Immunisation and Prophylaxis Flashcards
Who is immunisation given to?
Childhood schedule
Special patient groups
Occupational
Travelers
Who is prophylaxis given to?
Travelers
Post-exposure
Post-exposure - HIV
Surgical
What are the types of immunity?
Adaptive immunity - natural (maternal or infection) or artificial (antibody transfer or immunisation)
Innate immunity - body’s own immune system
What happens to the secondary response to infection?
Immunological memory - antibodies act quicker and more sustained response
What are the different types of vaccines?
Live attenuated
Inactivated (killed)
Detoxified exotoxin
Subunit of micro-organism - purified microbial products and recombinant
What are live attenuated vaccine used against?
Measles, mumps and rubella
BCG, Varicella-zoster virus, yellow fever, smallpox, typhoid, polio and rotavirus
What are inactivated (killed) vaccines used for?
Polio, hepatitis A, cholera, rabies, Japanese encephalitis, tick-borne encephalitis and influenza
How does a detoxified exotoxin vaccine work?
Toxin is rendered inactive
Treat wit formalin to give toxoid
Ex. diphtheria and tetanus
What are subunit vaccines used against?
Pertussis, haemophilus influenzae type b, meningococcus, pneumococcus, typhoid, anthrax and hepatitis B
How is a recombinant vaccine formed - ex. hepatitis B?
DNA segment coding for HBsAg
Removed, purified and mixed with plasmids
Inserted into yeast
Fermented
HBsAg produced
What does the ‘6 in 1’ vaccine - Infanrix hexa involve?
D - purified diphtheria toxoid
T - purified tetanus toxoid
aP - purified Bordetella pertussis
IPV - inactivated polio virus
Hib - purified component of haemophilus influenza B
HBV - hepatitis B rDNA
What ages are the childhood immunisation schedule to immunisations happen?
2 months, 3 months and 4 months
1 year, 2-8 years, 3-5 years
Girls 12-13 years - HPV
14 years
What immunisations are given for special patients and occupational groups?
BCG, influenza, pneumococcal, hepatitis B, varicella-zoster and herpes-zoster
Who is the BCG vaccine given to?
Some infants
Children screened at school for TB risk factors
New immigrants from high prevalence TB countries
Contacts of resp. TB patients
Healthcare workers
What are the indications for influenza vaccine?
Age over 65, nursing home residents, health care workers, immunosuppression, asplenia, CLD, CD, chronic renal and lung disease, DM, coeliac disease and pregnant women
Describe the influenza vaccine
New vaccine each year
Single dose - caution in egg allergy
Influenza A and B constantly change antigenic structure
What are the 2 pneumococcal vaccines?
Pneumococcal conjugate polysaccharide vaccine - part of childhood immunisation schedule and 3 doses
Pneumococcal polysaccharide vaccine - if increased risk and single dose
What are the indications for pneumococcal polysaccharide vaccine?
Immunosuppression, asplenia, sickle cell anaemia, chronic lung, renal, cardiac and liver disease, DM and coeliac disease
When is the hepatitis B vaccine given?
All new born children from 2018
Children at high risk exposure to HBV
Health care workers, PWID, MSM, prisoners, CLD, CKD
Given at 1,2 months and 1 year
When is the Varicella-zoster vaccine given?
Patients with suppressed immune system
Children if in contact with severe VZV
Health care workers
Live attenuated virus
2 doses and 4-8 weeks apart
When is herpes-zoster vaccine given?
All elderly patients (70-80 years)
Zostavax
Live attenuated virus
What are the 2 types of passive immunisation?
Human normal immunoglobulin
Disease specific immunoglobulin
Describe human normal immunoglobulin
Contains antibodies against hep A, rubella and measles
Used in immunoglobulin deficiencies
Treatment of some autoimmune disorders
What are some disease specific immunoglobulins?
Hep B, rabies, tetanus anti-toxin, varicella zoster, diphtheria and botulinum Ig
What is the risk assessment for prophylaxis for travel?
Health of traveller, previous immunisation, area to be visited, duration, accommodation, activities, remote areas and recent outbreaks
What are the sources of info for travel and prophylaxis?
British national formulary (BNF)
Green book - immunisation against infectious diseases
What are the general measures for travel?
Care with food/ water, hand washing, sunburn, altitude, RTA, safer sex and mosquitoes
What are common immunisations for travellers?
Tetanus, polio, typhoid, hepatitis A, yellow fever and cholera
What are some immunisations for travellers in special circumstances?
Meningococcus A, C, W and Y
Rabies
Diphtheria
Japanese B encephalitis
Tick borne encephalitis
When is prophylaxis used?
Chemoprophylaxis against Malaria
Post-exposure prophylaxis
HIV post-exposure prophylaxis
Surgical antibiotics prophylaxis
What is the ABCD of Malaria prevention?
Awareness of risk
Bite prevention
Chemoprophylaxis
Diagnosis and Treatment
What is involved in bite prevention for Malaria?
Cover up at dawn and dusk
Insect repellent sprays and lotions
Mosquito coils
Permethrin impregnated mosquito nets
Describe chemoprophylaxis against Malaria
Malarone daily - most popular
Doxycycline daily
Mefloquine weekly
Chloroquine weekly and Propuanil daily
What is the Malaria advice to traveller on return?
Any illness occurring within 1 year esp. 3 months of return might be Malaria
Patients should seek medical attention
