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PR3151 > christine teng > Flashcards

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
Q

Respiratory spread travel vaccines (5)

A

Influenza, Meningococcus, Diphtheria, Pertussis, MMR

26
Q

Blood and body fluids spread travel vaccine (1)

A

Hepatitis B

27
Q

References that can be used for travel

A

Yellow book; CDC travel guide

28
Q

Recommended co-administration of what vaccines for travel?

A

Yellow fever and measles-containing vaccines

29
Q

What to consider about choice of travel vaccines?

A

Consider exact itinerary like travel style, type of accommodations, food, activities

30
Q

Oral vaccines (3)

A

Cholera, Typhoid (live attenuated)
Cholera (inactivated)

31
Q

5 strains of Plasmodium (malaria)

A
  • P. falciparum
  • P. vivax
  • P. malariae
  • P. ovale
  • P. knowlesi
32
Q

Which antimalarial is P. falciparum resistant to?

A

Chloroquine

33
Q

4 types of antimalarial

A
  • Malarone (Atovaquone, Proguanil)
  • Chloroquine
  • Doxycycline
  • Mefloquine
34
Q

Patients with severe renal impairment (CrCl < 30ml/min) CANNOT take which antimalarial?

A

Atovaquone + Proguanil (Malarone)

35
Q

Which antimalarial needs to be taken for 4 weeks after return from trip?

A

Chloroquine, Doxycycline and Mefloquine

36
Q

How long does Malarone have to be taken after return from trip?

A

7 days

37
Q

Weekly dosing antimalarial?

A

Chloroquine and Mefloquine

38
Q

Take note of which side effect in mefloquine and respective contraindication?

A

Neuropsychiatric disorder; contraindicated in patients with history of neuropsychiatric disorders or convulsive disorders (e.g depression, anxiety or schizophrenia)

39
Q

Pregnancy and children safe antimalarial?

A

Malarone (got paediatric tablet, but not safe for pregnancy)
Chloroquine
Mefloquine

40
Q

DDI for Mefloquine

A

Ketoconazole

41
Q

Which antimalarial need to swallow capsule with full glass of water and maintain upright for at least 30mins?

A

Doxycycline

42
Q

Which antimalarial is not suitable for itinerary with a lot of sun exposure?

A

Doxycycline

43
Q

DEET as insect repellant ideal concentration:

A

20-50% provide 6-12h of protection; >50% does not offer more protection duration

44
Q

Picaridin ideal concentration:

A

at least 20%

45
Q

Non pharmacotherapy advise for malaria (6)

A
  • 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
Q

Exclusion from blood donation for how long?

A

4 months after return

47
Q

Possible dormancy for 2 strains of Plasmodium in liver cells?

A

P. vivax and P. ovale. Check for symptoms of malaria for up to 1 year.

48
Q

ABCDE Prevention strategies for malaria

A

Awareness of risk, possible delayed onset and main symptoms
Bite prevention
Chemoprophylaxis
Diagnosis - early recognition seek treatment
Environments - keep away from breeding areas

49
Q

DDI for Malarone (Atovaquone + Proguanil)

A

Rifampicin, metoclopramide and efavirenz

50
Q

DDI for chloroquine

A

QT-prolonging strong CYP3A4 inhibitors (e.g clarithromycin, voriconazole)

51
Q

Travel vaccine to recommend when patient is going to Hajj or Umrah (pilgrimage)

A

Vaccine for meningitis (Meningococcal Vaccine)

52
Q

Travel vaccine to recommend for travellers going to places with mass gathering, on plane/ship/bus, tropical countries

A

Influenza

53
Q

Since rabies vaccine is expensive and hard to get, what counselling advice should be given to patient?

A

Avoid animals during the trip, especially wild animals.

54
Q

If patient does not want to get a typhoid vaccine, what counselling advice should be given?

A

Try to get clean supplies for food and water, have warm food

55
Q

Japanese encephalitis vaccine is rare and difficult to get. For what type of travellers is this vaccine recommended for?

A

Travellers who have longer trip or spending longer periods of time in areas with Japanese encephalitis

PR3151 (7 decks)

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