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christine teng Flashcards

1
Q

Definition of herd immunity

A

Protect both vaccinated and unvaccinated individuals (e.g babies and immunocompromised) after a percentage of population is vaccinated

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2
Q

Severely immunocompromised patients includes? (3)

A
  • hematologic or solid organ malignancies
  • immunosuppressive meds and chemotherapy
  • HIV with CD4 count < 200 (AIDS)
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3
Q

Precautions for live (attenuated) vaccines (4)

A
  • avoid in pregnant women (risk of fetal infection)
  • usually not given in infancy (<1year) – mother’s antibodies still in circulation, therapeutic effect is reduced
  • severely immunocompromised patients (risk of full blown disease)
  • 2 or more live vaccines either give same day or space at least 4 weeks apart. Affect response of another vaccine
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4
Q

Example of toxoid vaccines

A

Tetanus

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5
Q

Vaccines in National Childhood Immunization
Schedule

A
  • BCG (Bacillus Calmette-Guerin)
  • HepB
  • Diphtheria, tetanus and acellular pertussis (DTaP) [D1,D2,D3,B1]
  • Tetanus, reduced diphtheria and acellular pertussis (Tdap) [B2 for DTaP]
  • Inactivated poliovirus (IPV)
  • H influenzae type b
  • Pneumococcal conjugate (PCV10 or 13)
  • Pneumococcal polysaccharide (PPSV23)
  • Measles, mumps and rubella (MMR)
  • Varicella
  • Human papillomavirus (HPV)
  • Influenza (above 6months, yearly)
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6
Q

Live attenuated vaccines in National Childhood Immunization Schedule (NCIS)

A

BCG, MMR and Varicella

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7
Q

Vaccines in National Adult Immunisation Schedule (NAIS)

A
  • Influenza
  • Pneumococcal conjugate (PCV13) - 1dose (above 65, unless indicated)
  • Pneumococcal polysaccharide (PPSV23)
  • Tdap - 1 dose during each pregnancy
  • HPV (3 dose, if not taken)
  • HepB (3 dose, if not taken)
  • MMR (2 dose, if not taken)
  • Varicella (2 dose, if not taken)
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8
Q

Why is live vaccine not suitable for severely immunocompromised patients?

A

Risk of full blown disease

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9
Q

live-attenuated vaccines contain viruses that have maintained ___________ but lost ____________.

A

antigenicity; pathogenicity

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10
Q

Which live vaccine is given to infants at birth?

A

BCG

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11
Q

Inactivated vaccines contain bacteria or virus that have been ____________________________.

A

heat or chemically inactivated

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12
Q

How do toxoid vaccines work?

A

Give immunity by stimulating antitoxoid antibodies that bind to toxin and neutralise toxic effects

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13
Q

Factors regarding vaccine effectiveness (4)

A
  • effectiveness varying by vaccine (90% vs 95% responder rate)
  • site of administration
  • patient age and immune status
  • cold chain problems
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14
Q

Common side effects

A

Pain, red and swelling at injection site; headache; myalgia

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15
Q

Severe but rare side effects

A

Anaphylaxis, hypersensitivity

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16
Q

Maximum interval between doses

A

No maximum interval.

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17
Q

How to continue an interrupted series?

A

Continue as per normal, resume with dose that is missed. Subsequent dose(s) administered as per usual.

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18
Q

Vaccines that cannot be given in the same day? (3)

A

Pneumococcal conjugate vaccine (PCV)
Pneumococcal polysaccharide vaccine (PPSV)
Meningococcal conjugate vaccine

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19
Q

Why need to inject at separate sites or space at least 2.5cm apart? (2)

A
  • To reduce local reaction from overlapping
  • To know which vaccine causes what reaction
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20
Q

Contraindications and precautions for people taking a vaccine (4)

A
  • Allergy to vaccine or components
  • moderate/severe illness (fever >38degC)
  • bleeding risk (on anti-coagulant or low platelet counts)
  • pregnancy and immunocompromised for live vaccines
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21
Q

How long before trip should pretravel consult take place?

A

4-6weeks

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22
Q

Vector-borne transmission travel vaccine (2)

A

Yellow fever, Japanese encephalitis

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23
Q

Transcutaneous spread travel vaccine (2)

A

Tetanus, Rabies

24
Q

Food and water borne spread travel vaccines (4)

A

Hepatitis A, Typhoid, Cholera, Poliomyelitis

25
Respiratory spread travel vaccines (5)
Influenza, Meningococcus, Diphtheria, Pertussis, MMR
26
Blood and body fluids spread travel vaccine (1)
Hepatitis B
27
References that can be used for travel
Yellow book; CDC travel guide
28
Recommended co-administration of what vaccines for travel?
Yellow fever and measles-containing vaccines
29
What to consider about choice of travel vaccines?
Consider exact itinerary like travel style, type of accommodations, food, activities
30
Oral vaccines (3)
Cholera, Typhoid (live attenuated) Cholera (inactivated)
31
5 strains of Plasmodium (malaria)
- P. falciparum - P. vivax - P. malariae - P. ovale - P. knowlesi
32
Which antimalarial is P. falciparum resistant to?
Chloroquine
33
4 types of antimalarial
- Malarone (Atovaquone, Proguanil) - Chloroquine - Doxycycline - Mefloquine
34
Patients with severe renal impairment (CrCl < 30ml/min) CANNOT take which antimalarial?
Atovaquone + Proguanil (Malarone)
35
Which antimalarial needs to be taken for 4 weeks after return from trip?
Chloroquine, Doxycycline and Mefloquine
36
How long does Malarone have to be taken after return from trip?
7 days
37
Weekly dosing antimalarial?
Chloroquine and Mefloquine
38
Take note of which side effect in mefloquine and respective contraindication?
Neuropsychiatric disorder; contraindicated in patients with history of neuropsychiatric disorders or convulsive disorders (e.g depression, anxiety or schizophrenia)
39
Pregnancy and children safe antimalarial?
Malarone (got paediatric tablet, but not safe for pregnancy) Chloroquine Mefloquine
40
DDI for Mefloquine
Ketoconazole
41
Which antimalarial need to swallow capsule with full glass of water and maintain upright for at least 30mins?
Doxycycline
42
Which antimalarial is not suitable for itinerary with a lot of sun exposure?
Doxycycline
43
DEET as insect repellant ideal concentration:
20-50% provide 6-12h of protection; >50% does not offer more protection duration
44
Picaridin ideal concentration:
at least 20%
45
Non pharmacotherapy advise for malaria (6)
- avoid exposure by staying indoors (especially dusk to dawn) - wear clothing that exposes as little skin as possible - wear light-coloured clothing - sleep under permethrin-impregnated bed net - sleep in sealed, air-conditioned room or screened windows with fan - use insect repellent
46
Exclusion from blood donation for how long?
4 months after return
47
Possible dormancy for 2 strains of Plasmodium in liver cells?
P. vivax and P. ovale. Check for symptoms of malaria for up to 1 year.
48
ABCDE Prevention strategies for malaria
Awareness of risk, possible delayed onset and main symptoms Bite prevention Chemoprophylaxis Diagnosis - early recognition seek treatment Environments - keep away from breeding areas
49
DDI for Malarone (Atovaquone + Proguanil)
Rifampicin, metoclopramide and efavirenz
50
DDI for chloroquine
QT-prolonging strong CYP3A4 inhibitors (e.g clarithromycin, voriconazole)
51
Travel vaccine to recommend when patient is going to Hajj or Umrah (pilgrimage)
Vaccine for meningitis (Meningococcal Vaccine)
52
Travel vaccine to recommend for travellers going to places with mass gathering, on plane/ship/bus, tropical countries
Influenza
53
Since rabies vaccine is expensive and hard to get, what counselling advice should be given to patient?
Avoid animals during the trip, especially wild animals.
54
If patient does not want to get a typhoid vaccine, what counselling advice should be given?
Try to get clean supplies for food and water, have warm food
55
Japanese encephalitis vaccine is rare and difficult to get. For what type of travellers is this vaccine recommended for?
Travellers who have longer trip or spending longer periods of time in areas with Japanese encephalitis

PR3151 (7 decks)

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