Infectious Disease Prevention & Immunoprophylaxis Flashcards

Question

how to diagnose smallpox

Answer 1

1. Culture, PCR 2. Antibodies

Answer 2

Strict isolation **Supportive** measures only Antivirals have not really been studied

Answer 3

1. Non-spore forming, but may survive weeks on surfaces 2. Not spread person ⇾ person, but as little as 10 organisms may infect the host 3. **Infection from insect bites or environment contamination** - ticks and fleas bite an infected host and pass along to humans also known as “rabbit fever” or “deer fly fever”

Answer 4

1-14 days post exposure 1. Inflammation of the airways * Pharyngitis, pleuritis, bronchopneumonia 2. Fever, HA, chills, fatigue, malaise 3. Conjunctivitis and exanthems possible 4. 50% - infiltrate on CXR; hilar adenopathy w/o infiltrate also possible

Answer 5

Gram stain or cultures of infected tissues or blood

Answer 6

1. streptomycin or doxycycline 2. also gentamicin, chloramphenicol, ciprofloxacin no vaccines

Answer 7

Fever, myalgia, prostration, DIC w/ thrombocytopenia and capillary hemorrhage

Answer 8

1. >38.3 ℃ (or 101 ℉) for at least 3 wks with **at least 2** of the following (in the absence of another cause) * Hemorrhagic or purpuric rash * Epistaxis * Hematemesis * Hemoptysis * Hematochezia 2. Serological testing for antigen and antibody; PCR - sent to the CDC

Answer 9

No approved treatment or vaccine Experimental - antibody cocktails and ribavirin

Answer 10

1. **Contact precautions** * Gown and gloves required for pt or environment contact * Sometimes above needed to even enter patient room 2. **Droplet precautions** * Surgical mask required w/in 3 feet of patient 3. **Airborne infection isolation** * Negative pressure isolation room * Respirator must be worn

Answer 11

1. **Gloves** * blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment 2. **Gowns** During procedures when contact of clothing, exposed skin w/ blood/body fluids, secretions, excretions, or body fluid is anticipated 3. **Mask / Goggles or Face shield** Any activity which may result in splashes or sprays of blood, body fluids, secretions, or excretions

Answer 12

1. **Active immunity** - induced by vaccines prepared from bacteria or their products * Capsular polysaccharides, inactivated protein exotoxins (toxoids), killed bacteria, or live-attenuated bacteria 2. **Passive immunity** - administration of preformed antibodies in preparations called immunoglobulins * May be used as prevention or treatment of certain bacterial disease * Examples: tetanus antitoxin, botulinum antitoxin, diphtheria antitoxin - used for tx and prevention

Answer 13

1. **Inactivated** - dead virus * More stable * Safest form * Weaker immune response * Often requires multiple doses or boosters * Examples: *seasonal influenza, polio* 2. **Live, attenuated** - live but weakened virus * Does not cause active disease (typically) * Provides greatest immunity * Examples: *measles, mumps, varicella* 3. **Subunit Vaccines** * Contain only antigens * Less risk of adverse reactions * Very time-consuming to make * Example: *Hep B* 4. **Toxoid Vaccines** For bacterial infections that secrete toxoids Inactivated toxoids Examples: *tetanus, diphtheria, pertussis* 5. **Conjugate Vaccines** * Works against bacteria w/ a cell wall * Produce synthetic product containing cell wall similar to the bacteria * Examples: *HIB type B vaccine, Pneumococcal (Prevnar)* 6. **Once Experimental, now Realistic** * DNA vaccines / RNA vaccines - Covid-19 vaccines * Recombinant vector vaccines * Use a live bacteria as a vector

Answer 14

* Severe allergic reaction - anaphylaxis * Pregnancy and severe immunosuppression - no LIVE vaccines, including live-attenuated vaccines

Answer 15

* Acute illness that is moderate to severe - with or without fever * Delay and vaccinate after illness resolves

Answer 16

**1. DTaP - Diphtheria, tetanus, and pertussis** * 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 * Brand names: *Daptacel, Infanrix* **2. Tdap - Tetanus, diphtheria, and pertussis** * Lower dose of the toxin components used for booster doses only * Indicated for those 7 years of age and older * Brand names: *Boostrix, Adacel* **3. Td - Tetanus and diphtheria** * Same as the Tdap w/o the pertussis component **4. DT - Diphtheria and tetanus**

Answer 17

* Protects against: *Corynebacterium diphtheriae, Clostridium tetani*, and *Bordetella pertussis* * Produces an active immune response by developing antibodies and antigens against the toxoids and acellular pertussis antigens

Answer 18

1. DTaP - 5 part series given at WCC * 2 months, 4 months, 6 months, 15 months, 4 years * Usually given as a combo vaccine * Pediarix - DTaP, Hep B, IPV or * Pentacel - DTaP, HIB, IPV 2. Tdap * Booster at age 11 or 12 and every 10 years 3. Td * Given for a dirty wound if it’s been > 5 years since last tetanus

Answer 19

* 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

Answer 20

Live-attenuated vaccine 90% prevention of rubella after a single dose; 99% measles and 95% mumps prevention after a second dose

Answer 21

1. Given SQ 2. 2-part series given at WCC * _12 months_ * _4 y/o_ - typically combined w/ varicella - ProQuad vaccine * MMRV combo not given under 23 months due to **febrile seizure risk** 3. leaving country to an endemic area * Given between _6-11 months_ * Second dose - _28 d after_ * Adults born _before 1970_ - _1 dose_; * HCW - _both doses_

Answer 22

May be administered w/in six days of exposure

Answer 23

* 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

Answer 24

Inactivated vaccine (IPV) The only type of polio vaccine given in the US since 2000 90% effective after the first dose, 99-100% effective after the third dose

Answer 25

1. Given IM or SQ 2. 4-dose series given at WCC * 2 months * 4 months * 6 months * 4 years 3. Usually in combinations w/ other vaccine: * Pentacel - DTaP-IPV/Hib / Pediarix -DTaP-IPV-HepB / Kinrix -DTaP-IPV 4. Modified schedule given to any child leaving country to travel to an endemic area * First dose given between 6-11 months of age, followed by 3 more doses

Answer 26

Previous reaction to IPV Allergy or sensitivities to streptomycin, polymyxin B, and neomycin precautions = pregnancy

Answer 27

_Inactivated / killed virus_ - activates lymphocytes to attack the antigen = releases inflammatory mediators signaling B and T-cells = produces new B and T-cells against hep A antigen

Answer 28

1. Given IM 2. 2-dose schedule given at WCC * _12 months_ * _2 years_ * Second dose sometimes given at 18 month visit - just needs to be 6 months apart

Answer 29

* Subunit vaccine - recombinant vaccine containing hepatitis B virus surface antigen only * Produced in yeast or mammalian cells (Chinese hamster ovaries) * HBsAg 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

Answer 30

Given IM 4-dose vaccine given at WCC * Birth - 1 month * 2 months * 4 months * 6 months Usually used in combination w/ other vaccines Pediarix - DTaP, Hep B, IPV

Answer 31

1. Hypersensitivity to yeast 2. Severe allergic reaction to latex

Answer 32

Live-attenuated vaccine Issue w/ different strains of RV in geographical regions 2 are licensed in the US 1. Rotarix - live-attenuated G1P human RV vaccine 2. RotaTeq - live pentavalent bovine-reassortant vaccine containing G1,2,3,4 and P1

Answer 33

1. Given PO 2. 2 or 3-dose vaccine given at WCC 3. Rotarix - 2-dose vaccine * 2 months * 4 months 4. RotaTeq - 3-dose vaccine * 2 months * 4 months * 6 months 5. Dose of either of the above should be given before 15 weeks of age and all doses given before 8 months of age

Answer 34

Severe immunodeficiency Previous h/o intussusception Severe illness - wait until recovery to give vaccine

Answer 35

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

Answer 36

1. Given IM 2. Individual vaccine or combo vaccine * Pentacel - DTaP/HIB/IPV 3. Given at WCC * 2 months * 4 months * 6 months * 12-15 month - booster

Answer 37

CI: * Same w/ all other vaccine * Do no give to infants < 6 weeks of age Precautions: * Moderate to severe illness with or w/o fever

Answer 38

* Active against Streptococcus pneumoniae * Immunity in 2-3 weeks after vaccine, lasting around 5 years

Answer 39

**1. PCV13 - Prevnar 13** * Produces *better immunity in children* * stimulates mucosal immunity, decreasing colonization, providing some herd immunity * 4-dose series given at WCC * 2 months * 4 months * 6 months * 12 - 15 months * >6 y/o - single dose **2. PPSV23 - Pneumovax 23** * 1-dose * Indicated in adult population of those **>65 y/o** _w/_ Prevnar 13 * **3. PCV 15 - Vaxnuvance** * Includes serotype from PCV 13 and some from PCV 23 * 1-dose * Indicated in adult population of those who >65 who have not received either PCV 13 or PPSV23 **4. PCV 20 - Prevnar 20** * Includes serotype from PCV 13 and additional from PCV 23 * Same as PCV15

Answer 40

**1. Inactivated / killed vaccine** * Derived from hybrid strain mixed w/ laboratory strain and grown in eggs **2. Live-attenuated vaccine** * Donor virus is mated w/ an anticipated epidemic wild strain * Induces nasal IgA antibodies

Answer 41

1. Quadrivalent vaccine - protects against 4 different strains 2. Trivalent vaccine - protects against 3 different strains - egg-based

Answer 42

1. Egg-based - Fluzone * Fluzone - 6 months and older for standard dose of Fluzone 2. Cell-culture based - Flucelvax - egg-free and grown in cells of mammals * 4 years and older 3. Recombinant - Flublok - uses recombinant technology and is egg-free as well * 18 years and older

Answer 43

1. Fluzone high dose * 65< * 4x the antigen = better protection 2. FLUAD - formulated with the adjuvant MF59 * 65< * Standard dose

Answer 44

must be Ages 2 - 49 1. Pregnancy 2. Children 2-17 receiving ASA therapy 3. Immunosuppression 4. Children 2-4 w/ asthma or wheezing in past 12 months 5. People who have taken influenza antiviral meds in the past 48 hrs 6. People who care for immunosuppressed individuals 7. Chronic medical conditions, such as DM, chronic kidney dz, etc.

Answer 45

1. Asthma in those 5 years and older 2. Moderate, acute illness w/ or w/o fever 3. Guillain-barré w/in 6 weeks following last influenza vaccine

Answer 46

1. 6 months ⇾ 8 years of age - 2 doses in the same season if they have never had two in one season previously 2. 9+ - 1 dose regardless of previous vaccination hx

Answer 47

- Severe latex allergy - Precautions - GBS infection w/in 6 wks of previous influenza vaccine

Answer 48

Live-attenuated vaccine Produces an IgG humoral immune response = cell-mediated immune response by varicella-zoster-specific activation of both CD4+ T-helper and CD8+ T-lymphocyte cells

Answer 49

1. Given SQ 2. 2-dose series at WCC * 12 month WCC * 4 year WCC - usually in combo w/ MMR vaccine

Answer 50

1. Hx of allergy to _neomycin_ 2. _Blood dyscrasias_ (leukemia, lymphoma - anything that affects the bone marrow) 3. Moderate to severe illness 4. Anyone who has _received blood products w/n 3-11 months_ 5. Immunocompromised or pregnant

Answer 51

1. Protects against Neisseria meningitidis * A, B, C, W, X, and Y are responsible for majority of invasive disease 2. Conjugated polysaccharide vaccines - protects against serotypes A,C,W, and Y * Menactra * Menveo 3. Recombinant vaccines - protect against serotype B * Bexsero * Trumenba

Answer 52

Severe allergic reaction to latex

Answer 53

1. Subunit vaccine 2. Recombinant DNA was used to generate virus-like particles capable of mimicking the natural virus and eliciting high-titers of virus neutralizing antibodies * They resemble authentic virions * Are not infectious * Induce high levels of antibodies

Answer 54

Gardasil 9 | Gardasil 4 and Cervarix (no longer in production)

Answer 55

1. Given IM 2. Indicated in ages 9-45, but most have no benefit over age 26 3. 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

Answer 56

* Immediate hypersensitivity to yeast * Severe latex allergy * Precaution - Pregnancy

Answer 57

1. The 17D vaccine is a live-attenuated vaccine 2. Live vaccine is introduced into system and patient produces a low-level viremia * IgM antibodies are produced against YF * Virus may be passed through blood products so _no blood donations_ allowed in pts who have received YF vaccine _w/in 14 days_

Answer 58

1. Given SQ or IM 2. indicated for 9 months - 59 years of age for those traveling to or living in at risk for YF * Africa and South America 3. Also indicated for lab personnel 4. Usually lifelong protection, but given again in 10 years if travelling to high risk areas

Answer 59

1. <6 months 2. Immunocompromised * Thymus d/o, organ transplant recipients, malignancies, other immunodeficiencies Precautions: 6 - 8 months old, Over 60 yo, Pregnancy / Breastfeeding

Answer 60

Protects from gram negative Salmonella enterica serotype typhi (Salmonella typhi)

Answer 61

1. Oral, live-attenuated vaccine * causes 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 2. Capsular, polysaccharide vaccine

Answer 62

1. Oral vaccine * 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 2. IM injection * One dose * May travel 2 weeks after vaccination * Given at 2 years of age and older * Booster every 2 years

Answer 63

1. Oral vaccine * Pregnancy * Immunocompromised 2. IM injection * No real contraindication except as w/ all vaccinations, but _best to delay until 2nd trimester of pregnancy_

Answer 64

1. Rabies immunoglobulin - passive immunization * Binds to the RV preventing it from invading the CNS * Also builds up antibodies to allow the vaccine to work more proactively 2. Rabies vaccine - active immunization * Inactivated antigen vaccine * Builds antibodies against the RV

Answer 65

1. 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 2. 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

Answer 66

1. no FDA approved 2. Antitoxin for those exposed * Will neutralize all 7 botulinum neurotoxin serotypes * Approved by FDA in 2013 * For use in those over 12 months of age

Answer 67

1. Immunoglobulin only - Synagis /palivizumab * Humanized monoclonal anti-RSV antibody * Bind RSV F protein, which plays a role in virus attachment and mediates fusion * *Does **not*** inhibit virus attachment * ***Does** inhibit* viral transcription

Answer 68

* Must be given **monthly to high-risk individuals during respiratory season** (Sept - May) * 55% reduction in RSV admissions in premature infants

Answer 69

* Attaches to and neutralizes the poisonous venom proteins causing it to be released from the receptor site * 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 venomous doses

Answer 70

1. The sooner initiated, the more effective - typically w/in *4 hours of bite* 2. Indicated for progressive local tissue findings, hematologic laboratory abnormalities, and/or evidence of systemic toxicity * Airway swelling, neurological toxicity, cardiovascular collapse

Answer 71

1. Initial dose * 4-6 vials IV over 1 hour 2. Subsequent doses * An additional 4-6 vials 3. Maintenance dose * 2 vials every 6 hours up to 3 doses * This is started 6 hours after control achieved * Decreases recurrence of symptoms 3. “Control” is defined as * Systemic symptoms resolved * Hematologic abnormalities are improving * Local effects have begun to improve

Answer 72

1. Sensitivity should be tested first and watching for any localized reaction over the next 30 min 2. Epinephrine and antihistamine should be at the bedside 3. Serum sickness * Hypersensitivity reaction to the alien immunoglobulin * Anaphylactic and pyrogenic reactions * Fever, chills, rigor, headache and tachycardia * Skin rash, generalized allergic reaction

Infectious Disease Prevention & Immunoprophylaxis Flashcards

(98 cards)