Rotavirus, Meningococcal, MMRV, Herpes Zoster Flashcards
What causes rotavirus?
viral infection caused by Rotavirus
-many serotypes
How is rotavirus transmitted?
fecal-oral
What is rotavirus the most common cause of?
most common cause of diarrhea and need for hospitalization for dehydration secondary to diarrhea in children < 5 yrs
-almost all unimmunized children will have at least 1 rotavirus infection by age 5
-can get multiple times but each time is milder (partial immunity)
What are the signs and symptoms of rotavirus?
appear 1-3 days after a person has become infected
-diarrhea, fever, vomiting, stomach pain
-diarrhea can last 3-8 days
How long are individuals with rotavirus contagious for?
before the individual becomes ill and for 24 hours after diarrhea stops
What kind of vaccine is the rotavirus vaccine?
live attenuated oral vaccine
What are contraindications to the rotavirus vaccine?
immunocompromised infants
-controversy: CI infants 0-6 months if TNF exposure in utero
How does the rotavirus vaccine come in terms of available products?
pentavalent or monovalent
Should children receive the rotavirus vaccine?
routine immunization
Can babies eat before or after the rotavirus vaccine?
babies can breastfeed, eat and drink any time before or after receiving the rotavirus vaccine
What should be done if an infant spits up or regurgitates after the rotavirus vaccine?
a replacement dose should not be administered
What is an important aspect to remember about the first 10 days after receiving the rotavirus vaccine?
virus shed in stool for up to 10 days
-caution: handwashing and immunocompromised household members
What are the adverse effects of the rotavirus vaccine?
common:
-fever, diarrhea, irritable, loss of appetite, flatulence, abdominal pain, dermatitis
intussusception (bowel obstruction)
-absolute risk is quite low
-if history of bowel obstruction, rotavirus usually not given
What is meningococcus caused by?
bacterial infection caused by Neisseria meningitidis
-many serotypes; majority of invasive disease is associated with A, B, C, Y, & W-135
How is meningococcus transmitted?
respiratory droplets
close contact with respiratory secretions/saliva
-kissing, sharing of vapes, lipstick, food/drink, toothbrushes
-risk factors: crowded housing
What does meningococcus cause?
meningitis and bacteremia (invasive meningococcal disease)
-mostly in children < 5 & 15-24 yrs
What are the complications of meningococcus?
limb amputations
hearing loss
brain damage
seizures
skin scarring
even with abx treatment, mortality rate is 10-15%
What are the different types of meningococcal vaccines?
Men-C-C = meningococcal conjugate C vaccine
-monovalent
Men-C-ACWY-135 = meningococcal conjugate A, C, Y, W-135 vaccine
-quadrivalent
serogroup B meningococcal vaccines
Which meningococcal vaccines are routine in childhood?
Men-C-C and Men-C-ACWY-135
-serogroup B meningococcal vaccines not routine in childhood or adulthood
Which meningococcal vaccines require boosters in adulthood?
no routine adult boosters for meningococcal vaccines
Are the two different serogroup B meningococcal vaccines interchangeable?
non-interchangeable
Does the MMR vaccine cause autism?
does not increase the risk for autism and does not trigger autism in susceptible children
What causes measles?
viral infection caused by the measles virus
How is measles transmitted?
respiratory droplets
-highly infectious
What is the leading cause of vaccine preventable deaths in children worldwide?
measles
What are the signs and symptoms of measles?
fever
sore throat
cough
runny nose
red rash
What are the complications of measles?
otitis media
pneumonia
encephalitis
seizures
brain damage
deafness
death
What causes rubella?
viral infection caused by the rubella virus
How is rubella transmitted?
respiratory droplets
What are the signs and symptoms of rubella?
rash
lymphadenopathy
arthralgia
fever
What can rubella cause in pregnancy?
congenital malformations or miscarriage
-can lead to congenital rubella syndrome in the infant (heart disease, cataracts, deafness)
What is varicella caused by?
infection caused by varicella zoster virus
How is varicella transmitted?
respiratory droplets or direct contact with the blister fluid; vertical transmission
What are the signs and symptoms of varicella?
high fever
red itchy rash (begins at scalp and moves towards trunk)
-begins as red spots that become fluid-filled blisters that gradually crust over
What are the complications of varicella?
SSTIs
pneumonia
What is Herpes Zoster/Shingles?
reactivation of the varicella virus
What causes mumps?
viral infection caused by the mumps virus
How is mumps transmitted?
respiratory droplets
What are the signs and symptoms of mumps?
fever
respiratory symptoms
parotitis
What are the complications of mumps?
meningitis or encephalitis
3/10 males develop swollen testicles
1/20 females develop swollen ovaries
congenital malformations or abortion in pregnancy
What kind of vaccine are the MMR/MMRV/V vaccines?
live attenuated
What are contraindications to MMR/MMRV/V vaccines?
pregnancy
immunocompromised
When are MMR/MMRV/V vaccines given?
deferred until 12 months of age
-maternal antibodies decline at this point
What is a potential allergy concern with MMRV vaccine?
contains trace amounts of neomycin and gelatin so be cautious in those with severe allergies
What is the relationship between efficacy of MMRV vaccines and age?
efficacy increases with age
Should children receive MMRV vaccines?
routine immunization
Do adults need MMRV boosters?
no routine boosters
What are some important considerations regarding MMRV vaccines in adults?
MMRV not indicated in adults
-use MMR and V (if required)
V vaccine only indicated to 49 years of age
What are common reactions to MMR vaccines?
soreness, redness, and swelling at injection site
mild subclinical infection occurring 1 week after
-malaise and fever, w or w/o rash for 3 days
-may occur ~7-12 days after getting the vaccine
possible joint aches from the R component may occur in teenage and adult women
What are the adverse effects of V vaccines?
swelling and redness, possible low grade fever
a varicella-like rash (blisters) at injection site may develop
-less contagious than virus, cover until dried + crusted
What causes herpes zoster?
viral infection caused by reactivation of VZV
-VZV causes varicella (chickenpox) –> remains dormant & may reactivate later in life –> herpes zoster (shingles)
Can you get herpes zoster if you have never had chicken pox?
persons who have neither experienced varicella nor received varicella vaccine are not at risk for herpes zoster
What are the signs and symptoms of herpes zoster?
prodromal pain can precede the rash by days-weeks
maculopapular vesicular rash occurring along 1-2 dermatomes (usually thoracic) that does not cross midline (unilateral)
-lasts 7-10 days
What are the complications of herpes zoster?
postherpetic neuralgia
disseminated zoster: ophthalmic, CNS, pulmonary, hepatic
association with increased risk of cerebrovascular events within ~ 1 year post infection
mortality is uncommon
< 10% of individuals 65+ will be hospitalized
Who is the Shingrix vaccine recommended for?
adults 50 years or older
-also if previously vaccinated with Zostavax II
-zoster/shingles episode
adults 18 years or older with an immunocompromising disease
Should the Shingrix vaccine be given in pregnancy?
no recommendation, delay until after ideal
breastfeeding: may give, no known risk to infant
What kind of vaccine is the Shingrix vaccine?
adjuvanted, recombinant subunit
Which patient populations were studied in the Shringix RCTs?
mean age of 76 years and 62 years
What was the comparator in the Shingrix RCTs?
placebo
How long were the RCTs for Shingrix?
~ 3 years
What were the outcomes of the Shingrix RCTs?
decreased risk of shingles 91%
decreased risk of PHN 90%
immune response maintained for 9 years
-unclear if this correlates with shingles and/or PHN
How many doses are required for Shingrix?
2 doses (0 then 2-6 months)
-for individuals who are or will be immunosuppressed the 2nd dose can be administered 1-2 months after 1st
*no further doses needed at this time
