Exam 1- Immunization

Question 1

What is Immunity?

Answer 1

ability of human body to tolerate presence of material indigenous to body “self” & to eliminate foreign “nonself” material

Question 2

What is Active Immunity? Give some examples.

Answer 2

protection that is produced by person’s own immune system, usually lasts for many years or a lifetime.
i.e. vaccines

Question 3

What is Passive Immunity? Give some examples.

Answer 3

protection by products produced by animal or human or transfer to another human.
i.e. in utero, mother’s milk, blood products

Question 4

What is antigen?

Answer 4

a live (virus/bacteria) or inactivated substance capable of immune response

Question 5

What is an antibody?

Answer 5

protein molecules (immunoglobulins) produced by B lymphocytes to help eliminate an antigen

Question 6

What is live attenuated vaccines? Which ones do we commonly use in the U.S.?

Answer 6

• produced by modifying a disease-producing virus or bacterium (does not cause illness)
• can replicate & produce immunity (usually w 1 dose)
• Examples: MMR, varicella, zoster (same virus as varicella but in higher amount), rotavirus, influenza (intranasal)

Question 7

Live vaccines: can we give them together? Who would we not give it to?

Answer 7

• Give together or more than 4 weeks apart

- immunocompromised

Question 8

What are Inactivated vaccines?

Answer 8

• cannot replicate
• require multiple doses, 1st dose “primes immune system” & “booster” doses
• antibody titers diminish w time

Question 9

What vaccine is given at birth?

Answer 9

Hepatitis B

Question 10

What vaccines are given at 2 month well visit ?

Answer 10

“B DR. Hip”

B-Hepatitis B (2nd dose)
D- DTap
R- rotavirus 
H-Hib
I- IPV
P- PCV

Question 11

What vaccines would you expect to give at a 4 month old well visit ?

Answer 11

“DR. HIP”

D- DTap
R- rotavirus

H- hib
I- IPV
P- PVC

(NO hep B)

Question 12

What vaccines are given at the 6 month well baby visit ?

Answer 12

“B DR. Hip”

B-Hepatitis B (3rd dose)
D- DTap
R- rotavirus 
H-Hib
I- IPV (polio)
P- PCV 

(Also, starting at 6 months, add annual flu vaccine)
(Same as two month check up)

Question 13

DIPHTHERIA

Type of pathogen
Symptoms presented with
Complications

Answer 13

Bacteria

Can affect any mucous membrane. Insidious onset of pharyngitis. Within 2 to 3 days membrane forms which can cause respiratory obstruction. Lymphadenopathy (“bulls neck”). Fever usually not high but patient appears toxic.

Myocarditis; neuritis; paralysis of the soft palate, eyes, and limbs; death.

Question 14

HAEMOPHILUS INFLUENZA TYPE B (Hib)

Type of pathogen
Symptoms presented with
Complications

Answer 14

Bacteria

Meningitis, epiglottitis, pneumonia, arthritis, and cellulitis

Hearing impairment and neurologic sequelae, death

Question 15

How long must you wawit between giving live vaccine first and then administering the antibody? Why?

Answer 15

2 weeks. Prevent antibody from interfering with viral replication (CH. 2 Pinkbook)

Question 16

HEPATITIS A

Type of pathogen
Symptoms presented with
Complications

Answer 16

Virus

Abrupt onset of fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice.

Immunologic, neurologic, hemetalogic, pancreatic, and renal extra hepatic manifestations; death

Question 17

HEPATITIS B

Type of pathogen
Symptoms presented with
Complications

Answer 17

Virus

Preicteric: insidious onset of malaise, anorexia, nausea, vomiting, RUQ pain, fever, headache, myalgia, skin rashes, arthralgia and arthritis, and dark urine.
Icteric: 1-3 weeks and is characterized by jaundice, white or gray stools, hepatic tenderness and hepatomegaly.

Fulminant hepatitis, hospitalization, cirrhosis, hepatocellular carcinoma, death.

Aka human carcinogen

Question 18

HPV

Type of pathogen
Symptoms presented with
Complications

Answer 18

Virus

Anogenital warts, respiratory papillmatosis

Cervical, anal, vaginal, vulvar, and penile cancers

Question 19

INFLUENZA

Type of pathogen
Symptoms presented with
Complications

Answer 19

Virus

Abrupt onset of fever, myalgia, sore throat, nonproductive cough, and headache

Pneumonia, secondary bacterial infections, Reye syndrome, myocarditis, death.

Question 20

MEASLES

Type of pathogen
Symptoms presented with
Complications

Answer 20

Virus

Fever, which increases in stepwise fashion, often peaking as high as 103-105°F. Onset of cough coryza (runny nose), or conjunctivitis. Koplik spots, a rash present on mucous membranes. Maculopapular eruption that usually lasts 5-6 days. It begins at the hairline, then involves the face and upper neck. During the next 3 days, the rash gradually proceeds downward and outward, reaching the hands and feet. The maculopapular lesions are generally discrete, but may become confluent, particularly on the upper body.

Diarrhea, AOM, pneumonia, encephalitis, seizures, death

Question 21

MENINGOCOCCAL DISEASE

Type of pathogen
Symptoms presented with
Complications

Answer 21

Bacteria

Sudden onset of fever, headache, and stiff neck nuchal rigidity, often with nausea, vomiting, photophobia, and altered mental status.

Petechial or purpuric rash, often associated with hypotension, shock, acute adrenal hemorrhage, and multi-organ failure.

Question 22

MUMPS

Type of pathogen
Symptoms presented with
Complications

Answer 22

Virus

Myalgia, malaise, headache, low-grade fever

Orchitis (testicular inflammation), and parotitis

Question 23

PERTUSSIS

Type of pathogen
Symptoms presented with
Complications

Answer 23

Bacteria

Onset of Kreiser, sneezing, low-grade fever, and a mild occasional cough, similar to the common cold. Cough gradually becomes more severe, and after 1 to 2 weeks, the second or proximal stage begins. Paroxysms of numerous rapid coughs, apparently due to difficulty expelling thick mucus from the tracheobronchial tree. At the end of the paroxysm, a long inspiratory effort is usually accompanied a characteristic high pitched whoop.

Secondary bacterial pneumonia (most common), neurologic complications, seizures, encephalopathy, otitis media, anorexia, dehydration, pneumothorax, epistaxis, subdural hematoma, hernias, rectal prolapse

Question 24

PNEUMOCOCCAL DISEASE

Type of pathogen
Symptoms presented with
Complications

Answer 24

Bacteria

Abrupt onset of fever and chills or rigors. Classically there is a single rigor, and repeated shaking chills are uncommon, pleuritic chest pain.

Bacteremia, meningitis, and death

Question 25

POLIOMYELITIS

Type of pathogen
Symptoms presented with
Complications

Answer 25

Virus

Asymptomatic, minor, non-specific illness, non-paralytic aseptic meningitis symptoms of stiffness of the neck, back, and or legs, usually following several days after a program similar to that of minor illness. If you were than 1% result in flaccid paralysis

Question 26

ROTAVIRUS

Type of pathogen
Symptoms presented with
Complications

Answer 26

Virus

May cause self limited watery diarrhea, or may result in severe dehydrating diarrhea with fever and vomiting. Up to 1/3 of infected children may have a temp >102°F.

Severe diarrhea, dehydration, electrolyte imbalance, and metabolic acidosis

Question 27

RUBELLA

Type of pathogen
Symptoms presented with
Complications

Answer 27

Virus

1-5 day prodrome with low-grade fever, malaise, lymphadenopathy, upper respiratory symptoms preceding the rash. The rash of rubella is maculopapular and occurs 14-17 days after exposure. The rash usually occurs initially on the face and then progresses from head to foot. It last about three days and is occasionally pruritic.

Arthralgia, encephalitis, hemorrhagic complications
Congenital rubella: fetal death, prematurity, deafness, high and cardiac defects, microcephaly

Question 28

TETANUS

Type of pathogen
Symptoms presented with
Complications

Answer 28

Bacteria

Trismus or lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated BP, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3 to 4 weeks.

Laryngeal spasm, HTN, PE, fractures

Question 29

VARICELLA ZOSTER

Type of pathogen
Symptoms presented with
Complications

Answer 29

Virus

VARICELLA: mild prodrome may proceed the onset of a rash: the rash usually appears first on the head, then on the trunk, and then the extremities; the highest concentration is on the trunk. Vesicular, 1-4mm, may rupture and crust. Form in crops. “Dew drop on the rose petal”.
SHINGLES: the vesicular eruption of zoster generally occurs unilaterally in the distribution of a sensory nerve. Most often this involves the trunk or the 5th cranial nerve. 2-4 days prior to the eruption, there may be pain and paresthesia in the involved area. There are a few systemic symptoms.

VARICELLA: bacterial superinfection, pneumonia, CNS manifestations, Reye syndrome, death.
SHINGLES: post herpetic neuralgia (PHN)