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Therapeutics 358 Final > Immunizations > Flashcards

Immunizations Flashcards

1
Q

What is the goal of immunization programs?

A

Goal of Immunization Programs

Protect individuals & communities from disease (e.g. Herd Immunity)

Prevent, control and/or eliminate transmission
e.g. eradication of smallpox

Saves lives and saves money

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2
Q

Who dvelops guidleines for immunizations?

A

Canadian
National Advisory Committee on Immunization (NACI)
Canadian Immunization Guide (CIG)

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3
Q

Define antigen/immunogen

A

the substance that stimulates or triggers an immune response

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4
Q

Define immunoglobulin/antibody

A

proteins produced in response to antigens which protect the body from disease

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5
Q

Define VAccine

A

highly regulated, complex biological product designed to induce a protective immune response

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6
Q

Define adaptive immune system

A

develops as a result of infection or following immunization
Defends vs a specific pathogen
Immunology memory – memory cells

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7
Q

Define innate immune system

A

e.g. physical barrier (skin); does not produce immunologic memory

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8
Q

Hos is her immunity established? Who does it protect?

A

Herd Immunity (or community immunity)
can be established by adequate vaccination rates
required to prevent person-to-person transmission of infectious diseases

indirectly protects individuals:
unvaccinated / under vaccinated e.g. infants
unable to mount a robust immune response to vaccines e.g. immunosuppressed

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9
Q

Describe herd immunity? Describe its role in certain disease states?

A
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10
Q

Describ ethe different types of vaccines regarding antigens?

A
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11
Q

Describe live vvacines?

A
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12
Q

Describe inactivated vaccines?

A
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13
Q

How long does one need to wait prior to another live vaccine?

A

Live Vaccines – Wait 4 weeks between vaccinations before another live vaccine

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14
Q

Examples of live and killed vaccines?

A
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15
Q

What are some different parts of a vaccine and examples?

A
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16
Q

What are some factors that affect vaccine response?

A

Viability of the antigen
Antigen Dose
Age (children and older adults get higher doses; adults have a weakned immune system; children immature immune reposne)
Immune status
Route & site of administration
Timing
Vaccine Storage

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17
Q

Routes of vaccinations

A
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18
Q

Vaccine administration. Exceptions?

A

May give multiple vaccines at the same visit
if possible, give in separate anatomic sites (different limbs)
if not, separate ≥1 inch
Exception:
–> LIVE vaccines give on same day or wait ≥4 weeks between live vaccines
Example: childhood immunizations, MMR and Varicella vaccines given at the same visit
–> Pneumococcal vaccines

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19
Q

Vaccine interchangeability

A

Ideally, complete vaccine series with the same product
Engerix-B

Most vaccines can be used interchangeably to complete series if the vaccine is not available

Exceptions
pneumococcal vaccines
some meningococcal vaccines

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20
Q

Vaccine Interchangeability Exceptions

A

Special Populations (high dosing if high risk)
HB – non-dialysis and dialysis
Twinrix

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21
Q

Interuptted Vaccine Schedule

A

Series do not need to be restarted regardless of time between doses

E.g. ideal hepatitis B vaccine schedule 3 doses (0,1,6 mos) in unvaccinated adults

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22
Q

Vaccine Contraindications

A

Very few true contraindications

Anaphylactic reaction to previous vaccine
Anaphylactic reaction to egg (yellow fever or RABAVERT rabies vaccine)

Pregnancy, Immunocompromised (live vaccines)

Guillian-Barre syndrome (GBS) ≤6 weeks of immunization
–> Tetanus containing vaccine and influenza vaccine
.

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23
Q

Caution of Vaccinations? Is it safe with illnesses?

A

Caution - Bleeding disorder

Okay to give vaccine if mild
URTI with/without fever

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24
Q

Egg allergy and VAccinations

A

Contain minuscule amounts of egg protein, which is also denatured, that they are safe for routine use in patinets with egg allergy

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25
Q

Adverse Effecrs of VAccinations

A

Expected (relatively common, predictable, self-limiting)

Local: tenderness, redness, swelling, pain at injection site

Systemic: fever, irritability/fussiness, drowsiness, decreased activity, decreased appetite, syncope (not often but can happen if nervous)

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26
Q

How is an adverse effect of vaccines reported?

A

Public Health Agency of Canada collects case reports
Part of post-marketing safety surveillance –> ensure safety

Data is stored in the Canadian Adverse Events Following Immunizations (CAEFI) database & used to signal AEs that require more investigations

Minor/expected reactions do not need to be reported

Serious, rare, or unexpected AEs thought to be caused by a vaccine:
Complete a Report of Adverse Event Following Immunization (AEFI)

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27
Q

Which vaccines cause most pain? Strategies to manage?

A

Rotavirus vaccine is sweet-tasting; usually given first & no additional sweet tasting solution is required – oral vaccine

Vaccines associated with more injection site pain:
Prevnar-20; M-M-R®II, HPV vaccines, (Shingrix as well)

Strategies: most painful give last (moderate confidence), give non-dominant arm (expert), cool compress (expert), use arm instead of resting it (expert)

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28
Q

Analgesic after vaccination

A

Administration of oral analgesics (such as acetaminophen or ibuprofen) to children to reduce pain prior to or at the time of vaccine injection is not recommended, as there is no evidence of a benefit from this intervention.

Concern that antipyretics may reduce immune response.

Can give in first 1-2 days post vaccine if required for fever or pain.

Suggestion not to routinely administer prophylactic antipyretic/analgesic agents at the time of or within four hours after immսոizatiοո

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29
Q

VAccine Drug Interactions

A

immunosuppressants e.g. DMARDs, prednisone ≥20mg/d x 2 wks

Killed: give ≥2 weeks before starting therapy, if possible; but safe if given while on therapy

LIVE: give ≥4 weeks before starting therapy or delay until after treatment is discontinued ± waiting period

antithrombotics – caution, bleeding risk

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30
Q

Describe cause of diptheria

A

Bacterial infection caused by Corynebacterium diphtheria

Releases toxin –> inhibit cell protein synthesis & membrane formation

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31
Q

Transmission of Diptheria

A

Respiratory droplets (e.g. sneezing or coughing)

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32
Q

Signs and S xDiptheria. CPmplications?

A

Upper respiratory infection - mild fever, sore throat, lymphadenopathy
A grayish white membrane appears in the throat within 2 to 3 days
Can lead to acute respiratory distress & systemic complications e.g. myocarditis

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33
Q

Mortality Diptheria

A

Unimmunized 5-10%, highest in very young/old individuals

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34
Q

What type of vaccine is diptehria?

A

Diphtheria toxoid vaccine
Contains detoxified diphtheria toxin (antigen), so immune system produces antibodies towards the toxin

Vaccine protects against effects of the toxin, but not infection/transmission

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35
Q

Describe the formulation of Diptheria vaccine qand its importance

A

Only available as combo vaccine

“D” = pediatric formulation (higher concentration antigen - immature immune system, needs more for an adequate immune response)
e.g. DTaP-IPV

“d” = adolescent/adult formulation (reduced concentration antigen)
e.g. Tdap

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36
Q

Describe diptheria schedule

A

SK Primary Series (“D”): 4 doses (2,4,6,18 months), then
Booster (“d”): 4-6 years & in Grade 8

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37
Q

Describe NACI recommendation of diptheria vacciine

A

Td booster every 10 years (routine)

Can also get if serious cuts/deep wounds &last tetanus vaccine was more than five years ago

Should receive Tdap once in adulthood x 1 to replace Td booster

Should receive Tdap vaccine in each pregnancy (see pertussis, pregnancy special population) – protects fetus for 12 months

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38
Q

Pregnancy Diptehria VAccination

A

Should receive Tdap vaccine in each pregnancy (exam, see pertussis, pregnancy special population) – protects fetus for 12 months

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39
Q

Cause of tetanus

A

Bacterial infection caused by Clostridium tetani
Found in the soil & feces
Releases a neurotoxin – toxin similar to diphtheria

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40
Q

Transmission Testanus

A

Wound contamination with soil, feces, or dust
Not spread person-to-person

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41
Q

Signsa nd Sx Tetanus

A

Signs & Symptoms (onset 3-21 days)
Painful muscle spasms beginning with jaw muscles (tetanus also known as “lockjaw”)
Complications: convulsions, respiratory failure

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42
Q

Mortality etatnus

A

Unimmunized 10-80%, highest in very young/old individuals

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43
Q

Tetanus vaccine formulation

A

Tetanus toxoid vaccine

Contains detoxified tetanus toxin (antigen), so immune system produces antibodies towards the toxin

Only available as combo vaccine
e.g. DTaP-IPV, Tdap, Td

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44
Q

Tetanus VAccine Schedule

A

SK Primary Series: 4 doses (2,4,6,18 months), then
Booster: 4-6 years & in Grade 8

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45
Q

NACI Tetanus Recommendation

A

Td booster every 10 years (routine)

Can also get if serious cuts/deep wounds & last tetanus vaccine was more than five years ago

Should receive Tdap x 1 in adulthood to replace Td booster

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46
Q

Tetanus VAccination Preganncy

A

Should receive Tdap vaccine in each pregnancy (exam, see pertussis)

Regardless ssof when last vaccine –> maternal antibody transfer to fetus

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47
Q

Pertusiss Cause

A

Bacterial infection caused by Bordetella pertussis

Produce toxin  paralyze respiratory cell cilia

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48
Q

Transmission Pertussis

A

Respiratory droplets (e.g. sneezing or coughing)
Close face-to-face contact (highly contagious)

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49
Q

Contagiousness of Whooping Cough

A

Can contract more than once, immunity wanes over time

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50
Q

Complications Pertussis

A

Complications are most often seen in infants
Pneumonia, seizures, encephalopathy
In Canada, 1 to 4 deaths/year related to pertussis, particularly in unimmunized or underimmunized infants less than 6 months

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51
Q

Pertussis in Canada

A

Pertussis is an endemic disease in Canada, regardless of ethnicity, climate or geographic location

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52
Q

Pertussis Formulation VAccine

A

Only available as acellular preparation in a combination vaccine

“aP” = pediatric formulation (higher concentration)

“ap” = adolescent/adult formulation (reduced concentration)

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53
Q

Tetanus and Pertussis Formulation Vaccine and Age

A
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54
Q

What is a concern pt’s may have regardinhg pertussis vaccination?

A

Myth/patient concern – pertussis vaccine leads to seizures
Old vaccine (whole cell) –> AEs (seizures, hyporesponsive episodes)

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55
Q

Pertusssis Schedule

A

Children: part of routine immunizations

SK Primary Series: 4 doses (2,4,6,18 months), then
Booster: 4-6 years & in Grade 8

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56
Q

Pertussis NACI

A

Td booster every 10 years (routine)

Can also get if serious cuts/deep wounds &last tetanus vaccine was more than five years ago

Should receive Tdap x 1 in adulthood to replace Td booster (vaccinate for pertussis once in adulthood)

Consider timing, recommended all parents/extended family/caregivers if haven’t received as an adult (limit transmission to un/undervaccinated infant/children – 4th dose at 18months)

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57
Q

Preganncy and Pertussis

A

Should receive Tdap vaccine in each pregnancy

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58
Q

POlio Cause

A

Viral infection cause by the Poliovirus
3 serotypes (1,2,3)

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59
Q

Transmission Polio

A

fecal-oral

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60
Q

Signs and Sx Polio. COmplications?

A

Signs & Symptoms (70-95% asymptomatic)
Flu-like e.g. fever, headache, sore throat, N/V, weakness
Can lead to meningitis, limps, post-polio syndrome paralysis

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61
Q

Polio Mortality

A

Mortality (paralytic polio): 2% to 5% among children and 15% to 30% for adults

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62
Q

Polio Vaccin Formulation

A

inactivated poliomyelitis vaccine (IPV)

Available as combo vaccine

e.g. Tdap-IPV or individually i.e. IPV IMOVAX Polio

Vaccine contains three types of wild poliovirus - trivalent

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63
Q

Other polio vaccine. Where is it used?

A

Live attenuated oral polio vaccine (OPV)
Used internationally, associated with paralytic polio (Not used here in Canada)

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64
Q

What is difdferent about the IPV vaccine?

A

IPV IMOVAX Polio –> Given SC which is different than an inactivated vaccine

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65
Q

Polio Schedule

A
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66
Q

Hib Stands for

A

Haemophilus influenzae (“h flu”) ≠ influenza or the “flu”

Haemophilus influenzae type b (Hib)

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67
Q

Hib Causative agent

A

Bacterial infection caused by Haemophilus influenzae serotype b

6 Serotypes “a” to “f” (typeable, encapsulated)

Hib is the most pathogenic
Since Hib vaccine, most invasive disease due to non-b H.influenzae in Canada

“invasive” = infection beyond the respiratory tract, e.g. meningitis

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68
Q

Transmission Hib

A

Respiratory droplets (e.g. sneezing, coughing)

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69
Q

Hib complicatuons

A

In Canada, most commonly infects children under 5 years old
Acute otitis media, meningitis, pneumonia, bacteremia, epiglottis
Death rate up to 5% & deafness up to 20% (secondary to meningitis)

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70
Q

Hib Vaccine Formuolation

A

Available as combo vaccine e.g. DTaP-IPV-Hib or individually e.g. Hib Act-HIB

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71
Q

Hib Schedule

A
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72
Q

Adult Immunizations: Tetanus, diphetheria hib, Polio, Pertussis

A

NACI: Td Td Adsorbed booster every 10 years

Can also get if serious cuts/deep wounds &last tetanus vaccine was more than five years ago

Tdap should replace one of the Td doses

Tdap ADACEL, BOOSTRIX vaccine in each pregnancy

No routine IPV booster in adults

No routine Hib booster in adults

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73
Q

Rotavirus cause

A

Viral infection caused by Rotavirus
Many serotypes

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74
Q

Rotavirus Transmission

A

Transmission: fecal-oral route

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75
Q

Sx of Rotavirus. Occurence rate?

A

cause of diarrhea and need for hospitalization for dehydration secondary to diarrhea in children < 5 years

Almost all unimmunized children will have at least 1 rotavirus infection by age 5

Can get multiple times, but each new infection is usually milder (initial infection provides partial immunity)

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76
Q

Signs and Sx of Rotavirus

A

Appear 1-3 days after a person has become infected fever, vomiting, diarrhea, stomach pain

Diarrhea can last from 3-8 days

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77
Q

Rotavirus Conatgiousness

A

Contagious - before the individual becomes ill and for 24 hours after diarrhea stops

78
Q

Rotavirus Formulation. Ci?

A

Live attenuated oral vaccine

CI in immunocompromised infants

79
Q

Rotavirus Vaccine Formulation

A

Available as pentavalent ROTATEQ (3 doses) or monovalent vaccine Rotarix (2 doses)

80
Q

SK Rotravirus Vaccine and Schedule

A

ROTATEQ (pentavalent)
3 doses at 2, 4, 6 mons (2mL po)

81
Q

Counselling of Rotavirus

A

Babies can breastfeed, eat and drink any time before or after receiving the rotavirus vaccine

If infant spits up or regurgitates, a replacement dose should NOT be administered

Virus shed in stool for up to 10 days (caution: handwashing; immunocompromised household members – don’t do diaper changes)

82
Q

Sk Timing Rotavirus

A

SK: 1st dose given before 15 weeks & last dose before 8 months of age

83
Q

Adevrse EFfecrs of Rotavirus Vaccine

A

Common:
Fever, diarrhea, irritability, loss of appetite; some may get flatulence, abdominal pain, dermatitis

Intussusception (bowel obstruction)
–> If history of bowel obstruction, rotavirus usually not given

84
Q

Menigicoccus Causitive AGent

A

Bacterial infection cause by Neisseria meningitidis

many serotypes; majority of invasive disease is associated with A, B, C, Y, & W-135

85
Q

Transmission Meningicoccus

A

Respiratory droplets, close contact with respiratory secretions/saliva (kissing, sharing of vapes, lipstick, food/drink, toothbrushes, etc)

86
Q

Risk Factors Meningicoccus

A

Risk factors: crowded housing (military barracks, post-secondary residence)

87
Q

Complications Meningicoccus

A

Cause meningitis & bacteremia (invasive meningococcal disease); mostly in children <5 & 15-24 years

Complications: limb amputations, hearing loss, brain damage, seizures, and skin scarring

Even with antibiotic treatment, mortality rate is 10-15%

88
Q

Meningicoccal Vaccine Formulation

A

Men-C-C=Meningococcal Conjugate (type) C Vaccine
Monovalent

Men-C-ACWY-135=Meningococcal Conjugate (types) A and C and Y and W-135 vaccine
Quadrivalent

89
Q

Sk Series Meningicoccus VAccine

A

Men-C-C=Meningococcal Conjugate (type) C Vaccine
Monovalent

SK Primary Series: 1 dose at 12 months

Effective in infants and children < 2 years of age

Adults: no routine booster
NEISVAC-C or MENJUGATE

Men-C-ACWY-135=Meningococcal Conjugate (types) A and C and Y and W-135 vaccine

Quadrivalent

SK Primary Series: 1 dose at Grade 6
Adults: no routine booster

MENACTRA or MENVEO or NIMENRIX or MENQUADFI

90
Q

Meningicoccal Type B Vaccines

A

Serogroup B meningococcal vaccines

Not routine in childhood or adulthood

91
Q

Meningicicoocal Serogroup B vaccines avilable and consideration

A

Available as (non-interchangeable)

Bexsero: 2 months-25 years, potential public funding in SK

Trumenba: 10-25 years, not publicly funded in SK

92
Q

Are the different types of Men-C-ACWY-135 vaccine inetrchanageable?

A

YES

93
Q

Measles Causative Agent

A

Viral infection caused by the measles virus

94
Q

Measles Trasnmission

A

Transmission: respiratory droplets; highly infectious

95
Q

Measles SIgnificance

A

Leading cause of vaccine-preventable deaths in children worldwide

96
Q

Signs and Sx of Measles

A

Fever, sore throat, cough, runny nose, red rash (URTi)

97
Q

Complications Measles

A

Otitis Media and Pneumonia
Encephalitis
Seizures, deafness, or brain damage
Death

98
Q

Mumps CAusative Agent

A

Viral infection caused by the mumps virus

99
Q

Mumps Transmission

A

Transmission: respiratory droplets

100
Q

Mumps SIgns and Sx

A

Fever, respiratory symptoms, parotitis (URTi sx)

101
Q

Complications Mumps

A

meningitis or encephalitis
3/10 males develop swollen testicles and 1/20 females develop swollen ovaries
Congenital malformations or abortion in pregnancy

102
Q

Rubella CAusative Agent

A

Viral infection caused by the rubella virus

103
Q

Rubella Transmission

A

respiratory droplets

104
Q

Sx Rubells

A

Cause rash, lymphadenopathy, arthralgia, fever
Not unlike the flu (non-specific symptoms)

105
Q

Complications Rubella

A

Congenital malformations or miscarriage in pregnancy
Infection during pregnancy can lead to congenital rubella syndrome in the infant (heart disease, cataracts, deafness)

106
Q

Varacella CAusative Agent

A

Infection caused by varicella zoster virus (VZV)

107
Q

Transmission Varicella

A

respiratory droplets or direct contact with the blister fluid; vertical transmission

108
Q

Varicella SIgns and Sx

A

Causes high fever, red itchy rash (begins at scalp and moves towards trunk). Rash begins as red spots that become fluid-filled blisters that gradually crust over

109
Q

Varicella Complications

A

skin and soft tissue infections, pneumonia

Herpes Zoster or Shingles – reactivation of the varicella virus

110
Q

MMR/MMRV/V Vaccine Type. CI? When is it given?

A

Live, attenuated vaccine:
Contraindicated in pregnancy & immunocompromised individuals
Deferred until 12 months of age (maternal antibodies decline at this point)

111
Q

MMRV Vaccine Formuations

A

Available as a combo vaccine MMR or MMRV; Varicella is also available as a monovalent vaccine e.g. VARIVAX III

112
Q

MMRV and Allergy Consideration

A

MMRV contains trace amounts of neomycin and gelatin: so be cautious in those with severe allergies

113
Q

MMRV Efficaxy

A

Efficacy increases with age

Maternal antibodies can decrease live vaccine replication & impact efficacy
MMR+/-V is deferred until 12 months of age when maternal antibodies have declined

114
Q

MMR/MMRV Schedule

A

SK Primary Series: MMRV x 2 doses (12, 18 months)

115
Q

MMR/MMR Adults

A

Adults: no routine booster
Note (unvaccinated adult, special populations)

MMRV not indicated in adults, use MMR and V (if required)

Varicella (V) vaccine only indicated to 49 years of age

116
Q

MMRV VS MMR and V adevrse EFfects

A

Febrile Seizures: Higher in MMRV vaccine (low risk still) – compared to MMR and univalent V vaccine

  • Have to give live vaccines at the same time or else have to wait 4 weeks
117
Q

MMRV Vaccine Adverse EFfects

A

Common reactions (e.g., soreness, redness and swelling at the injection site)

Mild subclinical infection occurring 1 week after (~5%)

Malaise and fever, with or without rash lasting for up to ~3 days

May occur ~7-12 days AFTER getting the vaccine

Possible joint aches from the rubella component may occur in teenage and adult women

118
Q

Varicella Vaccine DAverse Effects

A

Swelling and redness, possible low grade fever

A varicella-like rash (blisters) at injection site may develop
3 to 5%; may last up to 3-6 weeks

Less contagious than the wild-type varicella virus; to prevent possible viral spreading, cover the rash until the blisters have dried and crusted over.

119
Q

Herpes Zoster Causative Agent

A

Viral infection caused by reactivation of varicella zoster virus

Varicella zoster virus infection causes varicella (chickenpox) –> typically remains dormant in the dorsal root ganglia & may reactivate later in life–> reactivated infection results in herpes zoster (shingles)

120
Q

Risk Herpes Zoster

A

Baseline risk of shingles in adults ≥65 years old is approximately 1% per year

121
Q

Can you get herpes zoster if never had chicken pox?

A

No - if never had varicella vaccine or chicken pox

Varicella vaccine has a lower risk of herpes zoster than those who have had an infection with varicella

122
Q

Hepres Zoster Signs and Sx

A

Prodromal pain can precede the rash by days to weeks in most individuals

Maculopapular vesicular rash (painful, itchy) occurring along 1 or 2 dermatomes (usually thoracic) that does not cross the midline (unilateral).

Usually lasts ~7-10 days

123
Q

Complications Herpes zoster

A

postherpetic neuralgia (~13-20%)

Disseminated zoster: ophthalmic (10-15%), CNS, pulmonary & hepatic involvement

Association with increased risk of cerebrovascular event within ~1 year post herpes zoster infection (?↑ cardiac event)

<10% of individuals 65yrs + will be hospitalized
Mortality is uncommon

124
Q

Herpes Zoster Vaccine Formulation

A

Shingrix: adjuvanted, recombinant subunit

125
Q

Shingrix Recommendation

A

Recommended adults 50 years or older

Also recommended if :

Previously vaccinated with ZOSTAVAX II (wait 2 months [ACIP] to 1 year [NACI]) or
Zoster/shingles episode (wait post acute episode [ACIP] to 1 year [NACI])

126
Q

How well doses the shingrix Vaccine Work?

A

ZOE-70 - Mean Age 76 years old
ZOE-50 - Mean age 62 years old

Shingrix VS placebo over 3 years

Decraesed risk of shingles by 91% (NNT = 32)

Decreased risk of PHN (90%)

> = 70 - NNT 263

Age > or = 50 NNT 333

Immune response maintained for 9 years, unclear if corrleates with shingles or PHN

127
Q

Shingrix Vaccine Adults. NACI recommendation?

A

Recommended adults ≥18 with an immunocompromising disease (“new” indication)

NACI No recommendation yet

Pregnancy? No recommendation, delay until after ideal

Breastfeeding? May give, no known risk to infant

128
Q

Shingrisx ACIP Recommendation Audts

A

Recommended adults ≥18 with an immunocompromising disease (“new” indication)

ACIP - confirm varicella immunity (vaccinate for varicella instead)
hx chickenpox or shingles, varicella vaccine documentation, positive varicella titre

if not immune to varicella then at risk of chicken pox, not shingles, give varicella

129
Q

Herpes Zoter VAccine Schedule

A

2 doses (0, then 2-6 months)

For individuals who are or will be immunosuppressed the second dose can be administered 1 to 2 months after the first (if required).

E.g. starting immunosuppressant therapy

No furtehr doses at this time

130
Q

Coverage Shingrix

A

SK: not publicly funded

NIHB: benefit 60 years plus OR immunocompromised (e.g. HIV)

131
Q

Herpes zoster Shingix Indication Adults

A

Indicated for:
adults ≥18 years with an immunocompromising disease
adults ≥50 years
Still recommended in above populations in those with previous zoster infection or ZOSTAVAX II immunization

132
Q

Describe heaptitis B caustive agent

A

Viral infection

133
Q

Hepatitis B Infection Course

A

Most clear infection after 4-8 weeks
Some chronic HB carriers  cirrhosis, liver cancer, and death
Canada estimated <0.5% of residents are chronic HB carriers

134
Q

HEp B Transmission. Highest Risk?

A

Blood or bodily fluids containing HB virus e.g., sharing injection drug equipment, sexual contact, vertical transmission (parent to baby, highest risk of leading to chronic HB)

135
Q

Signs and Sx Hepatitis B

A

Asymptomatic in up to 50% of adults and 90% of children
Fatigue, fever, N/V, decreased appetite, jaundice

136
Q

HEP B vaccine Formulations

A

Pediatric and adult formulations
High-dose e.g. renal disease, HIV, congenital immunodeficiency disorders
Combo vaccine (HAHB) or monovalent HB

137
Q

Sk Series HEp-B

A

SK Primary Series: 2 doses in Grade 6 (0 months, 6 months)

Adult formulation of ENGERIX-B or RECOMBIVAX HB

No booster required
Exception: potentially some special populations based on serology e.g. dialysis

138
Q

HEP B Serology Interpretation

A

Serology is not routinely ordered in most patients for immunization purposes; see special populations*

139
Q

INterpretation of HEP B Serology

A

Healthy patients: if received appropriate immunizations series, then they are considered immune/protected for life even if anti-HBs (HB surface antibody) drop <10 overtime because immune memory to HB persists

Another HB vaccine dose is NOT required (exam)

Some special populations (immunocompromised, CKD etc) :
If anti-HBs <10, give another dose and repeat serology

140
Q

Hepatitis A Causuative agent

A

Viral infection cause by hepatitis A virus

141
Q

HEP-A Transmission

A

Transmission: fecal-oral
Contaminated food, water, drinks, etc
HA virus can remain infectious in the environment for several weeks

142
Q

Signs and Sx HEP-A

A

Asymptomatic (younger); adolescents/adults  anorexia, nausea, fatigue, fever, jaundice; rarely death
Lasts a few weeks to a few months

143
Q

HEP-A Course of Illness

A

~25% of adult cases are hospitalized

Does not lead to chronic hepatitis or chronic carrier state (like HBV)

144
Q

HEpatitis-A Vaccine Formulation

A

Many HA vaccines available
Pediatric and adult formulations

e.g. AVAXIM and AVAXIM PEDIATRIC

Combo vaccine or individually

145
Q

Hepatitis A Schedule

A

Not routinely given in childhood vaccinations

Recommended for people at increased risk of infection

2 doses (0, 6 months)
No BOOSTER required

146
Q

HEP-A and B VAccine Fomrulation

A

Twinrix (HAHB)
SK: not routinely given in childhood vaccines & not publicly funded

Role in SK today: convenience re travel

If someone requires hepatitis A for travel & unsure if they’ve received HB series/no HB series documented

But if they have already completed Hepatitis B series (or if serology was previously done & they are HB immune) then ONLY HA vaccination required

147
Q

HPV Caustive agent

A

Viral infection caused by Human Papillomavirus
Over 200 types
12 oncogenic & 8-12 possibly oncogenic

148
Q

Transmission HPV

A

Transmission: sexually by skin-to-skin contact (or mucosa contact), vertically

149
Q

HPV Prevalence

A

The most common STI
If not immunized, up to 75% of sexually active individuals will have at least one HPV infection in their lifetime

150
Q

HPV Signs and Sx

A

Most infections are asymptomatic & and are eventually cleared by the immune system within 24 months

Some develop genital warts (HPV types 6, 11, others)
Some develop cancer

151
Q

Describe the different HPV types and the risks

A

anal, cervical, vaginal, penile (HPV types 16, 18, 31, 33, 45, 52, 58, and others)

Oropharynx (HPV type 16)

causes almost all cases of cervical cancer (HPV types 16, 18)

152
Q

Describe the WH and CAnada Traget for hPV vaccination rates

A

WHO/Canada target: ≥17yrs 90% will be vaccinated with 2+ doses

Canada
2-dose series completion~60-90%
1-dose ≥14yrs ~80%

153
Q

HPV Vaccines

A

HPV-9 (GARDASIL-9): human papillomavirus types 6, 11, 16, 18, 31, 33, 45, 52, 58

HPV-2 (CERVARIX) contains HPV type 16 & 18; only approved in females & not commonly used

154
Q

HPV Vaccine EFficcay

A

In people who have never been infected with the 9 specific vaccine-types of HPV (6, 11, 16, 18, 31, 33, 45, 52, and 58), the vaccine will:

Prevent 7/10 cases of cervical cancer & 9/10 cases of genital warts

Does NOT protect against other STIs

HPV types included in HPV-9 (GARDASIL-9) cause ~90-95% HPV-attributable cancers

155
Q

NACI Recommendations HPV

A

HPV-9 (GARDASIL-9) preferred – protection vs the greatest number of HPV types and associated diseases

Healthy individuals
9-20 years: 1 dose of HPV vaccine (previous recommendation was 2 doses)

21-26 years: 2 doses of HPV vaccine (previous recommendation was 3 doses)

≥27 years: 2 doses of HPV vaccine using SDM (shared decision making) (previous recommendation was 3 doses)

HPV vaccine may be offered in pregnancy (prev recommendation delay post-pregnancy)

≥9 years, immunocompromised or HIV: 3 doses (0, 2, 6 months)

156
Q

How to talk about HPV vaccination in women over 26?

A

Gardasil 9 and Cervarix are approved for women up to age 45

Don’t feel compelled to bring up for most adults 27-45, especially if in long-term, mutually monogamous relationships

Consider discussing with unvaccinated adults who will have a new sex partner, especially those with few partners in the past. Vaccination might cover HPV strains they haven’t been exposed to before

157
Q

HPV Sk Schedule

A
158
Q

PAtiet Education Gardasil

A

Administer after other vaccines (known to cause more injection pain – adjuvanted)

May administer with other vaccines

159
Q

HPV Vaccine EFficacy rgarding sexual activity

A

Primary series is expected to provide lifelong immunity

HPV vaccine is 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

160
Q

HPV-9 Vaccine Age Indication

A

Some choose to still get the HPV-9 vaccine x 1 dose e.g. ongoing risk (approved in those up to 45 years)

161
Q

Males HPV-9 Vaccine

A

HPV-9 recommended 9-26 years (≥27yrs – SDM – approved in those up to 45 years)

SK: Only publicly funded for those born after 2006
~18yrs and younger..

162
Q

Mpox CAusative Agent

A

Viral infection caused by monkeypox virus

163
Q

MPOX Transmission

A

Skin to skin contact
Transmission is not prevented by condoms
Respiratory droplets (close, sustained face-to-face contact)
Animal to humans e.g. bites from rodents (Africa)
Low risk transmission: shared contaminated objects e.g. doorknobs, bed lines

164
Q

MPox Common Populations

A

Most cases have been diagnosed in MSM

Also diagnosed in heterosexual persons

Rarely household transmission to younger children

165
Q

Signs and Symptoms of Mpox and Contagiousness

A

Incubation period has generally ranged from 7 to 10 days following exposure

Signs & Symptoms
Systemic illness: fever, chills, headache, myalgias, rash (pimple-like / blisters, look similar to shingles but larger)

Atypical (2022 outbreak): oral, genital, and anal lesions without systemic illness
Usually self-limiting (2-4 weeks)

But 2022 outbreak: cases of mortality in those immunocompromised or those who developed encephalitis
Tecovirimat (TPOXX) treatment for high risk patients

Contagious for ~2-4 weeks (until all lesion scabs have fallen off)
Cover lesions, wear mask…

166
Q

MPOX Vaccine Discovery

A

Smallpox vaccine protects against mpox

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).

167
Q

MPOX VAccine Formualiton

A

Second generation smallpox vaccine; modified vaccinia Ankara IMVAMUNE

Live-attenuated, non-replicating virus (no risk of developing infection or transmission to others)

≥18 years at high risk for exposure

Safe immunocompromised e.g. HIV, pregnancy (limited data)

168
Q

MPOX Risk Factors

A

Close COntact: 4-14 days
Transgender, 2s, bisexual, gay or MSM, or individuals who have sex with MSM and
ONE OF:

1) prior STD in last 12 months
2) 2 or more partners where one has other partners
3) Sex in sex-on premises
4) Have has or plan to have sexual contact with annonymous partner
5) Are planning to travel to area in Canada or workld reporting cases
6) Sex Workers
7) Volunteer or work at places with sexual activity

169
Q

MPOX VAccine Schedule

A

PrEP: IMVAMUNE 2 doses (0.5 mL) subcut given 1 month apart (0, 1 month)
potential booster after 2 years

PEP: IMVAMUNE 1 dose ≤4 day (up to 14 days) since last exposure
consider 2nd dose in 1 month if ongoing exposure

170
Q

Pneumonococcal Causitive agent

A

Bacterial infection due to Streptococcus pneumonia

~100 serotypes, each serotype has a different capsule

Vaccine lead to antibodies vs capsule

171
Q

Transmission Pneumonococcal

A

respiratory droplets; direct oral contact or indirect contact with infectious oral secretions
children < 5years in daycare have 2-3x ↑ risk pneumococcal disease compared those who do not

172
Q

Signs and Sx Pneumonococcal

A

Signs & Symptoms  can cause:
sinusitis, acute otitis media, pneumonia
Invasive pneumococcal disease (infection in a normally sterile site): bacteremia, meningitis
Mortality: increased risk IPD risk factors older adults e.g. >10% case fatality in those ≥65yrs who develop IPD

173
Q

Pneumonococcal Vaccines Available

A

NOT INTERCHANGEABLE

174
Q

Pneomonoccal Types that CAuse Dx

A

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

175
Q

What type of vaccine is pneumonoccocal vaccines?

A

Conjugate vs. Polysaccharide

Longer lasting immune (create long-term memory cells)

More robust immune response – involve B & T cells

Polysaccharide – “T cell independent”

Infants – respond well to T-cell dependent antigens; do not respond well to T cell independent antigens e.g. previous, when pneumovax23 was used in infants at high risk of IPV, waited until 2 years of age

176
Q

NACi Penumonococcal Childhood- No IPD Risk FActors

A

VAXNEUVANCE (PCV15) or PREVNAR-20 (PCV20)

Either should be used for routine childhood immunization programs

Considered similar benefit (immune response) and AEs as PCV13

177
Q

NACiIPenumonococcal Adulthood - No IPD Risk FActors

A

≥65 years (& otherwise healthy), regardless of pneumococcal vaccination history with PREVNAR-13 PCV13, VAXNEUVANCE PCV15, or PNEUMOVAX-23 PPSV23 (wait ≥1 year from last pneumococcal dose)

PREVNAR-20 (PCV20) 0.5mL IM x 1 dose OR
CAPVAXIVE (PCV21) 0.5mL IM x 1 dose

178
Q

How long to wait between penumonococcal vaccines?

A

PREVAR-20 (PCV21), minimum interval

Wait ≥1 year between PCV20 and PCV13 (minimum 8 weeks)

Waiting 1yr expands serotype coverage in a time-effective manner

8 weeks may be used if immunocompromised or rapid completion required

Wait ≥5 year between PCV20 and PPSV23 (minimum 1 year)

Waiting 5 years may maximize total duration protected given PNEUMOVAX-23 expected duration of protection ~5 years

CAPVAXVIE (PCV21), minimum interval
Product monograph – minimum interval between PCV21 and other pneumococcal vaccine is 1 year

179
Q

Pneumonococcal Summary adult

A
180
Q

Pneumonococcal Vaccination with IPD Risk Factors

A

≥18 years & medical or environmental IPD risk factors (regardless of pneumococcal vaccination history with PREVNAR-13 PCV13, VAXNEUVANCE PCV15, or PNEUMOVAX-23 PPSV23):

PREVNAR-20 (PCV20) 0.5mL IM x 1 dose OR
CAPVAXIVE (PCV21) 0.5mL IM x 1 dose

181
Q

IPD Risk FActors

A

Chronic Herat Dise
Diabetes
CKD
Chornic Liver and LUng DX

Immunocompromising DX - HIVV, Transplant, Immunosuppressant TX

182
Q

RSV Causative Agent

A

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

183
Q

RSV Transmission

A

Transmission: respiratory droplets

184
Q

RSV Contagiousness, Outbreaks, Population

A

Common, very contagious

Annual outbreaks in Canada late fall to early spring

Usually infants / older adults impacted

Almost all 2-year-old RSV infection
Older adults with comorbidities e.g. COPD – severe disease

Reinfections common, but illness usually milder with subsequent infection

185
Q

Who are some individuals at high risk of RSv?

A

CArdiac
Respiratory Conditions
DM
Immunosupressed

186
Q

Signs and Sx RSV

A

Signs & Symptoms

URTI - mild, cold-like symptoms e.g. sore throat, cough, headache, nasal congestion, etc

Lower lung infections e.g. bronchiolitis and pneumonia

Severe - requiring oxygen and hospitalization / ICU

Leading cause of hospitalization in infants (US)

187
Q

RSV Vaccine Types and Recommendation

A
188
Q

RSV NACI Recommendations

A
189
Q

RSV Administartion Timing

A

Ideally admin before onset of RSV Season

190
Q

RSV Study

A

RSV Prefusion F protein in Older Adults

Indicuduals aged 60 and older

Primary Endpoint: RSV-lower respiratory tract infection

Arexvy Vs. Placebo

Arexvy decreased RSV-LRTi by 83%

Those with commorbidities had a further reduction by 94%

Cannot Say Arrexvy is better than AByso

191
Q

RSv Booster

A
  • Long-term effectivenss unknwin
    At this time, only one dose is recommended
  • CD: One dose of RSV vaccine can provide protection for atleast 2 years (2 RSV seasons)
192
Q

RSV Vaccine Adverse FEfects

A

Arrexvy - Adjuvant
- Systemic Reactions, Injection Site Reactions

Abryso -No adjuvant

  • GBS Abrexy and Abyso, A-fib with both

Therapeutics 358 Final (3 decks)

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