Travelers With Special Needs Flashcards
How many doses of meningitis C vaccine for HIV and asplenia?
2 doses more than 2 mos apart
What should be done after HB vaccination for a immunocompromised?
Titres
Name the conditions without immunologic compromise?
Corticosteroids Less than 20 mg of prednisone;
Long-term, alt day tx short-acting;
Maintenance physiologic doses;
Steroid inhalers;
Topical steroids;
Intraarticular injection;
More than 1 month since last high-dose steroids;
HIV >500/mm CD4;
Cancer patient, last chemo >3 mos & malignancy in remission
BMT: >2 yrs & not immunosupressive & without graft-versus-host;
Autoimmune disease- lupus, RA, inflammatory disease not tx immunosuppressive;
MS not on immunosuppressive or immunomodulatory agent & not experiencing exacerbation
Which vaccines are safe for preople with MS? Live , inactivated
Inactivated safe. Don’t give during relapse
Safe for people tx interferon, glatiramer acetate, mitoxantrone, fingolimod, natalizumab
Live: mmr , v , zoster- maybe safe if MS stable and administered 1 mos before starting or after discontinuing immunosuppressive therapy
Don’ t give live vaccine during immunosuppressants
When should live virus vaccine not be given to MS patient?
Receiving immunosuppressant: mitoxantrone, azathioprine, methotrexate, cyclophosphamide. Or
During chronic corticosteroid
Which disease is the terminal complement deficient more susceptible?
Meningococcal disease
This group is susceptible to meningitis
When should childhood vaccines be administered after BMT?
12 months
When should MMR vaccine be administered after a transplant?
24 mos
Same rule for varicella need to make sure immunocompetent
When should INF vaccine be administered in a transplant?
6 mos
When should a solid-organ transplant travel to high risk distination?
1 year
Which live virus vaccine can the household contact of severely immunocompromise receive?
MMR, YF, Var,
Not live influenza
Which vaccine still used should immunicompromise still be aware of risk?
Risk of transmission Oral polio &
Small pox
Can immnocompromise receive the varicella vaccine?
Yes. Should receive 2 doses spaced by 3 months
Should Previously unimmunized asplenic, hiv, immunocompromised adult receive the PCV13 followed by PPSV23?
Should receive 1 dose of PCV13 and> 8 wks later PPSV23
When can you give mmr vaccine to symptomatic HIV patient?
CD4 count greater than 200/mm without measles immunity
IG for short term protection for those facing high risk of measles and MMR vaccine is contraindicated
Name chronic conditions associated with varying degree of immune deficit?
Asplenia, chronic renal disease, chronic liver disease, diabetes, complement deficiencies
Which vaccines are recommended for asplenic patients regardless if they travel?
Men -c-quadrivalent
Hib conjugate vaccine
Pneumococcal
They are susceptible to overwhelming sepsis with encapsulated bacteria
Name some special consideration for immunocompromised traveler?
- Discourage travel to dedtination that present true risk for YF
- if unavoidable and at risk. Teach ins. Prec. Provide medical waiver
- pt with precaution to administer YF may be offered vaccine but to monitor closely and offer serology 1 month after vaccination
- give waiver if not a true exposure and YF is a travel requirement ( waiver may be rejected)
What are the antimalarial that would be considered reasonable for those on highly active antiretroviral therapy(HAaRT)?
- Doxycycline: no effects on proteaseinhibitors & NNRTIs
- Malarone: atovaqupne has no significant interaction with NRTIs no dta for proguanil
What is the recommended tx for uncomplicated P. Falciparum for the immunocompromise?
Artemether-lumefantrine: 6 doses taken over 3 days
Which medication is recommended to tx of sever malaria in immunocompromise?
IV artesunate
- quinidine should not be used if taking nelfinavir or ritonavir due to cardiotoxicity if no choice need close monitoring
Asplenic people at high risk of complicated malaria should teach?
Adhere to malaria chemoprophylaxis
What are the antimicrobial to be used for someone taking HAART?
Fluoroquinolones and rifaximin
Macrolide ( zithromax)may have significant interaction
- emerging therapy: probiotics
How can you avoid cryptosporidiosis and giardiasis?
Avoid swallowing water during swimming & should not swim in water cantaminated with sewage animal waste)
Best way to prevent gastoenteritis?
Handwashing
