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2025 PHPM Royal College Study - based on AN Summary Notes > CD - measles, mpox > Flashcards

CD - measles, mpox Flashcards

1
Q

what is the agent for measles (1)

A

1- measles morbillivirus

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2
Q

what is the reservoir for measles (1)

A

1- humans

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3
Q

what is the mode of transmission for measles (2)

A

1- Airborne, remains in the air with evaporated droplets for at least 2 hours
2- Direct contact with respiratory droplets

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4
Q

what is the incubation period for measles - range (1)

A

1-
7-21 days

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5
Q

what is the communicable period for measles (1)

A

1-
4 days before rash onset to 4 days after onset of
rash

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6
Q

what is the basic reproductive number (R0) for measles (1)

A

1-
R0 = 12-18

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7
Q

what is the secondary attack rate of measles among susceptible persons (1)

A

1-
90%

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8
Q

what are criteria for immunity re: measles (need to meet any one of these) (3)

A

1- documentation of vaccination
2- lab evidence of immunity (IgG)
3- history of lab-confirmed measles infection

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9
Q

what are criteria for documentation of ROUTINE vaccination for the following (i.e. how many doses does each group need):

-kids 12mo - 17yo
-adults 18+ born after 1970
-adults before before 1970

(3)

A

1- kids 12mo - 17yo:
*2 doses

2- adults 18+ born after 1970
*1 dose

3- adults before before 1970
*considered immune from natural infection

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10
Q

what groups of people are considered at greatest risk of exposure to measles - SATH (4)

A

1- travellers
2- healthcare workers
3- students
4- adults born between 1970 - 1991 (only received 1 dose)

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11
Q

what are measles vaccination requirements for HCW or military (1)

A

1-
2 doses regardless of birth year

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12
Q

what are measles vaccination requirements for travellers outside North America (2)

A

1-
2 doses if born after 1970

2-
1 dose if born before 1970

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13
Q

what are measles vaccination requirements for post-secondary students (2)

A

1-
2 doses if born after 1970

2-
1 dose if born before 1970 and no documentation of receipt of measles-containing
vaccine

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14
Q

what is the initial clinical presentation of measles F-DICCCK (7)

A

prodrome of:
1- fever
2- cough
3- coryza (inflammation of mucous membrane in the nose)
4- conjunctivitis
5- drowsiness
6- irritability
7- Koplik’s spots are not always present

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15
Q

how long after being infected with measles virus do initial symptoms tend to appear (1)

A

1-

7-21 days after being infected (i.e. incubation period)

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16
Q

how long after initial symptoms begin does measles rash appear (1)

A

1-

3-7 days after other symptoms appear

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17
Q

how long can measles rash last for (1)

A

1-

4-7 days

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18
Q

what is the physical characteristics of measles rash (1a) how does measles rash generally manifest - where does it start and where does it move to (1b)

A

1a- generalized erythematous maculopapular rash
1b- begins on the face, advances to the trunk
of the body and then to the arms and legs

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19
Q

what are potential complications of measles infection - BOPPED SDS (9)

A

1- blindness
2- deafness
3- encephalitis
4- otitis media
5- pneumonia
6- subacute sclerosing panencephalitis
7- premature labour
8- spontaneous abortion
9- death

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20
Q

what tests do you do to diagnose measles and within what timeline can you use each of these tests (3)

A

1- NP/throat swab: within 4-7 days of rash onset
2- Urine PCR: within 14 days of rash onset
3- Serology: IgM antibodies (present 3-4 days after
rash onset) and IgG antibodies

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21
Q

why do you NOT want to test for measles serology, IgM, if onset of rash has been less than 3-4 days (1)

A

1- IgM for measles can be falsely negative if taken less than 3 days after onset of the rash

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22
Q

what are other febrile rash infections that can cause false positive measles IgM - HEAP (3)

A

1- parvovirus b19
2- enteroviruses, adenovirus
3- human herpes virus 6 (roseola)

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23
Q

in the travel health context, what are other infections that can cause false positive measles IgM - CZ (2)

A

1- zika
2- chikungunya

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24
Q

what kind of vaccine is measles vaccine (1)

A

1- live attenuated

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25
Q

what is the efficacy of measles vaccine (2)

A

In general - 94-99% effective:

1- single dose of measles containing vaccine given between 12-15 months is 94-98% effective
2- with second dose (18 months – 4 to 6 years) it is 99% effective

26
Q

what is the schedule for measles vaccine (2)

A

1- 2 doses
2- first given at 12 months, second at 18 months (max by 4-6 years)

27
Q

can measles vaccine be given to children 6 months and older if they are travelling? (1a)

how does this impact their regular measles vaccine schedule (1b)

A

1a- MMR vaccine can be given to children ≥6 months of age who are traveling internationally
1b- these kids still require 2 regular doses of MMR after 12 months of age

28
Q

what groups are contraindicated to getting measles vaccine I-PIT (4)

A

1- pregnant people
2- immunocompromised people
3- infants less than 6 months old
4- active, untreated TB

29
Q

measles case mgmt: what things do you ask on history as part of case investigation (1a) and why (1b)

A

1a- TOCIS (travel, occupation, contacts, immunization status, symptom onset)
1b- to determine period of communicability

30
Q

measles case mgmt: what is management for a case? (1)

A

1- supportive management

31
Q

measles case mgmt: who needs to isolate (items 1-6) and for how long (item 7)

A

Isolate from:
1- child care settings
2- schools
3- post-secondary educational institutions
4- workplaces
5- sporting events and other group settings
6- healthcare settings

7- isolate for 4 days after the appearance of the rash

32
Q

measles contact mgmt: what is the definition of a contact (1)

A

1- any susceptible person who shared the same air space for any length of time during the period of communicability, including two hours after the case left the air space

33
Q

measles contact mgmt: is there any chemoprophylaxis (1)

A

1- NO

34
Q

measles contact mgmt - PEP: what is the general rule regarding measles vaccine’s use in PEP? in relation to time from exposure (1)

A

1- vaccine is not effective as PEP if it has been >72h since exposure

35
Q

measles contact mgmt - PEP: what is PEP for infants <6mo (all are susceptible)

*<72h from exposure
*72h - 6d from exposure

(2)

A

1- IMIg (immunoglobulin)
2- IMIg

36
Q

measles contact mgmt - PEP: what is PEP for immunocompetent infants 6-12 mo (all are susceptible)

*<72h from exposure
*72h - 6d from exposure

(2)

A

1- vaccine
2- IMIg

37
Q

measles contact mgmt - PEP: if immunocompetent infants 6-12 mo receive vaccine as part of PEP, how many additional doses of vaccine are needed for protection (1)

A

1- Two additional doses of MMR vaccine provided after 12 months of age are required for long-term
protection

38
Q

measles contact mgmt - PEP: what is PEP for susceptible immunocompetent people >12 mo

*<72h from exposure
*72h - 6d from exposure

(2)

A

1- vaccine
2- n/a

39
Q

measles contact mgmt - PEP: why is immunoglobulin not a priority for contacts who are immunocompetent people >12 mo following exposure (1)

A

1- due to low risk of disease complications - they should only be offered vaccine as PEP

40
Q

measles contact mgmt - PEP: what is PEP for susceptible pregnant people or immunocompromised people 6mo+

*<72h from exposure
*72h - 6d from exposure

(2)

A

1- IVIg or IMIg
2- IVIg or IMIg

41
Q

measles contact mgmt - PEP: why is IVIg used for those weighing >30kg, and IMIg used for those weighing <30kg? (1)

A

1- if you weigh <30kg (i.e. a child ~6yo and less) then the volume of IVIg that would have to be given to provide protection would be too large (~15mL)

42
Q

measles contact mgmt - PEP: put another way, which gives you better protection if you weigh >30kg - IVIg or IMIg (1)

A

1- IVIg

43
Q

measles contact mgmt: how long should contacts be excluded from childcare/school settings (item 1) and after what criteria have been met (any of items 2-4)

and what about children who may only have 1 dose of MMR - how long should they be excluded for (item 5)

A

1- from days 5-21 post-exposure until:
2- they are adequately immunized OR
3- demonstrate lab confirmation of immunity OR
4- or have received immuneglobulin
5- Susceptible children < 6 years old with only 1 dose of MMR vaccine should be excluded until they receive a 2nd dose of MMR vaccine

44
Q

measles contact mgmt: how long should HCW with only 1 dose of vaccine be excluded from HC settings (item 1) and after what criteria have been met (items 2-3)

A

1- from Days 5 to 21 post-exposure until:
2- they are tested for IgG antibody
3- receive a 2nd dose of MMR vaccine.

45
Q

measles contact mgmt: do you need to exclude people who have received PEP (item 1) and what is the exception (item 2)

A

1- No requirement to exclude individuals for any length of time after receipt of vaccine or Ig before their re-entry to childcare facilities, schools, or other settings
2- with the exception of healthcare workers

46
Q

why is measles a hot topic right now (2)

A

1- measles outbreaks are increasing in every region globally since 2023, especially 2024
2- also, with the resurgence of global travel, there is higher risk of spread from one region to another

47
Q

what is the agent for mpox (1)

A

1- monkeypoxvirus

48
Q

what are the clades (subtypes) of mpox (2)

A

1- clade 1 - divided into 1a, 1b
2- clade 2 - divided into 2a, 2b

49
Q

what are reservoirs of mpox (1)

A

1- small mammals from endemic African countries (e.g. dormice, rope squirrel, sun squirrel, Gambian pouched rat)

50
Q

what is the mode of transmission of mpox - FAVA-P (5)

A

1- Person-person: direct or intimate contact
2- Fomites: Contact with shared, contaminated object
3- vertical
4- Animal-human - animal skin lesion, body fluid,
mucosa
5- ?airborne

51
Q

what is the communicable period for mpox (2)

A

1- from onset of symptoms until the scabs have fallen off on their own and the skin is healed.
2- may be contagious up to 4 days before symptom onset

52
Q

what is the clinical presentation of mpox - some symptoms - PR (mpvpc) FLOP (6)

A

1- rash: macule -> papule -> vesicle -> pustule -> crusting
2- oral, genital, perianal lesions
3- fever/chills
4- lymphadenopathy
5- pharyngitis
6- proctitis

53
Q

which clade caused most cases in Canada in 2022 outbreak (1)

A

1- clade 2b

54
Q

which clade has been implicated in the 2024 outbreak (not seen in Canada thus far) (1)

A

1- clade 1b

55
Q

what are the recommendations surrounding pre-exposure immunization for mpox - what vaccines, how many doses, and who should get it (3)

A

1- imvamune vaccine
2- get two doses
3- those who are high risk of acquiring mpox

56
Q

which groups are considered high risk of acquiring mpox - MWST (4)

A

1- gbMSM who meet one or more of the following criteria:
*Have more than one partner
*Are in a relationship where at least one of the partners has other sexual partners
*Have had a confirmed sexually transmitted infection acquired in the last year
*Have engaged in sexual contact in sex-on-premises venues
2- Sex workers
3- Staff or volunteers in sex-on-premises venues where workers may have contact with contaminated fomites potentially
4- Those who engage in sex tourism

57
Q

what are investigations/diagnostic tests for mpox (items 1, 2 - PV) and where should you collect the specimens from (items 3, 4 - L-norbu)

A

1- PCR/NAAT (preferred)
2- viral culture
3- skin lesion (fluid, crusts, roofs) - preferred
4- otherwise could use NP, oropharyngeal, rectal, blood, urine

58
Q

what is the severity of mpox disease (1)

A

1- can range from mild to disseminated, multi-organ disease

59
Q

what is the treatment for mpox (2)

A

1- self-limited, typically
2- TPOXX off-label use (tecovirimat monohydrate capsules - existing treatment for smallpox) for severe or hospitalized cases

60
Q

what is case management for mpox - CPR-A (4)

A

1- cover lesions
2- PPE - use PPE when coming in contact
3- reduce contact - have cases reduce contact with vulnerable populations (e.g. immunocompromised, pregnant, children)
4- avoid sexual contact until lesions crusted over

61
Q

what is contact management for mpox - what is PEP, dosing (and how long after exposure), what to monitor for and do after (4)

A

1- do PEP with vaccine (Imvamune) to those identified as high risk contacts to confirmed or probable mpox cases
2- first dose given up to 14 days post-exposure
3- monitor for signs and symptoms x 21days from last exposure
4- if symptoms develop - isolate, contact PHU and healthcare provider to start testing

2025 PHPM Royal College Study - based on AN Summary Notes (30 decks)

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