2. Immunity

Question 1

When should immunisations not be given to a child?

Answer 1

1. If younger than the schedule
2. If acutely unwell with a fever
3. If has had an anaphylactic reaction to a previous dose of the vaccine

Question 2

What vaccinations are given at birth?

Answer 2

-Hep B
-BCG

Question 3

When should the DTaP/IPV/Hib/Hep B vaccine be given and what diseases do they protect against?

Answer 3

3 times in infancy:
-8 weeks
-12 weeks
-16 weeks
Protects against 6 diseases:
-Diphtheria
-Tetanus
-Pertussis
-Polio
-H. influenzae type B
-Hep B

Question 4

When should the pneumococcal and MenB vaccines be given and what do they protect against?

Answer 4

3 times in childhood:
-2 months
-4 months
-13 months
Protects against:
-Pneumococcal infections ie pneumonia, septicaemia, meningitis
-Meningococcal group B bacteria

Question 5

When are rotavirus jabs given?

Answer 5

-2 months and 3 months
-Protects against gastroenteritis

Question 6

When are Hib/MenC + MenB jabs given?

Answer 6

-MenB = 8 weeks + 16 weeks + 1 year
-Hib/MenC = 12months

Question 7

When is the MMR vaccine given and who is not eligible for it?

Answer 7

2 occasions:
-13 months
-3 years and 4 months
Should not be given to:
-Immunocompromised children
-Pregnant girls
-Children with an evolving neurological condition
-Severe allergy to egg (seek advice)

Question 8

When is the DTaP/IPV booster given and what does it protect against?

Answer 8

-3 years and 4 months (‘4-in-1 pre-school’ booster)
-Also given at 14 years (‘3-in-1 teenage’ booster, without whooping cough)
Protects against (‘dirty wounds’):
-Diphtheria
-Tetanus
-Whooping cough
-Polio

Question 9

When is HPV given?

Answer 9

-Girls aged 12-13, 2 doses at least 6 months apart
-Protects against strains 6, 11, 16, 18

Question 10

When is the Men ACWY given and to who?

Answer 10

-Aged 14
-University students
-Those travelling to high-risk areas

Question 11

What causes an allergic reaction (to food)?

Answer 11

-Immediate reaction involves production of (food-specific) IgE antibodies

Question 12

How do food allergies typically present?

Answer 12

-Diarrhoea +/- blood/mucus
-Vomiting
-Dysphagia (GORD, abdo pain)
-Faltering growth
-Eczema
-Urticaria
-Erythematous rash - particularly peri-oral
-Asthma symptoms (wheeze)
-Anaphylaxis

Question 13

How does food intolerance differ to food allergy?

Answer 13

-Food intolerance is NOT an immune-mediated response
-Presentations are similar
-Eg lactose intolerance due to lactase insufficiency

Question 14

What investigations can be done for food allergies?

Answer 14

-Skin prick test
–Drops of diluted allergen placed on skin, skin pierced
–Includes a histamine and sterile water control
–Interpret after 15mins, wheal develops if an allergy is present
–Positive result only useful if positive history, negative good for ruling out
-Radioallergosorbent test / ELISA
–Determines amount of specific IgE that reacts to allergens (food and wasp/bee venom)
–Used if skin prick not suitable eg eczema
–Positive result only useful if positive history, negative good for ruling out
-Skin patch testing
–Used for contact dermatitis
–Patch with 30-40 allergens is placed on back for 48 hours

Question 15

How can you manage food allergies?

Answer 15

DIETARY:
-Exclude from diet
-Consider food challenge 6-12 months after exclusion
DRUG:
-Regular eg oral sodium cromoglicate, corticosteroids, antihistamines
-Emergency eg IM adrenaline