PREGNANT HCWs Flashcards
Is a pregnant HCW considered to be healthy?
Yes. Immunologic function is normal during pregnancy. There is also some decrease in cell mediated immunity in the third trimester to viruses and pathogenic fungi
Which virus presents a primary risk to the mother and fetus-neonate?
Varicella zoster
What is a restriction for pregnant women for when a patient is infected with this particular virus?
When patients are infected with parvovirus B19 and for patients with RSV infections who are receding ribavirin aerosol
What type of vaccines are NOT recommended during pregnancy
LIVE virus vaccines
Which are live vaccines?
MMR
VARICELLA
Which are inactivated or dead versions of a vaccine?
Influenza
Polio
TDap
Which infectious agents are prevented by pre-exposure vaccines?
Anthrax
HAV
HBV
influenza
n. Meningitis
Pertussis
Rubella
Rubeola
Varicella
Tetanus
Diphtheria
Smallpox
Which infectious agent are known to have healthcare associated acquisition that is unlikely?
HSV
TOXOPLASMOSIS
Which infectious agents have infection prevention precautions as the only preventive measure?
CMV
HCV
PARVOVIRUS B19
TB
Which infectious agents are known to have post exposure chemoprophylaxis as effective?
HIV
N meningitis
Syphillis
What type of precautions do we use for Parvovirus?
Droplet
Which vaccines should pregnancy women have been vaccinated for as HCP?
MMR
Poliomyelitis
Varicella
Tetanus
Diphtheria
No risk if pregnant women have inactivated vaccines or toxoids
Which vaccines are contraindicated for pregnant women?
Human papilloma virus
Influenza (LAIV)
MMR
Varicella
Zoster
How is CMV transmitted most frequently by?
Sexual contact or by direct contact with infected urine, saliva, semen, vaginal secretions, or breast milk
What are major risks for primary infections among aerobatics women?
Age < 25 yrs old
Multiple sex partners
Exposure to young children (especially those who attend day care centers and schools
How is the spread of CMV among the general population facilitated?
Asymptomatic primary and recurrent infections, multiple sites of excretion, prolonged and intermittent excretion and excretion of virus despite the presence of specific immunity.
HAV Infection transmission to the fetus has not been established. What can HAV infection during pregnancy cause?
Increased risk of severe systemic infections, spontaneous abortion and preterm delivery
HBV INFECTION during pregnancy can result in severe disease for mother. Without post exposure immune prophylaxis what will happen to infants?
approximately 40% of infants born to HBV infected mothers in U.S. will develop chronic HBV infection, approximately one fourth of whom will eventually die from chronic liver disease
What should newborns receive if mother is HBsAg positive?
HBIG 0.5 mL IM and single antigen HBV vaccine at separa infection sites within 12 hrs of birth
How does HCV get transmitted
Sexually, by exposure to blood via transfusion, sharing needles for IV drug use, percutaneous injury and rarely perinatal exposure
Is there HCV vaccine?
No and no effective therapy during pregnancy or postnatal period
What is BEST way to prevent HCV occupational exposure?
Avoid percutaneous blood exposures via safety decide and wearing gloves
What do studies show with acute HCV infection in first and second trimesters?
Cause fetal hepatic injury
Is there a vaccine for HSV?
No but prevention is by using Standard Precautions
How does HSV MOSTLY present and how is it prevented?
Herpetic whitlow
Prevented by use of gloves for contact with mucous membranes and unlikely to affect genital tract or fetus
How does transmission of HSV occur through contact?
Oral-oral
Oral-genital
Genital to genital
Can transmission of HSV occur THROUGH fomites?
Yes fomites contaminated by body fluids
What is the percentage of the general population who have antibodies to HSV-1, HSV-2 or both
55 to 90%
For HIV what types of needles have increased risk of percutaneous transmission?
Hollow bore needles when an increased risk volume of blood is injected
What is the percentage seroconversion after HIV exposure for:
Percutaneous
Mucous membrane
Nonintact skin
Percutaneous 0.3%
Mucous membrane 0.1%
Nonintact skin <0.1%
For PEP for pregnant HCP what needs to be done?
Evaluation of risk of infection and need for PEP need to be done thoroughly and decision to use antiretroviral drug during pregnancy. Expert consultation for HIV PEP needed
Are HPV (Human Papillomavirus) vaccines recommended for pregnant women?
No! If woman found to be pregnant if vaccination serious started shoudl be delayed until completion of pregnancy
Is MMR VACCINE ok to give to pregnant women? And what should they be counseled on?
No!
They should be told to avoid becoming pregnant for 28 days after vaccinations with MMR vaccines or other rubella containing vaccines
What is parvovirus B19 and the causative agent and what is it also known as?
Causative agent of erythema infectiosum (also known as fifth disease)
Why is Parvovirus B19 of concern to pregnant HCP?
Can cause infection of RBC precursors and leads to severe anemia and high output cardiac failure in the fetus, hydrops fetalis and fetal death
What percentage of infections with Parvovirus B19 result in fetal death?
5% (often in early miscarriages)
How is Parvovirus B19 spread and what types of precautions needed?
Respiratory secretions and Droplet Precautions needed
How does Parvovirus present as?
Facial rash that resembles slapped cheek and a reticular pattern of rash on arms
What is pertussis?
An acute respiratory infection caused by Bordatella pertussis.
How does pertussis damage epithelium?
Organism produces multiple toxins that damage epithelium and can have systemic effects including promotion of lymphocytosis
What is incubation period of pertussis?
7 to 10 days (range 5 to 21 days)
What is classic pertussis characterized by in three phases?
Catarrhal
Paroxysmal
Convalescent
How is pertussis transmitted?
Person to person via large respiratory droplets generated by coughing or sneezing
Which age group in children likely to have severe pertussis?
Infants younger than 12 months and especially younger than 3 months and require hospitalization and have real and other complications
When do most deaths occur from pertussis ?
Infants less than 2 months of age
When should these age groups receive TDap?
Young children
Preteens
Pregnant women
Adults
Young children: 2,4, 6 months
15 through 18 months
4 through 6 years
Preteens 11 through 12 years
Pregnant women - during 27th to 36th week of each pregnancy
Adults - anytime if haven’t received
Should pregnant women receive varicella vaccine?
No!
How infectious is varicella zoster virus?
Highly contagious (90% transmission rate to susceptible household contacts) from 1 day before outbreak of rash and lasts until lesions have dried completely
What is the most common complication from VZV?
Chickenpox pneumonia and expected to occur in 15 to 50% of adults when no antiviral treatment is given.
How much more severe is chickenpox pneumonia in pregnancy?
Maternal mortality rate of 41 to 46 % compared with 11% in non pregnant adult
What should pregnant women be treated with for CPX?
Acyclovir
What is the result of severe maternal varicella infection?
Fetal death. Virus has not been shown that virus causes fetal death or first trimester wastage
variZIG is recommended for pregnant women without evidence of immunity. When should this occur?
ASAP following VZV exposure ideally within 96 hrs (4 days)
