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Micro- Winter > CNS Infections- Prevention & Vaccines > Flashcards

CNS Infections- Prevention & Vaccines Flashcards

1
Q

Community-acquired meningitis:
Before the introduction of the measles and mumps vaccine, viral meningitis/meningoencephalitis was more common than bacterial meningitis. Even after the widespread (and successful) use of the measles and mumps vaccine, ___________ remains more common than _________. In fact the measles and mumps vaccine has made the most significant reduction in the number of cases of meningitis compared to the case rate/100,000 persons in the pre-vaccine era.

A

viral meningtis (not mumps or meales etiology)

bacterial meningitis

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2
Q

Community-acquired meningitis:
For bacterial meningitis, _________ accountED (past tense) for majority of community-acquired cases and _________ was responsible for most of cases involving children. After a conjugated ____ vaccine was in common usage, ________ became the leading cause of community-acquired meningitis.

A

children

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3
Q

Community-acquired meningitis:

Recently a conjugated ________ was developed for infants and children.

A

pneumococcal vaccine

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4
Q

Community-acquired meningitis:
After common usage of the Hib conjugated and pneumococcal conjugated vaccines (TODAY), _______ account for the majority of community-acquired cases of bacterial meningits and __________ is now responsible for most cases, then _______, lastly _______. But the case rate for meningococcal meningitis has not changed over time.

A

adults
Neisseria meningitidis
Streptococcus pneumoniae
Hib

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5
Q

Vaccines exist for CNS diseases caused by

A
  1. N. meningitidis
  2. S. pneumoniae
  3. H. influenzae, type b
  4. polio
  5. rabies
  6. botulism
  7. tetanus
  8. measles
  9. mumps
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6
Q

Immunization with polysaccharide conjugate vaccines (T dependent antigen) helps by:

A
  1. decrease carriage rate.
  2. decrease incidence of disease (is capable of class switching)
  3. IS recommended for children
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7
Q

T dependent antigen vaccine for S. pneumoniae

A

-7/13 valent conjugated vaccine (PCV-7/13)
PCV=polysaccharide conjugate vaccine
-Recommended for all children up to 5-y-o-age –FDA has approved its use to prevent pneumococcal otitis media, meningitis, and bacteremia

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8
Q

T dependent antigen vaccine for N. meningitidis

2 vaccines- give names and age groups

A

-Quadrivalent (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid (CRM197) conjugate vaccine

  1. Menactra (MCV4; Sanofi-Pasteur) for all persons aged 11→ 18-y-o-age AND for persons aged 2→55 years at increased risk for meningococcal disease.
    (TEENS or YOUNG/ADULTS AT RISK)
  2. Menveo (Novartis Pharmaceuticals, Inc) in people 11 to 55-y-o-age.
    (NORMAL TEENS AND ADULTS)
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9
Q

N. meningitides group B vaccines (2 of them)

A
  1. 4CMenB (Bexsero; composed of 3 recombinant proteins)

2. Trumenba (composed of 2 recombinant proteins).

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10
Q

Immunization with polysaccharide

(Type II, T-independent antigen) vaccines:

A
  1. decrease incidence of disease
  2. NO decrease in carriage rate due to NO class switching
  3. is NOT recommended for children
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11
Q

Type II T-independent antigen vaccine for S. pneumoniae

A

23 valent (pnu-immune Pnuemovax)

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12
Q

Type II T-independent antigen vaccine for N. meningitidis: (only 1)

A
  • Tetravalent/quadrivalent polysaccharide vaccine for Groups A, C, Y, W-135
    1. Menomune (MPSV4)
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13
Q

Type II T-independent antigen vaccine for H. influenzae, type b (Hib)

A

Pure polysaccharide vaccine

compared to T dependent ag vaccine for Hib which is a Conjugated vaccine

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14
Q

Immunoglobulin (Ig) preps exist for:

A
  1. Rabies
  2. Tetanus
  3. Botulism
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15
Q

Post-exposure prophylaxis to prevent rabies:

A

Protocol: Rabies vaccine, IG, wound care, tetanus immunization

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16
Q

If carriage of H. influenzae, type b and/or N. meningitidis is detected by nasopharyngeal cultures:

A

1 . eliminating the immune carrier state by chemoprophylaxis of both vaccinated and non-vaccinated individuals.
2. Treat to prevent spread in families and closed populations like daycares and college campuses

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17
Q

If carriage of H. influenzae, type b and/or N. meningitidis is detected by nasopharyngeal cultures TREAT with:

A

Ciprofloxacin, ceftriaxone, rifampin, or azithromycin
unless fluoroquinolone-resistant N. meningitidis is detected in the area, if so, then do not administer ciprofloxacin

18
Q

Description of Inactivated (killed) Polio Vaccine (IPV)
Other names: Salk vaccine or IPOL

1st version of polio vaccine

A
  1. trivalent
  2. prepared by formalin inactivation of wt (wild type) virus, grown in primate tissue culture.
  3. Primary series is at least 4 inoculations over a 1→ 2 years
  4. High efficacy
    (> 90%, seroconversion/immunity)
19
Q

Polio-

Enhanced potency vaccine (e-IPV):

A
  1. more potent than original IPV
  2. results in increased seroconversion rates
  3. is the only IPV vaccine approved in US
    i. e., IPV = e-IPV
20
Q

Advantages of Polio vaccine

e-IPV

A

Safe/no risk for unvaccinated persons, e.g., the immunocompromised.

21
Q

Limitations to Polio vaccine

A
  1. Given parentally (i.e., injected) – more expensive than Oral polio vaccine (OPV) administration.
  2. Does not generate high sIgA responses but rather a serum IgG response. This response is still efficacious since if a vaccinated person is exposed to WT virus, the WT virus must first disseminate in blood and lymphatics to reach the CNS and serum anti-polio-IgG helps clear virus from these sites.
  3. Boosters are needed. In developing countries, a 4th booster may be required.
  4. Only protects those actually vaccinated. So religious/philosophical groups not participating in vaccine program can/do occasionally become infected in local outbreaks → the spread of wild-type (wt) virus.
22
Q

Oral polio vaccine (OPV)

aka Sabin

A
  1. trivalent vaccine.
  2. live attenuated virus which replicates in oropharynx and intestinal tract but cannot infect neuronal cells, less transimisable than wt virus.
  3. OPV has significant advantages over e-IPV
23
Q

Limitations to Oral Polio Vaccine (OPV)

A
  1. Puts other unvaccinated family members and contacts at risk, may spread to immunocompromised persons (vaccine is live)
  2. During viral replication in vaccinated children, the attenuated virus mutates back to the virulent/wt virus , but only causes extremely rare cases of vaccine-associated paralytic polio/poliomyelitis (VAPP) in the US (8→10 cases/year).
  3. Vaccine-derived poliovirus can circulate in the population, (cVDPV).
24
Q

In 1997, ACIP recommended use of e-IPV for first 2 doses (2, 6 months) and OPV forlast 2 doses (6 → 12 m, 12 → 16 m). This will prevent any back mutations from causing clinical manifestations (back mutations of OPV will still occur).

HOWEVER- In June 1999, ACIP and AAP recommended ______________

A

4 doses e-IPV (IPOL) ONLY to eliminate any chance of vaccine-associated paralytic polio and in doing so, assure parents and thus obtain better vaccination compliance.

25
Q

People at risk for Rabies

CDC publishes a list of pre-exposure prophylaxis by vaccination, these people need prophylaxis

A
  1. veterinarians.
    2. spelunkers.
    3. laboratory workers.
    4. animal handlers.
26
Q

Purpose of prophylaxis is to prime immune system for an anamnestic response when booster is administered; this anamnestic response:

A
  1. eliminates the need for passive immunization.

2. reduces number of doses of rabies vaccine needed for postexposure treatment (3 doses i.m., 3 days apart).

27
Q

Pre-exposure vaccine prophylaxis protocol is

A

3 doses i.m. in deltoid muscle in adult or anterolateral zone of thigh in children

28
Q

Post-exposure protocol for someone who received pre-expsoure prophylaxis

A

3 doses i.m. in deltoid muscle in adult or anterolateral zone of thigh in children.

29
Q

People provided with pre-exposure vaccination, were bitten by a rabid dog and then failed to receive appropriate post-exposure prophylaxis _____.

A

died

30
Q

Vaccination is never done as a _______ because it may cause neuropathy and lower antirabies antibody titers, true for both Pre- and Post-exposure vaccination.

A

gluteal injection

31
Q

Rabies Post-exposure management: It is efficacious (it works), if done ___________

Public health importance of reservoirs - Since rabies is epizootic in feral (wild/sylvatic) animals, knowledge of the animals in which rabies is endemic and the geographic distribution/range of the viral infection in each animal (the geographical boundaries of the currently recognized reservoirs in the US) is imperative when considering initiation of prophylaxis in a case of human exposure.

A

properly, in time!!

“But treatment is an urgency, NOT an emergency”

32
Q

Must do both _____________, unless

pre-exposure prophylaxis is done

A

Vaccination + antirabies serum

33
Q

Post-exposure management consists of:

A
  1. Human antirabies immune globulin (HRIG)
  2. Human diploid cell strain rabies vaccine (HDCV)

Must do both unlesspre-exposure prophylaxis was done

34
Q

Human antirabies immune globulin (HRIG) description

A

Two HRIG (IgG) formulations prepared from hyperimmunized human donors are licensed and available for use in the United States:

  1. HyperRab™ S/D (Talecris Biotherapeutics)
  2. Imogam® Rabies-HT (sanofi pasteur).

Given at the same time as the vaccine but at a different site:

a. Half of the dose IM, in gluteal region.
b. Half of the dose should be injected in and around the wound site.

35
Q

Human diploid cell strain rabies vaccine (HDCV) description

A
  • 2 other approved rabies vaccines but only HDCV and purified chick embryo cell vaccine (PCECV, RabAvert®, Novartis Vaccines and Diagnostics) is available in the US today.
  • All are killed (by chemical treatment) vaccines
  • Administration: IM in deltoid muscle in adult, and anterolateral zone of thigh in young children on 5 days: 0, 3, 7, 14, 28→30
36
Q

Factors in decision to do post-exposure prophylaxis:

A
  1. See chart in the PowerPoint presentation.

2. Observe biting animal for 10 d for symptoms, rabid animals (dogs) die in 4→5d.

37
Q

24 hour hot lines

A

IL Dept of Public Health: 217-785-1557

CDC: 404-963-9211

38
Q

Rabies Post Exposure Prophylaxis

A
  1. Wash wound with copious soap and water.
  2. HRIG at TWO sites: 1/2 of dose in and around the bite site BEFORE suturing & 1/2 of dose in the gluteal area
  3. Rabies vaccine ONLY in deltoid or anterior-lateral area of child. MUST BE DONE THIS WAY!
  4. Tetanus prophylaxis must also be done unless patient is protected by appropriate immunization
39
Q

Gluteal injection of rabies vaccine results in:

A

Neuropathy and lower antirabies antibody titers in blood

40
Q

Prevention of tetanus is accomplished by:

A
  1. Primary immunization with DTaP at 2, 4, 6 and 15 months-of-ages.
  2. Boosters (dTaP) administered at:
    i. 4→ 6-y-o-age.
    ii. every 10 years thereafter
41
Q

Prevention of Neonatal tetanus is accomplished by either of the following procedures:

A
  1. vaccination of pregnant women (2 doses of 2. through clean delivery and chord care procedures

Micro- Winter (26 decks)

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