Health Promotion & Vaccinations

Question 1

What is primary prevention?

Answer 1

Measures that spare individuals from suffering, burden and costs assoc. with a clinical condition. It is the first level of care.

Question 2

What is the focus of primary prevention?

Answer 2

Prevent illness or injury.

Question 3

What is the most effective form of healthcare?

Answer 3

Primary prevention

Question 4

What are examples of primary prevention?

Answer 4

Immunization

Chemoprophylaxis

Question 5

What is community immunity?

Answer 5

A significant portion of a population has immunity against an infectious agent thus the likelihood of infection to those not immune is decreased.

Question 6

What is passive immunity?

Answer 6

When a person receives select antibodies after exposure to an infective agent. Given through admin of immune globulin (IG) or through immunity acquisition from mother to unborn child. Provides temporary protection, IG protection starts within hours.

Question 7

What is active immunity?

Answer 7

When a person receives a vaccine containing the infectious agent allowing them to produce antibodies against the infection. Provides long-term protection.

Question 8

Which type of immunity is preferred for primary prevention?

Answer 8

Active immunity - has long-term protection.

Question 9

What is secondary prevention?

Answer 9

Measures that identify and treat asymptomatic persons who have risk factors for a given disease or in preclinical disease.

Question 10

What are examples of secondary prevention?

Answer 10

Screenings both preclinical or asymptomatic period.
Preclinical: mammo & pap.
Asymptomatic period: BP check for HTN, lipid profile for Hyperlipidemia.

Question 11

What is tertiary prevention?

Answer 11

Measures that help manage an established disease.

Question 12

What is the focus of tertiary prevention?

Answer 12

To minimize complications associated with the disease

Question 13

What are examples of tertiary prevention?

Answer 13

Medication and lifestyle modifications - ex. to help improve BS levels in DM

Question 14

A patient comes with abrupt onset of fever, myalgia, headache, malaise, nonproductive cough, sore throat and rhinitis. What is the most likely dx?

Answer 14

Uncomplicated influenza.

Question 15

How long do uncomplicated influenza symptoms last?

Answer 15

Worst symptoms 1wk.

Cough & malaise 2wks+

Question 16

Which patients are at higher risk for influenza-related complications?

Answer 16

Patients with:
Pulmonary & cardiac disease
Young children 
Pregnant women
Immunocompromised
Adults >65yrs

Question 17

How is the flu transmitted?

Answer 17

Droplet - cough & sneeze

Question 18

What considerations should be taken into account in immunocompromised patients with the flu?

Answer 18

Incubation period is shorter 1-4days, average 2days.

Remain infectious for up to 3wks.

Question 19

Which flu strain has higher infection rates for younger adults?

Answer 19

H1N1 swine flu & H5N1 avian flu.

Question 20

How effective is the flu vaccine?

Answer 20

70-80% effective in preventing the flu or reducing the severity of the disease.

Question 21

Can the flu vaccine be given in patients with mild-moderate illness and currently on antimicrobial therapy?

Answer 21

Yes, it is not contraindicated in both cases.

Question 22

Which populations should be given the flu vaccine?

Answer 22

Children 6-59mons.
Children 6mons-18yrs on long-term ASA risk for Reyes syn
Patients with chronic cardiac/ pulmonary illness
Immunosuppressed
Pregnant or child-bearing age
Community servers, students
Persons in nsg homes and long-term care facilities
American-Indians/ Alaska Natives
Morbidly obese BMI >40kg/m2
Caregivers of high-risk patients:
Healthcare workers, household contacts

Question 23

Which flu vaccine contains the live virus?

Answer 23

Live, attenuated influenza vaccine (LAIV) - nasal spray. It is cold-adapted and temp-sensitive, thus given in the nose and throat, not lower resp when temp is higher.

Question 24

What types of injectable flu vaccines are available?

Answer 24

Trivalent inactivated flu vaccine (TIV) - common flu shot
Intradermal TIV has lower dose than regular vaccine.
Inactivated TIV with higher dose is approved for >65yrs

Question 25

What is the dose in inactivated TIV for adults >65yrs?

Answer 25

60mcg compared to 15mcg (regular dose)

Question 26

What are contraindications for use of LAIV?

Answer 26

Pregnant women, immunocompromised, chronic illness, Guillain-Barre syndrome, children on long-term ASA therapy, allergies to LAIV.

Question 27

What flu vaccine can you give a patient who gets hives with exposure to eggs?

Answer 27

Recumbent Influenza Vaccine (RIV) or inactivated influenza vaccine (IIV). RIV is egg-free.

Question 28

Which flu vaccine can be given to patients with anaphylactic rxn for eggs?

Answer 28

Recumbent Influenza Vaccine (RIV) 3, if no other contraindications in adults 18-49yrs.

Question 29

What are advantages of the flu vaccine in pregnant women?

Answer 29

Pass on immunity to child and protect them for up to 6 months of life. Safe to give during lactation.

Question 30

What meds are approved for prevention and treatment of influenza A?

Answer 30

Adamantine derivatives: Amantadine (Symmetrel) & Rimantadine (Flumadine)

Question 31

What meds are used to treat both Flu A & B?

Answer 31

Neuraminidase inhibitors: Zanamivir (Relenza) & Oseltamivir (Tamiflu)

Question 32

What is the benefit of treating a person with Flu A & B with Zanamivir or Osteltamivir?

Answer 32

Use of meds during 1st 2 days if illness will shorten symptoms by 1 day.

Question 33

What are common side effects of Zanamivir (Relenza)?

Answer 33

Bronchospasm (since it is inhaled)

Question 34

What are the common side effects of Osteltamivir (Tamiflu)?

Answer 34

GI s/s like N/V - better when taken with food.