Prevention/Health Promotion/Immunization

Levels of Prevention

Primary Prevention

  • Objective: Aims to avert the onset of health conditions, making it the most cost-efficient approach to healthcare.
  • Examples: Vaccinations, safety education, and preventive measures for injuries and illnesses.

Secondary Prevention

  • Objective: Identifies diseases in their early, symptom-free, or preclinical stages to lessen their impact.
  • Examples: Diagnostic screenings such as blood pressure checks, mammograms, colonoscopies, and aspirin use in patients with a history of myocardial infarction.

Tertiary Prevention

  • Objective: Reduces complications and adverse effects of existing diseases.
  • Examples: Optimizing treatment for individuals with established conditions to prevent further organ damage. This phase may sometimes be considered a shortcoming of primary prevention. Includes participation in support groups.

Immunization Principles

Herd Immunity (Community Protection)

  • Vaccinating those who are eligible helps safeguard individuals who cannot receive immunizations.

Active Immunity

  • Immunity acquired through exposure to an antigen, whether from infection or vaccination.

Passive Immunity

  • Temporary immunity obtained through antibodies from another source, such as maternal antibodies transferred to an infant or immune globulin administration.

Administer vaccines unless immediate hospitalization via ambulance is required.

Key Considerations for Immunization and Anaphylactic History

Allergic Reaction TriggerVaccines to Avoid
NeomycinIPV, MMR, Varicella
Streptomycin, Polymyxin B, NeomycinIPV, Smallpox
Baker’s YeastHepatitis B
Gelatin, NeomycinVaricella Zoster
GelatinMMR

Hepatitis B Vaccination for Adults with Diabetes

HPV, particularly types 16 and 18, is strongly associated with cervical, anal, oropharyngeal, and other cancers.

Clinical Presentation:
Lesions caused by HPV are typically soft, flesh-colored, and may be pedunculated, flat, or papular. When acetic acid is applied during examination, lesions may appear white.

Treatment Options:

  • Topical treatments:
    • Imiquimod (Aldara) cream
    • Podofilox (Condylox) cream
  • Procedural options:
    • Cryotherapy
  • During pregnancy: Only chemical treatments like bichloracetic acid or trichloroacetic acid are recommended (safe for use in pregnancy)

HPV Vaccination (Gardasil 9):

  • Routine vaccination is recommended at ages 11–12 (can begin as early as age 9)
  • Catch-up vaccination is recommended through age 26 for all individuals who were not adequately vaccinated
  • Adults aged 27–45 may receive the vaccine based on shared clinical decision-making, especially if at risk for new HPV exposure (e.g., new sexual partners)

Vaccination significantly reduces the risk of HPV-related cancers and genital warts, and is most effective when given prior to HPV exposure.

Human Papillomavirus (HPV):
HPV, especially types 16 and 18, is linked to the development of cervical, anal, oropharyngeal, and other cancers.

Clinical Features:
HPV lesions are typically soft, flesh-colored, and may be pedunculated, flat, or papular. When examined with acetic acid, lesions may turn white, aiding in visual identification.

Treatment Options:

  • Topical therapies:
    • Imiquimod (Aldara)
    • Podofilox (Condylox)
  • Cryotherapy
  • Pregnancy-safe treatments:
    • Bichloracetic acid or trichloroacetic acid, as other agents may be contraindicated

HPV Vaccination (Gardasil 9):

  • Routine vaccination is recommended for boys and girls at ages 11–12 (can start as early as age 9)
  • Catch-up vaccination is recommended through age 26 for anyone not adequately vaccinated
  • Adults aged 27–45 may be vaccinated based on shared clinical decision-making, considering factors such as risk of new sexual partners and potential HPV exposure

Live Vaccines and Special Considerations

Live VaccineSpecial Notes & Precautions
MMR– Individuals born before 1957 are likely immune due to natural infection.
– Those never vaccinated should receive two doses, one month apart.
Varicella– Avoid in pregnancy, immune suppression, and HIV (CD4 < 200, case-by-case basis).
Zostavax– Contraindicated in immunocompromised individuals.
Intranasal Flu Mist– Should not be used in pregnant women or immunocompromised individuals.
Rotavirus– Do not administer to infants with severe combined immunodeficiency (SCID).

Hepatitis B Overview

  • Chronic Hepatitis B may result in liver cancer, cirrhosis, and ongoing transmission.
  • Routine childhood Hep B vaccination began in 1982.
  • Standard 3-dose series: Administered at 0, 1, and 6 months.
  • Post-exposure protocol:
    • Unvaccinated: HBIG + full vaccine series.
    • Previously vaccinated: Single booster dose.

Smoking History & Cessation Strategies

Calculating Pack-Year History

Formula: Packs per day (PPD)×Years smoked\text{Packs per day (PPD)} \times \text{Years smoked}Packs per day (PPD)×Years smoked

5 A’s of Smoking Cessation

  1. Ask about tobacco use.
  2. Advise quitting.
  3. Assess readiness to quit.
  4. Assist in developing a quit plan.
  5. Arrange follow-up support.

Pneumococcal Immunization Guidelines

For adults age 65 and older and adults aged 19–64 with certain risk factors, the CDC now recommends one of the following options:

  • A single dose of PCV20 (Prevnar 20) — no need for PPSV23 afterward
  • PCV15 (Vaxneuvance) followed by PPSV23 at least 1 year later (or 8 weeks later if immunocompromised)

PCV20 offers broader protection and simplifies the schedule by eliminating the need for a second vaccine in most cases. PCV13 is no longer routinely recommended in adults due to the superior coverage of PCV20.

High-risk populations eligible for pneumococcal vaccination include those with:

  • Chronic conditions: lung disease, heart disease, liver disease, kidney disease, diabetes
  • Lifestyle risks: smoking, alcohol dependence
  • Medical conditions: malignancies, asplenia, sickle cell disease, HIV, and other immunocompromised states

Special Considerations:

  • If PPSV23 was administered before age 65, give a second dose at least 5 years later
  • For individuals with HIV, PPSV23 should be given 8 weeks after PCV15 (if used instead of PCV20)

Note:

  • PPSV23 is not approved for children under 2 years old
  • PCV vaccines elicit a stronger and longer-lasting immune response than PPSV23

Infectious Diseases and Vaccination Guidelines

Smallpox (Variola Virus)

  • Spread through infectious droplets – contagious during fever but most infectious during rash.
    • Remains contagious until the last scab falls off.
  • Routine vaccination ended in 1972.
  • Incubation period: 7-17 days.
  • Early symptoms (prodromal stage): Fever, fatigue, headache, body aches.
  • Rash progression:
    • Starts on face → arms/legs → hands/feet.
    • All lesions are in the same stage and spread within 24 hours.
  • Post-exposure vaccination within 3 days can reduce severity.
  • Vaccinia method: Uses a bifurcated needle dipped in vaccine to prick the skin.

Poliovirus

  • Transmitted via fecal-oral route.

Sensitivity and Specificity in Diagnostic Testing

  • Sensitivity – Identifies those with disease (SEN = rule in).
  • Specificity – Identifies those without disease (SPOUT = rule out).

Varicella (Chickenpox & Shingles)

  • Live virus vaccine given in a two-dose series starting after 12 months of age.
  • Highly protective, but mild cases of chickenpox can still occur.
  • Healthcare workers who had chickenpox as children should have varicella antibody titers checked.
  • Varicella Zoster Immune Globulin (VZIG) is derived from pooled blood products and is safe for those with contraindications to the vaccine.
  • Pregnant women without immunity should receive two doses post-delivery.
  • Spread via respiratory droplets.
  • Vaccination within 3-5 days of exposure may reduce severity.

Stages of Change Model (Behavioral Change Process)

StageDescription
PrecontemplationLittle or no interest in change.
ContemplationWeighs pros and cons but feels stuck.
PreparationAttempts change but lacks tools.
ActionTakes steps forward but lacks consistency.
Maintenance/RelapseDevelops long-term adherence or struggles to sustain change.

Tetanus (Clostridium Tetani Infection)

  • Bacteria found in soil; can cause lockjaw.
  • No prior vaccination: Administer Tdap, followed by Td at 1 and 6 months.
  • Booster every 10 years, with one lifetime Tdap dose in adulthood.
  • If exposed via dirty wound:
    • Booster if last Td was over 5 years ago.
    • If unvaccinated, give Tdap and tetanus immune globulin (TIG).

Hepatitis A

  • Most contagious during the 2 weeks before jaundice or liver enzyme elevation.
  • No known risk factors in about 50% of cases.
  • Travelers to developing countries should avoid raw foods.
  • Vaccination recommended 4-6 weeks before traveling to endemic regions.
  • No specific antiviral treatment; supportive care only.

Shingles (Herpes Zoster) Vaccine

Herpes zoster is contagious until lesions have dried and crusted.

Current Vaccine Recommendation:

  • Shingrix (recombinant zoster vaccine) is the preferred and only available shingles vaccine in the U.S.
  • Recommended by ACIP for:
    • All immunocompetent adults aged ≥50 years
    • Certain immunocompromised adults aged ≥19 years
  • Dosage: Two doses, administered 2–6 months apart

Note:

  • Zostavax (live vaccine) was discontinued in the U.S. in 2020 and is no longer recommended
  • Shingrix offers superior and longer-lasting protection against shingles and postherpetic neuralgia

COVID-19 and RSV Vaccines:

These vaccines are now part of current immunization guidelines and important for clinical practice:

  • COVID-19 Vaccine: Recommended for all adults and eligible children, with updated formulations released regularly to match circulating variants. Staying up to date with primary series and boosters is essential for optimal protection against severe disease.
  • RSV (Respiratory Syncytial Virus) Vaccine:
    • As of 2023, an RSV vaccine is recommended for adults aged ≥60, based on shared clinical decision-making (e.g., considering comorbidities or exposure risks).
    • Additionally, RSV immunization is recommended during pregnancy (32–36 weeks) and in infants (via maternal vaccine or monoclonal antibody) to prevent severe RSV in newborns.

U.S. Preventive Services Task Force (USPSTF) Recommendations

Cardiovascular Disease & Colorectal Cancer Prevention

  • Aspirin Use: Recommended for adults ages 50-59 with ≥10% ASCVD risk to prevent cardiovascular events and colorectal cancer.

Ovarian Cancer

  • Routine screening is not recommended.
  • Postmenopausal women with a palpable ovary:
    • Consider intravaginal ultrasound and CA-125 testing.
  • Strongest risk factor: BRCA1 or BRCA2 gene mutations.
  • Other risk factors:
    • Advanced age.
    • Obesity.
    • Use of Clomid (fertility medication).
    • History of endometriosis.
  • Prostate and testicular cancer screenings are not routinely recommended.

Cancer Prevalence

  • Most common cancer overall: Skin cancer.
    • Basal cell carcinoma – Most frequent type.
    • Melanoma – Highest mortality rate.
  • Most common cancers by gender:
    • Men: Prostate cancer.
    • Women: Breast cancer.
  • Most common gynecological cancers:
    • Uterine (endometrial) cancer.
    • Ovarian cancer.
  • Most common childhood cancer: Acute lymphoblastic leukemia (ALL).

Mortality Rates

Leading Causes of Death (All Ages)

  1. Heart disease.
  2. Cancer:
    • Men: Lung, prostate, colorectal.
    • Women: Lung, breast, colorectal.
  3. Chronic respiratory diseases.

Adolescent Mortality

  • Teen males have a higher death rate than females.
  • Top causes of adolescent deaths:
    1. Accidents (Motor Vehicle Crashes – MVCs most common).
    2. Suicide.
    3. Homicide.

Posted

in

by

angelicasale08

Tags: