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CCFP Version 1 > Immigrants + Immunisations > Flashcards

Immigrants + Immunisations Flashcards

1
Q

What to cover in immigrant hx

A

Assess vaccination status + provide necessary vaccines
Screen for depression, inquire about history of abuse + torture, assess for support
Consider ddx of infectious diseases (malaria, parasitic disease, TB)
Enquire about use of alternative medicine, spiritual/ herbal medicines

Medical Interpreter (consider CanTalk - telephone interpreter)
Document findings (scars)
Medication review, including alternative/herbal remedies
Infection
Consider malaria, TB, hepatitis, HIV, parasitic disease in differential
Chronic disease
Age-appropriate screening
Screening for immigrants as above (Hep B/C, TB, HIV, parasites, DM2, Iron-deficiency anemia, Dental)
Consider other screening
Sickle cell, Thalassemia
Vision
Mental Health
Depression, PTSD
Trauma (child neglect, genital mutilation, intimate partner violence, torture, abuse, war)
Culture/tradition/religion/gender roles
Women’s health
Contraception
Cervical cancer screening
HPV vaccine
Vaccination
Primary immunization schedule according to age (Tdap, MMRV, etc…)
Consider Hepatitis A/B
If positive for sickle cell or thalassemia
Consider pneumococcal, H influenzae, meningococcal

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2
Q

How to approach immigrant consults

A

Modify approach by cultural context
Use interpreters + recognize limitations of interpreters (different agendas, lack of medical knowledge, something to hide)

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3
Q

How to approach vaccine hesitancy

A

Counsel during prenatal
Present vaccines as default approach
Be honest about SE
Provide stories as well as facts, build trust w/ parents
Address pain
Focus on protection for child

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4
Q

Vaccine pain reduction

A

No aspiration
Inject painful vax last (MMR)
Breastfeed during
Position skin to skin
Consider topical anesthetic
Parents present
Distraction

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5
Q

Pts at higher risk of infection + need more imms

A

Pts at risk:
Elderly
Immunosuppressed
Sickle cell anemia
CHF
Asplenia

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6
Q

Imms for asplenia

A

Pneumococcal
HiB
Meningococcal
Influenza

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7
Q

COVID vax efficiacy, SE + CI

A

Efficacy of vax: 95%
SE of vax: injection site pain, fatigue, myalgia, HA
CI to vax: allergy, VTE, capillary leak

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8
Q

Diphtheria sx, complications + management

A

Complications: myocarditis, paralysis, fatality
Sx: fever, bloody nasal DC, sore throat, neck swelling, croup cough, paralysis
Management: erythromycin

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9
Q

Diphtheria vax efficacy, when to administer, SE + CI

A

Efficacy of vax: 99% for 10 yrs
When to give vax: 2, 4, 6, 18mo, 4-6yr, 14-16yr, q10yrs
SE of vax: fever, fussy, fatigue, poor appetite, red sore limb
CI to vax: reaction to prev vax

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10
Q

Hib complications, when to give vax, efficacy of vax, SE + CI to vax

A

Complications: bacterial meningitis, epiglottitis, PNA, cellulitis, fatality
When to give vax: 2, 4, 6, 18mo, HIV, asplenia, transplant recipients
Efficacy of vax: 99%
SE of vax: temp, sore red limb
CI to vax: allergy

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11
Q

Herpes zoster complications, sx, efficacy of vax, types, SE + CI to vax

A

Complications: sight-threatening infection, CNS infection, nerve palsies, post herpetic neuralgia
Sx: unilateral painful vesicular rash
Efficacy of vax: reduced shingles by 51% in >60y/o
SE of vax: site reaction, HA
CI to vax: immunocompromised, pregnancy
Types: Shingrix, Zostavax

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12
Q

HPV complications, efficacy of vax, SE + CI to vax

A

Complications: cervical cancer
Efficacy of vax: 95% against lesions, 99% against cervical cancer
SE of vax:site pain/ swelling, HA, fatigue
CI to vax: pregnant, immunocompromised

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13
Q

Measles cause, sx, complications

A

Cause: rubeola
Complications: OM, PNA, encephalitis
Sx: conjunctivitis, coryza, cough, fever, Koplik’s sports

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14
Q

Measles vax efficacy, SE, CI, when to vax

A

Efficacy of vax: 100%
When to vax: 1 yr + 4-6yrs
SE of vax: subclinical infection, malaise, fever, thrombocytopenia
CI to vax: neomycin + gelatin allergy, immunocompromised

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15
Q

Meningococcal vax efficacy, SE, CI, when to vax

A

When to vax: 1yr, asplenia
Efficacy of vax: 97% 1st year, decreases to 67%
SE of vax: site reaction, fever, irritability
CI to vax: anaphylaxis to vax

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16
Q

Mumps complications + sx

A

Mumps
Complications: acute parotitis, seizures, hearing loss, orchitis, paralysis
Sx: neck stiffness, parotitis, fever, trismus, fever

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17
Q

What’s involved in mandatory immigration medical?

A

Complete physical examination (including vision/hearing screen)
>5yo - Urinalysis for protein, glucose (think diabetes), blood (think shistosomiasis)
If abnormal, urine microscopy
>11yo - CXR r/o TB
>15yo or risk factor (eg. known infected mother, unprotected sex)
HIV testing, Syphilis

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18
Q

What is the recommended screening for immigrants?

A

Hep B (Africa, Asia, Eastern Europe and parts of South America)
Vaccinate susceptible, refer chronic infection for treatment (and consider screen HCC as indicated)
Hep C (specifically subSaharan Africa [10%]; eastern Europe, especially Uzbekistan and Tajikistan [27%]; Egypt [25%–50%]; Vietnam [10%]; and Pakistan [5-35%]) and exposure to contaminated blood, usually as nosocomial transmission through unscreened blood products, surgery or receipt of intramuscular injections)
If positive, vaccinate Hep A/B, limit alcohol and refer for treatment
TB PPD skin test (Sub-Saharan Africa, Asia, and Central and South America, and some in Eastern Europe)
CXR to rule out active disease
HIV (sub-Saharan Africa, Caribbean, Thailand)
Post-test counselling and refer to HIV treatment program
Intestinal parasites if from endemic area, compatible sign/symptoms of infection (asthma) or evidence of peripheral eosinophilia
Strongyloides serology (consider in immigrants from Southeast Asia and Africa)
If positive, treat with ivermectin (or albendazole)
Shistosomiasis serology (Africa)
If positive, treat with praziquantel
DM2 >35yo South Asian, Latin American and African
Iron-deficiency anemia with hemoglobin for women of reproductive age, and children 1-4yo
Dental disease (ask all if any pain, and look for evidence of disease)
Refer to dentist (and treat pain with NSAID)

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19
Q

Mumps - when to vax, efficacy, SE + CI

A

When to vax: 1 yr, 4-6 yrs
Efficacy of vax: 90% after 2 doses
SE of vax: malaise, fever, parotitis
CI to vax: neomycin + gelatin allergy, immunocompromised

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20
Q

Parvovirus cause, complications + sx

A

Cause: fifth disease, slapped cheek
Complications: encephalopathy, meningitis, myocarditis, autoimmune hepatitis
Sx: cold sx, lacy rash, painful erythema on hands + feet

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21
Q

Pertussis cause, complications + sx

A

Cause: bordetella pertussis
Complications: PNA, sz, cerebral hemorrhage, apnea
Sx: cold sx, paroxysmal cough, insp whoop, post-tussive emesis

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22
Q

Pertussis - when to vax, efficacy, SE + CI

A

When to vax: 2, 4, 6, 18mo, 4-6yrs, 14-16yrs
Efficacy of vax: 92%
SE of vax: sore limb, fever, irritability, drowsiness, sz
CI to vax: anaphylaxis

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23
Q

Pneumococcal - complications, when to vax, efficacy, SE + CI

A

Complications: bacteremia, meningitis, PNA
When to vax: 2, 4, 12mo + if smoker/ asthma/ asplenic/ >65
Efficacy of vax: 90%
SE of vax: fever, sore limb
CI to vax: anaphylaxis

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24
Q

Polio - sx, complications, when to vax, efficacy, SE + CI

A

Complications: paralysis, aspiration, myocarditis
Sx: malaise, HA, fever, calf pain, neck stiffness
Efficacy of vax: 100%
When to vax: 2, 4, 6, 18 mo, 4-6 yrs
CI to vax: anaphylaxis

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25
Q

Rabies complications, sx, post exposure prophylaxis

A

Complications:
Sx: HA, malaise, fever, fatigue, paralysis, encephalitis
Post exposure prophylaxis: rabies Ig ASAP
Rabies vax on days 0, 3, 7, 14, 28

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26
Q

Rotavirus - CI to vax

A

hx of intusseception

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27
Q

Rubella - when to vax, efficacy, SE + CI

A

When to vax: 1yr, 4-6yrs
Efficacy of vax: 97%
SE of vax: rash, lymphadenopathy
CI to vax: neomycin + gentamicin allergy, immunocompromised

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28
Q

Rubella sx + complications

A

Complications: CRS in pregnancy (stillbirth, miscarriage, congenital heart defects)
Sx: erythematous rash, lymphadenopathy, arthralgia

29
Q

Tetanus cause, complications + sx

A

Cause: clostridium tetani
Complications: neurotoxic
Sx: sweating, drooling, fever, incontinence

30
Q

Tetanus - when to vax, efficacy, SE + CI

A

When to vax: 2, 4, 6, 18 mo, 4-6yrs, 14-16yrs, q10yr
SE of vax: sore red limb, lymphadenopathy, fever
CI to vax: anaphylaxis

31
Q

Rubella complications + sx

A

Complications: CRS in pregnancy (stillbirth, miscarriage, congenital heart defects)
Sx: erythematous rash, lymphadenopathy, arthralgia

32
Q

Rubella - efficacy, when to vax, SE, CI to vax

A

When to vax: 1yr, 4-6yrs
Efficacy of vax: 97%
SE of vax: rash, lymphadenopathy
CI to vax: neomycin + gentamicin allergy, immunocompromised

33
Q

Tetanus cause, complications, sx

A

Cause: clostridium tetani
Complications: neurotoxic
Sx: sweating, drooling, fever, incontinence

34
Q

Tetanus - when to vax, SE + CI

A

When to vax: 2, 4, 6, 18 mo, 4-6yrs, 14-16yrs, q10yr
SE of vax: sore red limb, lymphadenopathy, fever
CI to vax: anaphylaxis

35
Q

CI to vaccinations generally

A

Anaphylaxis or other serious reaction (eg. Guillain-Barre syndrome) upon administration of previous dose of a particular vaccine
Anaphylactic reaction or other serious reaction to a component of a vaccine (eg. egg, gelatin, latex, neomycin, thimerosal)
Pregnant or immunocompromised/suppressed, active TB should not receive LIVE vaccines (BCG, Zostavax, LAIV, MMRV, rotavirus, Smallpox Typhoid [oral], Yellow fever)
Consider delaying inactivated vaccines 1-3 months after immunosuppressive therapy

36
Q

CI to flu vax

A

Severe asthma
Medically attended wheezing in the 7 days prior to vaccination

37
Q

Rotavirus vax CI

A

Uncorrected congenital malformation of GI tract
Previous intussusception

38
Q

When can you NOT immunise because of illness?

A

GI illness for rotavirus (if does not affect dose scheduling age limit), oral cholera, and traveller’s diarrhea vaccine

Significant nasal congestion that will impede delivery of live-attenuated influenza vaccine

39
Q

When you should think about vaccinations

A

In infancy
Before pregnancy
Before traveling
When new to the country if not previously immunized

40
Q

Vaccine fears - how to approach fears about SE

A

Most common side effects are mild fever and sore extremity. Serious reactions (death, encephalopathy) are so rare that their incidence cannot be calculated.

41
Q

Vaccine hesitancy - how to approach fears about autism

A

The original paper in the Lancet publishing this association was recently withdrawn and there have been no definitive cases to support this claim. This was originally associated with a preservative agent called thimerosal. The only vaccines in Canada that are given to children and contain thimerosal are the multidose influenza vaccine and Hepatitis B. Both these vaccinations are available in formulations that do not contain thimerosal (ex. Vaxigrip for children and pregnant mothers). The only true contraindication to thimerosal is anaphylaxis.

42
Q

Vaccine hesitancy - how to approach fears about vaccines not working

A

No vaccine is entirely effective. If a vaccine-preventable disease outbreak does occur, some vaccinated individuals will contract the disease. However the proportion of unvaccinated individuals who contract the disease will be much higher than the proportion of vaccinated individuals.

43
Q

Vaccine hesitancy - how to approach people that say vaccine preventable diseases no longer exist

A

Certainly some vaccine-preventable diseases are rarely, if ever, seen in Canada and herd immunity for unvaccinated individuals does occur. However, unvaccinated individuals may still be exposed in their lifetime given the immigrant population that may not have been vaccinated or if the unvaccinated chooses to travel later in life.

44
Q

Vax in premature babies

A

Premature infants should receive immunizations at the same time (chronological age) as term infants, ie. do not delay vaccinations - in Quebec first vaccines at 2 months old
Exception: In jurisdictions where Hep B vaccine is given at birth in HbsAg negative mother, delay until infant 2000g or discharged from hospital

45
Q

Vax for asplenia/ hyposplenia

A

Pneumococcal (most common infection in asplenia)
Meningococcal
Haemophilus Influenza Type B
Influenza
Hep A and B if repeated transfusions

46
Q

Vax for chronic liver disease

A

Hepatitis A and B
Influenza
+/- Pneumococal

47
Q

Who gets pneumococcal

A

≥65yo, <65 with specific risk factor

48
Q

Who gets herpes zoster

A

≥60yo (consider 50-59yo), immunosuppressed
Live attenuated (Zostavax) vs. Non-live recombinant adjuvanted (Shingrix)
1 dose vs. 2 doses (2 months apart)
Herpes Zoster relative risk reduction 51% (NNT 59) vs. 97% (NNT 37)
Post-herpetic neuralgia RR reduction 67% (NNT 364) vs. 89%
Adults ≥50yo who are known VZV seronegative should be given univalent varicella vaccine rather than herpes zoster (routine testing not recommended)

49
Q

Who gets HPV

A

9-26yo and ≥27yo who are at ongoing risk
PIQ recommends vaccinating women 9-45yo, men 9-26yo even if previous HPV exposure

50
Q

Who gets meningococcal

A

Up to 24yo not immunized, or risk

51
Q

Immigrant health guidelines

A

testing for HIV, HCV, TB, strongyloides, schistosomiasis, vaccines, offer interpreter, screen for dental disease, diabetes, eye disease, screen for depression, test for IDA in women + children, contraception, paps, mammograms, HPV vax

52
Q

Test for TB

A

mantoux skin test, intradermal or IGRA test for latent TB

53
Q

Rx for TB: RIPE

A

rifampicin, isoniazid, pyrazinamide, ethambutol

54
Q

RF for strongyloides

A

walking barefoot in high risk area (Caribbean, SE Asia)

55
Q

Immigrant vaccines to give vs to test first

A

vax first Tdap (4 dose series) + MMR, test for HBV + varicella

56
Q

Populations that have unique immunisation needs

A

immunosuppressed, immigrants, HCW, travellers, elderly, infants, military

57
Q

When to give TDap in pregnancy?

A

give tdap in every preg after 13wks ideally 27wks

58
Q

Which vax are safe in breastfeeding women

A

all safe except BCG, jap encephalitis, yellow fever

59
Q

When is it appropriate to delay vaccines (which vaccines + when)?

A
  • nasal congestion - dont give nasal influenza
  • acute gi illness - defer oral cholera vax
  • mod-severe gi illness - defer rotavirus
60
Q

Flu vax - who to give to

A

children >6mo, high risk adults (neuro conditions, healthcare, working with poultry), >65

61
Q

Anti-vaxxer couselling

A

safe to vax, danger in not vaccinating, pain can be reduced

62
Q

Preventing painful pokes

A

don’t aspirate, most painful last, breastfeed, skin-to-skin, topical anesthetic, oral sugar

63
Q

Shingrix regime, when to give

A

2 doses, 2 months apart, >50y/o

64
Q

HPV - which strain

A

9 valent

65
Q

Men C for who?

A

travellers to Hajj or Africa, military recruits, asplenia/ sickle cell, all canadian adolescents

66
Q

What are the CI in these populations?
Anaphylactic to prev vax
Pregnancy
Active TB
Severe asthma
Congenital GI malformation
HIV
Allergic to chicken or eggs

A

Anaphylactic to prev vax = same vax CI
Pregnancy = MMR, BCG
Active TB = MMR, varicella, herpes zoster, BCG
Severe asthma = live attenuated influenza
Congenital GI malformation = rotavirus
HIV = MMR, BCG, polio, varicella (all live vax)
Allergic to chicken or eggs = don’t give yellow fever, tick borne encephalitis or rabies

67
Q

CI to COVID-19

A

prev anaphylaxis or allergy

68
Q

Precautions to covid-19

A

polyethylene glycol, myocarditis, thrombosis, thrombocytopenia

69
Q

Advice for vax in Immuncompromised

A

no live vax, caution vaxing close contacts w/ live vax, consider consulting public healt

CCFP Version 1 (67 decks)

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