Howrie Flashcards
annual flu epidemics are due to mutations caused by antigenic _____
drift
flu pandemics are due to reassortment of genomes between human and animal viruses caused by antigenic ____
shift
what is hemagglutin responsible for
attachment and fusion
what is neuraminidase responsible for
the release of virus from infected cells
which type of flu test can detect flue A or B
RT-PCR
high risk flu groups
65+ yo, <2 yo, pregnant or 2 weeks postpartum, chronic pulmonary disease, diabetes, morbidly obese, immunocompromised: HIV/AIDS, cancer
when is the greatest benefit of flu antivirals
administered within 24-30 hours of symptom onset
what are the benefits of flu antivirals
shorten duration of flu symptoms by 1-3 days, reduce severity and complications, length of hospital stay, mortality
oseltamivir dosing
75 mg po bid x 5 d. high dose of 150 bid for severely ill. adjust for renal function
tamiflu side effects
HA, n/v, confusion, dizzy
zanamivir dosing
2 inhalations (10 mg) BID x 5d
when is zanamivir not recommended
asthma or COPD (underlying respiratory disease)
what does baloxavir inhibit
cap-dependent endonuclease
big counseling point for baloxavir
avoid coadministration with cations, dairy
how is baloxavir dosed
weight-based. 40-80 kg gets 40 mg po once. >80 kg gets 80 mg po once
therapy for post-exposure flu prophylaxis
oseltamivir 75 mg daily. zanamivir 10 mg inhaled once daily. for SEVEN DAYS
who gets flu post-exposure prophylaxis
those at higher risk for complications who aren’t vaccinated or HCW who aren’t vaccinated. not a substitute for vaccine. only use if antivirals can be started within 48 hours of exposure. might still transmit the virus even without clinical illness
who gets pre-exposure chemoprophylaxis
nursing home residents when there is an outbreak, regardless of vaccination, for a minimum of 2 weeks. and the unvaccinated staff members who care for them.
what is a key point of flu in the respiratory tract
it causes an extensive loss of ciliated epithelium
which flu can infect animals
A
what kind of genome does flu virus have
RNA
what are flu-like symptoms due to
massive cytokine release and interferon effects
how is flu transmitted
aerosol droplets in cool, less humid environment (winter, heating)
what kind of virus is HPV
dsDNA
what kind of infection is HSV
latent
most cancers from HPV are due to what strains
16 and 18
what proteins inactivate p53 and p105 growth suppressor genes
E6, E7
what proteins enhance cell growth by making cells more sensitive to growth signals
E5
effects of 9-valent HPV vaccine
86% decrease in HPV that cause cancer and genital wards. does not prevent progression of infection to disease, treat disease, or improve clearance of infection
dosing schedule for HPV vaccine
2 doses for age 9. 3 doses for those who start at age 15 (6 months apart)
who should get HPV vaccine
everyone through age 26 years if they were not adequately vaccinated
HSV genome
dsDNA
how does HSV release
exocytosis, cell lysis, CELL TO CELL BRIDGES
what kind of immunity for control does HSV use
cell-mediated immunity
what infection pattern does HSV have
latent
what can cause reactivation of HSV
ultraviolet B radiation (tanning), fever, emotional or physical stress, immunosuppression (transient, chemo, HIV)
which HSV is primary STI
HSV2
which HSV infections are primary in infancy and childhood, transmitted by contact with infected saliva
HSV1
which HSV can cause genital lesions
HSV1
which HSV can cause oral lesions
HSV2`
recurrent genital HSV is more common with which HSV
HSV2
acyclovir, valacyclovir, and famciclovir are equally effective but most effective when used within ____
first 2 days of symptom onset
therapy for first clinical HSV episode
acyclovir 400 TID, valacyclovir 1 g BID, famciclovir 250 TID x 7-10d
episodic therapy for recurrent HSV infection
duration is 3-5d typically
when to use antivirals for HSV suppression
when 3 episodes in 6 months or 6 episodes in 12 months
how is VZV transmitted
direct contact or inhalation of aerosols from vesicular fluid of skin lesions or respiratory secretions. contagious 1-2 days before rash and until all chickenpox lesions have crusted
VZV treatment
topical agents like calamine, domeboro. acetaminophen to control fever. antivirals within 24h of onset: for 5-7 days (acyclovir 800 5x daily, valacyclovir 1 g TID, famciclovir 500 TID)
who cannot get VZV vaccine
immunocompromised: cancer, pregnancy, immunosuppression
dosing schedule for VZV vaccine
children who never had chickenpox: 2 doses at 12-15 months, 4-6 years.
ages 13+ who never had chickenpox: 2 doses at least 28 days apart
when to give antivirals for VZV prevention
individuals at high risk for disease contraction who are ineligible for vaccination or past the 96hr window after direct contact
what agent to give for VZV prevention
acyclovir 20 mg/kg/dose 4x daily for 7 days. passive immunization varicella immune globulin IM within 10 days of exposure
pre-eruptive phase zoster
paresthesia, pain, burning, itching, malaise, myalgia, HA, photophobia, fever
acute eruptive phase zoster
> 1 neighboring dermatomes, vesicles distributed in a stripe or belt-like pattern, heals within 2-4 weeks, post herpetic neuralgia can last for months
antivirals for zoster
acyclovir, famciclovir, valacyclovir with optimal duration 7 days. fam and val preferred to reduce post herpetic neuralgia
other management for zoster
burrow’s solution/domeboro, calamine lotion, pain management with topical lidocaine patches, gabapentin, opioids for as few days as possible
what kind of vaccine is shingrix
recombinant, adjuvanted, non-live
who gets shingrix
healthy adults age 50 and older: 2 doses separated by 2-6 months
what is unusual about flu replication
it replicates in nucleus
what vaccine can’t you give to immunocompromised
varicella- it is a live vaccine- can’t give to pregnant or cancer
which virus can you give passive immunization
varicella- immune globulin
