Vaccine Preventable Diseases Flashcards
risk factors for hepb
iv drugs blood products tattoos or acupuncture sex institutional care intimate contact w carriers
clinical manifestations of hepb
- asymptomatic
- fever, anorexia, malaise 6-7 weeks after exposure
- jaundice 8 weeks and lasts 4 weeks
- chronic: hepatitis, cirrhosis, hcc
diagnosis of hepb
acute: hbsag, anti-hbc igm, anti-hbs (recovery)
vaccinated: anti hbsag only
resolved infaction: antihbsag + antihbc
infectivity: hbeag
treatment for hepb
supportive and monitoring
interferon a2b
lamivudine, adefovir, pedinterferon a2
prevention of hepb
vaccine: seropositivity >95% after second dose
birth, 1-2 mos, 6 mos
if >2000g and HBsAg (-) birth, 1-4 mos, 6-18 mos
preterm, <2000g, HBsAg(-) mother: first dose 1 mo age
if hbsag (+) mother: hbig within 12 h
etiology of diptheria
corynebacterium diptheriae and diptheritic toxin
risk factors for diptheria
- large population of underimmunized adults
- decreased childhood immunization
- population migration
- crowding
- failure to respond to epidemic
pathogenesis of diptheria
transmission: airborne respiratory droplets, direct contact with secretions
toxin causes kidney necrosis, thrombocytopenia, cardiomyopathy, demyelination of nerves
clinical manifestations of diptheria
incubation: 2-4 d
most common sites of infection: tonsils or pharynx
key words: serosanguinous, purulent, erosive rhinitis with MEMBRANE FORMATION
respiratory diptheria
unilateral or bilateral tonsillar membrane (gray brown leather)
bull neck appearance
airway compromise
cutaneous diptheria
superficial nonhealing ulcer with gray brown membrane
extremities > trunk or head
complications of diptheria
toxic cardiomyopathy: 50-60% of deaths, dilated and hypertrophic cardiomyopathy
toxic neuropathy: weakness of posterior pharyngeal, laryngeal, and facial nerves (voice and swallowing); cranial neuropathies (eyes)
treatment for diptheria
equine diptheria antitoxin
erythromycin q 6h po/iv
aqueous crystalline penicillin g q 6h iv/im
procaine penicillin
wound care, bed rest
prophylaxis for diptheria
benzathine penicillin g im
erythromycin qid 10 d
prevention of diptheria
dtap/dt: 2, 4, 6 mos, 15-18 mos, 4-6 yo
booster (td/tdap): 11-12 yo
etiology of pertussis
bordatella pertussis and pertussis toxin
clinical manifestations of pertussis
catarrhal phase (1-2 w): congestion
paroxysmal (2-6 w): machine gun dry cough
convalescent (>2 w): less cough
gold standard for pertussis diagnosis
isolation of b pertussis in culture (nasopharyngeal swab)
treatment for pertussis
<3 mos/ preterm/ co-morbids: admit in quiet room
<1 mo-5 mo azithromycin 10 mg/kd/d 5 d
>6 mo azithromycin 10 mg/kg/d day 1, 5 mg/kg/d day 2-5
>1 mo erythromycin (<1 mo = hypertrophic pyloric stenosis)
complications of pertussis
secondary infections
conjunctival and scleral hemorrhage
cns hemorrhage
pulmo hypertension and 2ndary pneumonia (death)
prevention of pertussis
dtap 2, 4, 6, 15-18, 4-6 yo
tdap booster 11-18 yo
etiology of tenanus
clostridium tetani and tetanoplasmin
tennis racket or drumstick
pathogenesis of tetanus
tetanus produce toxin -> binds at nms junction -> enters motor nerve -> cytoplasm of alpha motorneuron -> prevents glycine and gaba release
clinical manifestations of tetanus
incubation: 2-14 d / months
course: 1-4 w
trismus (lockjaw), risus sardonicus (smile), opisthonos, conscious in extreme pain, tetanic seizures
neonatal tetanus
- occurs when mother is not vaccinated
- manifests 3-12 d after birth
diagnosis of tetanus
- hx: unimmunized pt and mother
- injured or born within 2 wks preceding infection
- trismus, rigid muscles, and clear sensorium
treatment for tetanus
- human tetanus ig
- equine or bovine derived tetanus antitoxin
- doc: penicllin g iv
- seizure control
- nm blocking agents
- morphine
t/f children with tetanus can tolerate noise
false, unnecessary sounds/touch can trigger tetanic spasms
prevention of tetanus
dtap: 2, 4, 6 mo
td/tdap: 4-6 yo, intervals of 10 ys
tetanus prophylaxis in uncertain or <3 doses
clean, minor wounds: tdap or td, NO TIG
other wounds: tdap or td with tig
tetanus prophylaxis in >3 doses
clean, minor wounds: NO VACCINE, NO TIG
other wounds: NO VACCINE NO TIG
child is immunized
t/f humans are the only reservoir for poliovirus and spread it by fecal oral route
true
pathogenesis of poliovirus
gi tract -> m cells in small intestine -> peripheral nerves -> anterior horn cells and medulla oblongata
> 50% motor neurons involved = weakness in limbs or paralysis
dorsal horn and dorsal root ganglia = hyperesthesia and myalgia
abortive poliomyelitis
- nonspecific influenza like 1-2 wks
- full recovery
- can spread polio unknowingly
nonparalytic poliomyelitis
- nonspecific
- more intense flu sx
- fleeting paralysis of bladder and constipation
- nuchal and spinal rigidity
spinal paralytic poliomyelitis
1st phase: like abortive myelitis, severe muscle pain, sensory and motor sx, recover in 2-5 d
2nd phase: within 1-2 days asymmetric flaccid paralysis or paresis
PE: nuchal rigidity, muscle tenderness, +++ DTR then — DTR, intact sensation
bulbar poliomyelitis
- dysfunction of cn and medullary centers
- pharyngeal and vocal problems
- deviation of palate, uvula, or tongue
- involves vital centers of medulla (RR, BP, HR, T)
- rope sign
polioencephalitis
- seizures, coma, spastic paralysis
- sensorium changes: irritability, disorientation, drowsiness, coarse tremors
diagnosis of poliovirus
isolation of virus from 2 stool specimens, 24-48 hrs apart
treatment of poliovirus
no specific treatment
if paralytic -> admit (airway compromise)
prevention of poliovirus
ipv (higher igg) opv (mucosal iga)
2, 4, 6-18 mo, 4-6 yo
t/f opv is not recommended by who to eradicate polio
false
clinical manifestations of h influenzae
- cellulitis (cheek and preseptal region)
- orbital cellulitis: lid edema, proptosis, pain upon movement
- supraglottis/epiglottis: dyspnea, toxic looking, hunched over, air hungry, stridor
- pneumonia
h influenzae prophylaxis
rifampin or rifampicin
prevention of h influenzae
hib conjugate vaccines (dtap + ipv) 2, 4, 6, 12-15 mo
measles transmission
large or small droplet aerosols in air, even after 1 hr after source leaves room
clinical manifestations of measles
prodrome: mild fever then conjunctivitis with photophobia, coryza, cough, increasing fever
enanthem: koplik spots
exanthem: head to toe rash -> symptoms subside -> faces in 7 d
diagnosis of measles
igm elevated 1-2 d after rash
igg elevated 2-4 wk after rash
most common cause of death in measles
pneumonia
most common complication in measles
acute otitis media
subacute sclerosing panencephalitis
- virus regains virulence after 7-10 yrs
stages:
- change in behavior or school
- massive myoclonus, involuntary movement
- choreoathetosis, immobility, dystonia, lead pipe rigidity
- loss of autonomic control, death
treatment for measles
vitamin a
- <6 mos 50,000 iu
- 6mo-1 yr 100,000 iu
- > 1 yo 200,000 iu
measles vaccine guidelines
monovalent 9 mos (6 mos for outbreak), mmr 12-15 mo, 4-6 yo
t/f measles vaccine does not prevent sspe
false
pathogenesis of mumps
transmission: droplets
- targets salivary glands, cns, pancreas, and testes
clinical manifestations of mumpms
- prodrome (1-2 d): fever, headache, vomiting, achiness
- parotitis: unilateral then bilateral with ear pain; peak 3 d, subside 7 d
- ingestion of sour food is painful
- red edematous stensen duct
meningitis with or without encephalitis (mumps)
- 5d after parotitis
- resolve in 7-10 d
- meningeal signs in adults, fever and lethargy in children
t/f orchitis occurs in 30-40% of post puberty males
true, causes fever, chills, pain, and testes swelling
treatment for mumps
antipyretics, bland diet
prevention of mumps
mmr 12-15, 4-6 yo
rubella is common in ___
preschool and school aged children. thats why 2 doses is recommended
pathogenesis of rubella
read
clinical manifestations of rubella
- prodrome: lymphadenopathy*
- rash: face and neck centrifugally to torso and extremities, 3 d, no desquamation
- forchheimer spots
diagnosis of rubella
rubella igm
- if false negative, do rtpcr
complications of rubella
- thrombocytopenia (2 wks after rash, self limiting, children)
- arthritis (1 week after rash, self limiting, adults)
- post infectious encephalitis (7 days after rash, 20% mortality or sequelae)
- progressive rubella panencephalitis (like sspe, death 2-5 yrs after onset)
- crs
what is congenital rubella syndrome
maternal infection during first 8 weeks
clinical manifestations of congenital rubella syndrome
small(IUGR) CATS and DEAF CHilDren RETaIN SALT AND PEPPER for their brainy (MENINGO) parents(PATENT DA)
- cataract + CHD
- nerve deafness
- iugr
- salt and pepper retinopathhy
- unilateral or bilateral cataracts
- pda
- meningoencephalitis
treatment for rubella
no specific treatment, ivig, corticosteroids
children with crs can excrete the virus until __
exposed pregnant women should monitor ___
1 years old
igg titers
vaccination for rubella
mmr / mmrv 12-15 mos, 4-6 yo
post exposure prophylaxis must be given within 3 d
pathogenesis of varicella
read
clinical manifestations of varicella
- lesions first in scalp, face, or trunk
- pruritic erythematous macules -> papular -> fluid filled vesicles
- clouding and umbilication 24-48 hrs
- simultaneous lesions in various stages
- ulcers in oropharynx and vagina
neonatal varicella
- infected 5d before to 2 d after delivery
- transplacental
- rash at end of 1st week
- varicella ig, ivig
congenital varicella
- mothers exposed <20 w of pregnancy
- cicatrical skin scarring (burned baby)!!
- limb hypoplasia!!
- neuro, eye, renal, ans symptoms
complications of varicella
- bacterial superinfection (gas, s. aureus) (fever 3-4d after exanthem)
- encephalitis and cerebellar ataxia (2-6d after rash, recovery 24-72 h)
- pneumonia (1-6 after rash)
treatment for varicella
acyclovir <24 h of exanthem
iv acyclovir for severe, disseminated, immunocompromised
prevention of varicella
vaccine 12-15 mos, 4-6 yo
pep: 3-5 d after exposure
diseases where humans are the only host
rubella mumps measles h influenzae poliovirus
clinical manifestations of hepA
- anicteric but jaundiced
- 7-14 d
diagnosis of hep a
anti hav igm
prevention of hep a
pep: hav ig
- indications: <12 mos, immunocompromised, chronic liver disease
hep a vaccine
- 1 yo, 2 doses 6-12 mos apart
morphology of meningococcemia
g -, kidney shaped pairs
a, b, c, w153, and y
pathogenesis of meningococcemia
transmission: aerosol droplets
attaches to nasopharyngeal mucosal cells -> endotoxin cause purpura fulminans and cytokine storm
acute meningococcemia
- nonspecific symtpoms
- fine maculopapular rash
- limb pain and myalgia
meningococcal meningitis
- more subtle in young children*
- seizures and focal neurologic signs
- rapidly progressive cerebral edema
- purpura fulminans
chronic meningococcemia
rare and non-toxic looking, 6-8 wks
diagnosis of meningococcemia
isolation of n meningitidis from blood, csf, or synovial fluid
treatment for meningococcemia
penicillin g ampicillin cefotaxime ceftriaxone chloramphenicol, ciprofloxacin, meropenem
most frequent neuro sequelae of meningococcemia
deafness
poor prognostic factors for meningococcemia
read
prevention of meningococcemia
pep rifampicin or ciprofloxacin for >18 yo
vaccination for meningococcemia
mpsv4: purified polysaccharide
mcv4 dt or menacwy-crm: conjugate vaccines, more immunogenic
11 yo
clinical manifestations of typhoid fever
5 d high grade fever with myalgia
hepatosplenomegaly
abdominal pain and anorexia
rose spots at 7-10th day, lower chest and abdomen
treatment for typhoid fever
gold standard: chloramphenicol
prevention of typhoid fever
ty21a: live attenuated
vi capsular polysaccharide
etiology of cholera
- g- comma shaped bacillus
- thrives in moderately salty water
clinical manifestation of cholera
profuse rice water stools with fishy smell
can be mild and inapparent
diagnosis of choldera
isolation from stool, rectal swab, or vomit
dark field: darting motility in wet mounts
treatment for cholera
doxycycline 300mg single dose OR
tetracycline 3d
children: erythromycin
rehydration and zinc
clinical manifestations of encephalitic rabies
- nonspecific symptoms
- hydrophobia and aerophobia!!
- death within 1-2 day
clinical manifestation of paralytic rabies
ascending motor weakness on both limbs and cranial nerves
diagnosis of rabies
rtpcr
category I: intact skin
II: abrasion or scratch, no blood
III: bite
treatment for rabies
sedation, rabies ig and vaccine dont alter course once symptoms appear
prevention of rabies
pep
- I: wound care
- II: 5 doses of rabies vaccine (day 0, 3, 7, 14, 21/28)
- III: vaccine + rig
preexposure p: 3 doses day 0, 7, 21/28
95% of vaccinated children get their vaccines from __
public facilities
only ___ had complete and timely vaccination
10%
