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Vaccine Preventable Illnesses

Terms in this set (101)

Disorders resulting form inherited defects of the immune system (both isolated and combined effects) that are presenting in any part or multiple parts of the immune system
Primary immunodeficiency
Impaired antibody (Ig) production
Humoral immunodeficiency
Recurrent severe URI/LRTI including OM, sinusitis, pneumonia
Infection with encapsulated bacteria
Poor growth, failure to thrive, unexplained splenomegaly, chronic diarrhea, sporadic intermittent fevers
Peds presentation of primary immunodeficiency
What is the most common immunodeficiency?
Selective IgA deficiency
Dx of _____ deficiency

Deficiency of serum IgA (with normal IgG and IgM) in a child >4 yo
Most are asymtomatic!!
IgA
Most kids with IgA deficiency are asymptomatic. What are some signs that they may have this condition if they did show symptoms?
Recurrent ________infections
• _______ disorders
• ______ infections and other intestinal disorders
• _______ disorders
• Anaphylactic ________ reactions
Sinopulmonary, autoimmune, GI, allergic, transfusion
What are some indications for work up for Selective IgA deficiencies? (6)
recurrent OM, sinusitis and/or PNA, Giardias, family hx of primary immunodeficiency, celiac dz
How is selective IgA deficiency dx and managed?
Serum level of IgA, IgG, IgM, refer to immunology
What is the condition with impaired B cell, T cell and dendritic cell production leases to impaired Ig production with pts usually presenting around puberty. These pts have variable clinical manifestations.
Common variable immunodeficiency
How can common variable immunodeficiency be diagnosed?
Reduced serum IgA, G, and M, with poor response or no response to vaccines
What are the s/s of common variable immunodeficiency?
Chronic or recurrent URI/LRTI that may develop bronchiectasis check on CXRs, diarrhea, malabsorption, weight loss,
How to managed Common variable immunodeficiency
Refer to immunologist for further evaluation, Ig replacement
Severe defect in BOTH T and B lymphocyte systems-early death from overwhelming infection usually in first year of life. Most common form is X linked (males only) part of new born screening in all states
Severe combined immunodeficiency
Can children become ill from live vaccines if they have severe combined immunodeficiency?
Yes! varicella, MMR, OPV or RV
Manifestations of SCID
Persistent mucocutanous candidiasis (thrush) (this indicates immune system is not doing it's job.. super bad!)
What is the most prevalent micro deflation syndrome in the US affected multiple body systems?
DiGeorge syndrome
What are some of the cardiac defects of digeogre syndrome?
TOF, ASD, VSD, truncus arteriousus, interrupted aortic arch
What are some immune dysfunctions associated with digeorge syndrome?
T cell deficits, hypoplastic thymus gland
S/s other than cardiac and immune dysfunction in digeorge syndrome?
Cleft palate, craniofacial abnormalities, hypocalcemia (parathyroid hypoplasia)
What is an autosomal recessive disorder if homozygous presents as progressive cerebral liar ataxia, oculocutaneous telangiectasias, and immune deficiency in kids
Ataxia telangiectasia
Presentation in kids in ataxia telangiectasia
Walk at normal age but don't develop fluids of gait, wobbly,
Difficulty coordinated eye and head movement, nystagmus,
Telangiectasia of conjunctiva face and neck,
Variable immune deficiency-usually recurrent URI/LRTI,
Malignancy in 25% of pts after Age 10
Management of ataxia telangiectasia
Manage each dz manifestation individually and refer to immunology
Virus is alive but weakened; virulence reduced
Live attenuated
What are some examples of live attenuated vaccines?
MMR, nasal influenza, varicella vaccines
Killed virus; capsid proteins remain and are antigenic
Inactivated
Small virus particles, no viral dna
Viral particles
Viral proteins only
Subunit vaccine
Inactivated toxin stimulates antibody production
Toxoid (ex tetanus)
CI for live virus vaccines
Pregnancy, severe cell mediated immunodeficiency, anaphylactic rx, egg/chicken allergy for some flu and yellow fever vaccines
What are common misconceptions and are NOT CI to live vaccines?
Mild acute illness regardless of fever, Low grade fever, mild to moderate local rx to previous vaccine
What are normal SE of vaccines
Fussiness (<3 hrs, consolable), Tiredness, Low grade fevers (<101.5F), Pain/swelling/redness at site of injection
When does fussiness and temperature become an abnormal rx after vaccine admin?
If inconsolable crying afte 4 hours and with high fever 104-105
What are considered abnormal rx after vaccines?
Inconsolable crying over 3 hours, high fever, sz, Neurological abnormalities, anaphylactic rx
When do we give Hep A?
2 doses at least 6 months apart before age 2, at 12 and 18 months
Hep B transmission
Virus via blood and other body fluids-mother to newborn during delivery
Vaccine schedule Hep B
Birth, 1-2 mo, 6-18 months
If mom is + give Hep B immunoglobulin
How many series is DTAp? When is it given
5, given at 2 mo, 4, 6, 15-18, 4-6
S/s Diptheria
Erythema gray and white exudate or pseudomembrane
Tx diptheria
14 days Emycin or PCN
What are the 3 distinct phased of symptoms of pertussis?
Catarrhal, paroxysmal, convalescent
Tx pertussis
Macroglides (prophylaxis for contacts)
When do we start series of 5 pertussis vaccines?
2 months (then at 4, 6, 15-18, 4-6 years)
T/F All pregnant mother get TDAP with every pregancy
True
T/F all pts hourly receive a single booster immunization with TDAP after age 11
True
S/S of Tetanus
Tonic contraction, trismus, intermittent intense muscular contractions
Tx of tetanus
Wound management, rx metronidazole, TIG, 3 doses of Td 2 weeks apart
What vaccines are part of tetanus vaccinations?
DTap, TDAP, DT, Td
DTAP is a series of ___ vaccines starting at what age?
5, 2 months (then 4, 6, 15-18, 4-6 years(
Which vaccines are given for kids less than 7? For diphtheria, tenanus, and pertussis?
DTap, DT
Which vaccines are given to kids older than 7?
Td, Tdap
When do you give DT?
Kids under 7 who can't tolerate pertussis (or for pt with prolonged vaccine schedule)
S/s haemophilus influenza (hib)
Meningitis, epiglottis, pneumonia, emphysema, pericarditis, bacteremia, and septic arthritis
Tx of haemophilus influenza (hib)
Amoxicillin
Hib vaccine series of __-___ starting at ___ months
3-4, 2months (then at 4, 6, 12-15 months)
Polio transmission
Fecal oral and resp droplet
S/S polio: Post polio syndrome
Progressive loss of motor neurons leading to muscle wasting and paralysis
Is polio an activated or inactivated vaccine?
Inactivated (activated form actually was giving ppl polio so no longer commonly used except in 3rd world countries)
Polio is a series of __ starting at __ months
4, 2 months
Tx Pneumococcal infections
PCN (or broad spectrum cephalosporin)
To prevent Steptococcus ______
PCV13 given to children < _____ years. Given starting at __ months. Series of
Pneumonia, 5 years old, 2 months (4, 6, 12-15), 4
PPSV23 (Pneumovax) given to ___ risk kids ___ y.o
High, 2
When both PCV13 and PPSV23 indicated give ___ first. Do not administer during same visit!
PCV13 (remember 13 comes before 23)
Transmission of Rotavirus
Fecal oral or fomites, shed in large number in stool
tx of rotavirus
Supportive
Is the rotavirus vaccine live or inactivated?
Oral, live attenuated
Rotavirus given in a series of __ or ___ staring at __ months
2 or 3, 2 months (then at 4 and/or 6 months)
CI to rotavirus vaccine
weakened immune system or hx of interssusception
measles (Rubeola) s/s
Fever, cough, Corya, conjunctivitis, exanthem 2-4 days later starting on face moving to trunk/extremities, Koplik's spots on mucosa
MMR vaccine series of __ live vaccines starting at ___-___ months then at ___-__ years (Rubeola/measles)
2, 12-15 months, 4-6 years
Describe exanthem presenting 2-4 days after measles/rubeola infection
Erythematous, maculopapular, blanching rash sitting on face moving to trunk/extremities
High risk people who need measles booster include?
Healthcare workers, university students who are traveling abroad where outbreaks are occurring
Who is immune to measles/dont' need boosters?
Hx of measles, high risk with hx of 2 doses, Non high risk with hx of at least 1 dose, MMR btwn 1957-1968 only immune if received live vaccine
T/F CDC recommends booster for anyone with questionable immunity
True
What is mumps caused by? What's is transmission?
Paramyxovirus, spread by resp droplets, fomites, direct contact
sx of mumps
LGF, malaise, myalgias, ha, parotid, orchitis/oophoritis, may cause hearing loss
Dx of mumps, tx, prevention
IgM or PCR,tx is supportive, MMR vaccine
Acute onset of maculopapular rash starting on face spreads within 24 hrs and disappears about 3 days later, Low grade fever, cervical lymphadenopathy.
Rubella (German measles)
Consequences of rubella (German measles)
Congenital rubella syndrome- healing loss, mental retardation, cardiovascular defects, ocular defects
Tx/prevention Rebella (German measles)
Supportive, prevent spread, MMR vaccine
Transmission of chickenpox
Respiratory droplets, vesicle fluid carnations 1-2 days prior to rash
Sx of chickenpox
Usually begins with vesicular rash (may have LGF, malaise) radish starts of face/trunk/scalp/proximal extremities
How long does it take for vesicles of chicken pox to rupture and crust over?
48 hrs
How id chicken pox dx?
Clinical or viral cx of fluid
Varicella vaccine serious of ___ LIVE vaccines given at __-__ months
2, 12-15
Meningitis serogorups A,C, W, and Y (MCV4) (Menveo and Menactra) are a __- dose series with first dose at ___-___ years of age and booster at ___
2, 11-12, 16
Menveo can be given at __ weeks and meanctra at __ months for infants with immune dz or travel to meningitis endemic countries
8, 9
Meningococcal serogroup B vaccination is a __ or __ dose series given to pts' age over 10 at ____d/t complement deficiencies, anatomical or functional asplenia, or at increased risk b/c of meningitis B disease outbreak
2 or 3 dose, risk
Meningococcal serogroup B
May be administered to adolescents and young adults not at increased
risk age ____-____years (preferred age 16-18 years) based on individual clinical
decision
16-23 (Think of college or travel to meningitis endemic areas)
Which type of HPC responsible for 80% of cervical cancers?
16 and 18
Which type of HPV responsible for 90% of genital warts?
6 and 11
Which vaccine covers all stereotypes of HPV? What are recommendations?
Gardasil 9
Recommended for all adolescents age 11-12 years (can start at age 9
years) and through age 26 years (2-3 dose series depending on age at initial vaccination)
When is the seasonal epidemic for flu?
Fall-late spring (peaks in mid February)
What are s/s of flu?
Abrupt onset fever, chills, myalgi, ha, malaise, nonproductive cough, sore throat, rhinitis
How long does a rapid diagnostic test for flu take?
10-15 minutes, detects influenza a or b antigens in nasal swab,
Potential for false negs
PCR test for influenza results in __ hours
24 hours highly sensitive (way better than rapids)
Treatment flu
Oseltamivir (Tamiflu) Weight based dosing for peds >2 weeks old, must be within 48 hrs of onset
T/F Flu vaccine is a activated only
False there is a live attenuated intranasal option
CI Inactivated flu vaccine
Serious allergic reaction to eggs
Inactivated flue vaccine indicated annually for everyone ages __ month and up. Children 6 months to 8 months need __ doses __ weeks apart the first year after receiving vaccine
6, 2, 4
Live attenuated intranasal flu vaccine can be given to healthy people ages __-__ years old
2, 49
Should not give live attenuated flu vaccine to: (there's a ton of restrictions)
History of severe allergic reaction to a previous dose of any influenza vaccine or to any vaccine component (excluding egg, see details above)

Receiving aspirin or salicylate-containing medications

Age 2-4 yo with Hx of asthma or wheezing

Immunocompromised due to any cause (including medications and HIV infection)

Anatomic or functional asplenia

Cochlear implant

Cerebrospinal fluid-oropharyngeal communication

Close contacts or caregivers of severely immunosuppressed persons who require a protected environment

Pregnancy

Received influenza antiviral medications within the previous 48 hours
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