PREVENTION/HEALTH PROMOTION/IMMUNIZATION LEVEL OF PREVENTION PRIMARY o Goal: preventing the health problem, the most cost-effective form of healthcare o Example: immunizations, counseling about safety, injury and disease prevention SECONDARY o Goal: detecting disease in early, asymptomatic, or preclinical state to minimize its impact o Example: screening tests, such as BP check, mammography, colonoscopy, ASA in hx MI TERTIARY o Goal: minimizing negative disease induced outcomes o Example: in established disease, adjusting therapy to avoid further target organ damage. Potentially viewed as a failure of primary prevention, support groups IMMUNIZATION PRINCIPLES Community (herd immunity) o Immunize those who can be to protect those who cannot be immunized Active immunity o Resistance developed in response to an antigen (either infection or vaccine) Passive immunity o Immunity conferred by an antibody produced in another host (infant of mother or immune globulin Immunize unless sending to the hospital in an ambulance IMMUNIZATION PEARLS HX of Anaphylactic reaction Immunization to avoid Neomycin IPV, MMR, varicella Streptomycin, polymyxin B, neomycin IPV, smallpox Baker’s yeast Hepatitis B Gelatin, neomycin Varicella zoster Gelatin MMR Previously unvaccinated adults age 19-59 with diabetes should be vaccinated against Hepatitis B LIVE VACCINES o MMR Patients born before 1957 have likelihood of immunity due to natural infection Two doses 1 month apart for those never immunized o Varicella o Zostavax o Intranasal Flu Mist Avoid these with Pregnancy, immune suppression and with HIV (CD4 count < 200> arms/legs > hands/feet o All lesions within same phase and spreads within 24 hours Vaccination within 3 days of exposure reduces severity Vaccinia – unique immunization method o 2-pronged needle dipped into vaccine and then pricks skin VARICELLA Live virus; 2 dose series starting > 1 year of age Although highly protective, mild cases of chicken pox have been associated with the disease Varicella antibody titers should be ordered on a healthcare worker who had chicken pox as a child Varicella Zoster Immune Globulin (VZIG) is made of pooled blood product with excellent safety rating (given if contraindications for vaccine) Pregnant women without immunity should be vaccinated with two doses after giving birth Varicella is transmitted via droplet Vaccination within 3-5 days of exposure has shown benefits to reduce disease TETANUS Infection caused by Clostridium tetani – found in soil lead to lockjaw If no previous immunity - give Tdap followed by Td in 1 and 6 months Need vaccine every 10 years with a single dose of Tdap in adulthood If dirty wound – BOOST if not TD in 5 years (Tdap and Immunoglobin if no previous vaccine) HEPATITIS A Peak infectivity occurs the 2-week period before the onset of jaundice or elevated liver enzymes Approximately 50% of cases have no specific risk factors identified When traveling to developing nations, avoid foods that are eaten raw Administer 4-6 weeks prior to traveling to an area where disease is endemic Treatment is supportive POLIOVIRUS Transmission is fecal-oral STAGES OF CHANGE MODEL PRECONTEMPLATION o Not interested or minimalizes CONTEMPLATION o Considering change, looks at positive and negative, feels “stuck” PREPARATION o Exhibits some change behaviors, but does not have tools to proceed ACTION o Ready to go forward, takes concrete steps, but no consistency MAINTENANCE/RELAPSE o Learns to continue the change and embraced the healthy habit SENSITIVITY AND SPECIFICITY Sensitivity – ability of a test to detect a person who has disease (SEN rule in) Specificity – ability of a test to detect a person who is healthy (SPOUT – rule out) SHINGLES VACCINE Recommended for everyone except those contraindicated Infectious until lesions dry/crusted Zostavax o Live; One-time dose age 60 Shingrix o Non-live; 2 doses age 50 o Preferred vaccine