Infectious Disease Prevention and Immunoprophylaxis (Billie incomplete) Flashcards
Define Bioterrorism
intentional telease of viruses, bacteria or other germs that can sicken or kill people, livestock, or crops.
What are the features of Biologic agents used as bioweapons
theres 10 of these do your best.
- high morbidity and mortality rates
- potential for person-to-person spread
- low infective dose and highly infectious by aerosol
- lack of rapid diagnostic capability
- lack of universally available effective vaccination.
- potential to cause anxiety
- availability of pathogen and feasibility of production
- environmental stability
- database of prior research and development
- potential to be “weaponized”
What are the Category A Bioweapons
Anthrax
Botulism
Plague
Smallpox
tularemia
viral hemmorhagic fevers
What are the Category B Bioweapons
Brucellosis
Epsilon toxin of Clostridium perfringens
food safety threats (salmonella/ecoli)
glanders
melioidosis
psittacosis
Q fever
Ricin Toxin from ricinus communis
staph enterotoxin B
Typhus fever
viral encephalitis
water safety threats (vibrio cholerae)
What are the Category C Bioweapons
Nipah, Nahtavirus, SARS or MERS, coronavirus, and pandemic influenza
Anthrax
what type of bacteria
how does it spread
where is it found
what forms does it come in
Gram + rod
Spore forming
Found in the soil
Comes in GI, Skin/cutaneous, Resp
Why does anthrax have such a long incubation period
since it is spore producing, the spore has the ability to remain dormant until it sees fit to begin reproducing and causing symptoms.
How is the GI form of anthrax contracted
contaminated meat
How is the Skin/Cutaneous form of anthrax contracted
Spores enter skin, infect papule, cause painless vesicle, create necrotic eschar.
How is the respiratory form of anthrax contracted
Most likely due to BIOTERRORISM!!!
How do you diagnose anthrax
- prompt recognition is KEY
- culture the blood, skin lesion or respiratory secretions
- look for Antibodies
How do you treat anthrax? what about post exposure prohphylaxis?
- obtain antitoxin from CDC
- use cipro first line and clindamycin if cant use cipro
prophylaxis - includes vaccination and treatment with cipro, doxy or amoxicillin
Treatment and prophylaxis can last up to 60 days!
describe how botulism spreads
contaminates a food supply by aerosolization
does not spread person to person
May result from C. botulinum in gut or wound, contaminate food ingestion, or inhalation of toxin
What is the only bioterrorism agent that is non living
botulism
What is botulism produced by
Gram +, spore forming anaerobe - Clostridium Botulinum
what is the natural habitat of botulism
soil
what does botulism do to the body
the toxin prevents the release of acetylcholine = flaccid paralysis of muscles
what are the signs and symptoms of botulism
multiple cranial nerve palsys leading to descending flaccid paralysis
Diplopia (double vision), dysphagia, dysarthria, dry mouth, ptosis (droopy eyelids), dilated pupils, fatigue, extreme weakness.
How do you diagnose botulism
toxin immunoassay
how do you treat botulism
- supportive measures: intubation, mechanical ventilation, parenteral nutrition
- equine antitoxin if Dx is made early in disease
- weeks to months of regeneration of new motor neuron synapses w/in the muscle cell.
how do you prevent botulism
there is no vaccination therefore no prevention tactics
what is the agent that causes the plague
Yersinia pestis
what type of bacteria is the plague
gram - bacillus
What are the two types of the plague
the bubonic plague
the pneumonic plague
What causes the bubonic plague
results from a bite of a plague-infected rat flea
What are the signs and symptoms of the bubonic plague
painful LAD w/ necrosis, fever, and bacteremia, leads to sepsis and death
also has nodes called “buboes”
extensive ecchymosis and necrosis of digits and of tips of nose.
How is the pneumonic plague spread
through inhalation of the bacteria
what are the signs and symptoms of the pneumonic plague
fever, cough, hemoptysis and GI symptoms.
causes pneumonia = plueral effusion = lung consolidation = death.
what is the mortality rate of the pneumonic plague
84%
How do you diagnose the plague
blood cultures and/or cultures of buboes and/or sputum
Also looking for antibodies.
what is the treatment for the plague
gentamicin, streptomycin, doxycycline, chloramphenicol
what is the prophylaxis treatment for the plague
doxycycline, levofloxacin
what is the agent that causes smallpox
variola major virus
what is the mortality rate of smallpox
10-30% when infected
what type of microbe is smallpox
double-stranded DNA virus from pxviridae family
Describe the course of the illness of small pox
exposure from aersolized droplets from close contact of infected person
virus infects host
spreads to lymphoid tissue
localized infection of skin dermis
2-14 days later symptoms begin with rash
rash spreads to trunk
Turns into vesicles, then pustules ,then scabs and mouth ulcers.
when is someone with small pox no longer contagious
when all lesions have formed scabs
how do you diagnose smallpox
culture, PCR
antibodies
how do you treat small pox
- strict isolation
- supportive measures only (no antivirals available)
what bacteria causes tularemia
francisella tularensis
how is tularemia spread
insect bites or environment contamination - ticks and fleas bite a host and pass along to humans
what type of bacteria is tularemia
small, non-motile, gram - cocccobacillus
how would tularemia likely be spread if used as a bioterrorism weapon
aerosol
what are the signs and symptoms
1-14 days post exposure
inflammation of airways (pharyngitis, pleuritis, bronchopneumonia
fever, chills, fatigue, malaise
conjunctivitis and exanthems also possible
50% will have infiltrte on CXR; hilar adenopathy w/o infiltrate also possible.
how do you diagnose tularemia
gram stain or cultrues of infected tissues or blood
how do you treat tularemia
streptomycin or doxycycline
also gentamicin, chloramphenical, cipro
what is the number 1 viral hemorrhagic fever that we care about
ebola
what is the mortality rate of ebola
40-90%
what types of microbes are viral hemorrhagic fevers
all are enveloped, single-stranded RNA viruses that require a host
how do you contract viral hemorrhagic fevers
by being in contact w/an infected host or direct contact w body fluids
what are the signs and symptoms of viral hamorrhagic fevers
fever, myalgia, prostration, DIC w/ thrombocytopenia and capillary hemorrhage.
how do you diagnose a viral hemorrhagic fever
Should be suspected in any person w/ temp >38.3 ℃ (or 101 ℉) for <3 weeks with at least 2 of the following (in the absence of another cause):
Hemorrhagic or purpuric rash
Epistaxis
Hematemesis
Hemoptysis
Hematochezia
Serological testing for antigen and antibody; PCR - sent to the CDC
what is the treatment for viral hemorrhagic fever?
no treatment, but current expirimentation such as antibody cocktails and ribavirin are being explored.
for all category A agents!!!
What organism causes it?
How is it spread?
Signs & Symptoms?
Management?
Why is it or why is it not a good weapon for use in a bioterrorism attack?
Has it been used in the past as a bioterrorism weapon?
answer these later
What is the basic idea of universal precautions and why were they introduced
Introduced to protect workers from HIV, HBV, and other human pathogens
Basically Treat all human body fluids as if they are infected
what is the difference between universal precautions and standard precautions
standard precautions Includes hand hygiene; PPE based on certain types of exposure; safe injection practices; and safe management of contaminated equipment and other items in the environment
what are transmission based precautions
implements standard precautions with additional controls
What are the three categories of transmission based precautions
contact precautions
droplet precautions
airborne infection isolation
What are the contact added precautions
gown and gloves required for pt or environment contact
sometimes above needed to even enter patient toom
what are the added droplet precautions
surgical mask required w/in 3 feet of patient
what are the added airborne infection isolation precautions
Negative pressure isolation room
Respirator must be worn
when do you use gloves?
When in contact w/ blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment
when do you use gowns?
During procedures when contact of clothing, exposed skin w/ blood/body fluids, secretions, excretions, or body fluid is anticipated
when do we use mask/goggles or face shields
Any activity which may result in splashes or sprays of blood, body fluids, secretions, or excretions
what PPE for Irrigating an abscess?
Gloves, gown, goggles
what PPE for drawing blood
Gloves
What is the Most Effective, Least Invasive Method for Preventing the Spread of Disease?
WASHING YOUR HANDS
what is immunoprophylaxis
“The prevention of disease by the production of active or passive immunity.”
what is active immunity
induced by vaccines prepared from bacteria or their products
what is passive immunity
administration of preformed antibodies in preparations called immunoglobulins
what are the pros and cons of the inactivated - dead virus vaccinations
pros:
more stable
safest form
cons
weaker immune response
often requires multiple doses or boosters
what are the pros and cons of live, attenuated viruses
pros:
provides greatest immunity
cons:
TYPICALLY does not cause active disease
what are the pros and cons of subunit vaccinations
pros:
contain ONLY antigens therefore less risk of adverse reactions
cons:
very time-consuming to make
describe toxoid vaccinations
used for bacterial infections that secrete toxoids
contain inactivated toxoids.
describe conjugate vaccinations
works against bacteria w a cell wall
produce synthetic product containing cell wall similar to the bacteria
what are examples of inactivated vaccines
seasonal flu
polio
what are examples of live, attenuated vaccines
measles
mumps
varicella
what are examples of subunit vaccines
hep B
what are examples of toxoid vaccines
tetanus
diptheria
pertussis
what are examples of conjugate vaccines
HIB type B
pneumococcal vaccine
what are contraindications for vaccination
severe allergic reaction
pregnancy and immunosuppression vaccine = no LIVE vaccines including live attenuated.
what are precautions for vaccinations
acute illness that is moderate to severe - with or without fever
delay and vaccinate after illness resolves
what are the 4 variations of diptheria/tetanus/pertussis vaccine
DTaP
Tdap
Td
DT
what is the DTaP
made of inactivated forms of toxins produced by diptheria/tetanus/pertussis as well as acellular antigens of pertussis
what age group is DTaP used for
approved for ages 6 weeks to 7 years of age.
what is the Tdap
lower dose of toxin components in diptheria/tetanus/pertussis. used for booster doses only
what age groups is Tdap used for
7 ages and older
what is Td
same as Tdap without the pertussis component
what is the dosing route of DTaP
5 part series given at WCC
2 months
4 months
6 months
15 months
4 years
what is the dosing route and schedule for Tdap
Booster at age 11 or 12 and every 10 years
what is the dosing route and schedule for Td
Given for a dirty wound if it’s been > 5 years since last tetanus
what are CI for diptheria/tetanus/pertussis vaccine
encephalopathy - coma or prolonged seizures w/in 7 days of administration of the vaccine w/ pertussis components
Progressive, unstable neurological d/o, uncontrolled seizures, etc. - hold off on vaccine until controlled
what is the mechanism of action of the MMR vaccine
90% prevention of rubella after a single dose; 99% measles and 95% mumps prevention after a second dose
what is the dose route and schedule of MMR vaccine
SQ given as a 2 part series
1 at 12 months
1 at 4 years typically combined with varicella vaccine.
why do you not give the MMR and varicella combo vaccine under 23 months of age
it has a risk of febrile seizures.
what is the protocol for MMR vaccination in a child that is leaving the country to travel to an endemic area.
can be given between 6-11 months of age BUT the second dose must be separated by 28 days.
how should adults born before 1970 get the MMR vaccine
they should receive one dose.
if HCW should receive both doses.
what is the prophylaxis protocol for MMR
vaccine can be administered within six days of exposure
CI of MMR vaccination
Pregnancy
Severe immunodeficiency
Postpone a month if pt has been on long-term (>14 days) of steroids
Immediate hypersensitivity reaction to gelatin or neomycin - components of the vaccine
what is the MOA of hte polio vaccination
Inactivated vaccine (IPV)
The only type of polio vaccine given in the US since 2000
90% effective after the first dose, 99-100% effective after the third dose
what is the dosing schedule and route for polio vaccination
given IM or SQ
4 series given at WCC
2 months
4 months
6 months
4 years
what is the protocol for the polio vaccine in a child leaving country to travel to an endemic area
first dose can be given between 6-11 months of age, followed by 3 more doses.
what are the CI for Polio vaccinations
previous reaction to IPV
allergy or sensitivities to streptomycin, polymyxin B, and neomycin
what is the mechanism of action in the Hep A vaccine
inactivated/killed virus that causes an immune reaction by activating lymphocytes to attack the antigen, engulf it, which releases inflammatory mediators signaling B and T-cells. These cells go on to produce new B and T-cells with specific activity against hepatitis A antigen
what is the dosing route and schedule of the Hep A vaccine
given IM in a 2 dose schedule at WCC
12 months
2 years
Second dose sometimes given at 18 month visit - just needs to be 6 months apart
what are the CI for Hep A
there are none
dun dun dunnnnnn
What is the MOA of the Hep B vaccine
Subunit vaccine - recombinant vaccine containing hepatitis B virus surface antigen only
Produced in yeast or mammalian cells (Chinese hamster ovaries)
HBsAg proteins in the vaccine are recognized by antigen presenting cells process the antigen and introduce it to the T-helper cells. B-cells now recognize the antigen causing a weak immune response which then produces neutralizing antibodies
ill make this readable later but i cant comprehend this rn dont come at me
what is the dosing route and schedule of the Hep B vaccine
given IM
4-dose vaccine given at WCC
Birth - 1 month
2 months
4 months
6 months
what are the CI in the Hep B vaccination
hypersensitivity to yeast
severe allergic reaction to latex
what is the MOA of the rotavirus vaccine
live-attenuated vaccine that is either G1P human RV (Rotarix) or live pentavalent bovine-reassortant containing G1, 2, 3, 4, and P1 (RotaTeq)
what is the dosing route and schedule for the Rotavirus vaccine
Given PO
2 or 3-dose vaccine given at WCC
Rotarix - 2-dose vaccine
2 months
4 months
RotaTeq - 3-dose vaccine
2 months
4 months
6 months
Dose of either of the above should be given before 15 weeks of age and all doses given before 8 months of age
what are the CI for the Rotavirus vaccination
severe immunodeficiency
previous h/o intussesception
severe illness - wait until recovery to give vaccine
What is the MOA of the HIB vaccine
polysaccharide conjugate vaccine that attaches a polyribosylribitol phosphate (PRP) capsule to a protein, which will recruit T-cells and lead to the formation of sufficient numbers of anti-PRP antibodies
what is the dosing route and schedule of the HIB vaccine
given IM at WCC
2 months
4 months
6 months
12-15 month - booster
what are the CI of the HIB vaccine
same as other vaccines
do nott give to infants < 6 weeks of age
what is the MOA of hte pneumococcal vaccination
active against strep pneumo
immunity in 2-3 weeks after vaccine, lasting about 5 years
what are the 4 types of pneumococcal vaccines. what type of vaccines are these?
PCV13
PPSV23
PCV15
PCV20
these are all conjugate polysaccharide vaccines
PCV13 vaccination
pneumococcal vaccine subtype that produces better immunity in children
also stimulates mucosal immunity, decreasing colonization and provides some herd immunity
PPSV23 vaccination
pneumococcal vaccine subtype that is indicated mainly in the adult population
PCV 15 vaccination
pneumococcal vaccine subtype that includes serotype from PCV13 and some from PCV 23
PCV 20 vaccination
includes serotype from PCV 13 and additional from PCV 23
very similar to PCV 15 but with more serotype from PCV 23
dosing route and schedule for PCV 13
IM route with a 4 dose series given at WCC
2 months
4 months
6 months
12 - 15 months
>6 y/o - single dose
dosing route and schedule for PPSV23
IM or SQ single dose
Indicated in adult population of those >65 y/o who have already received Prevnar 13
Dosing route and schedule for PCV 15 and PCV 20
1-dose
Indicated in adult population of those who >65 who have not received either PCV 13 or PPSV23
what are the contraindications for the pneumococcal vaccines
there are none
gotchaaa
