Vaccine Preventable Diseases Flashcards
3 vaccines recommended in pregnancy
influenza
Tdap
COVID
the varicella zoster virus causes
chicken pox
reactivated varicella zoster is
herpes zoster = shingles
varicella transmission
airborne (resp droplets) and virus shed from skin lesions- highly contagious (primary infection)
list 1 complication from varicella
pneumonia, abcteremia, severe skin infection, death
T or F: varicella infection results in life long immunity
T
2 preparations for varicella
live attenuated univalent
live attenuated MMRV
how many doses of varicella is required for immunity
2 dose primary series
which of the following is false
1. varicella zoster causes shingles upon reactivation
2. complications of varicella include pneumonia
3. varicella may be vaccinated against along with measles, mumps, and rubella
4. pregnant women are a priority in being vaccinated for varicella
4- can’t give varicella during pregnancy, women of childbearing age are a priority
should those >50yrs old, born before the varicella vaccine receive the vaccine?
no- assume that they had chickenpox
should those <50yrs get the varicella vaccine
yes- 2 doses if susceptible
____ doses of varicella are given _______
2 doses before school entry
varicella zoster virus inhabits _______ in the body
nerve base at specific dermatomes
zostavax is a ______ vaccine given ____ (route). it is approved for _____ and is ____ effective than shingrix
life attenuated
SC
>50yrs (rec >60yrs)
less eff than shingrix
shingrix is a ________ vaccine with ____ doses given ____. Recommended use is in ____ and is ____ effective than zostavax
inactivated, adjuvant
2 doses
IM
>50yrs
more eff than zostavax
RZV should be offered to those ________
1. are >50yrs without CI
2. have previously had shingles
3. have previously had chickenpox or the varicella vaccine
4. all of the above
4
protection against shingles for those that are immunocompromised can be done with
RZV (shingrix)
pros of chingrix
Much more eff than live attenuated - Adjuvant increases immune resp = longer lasting + greater immunogenicity
High lvl of efficacy up to 7yrs of FU
Not a live vaccine (↑ data in immunocomp pts)
89-91% eff in preventing PHN (~67% w/ LZV)
cons of chingris
Req 2 doses
Expensive + not publicly funded
Injection site (pain, redness, swelling) + other rxns (myalgia, fatigue, fever)
Rxns occur more often in 50-69yrs (↓ in 70yrs)
pneumococcal transmission
close, direct contacts, respiratory droplets
strep pneumoniae causes
otitis media, sinusitis, bronchitis, pneumonia
IPD is
invasive pneumococcal diseases including: meningitis, bacteremia, endocarditis, septic arthritis, osteomyelitis, peritonitis
2 types of pneumococcal vaccine + their routes
conjugate (M) and polysaccharide (IM or SQ)
number of doses of pneumococcal for ≥65yrs, regardless of RFs or prev pneumococcal vacc + which preparation
1 dose of polysaccharide
number of doses of pneumococcal for 18-65yrs at high risk of IPD due to underlying condition (heart, kidney, liver, lung, DM) + which prep
1 dose + 1 booster at least 5 years later
polysaccharide for both
which vaccine + schedule of pneumococcal for 18-65yrs + residents of LTC, smokers, alcoholism, homeless
1 dose of polysaccharide
which vaccine + schedule of pneumococcal for adults with immuncomp condition
1 dose Pneu-C-13
1 dose Pneu-P-23 at least 8 wks after Pneu-C-13
1 booster dose of Pneu-P-23 at least 5 yrs later
should those that are >65yrs and immunocomp receive pneumococcal
consider individually
which pneumococcal vaccine is effective in preventing pneumonia and IPD
pneu-C-13
which pneumococcal vaccine may or may not prevent CAP, but may be as effective as conjugate in preventng IPD
pneu-P-23
does the pneu-P-23 protect against pneumonia
may/ may not- not as good as conjugate
describe hyporesponsiveness to polysaccharide vaccines
Too many doses of polysaccharide = dead B cells = hyporesponsiveness = 2 doses max of polysaccharid
influenza is a _____ virus
RNA
influenza transmission is through
primarily by droplets spread through coughing or sneezing, direct or indirect contact with respiratory secretions
describe Type A influenza
Classified into strains or subtypes based on proteins/ antigens on virus surface (ex- H1N1, H3N2)
Seasonal, avian, swine influenza
Can cause significant disease
Infects humans and other species (Ex birds)
Can cause epidemics and pandemics (worldwide epidemics)
describe type B influenza
Classified into 2 antigenically distinct lineages- Yamagata and Victoria
Seasonal influenza
Generally causes milder disease but may also cause severe disease
Limited to humans
Generally causes milder epidemics
which influenza type is classified into subtypes based on proteins/ antigens on virus surface
type A
which influenza type is limtied to humans and generally seasonal
type B
trivalent influenza vaccines included
2 influenza A + 1 B
quadrivalent influenza vaccines included
2 A + 2B
how does WHO recommend which influenza strains to be included in the vaccine
look at what is spreading in the southern hemisphere
antigenic drift is
slight changes in strain that occur within a host
antigenic shift is
when 2 or more strains of influenza recombine in host = produces totally new strain = causes outbreaks
which influenza subtype experiences antigenic shift
1. type A
2. type B
3. both
4. neither
1
common influenza vaccine SEs
inj site pain, tenderness, redness, swelling, HA, malaise, fatigue, myalgia, fever, arthralgia
rare influenza SEs
immediate allergic type resp like hives, angioedema, anaphylaxis, GBS, ORS
CIs to TIV/QIV inactivated influenza vaccine
<6mths
anaphylactic rxn to prev dose of influenza
known hypersens to any component (except egg)
dx w/ GBS within 6wks of prev dose
experienced severe ORS w/in 24hrs of receiving influenza vaccine (assess before immunizing)
CIs to LIAV influenza vaccine
<2yrs
anaphylactic rxn to prev dose of influenza
known hypersens to any component
immune comp conditions
children with severe asthma (or medically attended wheezing in 7d prior to vaccination
children/ adolescents receiving aspirin
which flu vaccine is grown on mammalian cell culture
flucelvax
the immune response to the influenza vaccine includes production of circulating ____ to the viral _____ and _____ proteins, as well as a more limited _____ response
circulating IgG antibodies
viral haemagglutinin and neuraminidase proetins
cytotoxic T lymphocyte response
Ab levels achieved within 2 weeks of influenza vaccine usually lasts
<1yr
when is high dose influenza vaccine used
> 65yrs old
Evidence from SRs showed the high dose influenza had __________ eff in preventing influenza illnesses, influenza and pneumonia hospitalization and mortality compared to normal dose
no difference/ more
NACI recs for influenza vaccine
supports vax in =>6mths
consequences of influenza in pregnancy include
higher rates hospitalization, CV complications, death (vs general public), risk premature labor and delivery
the influenza vaccine in pregnancy
1. provides protection for the mother only
2. associated with infants that are larger for gestational age
3. may have safety concerns depending on mother medical conditions
4. provides protection to the fetus by transplacental antibodies
4
the influenza vaccine in preg is assocaited with
lower hospitalization rates in pregnancy + infants less likely to be premature or small for gestational age
in children <9yrs who are receiving influenza vaccine for the first time will recieve
2 doses, 1 month apart
1st dose is the priming dose
in children <9yrs who are getting their first shot of influenza vaccine, how long is the interval between the primer dose and booster dose
1mth
what happens if child getting flu shot for first time doesn’t come back for booster dose 1mth later
no protection for that first year, do 1 dose next year as normal
GBS is an illnses that attacks the
nervous system
GBS is characterized by
loss of reflexes + symmetrical paralysis usually starting in the legs
T or F: BGS has a complete/ near complete recovery in most cases
T
the risk of GBS with influenza __ influenza vaccine
>
Recommended to not provide influenza immunization to those diagnosed with GBS within ___ of previous influenza immunization
6 wks
GBS may be triggered by
infection
ORS onsets ___ after immunization
24hrs
ORS sx
bilateral red eyes + respiratory sx
COVID virus type
RNA
covid transmission
primarily by droplets spread through coughing, sneezing, or talking- lesser degree via contaminated surfaces
Long covid/ post covid complications include
wide range of sx that can persist weeks or years post exposure, more common in those who had severe COVID (vaccinated may be less at risk)
fatigue that intx w/ daily activities, sx worsen with physical/ mental activity, fever, cough with SOb, chest pain, heart palpitations, HAs, sleep problems, GI issues, joint and muscle pains
increase cases of covid increases the risk of
variants/ mutations
the WHO watches for variants of concern by watching for those that impact (3)
transmissibility
immunity to vaccines
infection severity
the WHO divides variants into
variants of concern
variants of interest
covid vaccine development has focused predominantly on the
viral structural spike protein
next generation vaccine platforms include
viral vector
DNA/ RNA
antigen presenting cells
the pfizer mRNA vaccine can be given as ______ for ______
bivalent booster dose for =>5yrs
the moderna vaccine primary series can be given to those _____ and the bivalent booster for those _________
primery series +6mths
18+ bosoter
what type of vaccine is the AZ covid vaccine
viral vector
what is the difference between mRNA vaccine in deltoid vs lymph node
deltoid has proteosomal degradation + presentation on MHC 1 to CD8 T cell
lymph node also has endosome intake to presentation on MHC 2 to CD4 T cell
what is the most common correlate of immunogenicity/ protection
neutralizing Ab titers
COVID recommendations for mod-severely immunocomp
primary series of 3 doses of mRNA, if already received a 1 or 2 dose vaccine = rec additional dose of mRNA
COVID vaccine recommendations for pregnancy/ breast feeding
mRNA preferred, but protein subunit or VLP may also be offered to those not able/ unwilling to receive mRNA
when should those infected with COVID get boosters
can do immediately but prefer to wait 5 months (3 months if immunocompromised)
Pts =>6mths, COVID vaccines may be given concurrently with ____________________
nonCOVID vaccines (including live and nonlive)
hep A transmission
fecal oral route
hep A incubation period
avg 28 days
hep A cases are infectious ________ until ____________
2 weeks before onset of sx until 1 wk after onset of jaundice
severity of hepA increases with
age
Children <6yrs commonly asymptomatic, 25% adult cases hospitalized
T or F: infection with hepA confers immunity
T
infants and children can shed hepA virus for up to
6 months after infection
HAV vaccine type
inactivated
which of the following is false about hepA vaccines
1. it is a 2 dose series
2. it can be given pre and post exposure (if within 1 week of exposure)
3. the booster is given 2 months after 1st dose
4. it is adsorbed to aluminum hydroxide adjuvant
3- booster given at 6-36 months
who should be considered for preimmunization serology for anti-HAV
born prior to 1945, from endemic country, hx of hepatitis or jaundice that may have been caused by HA, dx w/ hepB/ C
who should get HAV preexposure
those 6mths and older at increased risk of infection or severe HA (Ex- travel)
who should get HAV preexposure
offered to household and close contacts of proven or suspected cases of HA (ex- group childcare centres, clients of infected food handlers)
Vaccines should pref be given ASAP, and ideally within 14 days
when shoudl the HAV vaccine be given post exposure
pref ASAP, ideally within 14 days
can consider if >14 days (no data here tho)
in those <6mths of age who have been exposed to hepA, what should be recommended
immunoglobulin
hep B virus type
DNA virus
hep B is transmitted by
blood, semen, vaginal fluids
in hepB
1. initial infection may be asymptomatic
2. those who clear the virus in the first 6 months become immune
3. the risk of a chronic infection decreases with age
4. all of the above
5. none of the above
4
T or F: hepB vaccine may be given post exposure
T- highly eff in preventing HBV when given to exposed infants, within 1 wk of percutaneous exposure or within 2 wks of sexual exposure
anti-HBs +, HBsAg and anti-HBc - =
immune (vaccinated)
anti-HBs +, HBsAg - and anti-HBc + =
immune (infected before)
anti-HBs, HBsAg, and anti-HBc - =
susceptible
how long does hepB immunity last after immunzation
indefinitely - boosters not recommended for immunocompetent individuals
routine bosters may be recommended if anti-HB titres fall below
10IU/L (but timing is important)
when would a person quality for a second vaccine series/ a higher dose of hepB
if negative for anti-HBs after 1st series
HPV is a _____ virus
DNA
what is the most common STI in Canada
HPV
HPV is
1. usually symptomatic and causes warts
2. can cause head and neck cancer
3. high risk HPV = 6,11
4. men can not get HPV
2
which HPV vaccine is not approved for males
HPV2- only covers 16 and 18 - cervical cancer
which HPV straisn are low risk
6, 11 = causes warts
which HPV strains are oncogenic
16,18
what are the recommendations for HPV for 9-27yrs old
HPV 2, 4, or 9
boys and men 9-27yrs old should get the HPV ___ or ___ vaccinse
4 or 9
which of the following groups have a disproportionately high burden of HPV
1. men who have sex with men
2. women 45 years or older
3. women in their 20s
4. women who have sex with women
1
diphtheria is transmitted by
close, direct contact with droplets from a cough or sneeze
T or F: infection with diphtheria confers natural immunity
F
diphtheria vaccine is
1. a primary series of 3 vaccines
2. is only available in combos
3. is recommended for infants starting at 1 month of age
4. 1+2
4
not 3 because rec starting 2mths of age
in those 14-16yrs olds, _____ should be the first diphtheria 10yr booster dose
Tdap
what is in the Tdap vaccne
tetanus, diphtheria, pertussis
what is in the Td vaccine
tetanus and diphtheria
adults should protect themselves from diphtheria by getting the ____ vaccine q__yrs
Td vaccine q10yrs
pregnant females should get 1 dose of ____ with each pregnancy
Tdap
tetanus transmission
not contagious, spreads through spores in the environment (introduced into wound)
T or F: tetanus infection does not confer immunity
T
tetanus vaccine
1. is a 3 dose series
2. is only available in combo vaccines
3. can result in hypersensitivity rxns if too many doses are given
4. all of the above
5. none of the above
4
postexposure prophylaxis to tetanus is
Td +/- tetanus immunoglobulin
pertussis sx
paroxysmal cough, whooping caused by inspiration against closed glottis (lasts 6-12wks)
immunity after pertussis infection is
1. life long
2. 2-10 years
3. 4-20yrs
4. not present- will kill you
3
why is Tdap recommended every pregnancy
Maternal IgG Abs actively transferred through placenta to provide passive immunity in first few months (minimal transfer until 13-16wks gestation- continuously incr in 2nd/3rd trim
severe disease most commonly seen in infants <2mth old
whole cell pertussis vaccine was changed to acellular due to
SEs from whole cell
polio is transmitted through the _______ route
fecal oral
polio is a _____ dose primary series
3
what is the gold standard for indicating polio in a community
monitoring wastewater`
which polio vaccine is no longer recommended? why?
1. trivalent inactivated polio vaccine
2. combination polio with Tdap
3. OPV
4. 1 and 2
3- associated with paralytic polio
how many boosters is rec for polio- who needs the booster?
1 only for those at increased risk of exposure
what was the most common cause of bacterial meningitis in Canada
haemophilus influenzae type B
Hib is
1. natural infection may result in lifelong immunity
2. natural infection will result in lifelong immunity
3. was the second most common cause of bacterial meningitis
4. is transmitted by feces
1
the Hib vaccine is (pick all that apply)
1. live attenuated
2. inactivated IM
3. inactivated PO
4. toxoid
5. polysaccharide
6. conjugate
5,6
the primary series of Hib is ___ doses in the first ___ then a booster at ____
3 doses in first 2mths
booster at =>12mths
meningococcal is transmitted through
respiratory droplets, mouth secretions
describe the Characteristic rash of meningococcal disease
petechial rash caused by damage to small blood vessels
which 5 serotypes of meningococcal cause nearly all invasive meningococcal diseases in Canada
A, B, C, Y, Q135
