{"id":1217,"date":"2013-10-10T19:34:58","date_gmt":"2013-10-10T19:34:58","guid":{"rendered":"http:\/\/jacobimed.org\/NS\/?page_id=1217"},"modified":"2013-10-10T19:34:58","modified_gmt":"2013-10-10T19:34:58","slug":"case-2-answer","status":"publish","type":"page","link":"https:\/\/jacobimed.org\/old\/ambulatory\/mlove\/curriculumprevention\/immunizations\/case-2-answer\/","title":{"rendered":"Case 2 answer"},"content":{"rendered":"

 <\/p>\n

\n

ADULT
\n<\/span>IMMUNIZATIONS – Answers<\/span><\/h2>\n

\u00a0\u00a0\u00a0\u00a0 <\/span>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/h1>\n

\u00a0<\/span><\/span><\/p>\n

Case #2:<\/span><\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u00a0\u00a0\u00a0 <\/span>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>A 67-year-old
\nfemale comes to see you in your office for her regular fall follow-up physical
\nexamination.\u00a0 <\/span>She has a history of
\nhypertension and asthma, and is on chronic medications.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>\u00a0<\/span>What
\nimmunizations would you offer at this visit, or insure that she has <\/em><\/strong><\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>received? <\/span><\/em><\/strong><\/strong><\/p>\n

\u00a0<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>The
\nAnswer is D, pneumococcal vaccine and influenza vaccine<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/em><\/strong>\u00a0<\/span><\/span><\/strong><\/p>\n

INFLUENZA VACCINE<\/span><\/h6>\n

\u00a0<\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Developed in the 1950s as a
\nway to deal with the yearly winter epidemic of influenza <\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Influenza vaccine is made
\nfrom highly purified, egg-grown viruses that are inactivated.<\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Antigenic variations among
\ninfluenza viruses, as well as a short period of immunity, require that
\nhigh-risk populations receive the flu vaccine each fall. Worldwide surveillance
\nand antigenic characteristics provide the basis for the yearly selection of 2
\nstrains of influenza A and 1 strain of influenza B.<\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>65-80% protection against an
\nillness caused by an influenza virus with antigenic characteristics represented in the vaccine in young adults.<\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>30-40% effective in
\npreventing clinical illness in elderly population; provides greater benefit by
\nlessening the severity of disease and preventing hospital admissions and death.<\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Recently
\navailable\u2014intranasal flu vaccine (flu mist), reportedly the same efficacy, more
\nexpensive (~$25\/dose, whereas intramuscular vaccine is much less expensive, and
\nsubsidized by the government)<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/p>\n

19 of the annual flu
\nepidemics since 1957 have been associated with more than 10,000 excess deaths,
\nwith 40,000 excess deaths in 2 of the epidemics.\u00a0 <\/span>About 80-90% of the excess deaths occurred in people > 65 or
\nolder, especially in those patients with underlying cardiac or pulmonary
\ndisease.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Who should receive the vaccination?<\/span><\/strong><\/p>\n

\u00a0<\/span><\/p>\n

\u00a7
\n<\/span><\/span>Persons
\nage 50 or greater.\u00a0 <\/span>This was recently
\nchanged from age 65 and greater because this group has an increased prevalence
\nof persons with high-risk conditions, and by including a larger population for
\n\u201cblanket\u201d vaccination will help to improve the low vaccination rate among
\npersons in this age group with high-risk medical conditions.<\/span><\/p>\n

\u00a7
\n<\/span><\/span>Residents
\nin nursing homes or chronic care facilities.<\/span><\/p>\n

\u00a7
\n<\/span><\/span>Children
\nand adults with chronic pulmonary or cardiovascular disease including asthma.<\/span><\/p>\n

\u00a7
\n<\/span><\/span>Children
\nand adults with chronic medical conditions including diabetes, renal disease,
\nhemoglobinopathies, and immunosuppression.<\/span><\/p>\n

\u00a7
\n<\/span><\/span>Pregnant
\nwomen with any underlying medical conditions should be vaccinated prior to
\ninfluenza season, regardless of the stage of pregnancy.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Vaccination is also
\nindicated for those people who may transmit the infection to high risk groups,
\nsuch as health care workers, employees of chronic care facilities or day care
\nworkers, home health aides, and household members of high risk persons.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

In addition to the two
\ngroups listed above, the flu shot is indicated for any person who wishes to
\nhave the vaccine to decrease the likelihood of getting the flu.

\n<\/span><\/p>\n

Side-effects<\/span><\/em><\/strong>:\u00a0 <\/span><\/span><\/p>\n

Because the influenza vaccine contains only inactivated virus it CANNOT
\ncause the flu!!<\/span><\/strong><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Most commonly, soreness at the injection site.\u00a0 <\/span>Occasional systemic reaction of malaise and
\nmyalgias beginning 6 to 12 hours after receiving the shot and lasting 1 to 2
\ndays.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Rarely, an allergic reaction can occur, most likely due to the
\nresidual egg proteins in the vaccine. There have been no further adverse
\nneurological events since the association of Guillian-Barre syndrome with the
\n1976 “swine flu” vaccine.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Contraindications<\/span><\/em><\/strong>:<\/span><\/p>\n

Anaphylaxis in response to
\neggs.\u00a0 <\/span>Moderate or severe acute
\nillness.\u00a0 <\/span>Pregnancy and breastfeeding
\nare not contraindications to the use of this vaccine.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

To follow the progress of
\nthe annual flu epidemic visit the CDC\/WHO flu tracker website:\u00a0 <\/span>CDC flu-tracker<\/a><\/span><\/p>\n

\u00a0<\/span><\/strong><\/p>\n

PNEUMOCOCCAL VACCINE<\/span><\/h6>\n

\u00a0<\/span><\/p>\n

The currently licensed
\nvaccine in the US contains polysaccharide capsular antigens from 23 of the more
\nthan 80 different pneumococcal serotypes.
\n<\/span>These 23 serotypes are responsible for 88% of bloodstream isolates in
\ninfections in the US.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Primary vaccination with 0.5 cc subcutaneously or intramuscularly. <\/span><\/strong><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Routinely given as a
\none-time dose, revaccinate if previous vaccination history is unknown.<\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>One-time revaccination is
\nrecommended for patients at highest risk of fatal pneumococcal infection or
\nrapid antibody loss (ie renal disease), and for people over the age of 65 years
\n(if the first dose was given before the age of 65 and 5\u00a0 <\/span>years has elapsed).<\/span><\/p>\n

n\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Overall protective efficacy of 56<\/span><\/strong>%<\/span><\/p>\n

o
\n<\/span><\/span>among
\nimmunocompetent vaccine recipients, the protective efficacy is 61% but this
\nvaries greatly with age, from 93% in patients less than 55 years old to 46% in
\npatients greater than 85 years old.<\/span><\/p>\n

o
\n<\/span><\/span>the
\nprotective efficacy is poor in immunosuppressed recipients.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>**Thus, even full implementation of the vaccine would only
\nprevent about 1\/2 the cases of pneumococcal disease.\u00a0 <\/span>This however would not be inconsequential, as current estimates
\nare of 40,000 deaths per year.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Who should receive the vaccine?<\/span><\/strong><\/p>\n

\u00b7
\n<\/span><\/span>All
\npersons 65 year old or greater.<\/span><\/p>\n

\u00b7
\n<\/span><\/span>Immunocompetent
\nadults at increased risk of pneumococcal disease because of chronic illnesses
\nsuch as cardiovascular disease, pulmonary disease, diabetes, alcoholism or cirrhosis,
\nchronic renal failure or nephritic syndrome.<\/span><\/p>\n

\u00b7
\n<\/span><\/span>ALL
\nHIV-infected persons.<\/span><\/p>\n

\u00b7
\n<\/span><\/span>Asplenic
\npatients such as those persons with sickle cell disease, or s\/p splenectomy.<\/span><\/p>\n

\u00b7
\n<\/span><\/span>Immunosuppressed
\npatients secondary to being transplant recipients.

\n<\/em><\/strong><\/span><\/p>\n

Side-effects:<\/span><\/em><\/strong><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Erythema and pain at injection site in about 50% of patients.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Systemic symptoms in less than 1% of recipients.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Arthus-like reaction with booster doses less than 4 years after
\ninitial dose.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Contraindications:<\/span><\/em><\/strong><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Previous anaphylactic reaction to the vaccine or any of its
\ncomponents.<\/span><\/p>\n

Breast- feeding and
\npregnancy are not contraindications to the use of this vaccine.<\/span><\/p>\n

Cost:<\/span><\/em><\/strong><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>$9.57 per dose.<\/span><\/p>\n

\u00a0<\/span><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

  ADULT IMMUNIZATIONS – Answers \u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0 Case #2: \u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 A 67-year-old female comes to see you in your office for her regular fall follow-up physical examination.\u00a0 She has a history of hypertension and asthma, and is on chronic medications. \u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0What immunizations would you offer at this visit, or insure….<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1212,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"class_list":["post-1217","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1217","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/comments?post=1217"}],"version-history":[{"count":1,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1217\/revisions"}],"predecessor-version":[{"id":1222,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1217\/revisions\/1222"}],"up":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1212"}],"wp:attachment":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/media?parent=1217"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}