(4) Ch. 26: Infectious Disease Prevention and Control

VACCINE TYPES: *STORAGE AND TEMPERATURE REQUIREMENTS DIFFER*

- REFRIGERATED VACCINES SHOULD BE STORED BETWEEN 36° AND 46° FAHRENHEIT (2° TO 8° CELSIUS). - FROZEN VACCINES SHOULD BE STORED BETWEEN -58°F AND 5°F.

•THERE ARE TWO BASIC MECHANISMS FOR ACQUIRING IMMUNITY...

ACTIVE AND PASSIVE.

STRATEGIES FOR PREVENTION & CONTROL INFECTIOUS DISEASES: *OUTREACH AND EDUCATION*

ADDRESS HIGH RISK POPULATIONS: - YOUNG CHILDREN - OLDER ADULTS - IMMUNOCOMPROMISED - HIGH RISK BEHAVIORS - INTERNATIONAL TRAVEL (FOREIGN BORN) - HEALTH CARE WORKERS

IMMUNOGLOBULIN (IG)

ANOTHER SOURCE OF PASSIVE IMMUNITY ANTIBODY-CONTAINING PRODUCTS, HIGH CONCENTRATION GIVEN WHEN IMMEDIATE PROTECTION FROM A SPECIFIC DISEASE IS NEEDED - MAY BE GIVEN AS POST-EXPOSURE PROPHYLAXIS FOR MEASLES AND FOR HEPATITIS A - MAY BE GIVEN INTRAMUSCULARLY OR INTRAVENOUSLY DEPENDING ON THE PATIENT

COMMON VEHICLES: MODES OF TRANSMISSION: *Vectors*

ARTHROPODS (MOSQUITOS, TICKS) OR MAMMALS (RACCOONS) - ZIKA, MALARIA, WEST NILE VIRUS, LYME DISEASE, RABIES

LEVELS OF PREVENTION

EDUCATION IS PROVIDED AT *ALL LEVELS OF PREVENTION* - LOP DEPENDS ON WHERE PATIENT LIES ON CONTINUUM OF HEALTH AND DISEASE

UNIVERSAL (STANDARD) PRECAUTIONS: *CONTACT*

ELIMINATE EXPOSURE TO BLOOD/BODY FLUIDS

Disease Development

INFECTION MAY NOT LEAD TO DISEASE WHICH IS AN OUTCOME I.E. TB, HIV,

HEALTH CARE-ACQUIRED INFECTIONS (HAI

INFECTIONS ACQUIRED DURING HOSPITALIZATION OR DEVELOPED WITHIN THE HOSPITAL SETTING - IMPACTS PATIENTS, HCW, VISITORS, ANY PERSON WHO HAS CONTACT WITH A HOSPITAL

COMMON VEHICLES: MODES OF TRANSMISSION: *Airborne*

INHALED BY SUSCEPTIBLE HOST - MEASLES, CHICKENPOX, TUBERCULOSIS, PERTUSSIS, INFLUENZA, SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

STRATEGIES FOR PREVENTION & CONTROL INFECTIOUS DISEASES: *SURVEILLANCE*

KNOWLEDGE OF DISEASE RATES, MODES OF TRANSMISSION, INCUBATION, EARLY MANIFESTATIONS, COMMUNICABILITY, AND INTERVENTIONS AT ALL LEVELS OF PREVENTION TO STOP SPREAD OF DISEASE

INFECTION CONTROL AND PRECAUTIONS

KNOWLEDGE OF PORTALS OF ENTRY/EXIT ESSENTIAL FOR INFECTION CONTROL AND NECESSARY PRECAUTIONS I.E. PERSONAL PROTECTIVE EQUIPMENT (PPE), ISOLATION, QUARANTINE TO PROTECT AGAINST SPREAD OF DISEASE FOR HCW AND PATIENT

THERE ARE TWO BASIC TYPES OF VACCINES:

LIVE ATTENUATED AND INACTIVATED • THE CHARACTERISTICS OF LIVE AND INACTIVATED VACCINES ARE DIFFERENT, AND THESE CHARACTERISTICS DETERMINE HOW THE VACCINE IS USED.

NURSING ROLE AND INTERVENTIONS

NURSES PLAY A KEY ROLE IN ALL ASPECTS OF PREVENTION AND CONTROL OF COMMUNICABLE DISEASES GOAL IS TO REDUCE VPD BY INCREASING IMMUNIZATION LEVELS - IMMUNIZATION EDUCATION AND OUTREACH TO INDIVIDUALS, COMMUNITY, INCLUDING HEALTH CARE PROVIDERS AND CBO - ADMINISTER VACCINE IN PUBLIC HEALTH CLINIC SETTINGS - PUBLIC FLU CLINICS, CHILDHOOD IMMUNIZATION CLINICS - TRACK IMMUNIZATION LEVELS OF AT RISK POPULATIONS I.E. CHILDREN, OLDER ADULTS, IMMUNOCOMPROMISED, HCW - - STAY CURRENT ON VACCINE SCHEDULES/RECOMMENDATIONS - PREVENT MISSED OPPORTUNITIES - ENCOURAGE COMPLIANCE WITH USE OF NYSIIS - REGISTRY

COMMON VEHICLES: MODES OF TRANSMISSION: *Water*

ORAL/FECAL - INGESTED BY HOST - CHOLERA, TYPHOID FEVER, BACILLARY DYSENTERY, GIARDIA LAMBLIA

COMMON VEHICLES: MODES OF TRANSMISSION: *Food*

ORAL/FECAL - INGESTED BY HOST - FOOD INFECTED WITH BACTERIA, VIRUS, PARASITES - NOROVIRUS, SALMONELLOSIS, HEPATITIS A, FOOD TOXINS FROM BACTERIAL CONTAMINATION - STAPH AUREUS, CLOSTRIDIUM BOTULINUM

COMMON VEHICLES: MODES OF TRANSMISSION: *Direct Contact*

PERSON TO PERSON - STI, IMPETIGO, ENTEROBIASIS (PINWORM), INFECTIOUS MONONUCLEOSIS

UNIVERSAL (STANDARD) PRECAUTIONS: *AIRBORNE*

PPE (N95), NEGATIVE AIR FLOW

UNIVERSAL (STANDARD) PRECAUTIONS: *DROPLET*

PPE AND HAND HYGIENE

LEVELS OF PREVENTION: *TERTIARY*

PREVENT *COMPLICATIONS/WORSENING* OF DISEASE - MONITOR ADHERENCE TO TREATMENT - CASE MANAGEMENT

LEVELS OF PREVENTION: *PRIMARY*

PREVENT *OCCURRENCE* OF DISEASE - EDUCATE PUBLIC ABOUT VACCINES - ROUTINE, TRAVEL - ELIMINATE RISK FACTORS FOR ID - SAFE FOOD HANDLING PRACTICES - *HANDWASHING - FOR ID CAN BE BOTH PRIMARY/SECONDARY LOP

LEVELS OF PREVENTION: *SECONDARY*

PREVENT *SPREAD* OF DISEASE - SCREENING AND CASE FINDING - REFERRALS FOR DIAGNOSTIC CONFIRMATION OF ID - CONTACT INVESTIGATIONS AND POST EXPOSURE PROPHYLAXIS

UNIVERSAL (STANDARD) PRECAUTIONS

PROCEDURES TO PREVENT EXPOSURE TO BLOOD-BORNE DISEASES CONTACT DROPLET AIRBORNE PROTECTIVE ENVIRONMENT - REVERSE PRECAUTIONS

ACTIVE IMMUNITY

PROTECTION THAT IS PRODUCED BY THE PERSON'S OWN IMMUNE SYSTEM. - ACTIVE IMMUNITY IS STIMULATION OF THE IMMUNE SYSTEM TO PRODUCE ANTIGEN-SPECIFIC HUMORAL (ANTIBODY) AND CELLULAR IMMUNITY. UNLIKE PASSIVE IMMUNITY, WHICH IS TEMPORARY, ACTIVE IMMUNITY USUALLY LASTS FOR MANY YEARS, OFTEN FOR A LIFETIME. - ONE WAY TO ACQUIRE ACTIVE IMMUNITY IS TO SURVIVE INFECTION WITH THE DISEASE-CAUSING FORM OF THE ORGANISM. - NOT ALL DISEASES HOWEVER OFFER LIFELONG IMMUNITY, E.G. LYME DISEASE- A PERSON CAN BE REINFECTED.

STRATEGIES FOR PREVENTION & CONTROL INFECTIOUS DISEASES: *PREVENTION*

RECOMMENDED VACCINES FOR CHILDREN, ADOLESCENTS, ADULTS, HEALTH CARE WORKERS - INCLUDING "CATCH UP" SCHEDULES

INFECTION CONTROL AND PRECAUTIONS: *ENTRY*

Respiratory - Inhalation GI - Ingestion Skin/Mucous Membranes/Eyes - Absorption Blood Vessels - Injection

INFECTION CONTROL AND PRECAUTIONS: *EXIT*

Respiratory - Droplet GI - Saliva, Emesis, Feces Skin - Lesion Exudate - Vaginal Secretion/Semen - Blood/Body Fluids

DISEASE SPECTRUM -

SUBCLINICAL TO SEVERE •ENDEMIC-- CONSTANT PRESENCE I.E. LYME, MALARIA •EPIDEMIC-- OCCURRENCE IN EXCESS OF NORMAL EXPECTATIONS •PANDEMIC-- worldwide epidemic

*NATURAL IMMUNITY* IS...

THE ABILITY OF THE HUMAN BODY TO TOLERATE THE PRESENCE OF MATERIAL INDIGENOUS TO THE BODY ("SELF"), AND TO ELIMINATE FOREIGN ("NON-SELF") MATERIAL. THIS DISCRIMINATORY ABILITY PROVIDES PROTECTION FROM INFECTIOUS DISEASE, SINCE MOST MICROBES ARE IDENTIFIED AS FOREIGN BY THE IMMUNE SYSTEM

Common Vehicles

TRANSPORT INFECTIOUS AGENT TO SUSCEPTIBLE HOST

TRANSMISSION OF COMMUNICABLE DISEASES

• AGENT, HOST, AND ENVIRONMENT

RESOURCES FOR IMMUNIZATIONS

•CDC ACIP RECOMMENDATIONS •CDC 15TH EDITION EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE DISEASES, AKA THE "PINK BOOK •CDC YELLOW BOOK FOR TRAVELER'S HEALTH •IMMUNIZATION ACTION COALITION (IAC), SIGN UP FOR IAC NEWSLETTER AND TO OBTAIN MOST RECENT VACCINE INFORMATION STATEMENTS (VISS), WHICH ARE A LEGAL REQUIREMENT •LOCAL AND STATE HEALTH DEPARTMENT

NEW YORK STATE IMMUNIZATION INFORMATION SYSTEM (NYSIIS)

•HEALTH CARE PROVIDERS ARE MANDATED TO REPORT IMMUNIZATIONS ADMINISTERED TO PERSONS 0 THROUGH 18 YEARS OF AGE, ALONG WITH THEIR IMMUNIZATION HISTORIES •HEALTH CARE PROVIDERS ARE ENCOURAGED TO REPORT IMMUNIZATIONS FOR ADULTS 19 YEARS OF AGE AND OLDER TO THE REGISTRY

RECOMMENDED CHILDHOOD VACCINES

•HEPATITIS A, *B •*DIPHTHERIA, TETANUS, PERTUSSIS •*MEASLES, MUMPS, RUBELLA •*INACTIVATED POLIO •*HAEMOPHILUS INFLUENZAE TYPE B •*MENINGOCOCCUS •*VARICELLA •*PNEUMOCOCCUS •ROTAVIRUS •INFLUENZA •HPV *REQUIRED IN NYS FOR SCHOOL ENTRY

VACCINE TYPES: *INACTIVATED VACCINE*

•INACTIVATED VACCINES ARE NOT ALIVE AND CANNOT REPLICATE. THE ENTIRE DOSE OF ANTIGEN IS ADMINISTERED IN THE INJECTION. •THESE VACCINES CANNOT CAUSE DISEASE FROM INFECTION, EVEN IN AN IMMUNOCOMPROMISED PERSON. INACTIVATED VACCINES ARE SAFE TO USE IN IMMUNOSUPPRESSED PERSONS BUT THE RESPONSE MAY BE DECREASED. •ANTIBODY TITERS AGAINST INACTIVATED ANTIGENS DIMINISH WITH TIME. AS A RESULT, SOME INACTIVATED VACCINES MAY REQUIRE PERIODIC SUPPLEMENTAL DOSES TO INCREASE, OR "BOOST," ANTIBODY TITERS. •HENCE THE NEED FOR MULTIPLE DOSES OF SOME VACCINES. IN GENERAL, THE FIRST DOSE DOES NOT PRODUCE PROTECTIVE IMMUNITY, BUT "PRIMES" THE IMMUNE SYSTEM. A PROTECTIVE IMMUNE RESPONSE DEVELOPS AFTER THE SECOND OR THIRD DOSE.

VACCINE TYPES: *LIVE ATTENUATED*

•LIVE VACCINES ARE DERIVED FROM "WILD," OR DISEASE-CAUSING, VIRUSES OR BACTERIA. THESE WILD VIRUSES OR BACTERIA ARE ATTENUATED, OR WEAKENED, IN A LABORATORY, USUALLY BY REPEATED CULTURING. •A RELATIVELY SMALL DOSE OF VIRUS OR BACTERIA IS ADMINISTERED, WHICH REPLICATES IN THE BODY AND CREATES ENOUGH OF THE ORGANISM TO STIMULATE AN IMMUNE RESPONSE. •MEDICAL CONTRAINDICATIONS FOR LIVE VACCINES INCLUDE PREGNANCY AND IN SOME SITUATIONS HIV STATUS- SEE RECOMMENDATIONS FOR EACH VACCINE •LIVE VACCINES SHOULD BE GIVEN SIMULTANEOUSLY OR AT LEAST 28 DAYS APART TO LIMIT INTERFERENCE WITH IMMUNE RESPONSE. LIVE VACCINES GIVEN BEFORE 28 DAY MINIMUM INTERVAL WILL NOT COUNT AS VALID AND WILL NEED TO BE REPEATED.

TDAP (TETANUS, DIPHTHERIA, PERTUSSIS)

•TDAP IS RECOMMENDED DURING THE THIRD TRIMESTER (BETWEEN 27 AND 36 WEEKS GESTATION) DURING EACH PREGNANCY FOR THE PROTECTION OF THE INFANT, IN THE HOPES THAT THE INFANT RECEIVES PROTECTION THROUGH PASSIVE IMMUNITY. •TDAP SHOULD BE ADMINISTERED IMMEDIATELY POSTPARTUM, IF IT WAS NOT GIVEN DURING PREGNANCY. •TDAP IS RECOMMENDED FOR CLOSE FAMILY MEMBERS AND CAREGIVERS OF NEWBORNS WHO ARE UNIMMUNIZED (COCOONING). •PERTUSSIS CAN BE FATAL, PARTICULARLY TO THOSE UNDER A YEAR OLD. VACCINE INTRODUCED IN 1940'S, DRAMATIC DROP IN CASES REPORTED; IN 2017, MORE THAN 18,000 CASES OF PERTUSSIS WERE REPORTED NATIONWIDE DUE TO WANING IMMUNITY. •BOOSTER DOSES EVERY 10 YEARS

SOURCE OF PASSIVE IMMUNITY

•THE MOST COMMON FORM OF PASSIVE IMMUNITY IS THAT WHICH AN INFANT RECEIVES FROM ITS MOTHER. •ANTIBODIES ARE TRANSPORTED ACROSS THE PLACENTA DURING THE LAST 1-2 MONTHS OF PREGNANCY. •AS A RESULT, A FULL-TERM INFANT WILL HAVE THE SAME ANTIBODIES AS ITS MOTHER WHICH WILL PROTECT THE INFANT FROM CERTAIN DISEASES FOR UP TO A YEAR. FOR THIS REASON, SOME VACCINES ARE NOT GIVEN UNTIL A YEAR OLD AS THE MOTHER'S ANTIBODIES WOULD INTERFERE WITH THE INFANTS IMMUNE SYSTEM TO PRODUCE ANTIBODIES.

PASSIVE IMMUNITY

•THE TRANSFER OF ANTIBODY PRODUCED BY ONE HUMAN OR OTHER ANIMAL TO ANOTHER. •PASSIVE IMMUNITY PROVIDES PROTECTION AGAINST SOME INFECTIONS, BUT THIS PROTECTION IS TEMPORARY. THE ANTIBODIES WILL DEGRADE DURING A PERIOD OF WEEKS TO MONTHS, AND THE RECIPIENT WILL NO LONGER BE PROTECTED.

DISEASES OF TRAVELERS

•TRAVEL HISTORY IS A CRITICAL QUESTION WHEN ASSESSING PATIENTS TO ASSESS FOR POSSIBLE INFECTIOUS DISEASES •TRAVEL PRECAUTIONS FOR DISEASES ENDEMIC IN OTHER COUNTRIES •ARTHROPOD (ZIKA, MALARIA) •FOODBORNE AND WATERBORNE DISEASES (CHOLERA) •VECTOR (RABIES) •PARASITES (FOOD, WATER) •KEEP IN MIND VACCINATION SCHEDULES WHEN TRAVELING AND CERTIFICATES OF VACCINATION - YELLOW FEVER •*CDC TRAVELER'S WEBSITE - ADVISORIES, RESOURCES*

VACCINE-PREVENTABLE DISEASES

•VACCINES ARE ONE OF THE MOST EFFECTIVE METHODS TO PREVENT AND CONTROL COMMUNICABLE DISEASES •U.S "NO SHOTS NO SCHOOL" LEGISLATION KEY IN SUCCESS OF CHILDHOOD VACCINE PROGRAMS •VACCINE INFORMATION STATEMENTS (VIS) FOR EACH VACCINE GIVEN BEFORE ADMINISTRATION.

ANOTHER WAY TO PRODUCE ACTIVE IMMUNITY IS THROUGH *VACCINATION*

•VACCINES INTERACT WITH THE IMMUNE SYSTEM AND OFTEN PRODUCE AN IMMUNE RESPONSE SIMILAR TOTHAT PRODUCED BY THE NATURAL INFECTION, BUT THEY DO NOT SUBJECT THE RECIPIENT TO THE DISEASE AND ITS POTENTIAL COMPLICATIONS. MANY VACCINES ALSO PRODUCE IMMUNOLOGIC MEMORY SIMILAR TO THAT ACQUIRED BY HAVING THE NATURAL DISEASE. •PROTECTION IS BETTER AGAINST SOME DISEASES (E.G., MEASLES, RUBELLA, TETANUS) THAN OTHERS (E.G., POLIO, PERTUSSIS). •A PERSON WITH ACTIVE OR VACCINE-INDUCED IMMUNITY, WILL RECOGNIZE THE DISEASE-CAUSING ORGANISM AND IMMEDIATELY BEGIN PRODUCING ANTIBODIES NEEDED TO FIGHT THE INFECTION.

TRANSMISSION OF COMMUNICABLE DISEASES: *Modes of Transmission*

•Vertical transmission - parent to offspring •Horizontal transmission - person to person •Common vehicle - transportation to host via food, water, blood/body fluids •Vectors - animals, arthropods,

COMMUNICABLE DISEASES WORLDWIDE PUBLIC HEALTH THREAT

•WORLDWIDE, INFECTIOUS DISEASES ARE CAUSE MILLIONS OF DEATHS ANNUALLY. •LEADING CAUSES OF INFECTIOUS DISEASE DEATHS ARE ACUTE RESPIRATORY INFECTIONS (PNEUMONIA, INFLUENZA), HIV/AIDS, DIARRHEAL DISEASES, TUBERCULOSIS, MALARIA, AND MEASLES. •VIRAL HEPATITIS AND OTHER SEXUALLY TRANSMITTED INFECTIONS ARE ALSO A SIGNIFICANT PUBLIC HEALTH THREAT (NEW HIGH RISK POPULATIONS) •NEW INFECTIOUS DISEASES ARE EMERGING (COVID 19) •OLD INFECTIOUS DISEASES ARE RE-EMERGING AND BECOMING MORE VIRULENT (EBOLA, MDR TB) •INFLUENCED BY ENVIRONMENTAL CHANGES, SOCIETAL CHANGES, DEVELOPMENT, AND GLOBALIZATION •MOST INFLUENCING FACTOR IS BEHAVIOR AND ACTIVITIES OF HUMAN HOSTS •INTERNATIONAL (AND DOMESTIC) TRAVEL