Vaccines

What is the schedule for the HPV vaccine?

0,2,and 6 months

What are the enivonrmental exposure factors for developing Meningococcal disease?

1. Household exposure 2. Demographic/ socioeconomic factors and crowding 3. Antecedent viral infection 4. Active and passive smoking

What are some strategies to increase immunization rates?

1. School entry laws 2. Reducing cost of vaccination 3. Increased awareness of vaccination 4. Increase sites for vaccine administration like community pharmacies

What are the high risk HPV strains?

16 and 188

What are the low risk HPV strains?

6 and 11

What is the brandname for HPV2?

Cervarix or GSK

What should pertussis be treated with?

Erythromycin and all close contacts

People 19 years of age or older who has immunocompromising conditions, functional or anatomic asplenia, CDF least or cochlear implants and have not previously been vaccinated should receive what?

Receive a dose of PVC 13 first and then a dose of PPSV23 at least 8 weeks later.

What are the two Hep B vaccine formulations?

Recombivax and Engerix-B

What is gardasil?

This is a quatravalent vaccine that contains types 16 18 6 and 11 and it is approved for females and males 9-26

What is HPV?

This is a small DNA virus with more than 120 types

How should the oral thypoid vaccine be taken?

1 capsule PO approximately 1 hour before a meal with a cold or luke warm drink on days 1, 3, 5, 7 and this should be completed at least 1 week prior to initial expsoure

If there is an outbreak of Meningoccous than you can use both the MenACWY or MPSV4 vaccine. What constitutes if there is an outbreak?

1. 3 or more confirmed or probable primary cases in less than 3 months 2. Period of less than 3 months 3. Primary attack rate of greater than 10 cases per 100,000 population

What are general ways to prevent Mosquito bites?

1. Avoid outbreaks and affected areas 2. Know peak exposure times for example Dengue and Chikungunya is daylight hours and Malaria is twilight or after dark 3. Use bed nets 4. Wear appropriate clothing 5. Use insecticides

When should the Serogroup B be given?

1. If the patient has complement component deficiency or who are taking Soliris 2. Patients with asplenia 3. Microbiologists who are routinely exposed to Neisseria Meningitidis 4. People identified to be at an increased risk during an outbreak.

What are the two vaccines for rabies?

1. Imovax--human deployed cell rabies vaccines 2. RabAvert--purified chick embryo cell vaccine

What are some reasons for missed opportunities to vaccinate?

1. Invalid contraindications 2. Unaware that vaccines are needed 3. Inappropraite policies 4. Inappropriate policies

What are the reasons for a gap in Immunization?

1. Low income and minorities are at a greater risk 2. Uptake lagging for some vaccines 3. There are barriers to immunization that exist such as physical and psychological 4. There are many missed opportunities to vaccinate

What are the brand names for the 3 Meningococcal Conjugate Vaccines?

1. Menactra--A, C, W, Y conjugated to diptheria toxoid protein and approved for use 9 months to 55 years 2. Menveo--used for persons aged 2 through 55 years 3. MenHibirx--contains Heamophilius influenza and for children 2-18 months

What are the high risk groups for the Meningococcal vaccine?

1. Microbiologists who are routine exposed to isolates 2. Military receipts 3. Persons who travel to hyper endemic or endemic areas particularly in the meningitis belt 4. Revaccinate every 5 years as long as person remains at risk

What are invalid contradictions to therapy

1. Minor Illness 2. Antimicrobial disease 3. Mild or moderation reaction or fever after a prior dose 4. Premature birth 5. Breastfeeding 6. Allergies to products not in vaccine 7. Pregnancy or immunocompromised in the household

If a 65 year old man comes in with chronic heart disease and revived a dose of PPSV23 at age 63 than how to administer the vaccines?

1. One dose of PCV13 no because he is 65 and it has been over 1 year since PPSV23 2. Adminsiter PPS23 at 68 in order for it to be 5 years since his previous PPSV23 dose.

What are the contraindications to live vaccines?

1. Pregnant 2. Immunosuppressive or on immunosuppressive therapy 3. Allergic to vaccine or componenets

If giving a pneumococcal disease than must give 2 weeks prior to what three things?

1. Splenectomy 2. Cochlear Implant surgery 3. Immunosupressive surgery

What are host risk factors for developing Meningococcal disease?

1. Terminal complement for Invasive Disease 2. Asplenia 3. Genetic factors

How does someone present with Zoster?

1. The rash if often preceded by several days of prodromal phase where there is initial burning or stinging (if people catch during this phase than can treat early and won't be as severe) 2. There is a unilateral rash that involves at least 1-3 adjacent dermatomes. 3. Takes 2-4 weeks to heal

What areas are most common in shingles involvement?

1. Thoracic 2. Cervical 3. Opthalamic

Who should get the typhoid vaccine?

1. Travelers to areas with elevated incidence 2. Households with a carrier 3. Lab personnel who work with S. enteric serotype thyphi

When should the Ixiaro vaccine be considered?

1. Travels that go to endemic areas for less than a month if they go during transmission season and go outside an urban area 2. Travelers going to an area with ongoing JE outbreak 3. Travelers who are going to endemic areas but unsure of where they are going

What is the incubation period for Meningoccal disease?

3-4 days however can range from 2-10 days If someone is going to develop acute disease than they will have an abrupt onset of high fever

What is the minimal interval between vaccine doses?

4 weeks

Genital warts are caused by which strains?

6 and 11

What are the symptoms of Dengue?

75% of all infections asymptomatic; there can be nonspecific acute febrile illness with severe HA and joint and bone pain and rash; in 5% of patients there is a severe life threatening disease with persistent vomiting, severe abdominal pains, shock, and rapid decline in platelet count.

The most invasive disease that is caused by Neisseria Meningitidis is what serotypes?

A B C Y W

The quadrivalent meningococcal vaccine covers what serotypes?

A C W Y

What is the symptoms of Typhoid?

A person will present with gradually increasing fatigue and ever that increases daily from low grade to high. Transient macular rash of rose-colored spots can occasionally be seen on the trunk

When is the onset of active immunity and how long does it last?

Active immediate takes 3-4 weeks to work and the duration is years

What are the ACIP recommendations for the MenACWY vaccine for children aged 13-15?

Administer 1 dose at age 13 through 15 if not previously vaccinated and a one time booster at or after 16-18 years

What are the risk factors to reactivation of Zoster?

Age Immunosuppression Intrauterine exposure Primary varicella infection less than 18 months of age

What is the most common sexual transmitted infection in the US?

Anogenital HPV

What are the symptoms of yellow fever?

Asymptomatic in most people; initial illness is nonspecific influenza like syndrome and after a brief remission of hours to days than 15% of patients progress to be more serious and present with jaundice, hemorrhagic symptoms, and multiorgan failure

If a person decides to travel at the last minute and needs a drug for mosquito bite infection what would be the best drugs?

Atovaquone-proguanil Doxycycline Primaquine

What is the brandname for the new meningococcal vaccines Serogroup B?

Bexsero and Trumenba

Who should not get the live Influenza vaccine?

Children less than 2 Adults greater than 50 Immunocompromised pregnant Children and adults on chronic aspirin therapy Children less than 5 with a history of wheezing and astma

What are the ACIP recommendations schedule for the MenACWY vaccine?

Children should get this vaccine at 11 or 12 years of age with a booster at 16 years of age

What 2 vaccines cannot be used concurrently?

Cholera and yellow fever

What two travel vaccines are not available in the US?

Cholera vaccine Tickborne encephalitis

What requires high doses of Diphtheria, Pertusis, and Tetanus?

DTaP and this is used in the childhood series--if there is an underlying neurologic disorder than give DT

This is a toxin mediated disease that causes localized tissue damage and destruction?

Diptheria

T/F: The pneumococcal vaccine has shown to cause protection against pneumonia?

FALSE

What is the treatment of typhoid once someone has contracted it?

FQ In resistant areas than do injectable 3rd generation cep or azithromycin

T/F: Mingococcemia has to occur with Meningitis?

False--can be with or without

T/F: HPV is a substitute for cervical cancer screening

False--need to continue to have annual check ups and screenings every 3 years

What are the clinical findings of Meningococcemia?

Fever, Petechial rash, Hypotension, shock, multiorgan failure, and acute adrenal hemorrhage

What are the clinical findings of Meningococcal Meningitis?

Fever, headache and stiff neck

What is the brand name of the recombinant Influenza vaccine?

Flublok

What is the brand name for the live attenuated influenza vaccine?

Flumist

What is the brand name for the trivalent Influenza vaccine?

Fluvirin

What is the brand name for the quadrivalent Influenza vaccine?

Fluzone

When should a second PPSV23 dose be administered?

For people with immunocompromisng conditions and with functional or anatomic asplenia. This dose should be administered 5 years after the first PPSV23 dose.

Clostridium Tetani toxins blocks the release of this and causes what?

GABA causes Tetanus

What is the brandname for HPV 4?

Gardasil or Merck

What are the vaccines to treat Hepatitis A?

HAVRIX VAQTA (preservative free) given 0 and 6 months

If you have severe infection you can detect these hepatitis antigens?

HBeAg

What vaccine is given to children when they are first born?

Hep B

Humans are the only natural host of this disease and it is transmitted through the fecal oral route and leads to severe symptoms of fever, N/V and urine discoloration in adults?

Hepatitis A

This contains several antigenic components and transmission is through blood and bodily fluids?

Hepatitis B

What are presentations of someone with pneumonia?

High fever, cough with chest pain, mucus production and hypoxia

What would you recommend if a person 65 years or older has had a dose of PPSV23 but not PCV13?

I would recommend that the patient get a dose of PCV13 at least 1 year after the most recent PPSV23 dose.

Why would an adult 65 years or older after be revaccination 5 years after their first dose of PPSV23?

If the adult is 65 or older and received their first dose of PPSV23 for any indicated when they were younger than 65 years should get another dose of PPSV23. HOWEVER if they have not than we will receive a single vaccine

How should live vaccines be spaced apart?

Immune response to a live vaccine might be impaired of administered within 28 days of another live-virus vaccine so they either need to be given on the same day or wait.

What two types of people do you consider vaccinating up to 26?

Immunocompromised and MSM

Name the order that gives you the most robust immune response to the least

Infection>live immunization> whole killed immunization> split killed/conjugated>toxoid

What two disease dates are the 7th leading cause or death in the US?

Influenza and Pneumonia

When is the onset of passive immunity and how long does it last?

It is immediate and it will last for 3-4 weeks

What is the name of the vaccine for Japanese Encephalitis?

Ixiaro and it is recommended for travelers who plan to spend 1 month or more in endemic areas during the JE virus transmission season.

What are the live vaccines?

MMR Varicella Zoster (greater than 50 years) Oral typhoid OPV

If someone is allergic to gelatin do not give these vaccines?

MMR and Zoster

If someone allergic to streptomycin/Neomycin than do not gives these vaccines?

MMR and Zoster and IPV and OPV and MMR

Which is worse Meningitis or Meningococcemia?

Meningococcemia which has a 40% fatality rate compared to 10-15%

What is the brand name for the Meningococcal Polysaccharide Vaccine (MPSV4)?

Menomune

What are the symptoms of Japanese Enchepalitis?

Most infections as asymptomatic; less than 1% develop clinical disease such as mental status change, generalized weakness, and parkinsonian syndrome

What is the dosage and administration of Zostavax?

Must be put in the freezer with the diluent stored at room temperature, must be reconstituted and used within 30 minutes, only a SubQ infection, and the dose is 0.65mls

What bacteria causes meningitis, sepsis, and focal infections such as pneumonia and arthritis?

Neisseria Meningitidis

Can pregnant women get immunized with a live vaccines?

No and not if they plan on getting pregnant within the next 3 months

Can you give PPSV23 to children under 2 and why or why not?

No because it is a polysaccharide vaccine and it won't amount a great immune response

A 65 year old male asks you if he can get his Zostavax today. He is allergic to PCN, sulfa drugs, and gelatin. Can he get the vaccine?

No if allergic to gelatin or neomycin cannot get the Zostavax vaccine

If someone has had Malaria before are they immune to it?

No the infection does not have life long immunity--before a person travels it is important to know where and the resistance patterns

Can you give the HPV vaccine if someone gets pregnant?

No, initiation of the vaccine series should be delayed until after completion of pregnancy and the remaining doses should be delayed.

Can PPSV23 and PCV13 be administered at the same office visit?

No--PVC13 needs to be administered after 1 year as passed after taken the last PPSV23 dose.

When is the yellow certificate valid?

Not until 10 days after immunization--revaccination after 10 years and use within 1 hour of reconstitution

What are the ACIP recommendations for the MenACWY vaccine for children who are 16 years of age or older?

One time dose; do not need a booster vaccine

When are the shingles lesions contagious?

Only contagious after the rash erupts and until the lesion crusts over--cover them to decrease risk of transmission

Should be vaccinated persons 21 years or older with MenACWY vaccine?

Only if they are in the high risk groups?

What is the preferred treatment for the flu?

Oseltamivir which is an oral dosage form and preferred in prophylaxis

What do you treat Diptheria with?

PCN or macrolide for 14 days and the contagious period goes away in 2 days after the antibiotics are stopped

Is allodynia more prevalent in acute zoster or patients with postherpetic neuraliga?

Patients with posththerpetic neuralgia

Who is approved for the MPSV4 vaccine?

Persons 2 years of age or older (since it is a polysaccharide vaccine)

This is a toxin mediated disease which paralysis cilia and prevents clearing of respiratory secretions?

Pertussis

Which disease is the leading cause of vaccine preventable deaths each year?

Pneumococcal disease

What is the brand name for PPSV23?

Pneumovax23

What is the brand name for PVC13?

Prevnar 13

Why is Chloroquine Phosphate not used anymore?

Resistance

What is usually done if we do not know the pneumoccoal vaccination status of a patient?

Revaccinate

What is the vaccination schedule for children 2-59 months (5 years)?

Routinely be vaccinated with PCV13 which are 3 dosages routinely given at 2, 4, and 6 months

What is the immunization schedule for Ixiaro?

Should be given on days 0 and 28 and should be completed greater 1 week or greater before travel

If someone is over 65 and has not previously been vaccinated for pneumococcal disease than what vaccines should they receive?

Should receive 1 dose of PVC13 and one dose of PPS23 6-12 months later

Where is the risk highest for typhoid?

Southern Asia

What strain is the pediatric flu?

Strain B

Pneumococcal disease is caused by what pathogen?

Streptococcus Pneumonia

What are the symptoms of Chikungunya virus?

Sudden onset of high fever and severe joint pain or stiffness, rash, N/V, and myalgia and these can lead to complications such as myocarditis, retinitis, hepatitis, acute renal disease etc.

What is the presentation of Malaria?

Symptoms can develop early as 7 days after initial exposure and as late as several months or more. Patients can appear with fever and flu-like symptoms; can lead to anemia and jaundice and even death

T/F: Most HPV infections are asymptomatic and result in no clinical disease

TRUE

You should do this one time in adult hood since it is making a comeback?

Tdap and when you boost texans you use Td

Which vaccine oral or IM lasts longer for typhoid?

The oral vaccine lasts more than 6 years whereas IM is just 2 years

How is rabies presented?

The person will present with acute progressive encephalitis, fever, anxiety, and paralysis. There is an incubation period of 1-3 months

What is the whole cell pertussis vaccine no longer available in the US?

There is a high incidence of neurologic adverse effects

Why is Amantidine and Rimantidine not used anymore?

These have a high resistance against Influenza A and is no longer used

Who should get the rabies vaccines?

These vaccines are for all age groups and people who should get the vaccines are: 1. Travelers who are vets, animal handlers, filed biologists, caves, missionaries, and certain lab workers

If a patient decides to get the Zostavax vaccine today and they are currently taking a dose of acyclovir what do you tell them?

They need to wait until the finish their antiviral before you can administer the zoster vaccine

What are the disadvantages of toxoids?

They produce a poor immune response and therefore require boosters

What does the ACIP recommend regarding vaccination against HPV?

They recommend routine vaccination of females and males between 11 and 12

What is the recommendation for children 24-71 months of age with chronic medical conditions?

They should get 2 dosages of PCV13 separated by at least 8 weeks.

When can you give Zostavax?

This can be given at age 50 however the CDC recommends this to be given age 60 or older

What is Cervarix?

This contains 16 and 18 and is approved for females only through 9-25 years

What is Mefloquine?

This drug is used for mosquito bite prevention and should be taken greater than or equal to 2 weeks before travel, taken weekly on the same day of the week, and for 4 weeks after leaving

What is Dengue?

This is RNA viruses of the genus Flavivirus and they are transmitted by infected mosquitos to humans. This is endemic through the tropics

What is typhoid?

This is Salmonella enteric serotype Typhi that is transmitted through consumption of water or food that has been contaminated by feces

What is Twinrix?

This is a combination of hep A and hep B and it is administered at 0 and 6 months with hep B administered at 1 month

What is malaria?

This is a disease from protozoans and is transmitted by female mosquitos and this could be found worldwide

What is Primaquine?

This is a drug for mosquito bite prevention and is to be begun 1-2 days before travel and continued for 7 days after leaving.

What is Chloroquine Phopshate?

This is a drug for mosquito bite prevention and it should be begun 1-2 weeks before travel taken on the same day of the week and during the trip and for 4 weeks after leaving. The adverse effects are gastrointestinal disturbance, HA, and dizziness

What is hydroxychloroquine sulfate?

This is a drug for mosquito bite prevention and it should be begun 1-2 weeks before travel taken weekly on the same day of the week and for 4 weeks after leaving. Can lead to blurred vision and insomnia

What is Doxycycline?

This is a drug to prevent mosquito bites and you begin 1-2 days before table and for 4 weeks after leaving and can cause V/V and photosensitivity

What is Chikungunya?

This is a mosquito borne illness that is a single stranded RNA virus that comes from nonhuman and human primates

What is rabies?

This is a neurotic virus in the family Rhabdoviridae genus Lyssavirus and is transmitted through saliva of biting rabid mammals (bites to face and hands may increase the incidence of disease developing more rapidly). Most patients die in 7-14 days

What is herpes zoster or shingles?

This is a result from reactivation of the varicella-zoster virus. Following first infection of VZV it establishes permanent latent infection in dorsal root and cranial nerve ganglia and years later it reactivates and spreads to the skin through peripheral nerves

What is Japanese Enchepalitis?

This is a single stranded RNA virus that belongs to Flavivirus and is transmitted through infected mosquitoes and it is found in most of Asia and parts of the western Pacific.

What is yellow fever?

This is a single stranded RNA virus that belongs to the genus Favivirus and it is transmitted through mosquitos. This is endemic in sub-saharan Africa and tropical south america

What is Atovoquone-Proguanil?

This is an agent used for mosquito bite preventions and this is to be begun 1-2 days before travel and for 7 days after leaving the area. This medication could cause N/V and abdominal pain.

When should MPSV4 be used?

This is mainly a historical vaccine and therefore should only be used for persons at increased risk of N. meningitides infection who are 56 years of age or older or if the conjugate vaccines are not available

What is TIG?

This is used for all unvaccinated patients with potential exposure and is a single IM dose that is infected near the wound and is followed by vaccination with Td or Tdap

What is Postherpetic neuralgia?

This is when a loss of sensation occurs within an affected dermatome. This may persist for months or years

What HERD immunity?

This is when we all vaccinate so that we protect the people who are immunocompromised and cannot get vaccinated

How is Meningococcal transmitted?

Through droplet aerosol or secretions from the nasopharynx of the colonized persons

T/F: US has the most developed immunization system in the world

True

Can doxycycline be taken with the oral typhoid vaccine?

Vaccination with oral typhoid should be delayed for 24 hours or more after taking a dose of doxy

What vaccine is most commonly declined in childhood?

Varicella

What is the vaccine for typhoid?

Vivotif--oral live attenuated vaccine Typhim VI--IM vi capsular poysaccharide vaccine

Can you vaccinate someone on chemotherapy?

Wait 2 weeks before or 3 weeks after

Where can you come in contact with the Chikungunya virus?

We can come in contact with it in Africa and Asia and now the Americas--more prevalent in the rainy seasons

If someone has a fever with Dengue what should we give them?

We need to give them APAP because aspirin or NSAIDS can lead to a bleeding risk

What is the vaccine for yellow fever?

YF-Vax (live attenuated from chick embryos)

Do IGs interfere with live vaccines?

Yes and therefore should be given either 2 weeks before IG or 2-11 weeks after IG Killed vaccines are okay

You don't want to use this flu treatment with asthma?

Zanamivir

What is the name of the vaccine used for shingles?

Zostavax-- this is alive attenuated virus for prevention of shingles