IC12 Flashcards
general live attenuated vaccine
- replicate i body to stimulate response similar to natural infection
- fragile, maintain at proper conditions
precautions for live attenuated viruses
1) avoid in pregnant
2) not given in infancy < 1 yo since mother Ab still circulating
3) avoid in severely immunocompromised
- haematologic/solid organ malignancies
- immunosuppressive meds, chemotherapy
- HIV CD4 < 200
inactivated vaccines
- cannot replication = cannot cause disease even in immunocompromised
- weaker immune response = need more dose/booster
- more stable, easier to to store & transport
factors that affect effectiveness of vaccine
site of vaccine given
patient age & immune status
cold chain problems (X kept at recommended temp)
adverse effect of vaccines
1) mild & uncommon
- pain, redness, swelling at injection site, headache, myalgia
2) uncommon
- fever, haematoma
3) severe but rate
- hypersensitivity, anaphylaxis
what to do if give > 1 vaccines on the same day
- most vaccine can administer same day wo reducing efficacy & increasing AE
- live vaccine
1) circulating Ab interfere w replication process, minimise response to live vaccine -> need space out
** X 2 live vaccine within 28 days
** space live vaccine 3 months apart from Ab containing products - inject separate sites or at least 2.5cm apart
what happen if miss dose
just give the missed dose and maintain the same dosing interval for the subsequent doses
how early to do pre travel consultation for vaccination
4-6 wks cuz vaccines need time to work
modes of transmission - food/waterborne spread via fecal-oral
Hep A, typhoid, cholera, poliomyelitis
modes of transmission - insect vector borne
yellow fever, jap encephalitis
modes of transmission - transcutaneous spread
tetanus, rabies
modes of transmission - respiratory spread
influenza, MMR, chickenpox, tb, haemophilus influenzae, diphtheria, pertussis, meningococcus, pneumococcus
modes of transmission - blood & body fluids (Sexual contact)
hep b, hpv
which vaccinations require proof of vaccination for some countires?
meningococcus, poliomyelitis, yellow fever
vaccine -> type -> trip characteristics - cholera
cholera -> live attenuated -> poor hygiene & sanitation, humanitarian aid work, VFR
vaccine -> type -> trip characteristics - hep a
inactivated -> poor hygiene & sanitation, adventurous eating, gay sex
vaccine -> type -> trip characteristics - hep b
recombinant hep b surface antigen -> adventure travel, medical tourism, health condition that require intervention, injection/infusion, possibility of sexual contact at destination
vaccine -> type -> trip characteristics - influenza
inactivated virus/recombinant, trivalent, quadrivalent -> mass gathering, cruise ship, exposure to live poultry
vaccine -> type -> trip characteristics - japanese encephalitis
inactivated -> adventure travel in agricultural areas, open-air accoms, rural home stay, VFR
vaccine -> type -> trip characteristics - MMR
live attenuated
mass gathering, travel to one of many areas w current outbreak, travel to areas w antivaccine community
vaccine -> type -> trip characteristics - meningococcal, quadrivalent
bacterial polysaccharide, conjugated
mass gathering, sub-saharan africa, muslims undertaking hagg & umrahj pilgrimages in saudi
vaccine -> type -> trip characteristics - poliovirus
inactivated virus
endemic destination w low vaccine coverage or disruption in healthcare infrastructure
humanitarian aid work
vaccine -> type -> trip characteristics - rabies
inactivated virus
remote destinations in areas w high incidence of canine rabies
close contact w canine wildlife bats
vaccine -> type -> trip characteristics - Tdap, dp
toxoid, protein antigen
tetanus: participate in injury prone disease
diphtheria: humanitarian aid, destinations w low vaccine coverage
vaccine -> type -> trip characteristics - tick-borne encephalitis
inactivated virus
hiking, camping
consuming unpasteruised diary
vaccine -> type -> trip characteristics - typhoid
bacterial cell wall polysaccharide
destinations w poor hygeiene & sanitation practices
vaccine -> type -> trip characteristics - yellow fever
live attenutated virus
destinations wknown outrbeaks or irregular requirements
life cycle of malaria
1) human liver: exo-erythrocytic cycle
- grow & multiply in liver cell
- P. vivax, P. ovale: possible dormancy
2) human blod: erythrocytic cycle
- grow & multiply in RBC
- differentiation into sexual stages
- clinical symptoms
3) mosquito: sporogenic cycle
- mate, growth, multiply, release
clinical features of malaria
fever, chill, sweat, headache, body ache, weakness, nausea, vomiting, cough, diarrhoea, abdominal pain
malaria mode of transmission
pri: bites of infected female anopheles mosquitoes
secondary: transfusion of contaminated blood products, organ transplantation, vertical transmission (mother to fetus)
factors affecting risk of transmission of maleria
1) increase
- between dusk and dawn
- end/soon after rainy season
2) decrease
- colder season/region
- desert
- large urban area
- high altitude
factors affecting insect repellent efficacy and duration of protection
1) ambient temp
2) level of activity
3) perspiration
4) water exposure
5) abrasive removal
types of insect repellent
1) DEET
- 20-50% provide 6-12 hr protection
- > 50% doesnt offer more protection duration
2) picaridin
- at least 20%
what are the drugs involved for chemoprophylaxis (4x)
1) atovaquone + proguanil
2) chloroquine
3) doxycycline
4) mefloquine
atovaquone + proguanil (malarone) - MOA
active for liver stage
atovaquone + proguanil (malarone) - dosing instruction
1) 1 tablet daily
2) w food/milky drinks
3) start 1 day prior to trip, during trip, continue 7 days post trip
atovaquone + proguanil (malarone) - ADR
GI, headache, dizzy
atovaquone + proguanil (malarone) - special population
1) kids >/= 5kg
2) avoid in preg & lactate
atovaquone + proguanil (malarone) - :)
1) good for last minute travelers
2) some prefer daily meds
3) good choice for shorter trips
4) very well tolerated
5) pediatric tablets
atovaquone + proguanil (malarone) - :(
X take if pregnant, renal impair
$$
some people dont like daily meds
chloroquine - dosing instruction
taken weekly
start 1-2 wk before, 4 wk after
chloroquine - precuation
psoriasis, seizure, myasthenia gravis, liver impair
chloroquine - DDI
CYP3A4 inhi
doxycycline - dosing instruction
before/after meal
swallow capsule w full glass water
maintain uprigth position for at least 30 mins
1-2 days before trip, during trip, 4 wks after return
doxycycline - DI
hypersensitivity, X for children < 8 yo
pregnant, lactating
advantages of doxycycline
can help with other infections (Water-borne)
help with acne
disadvantages of doxycycline
photosensitivity
mefloquine - dosing instruction
after meals
at least 1 wk before departure, during trip, continue 4 wks after return
mefloquine - CI
hypersensitivity, mefloquine resistance, hist of pyschiatric/convulsive disorders, hist of cardiac conduction abnormalities
mefloquine adr
GI,. dz, fatigue, headache, insomnia, vivid dreams, neuropsychiatric disorder
definition for post op surgical site infection
1) infection occurring within 30 says after surgical operation
2) infection occurring within 1 year if implant was left in place & affecting incision/deep tissue at operation site
what is surgical antibiotic prophylaxis (SAP)
administration of antimicrobials prior to clean & clean-contaminated surgeries to prevent post op SSI
indication for SAP
1) clean surgery where prosthesis or implants will be inserted
2) when SSI pose catastrophic risk
3) clean-contaminated surgery
4) contaminated
classifications for surgical procedures
1) clean surgery
- healthy skin incised
- mucosa of respi/alimentary.genitourinary tract & oropharyngeal cavity not traversed
- insertion of prosthesis or artificial device
2) clean-contaminated
- respi, alimentary, genitourinary tract penetrated under controlled conditions wo unusual contamination
- SAP
3) contaminated
- macroscopic soiling of operative field
- treatment of infection
when to administer antimicrobial for SAP
- normally 30-60 mins before
- fluoroquinolones & vancomycin need at least 1 hr infusion
how long to administer antimicrobial for SAP
X more than 24 hr to prevent AKI, C. difficle, selection pressure for multi resistant drug
non SAP strategies to prevent SSI
1) X remove hair unless interfere
- if interfere X use razor, remove outside using clipper/cream
2) control blood glucose </= 180 mg/dL (10 mmol/L)
3) maintain normothermia during perioperative period
4) optimise tissue oxygenation
5) alc-containing preoperative skin prep
6) checklist based on WHO to ensure compliance
7) impervious plastic wound protector for GI & biliary tract surgery
8) surveillance for SSI
9) feedback on SSI rate
