Columbus: viral infections Flashcards
What vaccine is recommended for HIV-positive pregnant patients?
Pneumococcus
What vaccines are contraindicated in pregnancy?
Live attenuated vaccines. Measles, mumps, rubella, polio, varicella, yellow fever
How long should people wait for pregnancy after MMR?
Can MMR be given while breast-feeding?
How would you counsel a woman who received MMR during first trimester?
One month
Compatible with breast-feeding; no risk to newborn
No increased risk of anomaly; not indication for termination
How soon after influenza vaccination do antibodies present?
How long does passive neonatal protection exist
Two weeks
Six months
Who should not receive influenza vaccination?
Egg allergy
Children under 6 months due to Reye syndrome
Children 6 months to 18 years on chronic aspirin
Current illness with fever
History of vaccine reaction or Guillain Barre syndrome
When should tetanus, diphtheria, pertussis vaccination be given during pregnancy?
How long does newborn passive immunity persist?
When should other newborn caregivers receive Tdap vaccination?
At any point but best between 27 and 36 weeks
Three months
At least two weeks prior
What is the tetanus vaccination schedule for women who have never had the series?
0, 4 weeks, 6-12 months
What is thiomerosal?
What is the current status of thimerosal as a vaccination preservative?
Mercury-based preservative in multidose vials; broken down into ethylmercury and thiosalicylate
Remove from childhood vaccinations as of 2001; replaced by more expensive preservatives with less long-term data
What are the concerns for the fetus associated with maternal fever during pregnancy?
Risk of neural tube defects double with fever greater than 103.5° during neural tube closure
Risk of encephalopathy, neonatal seizures with increased fever near delivery
What type of virus is influenza?
Single-stranded RNA virus; two subtypes: A and B
How does influenza typically present?
Fever, chills, headache, myalgia
Does pregnancy make women more susceptible to influenza?
Is the fetus at risk for infection?
What complications should be considered?
No
No evidence of in utero infection
Increased risk of bacterial superinfection or pneumonia
Increased risk of preterm labor
How should influenza be managed?
Stay home, fluids, acetaminophen, rest, chicken soup
Oseltamivir 75-150 mg twice daily for five days or 75 mg twice daily 7-10 days for prophylaxis (type A only)
What type of virus causes rubella?
What are the other names for rubella?
How is it transmitted?
A togavirus, which is a single-stranded RNA virus
“Third disease” or German measles
Hand-to-mouth, droplet with 90% acquisition rate
When is rubella contagious?
How long is the incubation period?
Seven days prior to rash and seven days after
16-18 days
What are symptoms of rubella infection?
Low fever
Pink, macular rash starting on head, spreads to trunk and limbs
Transient arthritis in adults
How is rubella diagnosed?
IgM antibody presents 4 weeks after infection
Four-fold increase in IgG titers
IgG without IgM indicates immunity
What is the rate of fetal infection during the first trimester?
What is the rate of fetal infection during the second and third trimesters?
How is fetal infection diagnosed?
90%
30-50%
Culture from amniocentesis; no predictive value for fetal injury; late ultrasound findings
What is the risk of congenital rubella syndrome at 10 weeks or less?
11-14 weeks?
Greater than 14 weeks?
What is the mortality rate for infants with congenital rubella syndrome?
50%
10%
0%
10%
What is the most common sequela of congenital rubella syndrome?
What are other sequelae?
Cochlear degeneration with deafness 70%
Blindness with retinopathy and Cataracs 20-30%
Microcephaly and retardation 25%
Cardiac anomalies 20%
Hemolytic anemia and thrombocytopenia
What viruses are in the herpes family?
What type of viruses are these?
Herpes simplex I and II, varicella zoster, CMV, Epstein-Barr virus
Double-stranded DNA virus
How long do symptoms from primary HSV infection persist?
How long does viral shedding occur?
When do antibodies develop?
3 weeks
4-5 weeks
Within 7 days and peek at 3 weeks
What percentage of new genital infections are with HSV-1?
80%
What is herpetic whitlow?
What is scrum pox?
Herpes found on healthcare workers particularly on the finger or thumb
Herpes on rugby players
What is the risk of neonatal HSV infection with a primary maternal infection?
Non-primary first episode?
Recurrent genital infection?
Recurrent oral infection?
50%
33%
3%
Nearly 0%
How does neonatal HSV infection present?
45% mild and localized to face
30% herpetic encephalitis with 10% mortality and 20% permanent sequela
25% disseminated with 30% mortality
What percentage of the US population are anti-HSV-1 positive?
HSV-2 positive?
Cervical viral shedding of HSV occurs at what percent of deliveries?
50%
30%
0.5%
What is the most accurate way to diagnose herpes?
What other testing is available?
PCR testing of a vesicle
Viral culture of a new vesicle
Serologic testing
How should primary or non-primary first episodes of HSV infection be treated?
Valacyclovir 1 g twice daily for 7-10 days
Acyclovir 400 mg three times daily for 7-10 days
How should recurrent HSV be treated?
How does this differ from prophylaxis dosing?
Valacyclovir 500 mg twice daily for three days
Acyclovir 400 mg three times daily for five days
Same; start at 36 weeks
What is the effectiveness of HSV prophylaxis during pregnancy?
75% reduction in recurrence, 40% reduction in C-section rate, 90% reduction in viral shedding
When is C-section indicated for delivery in the setting of HSV?
If recurrent HSV lesions are distant from the genital hiatus, what mode of delivery is recommended?
Active lesions or prodromal symptoms
Cover lesion with occlusive dressing and allow vaginal delivery
