Module 1 - Health Promotion, Screening, & Immunizations

Question 1

How often should patients receive the influenza vaccine?

Answer 1

• Recommended annually for all age groups unless contraindicated
• Special populations: high risk populations include residents of chronic care facilities and nursing homes, individuals with a pmhx of asthma, neurological disorders, COPD, cystic fibrosis, CAD, DM, CKD, HIV/AIDs, cancer, pregnant women, American Indians and Alaskan Natives

Question 2

How often should patients receive the Tetanus, Diphtheria and acellular pertussis (Tdap) vaccine?

Answer 2

• Adults with unknown or incomplete history of 3 dose primary series should complete the primary adult series which includes 1 dose Tdap followed by 2 doses of Td at 1 month and 6 months
  
  • Then they will need a Tdap booster every 10 years
• Special Populations: Pregnant women should receive 1 dose of Tdap during each pregnancy, preferably during gestational weeks 27-36, regardless of prior history of receiving Tdap.

Question 3

How frequently should adults get vaccinated for varicella?

Answer 3

• Adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine (VAR) 4-8 weeks apart
• Pregnant women and immunocompromised patients should NOT receive the vaccination
  
  • They should get vaccinated after their pregnancy

Question 4

When should patients receive their herpes zoster vaccination?

Answer 4

• This vaccination is recommended for all adults aged 60 years or older, regardless of whether they had a prior episode of herpes zoster
• Special Populations: NOT RECOMMENDED in Adults age 60 years or older with severe immunodeficiency or malignancy that affects the bone marrow or lymphatic system or who receive systemic immunosuppressive therapy, or HIV+ adults with a CD4 T-lymphocyte count <200.

Question 5

When should patients receive the HPV vaccine?

Answer 5

• Adult females through age 26 years and adult males through age 21 years who have not received any HPV vaccine should receive a 3-dose series at 0 months, 1-2months, and 6 months.
• Special Populations: Men who have sex with men through age 26 should receive 3 dose series; Adult females and males through age 26 years with immunocompromising conditions ( including HIV, transplantation, malignant neoplasm, autoimmune disease and immunosuppressive therapy) should receive a 3 dose series.
• Pregnant women are NOT recommended to receive vaccine- although the vaccine poses no harm.

Question 6

When should patients receive their pneumococcal vaccination?

Answer 6

• Adults age 65 yrs or older are recommended to receive 1 dose of PCV13 and 1-3 doses of PPSV23 (5 years apart) depending upon indications. Do not administer both in the same visit.
• If an adult 65 yrs or older receives PPSV23 initially, no further doses of PPSV23 are indicated.

Question 7

What type of patients should receive the PPSV23 Pneumococcal vaccination?

Answer 7

• Adults age 19-64 with chronic heart/lung/liver disease, asthma, DM, or cigarette smokers
• At age 65 yo they should also receive recommended dosing above.

Question 8

What type of patients should receive the PCV13 Pneumococcal vaccination?

Answer 8

• Adults age 19-64 yrs with immunocompromising conditions or anatomical or functional asplenia (including splenectomy) should receive PCV 13 and a dose of PPSV23 8 weeks later, followed by a 2nd dose of PPSV23 5 years after first dose.
• At age 65 years they will need additional dosing.

Question 9

When should patient’s receive the hepatitis A vaccine?

Answer 9

Adults any age group may receive a 2 dose series of single-antigen hepatitis A vaccine (HepA) at 0 and 6-12 months

Question 10

Who is the Hepatitis A vaccine recommended for?

Answer 10

• The series is recommended for adults with the following indications: chronic liver disease, receiving clotting factor concentrates, men who have sex with men, use injection or non-injections drugs or work in labs with hepatitis A virus-infected primates.
• Also, adults who travel in countries with high or intermediate levels of endemic hepatitis A or anticipate close personal contact with an international adoptee from a country as stated above should receive vaccination within the first 60 days of arrival in the US.

Question 11

When should patients receive the hepatitis B vaccination?

Answer 11

• Adults who seek protection from hepatitis B virus infection may receive a 3 dose series of single-antigen hepatitis B vaccine (HepB) at 0, 1, and 6 months.
• This is an optional vaccination

Question 12

Which populations are at high risk for hepatitis B and should be vaccinated?

Answer 12

• Sexual exposure: sex partners of HBsAg positive persons, sexually active persons who are not in a mutually monogamous relationship, persons seeking evaluation or treatment for a sexually transmitted infection and men who have sex with men
• Injection drug users, household contacts of HBsAg positive persons, residents and staff of facilities for developmentally disabled persons, incarcerated, healthcare and public safety workers
• Adults with chronic liver disease, including Hep C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis and elevated LFTs > twice the upper limits of normal.
• Adults with ESRD on dialysis, HIV + individuals should receive series.
• Pregnant women who are at risk for HepB virus by inclusion of any of the above mentioned classes.

Question 13

When and who should patients receive a meningococcal vaccination?

Answer 13

• First-year college students aged 21 or younger who live in residence halls should receive 1 dose of MenACWY and revaccinate in 5 years if they have not received MenACWY at age 16 years or older.

Question 14

What type of patients should receive the Haemophilus influenza type b vaccination?

Answer 14

• Adults who have anatomical or functional asplenia or sickle cell disease, or who are undergoing elective splenectomy should receive 1 dose of H. influenza type b conjugate vaccine (Hib) if they have not previously received Hib.
• Hib should be administered at least 14 days prior to splenectomy.
• Adults with a hematopoietic stem cell transplant should receive 3 doses of Hib in at least 4 week intervals 6-12 months after transplant regardless of their Hib history.

Question 15

What is primary prevention?

Answer 15

Defined as health promotion that receded disease or onset of symptoms

Question 16

What is secondary prevention?

Answer 16

• Defined as identification and diagnosis, early intervention and limitation of disability in disease and injury encompassing secondary response to illness.
• Goals are to shorten or halt the disease process or prevent complications and further disability.

Question 17

What is tertiary prevention?

Answer 17

• The main goal of tertiary care is to restore or arrest disability. Objectives include returning the patient to optimal health within the constraints of disease impairment, preventing a further decline or arresting the progression of disease complications.
• Consulting specialized services- occupational, speech therapy, rehabilitative services, etc.) are examples of tertiary care. The inclusion of an interdisciplinary team to manage services is the best care model.

Question 18

What are the guidelines for coronary artery disease screening?

Answer 18

• Beginning at age 20, a fasting lipoprotein profile is recommended every 5 years, to include total cholesterol, LDL, HDL, and triglycerides.
• If total cholesterol > 200mg/dl, a cardiovascular disease risk factor screening is also indicated.
• Recommended daily intake of cholesterol is < 300mg

Question 19

What are the guidelines for breast cancer screening for women?

Answer 19

• Age < 40yo who are NOT high risk: self- breast exam monthly & clinical breast exam every 3 years
• Age < 40 yo who ARE high risk: self- breast exam monthly & clinical breast exam annually; mammograms ordered in consultation with physician regarding risks.
• Age > or equal to 40 yo who are NOT high risk: self-breast exam monthly & clinical breast exam annually; may begin screening mammograms between age 40-50 yrs old; after age 50 recommend mammograms annually in all cases
• Age > or equal to 40 yo who ARE high risk: self-breast exam monthly, clinical exam annually and mammogram annually
• Age > 74 yo annual screening should continue as long as life expectancy is > 10 years based on co-morbidities.

Question 20

What are the cervical cancer screening guidelines?

Answer 20

Pap test in females every 3 years beginning after intercourse or by age 21 years.

Question 21

What are the diabetes screening guidelines?

Answer 21

Assessment at age 45 years of age for all genders to include: blood glucose every 3 years.

Question 22

What are the colorectal cancer screening guidelines?

Answer 22

Assessment at age 50 years of age for all genders to include:

• Colorectal screening- annual home fecal occult blood testing and flexible sigmoidoscopy every 5 years or a double contrast barium enema or colonoscopy every decade.
• High risk patients ( if history of polyps, inflammatory bowel disease and heritable risk factors)- begin screening at age 40

Question 23

What are the prostate cancer screening guidelines?

Answer 23

• Prostate-specific antigen (PSA) with a digital rectal examination (DRE) for average risk males annually
• PSA with annual DRE for high risk patients (positive family history) at age 40

Question 24

What are the osteoporosis screening guidelines?

Answer 24

• Women at age 65 years should undergo screening for osteoporosis
• If the following risk factors are present, begin screening at age 60:
  
  • weight less than 70 kg
  • no estrogen replacement
  • family history
  • Smoking
  • sedentary lifestyle
  • alcohol or caffeine use
  • low calcium or vitamin D ingestion

Question 25

What are the skin cancer screening guidelines?

Answer 25

• The 2016 U.S Preventive Services Task Force concludes that for asymptomatic adults, current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults.
• If suspicious lesions develop, using the ‘ABCDE rule’ which involves looking for the following characteristics: asymmetry, border, irregularity, non-uniform color, diameter greater than 6 mm and evolving over time- individuals should contact their clinician for assessment.