Immunisation Flashcards
Who gets immunisation?
- Childhood schedule
- Special patient groups
- Occupational
- Travelers
Who gets prophylaxis?
- Travelers
- Post-exposure
- Post-exposure (HIV)
- Surgical
What are the two forms of immunity?
Adaptive and innate
What are the two forms of adaptive immunity?
Natural and artificial
What are the passive and active forms of natural and artifical immunity?
How did edward jenner discover the smallpox vaccination?
He noticed that people who suffered mild disease of cowpox never contracted smallpox
Inserted pus from a cowpox pustule into a boys arm
He proved that the boy having been inoculated with cowpox was now immune to small pox
(1798)
Where can you find out information about vaccinations?
Green book
BNF
What are the different types of vaccines?
- live attenuated
- inactivated (killed)
- detoxified exotoxin
- subunit of micro-organism
–purified microbial products
–recombinant
Give examples of live attenuated vaccines
MMR
BCG
Varicella-zoster virus
What are examples of inactivated (killed) vaccines
Polio
Hep A
Cholera
Rabies
Give exmamples of detoxified exotoxin vaccines
Diptheria
Tetanus
Give examples of subunit vaccines
Pertussis
Hamophilus infulenzae type b
Typhoid
Pneumococcus
Hep B
How is the recombinant hep B vaccine made?
The DNA segment coding for HBsAg is removed purified and mixed with plasmids
The plasmids are inserted into yeasts
Yeasts are fermeted
HBsAg is produced
What is the primary antibody response to infection?
Increase in total Ab
Early increase in IgM
Later increase in IgG
How does dosing differ between killed vaccine and live vaccine?
Killed vaccine requires multiple doses
Live vaccine - 1 dose
What is within the infranrix hexa vaccine?
- D = purified diphtheria toxoid
- T = purified tetanus toxoid
- aP = purified Bordetella pertussis
- IPV= inactivated polio virus
- Hib= purified component of Haemophilus influenzae b
- HBV= hepatitis B rDNA
What is the UK childhood immunisation schedule?
- 2 months: 6-in-1 vaccine + pneumococcal conjugate + rotavirus + Men B
- 3 months: 6-in-1 vaccine + rotavirus
- 4 months: 6-in-1 vaccine + pneumococcal conjugate + Men B
- 1 year: Hib/Men C+ MMR + pneumococcal conjugate + men B
- 2 -8 years: influenza nasal
- 3 - 5 years: 4-in-1 booster (DTaP/IPV) + MMR
- Girls, 12-13 yrs: Human papilloma virus
- 14 years: 3-in-1 booster (dT/IPV) + Men ACWY
What other demographic may be offered the HPV virus?
Gay men
What is the greatest reservoir of influenza?
Children - giving children influenza nasal spray at ages of 2-8 is trying to eliminate the risk of a pandemic
What immunisations are offered to special patient and occupational groups?
- BCG
- influenza
- pneumococcal
- hepatitis B
- varicella-zoster (chickenpox)
- herpes-zoster (shingles)
Who is offered BCG vaccine?
Some infants (0-12 months) - in areas of high TB incidence, if parents or grandparents are born in a country with annual incidence of TB greater than 40/100,000
- Children screened at school for TB risk factors, tested and vaccinated if appropriate
- New immigrants (previously unvaccinated) from high prevalence countries for TB – may be offered BCG
- Contacts (<35yrs) of resp TB patients
- Healthcare workers
Describe the influenza vaccine
Influenza A and B constantly change (haemaglutinins and neuraminidases)
New vaccine each year
Single dose
Caution in egg allergy
What are the indications for influenza vaccine?
- Age >65 years
- Nursing home residents
- Some health care workers
- Immunodeficiency,
- Immunosuppression
- Asplenia/hyposplenism
- Chronic liver disease
- Chronic renal disease
- Chronic cardiac disease
- Chronic lung disease
- Diabetes mellitus
- Coeliac disease
- Pregnant women
- Heath care workers
Who is given the pneumococcal conjugate polysaccharide vaccine?
Part of childhood immunisation schedule
3 doses
Who is given the pneumococcal polysaccharide vaccine?
Those with increased risk of pneumococcal infection
Indications
Immunodeficiency
Immunosuppression
Asplenia/hyposplenism
Sickle cell disease
Chronic liver disease
Chronic renal disease
Chronic cardiac disease
Chronic lung disease
Diabetes mellitus
Coeliac disease
Who gets the Hep B vaccination?
- All new born children from 2018 (6-in-1)
- Children at high risk of exposure to HBV
- Health care workers, PWID (people who inject drugs), MSM, prisoners, ch. liver disease, ch. kidney disease,
- Given at 0, 1 month, 2 months and 1 year
Who is given varicella zoster vaccine?
- patients who have a suppressed immune systems, for example having cancer treatment or organ transplant
- children if in contact with those at risk of severe vzv
- Health case workers (if sero-neg and in contact with patients)
- Live attenuated virus
- 2 doses, 4-8 weeks apart
Who gets herpes-zoser vaccine?
All elderly patients - 70-80 years
zostavax - live attenuated virus
What is human normal immunoglobulin?
–contains antibodies against hepatitis A, rubella, measles
–used in immunoglobulin deficiencies
treatment of some autoimmune disorders, e.g. myasthenia gravis
What post exposure diseases require immunoglobulins?
- hepatitis B Ig
- rabies Ig
- tetanus anti-toxin Ig
- varicella (chickenpox) Ig
- diphtheria anti-toxin Ig (horse)
- botulinum anti-toxin Ig
What are sources of information for travellers seeking vaccinations?
BNF
Immunization against infectious diseases (green book)
Internet
General measures for travellers
- Care with food/water
- Hand washing
- Sunburn / Sunstroke
- Altitude
- Road traffic accidents
- Safer sex
- Mosquitoes - bed nets, sprays, “cover up”
What are the common immunisations for travellers?
- Tetanus
- Polio
- Typhoid
- Hepatitis A
- Yellow fever
- Cholera
What are immunisations for travelers in special circumstances?
Meningococcus A, C, W, Y
Rabies
Diptheria
Japanese B encephalitis
Tick borne encephalitis
When might prophylaxis be indicated?
Chemoprophylaxis against malaria
Post-exposure prophylaxis (ciprofloxacin for meningococcal disease)
HIV post-exposure prophylaxis (needle stick)
Surgical antibiotic prophylaxis (perioperative)
What is malaria prevention?
ABCD
Awareness of risk
Bite prevention
Chemoprophylaxis
Diagnosis and treatment
How do you prevent bites?
Cover-up at dawn and dusk
Insect repellant sprays, lotions (DEET)
Mosquito coils
Permethrin-impregnated mosquito nets
What are the available chemoprophylaxis measures against malaria?
Malarone
Doxycycline
Melfloquine (SE include psychosis, nightmares. Avoid if there is a history of psychosis or epilepsey)
Chloroquine weekly and proquanil daily
What is malaria advice for travellers on return?
- Any illness occurring within 1 year and especially within 3 months of return might be malaria
- Patients should seek medical attention if become they ill particularly within 3 months and mention malaria risk
