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>