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Year 3 - Infection > Immunisation and Prophylaxis > Flashcards

Immunisation and Prophylaxis Flashcards

1
Q

When should immunisation occur?

A

> Childhood
Special patient groups
Occupational
Travelers

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2
Q

When should prophylaxis occur?

A

> Travelers
Post-exposure
Post-exposure (HIV)
Surgical

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3
Q

What types of adaptive immunity are there?

A

Natural:
> Passive (Maternal)
> Active (Infection)

Artificial:
> Passive (antibody transfer)
> Active (Immunisation)

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4
Q

What types of natural adaptive immunity are there?

A

Natural:
> Passive (Maternal)
> Active (Infection)

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5
Q

What types of artificial adaptive immunity are there?

A

Artificial:
> Passive (antibody transfer)
> Active (Immunisation)

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6
Q

Who pioneered vaccination and how?

A

Edward Jenner, 1798 - Small boy is injected with pus from a cowpox pustule. This led to immunisation against smallpox

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7
Q

Which types of vaccine are there?

A 
> Live attenuated
> Inactivated (Killed)
> Detoxified exotoxin
> Subunit of micro-organism:
- Purified microbial products
- Recombinant
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8
Q

Which pathogens are targeted with 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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9
Q

Which pathogens are targeted with 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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10
Q

Which pathogens are targeted with detoxified exotoxin vaccines?

A

> Diphtheria

> Tetanus

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11
Q

Example of a detoxified exotoxin vaccine?

A

Toxin treated with formalin to produce toxoid

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12
Q

Which pathogens are targeted with subunit vaccines?

A

> Pertussis (acellular)

> Haemophilus influenzae b

> Meningococcus (group C) = conjugated: capsular polysaccharide antigen & Corynebacterium diphtheria protein

> Pneumococcus

> Typhoid

> Anthrax

> Hepatitis B

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13
Q

An example of a pathogens which is targeted by recombinant vaccine?

A

Hepatitis B

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14
Q

How do recombinant vaccine work?

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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15
Q

In term of primary antibody response which antibody rise first in infection?

A

IgM and then IgG both in primary and secondary response

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16
Q

What differences are there between primary and secondary response to infection?

A

1) Secondary = More rapid response
2) Secondary = Greater increase of IgG
3) Secondary = Greater and more rapid rise in total Ab

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17
Q

What response is there to a killed vaccine?

A

With each vaccine there is an increased rise in immune response:
> 1st dose = small rise, fall to almost same as before

> 2nd dose = Greater rise with slight decrease

> 3rd dose = Even greater rise and then plateau

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18
Q

What is the 6 in 1 vaccine?

A

Infanrix hexa

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19
Q

What are the parts of the infanrix hexa?

A

“6 in 1” vaccine:
> 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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20
Q

UK Childhood Immunisation Schedule - 2 months?

A

> 6 in 1 vaccine
Pneumococcal conjugate
Rotavirus
Men B

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21
Q

UK Childhood Immunisation Schedule - 3 months?

A

> 6 in 1 vaccine

> Rotavirus

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22
Q

UK Childhood Immunisation Schedule - 4 months?

A

> 6 in 1 vaccine
Pneumococcal conjugate
Men B

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23
Q

UK Childhood Immunisation Schedule - 1 year?

A

> HiB/Men C
MMR
Pneumococcal conjugate
Men B

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24
Q

UK Childhood Immunisation Schedule - 2-8 years?

A

> Influenza nasal

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25
Q

UK Childhood Immunisation Schedule - 3-5 years?

A

> 4 in 1 booster (DTaP/IPV)

> MMR

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26
Q

UK Childhood Immunisation Schedule - Girls, 12-13 years?

A

Human papilloma virus

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27
Q

UK Childhood Immunisation Schedule - 14 years?

A

> 3 in 1 booster (dT/IPV)

> Men ACWY

28
Q

What is the concept of herd immunity?

A

Target 90-95 coverage which stops transmission of the disease

29
Q

Which immunisations are needed for special patients and occupational groups?

A 
> BCG
> Influenza
> Pneumococcal
> Hepatitis B
>Varicella-Zoster (Chickenpox)
> Herpes-zoster (shingles)
30
Q

What is BCG vaccine?

A

Bacille Calmette-Guerin vaccine - target TB

31
Q

Who should receive a BCG vaccine?

A

> Some infants (0-12 months):

  • areas with high incidence of TB >40/100,000
  • With parents or grandparents born in an area with high incidence

> New immigrants (previously unvaccinated) from high prevalence countries for TB

> Contacts (<35yrs) of respiratory TB patients

> Healthcare workers

32
Q

What are the indications for an influenza vaccine?

A 
> Age >65 years
> 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
33
Q

Which patient group should the influenza vaccine be given to with caution?

A

Egg allergy - Due to the production of the vaccine being in chicken egg embryo

34
Q

What does the the 2017-2018 influenza vaccine contain?

A

2017-18 Vaccine contains

  • A/ (H1N1)
  • A/ (H3N2)
  • B/
35
Q

What is regularly changed in the influenza vaccine?

A

Influenza A and B constantly change antigenic structure:

  • haemagglutinins (H)
  • neuraminidases (N) on surface of virus
36
Q

What are the two pneumococcal vaccines?

A

1) Pneumococcal conjugate polysaccharide vaccine (13 serotypes): Prevenar13®
2) Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®

37
Q

What are the indications of the pneumococcal vaccine?

A 
Indications: 
> Immunodeficiency 
> Immunosuppression
> Asplenia/hyposplenism
> Sickle cell disease
> Chronic liver disease 
> Chronic renal disease
> Chronic cardiac disease
> Chronic lung disease
> Diabetes mellitus 
> Coeliac disease
38
Q

How many doses does the influenza vaccine require?

A

1 dose

39
Q

How many doses does the Pneumococcal conjugate polysaccharide vaccine (13 serotypes): Prevenar13® require?

A

3 doses

40
Q

How many doses does the Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®?

A

1 dose

41
Q

Who receives the Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®?

A

Those with increased risk of pneumococcal infection

42
Q

Who receives the Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®?

A

Part of childhood immunisation schedule

43
Q

Who receives hepatitis B vaccination?

A

> All new born children from 2018 (6 in 1), given at 0, 1 month, 2 month and 1 year

> Children at high risk of exposure to HBV

> Healthcare workers

> Liver disease

> Kidney disease

> Prisoners

> PWID, MSM

44
Q

Who receives varicella-zoster (chickenpox) vaccination?

A

> Immune suppressed (Cancer treatment or organ transplant)

> Children in contact with those at high risk of severe VZV

> Healthcare workers

45
Q

Which type of vaccine is the varicella-zoster (chickenpox) vaccination?

A

Live attenuated virus

46
Q

How many doses are used with the varicella-zoster (chickenpox) vaccination?

A

2 doses, 4-8 weeks apart

47
Q

Who receives herpes-zoster (shingles) vaccination?

A

All elderly patients (70-80 years)

48
Q

Which type of vaccine is the herpes-zoster (shingles) vaccination?

A

Live attenuated virus

49
Q

What is the name of the herpes-zoster (shingles) vaccination?

A

Zostavax

50
Q

Which disease are targeted with normal human normal immunoglobulins (passive immunisation)?

A

> Contains antibodies against hepatitis A, rubella, measles

> Immunoglobulin deficiencies

> Some autoimmune disorders e.g. myasthenia gravis

51
Q

Which disease are targeted with normal disease specific immunoglobulins (passive immunisation)?

A 
Used post exposure:
> hepatitis B Ig
> rabies Ig
> tetanus anti-toxin Ig
> varicella (chickenpox) Ig 
> diphtheria anti-toxin Ig (horse)
> botulinum anti-toxin Ig
52
Q

What is involved int he risk assessment with prophylaxis when travelling?

A 
> Health of Traveller
> Previous immunisation and prophylaxis 
> Area to be visited 
> Duration of visit
> Accommodation
> Activities
> Remote areas
> Recent outbreaks
53
Q

Sources of information with infection and prophylaxis?

A

> British 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

54
Q

Common immunisation for travellers?

A 
> Tetanus
> Polio
> Typhoid 
> Hepatitis A
> Yellow fever
> Cholera
55
Q

Immunisation for Travelers

in Special Circumstances?

A 
> Meningococcus A, C, W, Y  
> Rabies
> Diphtheria
> Japanese B encephalitis 
> Tick borne encephalitis
56
Q

Prophylaxis used in travelling?

A

> Chemoprophylaxis against Malaria

> Post-exposure prophylaxis:
- ciprofloxacin for meningococcal disease

> HIV post-exposure prophylaxis:

  • “needle stick” (PEP)
  • sexual intercourse (PEPSI)

> Surgical antibiotic prophylaxis:
- perioperative

57
Q

What are the ABCD of malaria prevention?

A 
A = Awareness of risk
B = Bite prevention 
C = Chemoprophylaxis
D = Diagnosis and treatment
58
Q

What are the ABCD of malaria prevention - Awareness of risk?

A

Areas of the world with highest prevalence

59
Q

What are the ABCD of malaria prevention - Bite prevention?

A

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

60
Q

What are the ABCD of malaria prevention - Chemoprophylaxis?

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

61
Q

Who shouldn’t use Malarone ® (proquanil & atovaquone) daily
doxycycline daily?

A

Children <12 years old

62
Q

What are one of the key side effects of Malarone ® (proquanil & atovaquone) daily
doxycycline daily for malaria?

A

Photosensitivity

63
Q

Who’s shouldn’t use Mefloquine weekly for malaria?

A

Avoid if history of psychosis, epilepsy

64
Q

What are one of the key side effects of Mefloquine weekly for malaria?

A

Side effects: psychosis, nightmares (1:10,000)

65
Q

What is the advice for travellers upon returning in terms of malaria?

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

Year 3 - Infection (16 decks)

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