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CM 1B: ID/EENT > Lecture 11: Infectious Disease Prevention & Immunoprophylaxis > Flashcards

Lecture 11: Infectious Disease Prevention & Immunoprophylaxis Flashcards

1
Q

What makes an infection a CDC bioterrorism category A?

A

Requires special action for public health preparedness.

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2
Q

What falls under category A for bioterrorism?

A
  • Anthrax
  • Botulism
  • Plague
  • Smallpox
  • Tularemia
  • Viral hemorrhagic fevers (lassa, new world, ebola, etc)

PAST BH

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3
Q

What category of bioterrorism is coronavirus?

A

Category C

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4
Q

What is the causative organism of anthrax and what kind of bacteria is it?

A

Bacillus Anthracis
G+ rod that forms spores
Soil

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5
Q

How does anthrax present on skin?

A

Necrotic eschar (BLACK AND PAINLESS)

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6
Q

What kind of systemic S/S does anthrax show?

A
  • Fever
  • Fatigue
  • Malaise
  • N/V
  • Cough
  • SOB => pneumonia => pleural effusions => death
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7
Q

How is anthrax diagnosed?

A
  • Blood cultures
  • Skin lesions
  • Resp secretions
  • Ig checks
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8
Q

How is anthrax treated?

A

Antitoxin + Cipro or clinda

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9
Q

How is anthrax treated post exposure/prophylatically?

A

Vaccination
Cipro
Doxy
Amox

60 days regimen

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10
Q

How can botulism specifically not be transmitted?

A

Person to person

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11
Q

What is unique about the microbiology of botulism?

A

Non-living. It is the toxin itself.

Toxin made by clostridium botulinum

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12
Q

What is unique about the antitoxin for botulism?

A

Although there are 7 subtypes (A-G) of toxins, one antitoxin DOES work on the others.

Did not work on others previously.

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13
Q

Release of what NT is the cause for flaccid paralysis in botulism?

A

Acetylcholine

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14
Q

How does botulism present?

A
  • Multiple cranial nerve palsies with descending paralysis
  • Diplopia, dysphagia, dysarthria, dry mouth, ptosis, dilated pupils, etc.
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15
Q

How is botulism diagnosed?

A

Toxin immunoassay

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16
Q

How is botulism treated?

A

Equine antitoxin if early.

Otherwise…
* Intubation, mechanical ventilation, and parenteral nutriton.
* Regeneration of motor neuron synapses (SLOW)

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17
Q

How is botulism prevented?

A

Cannot.

Vaccine was taken off market.

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18
Q

What is the causative organism in plague?

A

Yersinia pestis

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19
Q

What are the two main types of plague?

A

Bubonic
Pneumonic

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20
Q

How does bubonic plague present? How do you get it?

A

Bite of plague-infected rat flea

  • PAINFUL LAN w/ necrosis, fever, bacteremia
  • Bubos
  • Extensive ecchymosis and necrosis of digits/nose

Ecchymosis resembles frostbite.

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21
Q

How does pneumonic plague present? How is it transmitted?

A

Inhalation of the bacteria.

  • Fever, cough, hemoptysis, and GI Sx
  • Pneumonia => pleurals => consolidation => death
  • 84% Mortality
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22
Q

How is plague diagnosed?

A

Blood/bubo/sputum cultures
Antibodies

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23
Q

How is plague treated?

A
  • Gentamicin
  • Streptomycin
  • doxy
  • chloramphenicol
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24
Q

How do you prophylaxis against plague?

A
  • Doxy
  • Levofloxacin
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25
Q

What is the causative organism for smallpox?

A

Variola major virus

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26
Q

What is the pathophysiology of smallpox?

A

Virus => lymphoid tissue => skin => S/S => face => trunk => vesicles, pustules, scabs, then ulcers.

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27
Q

When is smallpox no longer contagious?

A

Once all lesions form scabs, similar to chickenpox.

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28
Q

How is smallpox diagnosed?

A

Culture
PCR
Antibodies

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29
Q

How is smallpox treated?

A

Isolation.
Supportive.

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30
Q

What is the causative organism of tularemia?

A

Francisella tularensis

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31
Q

How infectious is tularemia?

A

Very.
Infected someone examining it in a petri dish.

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32
Q

What is tularemia more commonly known as?

A

Rabbit fever
Deer fly fever

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33
Q

How does tularemia present?

A
  • Airway inflammation
  • Fever, HA, chills, fatigue, malaise
  • Conjuctivitis and exanthems possible
  • 50% have infiltrates or hilar adenopathy w/o infiltrate
  • Visible lymph nodes on upper bronchi
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34
Q

How is tularemia diagnosed?

A

Gram stain or cultures of infected tissue/blood.

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35
Q

How is tularemia treated?

A
  • Strepto
  • Genta
  • Doxy
  • Cipro
  • Chloramphenicol
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36
Q

What is the most widely known viral hemorrhagic fever?

A

Ebola

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37
Q

What is the structure of the viruses that cause viral hemorrhagic fevers?

A

Enveloped, single-stranded RNA virus that requires a host.

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38
Q

What are the S/S of a viral hemorrhagic fever?

A
  • Fever
  • Malaise
  • Prostration
  • DIC w/ thrombocytopenia and capillary hemorrhage
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39
Q

What is the suspicion criteria for a viral hemorrhagic fever?

A

Fever > 38.3C for < 3weeks with 2+ following
* Hemorrhagic or pruritic rash
* Epistaxis
* Hematemesis
* Hemoptysis
* Hematochezia

Serologic testing for antigen and antibody with PCR sent to the CDC.

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40
Q

How is a viral hemorrhagic fever treated?

A

No approved treatment or vaccine.

Experimental: antibody cocktails and ribavirin

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41
Q

What are universal precautions?

A

Treat all human body fluid as infected.

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42
Q

What are standard precautions?

A

Hand hygiene
PPE

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43
Q

What are the main 3 transmission-based precautions we can take?

A

Contact (gown and gloves)
Droplet (surgical mask w/in 3 ft)
Airborne infection isolation (N95 + negative pressure room)

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44
Q

What are the two types of immunity a vaccine can offer?

A

Active
Passive

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45
Q

What is active immunity? What gives it?

A

Induced by vaccines made from bacteria or their products.

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46
Q

What is passive immunity? What gives it?

A

Administration of preformed antibodies in preparations called immunoglobulins.

Includes antitoxins.

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47
Q

What vaccinations are inactivated? What is the benefit?

A

Polio & seasonal influenza.

Safe, stable, but weaker immune response.

48
Q

What vaccinations are live & attenuated? What are the benefits?

A

MMR, varicella

Greatest immunity, usually does not cause disease.

49
Q

In what situations can a live vaccine potentially cause disease?

A

Pregnancy
Immunocompromised (AIDS)
Immunodeficient
Long-term steroid use

50
Q

What vaccinations are subunit? What are the benefits?

A

Hep B

Low risk of adverse reactions.

Very time-consuming to make.

51
Q

What vaccinations are toxoids?

A

Tetanus, Diphtheria, pertussis

Inactivated toxoids

52
Q

What vaccinations are conjugate? What are the benefits?

A

HIB type B, Pneumococcal (prevnar)

Works vs bacterial cell wall camoflauge

53
Q

What vaccinations are DNA/RNA?

54
Q

What condition should make you wary about giving a vaccine?

A

Moderate-severe illness.

55
Q

What are the 4 variations of the diphtheria, pertussis, tetanus vaccine?

A

DTaP: ages 6wk - 7y
Tdap: booster 7+
Td:
DT

D is only capitalized if it is first.
Tetanus is always capitalized
More upper case letters in DTaP = higher initial dose

56
Q

What is the dosing schedule of TDaP?

A

DTaP is a 5 part series
* 2mo
* 4mo
* 6mo
* 15mo
* 4y

IM injection

57
Q

What is the dosing schedule for Tdap and Td?

A

Tdap is a booster at 11-12 and every 10 years.
Td is for dirty wounds if last tetanus was >5y

58
Q

What is TDaP commonly given with?

A

Pediarix: DTaP, Hep B, IPV
or
Pentacel: DTaP, HIB, IPV

IPV is inactivated polio vaccine

59
Q

What are the two CIs for the DTaP vaccines?

A

Hx of encephalopathy
Progressive, unstable neurological d/o, uncontrolled seizures

60
Q

What is the dosing schedule for MMR?

A

12 months
4 years (given w/ varicella as proQuad)

ProQuad not given <2 years due to febrile seizure risk.

SQ injection

61
Q

What is the modified dosing schedule for MMR?

A

6-11mo
2nd dose > 28 days apart

Adults born before 1970 should get 1 dose.
HCW should get 2 doses.

62
Q

If someone gets exposed to one of the MMR diseases, should they still get the vaccine?

A

Yes, if within 6 days of exposure.

63
Q

What are the CIs of MMR administration?

A
  • Pregnancy
  • Severe immunodef
  • Postpone for 1 month is on steroids > 2 weeks.
  • Allergy to gelatin or neomycin

Good Night MR

64
Q

What is the dosing schedule of IPV?

A
  • 2 month
  • 4 month
  • 6 month
  • 4 years

Usually given as pentacel/pediarix/kinrix

IM or SQ

65
Q

What is the modified dosing schedule for IPV?

A

6-11 months
3 doses

Only if child going to endemic area.

66
Q

What are the CIs to IPV?

A

Previous reaction
Allergy to streptomycin, polymyxin B, or neomycin

SPIN

67
Q

What is the dosing schedule for Hep A?

A
  • 12 months
  • 2 years or 18 months

Doses just need to be 6 months apart

IM injection

68
Q

What are the CIs to the Hep A vaccine?

A

No real ones.

69
Q

What is the Hep B vaccine produced in?

A

Yeast or mammalian cells (chinese hamster ovaries)

70
Q

What is the dosing schedule for the Hep B vaccine?

A
  • Birth 1 month
  • 2 month
  • 4 month
  • 6 month

Can be given in pediarix

IM injection

71
Q

What are the CIs to the Hep B Vaccine?

A

Allergy to yeast or latex

72
Q

What kind of vaccine is the rotavirus vaccine? What are the two commercially available?

A

Live-attenuated.

Rotarix: G1P human RV vaccine
RotaTeq: pentavalent bovine-reassortment with G1,2,3,,4 and P1.

73
Q

What is the dosing schedule for the rotavirus vaccine?

A

Rotarix: 2 doses
* 2 months
* 4 months

RotaTeq: 3 doses
* 2 months
* 4 months
* 6 months

If you don’t get it before 15m, no need to get it.
T for triple doses.

PO

74
Q

What are the CIs for the rotavirus vaccines?

A
  • Severe immunodeficiency
  • Previous h/o intussusception
  • Severe illness
75
Q

What kind of vaccine is the HIB?

A

Polysaccharide conjugate vaccine

76
Q

What else did HIB vaccination reduce?

A

Epiglottitis cases

77
Q

What is the dosing schedule for the HIB vaccine?

A
  • 2 months
  • 4 months
  • 6 months
  • 12-15 months booster

Sometimes given as pentacel.

IM

78
Q

What are the CIs of the HIB vaccine?

A
  • Same as every other vaccine
  • Cannot give to infants < 6 weeks
79
Q

When do you actually get immunity from prevnar?

A

2-3 weeks post vaccine for 5 years.

80
Q

Which pneumococcal vaccine is mainly for children? Adults?

A

Children: PCV/Prevnar 13

Adults: PPSV23: pneumovax 23

81
Q

What serotypes do PCV15 and PCV20 contain?

A

Both also contain PCV13 and PCV23.

82
Q

What is the dosing schedule for PCV13?

A
  • 2 months
  • 4 months
  • 6 months
  • 12-15 months.

If > 6y, 1 dose only.

IM

83
Q

What is the dosing schedule for PPSV23?

A

1 dose.
Only for adults >= 65 with PCV13.

IM or SQ

84
Q

What are the dosing schedules for PCV15 and PCV20?

A

1 dose.
Only for adults >= 65 who have NOT gotten PSV13 or PPSV23.

IM or SQ?

85
Q

Which flu vaccine is live, attenuated?

A

Flumist, the nasal version.

86
Q

What are the 3 quadrivalent IIVs?

A

Fluzone (egg-based, MC, 6+ months)
Flucelvax (cell-culture based, egg-free, 4+ years)
Flublok (recombinant, 18y+, egg-free)

IM

87
Q

What are the 2 trivalent IIVs?

A

Fluzone high dose (4x antigen)
FLUAD (standard, adjuvant)

All egg-free and for 65+

88
Q

What age can you get flumist?

A

2-49

Many CIs!

89
Q

When do you need 2 doses of IIV in a year?

A

Children 6 months to 8 years old if they never got 2 in one season previously.

90
Q

What are the CIs of IIV?

A

Severe latex allergy
GBS infection w/in 6 wks of previous IIV.

Gullain-Barre Syndrome

91
Q

What is the dosing schedule for varicella?

A
  • 12 month
  • 4 year, usually with MMR

SQ

92
Q

What are the CIs to varicella vaccination?

A
  • Allergy to neomycin
  • Blood dyscrasias
  • Moderate to severe illness
  • Blood products in past 3-11 months
  • Immunocompromised or pregnant
93
Q

What strains does the conjugated meningococcal vaccine protect vs? Recombinant?

A

Neisseria meningitidis
Conjugated: ACWY
Recombinant: B

B for recombinant

94
Q

What serotype of N. meningitiditis is not covered by the vaccines?

95
Q

What is the dosing schedule for Men ACWY and Men B?

A

Men ACWY:
* 11 years
* 16 years

Men B:
* 16 years
* 6 months past 1st dose.

IM, men B is optional sometimes.

96
Q

What is the CI to Men vaccination?

A

Latex allergy

97
Q

What kind of vaccine is gardasil 9? What strains does it cover?

A

Subunit

6, 11 (genital warts)
16, 18 (cervical cancer)
31, 33, 45, 52, 58

98
Q

What is the dosing schedule for HPV?

A

Prior to age 15:
* 11 years old
* 6-12 months after

Post age 15: 3 doses

IM, no benefit given past 26.

99
Q

What are the CIs to gardasil 9?

A
  • Allergy to yeast
  • Allergy to latex
  • Careful in pregnancy
100
Q

What vaccine protects vs yellow fever? How?

A

17D live attenuated vaccine.

Induces low-level viremia.

No blood donating for 2 weeks.

101
Q

When is 17D vaccination indicated? Schedule?

A

Travel to africa/south america or lab worker.

  • 1 dose
  • given again in 10 years if needed

9 months - 59 years

SQ/IM

102
Q

What are the CIs for 17D vaccination?

A

6 months or younger
Immunocompromised

103
Q

What are the two typhoid vaccines? What do they protect against specifically?

A

Oral, live attenuated.
Injectable inactive.

Protects against salmonella enterica (serotype typhi)

104
Q

How is the oral typhoid vaccine dosed?

A

1 capsule every other day for 8 days. (4 doses)
Can travel 1 week after last dose.
6 years of age minimum, booster every 5.

105
Q

How is the IM typhoid vaccine scheduled?

A

one dose
2 weeks post vaccination
2 years+
booster every 2 years

106
Q

Which typhoid vaccine offers longer immunity?

A

Oral, live attenuated.

107
Q

What are the CIs of the typhoid vaccines?

A

Oral: same as any live

IM: wait until 2nd trimester usually.

108
Q

How is rabies immunized against?

A

Rabies immunoglobulin: passive immunity
+
Inactivated Rabies vaccine: active immunity

Ig binds to the virus
Vaccine fights the virus

109
Q

What is the dosing schedule for rabies?

A

HRIG 7 days after first vaccine dose. Injected around wound site. Only for no previous vaccination history.

Vaccine:
* Day 0 or 1
* Day 3
* Day 7
* Day 14

Previous rabies vaccination only requires days 0 and 3.
Immunocompromised need additional vaccine on day 28.
OK at 2mo+

110
Q

How is botulism vaccinated against?

A

No vaccine.

CDC equine antitoxin can neutralize all 7 botulism serotypes for ages 12mo+

111
Q

How is RSV vaccinated against?

A

Ig only.
Humanized monoclonal anti-RSV antibody.

112
Q

What is the mechanism of the RSV MAB?

A

Inhibit viral transcription only.

Does not reduce symptoms. Only stops it from getting worse.

113
Q

How is the RSV MAB given?

A

Monthly to high-risk individuals during sept-may

Costs $1100 per dose.

114
Q

How soon should we give an antivenom ideally?

A

Within 4 hours of bite

115
Q

What is considered getting envenomation under control?

A
  • Systemic symptoms resolving
  • Hematologic abnormalities improving
  • Local effects improving
116
Q

How do we test if someone is allergic to antivenom?

A

Give them 0.1mL SQ first to see their reaction.

117
Q

What should we be prepared for when giving antivenom?

A

Anaphylaxis: keep epi and NE bedside.

Serum sickness: during or way after.
Will cause delayed anaphylactic and pyrogenic reactions.

CM 1B: ID/EENT (27 decks)

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