Childhood immunisations Flashcards
1
Q
Vaccine
Common indications
A
- Childhood vaccines are routinely offered to all children as part of the childhood immunisation schedule
- Influenza vaccine is offered annually in at-risk groups including people aged over 6 months with chronic respiratory, heart, liver, renal or neurological disease, diabetes, immunosuppression or HIV
- Pneumococcal vaccine forms part of the childhood immunisation schedule. It is also offered for once-only administration in at-risk groups. These are similar to the at-risk groups for influenza vaccine, but with addition of patients aged over 65 years and those with other risk factors for pneumococcal disease
2
Q
Vaccine
MOA
A
- Vaccination involves administration of an Ag to incite an adaptive immune response and generate an immune ‘memory’, usually in the form of memory B cells
- This facilitates a more rapid and specific immune response on re-exposure to the Ag, attenuating the severity of the infection and often rendering it subclinical
- The Ag in vaccines may be provided as an inactivated form of the infectious agent (influenza); a live but attenuated form of the infectious agent (e.g. MMR); specific protein or peptide components of the infectious agent (pneumococcal vaccine); or a detoxified form of the exotoxin that would usually be produced by the infectious agent (tetanus)
3
Q
Vaccine
Important adverse effects
A
- Vaccines are safe. The most common side effects are local reactions: Pain, swelling and redness
- Mild systematic effects: Fever, headache and myalgia
- The MMR vaccine may cause a mild measles-like illness including a rash. And very rarely, vaccines may cause severe hypersensitivity reactions including anaphylaxis
4
Q
Vaccine
Warnings
A
- Mild intercurrent illness usually doesn’t present a barrier to vaccination
- Vaccines are contraindication in patients who have had an anaphylactic reaction to a past dose or to one of its constituents
- Live vaccines are contraindicated in patients with significant immunosuppression, and are usually avoided in pregnancy
5
Q
Vaccine
Important interactions
A
- Immunosuppressive drugs (including corticosteroids) reduce the immune response to (and therefore effectiveness of) vaccines, and may permit generalised infection with live vaccines
6
Q
Vaccine
Prescription
A
- Vaccines administered as part of the childhood immunisation schedule are in effect ‘pre-prescribed’ in the personal child health record, either by a GP or an independent nurse prescriber at the 6-8 week check
- Vaccines administered outside of this schedule (e.g. for adults) generally need to be prescribed individually
- Details are specific for each vaccine product and are provided in the BNF
7
Q
Vaccine
Administration
A
- Most vaccines are given by IM injection
- The usual practice for IM injection applies
- In babies, the injection is generally given into the thigh, while in older children and adults the upper arm is used
- Where more than one vaccination is required, they should ideally be given in different limbs
- The BCG vaccine for tuberculosis is given intradermally, ideally in the region of the insertion of the left deltoid muscle to aid later identification of the scar
8
Q
Vaccine
Communication
A
- Explain to the patient, or as appropriate the child’s parent, the nature and purpose of the vaccine and the likely side effects
- Advise that mild reaction, particularly when they involve fever, can be treated with paracetamol
- Parents are free to refuse vaccinations on behalf of their child, but you should offer reasonable encouragement towards acceptance
- Explain that there is considerable evidence that benefits of vaccinations far outweigh the risk of side effects
9
Q
Vaccine
Monitoring
A
- All individuals who have recieved a vaccine should be monitored for a few minutes in the surgery because of the very small risk of anaphylactic reactions
- Thereafter, the patient or, as appropriate, their parents can monitor and usually self-treat mild reactions
- There is usually no need to monitor the serological response to a vaccine, but this may be indicated in a few circumstances (e.g. HepB)
