Vaccinations

Question 1

Which vaccines are given in the first 6 months?

Answer 1

Hep B, DTaP, IPV, PCV-13, Hib, Rotavirus

Question 2

Hep B virus Tx

Answer 2

none for acute infection

chronic active hepatitis:
anti-virals – lamivudine
interferon-alpha

Question 3

What is given if infants born to hep B surface antigen positive mothers?

Answer 3

HBIG at birth with Hep B vaccination

Question 4

Diptheria clinical findings

Answer 4

acute URI
swelling, respiratory symptoms
dehydration
thick exudative membrane over pharynx

pharyngeal diptheria
obstructive tracheolaryngitis
can cause cutaneous, vaginal, conjunctival or otic infection
complications (“bull neck,” myocarditis, peripheral polyneuropathy)

Question 5

Diptheria Tx

Answer 5

IV equine anti-toxin
erythromycin or penicillin
active immunization

Question 6

Tetanus clinical presentation

Answer 6

Pain at the site of inoculation
Hypertonicity
Spasm
Exaggerated spasms in response to light stimuli

Question 7

Tetanus Tx

Answer 7

human tetanus immune globulin (TIG):
IVIG if TIG is not available
equine tetanus antitoxin (not available in U.S.)

treatment of wounds:
wound excision if necrotic tissue is present

antibiotics:
metronidazole or penicillin

spasm control:
minimized stimulation
muscle relaxants
time (if not fatal, symptoms subside in a few weeks)

Question 8

Pertussis Labs

Answer 8

Leukocytosis – lymphocytosis predominance (right shift)
lymphocytosis
Charcoal-Lowe media culture (poor sensitivity in practice)
PCR

Question 9

Pertussis Tx

Answer 9

antibiotics:
azithromycin (drug of choice)
may shorten course of disease in catarrhal phase

alternate – TMP/SMX
prevent spread of infection

inpatient monitoring until cyanotic episodes clear

supportive care:
oxygen
ventilatory support

Question 10

Pertussis vaccine contraindicated for who?

Answer 10

vaccines can cause seizure and are contraindicated in some children who have neurologic diseases or are undergoing evaluation for neurologic diseases. In these cases you would give DT.

Those who had encephalopathy within 7 days of administration of previous dose without another identifiable cause

Question 11

Who must we take precautions for when giving the pertussis vaccine?

Answer 11

temperature of 40.5°C within 48 hours without another identifiable cause

collapse or shock-like state within 48 hours

persistent crying of or over 3 hours within 48 hours

seizure within 3 days

Question 12

when do you have to switch from DTaP to Tdap?

Answer 12

once the child is over 7 y/o

Tdap is routine in adolescents 11-12 y/o, as they are a common reservoir.

Question 13

Polio Sx

Answer 13

headache, low-grade fever, sore throat, muscle weakness
(originally inoculates the oropharynx
headache may represent aseptic meningitis)

asymmetric, flaccid paralysis
(infection of anterior horn of spinal cord
0.1 to 2.0% of infected )

muscle tenderness and hyperesthesia; intact sensation

later - muscle atrophy

Question 14

What pathogen is the most common cause of invasive bacterial infection in children?

Answer 14

strep pneumo

Question 15

what is the current vaccine recommended for pneumococcus?

Answer 15

PCV-13

Question 16

Hib classic infections

Answer 16

meningitis, acute epiglottitis, pneumonia, septic arthritis, cellulitis.

Question 17

Hib Tx

Answer 17

3rd gen cephalosporin

Question 18

What viral pathogen is the most common cause of severe diarrhea in infants and children?

Answer 18

Rotavirus

*nearly every child is infected by 5 yo
severe infection at 4-36 mos of age

Question 19

Rotavirus Tx

Answer 19

hydration

Question 20

Rotavirus diagnostics

Answer 20

typically made without lab testing

antigen test of stool if diagnosis is uncertain

Question 21

Measles Dz progression

Answer 21

Starts with prodrome of fever and malaise. Progresses to cough, coryza and conjunctivitis.

2 days prior to rash Koplik’s spots can occur in the mouth. These are bluish, grey spots on the buccal.

2-4 days after fever patient will develop an erythematous, blanching full body rash.

Question 22

complications of measles

Answer 22

Diarrhea

Pneumonia- number one cause of mortality from measles

Encephalitis and Acute disseminated encephalomyelitis (ADEM)

Question 23

Mumps Dz progression

Answer 23

Starts with flu-like symptoms: fever, malaise, headache.

Progresses to parotitis (inflammation of the salivary glands) and in some cases orchitis or oopheritis

Question 24

Symptoms of rubella

Answer 24

Symptoms include a low grade fever, lymphadenopathy and pinpoint rash that starts on the face and progresses down to trunk and then generalizes.
Arthralgias can also be present.

Question 25

Congenital Rubella Sx

Answer 25

“blueberry muffin” rash, cataracts, deafness, cardiac defects

Question 26

How do infants get congenital rubella

Answer 26

90% of women who contract rubella in the first 3 months of pregnancy will give birth to a baby with congenital rubella syndrome.

Question 27

Varicella Complications

Answer 27

Encephalitis

Bacterial
Superinfections

Pneumonia

Reye’s Syndrome:
(Nausea, vomiting, headache, delirium, and coma)Precipitated by Salicylate (Aspirin) usage in children with viral illness

Shingles- recurrence of varicella later in life

Question 28

Congenital varicella sx

Answer 28

• Cicatricial skin lesions that are in a dermatomal distribution
• Limb abnormalities
• CNS abnormalities- microcephaly, seizures, cortical atrophy or intellectual disability
• Cataracts, choreoretinitis

Question 29

Neonatal Varicella Sx

Answer 29

Can range from mild disease with rash to generalized infection with encephalitis, hepatitis and pneumonia

Question 30

Which serogroup is most common for meningococcus?

Answer 30

Serogroup B