Immunisation

Question 1

What is the primary prevention of disease?

Answer 1

Prevent on sent of disease pre exposure: 
 Childhood immunisation 
Routine vaccines for elderly
Travel vaccines
Occupational vaccines
High risk clinical groups

Question 2

What is secondary prevention?

Answer 2

Alter course of infection/disease to prevent or limit consequences:
Immunoglobulin - hep B, rabies, varicella zoster

Question 3

How do vaccines work?

Answer 3

Teach the immune system to recognise bacteria and viruses before the individual encounters them as potential pathogens so allowing the body to fight against the pathogens

Question 4

What are the immunological mechanisms in vaccinations?

Answer 4

Active immunity
Passive immunity
Herd immunity

Question 5

What is an antigen?

Answer 5

Parts of bacteria and viruses which are recognised by the immune system
Antigens are usually proteins or polysaccharides (sugars)
Immune system generates a response to antigens often by the production of antibodies

Question 6

What is an antibody?

Answer 6

Proteins which binds to antigens
Antibodies are very specific to individual antigens
When an antibody-antigen complex is formed, this alerts other immune cells (lymphocytes: B and T cells)

Question 7

What is a B cell (humoral immune response)?

Answer 7

Triggered to produce antibodies when encountered with a foreign antigen

Question 8

Where are B cells produced?

Answer 8

Bone marrow

Question 9

Where are T cells produced?

Answer 9

Thymus

Question 10

What are the different types of T cells and what do they do?

Answer 10

CD4+ and CD8_

Orchestrate the response of the immune system by binding to other cells and sending out signals

Question 11

How is passive immunity transferred from mother to baby?

Answer 11

Via placenta
Lasts up to one year
Some antigens e.g. measles can pass through but others such as pertissus cannot

Question 12

How can passive immunity be transferred from another person or animal?

Answer 12

Antibodies from blood donors
Human normal Ig
Specific Ig

Question 13

What human Ig can be given via passive immunity?

Answer 13

Hep B
Rabies
Varicella zoster

Question 14

What anti-toxin can be given via passive immunity?

Answer 14

Diphtheria

Botulinum

Question 15

What are the advantages to passive immunity?

Answer 15

Rapid action 
Post-exposure
Can attenuate illness
Outbreak control
Can be used if contraindication to active vaccination

Question 16

What are the disadvantages to passive immunity?

Answer 16

Short term protection 
Short term window
Blood derived
Hypersensitivity reaction 
Expensive

Question 17

What is a live virus vaccine and what are examples of live viruses?

Answer 17

Attenuated organism, replicates in host

OPV, measles, mumps, rubella, varicella, rotavirus, flut

Question 18

What are the different subtypes of inactivated vaccines?

Answer 18

Suspensions of killed organisms
Subunit vaccines
Conjugate vaccines

Question 19

What are examples of suspensions of killed organisms vaccines?

Answer 19

Whole cell pertussis

Whole cell typhoid

Question 20

What are examples of subunit vaccines?

Answer 20

Toxoids - diphtheria toxoid, tetanus toxoid, pertussis toxoid
Polysaccharides - pneumococcal, typhoid

Question 21

What are examples of conjugate vaccines?

Answer 21

Polysaccharide attached to immunogenic proteins e.g Hib MenC

Question 22

What are contraindications to vaccines?

Answer 22

Confirmed anaphylaxis
Egg allergy - flu and yellow fever
Severe latex allergy
Acute or evolving illness - defer till resolved/stabilised

Question 23

What are specific contraindications to live vaccines?

Answer 23

Immunosuppression (primary, radiotherapy, high dose steroids, HIV)

Question 24

What is herd immunity?

Answer 24

Protect unvaccinated individuals, through having sufficiently large proportion of population vaccinated
Vaccinated individuals stop transmission of organism

Question 25

What percentage of the population need to be vaccinated to provide herd immunity for measles?

Answer 25

90%

Question 26

What percentage of the population need to be vaccinated to provide herd immunity for mumps?

Answer 26

75-86%

Question 27

What percentage of the population need to be vaccinated to provide herd immunity for smallpox?

Answer 27

80-85%

Question 28

What is the purpose of the routine vaccine schedule?

Answer 28

To provide early protection against infections that are most dangerous for the very young - whooping cough, pneumococcal, Hib, meningococcal To ensure continued protection by providing subsequent immunisations and booster doses before reaching age when risk increase

Question 29

How is the age chosen when to give certain vaccines?

Answer 29

Based on age-specific risk of disease, risk of complications and ability to respond to the vaccine optimal age chosen for scheduling children may be a compromise between risk of disease and level of protection

Question 30

Currently in scotland, what diseases are offered vaccination from?

Answer 30

``` Diphtheria Rotavirus Meningococcal Hib Hepatitis B Measles Mumps Rubella HPV - cervical cancer Flu Pneumococcal Polio Tetanus Whooping cough ```

Question 31

What is the hexavalent vaccine?

Answer 31

``` Diphtheria Tetanus Pertussis Polio Haemophilus infleunza type b Hepatitis B ```

Question 32

What vaccines are given at 2 months?

Answer 32

Pneumococcal, hexavalent,meningococcal group B, rotavirus

Question 33

What vaccines are given at 3 months?

Answer 33

Hexavalent | Rotavirus

Question 34

What vaccines are given at 4 months?

Answer 34

Hexavalent MenB Pneumococcal

Question 35

What vaccines are given at 12-13 months?

Answer 35

MenB Pneumococcal Hib/MenC MMR

Question 36

What vaccines are given at 3 years 4months - 5 years?

Answer 36

MMR | Diphtheria, tetanus, pertussis and polio booster

Question 37

What vaccine is given between 2-12 years?

Answer 37

Flu

Question 38

What vaccine is given to girls in S1 and S2?

Answer 38

2 doses of HPV

Question 39

What vaccine is given between 13-14 years?

Answer 39

Tetanus, diphtheria and polio booster | Meningococcal groups A, C, W and Y

Question 40

What are the selective childhood vaccines for children in at-risk groups?

Answer 40

Flu (annual) aged 2 or older Pneumococcal polysaccharide vaccine aged 2 or older bCG up to 16 Hep B all ages

Question 41

What adult vaccine programmes are available?

Answer 41

Pneumococcal polysaccharide vaccine - 65 years old Shingles - 70 years old Seasonal flu - over 65s, at-risk groups, pregnant women Hep B Travel Occupational

Question 42

What is a public health notification?

Answer 42

Legal duty of medical practitioners to notify health board on clinical suspicion of specified diseases or a health risk state posing significant public health risk Notification in writing with in 3 days Notification by phone as soon as reasonably practicable if urgent

Question 43

What diseases are to be registered by medical practitioners based on reasonable clinical suspicion and should not await lab confirmation?

Answer 43

``` Anthrax Botulism Brucellosis Cholera E.coli O157 infection Diphtheria HUS Hib Measles Meningococcal disease Mumps Necrotizing fasciitis Paratyphoid Pertussis Plague Poliomyelitis Rabies Rubella SARS Smalpox Tetanus TB Tularemia Typhoid Vrial haemorrhagic fevers West nile fever Yellow fever ```

Question 44

What is the presentation os diphtheria?

Answer 44

URTI characterised by sore throat, low rade fever | White adherent membrane on tonsils, pharynx and/or nasal cavity

Question 45

What causes diphtheria?

Answer 45

Aerobic gram positive bacterium - corynebacterium diphtheriae

Question 46

What causes meningococcal disease?

Answer 46

Invasive infection due to neisseria meningitidis

Question 47

What different infections can meningococcal disease cause?

Answer 47

Meningitis Septicaemia Men and sept

Question 48

How is meningococcal disease spread?

Answer 48

Person to person contact through respiratory droplets of infected people Colonisation of nasopharynx common, important reservoir for disease

Question 49

What is the incubation period of meningococcal?

Answer 49

3-5 days

Question 50

What is the peak ages in meningococcal disease?

Answer 50

Less than 5 years | 15-24 years

Question 51

How are new vaccines investigated?

Answer 51

Phase 1 = is it safe, is it immunogenic Phase 2 = how reactogenic is it, what dose should be used, how does it compare with current vaccines Phase 3 - is it efficacious, are there any rare reactions/ safety issues

Question 52

What is the yellow card scheme?

Answer 52

Passive reporting | Suspected adverse drug reactions

Question 53

What does the uptake of vaccines depend on?

Answer 53

Perception of relative risks and benefits

Question 54

What is the definition of control of a disease?

Answer 54

Reduction of the disease to a locally acceptable level; continued intervention required to maintain reduction e.g. diarrhoeal disease

Question 55

What is the definition of elimination of a disease?

Answer 55

Reduction to zero incidence of specified disease in defined geographical areas; continued intervention measures required e.g. neonatal tetanus

Question 56

What is the definitino of elimination of infections?

Answer 56

Reduction to zero incidence of infection caused by a specific agent in a defined geographical area/ continued measures to prevent re-establishment of transmission required e.g. measles, polio

Question 57

What is the definition of eradication of a disease?

Answer 57

Permanent reduction to zero fo the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed e.g. smallpox, rinderperst

Question 58

What is extinction of a disease?

Answer 58

The specific infectious agent no longer exists in nature of in the lab. There are no examples of this