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infection > Immunisation and Prophylaxis > Flashcards

Immunisation and Prophylaxis Flashcards

1
Q

When is immunisation currently recommended?

A

Childhood schedule
Special patient groups
Occupational
Travellers

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2
Q

When is prophylaxis recommended?

A

Travellers
Post-exposure
Post-exposure HIV
Surgical

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3
Q

How does active immunisation work?

A

Antigen stimulates the immune espouse which provides long-term immunity
Relies on immunological memory

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4
Q

Does active immunisation produce an immediate effect?

A

No immediate effect - but faster and better response to next antigenic encounter

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5
Q

Vaccine types

A

Live attenuated
Killed/inactivated
Detoxified exotoxin
Subunit

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6
Q

Examples of live attenuated vaccines

A 
Measles 
Mumps 
Rubella 
Polio
BCG 
Varicella Zoster virus 
Yellow fever 
Typhoid
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7
Q

How do live attenuated vaccines work?

A

Attenuation of pathogenic organism by repeated passage in cell culture or non-human host
Usually promotes a full long-lasting antibody response after one or two doses

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8
Q

Contraindications for live attenuated vaccines

A

Pregnancy

Immunocompromised

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9
Q

Why might the storage of live attenuated vaccines be difficult in developing countries?

A

They require refrigeration until administration

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10
Q

Examples of inactivated/killed whole cell vaccines

A 
Pertussis 
Polio 
Influenza 
Hepatitis A 
Cholera 
Rabies 
Japanese encephalitis 
Tick borne encephalitis 
Smallpox
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11
Q

How do inactivated/killed whole cell vaccines work?

A

Pathogenic organism inactivated by chemical inactivation, usually with formaldehyde
Promote weaker immune responses in comparison to live vaccines

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12
Q

Possible side effects of inactivated vaccines

A

Inflammatory responses against other proteins and antigens contained within the vaccine

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13
Q

Examples of detoxified exotoxin vaccines

A

Tetanus

Diphtheria

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14
Q

How do detoxified exotoxin vaccines work?

A

Toxin treated with formalin
Toxoid retains the antigenicity but has no toxic activity
Only induces immunity against the toxin, not the organism that produces it

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15
Q

Examples of subunit vaccines

A 
Pertussis - acellular 
Haemophilus influenzae type B 
Meningococcus groups A, C, W and Y 
Pneumococcus 
Hepatitis B 
Typhoid 
Anthrax
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16
Q

Benefits of subunit vaccines

A

Safe to use as there is no infectious agent and they are highly purified
Easy to produce large amounts

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17
Q

Disadvantage of subunit vaccines

A

Increased purity leads to loss of immunogenicity - may need an adjuvant

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18
Q

Example of recombinant vaccine

A

Hepatitis B surface antigen for HBV vaccination

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19
Q

How are recombinant vaccines prepared?

A

Gene encoding the antigen is excised from the organism’s nucleic acid, purified and mixed with plasmids
Gene is then inserted into yeast chromosome which grows in culture to produce the antigen

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20
Q

Immunisation schedule for 2 months old

A 
Diphtheria 
Tetanus 
Bordetella pertussis
Polio 
Haemophilus influenzae B
Pneumococcal conjugate
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21
Q

Immunisation schedule for 3 months old

A 
Diphtheria 
Tetanus 
Bordetella pertussis 
Haemophilus influenzae B 
Men C
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22
Q

Immunisation schedule for 4 months old

A 
Diphtheria 
Tetanus 
Bordetella pertussis 
Haemophilus influenzae B
Men C 
Pneumococcal conjugate
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23
Q

Immunisation schedule for 1 year old

A 
Haemophilus influenzae B 
Men C 
MMR 
Pneumococcal conjugate 
Men B
24
Q

Immunisation shcedule for 2, 3 and 4 years old

A

Influenza

25
Q

Immunisation schedule for 3-5 years old

A

4-in-1 booster DTaP, IPV

MMR

26
Q

Immunisation schedule for 12-13 year old girls

A

Human papilloma virus

27
Q

Immunisation schedule for 14 years old

A

3-in-1 booster DT, IPV and men ACWY

28
Q

What is herd immunity?

A

Vaccinated individuals less likely to be a source of infection to others
This reduces the risk of un-vaccinated individuals being exposed to infection
Individuals who cannot be vaccinated therefore still benefit from routine vaccination

29
Q

At what age are infants vaccinated with the new rotavirus vaccine and what protection does it offer?

A

Babies at 2 and 3 months

90% protection

30
Q

Immunisation recommended for special patient and occupational groups

A 
BCG 
Influenza 
Pneumococcal 
Hepatitis B 
Varicella-zoster
31
Q

Who is the BCG vaccination still given to?

A 
Some infants (0-12 months) from areas of the UK with an annual incidence of 40 or more per 100,000
or 
with parents/grandparents born in a country with an annual incidence of TB of 40 or more per 100,000

Children screened at school for TB risk factors if appropriate

New immigrants, previously unvaccinated, from high prevalence countries

Contacts of respiratory TB patients

Healthcare workers

32
Q

Example of the patient groups recommended to get the influenza vaccination

A 
Nursing home residents
Healthcare workers 
Immunodeficiency 
Immunosuppression 
Asplenia/hyposplenism
Chronic liver, renal, cardiac or lung disease 
Diabetes mellitus
Pregnant women 
Coeliac disease 
Age > 65
33
Q

In what adult groups is pneumococcal polysaccharide vaccine recommended?

A 
Immunosuppression
Immunodeficiency 
Asplenism/hyposplenism
Sickle cell disease 
Chronic liver, renal, cardiac or lung disease
Diabetes mellitus
Coeliac disease
34
Q

In what patient groups is hepatitis B vaccination given?

A 
Children at high risk of exposure to HBV 
Babies born to infected mothers 
Healthcare workers 
IVDA 
Men who have sex with men 
Prisoners 
Chronic liver or kidney disease
35
Q

In what patient groups is varicella vaccination (chickenpox) given?

A

Patients who have a suppressed immune system
Children in contact with those at risk of severe VZV
Healthcare workers if sero-negative and in contact with patients

36
Q

Dosage of varicella vaccine

A

Aged 1-12 years - 1 dose

Aged 13 or older - 2 doses, 4-8 weeks apart

37
Q

In what patient group is the herpes zoster vaccination given?

A

All elderly patients, 70+

38
Q

Use of human normal immunoglobulin

A

Contains antibodies against hepatitis A, rubella, measles
Used in immunoglobulin deficiencies
Treatment of some autoimmune disorders

39
Q

Examples of disease-specific immunoglobulin

A 
Hepatitis B Ig
Rabies Ig
Tetanus anti-toxin Ig
Varicella Ig
Diphtheria anti-toxin
Botulinum anti-toxin
40
Q

Examples of agents used in passive immunisation

A

Human normal immunoglobulin
Human specific immunoglobulin
Diphtheria anti-toxin
Tetanus anti-toxin

41
Q

Examples of natural passive immunisation

A 
Placental transfer of IgG 
Colostral transfer of IgA 
Human normal immunoglobulin 
Human specific immunoglobulin 
Disease-specific immunoglobulin
42
Q

Examples of artificial passive immunisation

A

Treatment with immunoglobulin

Immune cells

43
Q

Advantages of passive immunisation

A

Gives immediate protection

44
Q

Disadvantages of passive immunisation

A

Short-term effect
Serum sickness
Graft vs host disease

45
Q

Possible contraindications of vaccination

A

Febrile illness
Pregnancy
Allergy
Immunocompromised

46
Q

Risk assessment of the traveller

A 
Health of traveller 
Previous immunisation and prophylaxis 
Area to be visited 
Duration of visit 
Accommodation 
Activities 
Remote areas 
Recent outbreaks
47
Q

General measures to be advised when travelling

A 
Care with food/water
Hand washing 
Sunburn/sunstroke 
Altitude
RTAs
Safe sex
Mosquitoes
48
Q

Common immunisation for travellers

A 
Tetanus 
Polio 
Typhoid
Hepatitis A 
Yellow fever
Cholera
49
Q

Immunisations for travellers in specialised circumstances

A 
Meningococcus ACWY 
Rabies 
Diphtheria 
Japanese B encephalitis 
Tick borne encephalitis
50
Q

Prophylaxis options

A

Chemoprophylaxis against malaria
Post-exposure prophylaxis
HIV post-exposure prophylaxis
Surgical antibiotic prophylaxis

51
Q

ABCD of malaria prevention

A

A - awareness of risk
B - bite prevention
C - chemoprophylaxis
D - diagnosis and treatment

52
Q

Bite prevention advice

A

Cover up at dawn and dusk
Insect repellent sprays/lotions
Mosquito coils
Permethrin-impregnated mosquito nets

53
Q

Chemoprophylaxis for malaria

A

Malarone daily
Mefloquine weekly
Doxycycline daily
Chloroquine weekly and proquanil daily for vivax, ovale and malariae

54
Q

Contraindications for mefloquine use

A

History of psychosis or epilepsy

Side effects of psychosis and nightmares

55
Q

Malaria advice to travellers on return

A

Any illness occurring within 1 year, and especially within 3 months, of return might be malaria
Patients should seek medical attention if they become ill, particularly within the 3 months

infection (14 decks)

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