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Infection > Immunisation and Prophylaxis > Flashcards

Immunisation and Prophylaxis Flashcards

1
Q

Please see diagram explaining immunity:

A
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2
Q

What are the different types of vaccines available?

A
  • live attenuated
  • inactivated (killed)
  • detoxified exotoxin
  • subunit of micro-organism
    • purified microbial products
    • recombinant
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3
Q

For which pathologies do we use live attenuated vaccines?

A
  • Measles, mumps, rubella (MMR)
  • BCG
  • Varicella-zoster virus
  • Yellow fever
  • Smallpox
  • Typhoid (oral)
  • Polio (oral)
  • Rotavirus (oral)
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4
Q

For which infections do we use inactivated (killed vaccines)?

A
  • Polio (in combined vaccine D/T/P/Hib)
  • Hepatitis A
  • Cholera (oral)
  • Rabies
  • Japanese encephalitis
  • Tick-borne encephalitis
  • Influenza
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5
Q

How do Detoxified exotoxin vaccines work?

A

Toxin - treat with formalin = toxoid (for dipheria and tetanus)

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6
Q

Name some common subunit vaccines:

A
  • Pertussis (acellular)
  • Haemophilus influenzae type b
  • Meningococcus (group C) conjugated: capsular polysaccharide antigen & Corynebacterium diphtheria protein
  • Pneumococcus
  • Typhoid
  • Anthrax
  • Hepatitis B
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7
Q

How are recombinant vaccines created?

A
  1. DNA segment coding for HBsAg
  2. removed, purified, mixed with plasmids
  3. inserted into yeasts
  4. fermented
  5. HBsAg produced
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8
Q

Please explain how immunology memory works:

A
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9
Q

What are the differences between killed and live vaccines?

A
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10
Q

What is contained within the “6 in 1” vaccine: Infanrix hexa?

A
  • 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
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11
Q

What is the UK Childhood Immunisation Schedule (1)?

A
  • 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
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12
Q

What is the UK Childhood Immunisation Schedule (2)?

A
  • 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
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13
Q

What pathologies are immunised against for special groups and occupations?

A
  • BCG
  • influenza
  • pneumococcal
  • hepatitis B
  • varicella-zoster (chickenpox)
  • herpes-zoster (shingles)
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14
Q

Who gets the BCG vaccine?

A
  • 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
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15
Q

What are indications for influenza vaccination?

A
  • 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
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16
Q

What are the two pneumococcal vaccines?

A
  • 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
17
Q

Who gets Hep B vaccination?

A
  • 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
18
Q

Who gets varicella-zoster (chickenpox)
vaccine?

A
  • 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
19
Q

Who gets the shingles vaccine?

A
  • All elderly patients (70-80 years)
  • Zostavax
  • Live attenuated virus
20
Q

When is Human normal immunoglobulin used?

A
  • contains antibodies against hepatitis A, rubella, measles
  • used in immunoglobulin deficiencies
  • treatment of some autoimmune disorders, e.g. myasthenia gravis
21
Q

Which diseases require Disease specific immunoglobulin post-exposure?

A
  • hepatitis B Ig
  • rabies Ig
  • tetanus anti-toxin Ig
  • varicella (chickenpox) Ig
  • diphtheria anti-toxin Ig (horse)
  • botulinum anti-toxin Ig
22
Q

What is included in a risk assessment for a traveler?

A
  • Health of Traveller
  • Previous immunisation and prophylaxis
  • Area to be visited
  • Duration of visit
  • Accommodation
  • Activities
  • Remote areas
  • Recent outbreaks
23
Q

Where can we acquire info about immunisation for travelers?

A
  • 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
24
Q

What general measures do we advise travelers?

A
  • Care with food/water
  • Hand washing
  • Sunburn / Sunstroke
  • Altitude
  • Road traffic accidents
  • Safer sex
  • Mosquitoes - bed nets, sprays, “cover up”
25
Q

What are common immunisations for travelers?

A
  • Tetanus
  • Polio
  • Typhoid
  • Hepatitis A
  • Yellow fever
  • Cholera
26
Q

What are immunisations for travelers in special circumstances?

A
  • Meningococcus A, C, W, Y
  • Rabies
  • Diphtheria
  • Japanese B encephalitis
  • Tick borne encephalitis
27
Q

What are common uses of prophylaxis?

A
  • 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

28
Q

What is the ABCD of Malaria Prevention?

A
  • Awareness of risk
  • Bite prevention
  • Chemoprophylaxis
  • Diagnosis and treatment
29
Q

Elaborate on bite protection for malaria?

A
  • Cover-up at dawn and dusk
  • Insect repellent sprays, lotions (DEET)
  • Mosquito coils
  • Permethrin-impregnated mosquito nets
30
Q

Explain the chemoprophylaxis for malaria:

A
  • 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
31
Q

What malaria advice do we give returning travelers?

A
  • 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

Infection (12 decks)

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