vaccines, foodborne illnesses

Question 1

what is the likely natural reservoir of ebola?

Answer 1

unknown but maybe bats

Question 2

how is ebola transmitted?

Answer 2

from person to person through direct contact with ebola infected blood or body fluids (urine, saliva, feces, vomit, semen)

Question 3

what must a patient have in order to spread ebola?

Answer 3

symptoms!

Question 4

what does contract tracing consist of?

Answer 4

it is a standard public health procedure immediately employed to identify and monitor those who may have potentially been exposed to a sick patient (interviewing, constructing maps, assessing risks)

Question 5

how do we treat ebola?

Answer 5

provide IV fluids, balance electrolytes, maintain O2 status

Question 6

what must you ensure when dealing with your PPE should you become exposed with someone with an infectious disease?

Answer 6

remove the MOST contaminated PPE first

Question 7

what are the most common causes of death in international travel?

Answer 7

#1 cardiovascular
#2 medical
#3 injury
#4 homicide/suicide
#5 infectious disease (1/100,000 travelers will die)

Question 8

which two vaccines may be REQUIRED for international travel?

Answer 8

yellow fever, cholera

Question 9

how long does the yellow fever vaccine remain effective for? where are areas of risk?

Answer 9

10 years! equatorial africa, central, and south america are high risk

Question 10

which disease has a new circulating serotype for which vaccine has not been developed?

Answer 10

vibrio cholera 0139; affects indian subcontinent and asia

Question 11

what does the CDC recommend for vaccination for cholera?

Answer 11

one injection meets international requirements; full series of 3 shots for some patients

boosters may be required every 6 months

Question 12

how often should the tetanus (Tdap or Td) booster be given?

Answer 12

every 10 years unless puncture wound over 5 years past last booster

Question 13

who should receive the polio vaccine? do we give a booster?

Answer 13

• should be used in patients over 18
• small risk in paralysis with first dose (1/1.4 million)
• single booster for travel to india, nigeria, pakistan, somalia

Question 14

who gets pneumovax?

Answer 14

• over the age of 65

- anyone with chronic medical conditions

Question 15

where is typhoid endemic? who should get the vaccine?

Answer 15

people traveling to central and south america, india, africa

food and water born illness

Question 16

who should receive the vaccine for japanese encephalitis?

Answer 16

people engaging in outdoor activities (particularly rice and pig farming) and traveling over 1 month in rural areas far east (india, china, korea, japan, SE asia)

given in 3 doses with booster every 2 years

Question 17

where are hepatitis A and B endemic?

Answer 17

hep A: nearly all international locations

hep B: south america, africa, SE asia, south pacific

Question 18

how are hepatitis A and B vaccines given?

Answer 18

hep A: >4 weeks, booster at 6 months and 12 months

hep B: 0, 1, 6 months

Question 19

how is the rabies vaccine given?

Answer 19

series 0, 7, 21, or 28 days if exposure

Question 20

who gets the meningococcal vaccine?

Answer 20

pilgrims to mecca

meningitis is endemic in sub-saharan africa

Question 21

who is the smallpox vaccine indicated for?

Answer 21

military

Question 22

what mosquito causes malaria?

Answer 22

FEMALE anopheles mosquito

Question 23

what do the female anopheles mosquitos typically carry? which is the more concerning protozoal parasite it can carry?

Answer 23

typical: plasmodium vivax, ovale, malariae

BAD: plasmodium falciparum

Question 24

prevalence of malaria?

Answer 24

300 million cases with 3 million deaths annually

Question 25

how is malaria transmitted?

Answer 25

1) mosquito bites and injects malaria 2) goes to your liver to form merozoites 3) becomes sporozoites in RBC 4) break apart your RBC and symptoms begin

Question 26

which two species of malaria can remain dormant in the liver? why is this bad?

Answer 26

P. ovale and P. vivax they can still transmit disease when dormant! make sure to treat for P. ovale and P. vivax no matter what

Question 27

complications of malaria?

Answer 27

DIC, splenic rupture, anemia

Question 28

DOC for malaria prophylaxis?

Answer 28

depends on geography!! for pharm purposes: chloroquine

Question 29

how can we protect against acquiring malaria?

Answer 29

DEET, permethrin, appropriate clothing, screens

Question 30

most common pathogen in traveller's diarrhea?

Answer 30

e. coli (50 percent) fecally contaminated food and water

Question 31

which two pathogens capable of causing traveller's diarrhea are most infectious?

Answer 31

shigella and giardia - only require 10-100 organisms - shigella less common

Question 32

symptoms of traveller's diarrhea?

Answer 32

abrupt onset of loose stools, abdominal cramping, rectal urgency usually self-limited

Question 33

risk factors for developing traveller's diarrhea?

Answer 33

immunosuppressed, inflammatory bowel disease, H2 blockers, PPIs, antacids

Question 34

treatment of traveller's diarrhea?

Answer 34

fluoroquinolones (short course, 3 days) FLUID!

Question 35

is prophylaxis indicated for traveller's diarrhea?

Answer 35

NO. just avoid street vendors, buffets, raw or undercooked meats/seafood, raw fruits/veggies, tap water, unpasteurized dairy products

Question 36

what is a long-term sequelae that could develop due to food-borne infection with e. coli?

Answer 36

hemolytic uremic syndrome (2-5 percent) long term kidney dysfunction

Question 37

what is a long-term sequelae that could develop due to food-borne infection with campylobacter jejuni?

Answer 37

guillane barre syndrome (1 out of 1000)

Question 38

which organisms are responsible for possible reactive arthropathy as a long-term sequelae?

Answer 38

salmonella, campylobacter, yersinia enterocolitica, SHIGELLA 1-3 percent of infections

Question 39

what is the most common cause of food-related illness?

Answer 39

NOROVIRUS

Question 40

while we have seen significant drops in e. coli, campylobacter, salmonella...what have we seen a significant increase in?

Answer 40

VIBRIO! 85% increase

Question 41

why may we be seeing an increase in foodborne vibrio infections in the US?

Answer 41

associated with eating raw shellfish from WARM WATERS; increasing because our sewage is sent into our oceans and now oceans are warmer because of CLIMATE CHANGE

Question 42

characterized by a large number of cases in ONE jurisdiction, detected by affected group themselves, and involves a local investigation, local food handling error, and local solution

Answer 42

focal outbreak

Question 43

characterized by a small number of cases in many jurisdictions, detected by LAB-based subtype surveillance, and involves multi-state investigation, industrial contamination event, and broad implications

Answer 43

dispersed outbreak

Question 44

most common food related to outbreaks?

Answer 44

poultry! leafy greens #2, dairy #3, beef #4

Question 45

what is beginning to emerge as an important problem in regards to foodborne illness?

Answer 45

drug-resistant salmonellosis (typhimurium, newport) still sensitive to cipro, bactrim but these diseases cause more severe and longer illness all have dairy cattle as reservoir and are transmitted through GROUND BEEF

Question 46

which formulation of e.coli can cause hemolytic anemia (enterohemorrhagic e. coli)?

Answer 46

shiga-toxin producing E. coli 0157 serogroup (STEC)

Question 47

how long does norovirus typically last?

Answer 47

24-48 hours individual may be contagious for at least 2 weeks post recovery

Question 48

how is norovirus transmitted?

Answer 48

person-to-person extremely contagious fecal-oral route kitchen workers can contaminate food

Question 49

symptoms of norovirus?

Answer 49

nausea, vomiting, diarrhea (NOT bloody), abdominal cramping, LOW grade fever if present