immunisation and prophylaxis Flashcards
how many doses are needed for a live vaccine vs killed
1 vs 3
live - quicker and sustained response
killed - gradually increasing response with each dose
types of vaccines
live attenuated
inactivated (killed)
detoxified exotoxin
subunit of micro-organism - purified microbial products, recombinant
examples of live attenuated vaccines
mumps, measles, rubella (MMR) BCG varicella zoster virus yellow fever smallpox typhoid, polio, rotavirus (all oral)
examples of inactivated (killed vaccines)
polio (in combined vaccine D/T/P/Hib) hepatitis A cholera (oral) rabies japanese encephalitis tick-borne encephalitis influenza
examples of detoxified exotoxin vaccines
diphtheria
tetanus
examples of subunit vaccines
pertussis (acellular) haemophilus influenzae type B meningococcus (group C) pneumococcus typhoid anthrax hepatitis B
how are recombinant vaccines made e.g. hep B
DNA segment coding for HBsAg removed, purified, mixed with plasmids inserted into yeasts fermented HBsAg produced
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 = hepatitis B rDNA
UK childhood immunisation schedule (2-4mths)
2mths - 6 in 1 vaccine + rotavirus + men B
3mths - 6 in 1 vaccine + rotavirus + pneumococcal conjugate
4mths - 6 in 1 vaccine + men B
UK childhood immunisation schedule (1-14yrs)
1yr - Hib/men C + MMR + pneumococcal conjugate + men B
2-8yrs - influenza nasal
3-5yrs - 4 in 1 booster (DtaP/IPV) + MMR
12-13yrs - human papilloma virus twice
14yrs - 3 in 1 booster (dT/IPV) + men C ACWY
what is the target coverage for herd immunity
90-95% coverage
immunisation for special patient and occupational groups
BCG influenza pneumococcal hep B varicella zoster (chicken pox) herpes zoster (shingles)
BCG vaccination - who is vaccinated
some infants (0-12mths)
children - screen at school for TB risk factors, tested and vaccinated if appropriate
new immigrants (previously unvaccinated) from high prevalence countries for TB
contacts (<35y/o) of resp TB pts
healthcare workers
when are infants given BCG vaccine
areas of UK w/ annual incidence of TB ≥40/100 000
parents/grandparents born in a country w/ annual incidence of TB ≥40/100 000
influenza vaccine changes
influenza A and B constantly change antigenic structure
new vaccine each year
single dose
caution in egg allergy
indications for influenza vaccine
>65y/o nursing home residents health care workers immunodeficiency or suppression asplenia/hyposplenism chronic liver/renal/cardiac/lung disease DM coeliac disease pregnancy
pneumococcal vaccines
2 types:
pneumococcal conjugate polysaccharide vaccine (13 serotypes) - childhood immunisation schedule, 3 doses
pneumococcal polysaccharide vaccine (23 serotypes) - for those at increased risk of pneumococcal infection, single dose
indications for pneumococcal polysaccharide vaccine
immunodeficiency or suppression asplenia/hyposplenism sickle cell disease chronic liver/renal/cardiac/lung disease DM coeliac disease
hepatitis B vaccination
all new born children from 2018 (6 in 1)
children at high risk of exposure to HBV
healthcare workers, PWID, MSM, prisoners, chronic liver/kidney disease
given at 0,1mth,2mths and 1 year
varicella zoster vaccine
pts who have a suppressed immune system e.g. cancer treatment of organ transplant
children if in contact w/ those at risk of severe vzv
healthcare workers (if sero -ve and in contact w/ pts)
live attenuated virus
2 doses, 4-8wks apart
herpes zoster vaccine
all elderly pts (70-80y/o)
zostavax
live attenuated virus
human normal immunoglobulin
contains antibodies against hep A, rubella, measles
used in immunoglobulin deficiencies
treatment of some AI disorders e.g. myasthenia gravis
disease specific immunoglobulin
post-exposure
hep B Ig rabies Ig tetanus anti-toxin Ig varicella zoster Ig diphtheria antitoxin Ig (horse) botulinum anti-toxin Ig
risk assessment for travellers
health of traveller previous immunisation and prophylaxis area to be visited duration of visit accommodation activities remote areas recent outbreaks
travel advice
general measures
immunisation
chemoprophylaxis
general measures for travel
care with food/water hand washing sunburn/sunstroke avoidance care w/ altitude road traffic accidents safer sex mosquitoes - bed nets, sprays, cover up
common immunisations for travellers
tetanus polio typhoid hep A yellow fever cholera
immunisations for travellers in special circumstances
meningococcus A, C, W, Y - subsaharan africa, saudi arabia
rabies - in contact w/ dogs for prolonger periods of time
diphtheria - developing world and former soviet republics
japanese b encephalitis - some parts of far east
tick borne encephalitis - walkers in eastern europe
examples of prophylaxis
chemoprophylaxis against malaria
post exposure prophylaxis e.g. ciprofloxacin for meningococcal disease
HIV post-exposure prophylaxis - PEP, PEPSI
surgical abx prophylaxis - perioperative
ABCD of malaria prevention
awareness of risk
bite prevention
chemoprophylaxis
diagnosis and treatment
highest risk areas for malaria
sub saharan africa
far east
lesser risks in asia and central america
bite prevention for malaria
cover up at dawn and dusk
insect repellent sprays, lotions (DEET)
mosquito coils
permethrin impregnated mosquito nets
chemoprophylaxis against malaria
malarone
doxycycline
mefloquine
chloroquine and proquanil
choice depends on country
malarone
proquanil and atovaquone combination
daily
day before you leave and continue a week after return
doxycycline
daily
antibiotic w/ anti-malarial properties
not for children <12y/o
photosensitivity
mefloquine
weekly
side effects: psychosis, nightmares (1:10 000)
avoid if hx of psychosis, epilepsy
chloroquine and proquanil
chloroquine weekly and proquanil daily
for vivax/ovale/malariae only
malaria advice to travellers on return
any illness occurring within 1 yr and especially within 3 mths of return might be malaria
pts should seek medical attention if they become ill (esp within 3 mths) and mention malaria risk
