Download Vaccine Preventable Diseases

Vaccine Preventable Diseases
Vaccines Typically Given in the United States
Disease and Organism
Acelluar pertusis
(Whooping Cough)
(Bordetella pertussis)4
Vaccines Available1
Pediarix (combination –
DTaP/IPV/HepB)
TriHIBit (combination – DTaP/Hib)
Daptacel (combination – DTaP)
Infanrix (combination – DTaP)
Tripedia (combination – DTaP)
Boostrix (combination – Tdap)
Adacel (combination – Tdap)
Signs/ Symptoms2
Treatment
Supportive care
Erythromycin, Clarithromycin x 7
days, Azithromycin x 5 days (effective
as 10 -14 day course of erythromycin)
Trimethoprim/sulfamethoxazole X 7
days
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
Transmission
Human to human
(adolescents and
adults may serve a
reservoirs),
airborne
transmission
Reportable to CDC?3
Yes
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
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. (http://www.cdc.gov/epo/dphsi/phs/infdis.htm)
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.
1
Diptheria
(Corynebacterium
diphtheriae - symptoms
caused by exotoxin of
bacteria)
Pediarix (combination –
DTaP/IPV/HepB)
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)
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
Haemophilus influenzae
type B disease
(Haemophilus influenzae
type B)6
Hepatitis A6
5
6
Pediarix (combination –
DTaP/IPV/HepB)
TriHIBit (combination – DTaP/Hib)
Comvax (combination – HepB/Hib)
HibTITER
PedvaxHIB
ActHIB
Twinrix (combination – Hep A/Hep B)
Havrix
Vaqta
Meningitis: fever, decreased mental
status, stiff neck
Epiglottitis: swelling of epiglottis
Septic arthritis
Cellulitis
Pneumonia
Diptheria antitoxin5 (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 – 100,000 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
Acute hepatitis: dark urine, jaundice,
fever, malaise, N/V, abdominal pain,
arthralgia, increased LFTs
Antitoxin will not treat the disease itself; however, it will bind free toxin to avoid further complications.
Various formulations from different manufacturers may be used interchangeably without any decrease in protection.
Supportive care
Human to human
(some human may
be carriers and
asymptomatic);
respiratory tract,
occasionally skin
contact
Yes
Human to human,
with asymptomatic
carriers;
respiratory droplet
spread
Invasive disease, i.e.
associated with
meningitis, bacteremia,
epiglotittis, pneumonia
Human to human,
fecal-oral
transmission,
either person-toperson contact or
contaminated food
or water
Acute cases
Hepatitis B6
7
Pediarix (combination –
DTaP/IPV/HepB)
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
Human Papillomavirus
(HPV 6, 11, 16, 18)
Gardasil
(Cervarix7)
Influenza
(orthomyxovirus family,
may be type A, B, or C)
Fluarix
Fluvirin
Fluzone
FluLaval
FluMist (intranasal, live virus)
Mostly asymptomatic
Manifestations may include
anogenital warts, recurrent
respiratory papillomatosis, cervical
cancer precursors, cancers
Abrupt onset of fever, myalgia, sore
throat, nonproductive cough,
headache
Developed by GSK; awaiting FDA approval
Supportive treatment for acute
infection
Human to human,
parenteral or
mucosal exposure
to Hepatitis B
positive body
fluids from person
with acute or
chronic infection
Main modes:
sexual contact,
injection drug use
Yes
Dependent of manifestation of HPV
Human to human,
direct contact,
usually sexual
contact
No
Supportive care
If diagnosed within 48 hours of onset,
antiviral medications may be used
Influenza A –
human to human,
animal to human
Influenza B and C
– human to
human;
Airborne virusladen droplets,
direct/indirect
contact with
respiratory
secretions
Novel influenza A
isolates
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)
Oseltamivir 75 mg PO qday (types A
and B)
Zanamivir 10 mg inhaled qday (types
A and B)
Influenza-associated
mortality < 18 years of
age
Measles
(paramyxovirus,
Morbillivirus genus)
Meningococcal disease
(Neisseria meningitidis)
M-M-R-II (combination -MMR)
ProQuad (combination - MMRV)
Attenuax
Menomune
Menactra
Mainly supportive care
Human to human,
respiratory
droplets
Yes
Broad-spectrum cephalosporins for
intial treatment, with streamlining after
culture and sensitivities return
Human to human,
with some humans
as asymptomatic
carriers;
respiratory droplet
or direct contact
Yes
Supportive care
Human, to human,
airborne or direct
contact with
infected droplet
nuclei or saliva
Yes
In children, may consider Vitamin A
200,000IU PO x 2 days, especially if
hospitalized and ocular complications
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)
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
Mumps
(paramyxovirus)
M-M-R-II (combination -MMR)
ProQuad (combination - MMRV)
Mumpsvax
Until diagnosis is confirmed, patient
may receive empiric coverage for S.
aureus, another major cause of
parotitis
Prodrome: myalgia, anorexia,
malaise, headache, low-grade fever
Parotitis (unilateral or bilateral)
Pneumococcal disease
(Streptococcus
pneumoniae)
Poliomyelitis
(enterovirus,
Picornaviridae family)
Pneumovax 23
Prevnar
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
Pediarix (combination –
DTaP/IPV/HepB)
Ipol
Rotavirus
(Reoviridae family)
RotaTeq
Rubella
(German Measles)
(togavirus, Rubivirus
genus)
M-M-R-II (combination -MMR)
ProQuad (combination - MMRV)
Meruvax II
Prodrome: upper respiratory 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
Broad-spectrum treatment with
cephalosporin or fluroquinolone,
depending on PCN resistance rates in
area; consider using vancomycin if
suspect meningitis
Human to human
with asymptomatic
carriers; direct
contact with
respiratory
droplets
Only in children less
than five years of age
Supportive care
Human to human,
fecal-oral
transmission
Yes
Supportive care, with emphasis on rehydration
Human to human,
fecal-oral
transmission
No
Supportive care
Human to human,
Airborne
transmission,
droplets from
respiratory
secretions
May be shed by
infants with
congenital rubella
syndrome for up to
1 year
Soil, human and
animal intestinal
tracts;
Yes
Streamline treatment to appropriate
antibiotic once culture and sensitivity
has returned
(Congenital Rubella Syndrome)
Prodrome: low-grade fever, malaise,
lymphadenopathy, upper respiratory
symptoms
Maculopapular rash
Tetanus
(Clostridium tetani –
symptoms caused by
Pediarix (combination –
DTaP/IPV/HepB)
TriHIBit (combination – DTaP/Hib)
Local: persistant contraction in
same area of injury
Cephalic: otitis media, iN/Volvement
Tetanus immune globulin5 (TIG) 3,000
to 5,000 units, with part infiltrated at
site of wound
Yes
exotoxin of bacteria)
Varicella (Chicken pox)
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)
of cranial nerves
Intravenous immune globulin (IVIG)
may be used if TIG not available
Wounds should be cleaned with
necrotic, foreign tissue removed.
Generalized tetanus: lockjaw, neck
stiffness, difficulty in swallowing,
rigidity of abdominal muscles,
spasms
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 toxoid8.**
Supportive care
ProQuad (combination – MMRV)
Varivax
Avoid using aspirin in pediatrics to
treat fever to avoid Reye’s syndrome
Prodrome: mild, if any
Generalized, pruritic rash that
progresses to vesicular lesions
accompanied with malaise, pruritis,
fever
Zoster (Herpes Zoster,
Shingles)
Varicella zoster virus
(herpesvirus family)
Zostavax
Supportive care
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
contaminated
wounds (not
contagious from
person to person)
Human to human,
infected
respiratory tract
secretions as well
as airborne
droplet, direct
contact or
inhalation of
aerosols from
vesicular fluid of
lesions
Yes
Human to human,
infected
respiratory 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.
Vaccinia (Smallpox)
(variola virus)
Dryvax
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
Typhoid9
Typhim Vi
Vivotif Berna (oral, live)
Rabies7,10
BioRab
Imovax Rabies
RabAvert
Hallucinations, confusion, anxiety,
biting, hydrophobia, autonomic
dysfunction, SIADH, arrhythmias,
myocarditis, CHF, bleeding, N/V,
ileus
Yellow fever7
YF-Vax
Japanese Encephalitis7
(flavavirus family)
JE-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
Mild infections – fever, headache
Severe infections – quick onset,
headache, high fever, neck
stiffness, stupor, disorientation,
coma, tremors, occasional
convulsions
9 Only
10
Supportive treatment
Human to human;
respiratory
droplets
Yes
Ciprofloxacin 500 mg BID x 10 days
Bactrim DS BID x 15 days
Chloramphenicol 1 g q6h x 14 days
Pediatrics: Ceftriaxone 10-15 mg/kg
BID x 10 – 14 days
If from wild animals:
If previously vaccinated, one IM dose
of vaccine day 0, 3
If not previous vaccinated, rabies
immunoglobulin 20 IUnits/kg5 (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
Human to human,
some humans
may serve as
carriers; fecal-tooral contact
Animal (primarily
raccoons, skunks,
bats) to human
contact; animal
bite
Yes
Mosquito to
human (nonhuman
primates serve as
hosts);
transmission by
insect bite
Mosquito to
human (animals
serve as hosts);
transmission by
insect bite
Yes
Supportive therapy
recommended for those persons traveling to endemic areas. Consult the Yellow Book (http://wwwn.cdc.gov/travel/contentYellowBook.aspx) for more specific recommendations.
Recommended for certain persons with high risks of exposure to rabies.
Yes
Yes
Tuberculosis
(Mycobaterium
tuberculosis,
Mycobacterium bovis)
bacilli Calmette-Guérin11
(circle highlights caviation from TB)
Pulmonary TB: cough > 2 weeks,
fever, night sweats, weight loss,
hemoptysis, SOB
Disseminated TB: fever, weight
loss, organ involvement
11
Not available in the United States.
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 15 – 30 mg/kg
max 2 g, ethambutol 15 – 25 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;
respiratory
droplets
Yes