Vaccinations

Posted on 30 July، 2019 Tagged Primary CareLeave a comment

Peds 👶🏼
Vaccine	Age	?
Hepatitis B	· First 24 hours of life	· In HBsAg-positive mothers, the infant should receive the hepatitis B vaccine and hepatitis B immune globulin
Rotavirus	· 2-4-6	· Live
Dtap	· 2-4-6	· Inactivated
HiB	· 2-4-12	· Inactivated
Pneumococcal conjugate (PCV 13)	· 2-4-6	· Inactivated
Poliovirus	· 2-4-6 · Later in life (~ 5 ys)	· Inactivated
Influenza	· After ≥ 6 months → annually	· IM vaccine is an inactivated · Intranasal vaccine is a live-attenuated
MMR	· First dose at 12-15 months · Second dose at 4-6 years of age	· Live
Varicella	· First dose at 12-15 months · Second dose at 4-6 years of age	· Live
Hepatitis A	· First dose at 12-24 months · Second dose given at least 6 months after the first dose	· Inactivated
Adolescent
Vaccine	Age	Comments
Tdap	· 11-12 years of age	· Inactivated vaccine
HPV	· Two doses at 9-14 years of age · in patients between the ages of 9-14, the 2 dose are administered 6-12 months after the first dose · Three doses at ≥ 15 years of age · given at 0, 1-2, and 6 months	· Subunit vaccine · Three doses of this vaccine are also recommended in immunocompromised adolescent patients
Meningococcal	· First dose at 11-12 years of age · Second dose at 16 years of age	· Inactivated
Influenza	· First dose given at 7-10 years of age and then annually	· Intramuscular vaccine is an inactivated vaccine · Intranasal vaccine is a live-attenuated vaccine
Adults
Vaccine	Age	Comments
Influenza	· One dose annually	· Inactivated
Tdap / or tetanus and diphtheria (Td)	· One dose Tdap and then a Td booster every 10 years	· In pregnant women, 1 dose of Tdap should be given during each pregnancy between 27-36 weeks gestation
Pneumococcal (PPSV23)	· Given at least 1 year after PCV13 administration in adults ≥ 65 years of age · PPSV23 is indicated in patients 19-64 years of age with the following: · chronic heart disease (excluding hypertension) · chronic liver disease · chronic lung disease · diabetes mellitus · cigarette smoking · patients ≥ 19 with: · HIV · anatomical or functional asplenia · chronic renal failure or nephrotic syndrome · cerebral spinal fluid leak · cochlear implant	· 13 → 23 · PPSV23 is not conjugated and does not stimulate a helper T-cell response

HIV Vaccinations
Do u vaccinate for HPV, when?	Yes, 11-26
Hep B / A?	Yes
Influenze?	Every year
Meningococcus	Yes
Pneumococcus	Yes 13 → 23
Tdap?	Yes, once, The Td every 10 ys
When to stop live vaccines?	# CD4 <200

Recommended vaccines for chronic liver disease
Tdap/Td	Tdap once → Td every 10 years
Influenza	every year
Pneumococcal vaccines	PPSV23 once → PCV13 and PPSV23 at age 65
Hepatitis A	2 doses 6 months apart with initial negative serologies
Hepatitis B	3 doses at O months, 1 month & at least 4 months with initial negative serologies

Special Considerations
Splenectomy	· patients should receive vaccines to protect against encapsulated organisms · S. pneumoniae (pneumococcus) · H. influenzae · N. meningitidis (meningococcus) · vaccine regimen · PCV13 followed by PPSV23 ≥8 weeks later · H. influenzae type b vaccine · meningococcus vaccine · antibiotic prophylaxis · antibiotic prophylaxis (with penicillin V or amoxicillin) until the age of 5 (SCA) or for at least 1-year post splenectomy
HIV	· inactivated vaccines are SAFE · live-attenuated vaccines can be given in this patient population when their CD4+ T-cell count is ≥ 200 cells/μ

PPx for a baby exposed to VZV from infected mom?	IVIG only.
can I administer vaccines in mild URTI?	yes. if severe, postpone.
Pneumococcal	· Pneumococcal vaccine: · PCV= pneumococcal conjugated vaccine PPV-pneumococcal polysaccharide vaccine · Healthy normal kid: PCV at 2,4,6,12
Asplenia in SCA	Twice daily penicillin prophylaxis until 5 years of age for Asplenia in sickle cell disease
Before getting splenectomy done (for any reasons, eg Hereditary Spherocytosis)	Daily oral penicillin prophylaxis should be done after the operation for 3 -5 years or until adulthood to avoid sepsis which has a risk of happening until 30 years or more after splenectomy
Rheumatic Fever	They should receive continuous antibiotic prophylaxis to prevent recurrent GAS pharyngitis , they should receive IM benzathine penicillin G every 4 weeks: · Rheumatic Fever w /o Carditis: (5 years or until 21 y) (which ever is longer) · Rheumatic Fever + Carditis but no heart/valve dz by clinical or ECHO criteria : (10 years or until 21 years old) (which ever is longer) · RF + carditis + heart/ valvular disease present: (10 years or until 40 years) (whichever is longer)
Are vaccines given according to the gestational age or chronological age? Whats the exception?	They are given according to chronological age except in Hep B do not give dosage at birth if they are less than 2 kg.
allergic to neomycin, which vaccines can cause rash?	neomycin is found in MMR, polio and varicella. So its not contraindicated but if allergic then watch for rash.
CI to rotavirus vaccine?	SCID, intussusception, Meckel’s, severe allergy to rotavirus components
Which vaccine is indicated for travelers going to	a. Mecca- meningitis b. Subsahara- yellow fever c. Egypt- Hep A, B, typhoid, polio
Egg allergy may cause a reaction with which vaccines?	Influenza and yellow
Dog bite in patient with penicillin allergy. treatment?	· Adult: doxy · 👶🏼: TMP-SMX

Screenings

Posted on 30 July، 20196 April، 2022 Tagged Primary CareLeave a comment

	Who?	Age	Test	Every?
AAA	🤵🏻+🚬	65-75	Abdominal US	1 Time only
Breast cancer	💁🏻‍♀️	50-74	Mammogram	2 years
Cervical cancer	💁🏻‍♀️	21-65	pap smear	3 ys
Cervical cancer		30-65	pap smear + HPV DNA	5 ys
Colon cancer	💁🏻‍♀️🤵🏻	45-75	Colonoscopy	10 ys
	💁🏻‍♀️🤵🏻	45-75	FOBT FIT	1 year
	· 1st-degree relateive w/ cancer <60 · 2 relatives at ANY age	40 or 10 ys before the age of dx of the affected relative	Colonoscopy	5 ys
	IBD (crohn’s / UC)	8-10 ys post-dx	Colonoscopy	2 ys
	Familial adenomatous polyposis	10-12	Colonoscopy	EVERY YEAR
	Lynch	20-25	Colonoscopy	1-2 ys
HIV	💁🏻‍♀️🤵🏻	15-65	HIV Test	1 Time only
	Tx of STD	–	HIV Test
	Tx of TB	–	HIV Test
	gay, IVDU, partner of HIV pt, sex for money		HIV Test	annually
Lung cancer	🤵🏻💁🏻‍♀️ 🚬 ≥30 ys OR quit <15 ys	55-80	CT Scan	1 year
Osteoporosis	💁🏻‍♀️	>65	DEXA	uncertain
Hep C	Born <1965	–	Anti-HCV	1 time

___________________________________________________

Colon cancer screening in patients with high risk:

Indication	Recommendations
Family Hx of adenomatous polyps or CRC · 1 first-degree relative age <60 · ≥2 first-degree relatives at any age	· Age 40 or 10 years before the age of diagnosis in affected relative · Repeat every 5 years
IBS	· 8-10 years post-diagnosis (12-15 years of disease only in left colon) · Repeat every 1-2 years
Classic familial adenomatous polyposis	· Age 10-12 · Repeat annually
HNPCC (Lynch syndrome)	· Age 20-25 · Repeat every 1-2 years

*Whichever is earlier

US preventive services task force screening recommendations:

Disease	Age	Test and interval
Abdominal aortic aneurysm	Men age 65-75 who ever smoked	Abdominal ultrasound: 1time
Brest cancer	Women 50-74	Mammogram: every 2 years
Cervical cancer	Women 21-65	Pap smear: every 3 years ²
Colon cancer	Adults 50-75	FOBT or FIT: yearly or colonoscopy every 10 years
Hepatitis C	Adults born 1945-1965	Anti-HCV antibody: one time
HIV	Adults 15-65	HIV antibody screen: one time
Lung cancer	Adults 55-80, ≥30-pack-year smoking, current smoker or quit in last 15 years	Low-dose CT scan: every year
Osteoporosis	Women 65+	DEXA: interval uncertain

HIV screening indications:

Initial screening	· Age 15-65 (+ younger or older if at risk) · Treatment for tuberculosis · Treatment for another STD
Annual screening (or more frequent screening)	· IVDU + sex partners · MSM · Sex for money or drugs · Partner of HIV-positive · Patient or partner has had >1 partner since last HIV test · Homeless shelter living · Correctional facility incarceration
Additional screening	· Pregnancy · Occupational exposure to blood/body fluids · Any new STD symptoms · Suggested: prior to any new sexual relationship

MSM: gays

Recommendations for lung cancer screening:

Test	· Low-dose chest CT scan
⏰	· Yearly
Age	· 55-80
Who?	· ≥30-pack-year smoking hx AND · Still smoking · Quit within the last 15 years
When to stop?	· Age >80 OR · Patient successfully quit smoking for ≥ 15 years OR · Patient has other medical problems that significantly limit life expectancy or ability/ willingness to undergo lung cancer surgery.

Screening tests for DM
A1c	• Preferred test in nonfasting state • >6.5% = Diabetes mellitus • 5.7-6.4% =Increased risk for diabetes • <5.7% =Normal
Fasting blood glucose	• No caloric intake for >8 hours • ~126 mg/dl = Diabetes mellitus • 100-125 mg/dl = Increased risk for diabetes • <100 mg/dl =Normal
Random glucose levels	• ~200 mg/dl with symptoms of hyperglycemia = Diabetes mellitus • 140-199 mg/dl =Increased risk for diabetes. • <140 mg/dl =Normal
Oral glucose tolerance test	• Most sensitive test • 75 g glucose load with glucose testing for 2 hours • ~200 mg/dl = Diabetes mellitus • 140-199 mg/dl= Increased risk for diabetes • <140 mg/dl =Normal
Note	• Testing may be repeated in cases of discordant or equivocal results • If a patient is asymptomatic, a positive test should be *reconfirmed with the same test on a different day*

Metabolic Syndrome

Posted on 30 July، 2019 Tagged Primary CareLeave a comment

Metabloic Syndrome

The presence of any 3 of the following 5 characteristics:

Abdominal obesity, defined as a waist circumference in more > 102cm (40 in) and women > 88cm (35in)
Serum triglycerides ≥ 150 mg/dL (1.7 mmol/L) or drug treatment for elevated triglycerides.
Serum HDL cholesterol < 40 mg/dL (1mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women, or drug treatment for low HDL cholesterol.
Blood pressure ≥ 130/85 mmHg or drug treatment for elevated blood pressure.
Fasting plasma glucose ≥ 100 mg/dL (5.6 mmol/L) or drug treatment for elevated blood glucose.

Obesity:

Best tx: behavioral changes + exercise
When to investigate for endocrine dz? if Hx / Clx S/S are present.

Fast HY Review

Tag: Primary Care