Immunisation and prophylaxis Flashcards
Who tends to receive immunisations? [4]
- Children as part of schedule
- Special patient groups
- Occupational
- Travellers
When is prophylaxis given? [4]
- Travellers
- Post exposure
- Post exposure (HIV)
- Surgical
What different types of vaccines are given? [4]
- Live attenuated
- Inactivated (killed)
- Detoxified exotoxin
- Subunit of microorganism (Purified microbial products/recombinant)
Give some examples of live attenuated vaccines?
3 oral egs
5 others
- Measles, mumps, rubella (MMR)
- BCG
- Varicella-zoster virus
- Yellow fever
- Smallpox
- Typhoid (oral)
- Polio (oral)
- Rotavirus (oral)
Give some examples of inactivated (killed) vaccines? [7]
- Polio (combined vaccine)
- Hep A
- Cholera (oral)
- Rabies
- Japanese encephalitis
- Tick borne encephalitis
- Influenza
Detoxified exotoxin vaccines are made by treating a toxin with formalin, giving a toxoid. What are examples of these? [2]
- Diphtheria
- Tetanus
Give some examples of subunit vaccines? [7]
- Pertussis
- Haemophilus influenzae type b
- Meningococcus (group c)
- Pneumococcus
- Typhoid
- Anthrax
- Hep B
An example of recombinant vaccine is hep B. How are these made? [4]
> DNA segment coding for HBsAg
Removed, purified, mixed with plasmids
Inserted into yeasts and fermented
HBsAg produced
Out of killed and live vaccines, which one needs a succession of doses to boost immune response?
Killed vaccine
What is in 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 = hep B rDNA
Regarding the UK childhood immunisation schedule, what do children get in the first 4 months of life?
2m: Infanrix Hexa + pneumococcal conjugate + rotavirus + Men B
3m: Infanrix Hexa + rotavirus
4m: Infanrix Hexa + penumococcal conjugate + Men B
What special care groups get treated with BCG vaccine? [4]
- Children found to have TB risk factors
- New immigrants from high TB prevalance countries
- Contacts (<35y) of resp TB patients
- Healthcare workers
What special care groups get treated with influenza vaccine? [8]
- Age >65
- Nursing home residents
- HCW
- Immunodeficiency/suppression
- Chronic liver/renal/cardiac/lung disease
- DM
- Coeliac disease
- Pregnant women
Does the conjugate pneumococcal polysaccharide vaccine get given as part of childhood schedule or when patient has indication?
Both
Part of childhood immunization schedule with 3 doses
Pneumovax given when patient at increased risk
What are indications for patients to be given pneumococcal vaccine? [5]
- Immunodeficiency/suppression
- Sickle cell disease
- Chronic liver/renal/cardiac/lung disease
- DM,
- Coeliac disease
New born children are now being given hep B vaccine. Other than children, what groups are susceptible to HBV and should be vaccinated? [5]
- Healthcare workers
- Drug injectors/PWID
- MSM
- Prisoners
- Chronic liver/kidney disease
Varicella zoster vaccine is given as part of 2 doses, 4-8w apart. Who should be given it? [4]
- Immunosuppression
- Children if in contact with those at high risk of severe VZV
- Healthcare workers
- all elderly patients over 70 yo
Human normal immunoglobulin is a form of passive immunisation. What is it used for?
Contains: Antibodies against hep A, rubella, measles
- Immunoglobulin deficiencies
- Some autoimmune disorders eg myasthenia gravis
Disease specific immunoglobulin is a form of passive immunoglobulin given post exposure. Name [6]
- Hep B Ig
- Rabies Ig
- Tetanus anti-toxin Ig
- Varicella (chickenpox) Ig
- Diphtheria anti-toxin Ig
- Botulinum anti-toxin Ig
What is part of risk assessment for a traveller who may need immunisation and prophylaxis? [8]
- Health of traveller
- Previous immunisation and prophylaxis
- Area to be visited
- Duration of visit
- Accomodation
- Activities
- Remote areas
- Recent outbreaks
NEED to look at International Travel Health Advice
What is general measures given as travel advice? [7]
- Care with food/water
- Hand washing
- Sunburn/sunstroke
- Altitude
- Road traffic accidents
- Safer sex
- Mosquitoes - bed bets, sprays
What is common immunisations for travellers? [6]
- Tetanus
- Polio
- Typhoid
- Hep A
- Yellow fever
- Cholera
Name some immunisation for travellers in special circumstances? [5]
- Meningococcus A, C, W, Y
- Rabies
- Diphtheria
- Japanese B encephalitis
- Tick borne encephalitis
What are indications of prophylactic vaccines and give an example of each? [4]
- Chemoprophylaxis against malaria
- Post exposure prophylaxis (eg ciprofloxacin for meningococcal disease)
- HIV post exposure prophylaxis (eg needle stick (PEP) and sexual intercourse (PEPSI))
- Surgical antibiotic prophylaxis (eg perioperative)
What is the ABCD of malaria prevention?
- Awareness of risk of the area that you are traveling to
- Bite prevention
- Chemoprophylaxis
- Diagnosis and treatment
What is involved in bite prevention of malaria? [4]
- Cover up at dawn and dusk
- Insect repellant sprays, lotions
- Mosquito coils
- Permethrin-impregnated mosquito nets
What 4 drugs are given as chemoprophylaxis against malaria? What are side effects?
- Malarone daily
- Doxycycline daily (photosensitivity)
- Mefloquine weekly (pychosis, nightmares)
- Chloroquine weekly and proquanil daily
What is malaria advice to travellers on return? [2]
Any illness occurring within one year and especially within 3m may be malaria. Should seek medical attention especially if within 3m and mention malaria risk
SE of mefloquine [2] and doxycyline
Doxycycline - photosensitivity
Mefloquine - psychosis, nightmares
