Immunisation and Prophylaxis Flashcards
When should immunisation occur?
> Childhood
Special patient groups
Occupational
Travelers
When should prophylaxis occur?
> Travelers
Post-exposure
Post-exposure (HIV)
Surgical
What types of adaptive immunity are there?
Natural:
> Passive (Maternal)
> Active (Infection)
Artificial:
> Passive (antibody transfer)
> Active (Immunisation)
What types of natural adaptive immunity are there?
Natural:
> Passive (Maternal)
> Active (Infection)
What types of artificial adaptive immunity are there?
Artificial:
> Passive (antibody transfer)
> Active (Immunisation)
Who pioneered vaccination and how?
Edward Jenner, 1798 - Small boy is injected with pus from a cowpox pustule. This led to immunisation against smallpox
Which types of vaccine are there?
> Live attenuated > Inactivated (Killed) > Detoxified exotoxin > Subunit of micro-organism: - Purified microbial products - Recombinant
Which pathogens are targeted with live attenuated vaccines?
> Measles, mumps, rubella (MMR) > BCG > Varicella-zoster virus > Yellow fever > Smallpox > Typhoid (Oral) > Polio (Oral > Rotavirus (Oral)
Which pathogens are targeted with inactivated (Killed) vaccines?
> Polio (in combined vaccine D/T/P/Hib) > Hepatitis A > Cholera (oral) > Rabies > Japanese encephalitis > Tick-borne encephalitis > Influenza
Which pathogens are targeted with detoxified exotoxin vaccines?
> Diphtheria
> Tetanus
Example of a detoxified exotoxin vaccine?
Toxin treated with formalin to produce toxoid
Which pathogens are targeted with subunit vaccines?
> Pertussis (acellular)
> Haemophilus influenzae b
> Meningococcus (group C) = conjugated: capsular polysaccharide antigen & Corynebacterium diphtheria protein
> Pneumococcus
> Typhoid
> Anthrax
> Hepatitis B
An example of a pathogens which is targeted by recombinant vaccine?
Hepatitis B
How do recombinant vaccine work?
1) DNA segment coding for HBsAg
2) Removed, purified, mixed with plasmids
3) Inserted into yeasts
4) Fermented
5) HBsAg produced
In term of primary antibody response which antibody rise first in infection?
IgM and then IgG both in primary and secondary response
What differences are there between primary and secondary response to infection?
1) Secondary = More rapid response
2) Secondary = Greater increase of IgG
3) Secondary = Greater and more rapid rise in total Ab
What response is there to a killed vaccine?
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
What is the 6 in 1 vaccine?
Infanrix hexa
What are the parts of the infanrix hexa?
“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
UK Childhood Immunisation Schedule - 2 months?
> 6 in 1 vaccine
Pneumococcal conjugate
Rotavirus
Men B
UK Childhood Immunisation Schedule - 3 months?
> 6 in 1 vaccine
> Rotavirus
UK Childhood Immunisation Schedule - 4 months?
> 6 in 1 vaccine
Pneumococcal conjugate
Men B
UK Childhood Immunisation Schedule - 1 year?
> HiB/Men C
MMR
Pneumococcal conjugate
Men B
UK Childhood Immunisation Schedule - 2-8 years?
> Influenza nasal
UK Childhood Immunisation Schedule - 3-5 years?
> 4 in 1 booster (DTaP/IPV)
> MMR
UK Childhood Immunisation Schedule - Girls, 12-13 years?
Human papilloma virus
UK Childhood Immunisation Schedule - 14 years?
> 3 in 1 booster (dT/IPV)
> Men ACWY
What is the concept of herd immunity?
Target 90-95 coverage which stops transmission of the disease
Which immunisations are needed for special patients and occupational groups?
> BCG > Influenza > Pneumococcal > Hepatitis B >Varicella-Zoster (Chickenpox) > Herpes-zoster (shingles)
What is BCG vaccine?
Bacille Calmette-Guerin vaccine - target TB
Who should receive a BCG vaccine?
> 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
What are the indications for an influenza vaccine?
> 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
Which patient group should the influenza vaccine be given to with caution?
Egg allergy - Due to the production of the vaccine being in chicken egg embryo
What does the the 2017-2018 influenza vaccine contain?
2017-18 Vaccine contains
- A/ (H1N1)
- A/ (H3N2)
- B/
What is regularly changed in the influenza vaccine?
Influenza A and B constantly change antigenic structure:
- haemagglutinins (H)
- neuraminidases (N) on surface of virus
What are the two pneumococcal vaccines?
1) Pneumococcal conjugate polysaccharide vaccine (13 serotypes): Prevenar13®
2) Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®
What are the indications of the pneumococcal vaccine?
Indications: > Immunodeficiency > Immunosuppression > Asplenia/hyposplenism > Sickle cell disease > Chronic liver disease > Chronic renal disease > Chronic cardiac disease > Chronic lung disease > Diabetes mellitus > Coeliac disease
How many doses does the influenza vaccine require?
1 dose
How many doses does the Pneumococcal conjugate polysaccharide vaccine (13 serotypes): Prevenar13® require?
3 doses
How many doses does the Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®?
1 dose
Who receives the Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®?
Those with increased risk of pneumococcal infection
Who receives the Pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®?
Part of childhood immunisation schedule
Who receives hepatitis B vaccination?
> 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
Who receives varicella-zoster (chickenpox) vaccination?
> Immune suppressed (Cancer treatment or organ transplant)
> Children in contact with those at high risk of severe VZV
> Healthcare workers
Which type of vaccine is the varicella-zoster (chickenpox) vaccination?
Live attenuated virus
How many doses are used with the varicella-zoster (chickenpox) vaccination?
2 doses, 4-8 weeks apart
Who receives herpes-zoster (shingles) vaccination?
All elderly patients (70-80 years)
Which type of vaccine is the herpes-zoster (shingles) vaccination?
Live attenuated virus
What is the name of the herpes-zoster (shingles) vaccination?
Zostavax
Which disease are targeted with normal human normal immunoglobulins (passive immunisation)?
> Contains antibodies against hepatitis A, rubella, measles
> Immunoglobulin deficiencies
> Some autoimmune disorders e.g. myasthenia gravis
Which disease are targeted with normal disease specific immunoglobulins (passive immunisation)?
Used post exposure: > hepatitis B Ig > rabies Ig > tetanus anti-toxin Ig > varicella (chickenpox) Ig > diphtheria anti-toxin Ig (horse) > botulinum anti-toxin Ig
What is involved int he risk assessment with prophylaxis when travelling?
> Health of Traveller > Previous immunisation and prophylaxis > Area to be visited > Duration of visit > Accommodation > Activities > Remote areas > Recent outbreaks
Sources of information with infection and prophylaxis?
> 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
Common immunisation for travellers?
> Tetanus > Polio > Typhoid > Hepatitis A > Yellow fever > Cholera
Immunisation for Travelers
in Special Circumstances?
> Meningococcus A, C, W, Y > Rabies > Diphtheria > Japanese B encephalitis > Tick borne encephalitis
Prophylaxis used in travelling?
> Chemoprophylaxis against Malaria
> Post-exposure prophylaxis:
- ciprofloxacin for meningococcal disease
> HIV post-exposure prophylaxis:
- “needle stick” (PEP)
- sexual intercourse (PEPSI)
> Surgical antibiotic prophylaxis:
- perioperative
What are the ABCD of malaria prevention?
A = Awareness of risk B = Bite prevention C = Chemoprophylaxis D = Diagnosis and treatment
What are the ABCD of malaria prevention - Awareness of risk?
Areas of the world with highest prevalence
What are the ABCD of malaria prevention - Bite prevention?
> Cover-up at dawn and dusk
Insect repellent sprays, lotions (DEET)
Mosquito coils
Permethrin-impregnated mosquito nets
What are the ABCD of malaria prevention - Chemoprophylaxis?
> 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
Who shouldn’t use Malarone ® (proquanil & atovaquone) daily
doxycycline daily?
Children <12 years old
What are one of the key side effects of Malarone ® (proquanil & atovaquone) daily
doxycycline daily for malaria?
Photosensitivity
Who’s shouldn’t use Mefloquine weekly for malaria?
Avoid if history of psychosis, epilepsy
What are one of the key side effects of Mefloquine weekly for malaria?
Side effects: psychosis, nightmares (1:10,000)
What is the advice for travellers upon returning in terms of malaria?
> 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
