The best method of influenza prophylaxis in high-risk patients is administration of:
Correct Answer A:
Although they may be used for prophylaxis, amantadine and rimantadine are limited by lack of activity against influenza B, resistance, and adverse effects. Zanamivir and oseltamivir are about 70%-90% effective against influenza, including influenza B, but zanamivir is approved only for treatment of influenza. None of these drugs should be considered a substitute for vaccination, which remains the mainstay of protection against influenza.
Which one of the following should be offered to college freshmen prior to their arrival on campus if they are planning on living in a dormitory?
Correct Answer D:
College students living on campus have a higher risk of meningococcal infection compared to students living off campus. It has been recommended that students entering college be offered meningococcal vaccine. This vaccine contains antigens to serotypes A, C, Y, and W-135, which cause over 75% of cases among college students. The vaccine has an efficacy of over 85% in this population group.
Hepatitis A vaccine is indicated for individuals traveling abroad and men engaging in sex with men. Varicella zoster vaccine is usually given during the second year of life or to individuals without a previous history of chickenpox. Pneumococcal vaccine is given to individuals with chronic medical illnesses and at age 65. Influenza vaccine is indicated for college students, as well as the general population, but is usually administered in the late fall or early winter.
An 18-year-old male student presents for a physical examination prior to attending Faculty of Nursing at the University of Toronto. His records indicate that he was not immunized against hepatitis B as a child.
Based on current guidelines, this patient should:
Hepatitis B vaccine is indicated in all health professional students; it is recommended as part of the route childhood immunization schedule, and should be given to students who have not previously been immunized. This recommendation holds regardless of living situations or risk factors.
According to current guidelines, which one of the following conditions necessitates administration of the 23-valent pneumococcal vaccine for patients 2-64 years of age?
Correct Answer B:
According to current guidelines, the 23-valent pneumococcal polysaccharide (PPSV23) vaccine is recommended for all people who meet any of the criteria below:
1. All adults age 65 yrs and older.
2. Age 2 through 64 yrs with any of the following conditions:
The pneumococcal polyvalent vaccine (Pneumovax 23) would be recommended for which one of the following patients?
Correct Answer C:
The Advisory Committee on Immunization Practices (ACIP) recommends routine pneumococcal vaccination for healthy patients starting at age 65 years. Patients over 2 years of age with various chronic diseases and patients who are immunocompromised also should be vaccinated (choice C). Children less than 2 years of age should receive the 7 valent conjugate vaccine as a part of their routine well child vaccinations at 2, 4, 6, and 12 months of age. There is a lack of data concerning the safety of the vaccine when given three or more times.
→ A 1-year-old patient as a routine immunization (choice A) is incorrect. For children under the age of 2, the 7 valent conjugate vaccine is given as a part of their routine well child vaccinations at 2, 4, 6, and 12 months of age.
→ An 18-month-old patient diagnosed with cystic fibrosis (choice B) is incorrect. A child with cystic fibrosis should be at least 2 years of age to receive the pneumococcal polyvalent vaccine.
→ A healthy 49-year-old patient (choice D) is incorrect. For healthy patients, the vaccination is not recommended until age 65 is reached.
→ Previously healthy 55 year old who has been coughing for 2 weeks (choice E) is incorrect. While the cause of the patient's cough needs to be determined, the vaccination is not recommended simply based on these symptoms. Vaccination is recommended in patients with chronic diseases such as COPD.
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