocompromised patients

less effective if patient has circulating Igs already (passive immunity from mom)

CONTRA INDICATED IN PREGNANCY

30

Examples of live attenuated vaccines

MMR, varicella, rotavirus, intranasal flu, yellow fever, oral typhoid, oral polio, herpes zoster

31

What are inactivated vaccines

live agents grown then inactivated through heat or chemical

32

Are inactive vaccines ok in pregnancy

yes

33

Examples of inactivated vaccines

Hep A/B
polio
rabies
influenza
HPV
pertussis
pneumococcal
meningococcal
H. influenza type B
tetanus
diptheria

34

List vaccine components

1. immunogenic proteins and polysaccharides--fewer proteins now that vaccines are better targeted
2. inactivating agents--formaldehyde
3. adjuvants--stimulate immune response (i.e aluminum salts)
4. antibiotics--prevent contamination during production
5. preservatives--inhibit bacterial/fungal growth (thimerol)
6. stabilizers--protect against freeze-drying or heat (gelatin)

35

What is the role of adjuvants in vaccines?

stimulate immune response--i.e aluminum salts

36

Grade 6 vaccines

hep B, HPV, meningococcal C, varicella (catch up)

37

Grade 9 vaccines

TdaP, HPV (catch up)

38

How effective is the flu vaccine

about 70%

39

Which has higher safety standards, vaccines or drugs?

vaccines

40

List 5 antibiotic resistant organisms

MRSA
VRE
ESBL
CRO
Macrolide resistant S. Pneumonia

41

What is MRSA

Methicillin-resistant S. Aureus
Cloxacillin-resistant S. aureus
resistant to all B-lactam antibiotics

S. aureus is one of most important human pathogens--specific screening and infection-prevention approaches in hospitals

42

What is VRE

vancomycin resistant enterococcus

initially very worrisome because vanco was "last line" antibiotic

fears of resistance spread to staph
largely not a clinical issue now and efforts to ID and control spread have been relaxed

43

What is ESBL

extended spectrum Beta-lactamase--can cleave up cephalosporins

gram (-) bacilli
mostly in Enterobacteriaciae (some of most important mircoorgs in the biome)
Many human diseases are caused by own own bacteria
E. coli and L. pneumonia

44

What is CRO

carbapenem resistant organisms

carbapenems are last line antibiotics that have been reserved

NDM1--large amount of antibiotics resistance from India
We are :re-entering the pre-antibiotic era"
Mortality HIGH for these bugs

45

What is macrolide resistant S. pneumonia

macrolides are used widely for Tx of outpatient respiratory tract infections
Strep. pneumo is largest cause of CAP
resistance is >25% in many parts of Canada

46

What other conditions have been associated as adverse effect wth over prescription of antibiotics?

asthma
inflammatory bowel disease
changes in gut flora immediately

47

What is the provincial "antimicrobial clinical expert group" in BC called

PACE

48

What are some diagnostic aids that can be used to differentiate bacterial from viral and thus prevent over prescription of antibiotics

1. Procalcitonin--help differentiate bacterial from viral infections in several settings (more used in Europe)
2. Rapid Group A strep tests

49

"Specialized antibiotic clinical pharmacists are the backbone of acute care stewardship programs"

blah

50

list 4 adverse effects associated with antibiotics

1. promoting and selecting for antimicrobial resistance
2. C. difficile infection
3. allergic reactions
4. links with other diseases (asthma, inflamm bowel)