Immunization

Question 1

COVID19

Answer 1

single stranded RNA virus
spread via aerosol particles (breathing/talking) aerosol droplets (singing/coughing) touching mucus membranes with contam hands
target nasal and bronchial epithelial cells and pneumocytes through spike glycoprotein

Question 2

influenza

Answer 2

Single stranded RNA virus with 4 types
type A: mod-sev dx in all ages
type B: mild dx in kids
type C: mild resp sx
type D: not in humans
virus surface proteins undergo point mutational changes - antigenic drift
antigenic shift: major change in one or both surface proteins
spread via resp droplets after which the virus penetrates and replicates in epithelial cells = cell death

Question 3

influenza vaccine

Answer 3

inactivated virus may be split virus or subunit - may be trivalent (2 A 1 B) or quadrivalent
all inactivated preps admin IM
live attenuated quadrivalent prep admin intranasally
manufactured using egg protein
quadrivalent preferred in children
high dose trivalent for >65 and standard trivalent for everyone else
recommended for everyone over 6 months

Question 4

Diphtheria

Answer 4

toxin mediated disease by C diphtheria - gram pos bacilus spread through resp droplets
rare in Canada
toxoid vaccine lasts 10 years

Question 5

tetanus

Answer 5

toxin mediated dx from clostridium tetani
tetanus toxoid vaccine boosters needed every 10 years

Question 6

pertussis

Answer 6

whooping cough
toxin mediated dx caused by bordetella pertussis - pertussis toxin
highly communicable through respiratory droplets
attaches to epithelial cells in the rep tract and paralyze cilia - cause inflam
acellular pertussis vaccine - subunit only avail in Canada now
should be offered to all preg women in every pregnancy 27-32 weeks

Question 7

poliomyelitis

Answer 7

RNA enterovirus with 3 serotypes
fecal-oral and highly infectious
now have enhanced pontecy inactivated polio vaccine - 3 dose series and booster = 100% efficacy

Question 8

rotavirus

Answer 8

double stranded RNA - v stable exist in env for weeks-months
oral ingestion - replicates in small intestine epithelium
2 vaccine currently avail - live oral attenuated virus decreased risk of intussusception

Question 9

pneumococcal

Answer 9

strep pneumo - may or may not have polysaccharide capsule
conjugate vaccine are purified capsular polysaccharides from 7,10,13 serotypes conjugated to nontoxic diphtheria toxin- highly immunogenic in infants/children
pneu-C-13 recommended for routine vaccination
pneumococcal polysaccharide vaccines purified antigen from 23 serotypes of pneuomococcus - not effective in children <2 yrs and produces less robust immune response in older children
pneu-P-23 one dose should be given to adults >65yrs

Question 10

hemophilus influenzae type B (HiB)

Answer 10

polysaccharide conjugate vaccine survivors should also be vaccinated

Question 11

meningococcal

Answer 11

bacterial meningitis - Neisseria meningitidis - children under 5 greatest risk
monovalent conjugate meningococcal vaccine (men-C-C)
quadrivalent conjugate meningococcal vaccine (Men-C-ACYW)
quadrivalent polysaccharide meningococcal vaccine (Men-P-ACYW-135)
multicomponent meningococcal vaccine (4CMenB)
in ON: Men-C-C and Men-C-ACYW given

Question 12

measles

Answer 12

highly contagious caused by single stranded RNA paramyxovirus via resp droplets
survivors have permanent immunity
live attenuated vaccine - 2 dose schedule
outbreaks continue due to imported infections and due to high infectivity need 95% immunized for herd immunity

Question 13

mumps

Answer 13

single stranded RNA - spread via resp droplets
live attenuated vax avail - 2 doses outbreaks continue due to waning immunity over time

Question 14

rubella

Answer 14

enveloped RNA togovirus - highly communicable spread via resp droplets most sig complication is infection in pregnant women - congenital rubella infection viremia virus can cross the placenta to fetus - death abortion or preterm delivery and defects - most common in 1st trimester
prevention of congenital rubella syndrome is primary goal of vax
live attenuated rubella vaccine

Question 15

varicella

Answer 15

DNA herpesvirus varicella zoster virus spread through resp droplets or skin lesions
live attenuated varicella virus vax given to healthy children - persistence of protective antibodies
herpes zoster vaccine also avail for older pts at risk of reactivation - live attenuated or recombinant subunit vaccine (shingrix) both used in 50yrs or older but recombinant preferred due to greater immunogenicity and longer duration of protection - live vaccine in past should get the recombinant vax for more protection

Question 16

hepatitis B

Answer 16

recombinant HBsAg (anti Hbs) harvested from yeast - 2 dose series in school based programs to children in grade 7

Question 17

human papillomavirus

Answer 17

double stranded DNA
3 HPV vaccines available
bivalent (16 and 18) - cervical dx
quadrivalent (6,11,16,18) - external genital lesions
nine-valent (6,11,16,18,31,33,45,52,58) - high grade dx
no effect on existing infection so important to provide before sexually active as young as age 9 but can be given to older adults at ongoing risk

Question 18

SC vaccines

Answer 18

MMR
varicella
pneumococcal
yellow fever
isotonic, non irritating, non viscous water soluble

Question 19

SC meds

Answer 19

insulin
heparins
injectable biologics

Question 20

IM vaccines

Answer 20

tetanus-diphtheria
influenza
pneumococcal
hep A and B
recombinant herpes zoster
HiB
typhoid human papilloma
japanese encephalitis
rabies
meningococcal
covid-19

Question 21

live attenuated vaccines

Answer 21

MMR
varicella
yellow fever
influenza nasal
oral polio
oral typhoid