Vaccine Preventable Diseases

Transcription

1 Vaccine Preventable Diseases Vaccines Typically Given in the United States Disease and Organism Vaccines Available 1 Signs/ Symptoms 2 Treatment Transmission Reportable to CDC? 3 Acelluar pertusis (Whooping Cough) (Bordetella pertussis) 4 TriHIBit (combination DTaP/Hib) Daptacel (combination DTaP) Infanrix (combination DTaP) Tripedia (combination DTaP) Boostrix (combination Tdap) Adacel (combination Tdap) Click here to hear whooping cough Catarrhal stage: runny nose, sneezing, low-grade fever, occasional, mild cough Paraoxysmal stage: whooping cough, cyanosis, vomiting, exhaustion may follow fit of coughing, Convalescent stage: gradual recovery Erythromycin, Clarithromycin x 7 days, Azithromycin x 5 days (effective as day course of erythromycin) Trimethoprim/sulfamethoxazole X 7 days Antibiotics do not usually alter the course of the disease, unless given very early on in disease progression. Antibiotics are usually prescribed to eradicate organisms from secretions to minimize the risk of transmission. All those in close contact with infected patient should be treated with antibiotic effective against pertusiss. Close contacts of age < 7 should complete four-dose series with minimum intervals Human to human (adolescents and adults may serve a reservoirs), airborne transmission 1 Combination vaccines are preferred over the other available forms for childhood immunizations because they offer a combination of vaccines to be given at once, minimizing the number of injections as well as opportunities for missing a dose. However, some combinations may only be licensed for a certain age group. 2 All images are hyperlinked to original web pages. 3 May change yearly. Check with CDC website to confirm. ( 4 Different manufacturer s formulations may not be used interchangeably; no data exists on the effect of interchanging vaccines on the protection offered. Use of the same manufacturer s vaccine is preferred for at least the first three doses.

2 Diptheria (Corynebacterium diphtheriae - symptoms caused by exotoxin of bacteria) Haemophilus influenzae type B disease (Haemophilus influenzae type B) 6 TriHIBit (combination DTaP/Hib) Daptacel (combination DTaP) Infanrix (combination DTaP) Tripedia (combination DTaP) Boostrix (combination Tdap) Adacel (combination Tdap) Decavac (combination Td) Generic (combination Td) TriHIBit (combination DTaP/Hib) Comvax (combination HepB/Hib) HibTITER PedvaxHIB ActHIB Hepatitis A 6 Twinrix (combination Hep A/Hep B) Havrix Vaqta Anterior nasal diphtheria: mucopurulent nasal discharge, may be blood-tinged Pharyngeal and Tonsillar diphtheria: malaise, sore throat, anorexia, lowgrade fever, bluish-white membrane on tonsils, may extend to soft palate; may progress to lymphadenopahy Laryngeal diphtheria: fever, hoarseness, barking cough Cutaneous diphtheria: scaling rash, ulcers with demarcated edges and membranes Meningitis: fever, decreased mental status, stiff neck Epiglottitis: swelling of epiglottis Septic arthritis Cellulitis Pneumonia Acute hepatitis: dark urine, jaundice, fever, malaise, N/V, abdominal pain, arthralgia, increased LFTs Diptheria antitoxin 5 (in horse serum) Only available from CDC through IND Prior to giving, must do skin test for horse serum May need to follow desensitization protocol Dosage dependent on area of infection Pharyngeal/ laryngeal x 48 hours: 20,000 40,000 units Nasopharyngeal: 40,000 60,000 units Systemic disease > 3 days or diffuse neck swelling: 80, ,000 units Skin lesions only: 20,000 40,000 units Must also receive antibiotics x 14 days: Erythromycin 40 mg/kg/day, max 2 g/day OR Procaine pen G IM < 10 kg: 300,000 Units/day; > 10 kg: 600,000 Units/day Broad-spectrum cephalosporin until culture and sensitivity return Human to human (some human may be carriers and asymptomatic); tract, occasionally skin contact with asymptomatic carriers; droplet spread fecal-oral transmission, either person-toperson contact or contaminated food or water Invasive disease, i.e. associated with meningitis, bacteremia, epiglotittis, pneumonia Acute cases 5 Antitoxin will not treat the disease itself; however, it will bind free toxin to avoid further complications. 6 Various formulations from different manufacturers may be used interchangeably without any decrease in protection.

3 Hepatitis B 6 Twinrix (combination Hep A/Hep B) Comvax (combination HepB/Hib) Engerix-B Recombivax HB Prodrome: malaise, anorexia, N/V, RUQ pain, fever, headache, myalgia, skin rashes, arthralgia, dark urine Icteric phase: jaundice, light or gray stools, hepatic tenderness, hepatomegaly May lead to chronic infection: chronic hepatitis, cirrhosis, liver failure, hepatocellular carcinoma Supportive treatment for acute infection Chronic infection (must meet certain critieria): Interferon 5 million units SC qday x 16 weeks Lamivudine 100 mg PO qday (for life or antibody conversion) parenteral or mucosal exposure to Hepatitis B positive body fluids from person with acute or chronic infection Main modes: sexual contact, injection drug use Human Papillomavirus (HPV 6, 11, 16, 18) Influenza (orthomyxovirus family, may be type A, B, or C) Gardasil (Cervarix 7 ) Fluarix Fluvirin Fluzone FluLaval FluMist (intranasal, live virus) Mostly asymptomatic Manifestations may include anogenital warts, recurrent papillomatosis, cervical cancer precursors, cancers Abrupt onset of fever, myalgia, sore throat, nonproductive cough, headache Dependent of manifestation of HPV If diagnosed within 48 hours of onset, antiviral medications may be used Oseltamivir 75 mg PO qday (types A and B) Zanamivir 10 mg inhaled qday (types A and B) direct contact, usually sexual contact Influenza A human to human, animal to human Influenza B and C human to human; Airborne virusladen droplets, direct/indirect contact with secretions No Novel influenza A isolates Influenza-associated mortality < 18 years of age 7 Developed by GSK; awaiting FDA approval

4 Measles (paramyxovirus, Morbillivirus genus) M-M-R-II (combination -MMR) ProQuad (combination - MMRV) Attenuax Mainly supportive care In children, may consider Vitamin A 200,000IU PO x 2 days, especially if hospitalized and ocular complications droplets Meningococcal disease (Neisseria meningitidis) Menomune Menactra Prodrome: fever, cough, runny nose, conjunctivitis Rash, Koplik spots (rash on mucous membranes) Meningitis: sudden onset of fever, headache, stiff neck, N/V, photophobia, altered mental status In adults, some may choose to use ribavirin (20-35 mg/kg/day x 7days) Broad-spectrum cephalosporins for intial treatment, with streamlining after culture and sensitivities return with some humans as asymptomatic carriers; droplet or direct contact Mumps (paramyxovirus) M-M-R-II (combination -MMR) ProQuad (combination - MMRV) Mumpsvax Sepsis: abrupt onset of fever, petechial or purpuric rash, associated with hypotension, shock, acute adrenal hemorrhage, multiorgan failure May also see pneumonia, arthritis, otitis media, epiglottitis Until diagnosis is confirmed, patient may receive empiric coverage for S. aureus, another major cause of parotitis Human, to human, airborne or direct contact with infected droplet nuclei or saliva Prodrome: myalgia, anorexia, malaise, headache, low-grade fever Parotitis (unilateral or bilateral)

5 Pneumococcal disease (Streptococcus pneumoniae) Poliomyelitis (enterovirus, Picornaviridae family) Pneumovax 23 Prevnar Ipol Pneumonia: abrupt onset of fever and chills, pleuritic chest pain, productive cough with rusty sputum, dyspnea, tachypnea, hypoxia, malaise, weakness Meningitis: may present also with pneumonia, headache, lethargy, fever, cranial nerve signs, seizures, coma Bacteremia: 25-30% development in those with pneumonia Broad-spectrum treatment with cephalosporin or fluroquinolone, depending on PCN resistance rates in area; consider using vancomycin if suspect meningitis Streamline treatment to appropriate antibiotic once culture and sensitivity has returned Human to human with asymptomatic carriers; direct contact with droplets fecal-oral transmission Only in children less than five years of age Rotavirus (Reoviridae family) Rubella (German Measles) (togavirus, Rubivirus genus) Tetanus (Clostridium tetani symptoms caused by RotaTeq M-M-R-II (combination -MMR) ProQuad (combination - MMRV) Meruvax II TriHIBit (combination DTaP/Hib) Prodrome: upper tract infection, gastrointestinal diseases, influenza-like illness Nonparalytic aseptic meningitis, flaccid paralysis (less than 1%) Can range from asymptomatic, selflimited watery diarrhea, to severe dehydrating diarrhea with fever and vomiting; may be accompanied by fever Initial infections are worse than recurrent infections (Congenital Rubella Syndrome) Prodrome: low-grade fever, malaise, lymphadenopathy, upper symptoms Maculopapular rash Local: persistant contraction in same area of injury Cephalic: otitis media, in/volvement, with emphasis on rehydration Tetanus immune globulin 5 (TIG) 3,000 to 5,000 units, with part infiltrated at site of wound fecal-oral transmission Airborne transmission, droplets from secretions May be shed by infants with congenital rubella syndrome for up to 1 year Soil, human and animal intestinal tracts; No

6 exotoxin of bacteria) Varicella (Chicken pox) Varicella zoster virus (herpesvirus family) Zoster (Herpes Zoster, Shingles) Varicella zoster virus (herpesvirus family) Daptacel (combination DTaP) Infanrix (combination DTaP) Tripedia (combination DTaP) Boostrix (combination Tdap) Adacel (combination Tdap) Decavac (combination Td) Generic (combination Td) Generic (TT) ProQuad (combination MMRV) Varivax Zostavax of cranial nerves Generalized tetanus: lockjaw, neck stiffness, difficulty in swallowing, rigidity of abdominal muscles, spasms Prodrome: mild, if any Generalized, pruritic rash that progresses to vesicular lesions accompanied with malaise, pruritis, fever Prodrome: mild, if any Pruritic rash, present only on one side of the body, following a dermatome, that progresses to vesicular lesions accompanied with malaise, pruritis, fever In immunocompromised hosts, rash can be disseminated Intravenous immune globulin (IVIG) may be used if TIG not available Wounds should be cleaned with necrotic, foreign tissue removed. Supportive therapy may be necessary during spasms Antibiotics play no role in treatment of active tetanus ** Tetanus disease does not result in immunity. Once stable, patient should received tetanus toxoid 8.** Avoid using aspirin in pediatrics to treat fever to avoid Reye s syndrome contaminated wounds (not contagious from person to person) infected tract secretions as well as airborne droplet, direct contact or inhalation of aerosols from vesicular fluid of lesions infected tract secretions as well as airborne droplet, direct contact or inhalation of aerosols from vesicular fluid of lesions No Other Vaccines That May Be Encountered in the United States 8 Immunity does not result because of the potency of the toxin. The lethal dose of toxin is so small that the immune system cannot adequately respond to make appropriate antibodies.

7 Vaccinia (Smallpox) (variola virus) Dryvax Supportive treatment Human to human; droplets Typhoid 9 Rabies 7,10 Typhim Vi Vivotif Berna (oral, live) BioRab Imovax Rabies RabAvert Prodrome: high fever, malaise, prostration, severe headache and backache Maculopapular rash papules pustules; spreads from oral mucosa to face, forearms, trunks, legs High fever, weakness, abdominal pain, headache, loss of appetite, rose-colored rash Hallucinations, confusion, anxiety, biting, hydrophobia, autonomic dysfunction, SIADH, arrhythmias, myocarditis, CHF, bleeding, N/V, ileus Yellow fever 7 YF-Vax Acute phase: fever, muscle pain, headache, shivers, anorexia, N/V Toxic phase: (only 15%) fever, jaundice, abdominal pain, vomiting, bleeding from multiple orifices, kidney failure Japanese Encephalitis 7 (flavavirus family) JE-Vax Mild infections fever, headache Severe infections quick onset, headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions Ciprofloxacin 500 mg BID x 10 days Bactrim DS BID x 15 days Chloramphenicol 1 g q6h x 14 days Pediatrics: Ceftriaxone mg/kg BID x days If from wild animals: If previously vaccinated, one IM dose of vaccine day 0, 3 If not previous vaccinated, rabies immunoglobulin 20 IUnits/kg 5 (all at wound site if possible, otherwise IM and vaccine (IM) day 0,3,7,14,28 If from family pet: Observe animal for 10 days for signs of rabies Supportive therapy Supportive therapy some humans may serve as carriers; fecal-tooral contact Animal (primarily raccoons, skunks, bats) to human contact; animal bite Mosquito to human (nonhuman primates serve as hosts); transmission by insect bite Mosquito to human (animals serve as hosts); transmission by insect bite 9 Only recommended for those persons traveling to endemic areas. Consult the Yellow Book ( for more specific recommendations. 10 Recommended for certain persons with high risks of exposure to rabies.

8 Tuberculosis (Mycobaterium tuberculosis, Mycobacterium bovis) bacilli Calmette-Guérin 11 (circle highlights caviation from TB) Pulmonary TB: cough > 2 weeks, fever, night sweats, weight loss, hemoptysis, SOB Disseminated TB: fever, weight loss, organ involvement Once cultures confirm TB, patients will receive at least a combination of four drugs(depending on sensitivities), most likely including isoniazid 5 mg/kg max 300 mg, rifampin 10 mg/kg max 600 mg, pyrazinamide mg/kg max 2 g, ethambutol mg/kg max 1.6g frequency depends upon schedule determined by physician and patient but total length of treatment will be for at least 6 9 months Patient should be isolated until AFB negative x 3 Human to human; droplets 11 Not available in the United States.