Infectious Disease

Question 1

Hepatitis B testing that would indicate PPX needed during systemic treatment

Answer 1

HBsAg+
Anti-HBc+

Before chemotherapy
1) HB surface antigen
2) HB core antibody (total or IgG)
3) HB surface antibody (favorable, risk of past infection but protective; or prior vaccination)
Reactivation can occur if
HBsAg+/HBcAb+ or HBsAg+/HBcAb-
Suggestive of active or inactive carrier (chronic infection) = HBsAg and HBcAb are positive —> these pts should be on PPX
Suggestive of potential occult carrier and past infection = HBsAg negative but HBcAb positive —> these patients should be considered for PPX or HBV DNA should be followed as can live latently and can reactive
Findings of chronic HBV (HBsAg-positive) or past HBV (HBsAg-negative and anti-HBc–positive) infection require HBV reactivation risk assessment.

Question 2

Lives Vaccines

Answer 2

Measles, mumps, rubella, varicella, zoster, yellow fever, rotavirus, influenza (intranasal)

Should not be given to someone on systemic therapy

Question 3

PCV vaccination timeline

Answer 3

Naive: Give PCV13 then PCV23 at least 8 weeks later

Prior PCV23: Give PCV13 at least 1 year after last PCV23 dose

Question 4

Seronegative meningeal vaccine should be given to which groups

Answer 4

Pts with C’ component deficiencies, on eculizumab, functional/anatomic asplenia

Question 5

Timeline for infections in transplant

Answer 5

Preengraftment: <30 days following Tx
-HSV, gram neg, gram pos, candidate/aspergillus

Postengraftment: 30-100 days
-CMV, PCP, aspergillus

Late phase: >100 days
-aspergillus, PCP, encapsulated bacteria, VZV