Chapter 1 Flashcards
Primary Prevention
Prevent the onset or acquisition of a given disease.
Goal: to spare individuals the suffering, burden, and cost associated with the clinical condition.
Primary prevention is the first level of healthcare.
Secondary Prevention
Identify and treat asymptomatic persons who have risk factors for a given disease or in preclinical disease.
Flu symptoms, adults (7)
abrupt onset of signs and symptoms including:
fever,
myalgia,
headache,
malaise,
nonproductive cough,
sore throat, and
rhinitis
Flu symptoms, children (10)
Adult symptoms:
fever,
myalgia,
headache,
malaise,
nonproductive cough,
sore throat, and
rhinitis
Plus:
acute otitis media,
nausea and vomiting
Flu symptoms resolve in
The worst symptoms in most uncomplicated cases resolve in about 1 week,
the cough and malaise often persist for 2 or more weeks.
Flu spreads …
Primarily erson-to-person
Respiratory droplet,
primarily through a cough or sneeze.
Incubation and transmission periods of the flu, adults vs children
In an immunocompetent patient:
- Adults: Short incubation period, with a range of 1 to 4 days (average of 2 days).
- Adults pass the illness on 1 day before the onset of symptoms and continue to remain infectious for approximately 5 days after the onset of the illness.
- Children can shed the virus before the onset of symptoms and remain infectious for 10 or more days after the onset of symptoms.
People who are immunocompromised can remain infectious for up to 3 weeks.
H1N1 aka …
Swine Flu
H5N1 aka …
Avian flu
LAIV is ok for …
Healthy people aged 2 to 49 years.
LAIV no-nos:
Individuals who should not receive LAIV include:
- children younger than 2 years;
- adults older than 49 years;
- patients with a health condition that places them at high risk for complications from influenza, including chronic heart disease, chronic lung disease such as asthma or reactive airways disease, diabetes or kidney failure, and immunosuppression;
- children or adolescents receiving long-term high-dose aspirin therapy; - people with a history of Guillain-Barré syndrome;
- pregnant women; and
- people with a history of allergy to any of the components of LAIV.
Rubella typically causes …
a relatively mild, 3- to 5-day illness with little risk of complication to the person infected.
Rubella, reason for vaccination…
Prevention of: congenital rubella syndrome
While rubella typically causes mild disease, the effects on the fetus can be devastating.
Pneumococcal disease … caused by … results in …
Pneumococcal disease,
caused by the gram-positive diplococcus Streptococcus pneumoniae,
results in significant mortality and morbidity.
Differences between Pneumovax and Prevnar
- Pneumococcal polysaccharide vaccine (Pneumovax®, PPSV23) contains purified polysaccharide from 23 of the most common S. pneumoniae serotypes.
- Pneumococcal conjugate vaccine (Prevnar®, PCV13) contains purified capsular polysaccharide from 13 serotypes of pneumococcus.
- Use of PCV13 is associated with greater immunogenicity when compared with PPSV23, but it does not provide protection against as many pneumococcal serotypes, and is routinely used in childhood.
Purpose of vaccination with pneumococcal vaccines…
the pneumococcal vaccine primarily protects against:
- Invasive disease such as meningitis and septicemia associated with pneumonia and disease caused by S. pneumoniae.
This organism is the leading cause of death from community-acquired pneumonia (CAP) in the United States.
The polysaccharide form (Pneumovac, PPSV 23) protects from approximately 90% of the bacteremic disease associated with the pathogen, whereas the conjugate form (Prevnar, PCV 13) is protective from approximately 70%.
Prevnar 13 (PCV 13) and Pneumovac 23 (PPSV 23) do not protect against …
Protect against infection with Streptococcus pneumoniae, but not against anything else including:
- Mycoplasma pneumoniae;
- Chlamydophila (formerly Chlamydia) pneumoniae;
- Legionella species;
and gram-negative respiratory pathogens such as:
- Haemophilus influenzae,
- Moraxella catarrhalis, and
- Klebsiella pneumoniae.
Risk of severe, potentially life-threatening adverse reactions to PPSV 23 and PCV 13 is
Rare
PCV 13 and PPSV 23 vaccination recommendations:
Based on risk levels:
- Average risk: <65 years of age without any chronic medical conditions; no pneumococcal vaccination is needed.
- Increased risk: those ≥19 years and <65 years, cigarette smokers, or with chronic medical conditions (e.g., diabetes, lung disease, cardiovascular disease, liver disease, or kidney disease [except end-stage kidney disease or nephrotic syndrome]) but without immune compromise. These individuals should receive vaccination with PPSV23 and should be revaccinated with PPSV23 after 5 years.
- Highest risk: those ≥65 years, or with immune compromised conditions, including those due to disease (e.g., malignancy, HIV, end-stage kidney disease), iatrogenic causes (e.g., use of steroids, immunomodulators, transplant recipients), or functional or anatomic asplenia. For those ≥65 years, individuals should receive PCV13 followed by PPSV23 1 year later. For younger adults with high-risk conditions, individuals should receive PCV13 followed by PPSV23 ≥8 weeks later.
HIV and invasive pneumococcal disease prevention….
the risk of pneumococcal infection is up to 100 times greater in people with HIV infection than in other adults of similar age. Once the diagnosis of HIV infection is made, the patient should receive both PCV13 and PPSV23 vaccines as soon as possible:
- PCV13 is given first, followed by PPSV23 8 weeks later.
- A second dose of PPSV23 should be administered at least 5 years after the initial dose, and
- A third dose should be administered at age 65 years if the person was younger than age 65 years at the time of HIV diagnosis.
Who should be revaccinated and with what …
- Those between 19 but < 65 at increased risk of serious compliciations. In other words, cigarette smokers and those having chronic medical conditions (e.g., DM, lung disease, cardiovascular disease, liver disease, kidney disease (except end-stage kidney disease or nephrotic syndrome). They should receive PPSV 23 and should be re-vaccinated with PPSV 23 after 5 years.
- Those at highest risk, >= 65 or with immune compromised conditions (d/t disease, iatrogenic causes, asplenia):
- Younger adults: PCV 13, then PPSV23 >= 8 weeks later and repeat the PPSV 23 in 5 years
- Older adults, >= 65: PCV 13, then PPSV 23 one year later.
Hepatitis B infection is caused by …
the small double-stranded DNA hepatitis B virus (HBV) that contains an inner core protein of hepatitis B core antigen (HBcAg) and an outer surface of hepatitis B surface antibody (HBsAg).
