Influenza Incubation Period
1-4 days
Flu Meds
zanamvir (Relenza), oseltamivir (Tamiflu)
Flu Shot" Recommendations
Recommended for all pregnant womenInfants 6 months and olderAll persons 50 and up19-49 with the following:Medical chronic conditions including HIV & esp asplenia, occupational risk, residential occupancy risk
FluMist
Live attenuated vaccineHealthy people 2-49 years oldNon-pregnantNo high risk medical conditionsNo contact with severely immunocompromised personsAdverse effects: nasal irritation/discharge, muscle aches, sore throat, fever
FluMist Contraindications
Chronic heart diseaseChronic lung disease or asthmaDiabetesKidney failureImmunosuppressionChildren receiving long term high dose aspirinH/o Guillian-Barre' syndromePregnantAllergy to eggs
1st time Flu Protocol (Peds)
Children < 9 yo: 2 doses of vaccine separated by 4 or more weeks (with TIV), & 6 or more weeks (with LAIV)
amantadine, rimantadine
Tx. and prevent Influenza A onlyhigh level of viral resistancenot recommended for use in recent US flu seasons
zanamivir, oseltamivir
Tx. influenza A & BStart during 1st 2 days of illnessRelenza: inhaled, can cause bronchospasmTamiflu: n/v, take with food
MMR vaccine
Live attenuated vaccineUnclear vac hx? VaccinateTwo doses 1 month apart for adults born after 1957
Rubella
Mild 3-5 day illness, few complications to infected personHighly teratogenic
Measles
Can cause severe illnessSequelae: encephalitis, pneumonia
Mumps
Can cause severe illnessSequelae: orchitis, encephalitis, pneumonia
MMR Contraindications
Severe allergy to gelatin or neomycinPregnancy*Safe during lactation
Td/Tdap Protocol
One time dose of Tdap, then boost with Td every 10 yrsPregnant: & > 10 yrs last vacc? Give Td during 2nd or 3rd trimesterIf received Td < 10 yrs ago, give Tdap immediately postpartumClose contacts of infants < 12 mos oldIntervals: 2 years or less from last Td vacc
HPV Vaccination
Recommended: age 11 or 12Catch-up: ages 13-263 doses: 2nd 1-2 mos after 1st dose, 3rd 6 mos after 1st doseCan give to people with h/o genital warts, abnormal Pap, or positive HPV DNA test
Varicella Vaccination
Adults: 2 doses at least 4 weeks apartEvidence of immunity: US born before 1980 (N/A in health-care workers or pregnant women), h/o of documented dx, h/o verified herpes zoster, lab evidence of immunity or dx confirmationPregnancy: assess for immunity, give 1st dose upon completion of pregnancy, 2nd dose 4-8 wks later
Herpes Zoster Vaccination
Adults 60 and older: single dose
PPSV (Pneumococcal polysaccharide vaccine) Protocol
Vacc against 23 Streptococcus pneumoniae strainsIneffective against other organismsAges 19-64: 1 or 2 doses, 1 time revacc after 5 yrs if chronic renal failure, nephrotic syndrome, asplenia, immunocompromise65 and up: 1 dose, 1-time revacc recommended if 5 or more yrs since last dose & were < 65 at time of last doseAll chronic medical conditions including asthma & asplenia, immunocompromiseVaccinate as close to HIV dx. as possibleSmokersNursing home residents
Hepatitis A Vaccination
Common source: fecal-contaminated drinking water & foodVacc: All children 12-23 mos, 2 doses at least 6 mos apartAnyone wanting protection plus:Travel to or adopting from certain countriesMen who have sex with menIV drug usersChronic liver diseaseRecipient of clotting factor concentratesDz: self limiting, Tx: supportive
Hepatitis B Vaccination
Contraindication: baker's yeast allergyRoutine screen all pregnant women for antigens regardless of vaccine hxInfected infants: 25% risk of hepatocellular carcinoma or cirrhosisMultiple sex partners in past 6 months, STD tx.Health-care & public safety workers who are exposed to blood/body fluidsWorkers in multiple treatment facilities: drug abuse, STD, developmentally disabled care, correctional facilitiesEnd-stage renal dz, HIV, chronic liver dz.Household contacts of ppl with HBV
Hep B Post-exposure Prophylaxis
Complete vaccine series but no post-vacc testing: single booster dose with nonoccupational known HBsAG-positive source exposureIncomplete vaccine series: HBIG dose & complete the vaccine seriesUnvaccinated: HBIG and vaccine ASAP after exposure, preferably within 24 hrsOccupational exposure: intervention done in consultation with experts in the areaTest for Hep A & C & HIV
Meningococcal Vaccine Protocol
Asplenia1st year college students living in dormsMilitary recruitsTravel to certain countriesRevacc:after 5 years for adults who remain at increased risk for infection
Vaccines for Immunocompromised
PneumococcalMeningococcalInfluenza (inactivated)(With HIV, live vaccines usually not given with CD4 T cell count < 200)
Hib Vaccine
Generally not recommended for ages 5 and upOk to use for sickle cell, leukemia, HIV, or splenectomy patients
Smallpox Disease
Variola virus, serious, 30% fatality rateLast US case: 1949, worldwide: Somalia, 1977Spread: direct deposit of droplets onto nasal, oral, pharyngeal membrane, aveoli Contagious: sometimes during fever onset, sometimes during rash, until last scab falls offIncubation: 7-17 daysProdromal: 2-4 days with temp 101-104, HA, body aches, malaise, sometimes vomiting
Smallpox Rash
All skin lesions are at the same stageSmall spots on tongue & mouth, then open sores in mouth & throatRash appears on skin face first, then arms/legs, then feet within 24 hrsIsolate swiftly, reportLive vaccine
Varicella Vaccine
1st dose: after 1st birthday2nd dose: between ages 4-6Older children with no vacc history: 2 doses 4-8 weeks apartPregnant women: 1st dose on completion of pregnancy, 2nd dose 4-8 weeks laterMild cases of chickenpox may be reported after immmunizationWith HIV, live vaccines usually not given with CD4 T cell count < 200
Varicella Post-exposure Prophylaxis
Vacc w/in 3-5 days of exposure to prevent or modify diseaseNo evidence of immunity & contraindications for vaccine? use IG for post-exposure prophylaxisIG: pooled blood product, excellent safety profile
Tetanus
gram positiveContaminated wound = life threatening dz. of painful muscle weakness & spasm (aka Lockjaw)Titers wane over time, most cases >50 yoPost-exposure prophylactic: IG for those who haven't received vaccine
Gram positive bacteria
Clostridium tetani (spore-forming)
Gram negative bacteria
Corynebacterium diptheriae
Diptheria
gram negativeperson-to-person or contaminated liquids ie, milksevere respiratory tract infection including pseudomembranous phyarngitis
Pertussis Vaccine
Single-dose in childood provides protection
Poliovirus Facts
Fecal-oral transmissionHighly contagious=paralytic & life threatening1994: declared eradicated in North & South AmericaIPV: inactivated poliovirus, no shedding through stool as with OPV (OPV no longer used in US)
Breast self exam
Begin with women in early 20s
Clinical breast exam
Women in 20s and 30s at least every 3 years
Mammography MRI
Begin annual mammography at 40 yearsHigh risk: MRI and mammogram every year
Fecal occult blood test
Annually starting at age 50Fingertip test during office DRE: Not a substitute for collecting 2 samples from 3 consecutive specimens at homeNo toilet bowl specimens
Fecal immunochemical tst
Equal or better than FOBTIf positive, do not repeat, perform colonoscopy
Stool DNA test
Begin at age 50, interval uncertainIf positive, perform colonoscopy
Flexible sigmoidoscopy or Double contrast barium enema
Start at age 50, every 5 years
Colonoscopy
Start at age 40, every 10 years
CT colonoscopy
AKA virtual colonoscopyStart at Age 50, every 5 years
DRE and PSA test
Offer at age 50High risk= AA & 1+ 1st degree relative dx. < 65: begin at age 45Highest risk = multiple 1st degree relatives dx. at early age: begin at age 40
Pap test
3 years after onset of intercourse but no later than age 21Annual with conventional tests or every 2 years with liquid tests3 normal tests in a row: screen every 2-3 years with cervical cytology alone or CC & HPV DNA test> 70 yo & no abnormal paps in 10 years or total hysterectomy with no cervical CA or preCA: may stop screening
Endometrial Cancer
At menopause, report any unexpected bleeding or spotting to health care provider
Smoking: 5 As
Ask about useAdvise to quitAssess willingness to quitAssist in quit attemptArrange follow-up