35 Protecting the host: vaccination Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

Vaccination aims to prime adaptive immune system, so second contact will provide a rapid and effective secondary immune response by memory T and B cells.

What are different types of vaccines and examples?

A

Live attenuated -
- viral - measles, mumps, rubella, vaccinia, varicella, yellow fever, zoster, oral polio, intranasal influenza, rotavirus

  • bacterial - BCG, oral typhoid

Inactivated -
- Whole virus - polio, influenza, hepatitis A, rabies, JE

  • Whole bacteria - pertussis, cholera, typhoid

Fractions -
- toxoids - diptheria, tetanus

  • protein subunits - hepatitis B, influenza, pertussis, HPV 6/11/ 16/ 18
  • polysaccharides - pneumococcal, meningococcal, salmonella typhi, Hib
  • conjugates - pneumococcal, meningococcal, Hib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who should not be given live vaccines?

A

HIV patients

Pregnant

Inactivated vaccines are safe to use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why are toxoid vaccines used for diptheria/ tetanus?

A

It is the toxin which is damaging to host, not the bacteria itself. So use inactivated toxoid as vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Inactivated/ protein/ polysaccharide require multiple doses for vaccination. Why is this?

A

Less immunogenic than vaccines with whole organisms.

Sometimes adjuvants are required to improve immune response through inducing activation of Toll-like receptors on dendritic cells to improve antigen presentation. Certain chemicals can be used as adjuvants, such as aluminium salts, and cytokines IL1, IL2, IFNgamma can help boost immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are problems with vaccine safety?

A

Live attenuated -

  • insufficient attenuation
  • reversion to wild type
  • admisiter to immunodeficient patient
  • contamination other viruses
  • foetal damage

Non-living vaccines

  • contamination by chemicals
  • allergic reaction
  • auto-immunity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why are childrens vaccinations required to be repeated?

A

Can have maternal antibodies, so do not develop own memory cells

Some vaccines are less immunogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the two types of polio vaccine?

Three serotypes of polio, vaccine works against all three - trivalent.

But polio-2 and polio-3 has been eliminated, so may only need to use monovalent vaccine in future

A

Inactivated IPV - Salk 1954
Injectible
Risk if inadequatley killed

Attenuated OPV - Sabin 1957
Oral - easy to administer
Benefits - replicates in intestine produce local immunity IgA, and can be spread to other household members.
Risk of vaccine associated paralytic polio (VAPP)

they both target polio virus 1/ 2/ 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are risks of oral polio vaccine? OPV

A

Can can vaccine associated paralytic polio (VAPP)

OPV virus can be transmitted in community termed circulating vaccine-derived polio viruses cVDPV. If susceptible population, can survive moving between hosts. Mutations slowly develop, and cause paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why was it difficult to create pneumococcal vaccine?

A

over 90 serotypes

Most common 23 serotypes included in vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why does haemophilus vaccine target type b serotype?

A

six capsular serotypes, but type b causes 95% of disease.

Usually those under 5 affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why is influenza vaccine difficult to develop?

Influenza vaccine contains three flu strains -
2 A strains
1 B strain

A

Antigenic drift - gradual mutation

Antigenic shift - reshuffle of RNA can produce different H/N antigens

Given to people >65 who have weaker immune systems, so may not generate sufficient immune response - immunosenescence

Winter 2020-21
H1N1
H3N2
B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is it difficult to produce HIV vaccine?

A

gp120 can mutate easily

killed virus not sufficiently immunogenic

route of infection via genital tract, means need localised mucosal immunity, which vaccine can’t provide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Adenoviruses are useful as vaccine vectors, why is this?

What are draw backs?

A

Induce good CD8 T cell response

Some people have already been infected with adenovirus species, and have antibodies to them, so may not generate good immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why was smallpox easy to erradiacte?

A

highly effective vaccine
Easy to administer vaccine
Single vaccine dose

Infected patients can be easily spotted
Easy to contain patients once diagnosed

Permanent immunity after disease/ vaccination

No animal reservoir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When targeting next disease for erradication, what factors must be present?

A

Humans must be critical to circulating organism - no animal reservoir

Sensitive/ specific diagnostic tools

Effective vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is there a problem with developing a dengue vaccine?

A

Antibody dependent enhancement between serotypes

Antibodies generated during primary infection with one serotype of virus will not be sufficient to neutralise a second serotype.

However, they might be able to opsonise the secondary virus, and target it for phagocytes. This can lead to dengue haemorrhagic fever or severe dengue on repeat infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are organisms inactivated for vaccination?

A

heat

Chemicals

radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

some patients have egg allergy. Which vaccine should you seek alternative?

4CMenB
DTaP/ PIV/ Hib
Influenza
MMR
Q fever
Rotavirus
Yellow fever
Rabies
A

Influenza uses embryonated eggs - can use intranasal vaccine instead.

Yellow fever contains eggs and should be avoided

Rabies uses egg embyros and should be avoided

Q fever uses egg embryos and should be avoided

MMR produced in eggs, but is safe as long as no anaphylaxis, as no egg free alternative available

discuss with immunologist if require to give vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

VZV susceptible healthcare worker on oncology ward receives varicella vaccine dose through occupational health. She presents two weeks later with vesicular rash. Otherwise well. Not pregnant.

What is next management?

A

Avoid patient contact until lesions crusted over

<5% develop vesicular rash 5-26 days after vaccination. Given her rash is after two weeks, then it is less likely to be caused by vaccine, and may be new VZV infection.

In any case, vaccine strain is sensitive to aciclovir

  • viral PCR of lesion
  • viral genome analysis, to see if wild type. Serology does not help differentiate the two
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which vaccines are live attenuated?

A

Live attenuated -
- viral - measles, mumps, rubella, vaccinia, varicella, yellow fever, zoster, oral polio, intranasal influenza, rotavirus

  • bacterial - BCG, oral typhoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which vaccines come as combinantions?

A

MMR
DTaP/IPV/Hib/HepB or DTaP/ IPV/ Hib
Td/ IPV (tetanus)
Influenza A and B

22
Q

What are advantages of combination vaccines?

A

Less uncomfortable for patient

Mor efficient vaccination as easier to administer

Higher vaccine uptake

23
Q

If child has no vaccination history e.g refugee, should they be vaccinated?

A

Vaccinate as if never had a vaccine

Risk of extra dose is minimal if already vaccinated, and far outways risk of disease

24
Q

Fully vaccinated pregnant female, what extra booster should be given between 16-32 weeks?

A

DTaP/ IPV
Inactivated

Studied following outbreak of pertussis in infants

Never give live vaccines in pregnancy, including MMR

25
Q

One year old girl on high dose steroids for nephrotic syndrome for more than one month.

Which vaccine contraindicated?

DTaP/ IPV/ Hib
MenB
Inactivated influenza
MMR
Pneumococcal
A

MMR live vaccine

Consider those on 40mg prednisolone or above, for more than a week, to be immunosuppressed. This lasts until 3 months after cessation of immunosuppressive drug

26
Q

Vaccine schedule

8 weeks old

If start vaccination before this, poor immune response as will have maternal antibodies.

Personal Child Health Record (Red Book) records vaccines

A

DTaP/IPV/Hib/HepB - injection

Meningococcal B (MenB) - injection

Rotavirus - oral

27
Q

Vaccine schedule

12 weeks old

A

DTaP/IPV/Hib/HepB - injection

PCV13 - injection

Rotavirus - oral

28
Q

Vaccine schedule

16 weeks old

A

DTaP/IPV/Hib/HepB - injection

Meningococcal B (MenB) - injection

29
Q

Vaccine schedule

Prior to age of 1 year old, what vaccinations should have been given?

A

DTaP/IPV/Hib/HepB - 3x doses

PCV13 - 1x dose

MenB - 2x doses

Rotavirus - 1x dose

30
Q

Vaccine schedule

1 year old

A

Hib/MenC - injection

MenB - injection

PCV13 - injection

MMR - injection

31
Q

Vaccine schedule

What should child receive by age 2?

A

DTaP/IPV/Hib/HepB - 3x doses

PCV13 - 2x dose

MenB - 2x doses

Rotavirus - 1x dose

Hib/ Men C - 1x dose

MMR - 1x dose

32
Q

Vaccine schedule

3-4 year old

A

LAIV - intranasal

dTaP/IPV - injection

MMR - injection

33
Q

Vaccine schedule

12-13 years old

14 years old

A

HPV - 2x injections 6 months apart.
Note - females and males eligible up to age 25. Give three doses if course started after age 15

Td/IPV - injection

MenACWY - injection

34
Q

Vaccine schedule

What should be given before leaving school?

A

dTaP/IPV - 5x doses total

MenACWY - 1x dose

MMR - 2x doses

HPV - 2x doses

35
Q

What is in vaccination schedule for elderly?

A

65 - pneumococcal single dose/ influenza annual

70 - shingles

36
Q

At what age should premature infants be vaccinated?

A

Vaccinate as with chronological age i.e when they were born

This is because even higher risk of childhood disease

37
Q

Inactivated vaccines - how many can be given together?

How long to wait between doses?

A

Can give as many as possible

Wait 4 weeks before given another dose of same vaccine is recommended. Some give better response at 8 weeks.

If going travelling, or disease outbreak, and rapid immunisation required, can give vaccines early (by one week). However, this often leads to ineffective response, and another dose may be required

38
Q

Can these vaccines be given same day?

Yellow fever + MMR

Varicella + MMR

A

Yellow fever + MMR - both live. Wait 4 weeks between

Varicella + MMR - both live, can give together. But if not given together, wait 4 weeks before given the second one. Study showed outbreak varicella if given too close together. MMR may attenuate response to varicella

39
Q

Can these vaccines be given on same day?
All live

BCG
rotavirus
LAIV
oral typhoid vaccine
yellow fever
varicella zoster
MMR
A

Yes, apart from:

Yellow fever and MMR - wait 4 weeks between

Varicella + MMR - only if given together. If not, wait 4 weeks

40
Q

Household contacts of immunocompromised individual are eligible to receive vaccination, including varicella and seasonal influenza.

What precautions should be taken?

A

Give inactivated influenza vaccine instead of live vaccine, as risk of spreading to household member

41
Q

When is vaccination recommended in HIV patients?

A

Guided by CD4 count - chapter 6 Green book

Avoid BCG at any CD4 count

42
Q

Splenectomy patients are at risk of infection by encapsulated organisms. What vaccines should they receive?

A

Pneumococcal

Hib

MenACWY

Influenza - annual

43
Q

HBV vaccine introduced in 2017 childhood immunisation schedule.

Which other adult groups should receive this vaccine?

A

HCW

Prison staff

IVDU

Contacts of patient with HBV

Babies born to mothers with chronic HBV

Haemophiliac

CKD

Liver diseases

44
Q

What is the advice about avoiding school with following conditions?

Chickenpox

Herpes simplex

Rubella

Hand, foot and mouth

In all cases, if one child affected then do not need to contact public health. If multiple cases/ outbreak, then inform public health

A

Chickenpox - until all vesicles have crusted over

HSV - none. Avoid kissing and contact with the sores.
Cold sores are generally mild and self-limiting

Rubella - four days from onset of rash

Hand, foot and mouth - none

45
Q

What is the advice about returning to school with following conditions?

Impetigo

Measles

Molluscum contagiosum

Roseola

A

Impetigo - until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
Antibiotic treatment speeds healing and reduces the
infectious period

Measles - 4 days from onset of rash

Molluscum contagiosum - none A self-limiting condition. Unless doing contact sports/ swimming - need to cover lesions

Roseola (infantum) - none

46
Q

What is the advice about returning to school with following conditions?

Scabies

Scarlet fever

Slapped cheek (fifth disease or parvovirus B19)

A

Scabies - return after first treatment

Scarlet fever - teturn 24 hours after commencing
appropriate antibiotic treatment

Slapped cheek - none

47
Q

What is the advice about returning to school with following conditions?

Diarrhoeal disease including E.coli, salmonella, shigella, cryptosporidium

A

Return 48 hours after last episode of diarrhoea/ vomiting

48
Q

What is the advice about returning to school with following conditions?

Influenza

TB

Whooping cough

A

Influenza - once recovered

TB - individualised approach

Whooping cough - 48 hours after starting treatment, or 21 days after symptoms started

49
Q

What is the advice about returning to school with following conditions?

Mumps

Meningitis - bacterial

Glandular fever

HAV

A

Mumps - exclude for 5 days after onset swelling

Meningitis - bacterial - until recovered

Glandular fever - none

HAV - exclude until 7 days after onset of jaundice

50
Q

What is difference between eradication and elimination of disease?

A

Erradication - eliminated worldwide

Elimination - reduced to zero (or small number) of cases in defined geographical area

51
Q

Which diseases have been erradicated?

A

Smallpox - erradicated 1980

Rinderpest - cattle plague erradiacted 2001