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Clinical Med B > Infectious Disease Prevention and Immunoprophylaxis (Billie incomplete) > Flashcards

Infectious Disease Prevention and Immunoprophylaxis (Billie incomplete) Flashcards

1
Q

Define Bioterrorism

A

intentional telease of viruses, bacteria or other germs that can sicken or kill people, livestock, or crops.

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2
Q

What are the features of Biologic agents used as bioweapons

theres 10 of these do your best.

A
  1. high morbidity and mortality rates
  2. potential for person-to-person spread
  3. low infective dose and highly infectious by aerosol
  4. lack of rapid diagnostic capability
  5. lack of universally available effective vaccination.
  6. potential to cause anxiety
  7. availability of pathogen and feasibility of production
  8. environmental stability
  9. database of prior research and development
  10. potential to be “weaponized”
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3
Q

What are the Category A Bioweapons

A

Anthrax
Botulism
Plague
Smallpox
tularemia
viral hemmorhagic fevers

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4
Q

What are the Category B Bioweapons

A

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)

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5
Q

What are the Category C Bioweapons

A

Nipah, Nahtavirus, SARS or MERS, coronavirus, and pandemic influenza

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6
Q

Anthrax
what type of bacteria
how does it spread
where is it found
what forms does it come in

A

Gram + rod
Spore forming
Found in the soil
Comes in GI, Skin/cutaneous, Resp

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7
Q

Why does anthrax have such a long incubation period

A

since it is spore producing, the spore has the ability to remain dormant until it sees fit to begin reproducing and causing symptoms.

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8
Q

How is the GI form of anthrax contracted

A

contaminated meat

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9
Q

How is the Skin/Cutaneous form of anthrax contracted

A

Spores enter skin, infect papule, cause painless vesicle, create necrotic eschar.

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10
Q

How is the respiratory form of anthrax contracted

A

Most likely due to BIOTERRORISM!!!

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11
Q

How do you diagnose anthrax

A
  1. prompt recognition is KEY
  2. culture the blood, skin lesion or respiratory secretions
  3. look for Antibodies
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12
Q

How do you treat anthrax? what about post exposure prohphylaxis?

A
  1. obtain antitoxin from CDC
  2. 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!

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13
Q

describe how botulism spreads

A

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

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14
Q

What is the only bioterrorism agent that is non living

A

botulism

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15
Q

What is botulism produced by

A

Gram +, spore forming anaerobe - Clostridium Botulinum

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16
Q

what is the natural habitat of botulism

A

soil

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17
Q

what does botulism do to the body

A

the toxin prevents the release of acetylcholine = flaccid paralysis of muscles

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18
Q

what are the signs and symptoms of botulism

A

multiple cranial nerve palsys leading to descending flaccid paralysis
Diplopia (double vision), dysphagia, dysarthria, dry mouth, ptosis (droopy eyelids), dilated pupils, fatigue, extreme weakness.

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19
Q

How do you diagnose botulism

A

toxin immunoassay

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20
Q

how do you treat botulism

A
  1. supportive measures: intubation, mechanical ventilation, parenteral nutrition
  2. equine antitoxin if Dx is made early in disease
  3. weeks to months of regeneration of new motor neuron synapses w/in the muscle cell.
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21
Q

how do you prevent botulism

A

there is no vaccination therefore no prevention tactics

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22
Q

what is the agent that causes the plague

A

Yersinia pestis

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23
Q

what type of bacteria is the plague

A

gram - bacillus

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24
Q

What are the two types of the plague

A

the bubonic plague
the pneumonic plague

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25
Q

What causes the bubonic plague

A

results from a bite of a plague-infected rat flea

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26
Q

What are the signs and symptoms of the bubonic plague

A

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.

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27
Q

How is the pneumonic plague spread

A

through inhalation of the bacteria

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28
Q

what are the signs and symptoms of the pneumonic plague

A

fever, cough, hemoptysis and GI symptoms.
causes pneumonia = plueral effusion = lung consolidation = death.

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29
Q

what is the mortality rate of the pneumonic plague

A

84%

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30
Q

How do you diagnose the plague

A

blood cultures and/or cultures of buboes and/or sputum
Also looking for antibodies.

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31
Q

what is the treatment for the plague

A

gentamicin, streptomycin, doxycycline, chloramphenicol

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32
Q

what is the prophylaxis treatment for the plague

A

doxycycline, levofloxacin

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33
Q

what is the agent that causes smallpox

A

variola major virus

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34
Q

what is the mortality rate of smallpox

A

10-30% when infected

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35
Q

what type of microbe is smallpox

A

double-stranded DNA virus from pxviridae family

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36
Q

Describe the course of the illness of small pox

A

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.

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37
Q

when is someone with small pox no longer contagious

A

when all lesions have formed scabs

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38
Q

how do you diagnose smallpox

A

culture, PCR
antibodies

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39
Q

how do you treat small pox

A
  1. strict isolation
  2. supportive measures only (no antivirals available)
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40
Q

what bacteria causes tularemia

A

francisella tularensis

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41
Q

how is tularemia spread

A

insect bites or environment contamination - ticks and fleas bite a host and pass along to humans

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42
Q

what type of bacteria is tularemia

A

small, non-motile, gram - cocccobacillus

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43
Q

how would tularemia likely be spread if used as a bioterrorism weapon

A

aerosol

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44
Q

what are the signs and symptoms

A

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.

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45
Q

how do you diagnose tularemia

A

gram stain or cultrues of infected tissues or blood

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46
Q

how do you treat tularemia

A

streptomycin or doxycycline
also gentamicin, chloramphenical, cipro

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47
Q

what is the number 1 viral hemorrhagic fever that we care about

A

ebola

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48
Q

what is the mortality rate of ebola

A

40-90%

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49
Q

what types of microbes are viral hemorrhagic fevers

A

all are enveloped, single-stranded RNA viruses that require a host

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50
Q

how do you contract viral hemorrhagic fevers

A

by being in contact w/an infected host or direct contact w body fluids

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51
Q

what are the signs and symptoms of viral hamorrhagic fevers

A

fever, myalgia, prostration, DIC w/ thrombocytopenia and capillary hemorrhage.

52
Q

how do you diagnose a viral hemorrhagic fever

A

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

53
Q

what is the treatment for viral hemorrhagic fever?

A

no treatment, but current expirimentation such as antibody cocktails and ribavirin are being explored.

54
Q

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?

A

answer these later

55
Q

What is the basic idea of universal precautions and why were they introduced

A

Introduced to protect workers from HIV, HBV, and other human pathogens
Basically Treat all human body fluids as if they are infected

56
Q

what is the difference between universal precautions and standard precautions

A

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

57
Q

what are transmission based precautions

A

implements standard precautions with additional controls

58
Q

What are the three categories of transmission based precautions

A

contact precautions
droplet precautions
airborne infection isolation

59
Q

What are the contact added precautions

A

gown and gloves required for pt or environment contact
sometimes above needed to even enter patient toom

60
Q

what are the added droplet precautions

A

surgical mask required w/in 3 feet of patient

61
Q

what are the added airborne infection isolation precautions

A

Negative pressure isolation room
Respirator must be worn

62
Q

when do you use gloves?

A

When in contact w/ blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment

63
Q

when do you use gowns?

A

During procedures when contact of clothing, exposed skin w/ blood/body fluids, secretions, excretions, or body fluid is anticipated

64
Q

when do we use mask/goggles or face shields

A

Any activity which may result in splashes or sprays of blood, body fluids, secretions, or excretions

65
Q

what PPE for Irrigating an abscess?

A

Gloves, gown, goggles

66
Q

what PPE for drawing blood

A

Gloves

67
Q

What is the Most Effective, Least Invasive Method for Preventing the Spread of Disease?

A

WASHING YOUR HANDS

68
Q

what is immunoprophylaxis

A

“The prevention of disease by the production of active or passive immunity.”

69
Q

what is active immunity

A

induced by vaccines prepared from bacteria or their products

70
Q

what is passive immunity

A

administration of preformed antibodies in preparations called immunoglobulins

71
Q

what are the pros and cons of the inactivated - dead virus vaccinations

A

pros:
more stable
safest form

cons
weaker immune response
often requires multiple doses or boosters

72
Q

what are the pros and cons of live, attenuated viruses

A

pros:
provides greatest immunity

cons:
TYPICALLY does not cause active disease

73
Q

what are the pros and cons of subunit vaccinations

A

pros:
contain ONLY antigens therefore less risk of adverse reactions

cons:
very time-consuming to make

74
Q

describe toxoid vaccinations

A

used for bacterial infections that secrete toxoids
contain inactivated toxoids.

75
Q

describe conjugate vaccinations

A

works against bacteria w a cell wall
produce synthetic product containing cell wall similar to the bacteria

76
Q

what are examples of inactivated vaccines

A

seasonal flu
polio

77
Q

what are examples of live, attenuated vaccines

A

measles
mumps
varicella

78
Q

what are examples of subunit vaccines

A

hep B

79
Q

what are examples of toxoid vaccines

A

tetanus
diptheria
pertussis

80
Q

what are examples of conjugate vaccines

A

HIB type B
pneumococcal vaccine

81
Q

what are contraindications for vaccination

A

severe allergic reaction
pregnancy and immunosuppression vaccine = no LIVE vaccines including live attenuated.

82
Q

what are precautions for vaccinations

A

acute illness that is moderate to severe - with or without fever
delay and vaccinate after illness resolves

83
Q

what are the 4 variations of diptheria/tetanus/pertussis vaccine

A

DTaP
Tdap
Td
DT

84
Q

what is the DTaP

A

made of inactivated forms of toxins produced by diptheria/tetanus/pertussis as well as acellular antigens of pertussis

85
Q

what age group is DTaP used for

A

approved for ages 6 weeks to 7 years of age.

86
Q

what is the Tdap

A

lower dose of toxin components in diptheria/tetanus/pertussis. used for booster doses only

87
Q

what age groups is Tdap used for

A

7 ages and older

88
Q

what is Td

A

same as Tdap without the pertussis component

89
Q

what is the dosing route of DTaP

A

5 part series given at WCC
2 months
4 months
6 months
15 months
4 years

90
Q

what is the dosing route and schedule for Tdap

A

Booster at age 11 or 12 and every 10 years

91
Q

what is the dosing route and schedule for Td

A

Given for a dirty wound if it’s been > 5 years since last tetanus

92
Q

what are CI for diptheria/tetanus/pertussis vaccine

A

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

93
Q

what is the mechanism of action of the MMR vaccine

A

90% prevention of rubella after a single dose; 99% measles and 95% mumps prevention after a second dose

94
Q

what is the dose route and schedule of MMR vaccine

A

SQ given as a 2 part series
1 at 12 months
1 at 4 years typically combined with varicella vaccine.

95
Q

why do you not give the MMR and varicella combo vaccine under 23 months of age

A

it has a risk of febrile seizures.

96
Q

what is the protocol for MMR vaccination in a child that is leaving the country to travel to an endemic area.

A

can be given between 6-11 months of age BUT the second dose must be separated by 28 days.

97
Q

how should adults born before 1970 get the MMR vaccine

A

they should receive one dose.
if HCW should receive both doses.

98
Q

what is the prophylaxis protocol for MMR

A

vaccine can be administered within six days of exposure

99
Q

CI of MMR vaccination

A

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

100
Q

what is the MOA of hte polio vaccination

A

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

101
Q

what is the dosing schedule and route for polio vaccination

A

given IM or SQ
4 series given at WCC
2 months
4 months
6 months
4 years

102
Q

what is the protocol for the polio vaccine in a child leaving country to travel to an endemic area

A

first dose can be given between 6-11 months of age, followed by 3 more doses.

103
Q

what are the CI for Polio vaccinations

A

previous reaction to IPV
allergy or sensitivities to streptomycin, polymyxin B, and neomycin

104
Q

what is the mechanism of action in the Hep A vaccine

A

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

105
Q

what is the dosing route and schedule of the Hep A vaccine

A

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

106
Q

what are the CI for Hep A

A

there are none
dun dun dunnnnnn

107
Q

What is the MOA of the Hep B vaccine

A

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

108
Q

what is the dosing route and schedule of the Hep B vaccine

A

given IM
4-dose vaccine given at WCC
Birth - 1 month
2 months
4 months
6 months

109
Q

what are the CI in the Hep B vaccination

A

hypersensitivity to yeast
severe allergic reaction to latex

110
Q

what is the MOA of the rotavirus vaccine

A

live-attenuated vaccine that is either G1P human RV (Rotarix) or live pentavalent bovine-reassortant containing G1, 2, 3, 4, and P1 (RotaTeq)

111
Q

what is the dosing route and schedule for the Rotavirus vaccine

A

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

112
Q

what are the CI for the Rotavirus vaccination

A

severe immunodeficiency
previous h/o intussesception
severe illness - wait until recovery to give vaccine

113
Q

What is the MOA of the HIB vaccine

A

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

114
Q

what is the dosing route and schedule of the HIB vaccine

A

given IM at WCC
2 months
4 months
6 months
12-15 month - booster

115
Q

what are the CI of the HIB vaccine

A

same as other vaccines
do nott give to infants < 6 weeks of age

116
Q

what is the MOA of hte pneumococcal vaccination

A

active against strep pneumo
immunity in 2-3 weeks after vaccine, lasting about 5 years

117
Q

what are the 4 types of pneumococcal vaccines. what type of vaccines are these?

A

PCV13
PPSV23
PCV15
PCV20
these are all conjugate polysaccharide vaccines

118
Q

PCV13 vaccination

A

pneumococcal vaccine subtype that produces better immunity in children
also stimulates mucosal immunity, decreasing colonization and provides some herd immunity

119
Q

PPSV23 vaccination

A

pneumococcal vaccine subtype that is indicated mainly in the adult population

120
Q

PCV 15 vaccination

A

pneumococcal vaccine subtype that includes serotype from PCV13 and some from PCV 23

121
Q

PCV 20 vaccination

A

includes serotype from PCV 13 and additional from PCV 23

very similar to PCV 15 but with more serotype from PCV 23

122
Q

dosing route and schedule for PCV 13

A

IM route with a 4 dose series given at WCC
2 months
4 months
6 months
12 - 15 months
>6 y/o - single dose

123
Q

dosing route and schedule for PPSV23

A

IM or SQ single dose
Indicated in adult population of those >65 y/o who have already received Prevnar 13

124
Q

Dosing route and schedule for PCV 15 and PCV 20

A

1-dose
Indicated in adult population of those who >65 who have not received either PCV 13 or PPSV23

125
Q

what are the contraindications for the pneumococcal vaccines

A

there are none
gotchaaa

Clinical Med B (22 decks)

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