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
Two types of immunity
Adaptive
Innate
Types of adaptive immunity
Natural - passive (maternal) - active (infection) Artificial - passive (antibody transfer) - active (immunisation)
What type of immunity are you born with?
Innate immunity
What childhood immunisations are given at 2 months?
6 in 1 vaccine
Rotavirus
Men B
Pneumococcal conjugate
What childhood immunisation can be given at 3 months?
6 in 1 vaccine
Rotavirus
What childhood immunisation can be given at 4 months?
6 in 1 vaccine
Pneumoccocal conjugate
Men B
What childhood immunisation can be given at 1 year old?
Hib/Men C
MMR
pneumococcal conjugate
Men B
What childhood immunisation can be given at 2-8 years?
Influenza nasal
What childhood immunisation can be given at 3-5 years?
4-in-1 booster (DTaP/IPV)
MMR
What immunisations are given at 12-13 years?
HPV
What immunisations are given at 14 years old?
3-in-1 booster (dT/IPV)
Men ACWY
What is the BCG (bacilli Calmette-guerine vaccine) an immunisation for?
TB
Who gets the BCG vaccine?
Some infants (0-12 months)
- areas of UK with certain incidence
- parents/grandparents born in a country with annual incidence
New immigrants (Not previously vaccinated) for high prevalence countries of TB
Contacts (<35 years) of resp TB patients
Healthcare workers
Indications for the influenza vaccine
Age > 65 y/o Nursing home residents Healthcare workers Immunodefiency/suppression Asplenia/hyposplenism Chronic liver/renal/cardiac/lung disease DM Coeliac disease Pregnant women
What is to be cautioned in the influenza vaccine?
Egg allergy
Two types of pneumococcal vaccine
Prevenar 13
- Pneumoccocl conjugate polysaccharide vaccine
Pneumovax II
- Pneumococcal polysaccharide vaccine
When is prevenar 13 given? (conjugate)
Part of childhood immunisation schedule - 3 doses
When is pneumonax II given?
For those at increased risk of pneumococcal infection - 1 dose
Indications for pneumococcal vaccine
Immunodeficiency/suppression Asplenia/hyposplenism Sickle cell disease Chronic liver/renal/cardiac/lung disease DM coeliac disease
Who is given Hepatitis B vaccine?
All newborne children from 2018 (6 in 1) Children at high risk of exposure to HBV Healthcare workers PWID MSM prisoners chronic liver/kidney disease
What does PWID stand for?
People who inject drugs
When is the Hep B vaccination given?
0, 1 month, 2 months + 1 year
Who is given the varicella-zoster (chicken pox) vaccine?
Patients with suppressed immunity e.g. cancer treatment or organ transplant
Children if in contact with those at risk of severe VZV
Healthcare workers (if sero negative and in contact with patients)
What type of vaccination is VZV and how often is it given?
Live attenuated vaccination
2 doses, 4-8 weeks apart
What does the varicella zoster virus cause?
Chicken pox
Who is given the herpes-zoster (shingles) vaccination?
all elderly patients (70-80 years)
What does the herpes-zoster virus cause?
Shingles
Types of vaccines
Live attenuated
Inactivated (killed)
Detoxified exotoxin
Subunit of microorganism
What do live attenuated vaccines do?
More likely to stimulate the immune system to bring about an immune response
When is a live attenuated vaccine relatively contraindicated?
In immunocompromised e.g. HIV or chemo
Examples of a live attenuated vaccine
MMR
Rotavirus (oral)
Varicella-zoster (chicken pox)
BCG
Examples of an inactivated (killed) vaccine
Rabies
Influenza
Hep A
Cholera (oral)
Examples of detoxified exotoxin vaccines
Diptheria
Tetanus
Examples of subunit vaccines
Hep B
Thyphoid
Pneumococcus
Example of a recombinant vaccine
Hep B
In antibody response to infection, what does the second response represent?
Immunological memory
How many doses of killed vaccines are usually given and why?
2 or 3 doses - as need to build up the response
How many doses of live vaccines are usually given and why?
1 dose - does not need multiple doses as the immune system is stimulated
What does the “6 in 1 vaccine” contain?
D = purified T = Purified tetanus toxin aP = purified boraetella pertussis IPV = Inactivated polio viruses Hib = purified component of haemophilus, influenza b HBV = hepatitis B rDNA
Herd immunity targets what amount of coverage?
90-95%
Examples of disease specific immunoglobulins used for post exposure (passive immunisation)
Hepatitis Ig
Rabies Ig
Varicella (chicken pox) Ig
What does human normal immunoglobulin contain?
Antibodies against
- hep A
- rubella
- measles
When is human normal immunoglobulin used?
Immunoglobulin deficiencies
treatment of some autoimmune disorders e.g. myesthesia gravis
Types of passive immunisation
Human normal immunoglobulin
Disease specific immunoglobulins (post exposure)
Risk assessment for travellers look at….
Health of traveller Previous immunisation and prophylaxis Areas visiting Duration of visit Accommodation activities Remote areas Recent outbreaks
General safety measures for health of travellers
Care with food/water Hand washing Sunburn/stroke Altitude RTAs Safe sex Mosquitos (bed nets, sprays, cover up)
Travellers are commonly immunised for….
Tetanus Polio typhoid Hep A Yellow fever (need certificate) Cholera
Travelers may need immunised with these in special circumstances….
Meningococcus A, G, W, Y Diptheria Jap B encephalitis Rabies Tick borne encephalitis
ABCD prevention of malaria
A = awareness of risk - location of travel B = bite prevention - cover up at dawn and dusk - insect repellent sprays, lotions - mosquito coils - nets C = Chemoprophylaxis (choice depends on country) - malanone, doxycycline, mefloquine D = diagnosis and treatment
Malaria advice to returning travellers
Any illness occurring within 1 year and especially within 3 months of return might be malaria
Who should have their immunisation withholded?
Immunosuppression
- for VZV, MMR, BCG
History of anaphylaxis
How many doses of tetanus provide life long protection?
5
Who are live attenuated vaccines contraindicated in? (One of the groups)
HIV positive patients
