Infectious diseases - Vaccination, influenza, TB, Zica and COVID Flashcards by Anna Hay

What are the 4 main types of vaccine?

Killed organisms
Live-attanuated - replicate of host
Sub-unit vaccines - use antigen subunit
Toxoid - bacterial exotoxin

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Which vaccines are live attenuated

Bacterial
- BCG, tuberculous

Viral
- MMR
- Polio
- Varicella zoster
- Adenovirus
- Yellow fever

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What 2 vaccines are offered in pregnancy?

Whooping cough, offered between 16-32 weeks.
Most deaths occur in children before they can be vaccinated, vaccinating the mother protects the baby

Influenza
- Risk higher in pregnancy, also risk to baby, offered Sep-Feb

Rubella offered pre-pregnancy if not already vaccinated.

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What antivirals can be give in the treatment of influenza? When should they be commenced?

Oseltamivir (tamiflu) 75mg OD- 48hrs
Zanamivir (relenza) 10mg inhaled OD - 36hr

Can still be given with 7 days

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Which antiviral for influenza is preferred in pregnancy +/- breastfeeding.

Pregnancy - Zanamivir, oseltamivir if severe/zanamivir not available

Oseltamivir if breastfeeding

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If pregnant women are in close contacting with H1N1 influenza, what should occur?

1) Zanamivir (10 mg inhaled daily) or oseltamivir (75 mg daily by mouth) for 10 days after exposure

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When are people infectious with influenza?

1 day before symptoms up tp 5-7 days after becoming sick.

Children and people with weakened immune system may be unwell for longer than 7 days.

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How long is protection conferred after influenza vaccine?

2 weeks

Note H1N1 vaccine is different - Pandemrix

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What type of pathogen is malaria

Protozoa called plasmodium. There are 4 types that effect humans - P. falciparum, viva, oval and malariae

Primary host - female anopheles mosquito

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Which parasite causes the most severe infection?

P falciparum (cerebral complications)

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What % of malaria infection in UK are due to P.falciparum?

80%

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Which trimester is highest risk of severe infection with malaria?

2nd

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What are the maternal complications of malaria in pregnancy?

Anaemia

Severe cerebral malaria

Acute pulmonary oedema / ARDS

Hypoglycaemia – commoner in pregnancy and may be worsened by treatment with iv quinine

Renal failure with haemoglobinuria

DIC

Maternal mortality

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What are the fetal complications of malaria in pregnancy?

Miscarriage

Pre-term delivery

Stillbirth

Low birth weight

Fetal anaemia

Neonatal death

Neonatal anaemia

Congenital malaria - evidence of placental infection at delivery in up to 25% of cases. P falciparum infection in pregnancy is typically has parasites sequestered in the placenta

Increased susceptibility to other infections

Failure to thrive

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Prevention of malaria using ABCD Mnemonic?

Awareness - avoid endemic area, avoidance strategies, can sitill present within 1 year of visit

Bite prevention - Dusk til dawn, 50% DEET, bed nets, clothing

Chemoprophyalxsis - Take until 7 days after leaving area, should not become pregnancy during this time and need to await the clearance time of those drugs.

Diagnose & treat

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Drug excretion time of
- Mefloquine

3 months

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Drug excretion time of
- Atovaquone and proguanil (Malarone®)

2 weeks

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Drug excretion time of
- Doxycycline and proguanil

1 week

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Which is the prophylaxis of choice if 2nd/3rd trimester or breastfeeding?

When is it contraindicated?

Mefloquine

CI Hx depression, Neuro-psychiatric disorder, epilepsy, hypersentivity to mefloquine/quinine

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What investigation should be performed to Ix malaria.

Thick and thin blood films - need 3 negative films 12-24hrs apart to exclude malaria.

FBC, glucose, ABD, U+E, LFT, CRP, urine, CXR, stool culture, blood culture. Consider LP
Obs USS

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Where should pregnancy women with malaria be treated?

Uncomplicated - admit to hospital
Complicated - ITU

What is the treatment of choice for severe falciparum malaria?

IV artesunate

or
IV quinine + clindamycin

What is the treatment of choice for uncomplicated falciparum malaria?

Qunine and clindamycin

What is the treatment of choice for P. vivax, P. ovale or P. malariae.

Chloroquine

What signs are of severe falciparum infection?

- Impaired GCS - Hypoglyceamia - Pulmonary oedema or ARDS - Hyperparasitaemia >2% parasite RBC - Severe anaemia <80 - Abnormal bleeding/DIC - Haemglobinuira - Renal impairment/electrolyte, acidosis <7.3 Hyperlactaemia Shick

Placental parasitaemia is asssocaitewd with congenital malaria and increased mortality. how should this be tested for?

Cord blood film + weekly blood films from neonate for 28 days Send placenta to histology

Incidence of TB in pregnancy women?

4.2/100 000

Risk factors of TB

Close contact with infectious cases Travel to or receiving visitors from places where TB is endemic Living in ethnic minority communities originating from places where TB is endemic Immune compromise – HIV positive, the very young / elderly Chronic poor health and mal-nutrition, drug abuse or alcoholism Living in over-crowded housing conditions

How to IX TB

Microbiology of sputum, CSF - acid-fast bacilli Mantous test - not effect by pregnancy, but +ve if previous BCG Bloods/CXR +/- MRI

Treatment of TB

Isoniazid, rifampicin and ethambutol for 6 months.

What is a common side effect of isoniazid? How is it prevented?

Isoniazide-induced neuropathy - pyridoxine 10mg OD Monthly LFT

Side effect of ethambutol?

Retrobulbar neuritis - blurred vision and mental scotomata

Can you breastfeed with TB?

Anti-TB drugs cross into breastmilk but not contraindicated

What contact tracing should occur with TB

All close contacts based on history, examination, tuberculin testing and chest X-ray. TB is a notifiable disease

Can the BCG vaccine be given in pregnancy?

No, live vaccine so contraindicated Should be offered to neonates & infants in areas where annual TB incidence > 40 per 100,000/ Fax TB in last 5 years, parent/grandparternt from country with high incidence Do not give to babies who mothers are HIV +ve until shown to be HIV -ve

How is Zica virus transmitted?

Infected Aedes species of mosquito (same as dengue, yellow fever)

Can maternal - fetal transmission of zica occur?

Yes via placental barrier Not though breastmilk

When to screen for Zica infection in pregnancy

At booking ask re travel history - If area with active zica, present with zica symptoms or symptoms within 2 weeks of travel should be tested

If woman test +ve for Zica virus infection, What should be done?

Redere to FMU for 4 weekly USS and consider MRI If +ve travel Hx offer baseline fetal USS

If travelled to Zica area but does not have symptoms of the infections

Offer baseline USS then 4 weekly USS

How long should conception be avoided if travelled to Zica country?

3 months if both travelled or male partner travelled 2 month if female travelled From date left area or sexual contact with a potential infectious partner If women develops symptoms compatible with Zica should avoid pregnancy for 2 month

At what gestation can a Dx of microcephalic be given?

Until 28 weeks but not possible to given definitive Dx at all. Consider amniocentesis for zica virus if microcephaly

If person has zica virus, when can they try to concieve/donate gametes/fertility treatment?

6 months

When can a sperm donor donate sperm after visiting a zica country?

Asymptomatic sperm donors should be deferred for six months after return unless the semen tests negative for Zika virus by NAT

Which covid variant is associated with the most severe disease?

Delta varient

Effects of COVID 19 on foetus?

Double risk of stillbirth ?Increased SGA - no congenital abnormality, vertical transmission is rare

Can breastfeeding or pregnant women receive the covid 19 vaccine?

Yes both can, do not need to stop breast-feeding.

If a patient has COVID 19 and is on aspirin?

Should be discontinued, duration of infection as may increase risk of thrombocytopenia and bleeding

What treatments can be given for COVID 19 following MDT discussion?

Steroids - PO preg 40mg PD or IV hydrocortisone 80mg BD for 10 days or until discharge Tocilizumab if evidence of systemic infection CRP >75

According to UKOSS, what % of hospitalised women required ITU care?

5% Maternal mortality of hospitalised pregnancy women 2.4/100 000