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Influenza Incubation Period

1-4 days

Flu Meds

zanamvir (Relenza), oseltamivir (Tamiflu)

"Flu Shot" Recommendations

Recommended for all pregnant women
Infants 6 months and older
All persons 50 and up
19-49 with the following:
Medical chronic conditions including HIV & esp asplenia, occupational risk, residential occupancy risk


Live attenuated vaccine
Healthy people 2-49 years old
No high risk medical conditions
No contact with severely immunocompromised persons
Adverse effects: nasal irritation/discharge, muscle aches, sore throat, fever

FluMist Contraindications

Chronic heart disease
Chronic lung disease or asthma
Kidney failure
Children receiving long term high dose aspirin
H/o Guillian-Barre' syndrome
Allergy 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 only
high level of viral resistance
not recommended for use in recent US flu seasons

zanamivir, oseltamivir

Tx. influenza A & B
Start during 1st 2 days of illness
Relenza: inhaled, can cause bronchospasm
Tamiflu: n/v, take with food

MMR vaccine

Live attenuated vaccine
Unclear vac hx? Vaccinate
Two doses 1 month apart for adults born after 1957


Mild 3-5 day illness, few complications to infected person
Highly teratogenic


Can cause severe illness
Sequelae: encephalitis, pneumonia


Can cause severe illness
Sequelae: orchitis, encephalitis, pneumonia

MMR Contraindications

Severe allergy to gelatin or neomycin
*Safe during lactation

Td/Tdap Protocol

One time dose of Tdap, then boost with Td every 10 yrs
& > 10 yrs last vacc? Give Td during 2nd or 3rd trimester
If received Td < 10 yrs ago, give Tdap immediately postpartum
Close contacts of infants < 12 mos old
Intervals: 2 years or less from last Td vacc

HPV Vaccination

Recommended: age 11 or 12
Catch-up: ages 13-26
3 doses: 2nd 1-2 mos after 1st dose, 3rd 6 mos after 1st dose
Can give to people with h/o genital warts, abnormal Pap, or positive HPV DNA test

Varicella Vaccination

Adults: 2 doses at least 4 weeks apart
Evidence 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 confirmation
Pregnancy: 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 strains
Ineffective against other organisms
Ages 19-64: 1 or 2 doses, 1 time revacc after 5 yrs if chronic renal failure, nephrotic syndrome, asplenia, immunocompromise
65 and up: 1 dose, 1-time revacc recommended if 5 or more yrs since last dose & were < 65 at time of last dose
All chronic medical conditions including asthma & asplenia, immunocompromise
Vaccinate as close to HIV dx. as possible
Nursing home residents

Hepatitis A Vaccination

Common source: fecal-contaminated drinking water & food
Vacc: All children 12-23 mos, 2 doses at least 6 mos apart
Anyone wanting protection plus:
Travel to or adopting from certain countries
Men who have sex with men
IV drug users
Chronic liver disease
Recipient of clotting factor concentrates
Dz: self limiting, Tx: supportive

Hepatitis B Vaccination

Contraindication: baker's yeast allergy
Routine screen all pregnant women for antigens regardless of vaccine hx
Infected infants: 25% risk of hepatocellular carcinoma or cirrhosis
Multiple sex partners in past 6 months, STD tx.
Health-care & public safety workers who are exposed to blood/body fluids
Workers in multiple treatment facilities: drug abuse, STD, developmentally disabled care, correctional facilities
End-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 exposure
Incomplete vaccine series: HBIG dose & complete the vaccine series
Unvaccinated: HBIG and vaccine ASAP after exposure, preferably within 24 hrs
Occupational exposure: intervention done in consultation with experts in the area
Test for Hep A & C & HIV

Meningococcal Vaccine Protocol

1st year college students living in dorms
Military recruits
Travel to certain countries
Revacc:after 5 years for adults who remain at increased risk for infection

Vaccines for Immunocompromised

Influenza (inactivated)
(With HIV, live vaccines usually not given with CD4 T cell count < 200)

Hib Vaccine

Generally not recommended for ages 5 and up
Ok to use for sickle cell, leukemia, HIV, or splenectomy patients

Smallpox Disease

Variola virus, serious, 30% fatality rate
Last US case: 1949, worldwide: Somalia, 1977
Spread: direct deposit of droplets onto nasal, oral, pharyngeal membrane, aveoli
Contagious: sometimes during fever onset, sometimes during rash, until last scab falls off
Incubation: 7-17 days
Prodromal: 2-4 days with temp 101-104, HA, body aches, malaise, sometimes vomiting

Smallpox Rash

All skin lesions are at the same stage
Small spots on tongue & mouth, then open sores in mouth & throat
Rash appears on skin face first, then arms/legs, then feet within 24 hrs
Isolate swiftly, report
Live vaccine

Varicella Vaccine

1st dose: after 1st birthday
2nd dose: between ages 4-6
Older children with no vacc history: 2 doses 4-8 weeks apart
Pregnant women: 1st dose on completion of pregnancy, 2nd dose 4-8 weeks later
Mild cases of chickenpox may be reported after immmunization
With 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 disease
No evidence of immunity & contraindications for vaccine? use IG for post-exposure prophylaxis
IG: pooled blood product, excellent safety profile


gram positive
Contaminated wound = life threatening dz. of painful muscle weakness & spasm (aka Lockjaw)
Titers wane over time, most cases >50 yo
Post-exposure prophylactic: IG for those who haven't received vaccine

Gram positive bacteria

Clostridium tetani (spore-forming)

Gram negative bacteria

Corynebacterium diptheriae


gram negative
person-to-person or contaminated liquids ie, milk
severe respiratory tract infection including pseudomembranous phyarngitis

Pertussis Vaccine

Single-dose in childood provides protection

Poliovirus Facts

Fecal-oral transmission
Highly contagious=paralytic & life threatening
1994: declared eradicated in North & South America
IPV: 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 years
High risk: MRI and mammogram every year

Fecal occult blood test

Annually starting at age 50
Fingertip test during office DRE: Not a substitute for collecting 2 samples from 3 consecutive specimens at home
No toilet bowl specimens

Fecal immunochemical tst

Equal or better than FOBT
If positive, do not repeat, perform

Stool DNA test

Begin at age 50, interval uncertain
If positive, perform colonoscopy

Flexible sigmoidoscopy or Double contrast barium enema

Start at age 50, every 5 years


Start at age 40, every 10 years

CT colonoscopy

AKA virtual colonoscopy
Start at Age 50, every 5 years

DRE and PSA test

Offer at age 50
High risk= AA & 1+ 1st degree relative dx. < 65: begin at age 45
Highest 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 21
Annual with conventional tests or every 2 years with liquid tests
3 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 use
Advise to quit
Assess willingness to quit
Assist in quit attempt
Arrange follow-up

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