2018 AOCOPM Midyear Educational Conference San Antonio

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1 FAQs $100 $200 $300 $400 $500 Current Concepts in Vaccination Vaccinepreventable diseases Special populations I m Leavin on a jet plane What s new? $100 $100 $100 $100 $200 $200 $200 $200 $300 $300 $300 $300 $400 $400 $400 $400 $500 $500 $500 $500 FINAL ROUND $100 Question What is the limit to the number of vaccines that can be given at the same visit? a. 3 b. 4 c. 5 d. no limit $100 Answer What is the limit to the number of vaccines that can be given at the same visit? a. 3 b. 4 c. 5 d. no limit All vaccines can be administered at the same visit* There is no upper limit for the number of vaccines that can be administered during one visit ACIP and AAP consistently recommend that all needed vaccines be administered during an office visit Vaccination should not be deferred because multiple vaccines are needed All live vaccines (MMR, varicella, zoster, live attenuated influenza, yellow fever, and oral typhoid) can be given at the same visit If live vaccines are not administered during the same visit, they should be separated by 4 weeks or more *exceptions: PCV13 and PPSV23; Menactra and PCV13 $200 Question Your patient received 0.25 ml influenza vaccine (her first-ever dose) at age 34 months. She returns for her second dose at 36 months. She should receive: a. the same dose as before, 0.25 ml b. the age-appropriate 0.50 ml dose c. none, only one dose is needed d. none, it is too soon for dose #2 $200 Answer Your patient received 0.25 ml influenza vaccine (her first-ever dose) at age 34 months. She returns for her second dose at 36 months. She should receive: a. the same dose as before, 0.25 ml b. the age-appropriate 0.50 ml dose c. none, only one dose is needed d. none, it is too soon for dose #2 O-1

2 Children 6 months through 8 years of age should receive two doses administered at least 4 weeks apart if receiving influenza vaccine for the first time or if they did not receive a total of at least two doses of trivalent or quadrivalent influenza vaccine before July 1, 2017 A child should always receive the dose appropriate for his or her age at the time of the clinic visit. $300 Question With rare exceptions, Vaccine Information Sheets (VISs) are required to be provided to vaccine recipients. True/False $300 Answer With rare exceptions, Vaccine Information Sheets (VISs) are required to be provided to vaccine recipients. True/False Federal law (under the National Childhood Vaccine Injury Act) requires a health care provider to give a copy of the current VIS to an adult patient or to a child s parent/legal representative before vaccinating an adult or child with a dose of the following vaccines: diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, hepatitis A, hepatitis B, Haemophilus influenzae type b (Hib), influenza, pneumococcal conjugate, meningococcal, rotavirus, human papillomavirus (HPV), or varicella (chickenpox only). $400 Question $400 Answer Your patient received a MMR vaccine today. If not given today, he must wait at least 4 weeks before receiving: a. hepatitis A vaccine b. varicella vaccine c. Tdap vaccine d. meningococcal vaccine Your patient received a MMR vaccine today. If not given today, he must wait at least 4 weeks before receiving: a. hepatitis A vaccine b. varicella vaccine c. Tdap vaccine d. meningococcal vaccine O-2

3 $500 Question Combination Two live parenteral, or live intranasal influenza vaccine All other Minimum Interval 4 weeks None If a dose of HPV vaccine is significantly delayed, do you need to start the series over? a. yes b. no c. it depends on how long the delay $500 Answer If a dose of HPV vaccine is significantly delayed, do you need to start the series over? a. yes b. no c. it depends on how long the delay No routine vaccination series needs to be restarted if delayed Exceptions may include oral typhoid, rabies vaccine $100 Question VIDEO DAILY DOUBLE This infection starts with fever, runny nose, and watery eyes, followed by a maculopapular rash spreading from the head to the trunk to the extremities. NEXT a. varicella b. measles c. hepatitis A d. rubella O-3

4 $100 Answer a. varicella b. measles c. hepatitis A d. rubella Fever 3 C s Cough Coryza Conjunctivitis Koplik spots Rash $200 Question $200 Answer Hepatitis A is usually transmitted by the fecal/oral route. True/False Hepatitis A is usually transmitted by the fecal/oral route. True/False $300 Question Fecal-oral route Direct contact Contaminated food or water Incubation 28 days (15-50 days) Which subtypes of human papillomavirus cause the majority of HPV-related cancers in the US? a. 6 and 11 b. 16 and 18 c. 6, 11, 16, and 18 O-4

5 $300 Answer Which subtypes of human papillomavirus cause the majority of HPV-related cancers in the US? a. 6 and 11 b. 16 and 18 c. 6, 11, 16, and 18 HPV-related cancers in the United States 26,900 cases annually 64% attributable to HPV 16 or 18 10% are attributable to HPV types 31, 33, 45, 52, 58 HPV type 16, 18, 31, 33, 45, 52, or 58 account for about 81% of cervical cancers in the United States HPV Vaccines Gardasil 9 (9vHPV, Merck) HPV types 16, 18, 31, 33, 45, 52 and 58). The 9vHPV vaccine is licensed for females and males age 9 through 26 years. Gardasil (4vHPV, Merck) HPV types 16, 18, 6 and 11, 4vHPV, and Cervarix (2vHPV, GlaxoSmithKline) HPV types 16 and 18 (females only) are no longer being manufactured in the US $400 Question This infection causes a pruritic rash beginning on the head and spreading to the rest of the body. Fever, headache, malaise, and fatigue are common. a. varicella b. mumps c. rubella d. measles $400 Answer a. varicella b. mumps c. rubella d. measles $500 Question Varicella Clinical Features Incubation period 14 to 16 days (range 10 to 21 days) Mild prodrome for 1 to 2 days (adults) Rash generally appears first on head; most concentrated on trunk Macules papules vesicles on erythematous base ( dewdrop on a rose petal ) Successive crops over several days with up to 500 lesions present in several stages of development Twinrix provides protection against which two infections? a. hepatitis A and hepatitis B b. hepatitis A and typhoid c. measles and mumps d. yellow fever and Japanese encephalitis O-5

6 $500 Answer Twinrix provides protection against which two infections? a. hepatitis A and hepatitis B b. hepatitis A and typhoid c. measles and mumps d. yellow fever and Japanese encephalitis Contains same amount of antigen as hepatitis B vaccine Half the antigen of adult hepatitis A vaccine Approved for use in persons 18 years of age or older Standard Dosing: A series of 3 doses (1 ml each) given on a 0-, 1-, and 6-month schedule Accelerated Dosing: A series of 4 doses (1 ml each) given on days 0, 7, and 21 to 30 followed by a booster dose at month 12 $100 Question $100 Answer Which vaccine is NOT routinely recommended for healthcare workers? a. meningococcal b. influenza c. varicella d. MMR Which vaccine is NOT routinely recommended for healthcare workers? a. meningococcal b. influenza c. varicella d. MMR $200 Question Hepatitis B If previously unvaccinated, give 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2). For HCP who perform tasks that may involve exposure to blood or body fluids, obtain anti-hbs serologic testing 1 2 months after dose #3. Influenza Give 1 dose of influenza vaccine annually. MMR For healthcare personnel (HCP) born in 1957 or later without serologic evidence of immunity or prior vaccination, give 2 doses of MMR, 4 weeks apart. For HCP born prior to 1957, consider for unvaccinated HCP without evidence of immunity. Varicella (chickenpox) For HCP who have no serologic proof of immunity, prior vaccination, or diagnosis or verification of a history of varicella or herpes zoster (shingles) by a healthcare provider, give 2 doses of varicella vaccine, 4 weeks apart. Tetanus, diphtheria, pertussis Give 1 dose of Tdap as soon as feasible to all HCP who have not received Tdap previously and to pregnant HCP with each pregnancy. Give Td boosters every 10 years thereafter. VIDEO DAILY DOUBLE NEXT O-6

7 $200 Answer There are now vaccines approved in the US to prevent this condition: There are now vaccines approved in the US to prevent this condition: a. 1 a. 1 b. 2 b. 2 c. 3 c. 3 d. 0 d. 0 Herpes zoster vaccines Shingrix (preferred) recombinant vaccine, approved 2017 recommended for adults age doses, 2-6 months apart efficacy 90% Zostavax live vaccine, introduced 06 efficacy 64% (younger)- 18% (older) $300 Question A person taking this corticosteroid regimen would be considered immunosuppressed for purposes of vaccination : a. topical hydrocortisone for eczema b. 40 mg/day of prednisone for 3 months for rheumatoid arthritis c. inhaled beclomethasone for asthma d. 5 day prednisone taper for poison ivy $300 Answer A person taking this corticosteroid regimen would be considered immunosuppressed for purposes of vaccination : a. topical hydrocortisone for eczema b. 40 mg/day of prednisone for 3 months for rheumatoid arthritis c. inhaled beclomethasone for asthma d. 5 day prednisone taper for poison ivy Corticosteroids 20 mg or more per day of prednisone for 14 days or longer 2 mg/kg or more per day of prednisone for 14 days or longer NOT aerosols, alternate-day, short courses, topical, or physiologic replacement doses O-7

8 $400 Question In which adults would hepatitis A vaccine be routinely recommended? a. adoptive families of a child from a developing country b. plumbing and sewer workers c. healthcare workers d. food handlers $400 Answer In which adults would hepatitis A vaccine be routinely recommended? a. adoptive families of a child from a developing country b. plumbing and sewer workers c. healthcare workers d. food handlers $500 Question You should be vaccinated if any of the following apply to you: Desire to be vaccinated against hepatitis A to avoid an infection in the future. Travel or work in areas outside the United States where hepatitis A is common. (This includes everywhere except Australia, New Zealand, Northern and Western Europe, Japan, and Canada.) Have (or will have) contact with an adopted child within the first 60 days of the child s arrival from a country where hepatitis A is common. Have chronic liver disease. Have a blood clotting-factor disorder. Men who have sex with men. Use street drugs (injectable or noninjectable). Exposure to the hepatitis A virus in the past two weeks. Work with nonhuman primates. Fluzone high-dose influenza vaccine contains antigen as regular dose influenza vaccine. a. same amount of b. 2 times as much c. 4 times as much d. 10 times as much $500 Answer Fluzone high-dose influenza vaccine contains antigen per strain as regular dose influenza vaccine. a. same amount of b. 2 times as much c. 4 times as much d. 10 times as much Fluzone High-Dose Inactivated influenza virus vaccine Indicated for persons 65 years of age and older Approved in mcg HA per strain (regular-dose influenza vaccine contains 15 mcg HA per strain) O-8

9 $100 Question Your young patient is traveling with her parents to a measles-endemic area. According to ACIP recommendations, you may consider giving a dose of MMR vaccine as early as: a. 4 weeks b. 3 months c. 6 months d. 12 months- (do not give earlier than usual age) $100 Answer Your young patient is traveling with her parents to a measles-endemic area. According to ACIP recommendations, you may consider giving a dose of MMR vaccine as early as: a. 4 weeks b. 3 months c. 6 months d. 12 months- (do not give earlier than usual age) $200 Question ACIP recommends that children who travel or live abroad should be vaccinated at an earlier age than that recommended for children who reside in the United States. Before their departure from the United States, children age 6 through 11 months should receive 1 dose of MMR. A measles-containing vaccine administered before the first birthday should not be counted as part of the series. MMR should be repeated when the child is age 12 through 15 months, and an additional dose should be administered at least 28 days afterwards. Yellow fever might be a travel risk for which destination? a. South Africa b. China c. Peru d. Honduras $200 Answer Yellow fever might be a travel risk for which destination? a. South Africa b. China c. Peru d. Honduras O-9

10 $300 Question $300 Answer Saudi Arabia requires Hajj pilgrims aged 3 months and older to provide evidence of which vaccination? a. hepatitis A b. hepatitis B c. typhoid d. meningococcal Saudi Arabia requires Hajj pilgrims to provide evidence of which vaccination? a. hepatitis A b. hepatitis B c. typhoid d. meningococcal $400 Question Outbreaks of meningococcal disease have historically been a problem during Hajj Intensely crowded conditions of the Hajj High carrier rates of Neisseria meningitidis among pilgrims Saudi Ministry of Health requires all pilgrims and local at-risk populations to receive the meningococcal vaccine Hajj visas cannot be issued without proof of meningococcal vaccination Travelers over age 2: one dose of quadrivalent A/C/Y/W-135 vaccine Children between 3 months and 2 years of age: 2 doses of meningococcal A monovalent vaccine, 3-month interval between doses Must show proof of vaccination on a valid International Certificate of Vaccination or Prophylaxis Hajj pilgrims must have had the meningococcal vaccine 3 years and 10 days before arriving in Saudi Arabia Ixiaro was approved in the United States in 2009 for protection against: a. cholera b. yellow fever c. typhoid fever d. Japanese encephalitis $400 Answer Ixiaro was approved in the United States in 2009 for protection against: a. cholera b. yellow fever c. typhoid fever d. Japanese encephalitis IXIARO is given in 2 doses: Doses are spaced 28 days apart. The last dose should be given at least 1 week before travel. For adults and children aged 3 years, each dose is 0.5 ml. For children aged 2 months through 2 years, each dose is 0.25 ml. For persons aged 17 years and older, a booster dose may be given if a person received the JE vaccine more than a year ago and there is a continued risk for JE virus infection or potential for re-exposure. O-10

11 $500 Question $500 Answer Which meningococcal vaccine might be appropriate for your traveler to Africa? a. MCV4 (Menactra, Menveo) b. MenB (Trumemba, Bexsero) c. MPSV4 (Menomune) d. a or c Which meningococcal vaccine might be appropriate for your traveler to Africa? a. MCV4 (Menactra, Menveo) b. MenB (Trumemba, Bexsero) c. MPSV4 (Menomune) d. a or c $100 Question In the meningitis belt, serogroup A has historically accounted for 90% of meningococcal disease cases and the majority of largescale epidemics MPSV4 and MenACWY provide no protection against serogroup B disease, and meningococcal serogroup B vaccines (MenB) provide no protection against serogroup A, C, W, or Y disease For protection against all 5 serogroups of meningococcus, it is necessary to receive MenACWY or MPSV4 and MenB. In October 2016, ACIP changed the recommendation from 3 doses to 2 for this vaccine in adolescents aged 9-14? a. HPV b. polio c. hepatitis A d. influenza $100 Answer In October 2016, ACIP changed the recommendation from 3 doses to 2 for this vaccine in adolescents aged 9-14? a. HPV b. polio c. hepatitis A d. influenza HPV new recommendations Age 9-14: Two doses, at least 6 months apart Age 15-26: Three doses, at 0, 1-2, and 6 months (no change) O-11

12 $200 Question The general recommendation for MMR vaccination is 2 doses, at least 28 days apart. What is the recommendation in the setting of a mumps outbreak? a. offer 3 rd dose to entire population b. offer a 3 rd dose to only those at increased risk c. do not give any additional doses if 2 doses documented $200 Answer The general recommendation for MMR vaccination is 2 doses, at least 28 days apart. What is the recommendation in the setting of a mumps outbreak? a. offer 3rd dose to entire population b. offer a 3rd dose to only those at increased risk c. do not give any additional doses if 2 doses documented Persons previously vaccinated with 2 doses of a mumps virus-containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a 3 rd dose Prolonged or intense exposure to saliva Close contact Sharing drinks or utensils MMWR January 12, 2018 $300 Question In June 2016, the FDA approved a vaccine for this infectious disease: a. hepatitis C b. cholera c. Zika virus d. dengue fever $300 Answer In June 2016, the FDA approved a vaccine for this infectious disease: a. hepatitis C b. cholera c. Zika virus d. dengue fever VAXCHORA is a vaccine indicated for active immunization against disease caused by Vibrio cholerae serogroup O1 in adults 18 through 64 years of age traveling to an area of active cholera transmission Not routinely recommended for most travelers from the United States Single oral dose taken at least 10 days before exposure Vaccine efficacy 90% and 80%, respectively 10 days and at 3 months after vaccination O-12

13 $400 Question $400 Answer Which vaccine(s) prevent cancer? a. HPV b. hepatitis B c. influenza d. a and b Which vaccine(s) prevent cancer? a. HPV b. hepatitis B c. influenza d. a and b Worldwide, the most common risk factor for liver cancer is chronic (longterm) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). Incidence of liver cancer in US HPV is believed to be responsible for nearly all cervical cancers, 90% of anal cancers, 71% of vulvar, vaginal, or penile cancers, and 72% of oropharyngeal cancers. HPV vaccine efficacy: CIN 2/3 or AIS: 97% AIN 2/3: 75% Genital warts: 88-99% $500 Question 29 Code of Federal Regulations (CFR) requires that this vaccine be offered to certain employees within 10 days of employment: a. influenza b. hepatitis B c. meningococcal d. hepatitis A $500 Answer 29 Code of Federal Regulations (CFR) requires that this vaccine be offered to certain employees within 10 days of employment: a. influenza b. hepatitis B c. meningococcal d. hepatitis A Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard 29 Code of Federal Regulations (CFR) Applies to all persons who may reasonably anticipate contact with blood or other potentially infectious materials (OPIMs) in the course of their employment Hepatitis B vaccine offered by employer at no cost Also covers training, exposure determination, postexposure evaluation, PPE, housekeeping, and waste disposal O-13

14 FINAL ROUND Question Prior to introduction of rubella vaccination, up to 20,000 cases of congenital rubella syndrome (CRS) occurred in the US annually. How many cases were reported in 2015? a b. 100 c. 10 d. 1 FINAL ROUND Answer Prior to introduction of rubella vaccination, up to 20,000 cases of congenital rubella syndrome (CRS) occurred in the US annually. How many cases were reported in 2015? a b. 100 c. 10 d. 1 THE END Up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome (CRS) Heart defects, cataracts, mental retardation, and deafness epidemic of rubella resulted in an estimated 20,000 infants born with CRS, with 2,100 neonatal deaths and 11,250 miscarriages. THE END O-14