1.8 Vaccination

Question 1

[Vaccinations and timing]

Babies will have some passively acquired immunity from maternal IgG antibodies. This can last for weeks to months in the newborn and influences when vaccinations are administered. At birth _____________ are given. Hep B is common in Singapore and so this is part of the routine childhood schedule whereas it is not routinely given at birth in other countries and may just be given to those at high risk. The measles, mumps and rubella vaccination is however, administered later at ________ as passive immunity persists for this time and if given before, this may interfere with the efficacy of the vaccine.

Several vaccinations are given in combination _____________: this tends to increase the timeliness of delivery and the vaccine coverage. It also has certain practical advantages for the parents and the doctor’s office in that it means that there are fewer office visits necessary which is therefore more efficient in terms of time and cost.

You will notice that children are vaccinated against the poliomyelitis virus which can cause significant illness resulting in permanent physical disability. It is transmitted through contact with faeces or respiratory secretions of an infected person. Every country in the world except Sweden and Iceland used the Oral Polio Vaccine (OPV) which is a _______________, for polio elimination. The Oral polio vaccine is the WHO recommended vaccine for eradication of poliomyelitis.

The Oral polio vaccine provides some degree of protection to the community as as the vaccine virus is excreted by those recently immunised so unvaccinated contacts develop some immunity also. It also confers protection against ____________ which the inactivated polio vaccine does not protect against. There is however a very small risk of developing __________________ but it is an incredibly low risk. As it is a live attenuated vaccine its use is contraindicated in those who are immunosuppressed. It should also not be given to contacts of someone who is immunosuppressed as they will be at risk of contact with the live virus through excretions of the immunised individual.

Most industrialised countries have now switched to inactivated polio vaccine (IPV) now that they have moved closer to polio eradication and the risk of wild type polio virus has reduced. Inactivated polio vaccine only confers individual protection and has no community advantages however.

The oral polio vaccine in the Singapore schedule is used as a ________________ -this can ensure sufficient protection in the intestinal mucosa but also decreases the burden of vaccine associated paralytic polio cases. The WHO states that IPV+OPV schedules can be used in the this way in countries with high levels of immunisation coverage 90-95%. Research is ongoing about the benefits of combined schedules for polio.

Answer 1

BCG against TB and vaccination against Hep B;

12 months;

Diptheria, Tetanus and Polio (DTP) and the MMR;

live attenuated vaccine;

wild type polio virus;

vaccine associated paralytic polio (VAPP) ;

second booster

Question 2

vaccines given at birth

Answer 2

bcg, hep b (D1)

Question 3

vaccine given at 1 month

Answer 3

hep b (D2)

Question 4

vaccines given at 3 months

Answer 4

DTap (D1) , Inactivated polio vaccine (D1), Hib (D1), pneumococcal disease (D1)

Question 5

vaccine given at 4 months

Answer 5

DTap (D2) , Inactivated polio vaccine (D2), Hib (D2),

Question 6

vaccine at 5 months

Answer 6

DTap (D3) , Inactivated polio vaccine (D3), Hib (D3), pneumococcal disease (D2), Hep B (D3- can also be given at 6 months)

Question 7

vaccine at `12 months

Answer 7

MMR (D1), PCV (B1)

Question 8

vaccine at 18 months

Answer 8

DTAP (B1), IPV (B1), Hib (B1), MMR (D2)- also can give at 18 months)

Question 9

Vaccine at 10-11 years

Answer 9

Tdap - 2nd booster

Oral Polio - 2nd booster

Question 10

All vaccines are contraindicated in those who have had: a confirmed anaphylactic reaction to a previous vaccine with the ______________

a confirmed anaphylactic reaction to _____________ of the vaccine, e.g. neomycin, streptomycin

Live vaccines may be contraindicated in individuals who are ___________

The current evidence suggests that there is no likely link between egg allergy and reactions to MMR.

Concurrent illness- this is not a contraindication if there is no fever. If there is a concurrent febrile illness, it is advisable not to administer the vaccination. It will increase the risk of febrile illness further and increases the risk of febrile convulsions

Answer 10

same antigens;

another component;

immunosuppressed or pregnant

Question 11

[Adult vaccination]
- Catch up vaccinations/boosters If not up to date with childhood vaccinations

Pregnancy:

• ____________
• Check immune status re: varicella zoster(chicken pox), rubella, hepatitis B

“At risk groups”

• Immunocompromise from chronic disease eg renal failure
• Post splenectomy (_________________)
• Elderly
• Post exposure (varicella in pregnancy, tetanus)

Travel
- Holidays, Hajj (close contact with many people)

Answer 11

Pertussis, influenza;

pneumococcal vaccination, flu, Hib, Men C)

Question 12

Tetanus-Clostridium tetani-causes muscle spasm and rigidity, lock jaw-spores found in soil so if someone sustains a “dirty” wound, there is a risk of tetanus and _______________ should be administered for immediate protection. Tetanus vaccine is part of routine childhood schedule but if inadequate doses have been given or if not up to date or not sure, then tetanus vaccine should be administered.

Answer 12

immediate tetanus immunoglobulin