Immunisation and Prophylaxis

Question 1

Define immunisation

Answer 1

Induction of immunity to a specific infectious disease

Question 2

Define prophylaxis

Answer 2

Prevention of disease

Question 3

Break down immunity into its different categories

Answer 3

Immunity - innate and acquired
Acquired - natural and artificial
Natural - passive (maternal) & active (dx)
Artificial - passive (Ig) & active (vaccination)

Question 4

Where is all the information about vaccines held?

Answer 4

Green book

BNF

Question 5

How do vaccines work?

Answer 5

Stimulate active immunity and provide immunological memory (so if you were to encounter the pathogen you’d have a rapid response)

Question 6

What are the different types of vaccines?

Answer 6

Live attenuated
Inactivated
Subunits of micro-organism
Detoxified exotoxin

Question 7

What are live attenuated vaccines?

Answer 7

Live micro-organisms that have been modified to make them less deadly/closely related microorganisms
Provoked better immune response but not suitable for immunocompromised

Question 8

Give examples of live attenuated vaccines

Answer 8

Yellow fever, MMR, BCG, VV, smallpox, typhoid, polio, rotavirus

Question 9

What are inactivate vaccines?

Answer 9

Whole micro-organism has been killed with radiation, chemicals, antibiotics
Cannot become infected from this

Question 10

Give examples of inactivated vaccines

Answer 10

Polio, hep A, cholera, Japanese encephalitis, tick-borne encephalitis, influenza

Question 11

What are detoxified exotoxin vaccines?

Answer 11

Mix toxin with formula to make it inactive

Question 12

Give examples of detoxified exotoxin vaccines?

Answer 12

Tetanus, diptheria

Question 13

What are the different types of subunit micro-organisms?

Answer 13

A. purified microbial products

B. recombinant DNA

Question 14

Give examples of recombinant DNA vaccines

Answer 14

Hep B, Hib, pertussis, MenC, pneumococcus, typhoid, anthrax

Question 15

What are IgM?

Answer 15

Ab released after immediate exposure to a pathogen
Temporary - only stays in body for a while
Indicator of current infection

Question 16

What are IgG?

Answer 16

Responsible for long lived immunity and memory

Indicator of previous infection

Question 17

How many doses of killed vaccines do you need?

Answer 17

Often 2-3 as first few may not be adequate in producing an immune response

Question 18

How many doses of live vaccines do you need?

Answer 18

Often only req. single dose as they are more immunogenic

Question 19

What is in the 6 in 1 vaccine Infranrix hexa?

Answer 19

D - purified diptheria toxin 
T - purified tetanus toxin 
aP - purified Bordetella pertussis
IPV - inactive polio virus 
Hib - purified component of Hib
HBV - hepB rDNA

Question 20

Define herd immunity

Answer 20

Immunity that occurs when a significant percentage of population are vaccinated (90-95%)
Really important to protect those who are too ill/young to be vaccinated

Question 21

What patients are offered BCG?

Answer 21

Infants 0-12m from area in UK with/parents/grandparents from country with incidence of 40/100, 000 or more of TB
New immigrants from high prevalence countries
Contacts <35y of resp TB
Healthcare workers

Question 22

Who is offered influenza vaccine?

Answer 22

>65y
Nursing home resident 
Immunodeficiency/suppression
Asplenia/hyposplenism 
Chronic liver/renal/heart/lung dx 
DM 
Coeliac disease
Pregnant woman

Question 23

What are the two pneumococcal vaccines?

Answer 23

13 serotype: Prevenar13 - 3 doses, part of childhood immunisation schedule

23 serotype: pneumovax II (single dose) - for certain indications

Question 24

What indicates the 23 serotype pneumonoccal polysaccharide vaccination?

Answer 24

Immunodeficiency/suppression
Asplenia/hyposplenism 
Sickle cell dx 
Chronic liver/renal/cardiac/lung disease
DM 
Coeliac dx

Question 25

Who are offered HepB vaccination?

Answer 25

All new born children from 2018 (0, 1, 2 m & 1y) | Healthcare workers, PWID, MSM, prisoners, ch. liver/kidney disease

Question 26

Who is the VZV vaccine offered to?

Answer 26

Immunosupression, e.g. cancer/organ tx Children if at high risk of severe VZV Healthcare workers (if sero-neg)

Question 27

What kind of vaccine is VZV and when is it given/

Answer 27

Live attenuated | 2 doses - 4-8wks apart

Question 28

What is a lifethreatening complication of VZV?

Answer 28

Pneumonitis

Question 29

Who is the shingles vaccine given to?

Answer 29

All elderly patients (70-80)

Question 30

What is shingles?

Answer 30

Dermatomal rash with painful blistering assoc with reactivation of VZV (virus remains dormant in dorsal root ganglia)

Question 31

When should human normal Ig be given?

Answer 31

Immunodeficiencies, some autoimmune dx, e.g. myasthenia gravis

Question 32

What does human normal Ig contain?

Answer 32

Hep A, rubella, measles

Question 33

What are some disease specific Ig you can give post-exposure?

Answer 33

``` Hep B Ig Rabies Ig Tetanus antitoxin Ig Varicella Ig Diphtheria anti-toxin Ig Botulinium anti-toxin Ig ```

Question 34

What is involved in risk assessment of a traveller?

Answer 34

``` Health of traveller Prev. immunisation/prophylaxis Area to be visited Duration of visit Accommodation Activities Remote areas Recent outbreaks ```

Question 35

What general travel advice should you give?

Answer 35

``` Avoid sunburn, sunstroke, altitude sickness Care with food/water Handwashing Road traffic accidents Safer sex Mosquitos - bed nets, sprays, cover up ```

Question 36

What are some common immunisations for travellers?

Answer 36

Yellow fever, tetanus, polio, hep B, cholera, typhoid

Question 37

When should you give men ACWY vaccine?

Answer 37

If going to certain areas with high incidence of meningococcus, e.g. Saharan Africa

Question 38

When should you give rabies vaccine?

Answer 38

Working with bats/dogs/likely to be bitten

Question 39

What is the ABCD of malaria prevention?

Answer 39

Awareness of risk Bite prevention - cover up at dusk/dawn/insect repellent, DEET, mosquito nets Chemoprophylaxis Diagnosis and Rx

Question 40

What chemoprophylaxis options are there for malaria prevention?

Answer 40

Malarone (proquanil and atovaquone) daily Doxycycline daily (>12 only, photosensitivity) Mefloquine weekly Chloroquine weekly & proquanil daily

Question 41

What are the side effects of mefloquine?

Answer 41

Psychosis, nightmares

Question 42

What type of malaria does chloroquine and proquanil protect against?

Answer 42

Vivax, ovale, malariae only

Question 43

What malaria advice is given to travellers on return?

Answer 43

Any illness occurring within 1 year, esp 3 months of return may be malaria