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PHAR358 > Hep A+B, HPV, Mpox, Pneumococcal, RSV, COVID > Flashcards

Hep A+B, HPV, Mpox, Pneumococcal, RSV, COVID Flashcards

1
Q

What causes hepatitis B?

A

viral infection
-most clear infection after 4-8 weeks

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2
Q

What can chronic hepatitis B carriers develop?

A

cirrhosis
liver cancer
death

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3
Q

How is hepatitis B transmitted?

A

blood or bodily fluids containing HB virus
-e.g. sharing injection drug equipment, sexual contact, vertical transmission

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4
Q

What are the signs and symptoms of hepatitis B?

A

asymptomatic in up to 50% of adults and 90% of children
fatigue, fever, NV, decreased appetite, jaundice

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5
Q

What are the many different variations of the hepatitis B vaccine?

A

pediatric and adult formulations
high-dose e.g. renal disease, HIV, congenital immunodeficiency
combo vaccine (HAHB) or monovalent HB

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6
Q

When is the hepatitis B vaccine given?

A

routine childhood

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7
Q

Do adults require hepatitis B vaccine boosters?

A

no booster required
-exception: potentially some special populations based on serology

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8
Q

Which people are susceptible to hepatitis B?

A

HBsAg: negative
anti-HBc: negative
anti-HBs: negative

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9
Q

Which people are immune to hepatitis B from vaccination?

A

HBsAg: negative
anti-HBc: negative
anti-HBs: positive with > 10 IU/L

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10
Q

Which people are immune to hepatitis B from infection?

A

HBsAg: negative
anti-HBc: positive
anti-HBs: positive

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11
Q

Does a HBs dropping below 10 require additional vaccination?

A

health patients: if received appropriate immunization series, then they are considered immune/protected for life even if anti-HBs drop < 10 overtime because immune memory to HB persists
-another HB vaccine dose is NOT required
special populations need another dose

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12
Q

What causes hepatitis A?

A

viral infection caused by hepatitis A virus

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13
Q

How is hepatitis A transmitted?

A

fecal-oral
-contaminated food, water, drinks, etc.
-HA virus can remain infectious in the environment for several weeks

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14
Q

What are the signs and symptoms of hepatitis A?

A

asymptomatic (younger)
adolescents/adults: anorexia, nausea, fatigue, fever, jaundice; rarely death
lasts a few weeks to a few months

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15
Q

True or false: hepatitis A can lead to chronic hepatitis or chronic carrier state

A

false
does not lead to chronic hepatitis or chronic carrier state (like HBV)

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16
Q

How does the hepatitis A vaccine come in terms of available products?

A

adult and pediatric formulations
combo vaccine or individually

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17
Q

Is hepatitis A a routine childhood vaccination?

A

not routinely given in childhood vaccinations
-recommend for people at increased risk of infection

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18
Q

What is the name of the hepatitis A and B vaccine?

A

Twinrix

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19
Q

What is the role of Twinrix in SK?

A

not routinely given in childhood vaccines & not publicly funded
role today is for travel
-if someone requires HA for travel & unsure if they received HB series/no documented HB series
-if completed HB series then only HA vaccine required

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20
Q

What causes human papillomavirus?

A

viral infection caused by HPV
-over 200 types
-12 oncogenic & 8-12 possibly oncogenic

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21
Q

How is HPV transmitted?

A

sexually by skin-to-skin contact (or mucosa contact)
vertically

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22
Q

What is the most common STI?

A

HPV
-if not immunized, up to 75% of sexually active individuals will have at least one HPV infection in their lifetime

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23
Q

What are the signs and symptoms of HPV?

A

most infections are asymptomatic and are eventually cleared by the immune system within 24 months
some develop genital warts (6, 11, others)
some develop cancer
-anal, cervical, vaginal, penile (16, 18, 31, 33, 45, 52, 58)
-oropharynx (16)
-causes almost all cases of cervical cancer (16, 18)

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24
Q

What are the available vaccines for HPV?

A

HPV-9 (Gardasil): 6, 11, 16, 18, 31, 33, 45, 52, 58
-types included cause 90-95% HPV-attributable cancers
HPV-2 (Cervarix): 16 and 18
-only approved in females and not commonly used

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25
What does HPV-9 (Gardasil) protect against?
in people who have never been infected, the vaccine will: -prevent 7/10 cases of cervical cancer & 9/10 cases of genital warts -does NOT protect against other STIs
26
What are NACIs new recommendation regarding HPV vaccines?
HPV-9 preferred -protection vs greatest # of HPV types and associated diseases healthy individuals: -9-20 yrs: 1 dose -20-26 yrs: 2 doses - > 27 yrs: 2 doses HPV vaccine may be offered in pregnancy > 9 yrs, immunocompromised or HIV: 3 doses
27
Do women older than 26 require the HPV vaccine?
Gardasil and Cervarix are approved for women up to 45 dont feel compelled to discuss with most adults 27-45 -especially if in long-term, mutually monogamous relationship consider discussing with unvaccinated adults who will have a new sex partner, especially if few partners in past -vaccination might cover HPV strains they havent been exposed to before
28
What are Saskatchewans current HPV vaccine recommendations?
continuing with previous recommendation -routine: 2 doses in grade 6 publicly funded -females since Jan 1/1996 -males since Jan 1/2006
29
How should HPV vaccine be administered?
administer after other vaccines -known to cause more injection pain - adjuvant may administer with other vaccines
30
What is expected with the primary series of the HPV vaccine?
primary series is expected to provide lifelong immunity
31
When is the HPV vaccine most effective?
most effective when given at a younger age, before exposure to HPV -HPV vaccine after onset of sexual activity is recommended because unlikely vaccine recipient has been infected with all HPV types in the vaccine -still indicated in women with abnormal pap test, cervical cancer or genital warts
32
What causes mpox?
viral infection caused by monkeypox virus
33
How is mpox transmitted?
skin to skin contact -transmission is not prevented by condoms respiratory droplets (close, sustained face-to-face contact) animals to humans (e.g. bites from rodents in Africa) low risk transmission: -shared contaminated objects (e.g. doorknobs bed lines) -rarely household transmission to younger children
34
Which population are most cases of mpox diagnosed in?
MSM -also diagnosed in heterosexual persons
35
What are the signs and symptoms of mpox?
systemic illness -fever, chills, HA, myalgia, rash (shingles-like but larger) usually self-limiting (2-4 weeks) incubation period generally ranges from 7-10 days following exposure
36
How long is someone contagious with mpox?
2-4 weeks (until all lesion scabs have fallen off) -cover lesions, wear mask
37
Which vaccine protects against mpox?
smallpox vaccine -mpox virus is an orthopoxvirus that is in the same genus as variola (causative agent of smallpox) and vaccinia viruses (the virus used in the smallpox vaccine)
38
What kind of vaccine is the smallpox vaccine?
live-attenuated, non-replicating virus -no risk of developing infection or transmission to others - > 18 yrs at high risk for exposure -safe immunocompromised
39
Is it routine for mpox/smallpox vaccination?
not routine -based on risk
40
What causes pneumococcal disease?
bacteria infection due to Streptococcus pneumoniae - ~ 100 serotypes, each serotype has a different capsule -vaccine lead to antibodies vs capsule
41
How is pneumococcal disease transmitted?
respiratory droplets; direct oral contact or indirect contact with infectious oral secretions children < 5 yrs in daycare have 2-3x increased risk
42
What can pneumococcal disease cause?
sinusitis, AOM, pneumonia invasive pneumococcal disease (infection in normally sterile site) -bacteremia, meningitis mortality: increased risk of IPD risk factors, older adult
43
Why are there so many pneumococcal vaccines?
most common serotypes that cause disease vary across different populations and tend to change over time
44
Differentiate the types of pneumococcal vaccines.
conjugate vaccine (PCV13, PCV15, PCV20, PCV21) -longer lasting immunity (create long-term memory cells) -more robust immune response (involve B & T cells) polysaccharide vaccine (PPSV23) -T cell independent -infants do not respond well
45
What are the recommendations for pneumococcal routine childhood vaccinations?
NACI: PCV15 (Vaxneuvance) or PCV20 (Prevnar-20) -either should be used -similar benefit & AE as PCV13
46
Do children with a completed PCV13 series need PCV15?
children who have completed a full series with PCV13 do not need an additional dose of PCV15
47
What are the recommendations for pneumococcal vaccinations in adults?
NACI: > 65 yrs regardless of pneumococcal vaccination history with PCV13, PCV15 or PPSV23: -one dose of PCV20 or PCV21
48
What are NACIs recommendations for the pneumococcal vaccine for individuals at increased risk of IPD?
18 yrs or older & medical or environmental IPD risk factors (regardless of vaccine hx with PCV13, PCV15, or PPSV23): -one dose of PCV20 or PCV21
49
What are some patient populations at increased risk of IPD?
chronic heart disease diabetes mellitus CKD chronic liver disease chronic lung disease immunocompromised (ex: HIV, transplant)
50
What causes RSV?
viral infection -RSV-A, RSV-B subgroups commonly co-circulate
51
How is RSV transmitted?
respiratory droplets
52
Describe the incidence of RSV.
common, very contagious annual outbreaks in Canada late fall to early spring usually infants/older adults impacted reinfections common, but illness usually milder with subsequent infections
53
What are the signs and symptoms of RSV?
URTI - mild, cold-like symptoms lower lung infections - e.g. bronchiolitis, pneumonia severe - requiring O2 and hospitalization
54
What are the 3 approved vaccines for RSV?
Arexvy Abrysvo Mresvia
55
Describe Arexvy.
monovalent RSV-A, adjuvanted individuals 60 yrs or older for prevention of lower resp dx caused by RSV not indicated in pregnancy
56
Describe Abrysvo.
bivalent RSVpreF (RSV-A & RSV-B), no adjuvant individuals 60 yrs or older for prevention of lower resp dx caused by RSV pregnancy 32-36 weeks (passive immunity to infant)
57
Describe Mresvia.
monovalent RSV-A; mRNA, no adjuvant individuals 60 yrs or older for prevention of lower resp dx caused by RSV not indicated in pregnancy
58
Describe NACI's recommendations for the RSV vaccine.
recommended for the following who are vaccine naive: -75 yrs or older -60-74 yrs in LTC -60-74 yrs at increased risk of RSV
59
Which RSV vaccine is preferred by NACI?
guidelines do not prefer one agent over the other
60
Describe the PICO for Arexvys RCT.
population: ~78 yrs, many had conditions that increase risk of RSV intervention: Arexvy comparator: placebo outcome: decreased risk of LRTD, esp if comorbidities
61
Describe the PICO for Abrysvo and Mresvias RCTs.
population: ~68 yrs, many had conditions that increase risk of RSV intervention: Abrysvo or Mresvia comparator: placebo outcome: decreased risk of LRTD
62
What are the limitations of the RCTs for RSV vaccines?
patient important outcomes such as hospitalization or mortality were not studied
63
Do you need an RSV booster?
1 dose for now -long term effectiveness not known
64
What are some rare side effects of RSV vaccines?
GBS atrial fibrillation
65
What causes COVID-19?
viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
66
How is COVID-19 transmitted?
respiratory droplets
67
What are the signs and symptoms of COVID-19?
mild: sore throat, cough, headache, etc severe: need O2/hospitalization/ICU
68
Who does CIG suggest receive the COVID-19 vaccine?
anyone but recommended in the following: -65 yrs or older -6 months or older and LTC or medical conditions
69
How long should an individual wait before getting a COVID vaccine after a COVID infection?
3-6 months after the infection
70
How long do you need to wait between COVID vaccines?
3-6 months -3 months if increased risk for severe disease
71
Does the COVID vaccine reduce risk of post-COVID?
continues to be monitored, unclear at the moment -vaccine provides protect against COVID so likely

PHAR358 (20 decks)

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