Clinical and Public Health Aspects of Immunisation

Question 1

Describe the vaccination programme for babies under 1

Answer 1

Question 2

Describe the vaccination programme for ages 1-15 years

Answer 2

Question 3

Describe the vaccination programme for adults, and why they are offered

Answer 3

HZ incidence and severity dramatically increases after 50 yrs of age

Question 4

Which vaccines are offered to pregnant women?

Answer 4

From Sept 2012 all pregnant women offered pertussis (whooping cough) immunisation.
“Cocooning” – protecting the unborn baby via passive immunity from mother

Question 5

Draw a table to describe the immunisation schedule for at risk children

Answer 5

Question 6

Why do we not give live vaccines to immunocompromised patients?

Answer 6

Immunocomp patients may not mount normal immune response to live vaccines- could suffer severe manifestations e.g. disseminated Tb infection w BCG
Specifically indicated are: pneumococcal vaccine (PCV13 and PPV) and annual flu vaccine
Inactivated vaccines safe but may have reduced efficacy

Question 7

Patients w splenic dysunction are also immunocomp. What is their vaccine schedule?

Answer 7

Patients w no spleen/splenic dysfunction (sickle cell /coeliac) are at more risk from bacterial infections, most commonly caused by encapsulated organisms (spleen breaks down encapsulated organisms)

Pneumococcal vaccine (PCV13 and PPV) and annual flu vaccine are recommended as per general reduced immunity, but in addition: Hib/Men C Men A,C,W,Y & Men B

Question 8

What about immunisation for travel abroad?

Answer 8

Ensure up to date w primary immunisation courses
Some regions: typhoid and hepA if high risk of faecal-oral infection
Consider Hep B for high sero-prevalence areas
yellow fever (live vaccine) for S. America and Sub-Saharan Africa, certificate for entry
Rabies (remote enzootic areas)
Tick borne encephalitis (forested Eastern Europe)
MenACWY for those on Hajj or Umra

Question 9

Describe immunisation for occupational groups

Answer 9

HC and public safety workers: hepatitis B, rubella, tuberculosis and chicken pox (varicella zoster), COVID

Rabies prophylaxis for laboratory workers handling rabies virus and handlers of imported animals

Question 10

What are the contraindications to immunisation?

Answer 10

Question 11

What are the health benefits of vaccines?

Answer 11

Eradication of disease
Induce herd immunity
Reduce morbidity & mortality associated with infectious disease
Prevent cancers
Prevents development of antibiotic resistance
Improvement in health, social and economic

Question 12

Describe the economic and societal vaccine benefits

Answer 12

Question 13

Give some groups at risk of not being fully immunised- you do not need to list all of them

Answer 13

Question 14

What are the 3 models of vaccine hesitancy?

Answer 14

Complacency: risks of vaccine-preventable diseases are low, vaccination not necessary

Confidence in: vaccine effectiveness and safety
The reliability of the system/ services/HCWs
The motivations of policy-makers who decide on the needed vaccines.

Convenience: Physical availability, affordability, geographical accessibility, ability to understand, and appeal of immunisation services.

Question 15

Describe the WHO Behavioural and Social Drivers of Vaccination Increasing Vaccination Model

Answer 15

Question 16

How must a HCW address vaccine concerns?

Answer 16

Avoid technical jargon
Explain risks
Do not overstate vaccine safety
Be honest if you don’t know, signpost to accurate resources
Reinforce importance of community protection
Elicit ideas and concerns, use open, non-judgemental questions, empathy

Question 17

What is herd immunity?

Answer 17

The immunity level in a population against a SPECIFIC disease
Needed to prevent infectious disease outbreaks

High herd immunity esp protects vulnerable groups, e.g. immunocomp, neonates, people who can’t tolerate vaccines

Low vaccination= herd immunity falls–> epidemics

Question 18

What is vaccine efficiency vs efficacy?

Answer 18

Efficacy usually refers to trial conditions, while effectiveness is in relation to wider population
BUT used interchangeably
Percentages commonly quoted in media= risk reduction of disease from being vaccinated vs. not = 0.95 or 95%

Question 19

What are some ethical considerations w vaccination?

Answer 19

What is the balance between the benefits of herd immunity for society versus personal choice?
Collective Action vs. Free Riding

How do we ensure equality of access for vaccination? Distributive Justice

Question 20

Should vaccination be legally mandated e.g. in emergencies, for school entry, vaccine passports, health care professionals?
Discuss the ethics of this

Answer 20

Individual vs collective vs institutional responsibility
Informed Consent
Autonomy
Principles of least restrictive alternative: persuasion, Nudging, Incentives, Disincentives, Compulsion