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2025 PHPM Royal College Study - based on AN Summary Notes > CD - diptheria, Hep A, Hep B > Flashcards

CD - diptheria, Hep A, Hep B Flashcards

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1
Q

What is the agent for hepatitis A

A

HAV - hep A virus

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2
Q

what is the reservoir for hep A

A

humans

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3
Q

what are risk factors for acquiring hep A (endemic-3; sex/substance-2; occupation-3; med condition-1) (9)

A

1-Travellers to HAV-endemic countries
2* Living in community at risk of HAV outbreaks or in which HAV is endemic
3* Household or close contacts of children adopted from HAV-endemic countries
4* Men who have sex with men
5* Injectable and non-injectable illicit drug users
6* Workers involved in research or production of HAV vaccine
7* Military personnel and humanitarian relief workers who are likely to be posted to areas with high rates of HAV
8* Zoo-keepers, veterinarians and researchers who handle non-human primates
9* People receiving repeated replacement of plasma-derived clotting factors

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4
Q

what is the mode of transmission for hep A (1 + 1)

A

1- Fecal oral
2- i.e. Ingestion of contaminated food or water (e.g. frozen fruits)

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5
Q

how long can HAV last in the environment

A
  • Virus can persist for days or weeks in the environment
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6
Q

what is the incubation period for Hep A (2)

A

1- Average: 28 days
2- Range: 15 – 50 days

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7
Q

what is the communicable period for Hep A (2 points)

A
  • 2 weeks prior to symptom onset up to 1 week after jaundice
    -Prolonged shedding up to 6 months in infants and children
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8
Q

what is the clinical presentation of hep A in children (2 points)

A

-majority asymptomatic
- jaundice in < 10% under 6 years old

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9
Q

what is the clinical presentation of hep A in adults (3)

A
  • 1-7 day prodrome of flu like illness with fever, malaise, anorexia, nausea, abdominal pain
  • followed by 1-2 weeks of mild and self-limited jaundice.
  • Most recover without complications, fulminant hepatitis is rare
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10
Q

does hep A persist as chronic infection

A

no - chronic hep A infection does not occur

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11
Q

what does anti-HAV IgM indicate (3)

A

-recent infection
-detectable 5-10 days after infection
-decrease to undetectable levels within 6 months after infection

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12
Q

what does anti-HAV IgG indicate

A

indicates either natural or vaccine- derived immunity to HAV

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13
Q

what are the indications of hep A vaccine (1)

A

1- pre-exposure immunization of persons 6 months of age and older at increased risk of infection or severe HAV

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14
Q

what kind of vaccine is the hep A vaccine

A

non-live, inactivated antigen

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15
Q

what is the schedule for hep A vaccine

A

two doses at 0 months and 6 - 36 months

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16
Q

what is the effectiveness of hep A vaccine

A

90-97% effective in preventing hepatitis illness.

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17
Q

how long does hep A vaccine protect against disease (i.e. how long do antibodies last) (3)

A

-Protective antibody concentrations persist for at least 20 years
-possibly for life
-Immune memory has been demonstrated, indicating that protection may persist even when antibodies are no longer measurable

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18
Q

Hep A case mgmt: what information do you ask on case history - specific to hep A (5)

A

1- symptom onset date including onset of jaundice
2- determine infectious/communicable period (2 weeks pre-symp to 1 wk post-jaundice)
3- identify potential contacts during communicable period
4- any HAV vaccine received in last 2 weeks (to rule out false-positive)
5- identify potential source (see next Q)

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19
Q

Hep A case mgmt: what questions would you ask to identify potential source of infection (TOCIS + 5)

A

1- food history
2- attendee/employee of child care centre or other institution
3- MSM
4- IV drug user or non-IV drug use
5-attendance at large function in previous 50 days

TOCIS = travel hx, occupational hx, sick contacts, immunization status, symptom onset

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20
Q

Hep A case mgmt: what are questions you would ask in a risk assessment of a case in terms of their potential to spread HAV to contacts (4)

A

1- At-risk populations served (e.g. LTCH residents,
immunocompromised)
2- Evidence of transmission to others
3- Immunization status
4- Opportunity to offer PEP within 14 day window

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21
Q

Hep A case mgmt: what would you provide education on to a case (2)

A

1- educate re: HAV transmission and personal hygiene (emphasize proper hand hygiene)
2- limit food handling and discourage
the sharing of food prepared by the case during infectious
period

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22
Q

Hep A case mgmt: which cases would fall under exclusion criteria (3)

A

1- food handlers
2- child care staff/attendees
3- HCWs from high risk settings

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23
Q

Hep A case mgmt: how long should a case be excluded from work/daycare for

A

excluded for 14 days after symptom onset, or 7 days after jaundice onset, whichever comes earlier

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24
Q

Hep A contact mgmt: what is the definition of ‘contact’

A

a susceptible individual who was exposed to a case during the case’s communicable/infectious period

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25
Q

Hep A contact mgmt: which groups of people are considered contacts (5)

A

1- household contacts
2- close non-household contacts (e.g. sexual partners, drug sharing partners)
3- coworkers of infected food handler who worked during communicable period
4- food establishment patrons if case is food handler who worked in their communicable period (need to consider role, glove wearing, if food was cooked) – consider if patrons can be ID’d and offered immunoproph within 14d from exposure to case
5- daycare and institutional attendees/staff (may have handled diapers, toileting, personal care of a case)

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26
Q

Hep A contact mgmt: what would you provide education on to a contact (4)

A

1- proper (hand) hygiene
2- mode of disease transmission
3- incubation period and symptoms
4- advise to seek medical care if symptoms develop

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27
Q

Hep A contact mgmt: why use HAV vaccine in contact management as part of PEP

A

in susceptible populations, HAV vaccine interrupts outbreaks

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28
Q

Hep A contact mgmt: when should you immunize contacts after exposure to a case as part of PEP

A

HAV vaccine is ~80% protective efficacy if used within 1 week of exposure - so give vaccine within 1 week for all contacts 6mo old and older

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29
Q

Hep A contact mgmt: when do you give HAV immunoglobulin to contacts after exposure to a case, as part of PEP

A

offer to susceptible contacts up to 14 days after exposure to case

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30
Q

Hep A contact mgmt: which groups of contacts meet criteria to recieve Ig (4)

A

1- infants <6mo old
2- people for whom HAV vaccine is c/i or unavailable
3- immunocompromized people
4- those with chronic liver disease
5- adults 60yo and older who are HH or close contacts of a case

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31
Q

why is Hep A immunoglobulin indicated (in addition to HAV vaccine) for people with chronic liver disease or immune compromise? (2)

A

1- an increased risk of severe disease
2- suboptimal immune response to HAV vaccine

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32
Q

why is Hep A immunoglobulin indicated (in addition to HAV vaccine) for those 60yo and older who are contacts to a case? (2)

A

1- reduced response to HAV vaccine
2- increased risk of severe disease with increasing age

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33
Q

Hep A contact mgmt: what are exclusion requirements for symptomatic contacts? (2)

A

1- exclusion from high risk settings is same as for cases
2- ensure contact is screened to confirm if they are acutely ill with Hep A (i.e. if they are anti-HAV IgM positive)

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34
Q

Hep A contact mgmt: what are exclusion requirements/criteria for asymptomatic contacts? (1, 2abc)

A

1- exclusion usually not warranted
2- BUT asymp food handler contact may be excluded if:
2a- they don’t get timely PEP
2b- do not have serological evidence of immunity
2c- assessed to be high risk of transmitting HAV via handling food that is uncooked, or handled after being cooked

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35
Q

HAV PEP summary: can infants have HAV vaccine within 7 days of contact to a case?

A

No

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36
Q

HAV PEP summary: can infants have Hep A immunoglobulin within 14 days of contact to a case?

A

yes

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37
Q

HAV PEP summary: can healthy children/adults 6mo to 59yo have HAV vaccine within 7 days of contact to a case?

A

yes

38
Q

HAV PEP summary: can healthy children/adults 6mo to 59yo have hep A immunoglobulin within 14 days of contact to a case?

A

no (not eligible since this population is generally not contraindicated to have the vaccine)

39
Q

HAV PEP summary: can healthy adults 60yo and older have HAV vaccine within 7 days of contact to a case?

A

yes

40
Q

HAV PEP summary: can healthy adults 60yo and older have hep A immunoglobulin within 14 days of contact to a case?

A

you can consider (yes)

41
Q

HAV PEP summary: can those who are immunocompromised or have chronic liver disease have HAV vaccine within 7 days of contact to a case?

A

yes

42
Q

HAV PEP summary: can those who are immunocompromised or have chronic liver disease have hep A immunoglobulin within 14 days of contact to a case?

A

yes

43
Q

what is the agent for diptheria

A

corynebacterium diptheriae

44
Q

what is the reservoir for diptheria

A

humans

45
Q

what is the mode of transmission for diptheria (2)

A

1- droplet (respiratory)
2- contact (directly with lesion)

46
Q

what is the incubation period for diptheria (2)

A

1- average 2-5 days
2- range 1-10 days

47
Q

what is the communicable period for diptheria (2)

A

1- usually 2-4 weeks for respiratory dip once virulent bacilli have disappeared
2- chronic carriers can shed for > 6mo

48
Q

what is the clinical presentation of diptheria (4)

A

1- respiratory (hoarseness, nasal discharge, fever, sore throat; case fatality 5-10%)
2- systemic (myocarditis, CNS effects from toxin dissemination)
3- cutaneous (scaly rash, rarely associated with systemic complications)
4- chronic carrier (asymptomatic; colonized on skin or nasopharynx)

49
Q

what kind of vaccine is the anti-diptheria vaccine? what is its current formulation? (2)

A

1- toxoid (inactivated toxins)
2- currently only available in combination with tetanus, acellular pertussis and polio vaccines

50
Q

what is the efficacy of the diptheria vaccine (2)

A

1- after completing primary series of 3 doses, 97% of vaccinees develop protection against effects of the toxin
2- vaccine does NOT protect against infection, so immunized adults can become carriers

51
Q

what are the schedule recommendations in terms of age for diptheria vaccines for primary series, and which vaccine formulation (how many antigens)? (2)

A

1- 2, 4, 6, (18) months for primary series
2- DTaP-IPV-Hib (5 antigens)*

*may also have Hep B to make 6 antigens

52
Q

what are the schedule recommendations in terms of age for diptheria vaccines for school-age children, and which vaccine formulation (how many antigens)? (2)

A

1- 4-6 years old (school age)
2- DTaP-IPV or Tdap-IPV (i.e. 4 antigens)

53
Q

what are the schedule recommendations in terms of age for diptheria vaccines for teenage years, and which vaccine formulation (how many antigens)? (2)

A

1- 14-16 years old
2- booster of Tdap (3 antigens)

54
Q

what are the schedule recommendations for diptheria vaccines for adults previously immunized, and which vaccine formulation (how many antigens)? (2)

A

1- 1 dose Tdap if not previously given in adulthood (18yo and older) - 3 antigens
2- Td booster q10yrs (2 antigens)

55
Q

what are the schedule recommendations for diptheria vaccines for unimmunized adults, and what vaccine formulation (how many antigens)? (2)

A

1- full primary series
2- DTaP-IPV-Hib (5 antigens)*

*can also include Hep B

56
Q

what is the diptheria anti-toxin made from?

A

purified immunoglobulins from the plasma of horses hyper-immunized with diptheria toxoid

57
Q

Diptheria case mgmt: how do you treat respiratory dip? (2 tx, 3 points)

A

1- antibiotics (procaine penicillin G or parenteral erythromycin)
2- give anti-toxin ASAP
3- provide either immediately without waiting for lab confirmation

58
Q

Diptheria case mgmt: how do you treat asymptomatic carriers of toxigenic strains? (who are sufficiently vaccinated) (2)

A

1-antibiotics (10d course macrolide OR 1 single dose benzathine penicillin G)
2- nasal & throat swabs at least 24h post-antibiotics completion to confirm eradication

59
Q

Diptheria case mgmt: how do you treat asymptomatic carriers of toxigenic strains? (who are under/unvaccinated) (3)

A

1- same as tx for asymp carriers who are sufficiently vaccinated, AND
2- immediate dose of dip toxoid-containing vaccine
3- complete primary series

60
Q

Diptheria case mgmt: do you manage cases of cutaneous diptheria?

A

No - they do not meet case definition, but you manage them like carriers

61
Q

diptheria contact mgmt: what groups would be considered as contacts of a case? (4)

A

1- household members
2- close contacts like intimate contact, face-to-face contact
3- HCWs exposed to pharyngeal secretions
4- those who provided wound care w/o PPE in 10 days prior to symptom onset in case

62
Q

diptheria contact mgmt: how long should contacts surveille themselves for symptoms? (2)

A

1- 10 days from date of last contact with case, regardless of immunization status
2- seek medical care if any symptoms of Dip develop

63
Q

diptheria contact mgmt: describe chemoprophylaxis for contacts (2)

A

1- same as carrier tx; give to all close contacts of a case regardless of immunization status
2- give after nose and throat swabs have been collected

64
Q

diptheria contact mgmt: describe immunoprophylaxis for contacts (1)

A

close contacts should get an immediate dose of dip toxoid-containing vaccine if they haven’t received within the last 5 years

65
Q

diptheria contact mgmt: which contacts should be excluded? (5)

A

1- HCWs
2- those who attend school
3- food handlers
4- close contact with children < 7yo
5- close contact with known unimmunized people

66
Q

diptheria contact mgmt: what should excluded contacts do if nose/throat swab cultures return as negative

A

they can return to work or school while completing antibiotics course

67
Q

diptheria contact mgmt: are contacts of cases infected with non-toxic corynebacterium species required to get chemoprophylaxis?

A

no - not routinely offered, as they are considered extremely low risk

68
Q

what is the agent for Hepatitis B

A

HBV - hep B virus

69
Q

what is the prevalence of chronic Hep B in Canada (2)

A

1- <1% - rare
2- immigrants from endemic countries account for the majority of chronic infections

70
Q

what are risk factors for hep B infection - category “country” (3)

A

1- immigrants from countries endemic for HBV
2- children born in Canada who may be exposed to HBV carriers through family or when visiting country of origin
3- travellers to endemic areas

71
Q

what are risk factors for hep B infection - categories “sex” and “substance use” (3 + 1)

A

1- high risk sex practices (e.g. unprotected sex with new partners; >1 partner in last 6 months; history of STI)
2- MSM
3- household and sexual contacts of acute HBV cases and HBV carriers
4- persons who use injection drugs

72
Q

what are risk factors for hep B infection - category “institutional” (3)

A

1- children and workers at childcare settings where there is acute HBV case or HBV carrier
2- residents/staff of institutions for those with developmental disabilities
3- staff/inmates at correctional facilities

73
Q

what are risk factors for hep B infection - category “medical condition” (6)

A

1- chronic renal and liver disease
2- hemophiliacs and others receiving repeated infusion of blood/blood products
3- congenital immunodeficiencies
4- hematopoetic stem cell transplant recipients, or awaiting solid organ transplant
5- persons with HIV
6- HCWs with potential occupational exposure to blood/blood products/bodily fluids

74
Q

what is the reservoir for HBV

A

humans

75
Q

what is the mode of transmission for HBV

A

blood borne exposure

76
Q

what are examples of blood borne exposure routes that transmit HBV (3)

A

1- percutaneous (needle sharing, blood products)
2- sexual (semen, vaginal secretions)
3- vertical (mother -> fetus)

77
Q

what are examples of non-blood borne exposure routes that transmit HBV (2)

A

1- exposure to other bodily fluids (saliva, CSF, pleural, peritoneal)
2- horizontal (household contacts)

78
Q

what is the incubation period for hep B (2)

A

1- average: 60-90 days
2- range: 45-180 days

79
Q

what is the communicable period for hep B - acute infection (3)

A

1- Communicable when HBsAg is detectable
2- Blood is infective for many weeks before onset of first symptoms
3- blood remains infective through the acute and chronic periods

80
Q

what is the communicable period for hep B - chronic carrier (3)

A

1- Majority of individuals spontaneously clear the infection after 4 to 8 weeks
2- chronic carriers can shed for months (most likely children)
3- Risk of becoming a chronic carrier varies inversely with the age: 90% of
infants, 30-50% of children, and 5% of adults become chronically infected

81
Q

what is the clinical presentation of acute Hep B infection (4)

A

1- asymptomatic in most infants/adults
2- asymptomatic in 50-70% of adults
3- if symptomatic, symptoms include: anorexia, fatigue, abdominal pain, fever, jaundice
4- 1-2% of infections result in fulminant hepatitis

82
Q

what is the timeline for acute Hep B infection (how many months)?

A

<6 months of infection

83
Q

what is the clinical presentation of chronic (carrier) hep B infection (2)

A

1- carriers often asymptomatic
2- 15-50% of chronic infections will develop cirrhosis, end-stage liver disease, or hepatocellular carcinoma

84
Q

what is the timeline for chronic Hep B infection (how many months)?

A

> 6 months of infection

85
Q

Hep B diagnosis: what is HBsAg and what does it indicate (4)

A

1- hep B surface antigen, protein on surface of virus
2- indicates that an individual has an active infection and is infectious
3- HBsAg is used to make the
HBV vaccine - can get transient HBsAg positivity up to 18d post-vaccination
4- up to 50% of people with chronic infection will clear HBsAg

86
Q

Hep B diagnosis: what is HBcAg and what does it indicate (2)

A

1- Hep B core antigen
2- body doesn’t see it and you can’t see HBcAg on serology (only Ab towards it - i.e. anti-HBc)

87
Q

Hep B diagnosis: what is HBeAg and what does it indicate (3)

A

1- Hep B envelope protein antigen
2- produced during active viral replication HBcAg and is secreted into cell plasma
3- it is not part of the mature virus therefore presence of HBeAg indicates high infectivity

88
Q

Hep B diagnosis: what is anti-HBs and what does it indicate (3)

A

1- antibody to surface antigen
2- indicates immunity
from natural infection or from vaccination (titre > 10 IU/mL indicate definitive immunity)
3- titres may decline to undetectable levels but individual may retain anamnestic immunity

89
Q

Hep B diagnosis: what is anti-HBc (2 types) and what does it indicate (5)

A

1- antibody to core antigen
2- indicates ongoing (IgM) or previous (IgG) HBV infection
3- produced because infected hepatocytes express HBsAg on their surface
4- total anti-HBc = IgM + IgG; remains positive for life
5- does not develop after vaccination as vaccine does not contain core antigen

90
Q

Hep B diagnosis: what is anti-HBe and what does it indicate (3)

A

1- antibody to envelope antigen
2- indicates low infectivity and low viral replication
3- this antibody mops up eAg

2025 PHPM Royal College Study - based on AN Summary Notes (10 decks)

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