MPH Block 1 Review Flashcards
1
Q
Define Herd Immunity
A
Indirect protection from infectious disease for those that are not immune
Only applies to contagious diseases
2
Q
Define Herd Immunity Threshold
A
When a disease is no longer persistent in a population due to a critical proportion of the population is already immune
3
Q
Define Basic Reproduction Number
A
Average number of new cases caused in a susceptible, well mixed population
4
Q
What are examples of microbes that are transmitted through Direct Contact and Droplet transmission
A
Contact- Herpes, Syphilis, Hookworm
Droplet: travel short distance, less than 1meter but are not suspended in the air- Pertussis, Meningococcal, Mumps
5
Q
What are microbes that are passed through Indirect Vehicle and Vector (mechanical/biological) transmission from reservoir to host?
A
Vehicle Borne= Food, Water, Fomites: Salmonella, HCV, MRSA
Vector Borne-
Mechanical- Shigellosis/Bacillary dysentery, Plague
Biological- Malaria, Dengue
6
Q
What are examples of microbes that are passed through airborne transmission?
A
TB
Measles
7
Q
What types of PTs are screened for gonorrhea and chlamydia?
A
ASx Abstinence Monogamy Barrier methods Alternative methods
8
Q
HPV screening is recommended to start at what age but can be done as young as ?
A
11-12
9
9
Q
What age of PTs can have catch up HPV vaccines?
A
Both genders ages 13-26 who have been previously vaccinated or have not completed the series
10
Q
Can PTs 27-45y/o receive HPV vaccine?
What is NOT considered a contraindication?
A
Yes, if it’s a shared clinical decision
Hx of HPV, abnormal PAP, or genital warts
11
Q
How old can non-immune compromised PTs receive the HPV vaccine?
A
2 doses prior to 15th birthday
On or after 15th birday- 3 doses
12
Q
What is the STANDARD schedule for receiving pneumococcal vaccines?
A
PCV13 @ 2, 4, 6, 12-15 months
13
Q
PTs with chronic conditions such as DM, heart Dz or lung Dz should get what form of the pneumococcal vaccine?
A
PPSV 23
14
Q
Immune compromised PTs w/ HIV, asplenia, chronic renal failure nephrotic syndrome get what form of the pneumococcal vaccine?
A
PCV13 8wks PPSV23 5yrs later PPSV23
15
Q
What form of the pneumococcal vaccine can pregnant women receive?
A
PPSV 23
16
Q
What schedule of pneumococcal vaccines should PTs with CSF leak or cochlear implants follow?
A
PCV13
8 wks later
PPSV23
17
Q
Define VAERS
A
Unified national system to collect, manage and evaluate reports of possible adverse events that occur after the administration of a US licensed vaccination
18
Q
What vaccine products are given first or at what timeline?
A
Live vaccine- 2 wks before Ab
Ab/Ig- wait 3+mon then give vaccine (except yellow fever and zoster)
PPD- give live vaccine when PPD is read
Live vaccine- wait 4-6wks to apply PPD
19
Q
What is the administration interval for combo vaccines?
A
2 inactivated, Inactivated and Live, Oral and Injectable live vaccines- no interval
Two life injected vaccines- 4wks (except yellow fever, can be given <4wks after measles)
20
Q
What are 3 additives found in vaccines?
A
Adjuvant
Preservatives
Residual materials
21
Q
Define Adjuvant and 3 examples
A
Substance, primarily Alum, used to enhance vaccines and reduces number of active components and doses needed due to enhancement
22
Q
What are 3 examples of Adjuvant used in vaccines
A
Shingris
Heplisav
FLUAD- squalene based oil-water emulsion
23
Q
What are the functions of preservatives in vaccines?
A
Maintain potency and sterility of multi-doses
24
Q
What are 3 examples of preservatives found in vaccines?
A
Thimerosal
Formaldehyde
MSG
Phenoxyethanol
25
What is the function of residual materials in vaccines?
What are 3 examples
Used to grow virus/bacteria contained in vaccine
ABX, egg protein, gelatin
26
What are the 3 types of prevention?
1*- Prevent onset of illness before dz process
2*- leads to early Dx and rapid Tx
3*- Reduces morbidity/mortality from existing Dz (most of what occurs in medical treatment)
27
What is the gold standard of testing a respirator?
Use test
28
Significance of OSHA, CFR, EO 12196, and DODI 6055
OSHA 1970- Primary federal law governing OccHealth
29 CFR 1910 1960- labor laws governing work environment
ExOrder 12196 1980- required OSHA compliance, military exempted (noise on battlefield)
DODI 6055.5-M- minimum standards for medical surveillance/work place exposure health risks and hearing conservation
29
Define Communicable Period
Period of time during which infectious agents may be transferred from person/animal to susceptible host
30
Define Incubation
Time interval between infections and initial onset of clinical illness/Sxs and when a person can transmit the infection w/out showing and signs of the Dz
31
Define Latency Period
Time from infection to infectiousness, shorter than the incubation period
32
When is a member placed on into the hearing conservation program?
>85dB
8hr TWA
>140dB peak
STS of 10dB avg from 2k, 3k and 4k in either ear
33
What are the reproductive workplace hazards?
Blood- HIV and hepatitis
Airborne- Rubella, V-Zoster
Physical hazards not specified by OSHA- Vibration ranges of 5-10hz
Exposure to lead, ethylene oxide, waste anesthetic gases, mercury
34
What is the criteria for a reproductive protection deferral
Job description indicates exposure to teratogenic, fetotoxic or reproductive toxic substance AND worker indicates attempts to conceive OR
Female currently pregnant/breast feeding
35
What is the key to treatment for diarrhea diseases during a disaster?
PO fluids that are glucose/Na ratio equivalent
| Total osmolality between 200-310 mOsm/L
36
What are the 3 vaccination immunity types?
Active- Abs in response to exposure/vaccine and leads to memory
Passive- Abs transferred from mother to baby as immune globulins, no memory.
Herd- no Abs, no memory but those around have the Abs and prevent Dz from growing/passing
37
Criteria for Mild Traveler's Diarrhea and how is it Tx
Tolerable, no distressing and doesn't interfere w/ planned activities
Use Loperamide or Bismuth Subsalicylates
38
Criteria for Moderate Traveler's Diarrhea and how is it Tx
Distressing or interferes w/ planned activity
May use Loperamide alone or
Adjuvant w/ AB and +/- ABX
39
Criteria for Severe Traveler's Diarrhea and how is it treated?
Incapacitating or prevents planned activities
| May use Loperamide as adjuvant to ABX and should use ABX
40
Acute Traveler's Diarrhea is treated how?
When is microbiological testing recommended?
Empirically
Severe or persistent Sx or those who fail empiric therapy
41
When is multiplex molecular diagnostics preferred?
All dysentery is considered ?
PTs with persistent or chronic Sxs
Severe
42
Characteristics of using Azithromycin
1g or 500mg PO- if Sx don't resolve in 24hrs, continue daily dosing x 3 days
Use empirically as 1st line in SE Asia/India to cover fluoroquinolone resistant Campylobacter or areas if Campylobacter/resistant ETEC are suspected
Preferred regiment for dysentery or febrile dysentery
43
Characteristics of Rifaximin
Do not use if suspected Campylobacter, Salmonella, Shigella or other causes of invasive diarrhea are present
44
How are vector borne disease prevented?
PPM- sometime only effective protection and ALWAYS first line of defense
Vector control- impractical, logistics, time
Prophylaxis/Vaccines
45
What protective measures are taken for bug protection?
```
Full protection require each layer
ACU permethrin
DEET/picardian repellent on skin
Wearing of uniform
Sleep in permethrin netting
```
46
Permethrin treated netting doesn't stop what bug that carries what disease?
Sand fly- causes leishmaniasis
47
Function of DEET
N,N-diethyl-meta-toluamide
Repels biting bugs such as mosquitoes, ticks, chiggers, fleas and flies
Applied before face paint
Apply sunscreen then DEET
48
Characteristics of permethium
Insecticide in pyrethroid family
Odorless/non-irritating
Prevents mosquito bites through fabric by killing/repelling insects that contact fabric
49
What is the MOA of permethium
Inhibits Na channels causing bugs to spaz/paralysis to death
50
What are the benefits of STI screening?
Female- reduce risk of PID/infertility
Male- reduce risk of reinfecting partners or overall transmission
Lower long term sequals
51
What are the 5 Ps of conducting a sexual Hx?
```
Partners
Practices
Protection from STDs
Past Hx of STDs
Prevention of pregnancy
```
52
What is the difference in disease prevalence from 1900s to 2010?
Where is the biggest decrease seen?
1910- TB and Pneumonia/Influenza
2010- CA and heart dz
Biggest decrease in infectious disease deaths
53
Altitude Sickness Sxs are caused by ?
Mild/Moderate hypoxia occurring above 8000ft
54
What are the less severe, more common Sxs seen in travelers w/ acute mountain sickness?
HA, fatigue, loss of appetite, nausea, insomnia
55
What are the two severe forms of Mountain Sickness?
High altitude pulmonary edema
| High altitude cerebral adema
56
What meds can be used as prophylaxis for Mtn Sickness?
How is Mtn Sickness treated?
Acetazolamide 250mg BID starting 24hrs prior to ascent and continued for 48hrs at highest altitude
Tx= Acetazolamide 250mg BID
Numbness, tingling in extremeties, inc urination
57
What are the prophylaxis recommendations for PTs with and without Hx of Mtn Sickness/
Hx- considered for 8-9K ft and recommended if +9Kft
AHx- considered 9-11k ft and recommended for +11.5K ft
58
Suspected or confirmed cases of ? are considered medical emergencies
Malaria, especially P Faliciparum
59
When are malaria exposure risks the highest?
Dusk, dawn and night
60
What are the two stages of malaria?
Blood- clinical manifestations of Dz
| Liver- hypnozoites, dormant stage (Vivax, Ovale)
61
When are kids 6-11mon and +12mon that are traveling OCONUS given vaccines?
```
6-11mon= 1 MMR followed by 2 doses after 1st birthday
+12mon= 2 doses separated by +28 days
```
62
When can suppressive meds be used for malaria?
Only effective at killing parasites in erythrocytic/blood stage
Provides relief of S/Sxs
63
What is the regime for taking Doxy for malaria?
Take 1-2 days prior to travel
Daily while in area
For 4wks post travel to kill parasites
64
What is the benefits of taking Tafenoquine for malaria?
What is the screening and dosing requirement?
Prevents parasite development in liver and active against blood and dormant liver stage parasites
Reqs G6PD screening
PART dosing 300mg x 1
65
What medication is most effective at preventing P Vivax?
What is the screening and dosing requirement?
Primaquine
Active against dormant liver stage
G6PD screening
PART dosing 52/5mg qday x 14
66
What is the risk of taking Malarone for malaria?
Doesn't kill dormant liver stage
67
What are the four infectious sources of mortality consistently associated with humanitarian emergencies?
Diarrhea
ARI
Vectore-borne- malaria
Measles
68
In all suspected and confirmed cases of measles, treatment involves ?
Vitamin A- immediately up Dx and the next day
69
What is measles' Ro and HIT?
What is pertussis' Ro and HIT?
12-18, 92-95%
12-17, 92-94%
70
Who is considered high priority for getting a measles vaccination?
Refugees
71
How is Salmonella Typhoidal transmitted?
Fecal/urine contamination of food/water
72
How often is typhoid vaccine given?
Vi Capsular Polysaccharide given >2wks prior to travel and booster q2yrs
73
What is the PO typhoid vaccine schedule?
Live attenuated vaccine
4 capusles taken q other day >1wk prior to travel
Must be kept refrigerated, take with cool liquid 1hr prior to meal or 2hrs post meal
Booster q5yrs
74
What are the common characteristics of pre-formed toxin ingestion?
```
N/V
Watery diarrhea
6hrs post-ingestion
Resolves in 24hrs
From improper processing, storage, handling of food
```
75
Characteristics of Clostridium Perfringens
One of the most common causes of food poisoning in US
Cooking kills cells, not spores
Causes diarrhea, cramps but NO fever or vomit and isn't passed from person to person
76
Characteristics of Bacillus Cereus
Emetic from food cooked for insufficient time/temps to kill spores then improperly refrigerated
Causes N/V 1-5hrs post consumption
77
What bug carries Dengue?
Aedes mosquito- daytime mosquito (Aedes aegypti, Albopictus)
78
What protective measures are available for Dengue?
Dengyvaxia
| Supportive care only
79
Where is Dengue a risk?
Re-exposure increases risk of ?
Urban areas
Dengue rheumatic fever
80
What are the recommendations of USPSTF?
```
A- recommend, substantial benefit
B- recommend, moderate benefit
C- against
D- against, mod-high risk
I- insufficient evidence, balance of harm/benefit can't be determined
```
81
What is the NMCI methodology for assessing disease risk?
Realistic Max rate + Disease endemicity= Potential attack rate in troops
Potential attack rate + typical severity= risk (red, amber, green)
82
Assessing disease risks of STIs
```
GC/Ch: women 24 and younger, older @ higher risk
Men- considered class 1, insufficient evidence
```
83
How is screening for STIs in men accomplished?
Nuclear Chemical Acid Amplification Testing NAAT on urine or urethral swab
84
How is screening for STIs in women accomplished?
NAAT on vaginal swab or endocervical swab
| Conjunctival Anne rectal swab are equal or better than other methods
85
What are the Suppressive and Causal meds used for malaria?
Suppressive: Doxy, Mefloquine, Choroquine
Provides clinical cure and relieves Sxs
All suppressive meds are taken with Primaquiine for presumptive antirelapse treatment for Plasmodium sp.
Casual: Tafenoquine, Primaquine, Malarone- only one not requiring G6PD screening and still uses Primaquine for PART
86
Suppressive malaria meds have what effect compared to causal meds that have ? effect?
Suppressive- kills RBC stage
| Causal- kills blood and liver stages
87
Prophylaxis for Traveler's Diarrhea is not recommended except for in ? type of PTs and ? med is recommended
Crohns
UC
Chronic Diarrhea
Rifaximin is DOC
88
What medication is used against leptospirosis
Doxy 200mg, single weekly dose
89
What two microbes in this block is there no vaccine for?
Campylobacter
| Leishmaniasis
90
Define Incidence
Number of new Dz cases occurring in a specific time period in a population
Measure of risk, is a 'rate' and must have an element of time in denominator
Rate and element of time in denominator
(# new cases/avg population at risk during time)
91
Define Incidence Density
All people not followed for same amount of time
| Number of new events per person-time
92
Define Crude Rate
W/out rates
93
Define Specific Rate
Homogenous population
94
Define Adjusted Rate
Modified calculation to control of variable population characteristics
95
Define Prevalence
Proportion of people in population who have certain Dz or over a specific period of time
96
# Define Point Prevalence
Define Period Prevalence
Prevalence- all cases at a certain POINT of time, a proportion
All cases during a certain PERIOD of time
97
What vaccines are and are not recommended for pregnant women?
Recommend:
Inactivated/injected influenza and Tdap between 27-36wks of EVERY pregnancy
Not: Live influenza, MMR, Varicella, Zoster, Anthrax, HPV, typhoid, PCV13
98
Characteristics of Quarantine
Individual- healthy
Duration- incubation
Location- home
Action- police power
99
Characteristics of Isolation
Individual- sick
Duration- communicable
Location- hospital
Action- common/standard precaution
100
What microbe causes >50% of all food borne illness cases
Norovirus
101
How are Salmonella infection acquired?
Meat and poultry
| Most common source of fatal infections caused by Salmonella and Listeria
102
How are Clostridium Perfringens infections acquired?
Dairy and eggs
103
How are Campylobacter infections acquired?
Fish and shellfish
| Majority of chemical-fish and parasitic
104
What are the top 5 causes of illnesses w/ NO hospitalization/death?
```
Norovirus
Salmonella
Clostridium
Campylobacter
Staph A
```
105
What are the top 5 causes of food borne illness hospitalizations?
```
Salmonella, non-typhoidal
Norovirus
Campylobacter
Toxoplasmosa Gondii
E Coli STEC O157
```
106
Stopped on
#40
107
Define Public Health
Science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts- Winslow
Population health perspective
108
Epidemiology is based on what two fundamental assumptions?
Dz do not occur by chance
| Dz are not distributed randomly among a population
109
What are the objectives of epidemiology?
```
ID etiology and risk factors
Determine Dz extent in community
Study Hx and prognosis of Dz
Evaluate new and existing measures
Provide foundation for policy
```
110
What are today's risks for cause of death?
What are today's lifestyle risk factors?
Heart Dz, CA, CVA, COPD
Tobacco/ETOH, Nutrition, Obesity, Inactivity, Exposures
111
What do immunizations do?
```
Prevent: ST WISP
Invasion
Destruction of organs
Permanent damage
Over stimulation of imm. system
Weakened state for opportunisitcs
Toxin susceptibility
```
112
Define Contraindications and the four types
Condition that DOES increase the risk of a serious adverse reaction
Four true contraindications:
Anaphylactic, Encephalopathy, Pregnancy, Immunocompromised
113
Define Precautions
```
Condition that MAY increase the risk for an adverse reaction or affect the vaccines ability to produce immunity
Prior reactions
Illness
Breastfeeding
Hx of Guillain-Barre Syndrome
```
114
Which vaccines are considered in special circumstances during pregnancy?
RHYTHMIST JAP
| Rabies Hep A Yellow fever Td Hep B Meningococcal IPV Small pox Typhoid JE Anthrax PPSV 23
115
What are the three types of VAREs?
Confined to local injection site
Body reaction
Hypersensitivity
116
S/Sx of a local inflammatory or hypersensitivity reaction
Severe pain, Swelling, Induration, Edema that onset within 4-12hrs after vaccine, peaks 12-48hrs after and resolves within a week
Tx w/ acetaminophen/ibuprofen, cool compress, observation
117
What are the S/Sx of a cellulitis reaction from an immunization?
Erythema, Pain, Swelling, Warm, Tight glossy skin
Usually has system Sx
Treat w/ ABX and Warm compresses
118
Define SIRVA
Shoulder Injury Related to Vaccine Administration
Rapid onset of pain w/ limited RoM
Tx w/ NSAIDs, PT and corticosteroid injections
119
What are the different types of adverse neurological events from vaccines?
ADEM
Transverse myelitis
Guillian-Barre- nerves are attacked starting w/ legs to arms
Brachial Plexus Neuritis- severe arm pain w/ upper arm weakness
120
When are febrile seizures likely to happen and they're more likely to occur if ?
Rarely before 6mon/after 3yrs
More likely if:
Already had one, immediate relative has had one, Hx of frequent fevers,
121
Who manages VAERS?
What type of reactions are monitored for?
CDC and FDA
Alopecia after Hep B
Thrombocytopenia after measles
Myopericarditis after small pox
122
What vaccine program is a no fault resolution program and provides ACIP childhood schedules?
Which one provides compensation for injuries?
NVICP
CICP
123
What is the incubation and communicable periods for measles?
Incubation- 14 days for rash
| Communicable- 4 days before rash until 4 days after
124
What is the incubation and communicable period for Hep A?
Inc- 28-30 days
| Comm- latter half of incubation to few days after onset of jaundice
125
What is the incubation and communicable period for smallpox?
Inc- 7-17 days
| Comm- from onset of Sxs to separation of scabs
126
What are the three parts of the Epidemiological Triad?
Sometimes there's a fourth part, what is it and what three microbes are transmitted through the fourth component?
Susceptible host
Causative agent
Environment
Vector- malaria, dengue, scrub typhus)
127
What are the components of the Host within the epidemiologic traid?
```
I CAPS
Susceptibility
Prior exposure
Age
Co-infection
Immune response
```
128
What are the components of the Agent within the epidemiologic traid?
```
STIRS V
Susceptibility to ABX
Toxicity
Infectivity
Reservoir
Survival out of the body
Virulence
```
129
What are the components of the Environment within the epidemiologic triad?
```
SPPC
Social structure
Population density
Physical structure
Climate
```
130
Define Primary/Definitive host
Organisms that a pathogen reaches maturity and reproduces in
131
Define Secondary/Intermediate host
Organism that harbors the sexually immature parasite and is required for completion of the life cycle
132
Define Dead End/Accidental host
Organism that doesn't allow transmission to the definitive host
133
What are two examples of dead end hosts?
Horses and humans for the West Nile virus, normally between mosquito and birds
134
Define Natural Reservoir
Specific environment in which an infectious pathogen naturally lives and reproduces or one that is primarily depended upon for survival
135
A reservoir is usually what main characteristic
Living host of certain species without causing dz to reservoir itself
136
Define and list characteristics of a Carrier
Organism that is infected with a pathogen w/out showing S/Sxs and can transmit pathogen to others or eventually develop Sxs
137
# Define Convalescent Carrier
Where is this method commonly seen?
Capable of spreading disease following a period of illness
Viral diseases- hepatitis, polio
138
# Define Asymptomatic Carriers
Where is this method commonly seen?
Never exhibit S/Sxs of disease but are capable of infecting others
6% of individuals infected w/ Salmonella typhi become chronic ASx carriers
139
Define the type of disease transmission: fly carries shigella from latrine to food?
Indirect vector borne mechanical transmission
140
Define the type of disease transmission: staphylococcal poisoning from a single meal?
Indirect vehicle borne transmission single exposure
141
Define the type of disease transmission: student in hallway sneezes on you?
Direct transmission droplet spread
142
Define the type of disease transmission: cook with poor hand washing contaminates a salad?
Indirect vehicle borne transmission probable multiple exposure
143
Define the type of disease transmission: person w/ TB repeatedly coughs during 9hr flight?
Airborne transmission
144
Define the type of disease transmission: child with impetigo gives you multiples hugs?
Direct transmission person to person
145
Incidence represents the ?
Prevalence represents the ?
Risk of getting a Dz
Odds of having it in a population
146
In a steady state situation, what is the prevalence equation?
P= incidence x duration of dz
147
High prevalence of a Dz may reflect ?
Low prevalence may reflect ?
High- High incidence (risk) or prolonged survival w/out care
Low- low incidence (risk), a rapidly fatal process, or rapid recovery
148
Define Isolation
Separation/restricted movement of ILL people who have a contagious disease in order to prevent transmission
149
Define Quarantine
Separation/restricted movement of exposed but ASx/WELL people before it is known if they will become ill
Essentially a monitoring need resulting in loss of personal freedom
150
Historically, when has quarantine methods been used?
```
Public health Action
Executive Order 13295
CYSTS PDF
Cholera Yellow fever Smallpox TB SARS
Plague Diphtheria Fever, hemorrhagic
```
151
What is the purpose of Hospital Isolation
Transmission-based precautions
| Established for a specific Dx
152
Who does exclusion from work apply to?
Health care
Day care
Food handler
Law enforcement/detainees
153
What is the mission of occupational health?
What two areas does it focus on?
Promote health and safety of workplace and community
Focuses on education regarding hazards and surveillance within the occupational environment
154
What is the primary role of occupational health in a military setting?
Protect service members and DOD civilians
PrevMed
Public Health
155
What are 4 reasons for Occupational Health
Compliance with laws, regulations and executive orders
Maintain healthy work force
Maintain productivity
Decrease organization costs
156
What was NIOSH created under?
OSHA 1970
157
When are reference/initial audiograms conducted?
What is the first valid hearing test?
Within 30 days of initial exposure to hazardous noises
Reference audiogram, preceded by 14hrs w/out noise exposure
158
Human remains do not pose a threat as communicable disease hazards with what exception?
Death from cholera,
Viral hemorrhagic fever
Epidemic typhus (Louse-borne)
159
Disaster associated outbreak population characteristics and the characteristics of sudden displacement
Population: size, health and living conditions
| Sudden displacement: inadequate water, poor sanitation, lack of access to health services
160
What type of diarrhea outbreak is considered a public health emergency?
Cholera
161
What is the goal of diarrhea disease treatment?
What is the main treatment goal?
Prevent death from dehydration and circulatory collapse
Re-hydration
162
When are ABX used for diarrhea disease?
Moderate/sever cholera
Dysentery- bacillary or amoebic
Giardiasis
163
What is a major respiratory cause of morbidity and mortality in emergency setting
Pneumonia
164
Characteristics of Influenza A
Primary reservoir in humans and birds but can also infect swine, seals and horses
Seasonal epidemics
Only know cause of pandemics
165
Characteristics of Influenza B
Infects humans and swine
Seasonal epidemics
Mostly antigenic drifts
166
Characteristics of Influenza C and D
C= mild illness
D- infects cattle
167
What are the H and N parts of Influenza A
Hemagglutinin- binds to respiratory cells
Neuraminidase- releases new virions from cells
168
When is flu season in the northern/southern hemisphere?
```
N= Oct-March
S= Apr-Sept
```
169
What factors increase and inverse Influenza A ability to transfer?
Aerosol- little/no transmission with high humidity
| Temps- greater transmission at lower temps
170
Current influenza vaccines are categorized as ? or ?
Trivalent- two influenza A and one B
Quadrivalent- two As and two Bs
171
What is the definition of measles outbreak?
Three or more confirmed cases linked in time and space
172
What is the target population for measles vaccine during the emergency phase?
All kids 6mon-14yrs
Priority= 6mon-5yrs
If immunized between 6-9mon, re-immunize at 9mon
173
What is the target population for measles vaccine during time that there is insufficient vaccines available?
Undernourished/sick kids- 6mon-12yrs
All kids 6mon-23mon
Kids 24-59mon
174
What medication is used for chemoprophylaxis for Traveler's Diarrhea if a PT requests it?
Bismuth subsalicylate- 2oz of liquid or,
| 2 tabs Q4D
175
What travel vaccines are considered for widespread, geographical and duration/activity risks
Widespread- Hep A, Typhoid
Geographic- Yellow, Meningococcal, Polio, JEV
Duration/activity- Hep B, Rabies
176
What are the routine childhood vaccines?
```
MMR
Varicella
DTaP
Polio
HiB
Hep A/B
PCV
Rota
Influena
```
177
What are the routine vaccines for adolescents/Adults?
```
Tdap
Meningococcal
HPV
Influenza
Penumococal
Vericella/Zoster
MMR
```
178
What type of mosquito carries JEV?
What time of the day do they eat?
Culex
Evening and night biter
179
What are the sources of medical intelligence?
Strategic- NCMI for DoD
Tactical- S2/G2
180
What info IS provided by NCMI
```
Health risk
Health services
Trends/forecasts
Indications/warnings
Facility database
```
181
Uses of taking Tafenoquine for malaria prevention
Prevents initial parasite development in liver
Acts on blood stage parasites
Active against dormant liver stage
300mg x 1
182
Uses of taking Primaquine for malaria prevention
Most effective against P. Vivax
Active against dormant liver stage
No action for blood stage of P Falciparum
52/5mg qday x 14 days
183
Use of Malarone for malaria prevention
Does not kill dormant liver stage
| Must still use Primaquine for presumptive PART
184
What two meds are the only approved drugs for acting on the dormant hypnozoites in the liver?
Primaquine
| Tafenoquine
185
What are the ABCDEs of malaria prevention
```
Awareness
Bite prevention
Chemoprophylaxis
Dx
Emergency standby treatment
```
186
What is the primary host of Leptospirosis
Brown rats
| Humans are dead end hosts
187
What medication is used for preventing Leptospirosis infections in service members?
Doxy 200mg 1x/wk= 95% effective prevention
188
When is re-screening peformed after STI treatment?
3, 6, 9 and 12 mon
189
What are the stats of Gonorrhea
Second most commonly reported communicable disease Second most prevalent STI in US
Men to Women= 4x more common
Men usually ASx
190
What class of ABXs are the last ones recommended and still effective for gonorrhea treatment?
Cephalosporins
191
What is the current combo therapy recommended for treating gonorrhea?
Ceftriaxone 250mg IM
| Azithromycin 1g PO
192
How is Expedited Partner Therapy for gonorrhea treated?
Cefixime
| Azithromycin
193
Characteristics of Chlamydia
Most reported bacterial STD in US
10x more prevalent than gonorrhea
Most costly non-viral transmitted infection
194
What is the screening method for chlamydia?
NAAT for men
| Vaginal swabs for women
195
What is the recommended chlamydia treatment regiment?
Azithromycin 1g PO or
| Doxy 100mg PO BID x 7 days
196
What is the alternative treatment recommendation for chlamydia
Ezithromycin 500mg Q4D x 7 days
| Ofloxacin 300mg BID x 7 days- for pregnancy
197
When is re-testing needed after chlamydia treatment?
Not needed if treated w/ Azithromycin or Doxy
| Retest if treated w/ Erythromycin
198
Define Food Infection
Organisms are present/introduced to foods and multiply in the food/human body until they cause sickness
199
Define Food Intoxication
Microbes are present in food and produce a toxin. The toxin causes the illness and not the actual microbe
200
What is an examples of a naturally occurring chemical and introduced chemicals
Ciguatera Toxin
Poison, pesticide, leeching from containers
201
What are the majority of food borne illnesses caused by?
What are the majority of fatal infections caused by?
Half by produce contaminated w/ Norovirus
Meat and poultry
202
What causes the majority of chemical and parasitic food borne illness?
Aquatic animals
Fish= chemical
Parasitic= mollusks
203
What are the top five pathogens contributing to domestically acquired food borne illnesses resulting in death?
```
Salmonell
Toxoplasma gondii
Listeria
Norovirus
Campylobacter
```
204
What are the 3 food borne investigation tasks in bold?
Detecting possible outbreak
Generating hypotheses about sources
Controlling outbreaks
205
What is one of the reasons we do routine surveillance in food services?
Detecting possible outbreaks
206
What is the criteria to verify a food borne illness outbreak?
What is the exception to this criteria?
Two or more people from different house holds who eat a common food and is confirmed through lab analysis as the source of the illness
Except- botulism or chemical caused illnesses
207
For food borne illnesses, define diarrhea
Loose/water stools three times on 24hrs
Acute= <14 days
Persistent= >14days, < 30days
Chronic= >30days
208
How long does it take for N/V from ingesting preformed toxins to start showing?
Within 6hrs
209
Define Scombroid
From eating improperly stored/processed fish
| Commonly from tuna, mackerel, mahi mahi, or blue fish (fish with high histidine levels)
210
What are the S/Sx of Scombroid?
Facial flushing
Burning/peppery taste in mouth
Facial rash/pruritus
211
What are the non-inflammatory viruses?
Rotavirus
Norovirus
Adenovirys
Cytomegalovirus
212
What are the non-inflammatory bacterias?
```
Enterotoxigenic
E Coli
Clostridium Perf.
Staph A
Bacillus Cereus
Vibrio Cholera
```
213
What are the non-invasive parasites?
Giardia intestinalis
Cryptosporidium
Cyclospora
214
How are Bacillus Cereus infections acquired?
Meat/veggie foods after cooking and not maintained at temp
215
What are the S/Sxs and time frames of a Bacillus Cereus infection?
8-16hr incubation
| Watery diarrhea and GI pain
216
How is Norovirus testing conducted for Dx?
PCR
217
There are no standardized/validated lab tests for detecting Norovirus in food except for in ?
Shellfish
218
What is the Kaplan Criteria
Mean illness duration of 12-60hrs
Mean incubation of 24-48hrs
50% w/ vomitting
No bacterial agent ID'd
219
What methods are used for preventing Norovirus infections?
Water and Soap= effective
Alcohol sanitizer- not as effective due to lack of lipid envelope
Bleach for surfaces
220
Characteristics of Salmonella, non-typhoidal
Leading cause of food borne illnesses, hospitalizations and death
More common in warmer months
Present in poultry
221
What temp and time frame is recommended for killing Salmonella?
165*F x 15 min
222
How are PTs determined to be ASx from Salmonella?
Two negative stool cultures collected no less than 24hrs apart
223
What is the most common contaminated method of Campylobacter transmission?
Unpasteurized milk
224
Capylobacter infections are at highest risk for people traveling to what countries?
Africa
| S. America
225
What is the only source of the Salmonella bacteria?
| How is it transmitted?
Human
| Fecal/urine contamination of food/water
226
What is a superior form of drying hands?
Paper towels
227
What is the danger zone temps for bacteria growth?
40-140*F
| Especially 90-110*, can double population in 20min
228
What are the recommended temps and storage times for food?
Shallow containers
40*F or lowers within 2hrs
If outside and temps are >90*F, refrigerate within 1hr
229
Define Primary Prevention and it's main goal
Pre-pathogenesis phase
Prior to Dz exposure
Remove cause of disease- imms
