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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
What is the causative organism for smallpox?
Variola major virus
26
What is the pathophysiology of smallpox?
Virus => lymphoid tissue => skin => S/S => face => trunk => vesicles, pustules, scabs, then ulcers.
27
When is smallpox no longer contagious?
Once all lesions form scabs, similar to chickenpox.
28
How is smallpox diagnosed?
Culture PCR Antibodies
29
How is smallpox treated?
Isolation. Supportive.
30
What is the causative organism of tularemia?
Francisella tularensis
31
How infectious is tularemia?
Very. Infected someone examining it in a petri dish.
32
What is tularemia more commonly known as?
Rabbit fever Deer fly fever
33
How does tularemia present?
* 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
34
How is tularemia diagnosed?
Gram stain or cultures of infected tissue/blood.
35
How is tularemia treated?
* Strepto * Genta * Doxy * Cipro * Chloramphenicol
36
What is the most widely known viral hemorrhagic fever?
Ebola
37
What is the structure of the viruses that cause viral hemorrhagic fevers?
Enveloped, single-stranded RNA virus that requires a host.
38
What are the S/S of a viral hemorrhagic fever?
* Fever * Malaise * Prostration * DIC w/ thrombocytopenia and capillary hemorrhage
39
What is the suspicion criteria for a viral hemorrhagic fever?
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.
40
How is a viral hemorrhagic fever treated?
No approved treatment or vaccine. Experimental: antibody cocktails and ribavirin
41
What are universal precautions?
Treat all human body fluid as infected.
42
What are standard precautions?
Hand hygiene PPE
43
What are the main 3 transmission-based precautions we can take?
Contact (gown and gloves) Droplet (surgical mask w/in 3 ft) Airborne infection isolation (N95 + negative pressure room)
44
What are the two types of immunity a vaccine can offer?
Active Passive
45
What is active immunity? What gives it?
Induced by vaccines made from bacteria or their products.
46
What is passive immunity? What gives it?
Administration of preformed antibodies in preparations called immunoglobulins. Includes antitoxins.
47
What vaccinations are inactivated? What is the benefit?
Polio & seasonal influenza. Safe, stable, but weaker immune response.
48
What vaccinations are live & attenuated? What are the benefits?
MMR, varicella Greatest immunity, usually does not cause disease.
49
In what situations can a live vaccine potentially cause disease?
Pregnancy Immunocompromised (AIDS) Immunodeficient Long-term steroid use
50
What vaccinations are subunit? What are the benefits?
Hep B Low risk of adverse reactions. Very time-consuming to make.
51
What vaccinations are toxoids?
Tetanus, Diphtheria, pertussis Inactivated toxoids
52
What vaccinations are conjugate? What are the benefits?
HIB type B, Pneumococcal (prevnar) Works vs bacterial cell wall camoflauge
53
What vaccinations are DNA/RNA?
Covid-19
54
What condition should make you wary about giving a vaccine?
Moderate-severe illness.
55
What are the 4 variations of the diphtheria, pertussis, tetanus vaccine?
DTaP: ages 6wk - 7y Tdap: booster 7+ Td: DT ## Footnote D is only capitalized if it is first. Tetanus is always capitalized More upper case letters in DTaP = higher initial dose
56
What is the dosing schedule of TDaP?
DTaP is a 5 part series * 2mo * 4mo * 6mo * 15mo * 4y ## Footnote IM injection
57
What is the dosing schedule for Tdap and Td?
Tdap is a booster at 11-12 and every 10 years. Td is for dirty wounds if last tetanus was >5y
58
What is TDaP commonly given with?
Pediarix: DTaP, Hep B, IPV or Pentacel: DTaP, HIB, IPV ## Footnote IPV is inactivated polio vaccine
59
What are the two CIs for the DTaP vaccines?
Hx of encephalopathy Progressive, unstable neurological d/o, uncontrolled seizures
60
What is the dosing schedule for MMR?
12 months 4 years (given w/ varicella as proQuad) | ProQuad not given <2 years due to febrile seizure risk. ## Footnote SQ injection
61
What is the modified dosing schedule for MMR?
6-11mo 2nd dose > 28 days apart Adults born before 1970 should get 1 dose. HCW should get 2 doses.
62
If someone gets exposed to one of the MMR diseases, should they still get the vaccine?
Yes, if within 6 days of exposure.
63
What are the CIs of MMR administration?
* Pregnancy * Severe immunodef * Postpone for 1 month is on steroids > 2 weeks. * Allergy to gelatin or neomycin Good Night MR
64
What is the dosing schedule of IPV?
* 2 month * 4 month * 6 month * 4 years Usually given as pentacel/pediarix/kinrix ## Footnote IM or SQ
65
What is the modified dosing schedule for IPV?
6-11 months 3 doses ## Footnote Only if child going to endemic area.
66
What are the CIs to IPV?
Previous reaction Allergy to streptomycin, polymyxin B, or neomycin SPIN
67
What is the dosing schedule for Hep A?
* 12 months * 2 years or 18 months | Doses just need to be 6 months apart ## Footnote IM injection
68
What are the CIs to the Hep A vaccine?
No real ones.
69
What is the Hep B vaccine produced in?
Yeast or mammalian cells (chinese hamster ovaries)
70
What is the dosing schedule for the Hep B vaccine?
* Birth 1 month * 2 month * 4 month * 6 month Can be given in pediarix ## Footnote IM injection
71
What are the CIs to the Hep B Vaccine?
Allergy to yeast or latex
72
What kind of vaccine is the rotavirus vaccine? What are the two commercially available?
Live-attenuated. Rotarix: G1P human RV vaccine RotaTeq: pentavalent bovine-reassortment with G1,2,3,,4 and P1.
73
What is the dosing schedule for the rotavirus vaccine?
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. ## Footnote PO
74
What are the CIs for the rotavirus vaccines?
* Severe immunodeficiency * Previous h/o intussusception * Severe illness
75
What kind of vaccine is the HIB?
Polysaccharide conjugate vaccine
76
What else did HIB vaccination reduce?
Epiglottitis cases
77
What is the dosing schedule for the HIB vaccine?
* 2 months * 4 months * 6 months * 12-15 months booster Sometimes given as pentacel. ## Footnote IM
78
What are the CIs of the HIB vaccine?
* Same as every other vaccine * Cannot give to infants < 6 weeks
79
When do you actually get immunity from prevnar?
2-3 weeks post vaccine for 5 years.
80
Which pneumococcal vaccine is mainly for children? Adults?
Children: PCV/Prevnar 13 Adults: PPSV23: pneumovax 23
81
What serotypes do PCV15 and PCV20 contain?
Both also contain PCV13 and PCV23.
82
What is the dosing schedule for PCV13?
* 2 months * 4 months * 6 months * 12-15 months. If > 6y, 1 dose only. ## Footnote IM
83
What is the dosing schedule for PPSV23?
1 dose. Only for adults >= 65 with PCV13. ## Footnote IM or SQ
84
What are the dosing schedules for PCV15 and PCV20?
1 dose. Only for adults >= 65 who have NOT gotten PSV13 or PPSV23. ## Footnote IM or SQ?
85
Which flu vaccine is live, attenuated?
Flumist, the nasal version.
86
What are the 3 quadrivalent IIVs?
Fluzone (egg-based, MC, 6+ months) Flucelvax (cell-culture based, egg-free, 4+ years) Flublok (recombinant, 18y+, egg-free) ## Footnote IM
87
What are the 2 trivalent IIVs?
Fluzone high dose (4x antigen) FLUAD (standard, adjuvant) ## Footnote All egg-free and for 65+
88
What age can you get flumist?
2-49 Many CIs!
89
When do you need 2 doses of IIV in a year?
Children 6 months to 8 years old if they never got 2 in one season previously.
90
What are the CIs of IIV?
Severe latex allergy GBS infection w/in 6 wks of previous IIV. ## Footnote Gullain-Barre Syndrome
91
What is the dosing schedule for varicella?
* 12 month * 4 year, usually with MMR ## Footnote SQ
92
What are the CIs to varicella vaccination?
* Allergy to neomycin * Blood dyscrasias * Moderate to severe illness * Blood products in past 3-11 months * Immunocompromised or pregnant
93
What strains does the conjugated meningococcal vaccine protect vs? Recombinant?
Neisseria meningitidis Conjugated: ACWY Recombinant: B ## Footnote B for recombinant
94
What serotype of N. meningitiditis is not covered by the vaccines?
X
95
What is the dosing schedule for Men ACWY and Men B?
Men ACWY: * 11 years * 16 years Men B: * 16 years * 6 months past 1st dose. ## Footnote IM, men B is optional sometimes.
96
What is the CI to Men vaccination?
Latex allergy
97
What kind of vaccine is gardasil 9? What strains does it cover?
Subunit 6, 11 (genital warts) 16, 18 (cervical cancer) 31, 33, 45, 52, 58
98
What is the dosing schedule for HPV?
Prior to age 15: * 11 years old * 6-12 months after Post age 15: 3 doses ## Footnote IM, no benefit given past 26.
99
What are the CIs to gardasil 9?
* Allergy to yeast * Allergy to latex * Careful in pregnancy
100
What vaccine protects vs yellow fever? How?
17D live attenuated vaccine. Induces low-level viremia. ## Footnote No blood donating for 2 weeks.
101
When is 17D vaccination indicated? Schedule?
Travel to africa/south america or lab worker. * 1 dose * given again in 10 years if needed | 9 months - 59 years ## Footnote SQ/IM
102
What are the CIs for 17D vaccination?
6 months or younger Immunocompromised
103
What are the two typhoid vaccines? What do they protect against specifically?
Oral, live attenuated. Injectable inactive. Protects against salmonella enterica (serotype typhi)
104
How is the oral typhoid vaccine dosed?
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
How is the IM typhoid vaccine scheduled?
one dose 2 weeks post vaccination 2 years+ booster every 2 years
106
Which typhoid vaccine offers longer immunity?
Oral, live attenuated.
107
What are the CIs of the typhoid vaccines?
Oral: same as any live IM: wait until 2nd trimester usually.
108
How is rabies immunized against?
Rabies immunoglobulin: passive immunity + Inactivated Rabies vaccine: active immunity ## Footnote Ig binds to the virus Vaccine fights the virus
109
What is the dosing schedule for rabies?
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 ## Footnote Previous rabies vaccination only requires days 0 and 3. Immunocompromised need additional vaccine on day 28. OK at 2mo+
110
How is botulism vaccinated against?
No vaccine. CDC equine antitoxin can neutralize all 7 botulism serotypes for ages 12mo+
111
How is RSV vaccinated against?
Ig only. Humanized monoclonal anti-RSV antibody.
112
What is the mechanism of the RSV MAB?
Inhibit viral transcription only. ## Footnote Does not reduce symptoms. Only stops it from getting worse.
113
How is the RSV MAB given?
Monthly to high-risk individuals during sept-may ## Footnote Costs $1100 per dose.
114
How soon should we give an antivenom ideally?
Within 4 hours of bite
115
What is considered getting envenomation under control?
* Systemic symptoms resolving * Hematologic abnormalities improving * Local effects improving
116
How do we test if someone is allergic to antivenom?
Give them 0.1mL SQ first to see their reaction.
117
What should we be prepared for when giving antivenom?
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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