MPH Block 1 Review Flashcards
Define Herd Immunity
Indirect protection from infectious disease for those that are not immune
Only applies to contagious diseases
Define Herd Immunity Threshold
When a disease is no longer persistent in a population due to a critical proportion of the population is already immune
Define Basic Reproduction Number
Average number of new cases caused in a susceptible, well mixed population
What are examples of microbes that are transmitted through Direct Contact and Droplet transmission
Contact- Herpes, Syphilis, Hookworm
Droplet: travel short distance, less than 1meter but are not suspended in the air- Pertussis, Meningococcal, Mumps
What are microbes that are passed through Indirect Vehicle and Vector (mechanical/biological) transmission from reservoir to host?
Vehicle Borne= Food, Water, Fomites: Salmonella, HCV, MRSA
Vector Borne-
Mechanical- Shigellosis/Bacillary dysentery, Plague
Biological- Malaria, Dengue
What are examples of microbes that are passed through airborne transmission?
TB
Measles
What types of PTs are screened for gonorrhea and chlamydia?
ASx Abstinence Monogamy Barrier methods Alternative methods
HPV screening is recommended to start at what age but can be done as young as ?
11-12
9
What age of PTs can have catch up HPV vaccines?
Both genders ages 13-26 who have been previously vaccinated or have not completed the series
Can PTs 27-45y/o receive HPV vaccine?
What is NOT considered a contraindication?
Yes, if it’s a shared clinical decision
Hx of HPV, abnormal PAP, or genital warts
How old can non-immune compromised PTs receive the HPV vaccine?
2 doses prior to 15th birthday
On or after 15th birday- 3 doses
What is the STANDARD schedule for receiving pneumococcal vaccines?
PCV13 @ 2, 4, 6, 12-15 months
PTs with chronic conditions such as DM, heart Dz or lung Dz should get what form of the pneumococcal vaccine?
PPSV 23
Immune compromised PTs w/ HIV, asplenia, chronic renal failure nephrotic syndrome get what form of the pneumococcal vaccine?
PCV13 8wks PPSV23 5yrs later PPSV23
What form of the pneumococcal vaccine can pregnant women receive?
PPSV 23
What schedule of pneumococcal vaccines should PTs with CSF leak or cochlear implants follow?
PCV13
8 wks later
PPSV23
Define VAERS
Unified national system to collect, manage and evaluate reports of possible adverse events that occur after the administration of a US licensed vaccination
What vaccine products are given first or at what timeline?
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
What is the administration interval for combo vaccines?
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)
What are 3 additives found in vaccines?
Adjuvant
Preservatives
Residual materials
Define Adjuvant and 3 examples
Substance, primarily Alum, used to enhance vaccines and reduces number of active components and doses needed due to enhancement
What are 3 examples of Adjuvant used in vaccines
Shingris
Heplisav
FLUAD- squalene based oil-water emulsion
What are the functions of preservatives in vaccines?
Maintain potency and sterility of multi-doses
What are 3 examples of preservatives found in vaccines?
Thimerosal
Formaldehyde
MSG
Phenoxyethanol
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
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)
What is the gold standard of testing a respirator?
Use test
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
Define Communicable Period
Period of time during which infectious agents may be transferred from person/animal to susceptible host
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
Define Latency Period
Time from infection to infectiousness, shorter than the incubation period
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
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
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
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
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
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
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
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
Acute Traveler’s Diarrhea is treated how?
When is microbiological testing recommended?
Empirically
Severe or persistent Sx or those who fail empiric therapy
When is multiplex molecular diagnostics preferred?
All dysentery is considered ?
PTs with persistent or chronic Sxs
Severe
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
Characteristics of Rifaximin
Do not use if suspected Campylobacter, Salmonella, Shigella or other causes of invasive diarrhea are present
How are vector borne disease prevented?
PPM- sometime only effective protection and ALWAYS first line of defense
Vector control- impractical, logistics, time
Prophylaxis/Vaccines
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
Permethrin treated netting doesn’t stop what bug that carries what disease?
Sand fly- causes leishmaniasis
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
Characteristics of permethium
Insecticide in pyrethroid family
Odorless/non-irritating
Prevents mosquito bites through fabric by killing/repelling insects that contact fabric
What is the MOA of permethium
Inhibits Na channels causing bugs to spaz/paralysis to death
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
What are the 5 Ps of conducting a sexual Hx?
Partners Practices Protection from STDs Past Hx of STDs Prevention of pregnancy
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
Altitude Sickness Sxs are caused by ?
Mild/Moderate hypoxia occurring above 8000ft
What are the less severe, more common Sxs seen in travelers w/ acute mountain sickness?
HA, fatigue, loss of appetite, nausea, insomnia
What are the two severe forms of Mountain Sickness?
High altitude pulmonary edema
High altitude cerebral adema
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
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
Suspected or confirmed cases of ? are considered medical emergencies
Malaria, especially P Faliciparum
When are malaria exposure risks the highest?
Dusk, dawn and night
What are the two stages of malaria?
Blood- clinical manifestations of Dz
Liver- hypnozoites, dormant stage (Vivax, Ovale)
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
When can suppressive meds be used for malaria?
Only effective at killing parasites in erythrocytic/blood stage
Provides relief of S/Sxs
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
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
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
What is the risk of taking Malarone for malaria?
Doesn’t kill dormant liver stage
What are the four infectious sources of mortality consistently associated with humanitarian emergencies?
Diarrhea
ARI
Vectore-borne- malaria
Measles
In all suspected and confirmed cases of measles, treatment involves ?
Vitamin A- immediately up Dx and the next day
What is measles’ Ro and HIT?
What is pertussis’ Ro and HIT?
12-18, 92-95%
12-17, 92-94%
Who is considered high priority for getting a measles vaccination?
Refugees
How is Salmonella Typhoidal transmitted?
Fecal/urine contamination of food/water
How often is typhoid vaccine given?
Vi Capsular Polysaccharide given >2wks prior to travel and booster q2yrs
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
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
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
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
What bug carries Dengue?
Aedes mosquito- daytime mosquito (Aedes aegypti, Albopictus)
What protective measures are available for Dengue?
Dengyvaxia
Supportive care only
Where is Dengue a risk?
Re-exposure increases risk of ?
Urban areas
Dengue rheumatic fever
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
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)
Assessing disease risks of STIs
GC/Ch: women 24 and younger, older @ higher risk Men- considered class 1, insufficient evidence
How is screening for STIs in men accomplished?
Nuclear Chemical Acid Amplification Testing NAAT on urine or urethral swab
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
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
Suppressive malaria meds have what effect compared to causal meds that have ? effect?
Suppressive- kills RBC stage
Causal- kills blood and liver stages
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
What medication is used against leptospirosis
Doxy 200mg, single weekly dose
What two microbes in this block is there no vaccine for?
Campylobacter
Leishmaniasis
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)
Define Incidence Density
All people not followed for same amount of time
Number of new events per person-time
Define Crude Rate
W/out rates
Define Specific Rate
Homogenous population
Define Adjusted Rate
Modified calculation to control of variable population characteristics
Define Prevalence
Proportion of people in population who have certain Dz or over a specific period of time
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
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
Characteristics of Quarantine
Individual- healthy
Duration- incubation
Location- home
Action- police power
Characteristics of Isolation
Individual- sick
Duration- communicable
Location- hospital
Action- common/standard precaution
What microbe causes >50% of all food borne illness cases
Norovirus
How are Salmonella infection acquired?
Meat and poultry
Most common source of fatal infections caused by Salmonella and Listeria
How are Clostridium Perfringens infections acquired?
Dairy and eggs
How are Campylobacter infections acquired?
Fish and shellfish
Majority of chemical-fish and parasitic
What are the top 5 causes of illnesses w/ NO hospitalization/death?
Norovirus Salmonella Clostridium Campylobacter Staph A
What are the top 5 causes of food borne illness hospitalizations?
Salmonella, non-typhoidal Norovirus Campylobacter Toxoplasmosa Gondii E Coli STEC O157
Stopped on
40
Define Public Health
Science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts- Winslow
Population health perspective
Epidemiology is based on what two fundamental assumptions?
Dz do not occur by chance
Dz are not distributed randomly among a population
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
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
What do immunizations do?
Prevent: ST WISP Invasion Destruction of organs Permanent damage Over stimulation of imm. system Weakened state for opportunisitcs Toxin susceptibility
Define Contraindications and the four types
Condition that DOES increase the risk of a serious adverse reaction
Four true contraindications:
Anaphylactic, Encephalopathy, Pregnancy, Immunocompromised
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
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
What are the three types of VAREs?
Confined to local injection site
Body reaction
Hypersensitivity
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
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
Define SIRVA
Shoulder Injury Related to Vaccine Administration
Rapid onset of pain w/ limited RoM
Tx w/ NSAIDs, PT and corticosteroid injections
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
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,
Who manages VAERS?
What type of reactions are monitored for?
CDC and FDA
Alopecia after Hep B
Thrombocytopenia after measles
Myopericarditis after small pox
What vaccine program is a no fault resolution program and provides ACIP childhood schedules?
Which one provides compensation for injuries?
NVICP
CICP
What is the incubation and communicable periods for measles?
Incubation- 14 days for rash
Communicable- 4 days before rash until 4 days after
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
What is the incubation and communicable period for smallpox?
Inc- 7-17 days
Comm- from onset of Sxs to separation of scabs
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)
What are the components of the Host within the epidemiologic traid?
I CAPS Susceptibility Prior exposure Age Co-infection Immune response
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
What are the components of the Environment within the epidemiologic triad?
SPPC Social structure Population density Physical structure Climate
Define Primary/Definitive host
Organisms that a pathogen reaches maturity and reproduces in
Define Secondary/Intermediate host
Organism that harbors the sexually immature parasite and is required for completion of the life cycle
Define Dead End/Accidental host
Organism that doesn’t allow transmission to the definitive host
What are two examples of dead end hosts?
Horses and humans for the West Nile virus, normally between mosquito and birds
Define Natural Reservoir
Specific environment in which an infectious pathogen naturally lives and reproduces or one that is primarily depended upon for survival
A reservoir is usually what main characteristic
Living host of certain species without causing dz to reservoir itself
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
Define Convalescent Carrier
Where is this method commonly seen?
Capable of spreading disease following a period of illness
Viral diseases- hepatitis, polio
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
Define the type of disease transmission: fly carries shigella from latrine to food?
Indirect vector borne mechanical transmission
Define the type of disease transmission: staphylococcal poisoning from a single meal?
Indirect vehicle borne transmission single exposure
Define the type of disease transmission: student in hallway sneezes on you?
Direct transmission droplet spread
Define the type of disease transmission: cook with poor hand washing contaminates a salad?
Indirect vehicle borne transmission probable multiple exposure
Define the type of disease transmission: person w/ TB repeatedly coughs during 9hr flight?
Airborne transmission
Define the type of disease transmission: child with impetigo gives you multiples hugs?
Direct transmission person to person
Incidence represents the ?
Prevalence represents the ?
Risk of getting a Dz
Odds of having it in a population
In a steady state situation, what is the prevalence equation?
P= incidence x duration of dz
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
Define Isolation
Separation/restricted movement of ILL people who have a contagious disease in order to prevent transmission
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
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
What is the purpose of Hospital Isolation
Transmission-based precautions
Established for a specific Dx
Who does exclusion from work apply to?
Health care
Day care
Food handler
Law enforcement/detainees
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
What is the primary role of occupational health in a military setting?
Protect service members and DOD civilians
PrevMed
Public Health
What are 4 reasons for Occupational Health
Compliance with laws, regulations and executive orders
Maintain healthy work force
Maintain productivity
Decrease organization costs
What was NIOSH created under?
OSHA 1970
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
Human remains do not pose a threat as communicable disease hazards with what exception?
Death from cholera,
Viral hemorrhagic fever
Epidemic typhus (Louse-borne)
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
What type of diarrhea outbreak is considered a public health emergency?
Cholera
What is the goal of diarrhea disease treatment?
What is the main treatment goal?
Prevent death from dehydration and circulatory collapse
Re-hydration
When are ABX used for diarrhea disease?
Moderate/sever cholera
Dysentery- bacillary or amoebic
Giardiasis
What is a major respiratory cause of morbidity and mortality in emergency setting
Pneumonia
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
Characteristics of Influenza B
Infects humans and swine
Seasonal epidemics
Mostly antigenic drifts
Characteristics of Influenza C and D
C= mild illness
D- infects cattle
What are the H and N parts of Influenza A
Hemagglutinin- binds to respiratory cells
Neuraminidase- releases new virions from cells
When is flu season in the northern/southern hemisphere?
N= Oct-March S= Apr-Sept
What factors increase and inverse Influenza A ability to transfer?
Aerosol- little/no transmission with high humidity
Temps- greater transmission at lower temps
Current influenza vaccines are categorized as ? or ?
Trivalent- two influenza A and one B
Quadrivalent- two As and two Bs
What is the definition of measles outbreak?
Three or more confirmed cases linked in time and space
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
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
What medication is used for chemoprophylaxis for Traveler’s Diarrhea if a PT requests it?
Bismuth subsalicylate- 2oz of liquid or,
2 tabs Q4D
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
What are the routine childhood vaccines?
MMR Varicella DTaP Polio HiB Hep A/B PCV Rota Influena
What are the routine vaccines for adolescents/Adults?
Tdap Meningococcal HPV Influenza Penumococal Vericella/Zoster MMR
What type of mosquito carries JEV?
What time of the day do they eat?
Culex
Evening and night biter
What are the sources of medical intelligence?
Strategic- NCMI for DoD
Tactical- S2/G2
What info IS provided by NCMI
Health risk Health services Trends/forecasts Indications/warnings Facility database
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
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
Use of Malarone for malaria prevention
Does not kill dormant liver stage
Must still use Primaquine for presumptive PART
What two meds are the only approved drugs for acting on the dormant hypnozoites in the liver?
Primaquine
Tafenoquine
What are the ABCDEs of malaria prevention
Awareness Bite prevention Chemoprophylaxis Dx Emergency standby treatment
What is the primary host of Leptospirosis
Brown rats
Humans are dead end hosts
What medication is used for preventing Leptospirosis infections in service members?
Doxy 200mg 1x/wk= 95% effective prevention
When is re-screening peformed after STI treatment?
3, 6, 9 and 12 mon
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
What class of ABXs are the last ones recommended and still effective for gonorrhea treatment?
Cephalosporins
What is the current combo therapy recommended for treating gonorrhea?
Ceftriaxone 250mg IM
Azithromycin 1g PO
How is Expedited Partner Therapy for gonorrhea treated?
Cefixime
Azithromycin
Characteristics of Chlamydia
Most reported bacterial STD in US
10x more prevalent than gonorrhea
Most costly non-viral transmitted infection
What is the screening method for chlamydia?
NAAT for men
Vaginal swabs for women
What is the recommended chlamydia treatment regiment?
Azithromycin 1g PO or
Doxy 100mg PO BID x 7 days
What is the alternative treatment recommendation for chlamydia
Ezithromycin 500mg Q4D x 7 days
Ofloxacin 300mg BID x 7 days- for pregnancy
When is re-testing needed after chlamydia treatment?
Not needed if treated w/ Azithromycin or Doxy
Retest if treated w/ Erythromycin
Define Food Infection
Organisms are present/introduced to foods and multiply in the food/human body until they cause sickness
Define Food Intoxication
Microbes are present in food and produce a toxin. The toxin causes the illness and not the actual microbe
What is an examples of a naturally occurring chemical and introduced chemicals
Ciguatera Toxin
Poison, pesticide, leeching from containers
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
What causes the majority of chemical and parasitic food borne illness?
Aquatic animals
Fish= chemical
Parasitic= mollusks
What are the top five pathogens contributing to domestically acquired food borne illnesses resulting in death?
Salmonell Toxoplasma gondii Listeria Norovirus Campylobacter
What are the 3 food borne investigation tasks in bold?
Detecting possible outbreak
Generating hypotheses about sources
Controlling outbreaks
What is one of the reasons we do routine surveillance in food services?
Detecting possible outbreaks
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
For food borne illnesses, define diarrhea
Loose/water stools three times on 24hrs
Acute= <14 days
Persistent= >14days, < 30days
Chronic= >30days
How long does it take for N/V from ingesting preformed toxins to start showing?
Within 6hrs
Define Scombroid
From eating improperly stored/processed fish
Commonly from tuna, mackerel, mahi mahi, or blue fish (fish with high histidine levels)
What are the S/Sx of Scombroid?
Facial flushing
Burning/peppery taste in mouth
Facial rash/pruritus
What are the non-inflammatory viruses?
Rotavirus
Norovirus
Adenovirys
Cytomegalovirus
What are the non-inflammatory bacterias?
Enterotoxigenic E Coli Clostridium Perf. Staph A Bacillus Cereus Vibrio Cholera
What are the non-invasive parasites?
Giardia intestinalis
Cryptosporidium
Cyclospora
How are Bacillus Cereus infections acquired?
Meat/veggie foods after cooking and not maintained at temp
What are the S/Sxs and time frames of a Bacillus Cereus infection?
8-16hr incubation
Watery diarrhea and GI pain
How is Norovirus testing conducted for Dx?
PCR
There are no standardized/validated lab tests for detecting Norovirus in food except for in ?
Shellfish
What is the Kaplan Criteria
Mean illness duration of 12-60hrs
Mean incubation of 24-48hrs
50% w/ vomitting
No bacterial agent ID’d
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
Characteristics of Salmonella, non-typhoidal
Leading cause of food borne illnesses, hospitalizations and death
More common in warmer months
Present in poultry
What temp and time frame is recommended for killing Salmonella?
165*F x 15 min
How are PTs determined to be ASx from Salmonella?
Two negative stool cultures collected no less than 24hrs apart
What is the most common contaminated method of Campylobacter transmission?
Unpasteurized milk
Capylobacter infections are at highest risk for people traveling to what countries?
Africa
S. America
What is the only source of the Salmonella bacteria?
How is it transmitted?
Human
Fecal/urine contamination of food/water
What is a superior form of drying hands?
Paper towels
What is the danger zone temps for bacteria growth?
40-140*F
Especially 90-110*, can double population in 20min
What are the recommended temps and storage times for food?
Shallow containers
40F or lowers within 2hrs
If outside and temps are >90F, refrigerate within 1hr
Define Primary Prevention and it’s main goal
Pre-pathogenesis phase
Prior to Dz exposure
Remove cause of disease- imms
