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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
Q

What does HPV-9 (Gardasil) protect against?

A

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

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26
Q

What are NACIs new recommendation regarding HPV vaccines?

A

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

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27
Q

Do women older than 26 require the HPV vaccine?

A

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

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28
Q

What are Saskatchewans current HPV vaccine recommendations?

A

continuing with previous recommendation
-routine: 2 doses in grade 6
publicly funded
-females since Jan 1/1996
-males since Jan 1/2006

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29
Q

How should HPV vaccine be administered?

A

administer after other vaccines
-known to cause more injection pain - adjuvant
may administer with other vaccines

30
Q

What is expected with the primary series of the HPV vaccine?

A

primary series is expected to provide lifelong immunity

31
Q

When is the HPV vaccine most effective?

A

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
Q

What causes mpox?

A

viral infection caused by monkeypox virus

33
Q

How is mpox transmitted?

A

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
Q

Which population are most cases of mpox diagnosed in?

A

MSM
-also diagnosed in heterosexual persons

35
Q

What are the signs and symptoms of mpox?

A

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
Q

How long is someone contagious with mpox?

A

2-4 weeks (until all lesion scabs have fallen off)
-cover lesions, wear mask

37
Q

Which vaccine protects against mpox?

A

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
Q

What kind of vaccine is the smallpox vaccine?

A

live-attenuated, non-replicating virus
-no risk of developing infection or transmission to others
- > 18 yrs at high risk for exposure
-safe immunocompromised

39
Q

Is it routine for mpox/smallpox vaccination?

A

not routine
-based on risk

40
Q

What causes pneumococcal disease?

A

bacteria infection due to Streptococcus pneumoniae
- ~ 100 serotypes, each serotype has a different capsule
-vaccine lead to antibodies vs capsule

41
Q

How is pneumococcal disease transmitted?

A

respiratory droplets; direct oral contact or indirect contact with infectious oral secretions
children < 5 yrs in daycare have 2-3x increased risk

42
Q

What can pneumococcal disease cause?

A

sinusitis, AOM, pneumonia
invasive pneumococcal disease (infection in normally sterile site)
-bacteremia, meningitis
mortality: increased risk of IPD risk factors, older adult

43
Q

Why are there so many pneumococcal vaccines?

A

most common serotypes that cause disease vary across different populations and tend to change over time

44
Q

Differentiate the types of pneumococcal vaccines.

A

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
Q

What are the recommendations for pneumococcal routine childhood vaccinations?

A

NACI: PCV15 (Vaxneuvance) or PCV20 (Prevnar-20)
-either should be used
-similar benefit & AE as PCV13

46
Q

Do children with a completed PCV13 series need PCV15?

A

children who have completed a full series with PCV13 do not need an additional dose of PCV15

47
Q

What are the recommendations for pneumococcal vaccinations in adults?

A

NACI: > 65 yrs regardless of pneumococcal vaccination history with PCV13, PCV15 or PPSV23:
-one dose of PCV20 or PCV21

48
Q

What are NACIs recommendations for the pneumococcal vaccine for individuals at increased risk of IPD?

A

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
Q

What are some patient populations at increased risk of IPD?

A

chronic heart disease
diabetes mellitus
CKD
chronic liver disease
chronic lung disease
immunocompromised (ex: HIV, transplant)

50
Q

What causes RSV?

A

viral infection
-RSV-A, RSV-B subgroups commonly co-circulate

51
Q

How is RSV transmitted?

A

respiratory droplets

52
Q

Describe the incidence of RSV.

A

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
Q

What are the signs and symptoms of RSV?

A

URTI - mild, cold-like symptoms
lower lung infections - e.g. bronchiolitis, pneumonia
severe - requiring O2 and hospitalization

54
Q

What are the 3 approved vaccines for RSV?

A

Arexvy
Abrysvo
Mresvia

55
Q

Describe Arexvy.

A

monovalent RSV-A, adjuvanted
individuals 60 yrs or older for prevention of lower resp dx caused by RSV
not indicated in pregnancy

56
Q

Describe Abrysvo.

A

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
Q

Describe Mresvia.

A

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
Q

Describe NACI’s recommendations for the RSV vaccine.

A

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
Q

Which RSV vaccine is preferred by NACI?

A

guidelines do not prefer one agent over the other

60
Q

Describe the PICO for Arexvys RCT.

A

population: ~78 yrs, many had conditions that increase risk of RSV
intervention: Arexvy
comparator: placebo
outcome: decreased risk of LRTD, esp if comorbidities

61
Q

Describe the PICO for Abrysvo and Mresvias RCTs.

A

population: ~68 yrs, many had conditions that increase risk of RSV
intervention: Abrysvo or Mresvia
comparator: placebo
outcome: decreased risk of LRTD

62
Q

What are the limitations of the RCTs for RSV vaccines?

A

patient important outcomes such as hospitalization or mortality were not studied

63
Q

Do you need an RSV booster?

A

1 dose for now
-long term effectiveness not known

64
Q

What are some rare side effects of RSV vaccines?

A

GBS
atrial fibrillation

65
Q

What causes COVID-19?

A

viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

66
Q

How is COVID-19 transmitted?

A

respiratory droplets

67
Q

What are the signs and symptoms of COVID-19?

A

mild: sore throat, cough, headache, etc
severe: need O2/hospitalization/ICU

68
Q

Who does CIG suggest receive the COVID-19 vaccine?

A

anyone but recommended in the following:
-65 yrs or older
-6 months or older and LTC or medical conditions

69
Q

How long should an individual wait before getting a COVID vaccine after a COVID infection?

A

3-6 months after the infection

70
Q

How long do you need to wait between COVID vaccines?

A

3-6 months
-3 months if increased risk for severe disease

71
Q

Does the COVID vaccine reduce risk of post-COVID?

A

continues to be monitored, unclear at the moment
-vaccine provides protect against COVID so likely

PHAR358 (20 decks)

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