Immunisation and Prophylaxis Flashcards
Please see diagram explaining immunity:
What are the different types of vaccines available?
- live attenuated
- inactivated (killed)
- detoxified exotoxin
- subunit of micro-organism
- purified microbial products
- recombinant
For which pathologies do we use live attenuated vaccines?
- Measles, mumps, rubella (MMR)
- BCG
- Varicella-zoster virus
- Yellow fever
- Smallpox
- Typhoid (oral)
- Polio (oral)
- Rotavirus (oral)
For which infections do we use inactivated (killed vaccines)?
- Polio (in combined vaccine D/T/P/Hib)
- Hepatitis A
- Cholera (oral)
- Rabies
- Japanese encephalitis
- Tick-borne encephalitis
- Influenza
How do Detoxified exotoxin vaccines work?
Toxin - treat with formalin = toxoid (for dipheria and tetanus)
Name some common subunit vaccines:
- Pertussis (acellular)
- Haemophilus influenzae type b
- Meningococcus (group C) conjugated: capsular polysaccharide antigen & Corynebacterium diphtheria protein
- Pneumococcus
- Typhoid
- Anthrax
- Hepatitis B
How are recombinant vaccines created?
- DNA segment coding for HBsAg
- removed, purified, mixed with plasmids
- inserted into yeasts
- fermented
- HBsAg produced
Please explain how immunology memory works:
What are the differences between killed and live vaccines?
What is contained within the “6 in 1” vaccine: Infanrix hexa?
- 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 (1)?
- 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
What is the UK Childhood Immunisation Schedule (2)?
- 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 pathologies are immunised against for special groups and occupations?
- BCG
- influenza
- pneumococcal
- hepatitis B
- varicella-zoster (chickenpox)
- herpes-zoster (shingles)
Who gets the BCG vaccine?
- Some infants (0-12 months)
- areas of UK with annual incidence of TB >40/100,000
- Parents/grandparents born in a country with annual incidence of TB >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
- Contacts (<35yrs) of resp TB patients
- Healthcare workers
What are indications for influenza vaccination?
- 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
What are the two pneumococcal vaccines?
- pneumococcal conjugate polysaccharide vaccine (13 serotypes): Prevenar13®
- Part of childhood immunisation schedule
- 3 doses
- pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®
- for those at increased risk of pneumococcal infection
- single dose
Who gets Hep B vaccination?
- All new born children from 2018 (6-in-1)
- Children at high risk of exposure to HBV
- Health care workers, PWID, MSM, prisoners, ch. liver disease, ch. kidney disease,
- Given at 0, 1 month, 2 months and 1 year
Who gets varicella-zoster (chickenpox)
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 the shingles vaccine?
- All elderly patients (70-80 years)
- Zostavax
- Live attenuated virus
When is Human normal immunoglobulin used?
- contains antibodies against hepatitis A, rubella, measles
- used in immunoglobulin deficiencies
- treatment of some autoimmune disorders, e.g. myasthenia gravis
Which diseases require Disease specific immunoglobulin post-exposure?
- hepatitis B Ig
- rabies Ig
- tetanus anti-toxin Ig
- varicella (chickenpox) Ig
- diphtheria anti-toxin Ig (horse)
- botulinum anti-toxin Ig
What is included in a risk assessment for a traveler?
- Health of Traveller
- Previous immunisation and prophylaxis
- Area to be visited
- Duration of visit
- Accommodation
- Activities
- Remote areas
- Recent outbreaks
Where can we acquire info about immunisation for travelers?
- Bitish National Formulary (BNF)
- “Immunization Against Infectious Diseases” (Green Book)
- Internet
- www.travax.scot.nhs.uk (registration required)
- www.fitfortravel.scot.nhs.uk/
- www.cdc.org
- Schools of Tropical Medicine - telephone advice
What general measures do we advise travelers?
- Care with food/water
- Hand washing
- Sunburn / Sunstroke
- Altitude
- Road traffic accidents
- Safer sex
- Mosquitoes - bed nets, sprays, “cover up”
What are common immunisations for travelers?
- Tetanus
- Polio
- Typhoid
- Hepatitis A
- Yellow fever
- Cholera
What are immunisations for travelers in special circumstances?
- Meningococcus A, C, W, Y
- Rabies
- Diphtheria
- Japanese B encephalitis
- Tick borne encephalitis
What are common uses of prophylaxis?
- Chemoprophylaxis against Malaria
- Post-exposure prophylaxis*
- e.g. ciprofloxacin for meningococcal disease
- HIV post-exposure prophylaxis*
- “needle stick” (PEP), sexual intercourse (PEPSI)
- Surgical antibiotic prophylaxis*
- perioperative
*covered elsewhere
What is the ABCD of Malaria Prevention?
- Awareness of risk
- Bite prevention
- Chemoprophylaxis
- Diagnosis and treatment
Elaborate on bite protection for malaria?
- Cover-up at dawn and dusk
- Insect repellent sprays, lotions (DEET)
- Mosquito coils
- Permethrin-impregnated mosquito nets
Explain the chemoprophylaxis for malaria:
- Malarone ® (proquanil & atovaquone) daily
- doxycycline daily
- Not for children <12 years
- photosensivity
- mefloquine weekly
- Side effects: psychosis, nightmares (1:10,000)
- Avoid if history of psychosis, epilepsy
- chloroquine weekly + proquanil daily
- For vivax/ovale/malariae only
What malaria advice do we give returning travelers?
- 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
