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
...
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) – case by case
situation
Rotavirus
o Avoid with SCID (severe combined
immunodeficiency)
SMOKING - PACK YEAR HX
Number of packs-per-day (PPD)
Multiplied by # of years smoked
5 A’S OF SMOKING CESSATION
1. Ask about tobacco use
2. Advise to quit
3. Assess willingness to make a quit
attempt
4. Assist in quit attempt
5. Arrange follow-up
PNEUMOCOCCAL IMMUNIZATION
PCV13 associated with greater
immunogenicity
PPSV23 not licensed for children
under 2
Indications: chronic lung disease,
chronic cardiovascular disease,
diabetes, chronic liver disease,
chronic alcohol abuse, smokers,
malignancy, chronic renal failure,
asplenia, sickle cell,
immunocompromised, HIV.
PCV13 followed by PPSV23 one year
later and then again at 65
o Exception: HIV (8 weeks
later)
If PPSV23 before age 65, repeat in 5
years
HEPATITIS B
Chronic Hep B can lead to hepatocellular
carcinoma, cirrhosis and continued infectivity
Childhood Hep B vaccines began in 1982
3 dose series 0, 1, 6 months
If not vaccinated and exposed – HBIG and series
If vaccinated and exposed – single dose vaccine
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