Immunisation

Question 1

What are the types of immunisation?

Answer 1

• Active: give them Ag and make them develop immune response
• Passive: give them Ig

Question 2

Explain ‘herd immunity’.

Answer 2

Resistance to a pathogen occurs in a population if enough people are immune to a disease: when < 90% of population vaccinated, disease will reappear

Question 3

Give some reasons anti-vaxxers have for not immunising.

Answer 3

• Family history of previous problems
• Autism - linked with MMR
• Unnatural
• Additives
• See no need in Australia as diseases are uncommon
• Concern of too many vaccines in child’s immune system

Question 4

What are some common and rare side effects of vaccination?

Answer 4

Common
• Local: swelling, pain, redness
• Systemic: Mild Fever, irritability, crying, drowsiness, muscle aches

Rare
• Hypotonic hypo-responsive episode (essentially a vaso-vagal)
- Convulsion or pale limp and unresponsive baby
• Anaphylaxis
- 1 in 1,000,000

Question 5

What are some side effects specific to the following viruses:

• MMR
• varicella
• rotavirus

Answer 5

• MMR: not uncommon - 1 in 10 kids will get fever and maculopapular rash 1 week later (incubation period) -
• Varicella: unusual, but can get vesicles at site
• Rotavirus: diarrhoea, vomiting and more rare - intussusception

Question 6

Absolute contraindications for vaccines

Answer 6

• Unexplained encephalopathy (post pertussis containing vaccine)
• Anaphylaxis to component of vaccine
• Live vaccines
  
  • Immunosuppression/compromised e.g. asplenia, post-transplant, HIV
    
    • Wait 6 months post-chemo
  • Pregnancy
  • Previous live vaccine or Immunoglobulin

Question 7

Relative contraindications for vaccines

Answer 7

• Evolving (undiagnosed) neurological illness

- Temperature >38.5. Children with minor coughs and colds can be safely immunized.

Question 8

Briefly outline how you might counsel a parent about vaccines.

Answer 8

• Acknowledge concerns
• Clarify fears
• explain against fears
• explain why vax needed:
• “Herd immunity”
• Explain diseases immunized against
  • Possible risks in Australia, particularly for younger infants
• Risk increased if travelling
• explain CIs

Question 9

Outline the normal child vaccination program.

Answer 9

• birth: hep B
• 2, 4, 6 months: hep B, rotavirus, pneumococcal, HiB, DTPa, polio
• 12 months: MMR and meningococcal C
• 18 months: MMRV and DTPa
• 4 years: DTPa, polio

Question 10

Outline the school vaccination program.

Answer 10

• Year 7 (or age equivalent) vaccination program in Vic:
  
  • dTp (1 dose)
  • HPV i.e. gardasil (3 doses) - all genders
  • Varicella (1 dose)

Question 11

What extra vaccinations are recommended for the elderly?

Answer 11

> 65yo:

• influenza every year
• pneumococcus
• zostavax free 70-79yo

Question 12

Outline extra vaccinations ATSI individuals might have.

Answer 12

• BCG if neonate in high risk area
• pneumococcus: 12-18 mo in high risk area
• hepatitis A: 12-24mo in high risk area
• influenza: 15 yo and over
• pneumococcus: 15yo and over, esp. 50yo and over

Question 13

What extra vax do at risk (non-ATSI) individuals need?

Answer 13

• > 6mo: influenza
• 12mo: pneumococcus 13v, hep B
• 4 yo: pneumococcus 23v