{"id":3289,"date":"2012-10-13T21:17:03","date_gmt":"2012-10-14T01:17:03","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=3289"},"modified":"2015-06-04T15:13:50","modified_gmt":"2015-06-04T19:13:50","slug":"more-questions-from-id-in-primary-care-course","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/more-questions-from-id-in-primary-care-course\/2012\/10\/13\/","title":{"rendered":"More Questions from “ID in Primary Care” Course"},"content":{"rendered":"

\"\"<\/a>Some additional excellent questions from the course:<\/p>\n

    \n
  1. For someone who has had 3 doses of hepatitis B vaccine but does not have the antibody, should we just go ahead and give another 3 shots?<\/strong>
    \nA: \u00a0(Per vaccine guru Howard Heller): \u00a0The guidelines say to just go ahead and give another 3 shots but if the initial series was many years before then I usually give one booster dose and recheck antibody level 2 weeks later. If there is a robust response then I stop. And always consider the possibility of and screen for chronic infection as a possible reason for why the patient did not “respond” to the first series of shots.<\/li>\n
  2. If someone has a history of receiving 2 doses of MMR but they do not have antibodies, do you just give them one dose of MMR or 2 doses?<\/strong>
    \nA: \u00a0If they have documentation of the 2 previous doses or if their history is very reliable, then one dose. If there is any doubt about the reliability, then give 2.<\/li>\n
  3. My patient had a positive HIV ELISA, and an indeterminate Western blot. What should I do next?
    \n<\/strong>A: \u00a0As I wrote     here<\/a>, you must exclude acute HIV infection with an HIV RNA (viral load). And if that’s negative, it also would make sense to exclude HIV-2 with a differentiation assay. If both are negative, then it’s a false positive ELISA. Would repeat again in a month just to make sure.<\/li>\n
  4. How long is a person contagious with shingles?
    \n<\/strong>A: \u00a0When the lesions are crusted over, there’s no further viral replication and the person is no longer contagious.<\/li>\n
  5. Can a person get mononucleosis twice?<\/strong>
    \nA: \u00a0They can only get EBV-related mononucleosis once, but other infections that can mimic acute EBV mono include CMV, toxoplasmosis, and HIV.<\/li>\n
  6. Why do people think you look like Paul Farmer? You have a much stronger resemblance to Steve Buscemi.<\/a><\/strong>
    \nA: \u00a0Umm … Thank you… or not? (Above image with permission of     www.mattleese.com<\/a>.)\u00a0Just in time for Halloween!<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Some additional excellent questions from the course: For someone who has had 3 doses of hepatitis B vaccine but does not have the antibody, should we just go ahead and give another 3 shots? A: \u00a0(Per vaccine guru Howard Heller): \u00a0The guidelines say to just go ahead and give another 3 shots but if the […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,6,8],"tags":[],"class_list":["post-3289","post","type-post","status-publish","format-standard","hentry","category-infectious-diseases","category-medical-education","category-patient-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/3289","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=3289"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/3289\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=3289"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=3289"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=3289"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}