allylz

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Hi all:

I'm doing UW questions and as you know, there are a ton on vaccine schedules. I just got a question about a 45 year old man with all his childhood vaccines and diagnosed with HIV.

I answered that you should give DPT, but their answer was Td because pertussis is rare in the adult population. I thought recent studies had revealed that pertussis is more common than people had thought and so now DPT would be recommended even for adults without HIV. Am I wrong? Or is UW just out of date?

... I really hope I don't get a picky question like that on step 2 since the vaccine recommendations change so frequently.
 

Bevo

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depends on when the study was and what the recommendations are. Things than less than 2 years old won't be seen on the USMLE.

As for the DPT issue. I think you gotta go to the peds book about vaccinations. I think once the child is older than 5? years old, you no longer give the DPT vaccine.
You give the Td vaccine instead
 
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allylz

allylz

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Bevo said:
depends on when the study was and what the recommendations are. Things than less than 2 years old won't be seen on the USMLE.

As for the DPT issue. I think you gotta go to the peds book about vaccinations. I think once the child is older than 5? years old, you no longer give the DPT vaccine.
You give the Td vaccine instead
That's probably what I should stick to. Also the answer to the Q said that people with HIV are more susceptible to diptheria, so if it wasn't an HIV+ person we'd probably just give tetanus toxoid.

Thanks - and by the way, every time I see your avatar I just want to give that black cat a hug. He reminds me of how I feel about med school - getting a beat-down every minute of every day.
 
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Bevo

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I dunno if I just had the same question as you or not, but I had a preventive med question on giving the Td vaccine every 10 years.

I put down the Influenza vaccine cause I thought you gave it yearly to anyone 55 and over.

answer was 65 and over, but more commonly being given at 55.
 

Doc Ivy

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I agree with you that whooping cough is making a comeback because of waning immunity after about 15 years post vaccine. We had a small outbreak here in Illinois. On my IM rotation last year we were told that some physicians are advocating booster pertussis for adults but I guess that is a fairly new and unofficial recommendation-- I got it wrong on UW as well.

Thankfully it wasn't on the real exam ;)
 

sophiejane

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Doc Ivy said:
I agree with you that whooping cough is making a comeback because of waning immunity after about 15 years post vaccine. We had a small outbreak here in Illinois. On my IM rotation last year we were told that some physicians are advocating booster pertussis for adults but I guess that is a fairly new and unofficial recommendation-- I got it wrong on UW as well.

I've heard this too. I know that older kids now get a pertussis booster because little ones were getting it from their older sibs before they were old enough for the primary vax. I've never heard of giving an adult a pertussis booster, however.
 

12R34Y

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sophiejane said:
I've heard this too. I know that older kids now get a pertussis booster because little ones were getting it from their older sibs before they were old enough for the primary vax. I've never heard of giving an adult a pertussis booster, however.
There is finally a new vaccine that just came out last year call the TdaP that is for adults. Get it. you don't want the 100 day cough. pertussis in adults is fairly common. My personal philosophy is to get as many vaccinations as possible.

Eat out much? Get the Hep A vaccine etc...

vaccinate up baby.
 
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allylz

allylz

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I agree with the 'vaccinate up' motto - I've got vaccines for hep A, typhoid, yellow fever, meningitis and all that good stuff. I sleep well at night. :)

Anyway I came to another UW question where the guy is healthy and you do give him both diptheria and tetanus, so I just wanted to correct myself that previously I had speculated it was only Td because the pt. had AIDS.
 

Doc Ivy

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allylz said:
Anyway I came to another UW question where the guy is healthy and you do give him both diptheria and tetanus, so I just wanted to correct myself that previously I had speculated it was only Td because the pt. had AIDS.

This is probably stating the obvious, but always look at the CD4 count of an HIV patient who is being considered for vaccinations. For the most part, if they are newly diagnosed, assymptomatic and have a decent CD4 count they can get even live vaccines
 

dagr8vik

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Please refer to the CDC website for their latest guidelines

In March 2006, the CDC recommended replacing Td with Tdap for adults.
Your Usmleworld question is probably "outdated" however, Tdap and DPT are not the same thing.
 

Bevo

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dagr8vik said:
Please refer to the CDC website for their latest guidelines

In March 2006, the CDC recommended replacing Td with Tdap for adults.
Your Usmleworld question is probably "outdated" however, Tdap and DPT are not the same thing.
March 2006 is too new to be represented on the test.
 

Bevo

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dagr8vik said:
hence the quotes around "outdated"
wasn't referring to UW, I was talking about the usmle. I've been told anything new within the last 2 years won't be represented on the exam.

so while UW is outdated, the actual exam will be as well.
 
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