11 Flashcards
example of live attenuated vaccine
mmr
example of inactivated
hep A, polio
example of toxoid vaccine
diphtheria, tetanus
eg of subunit vaccine
hep B, influenza, pertussis
which vaccine type needs refrigerati
live attenuated vaccine
precautions for live attenuated - 5
-avoid in pregnancy
-usually not in infants <1
-not in severely immunocompromised
-spaced at least 3-10 months from antibody containing products ike immunoglobulins and blood transfusions
-avoid giving another vaccine in 28 days
precautions for live attenuated - 5
-avoid in pregnancy
-usually not in infants <1
-not in severely immunocompromised
-spaced at least 3-10 months from antibody containing products ike immunoglobulins and blood transfusions
-avoid giving another vaccine in 28 days
national childhood immunisation schedule
BCG, Tdap, MMR, varicella, Hep B, polio, hemophilus influenzae type b, pneumococcal, HPV, influenza (aged 6mo - 4 years)
national adult immune schedue
tdap (if other indications), varicella, MMR, HPV, influenza (if other indications), pneumococcal (if other indications), Hep B
contraindications
allergy to vaccine or components, bleeding risk, severe illness (eg fever more than 38), live attenuated not for pregnant and immunocmprimsed
exception to rule of simultaneous vaccine administration
pneumococcal conjugate and meningococcal conjugate vaccine in those with asplenia–> 4 wk interval
how long should live attenuated via IM or SQ be spaced
28 days
what is surgical AB prophylaxis
admin of antimicrobials just prior to clean and clean contaminated surgeries to prevent post op surgical site infections
SSI are defined as
infections that occur within 30 days after operation of 1 year if an implant was left in place
SSI are considered
health care associated infections
SSI can be
superficial or Deep incisional affecting body spaces and organs
deep incisional SSI affects
fascia and muscle layers
superficial incisional SSI affects
skin and SQ tissue
patient related risk factors for SSI
extreme age, smoking, coexisting infection at other sites, immunosuppressed, length of hospital stay, MRSA infection, recent surgical procedure, obese, malnourished, diabetes, underlying disease
operation related risk factors for SSI
pre op shaving, inadequate sterilisation, antimicrobial prophylaxis, foreign material in surgical site, skin antisepsis, duration of surgery and surgical scrub
SAP indicated for
clean surgery when implant is inserted
clean contaminated surgery always need SAP
contaminated surgery needs AB used as treatment not prophylaxis
always needed for immunocompromised pts or those w conditions that increase risk of SSI
clean contaminated surgery examples
respiratory, alimentary and genitourinary tract penetrated
examples of clean surgery and is SAP recommended for these?
healthy skin incised (not)
mucosa of respiratory, alimentary and genitourinary tract and oropharyngeal cavity not traversed (not)
insertion of prosthesis or artificial device (recommended)
broad or narrow spectrum preferred for SAP
narrow
should conc be high or low at site prior to infections
high
ABs with high risk of Cdiff infections
3rd gen cefalosporins, clindamycin, FQ
common pathogens and recommended abntimicrobials for coronary artery bypass, implants
staph aureus, staph epidermidis
use cefazolin or cefuroxime
for GI ops w entry into GI lumen common pathogens and AB for SAP
enteric G neg bacilli and G pos cocci
use cefazolin
cefazolin IV can begin as SAP for all ops except
Genitourinary
use ciprofloxacin (PO or IV) or cotrimoxazole (PO) unless open laparoscopic surgery (cefazolin)
MRSA choice of AB for SAP
screen for MRSA for pts who are going through high risk surgeries (cardiac, orthopedic, neurosurgery with implant)
use vancomycin for pts w known MRSA colonisation recent MRSA infection
can add cefazolin to Vanco to cover MSSA in MRSA colonised patients
choice of AB for SAP in B lactam allergy
verify true allergy
If severe penicillin allergy (anaphylaxis, urticaria, angioedema, SJS, TEN), should not receive a B lactam
If uncomplicated non IgE mediated reaction to penicillin eg maculopapular rash –> consider cephalosporins or cefazolin which has unique R1 side chain
when to start administration before surgical incision
30 - 60 min
but for Vanco and FQs, start 60-120 min before
when is intra operative re dosage required
when duration of exposure exceeds 2 half lives of drug or extensive blood loss (more than 1.5l) or extensive burns
duration of SAP should not exceed
24h
what happens if SAP given more for than 24h
risk of Cdiff infection, acute kidney injury, increase section pressure and risk or MDR orgs
non SAP strategies
don’t remove hair unless necessary and don’t shave (use depilators or clippers)
control post op blood glucose to be below 180mg/dL
maintain normothermia (more than 35.5) during peri op period
use alcohol contains pre op skin prep agents
maintain adequate oxygenation of tissue
use impervious plastic wound protectors for GI and biliary tract surgery
useful resources for travel health
CDC Health information for travellers, CDC Yellow book, WHO Travel advice, Ministry of foreign affairs travel restriction and requirements
medical considerations before international travel
pre travel consult 4-6 weeks before
look for individual risk factors
include post op advice if relevant
focussed education eg precautions etc
information for risk assessment during ore travel lconsult
PMH, special conditions, immunisation history, prior travel experience (experience with malaria chemoprophylaxis and altitude), itinerary, timing, reason for travel, travel style, special activities
major routes of infection
food/water borne infections via fecal oral,
insect vector borne
transcutaneous, respiratory, blood and body fluids via sex or sharing contaminated needles
travel vaccines - 14
not all are compulsory for all countries
respiratory - influenza, meningococcus *, deptheria, MMR, pertussis
food and waterborne - hep A, typhoid, cholera, polio *
vector borne - yellow fever*, Japanese encephalitis
blood/fluid borne - hep B
Transact - tetanus, rabies
hep A virus is
cholera is
hep B is
influenza is
jap encephalitis is
mmr is
inactivated
live atten
recombinant
inactivated or recombinant
inactivated
live atten
muslims taking Hajj and pilgrimages in Saudi Arabia should be vaccinated against
meningococcal
participating in injury prone activities should take
tap (tetanus dipth) - toxoid vaccine
vaccines take __ to elicit protective effects
2 weeks
can 2 live vaccines be administered on same day
can be done, of not second should be given 28 days after first
coadministration of which 2 vac is recommended
yellow fever and MMR
missed dose
don’t give additional dose
continue w the overdue dose
there is no max interval between doses of primary vaccine series
which vac has oral ROA
cholera
influenza ROA
instransal or IM
SQ vacs
polio and MMR and yellow fever
which parasite causes malaria
protozoan parasite called plasmodium
5 species of plasmodium
P falciparum, malariae, ovale, vivax and Knowlesi
most prevalent plasmodium:
vivax and falciparum (most dangerous is falc)
clinical features of malaria
fever, chills, body ache, cough, vomitingm diarrhoea, sweats, headaches, abdominal pain, nausea
what transmits malaria
female anopheles mosquito or transfusions organ transplant and meter to foetus (vertical transmission)
risk of transmission is higher during
higher between dusk and dawn
cold season
at end of rainy season
decreases at high altitudes
does SEA have malaria risk
no
those who developed malaria as children have immunity as adults/
yes
plasmodium life cycle
exo erythrocytic cycle (grow an d multiply in human liver)
- P vivax and oval have possible dormancy
erythrocytic cycle in human blood
- differentiate into gametocytes
-clincal symptoms
mosquito (sporagenic cycle)
strategies for malaria prevention
awareness
bite prevention
chemoprophylaxis
diagnosis through blood smear and seeing parasite in blood
environments
drugs used for malaria chemoprophylaxis
atovaquone + proguanil (malarone)
chloroquine
doxycycline
mefloquine
3 types of malaria risk prevention
A- bite prevention
B (non falciparum risk) - bite prevention + chloroquine or doxy or malrone or mefloquine
C (falciparum malaria risk = high resistance to chloroquine) - use bite prevention + malarone or doxy or mefloquine
malaria advice after returning
no blood transfusion fr 4 month
monitor for fever and flu like symptoms for a year
insect repellant precautions
- only on exposed skin
- not on broken skin
- don’t spray on face directly
-wash hands after - wash skin an clothes when home
active ingredients in insect repellants
DEET, picaridine, oil of lemon eucalyptus, IR 3535, 2 undecanone
which repellant ingredient is most effective
DEET provides 6-12h protection
protection against malaria
wear light coloured clothing
stay indoors between dusk and dawn
expose less skin
sleep under a permethrin impregnanted bed net
sealed aircon room with or screened windows with fan
atovaquone proguanil
- regimen
- CI
- ADR
- DDI
- avoid in
- classification in SG
- start 1-2 days before travel and continue for 7 days after return (WITH FOOD OR MILKY DRINKS)
- renall impairment (CrCl below 30) and hypersensitivity
- nausea, vomiting, diarrhoea, headache, dizziness
- rifampicin, metoclo[ramide
- preg and lac
- POM w exemption
chloroquine
- regimen
- CI
-precautions
- ADR
- DDI
- classification in SG
- weekly in one dose, with or after meals. start 1-2 weeks before departure, continue toll 4 weeks after return
- hypersensitivity, chloroquine resistance
-exacerbates psoriasis, myasthenia graves, seizure, liver impairment - NV, stomach pain, rash
- QT prolonging CYP3A4 inhibitors eg clarithromycin and voricinazole
- P only
doxyxline
- regimen
- CI
-precautions
- ADR
- DDI
- classification in SG
- daily with or after meals w FULL glass of water. start 1-2 days prior to top and continue till4 weeks after return
- hypersens, children below 8, preg and lact
- GI discomfort, photosens
- reduce F w multivalent ions
- prescription only
if a;rdy taking for acne, don’t need additional regimen
least expensive malaria agent
doxy
women prone to vaginal yeast infections when taking ABs should avoid
doxy
mefloquine
- regimen
- CI
-precautions
- ADR
- DDI
- classification in SG
one dose weekly after meals. start 1 week prior at least and continue till 4 weeks after return
- hypersens, regions w meflo resistance, psychiatric conditions, convulsive disorders, cardiac conduction abnormalities (can cause QT prolongation)
- GI, dizziness, headache, insomnia, vivid dreams, NEUROPSYCHIATRIC DISORDER
- ketoconazole
- pharmacy only
- can be used in preg and lact and children above 5
