Immunisation and prophylaxis Flashcards
What are the 2 main divisions of the immune system?
Innate
Adapative
What is innate immunity?
The body’s own immune system – involves white cells e.g neutrophils + lymphocytes
Nonspecific, meaning anything that is identified as foreign or non-self is a target for the innate immune response.
Adaptive immunity can be further divided into what?
Natural and artificial adaptive immunity
Natural immunity
Passive - maternal
Active - infection
Artificial immunity
Passive - antibody transfer + breast milk give immunity to baby against respiratory or enteric infections straight away
Active - immunisation
Antibody primary response to infection
IgM produced first then IgG. Total antibody goes up then comes back down
Antibody secondary response to infection
Production of antibodies occurs much quicker and at a higher level due to immunological memory
This hopefully prevents the individual becoming infected with that pathogen again
How does a killed vaccine work to produce an immune response?
Killed vaccine causes a production of antibody – after a period of weeks or months will gradually come down again. This is when you need a 2nd – due to immunological memory that does will result in a quicker and higher response. A 3rd dose is needed to make a decent level of humoral immunological memory
How does a live vaccine work to produce an immune response?
As the live vaccine begins to replicate and produce more antibodies this becomes like a cascade – quicker and more sustained response to the vaccination
Types of vaccines you can get (4)
live attenuated
inactivated (killed)
detoxified exotoxin
subunit of micro-
organism: purified microbial products or recombinant
Give some examples of common live attenuated vaccines (8)
MMR
BCG
Varicella-zoster virus - chicken pox
Yellow fever
Smallpox
Typhoid, polio, rotavirus (oral vaccines)
Give some examples of common killed vaccines (7)
Polio (in combined vaccine D/T/P/Hib)
Hep A
Cholera (oral)
Rabies
Japanese encephalitis
Tick-borne encephalitis
Influenza
Give 2 examples of vaccines that contain detoxified exotoxins produced by the micro-organism
Tetanus
Diphtheria
Give examples of vaccines that contain only a subunit of the micro-organism
Pertussis
Haemophilus influenzae type b
Meningococcus - group C
Pneumococcus
Typhoid
Hep B
What is the main vaccine started from the age of 2 months to prevent illness in young children?
6 in 1 vaccine
What is the BCG vaccine for?
Immunisation against TB
Children screened at school for TB risk factors, tested and vaccinated if appropriate
Who is the BCG vaccine given to in the UK?
BCG vaccine is only offered to some children either those in areas of the UK with a high incidence of TB or those with parents/grandparents born in a high risk TB country
Also new immigrants
Contacts of resp TB patients
Healthcare workers
Influenza vaccine
There is a new influenza vaccine each year with different strains
Indicated for elderly, nursing home residents, immunodeficient, immunosuppressed, asplenia, chronic liver, renal, cardiac and lung disease, DM and pregnant women
Name 3 conditions that the pneumococcus bacteria causes?
Pneumonia
Septicaemia
Meningitis
Who should get the hep B vaccine?
All new born children from 2018 (6-in-1)
Also given to:-
Children at high risk of exposure to HBV
Health care workers, PWID, MSM, prisoners, ch. liver disease, ch. kidney disease,
Given at 0, 1 month,2 months and 1 year
Who is the Varicella-zoster vaccine recommended to?
Patients who have a suppressed immune system e.g having cancer treatment or organ transplant
Children if in contact with those at risk of severe vzv
Health case workers if they’ve never had it before
What is human normal immunoglobulin?
A method of passive immunisation i.e injecting preparations made from the plasma of immune individuals with adequate levels of antibody to the disease for which protection is sought.
HNI is prepared from pools of at least 1000 donations of human plasma; it contains immunoglobulin G (IgG) and antibodies to hepatitis A, measles, mumps, rubella, varicella, and other viruses that are currently prevalent in the general population.
It is used in patients with immunoglobulin deficiencies
What are the 2 types of human immunoglobulin preparation available?
Human normal immunoglobulin
Disease-specific immunoglobulins.
What is an immunoglobulin?
Antibodies of human origin are usually termed immunoglobulins.
What is disease specific immunoglobulin?
Specific immunoglobulins are prepared by pooling the plasma of selected human donors with high levels of the specific antibody required.
These are used following exposure ie when the patient has the infection.
So for example…
Rabies Ig is administered after an unimmunised individual has been bitten by an animal in or from a country where the risk of rabies is high
or hep B Ig should be given to laboratory and other personnel who have been accidentally inoculated with hepatitis B virus, and in infants born to mothers who have become infected with this virus in pregnancy
What should you find out about a patient who needs vaccinations for travelling?
Health of Traveller – are they immunocompromised etc?
Previous immunisation and prophylaxis
Area to be visited and duration of visit
Accommodation - hotels or hostels/camping/rough sleeping etc
Activities
Remote areas or cities
Recent outbreaks where they are going
General measures that a patient who is going travelling should be given advice on (7)
Care with food/water Hand washing Sunburn / Sunstroke Altitude Road traffic accidents Safer sex Mosquitoes - bed nets, sprays, “cover up”
Common immunisations for travellers (6)
Tetanus Polio Typhoid Hepatitis A Yellow fever Cholera
Most common prophylaxis medication
Anti-malaria tablets
chemoprophylaxis
ABCD of malaria prevention
Awareness of risk
Bite prevention - cover up at dawn and dusk, DEET spray, Permethrin-impregnated mosquito nets
Chemoprophylaxis - malarone = most popular then doxycycline, mefloquine
Diagnosis and treatment - know the signs of malaria, if they become ill - seek medical help
What are the components of the “6 in 1” childhood vaccination?
diphtheria, tetanus, Bordetalla pertussis, polio, Haemophilus influenzae, hepatitis B
There is no vaccine for which hepatitis infection?
Hep C
