Immunisation Schedule UK Flashcards
What is included in the 6 in 1 vaccine?
Diphtheria Tetanus Pertussis Polio HiB Hep B
When is the 6 in 1 vaccine given?
8 weeks
12 weeks
16 weeks
Describe the diphtheria organism
Corynebacterium diphtheria Toxin producing gram positive bacteria Respiratory droplet spread from coughing or sneezing Infectious for 4 weeks Incubation 3-5 days
Describe th clinical features of diphtheria
Toxin kills cells in mouth, nose, throat
Dead cells can build up to form a membrane that can cause choking
- membranous pharyngitis
- fever
- enlarged anterior cervical LNs
- oedema of soft tissue ‘bull neck’
Systemic disease:
- myocarditis can lead to HF
- neurological manifestations e.g nerve inflammation leading to paralysis
Has immunisation practically eradicated diphtheria in the UK?
Yes
But remains serious threat worldwide, with many endemic areas
Describe the tetanus organism
Gram positive rod shaped bacillus
Under suitable conditions forms spores that are very hardy, found in soil, dust, manure
Transmission: enter body through wounds, spores produce tetanospasmin (potent toxin)
What are the clinical features of tetanus?
Toxins enter nervous system - block inhibitory neurotransmitters at motor nerve endings - widespread activation of motor neurons
- muscle spasm throughout body
- begin at head: lockjaw and moves down
- spasm cont for several weeks
How is tetanus treated?
Debride and clean wound
IVIG
Sedation
Muscle relaxation/ventilation
Is tetanus transferred person to person?
No - can not prevent with herd immunity
What percentage die from tetanus?
1 in 10 even in UK
Mortality up to 90% if no good medical care
In the UK there are a small number of cases of tetanus each year in…
Unvaccinated elderly
Contaminated needles
There has been a marked decline in pertussis incidence with immunisation, but epidemics recur when…
Immunisation rates fall
Following an increasing number of infants less than 3 months with pertussis in UK, what has now been recommended?
Pregnant women now recommended to have pertussis immunisation from 20w gestation (booster dTaP/IPV)
How is whooping cough transmitted?
Respiratory droplet spread by coughing and sneezing
Highly contagious
Most infectious during catarrhal phase before onset of whoop
Describe the stages of pertussis
Catarrhal phase
- low grade fever, rhinorrhoea, sneezing
- most infectious
Paroxysmal phase (can last for 10 weeks)
- paroxysms of intense coughing
- coughing can be followed by loud whoop
- infants less than 6 months do not have whoop, at risk of apnoea from exhaustion
Convalescent phase
- chronic cough that may last weeks
Is pertussis always present in the community?
Yes
Why is there a continued infection risk with pertussis?
Infection does not provide lifelong immunity
Vaccination protection lasts about 6 years
In the early 2000s the pertussis vaccine was cellular. What has replaced this?
Acellular vaccine (toxoid)
- wears off more quickly
- lower incidence of side effects
Why was there a rise in pertussis cases in the UK?
Due to a fall in vaccination coverage because of professional and public anxiety about safety of whole cell vaccine
What type of vaccines are diphtheria, tetanus and pertussis?
Inactivated toxoid vaccine
What causes poliomyelitis?
Polio virus - an RNA enterovirus (3 serotypes)
How is polio virus transmitted?
Faecal oral route
Virus ingested and replication occurs in alimentary tract - replication occurs for long period
After the initially alimentary phase of polio, what happens?
Virus enters blood stream
In 5% it enters NS across the BBB
What are the 3 types of polio infection?
Sub clinical in 95% - no or mild coryzal symptoms
Non paralytic - flu like symptoms, headache, fever, myalgia, sore throat
Paralytic - follows non-paralytic symptoms with acute onset paralysis (proximal paralysis more severe than distal)
What type of vaccine is the polio vaccine?
Inactivated whole killed virus vaccine
Part of the 6 in 1 vaccine and also 4 in 1 at 3 years 4 months and again at 14 years old
Although most children infected with polio virus are asymptomatic, some can develop…
Aseptic meningitis
And less than 1% develop paralytic poliomyelitis
Describe the Haemophilus influenza type B organism and how it is transmitted
Gram neg bacteria
Opportunistic pathogen that lives in host without causing harm
Causes problems when other factors present e.g viral illness
Spread through coughing/sneezing/close contact with carrier or infected
What, now rare, acute respiratory condition can Hib cause?
Epiglottitis
Hib can cause invasive disease primarily in what age group?
Young children (although now rare due to vaccine)
What serious infections can Hib cause?
Meningitis Sepsis Pneumonia Pericarditis Epiglottitis Septic arthritis Cellulitis Osteomyelitis
When is Hib vaccine given?
Part of 6 in 1 at 2,3,4 months
Booster dose at 1 year with Men C
When is the meningococcal group B vaccine given?
8 weeks
16 weeks
1 year
MenB is responsible for what percentage of meningococcal infections in the UK?
90%
There are many strains of meningococcal group B bacteria, the Bexsero MenB vaccine protects again almost…of the ones in UK
90%
Describe the neisseria meningitidis organism
Gram neg diplococci
12 capsular groups - BCWY most common in UK
Describe the clinical features associated with neisseria meningitidis infection
Prodrome: malaise, fever, vomiting
Headache, neck stiffness, photophobia, drowsiness, confusion, petechial rash (80%)
What type of vaccine is MenB?
Inactivated recombinant
When is MenC vaccine given?
12 months as Hib/MenC
14 years as MenACWY
What type of vaccine in MenC and MenACWY?
Inactivated conjugate vaccine
Conjugated with tetanus toxoid
Describe the rotavirus organism
RNA virus - type A most common
Infection occur via faecal oral route
What clinical features are associated with rotavirus ?
Mild fever, severe watery diarrhoea, cramps and vomiting lasting 3-8 days
Vomiting often first symptom
Can lead to dehydration requiring hospitalisation
What type of vaccine is the rotavirus vaccine?
Live attenuated
When is the rotavirus vaccine given?
2 months
3 months
When is the MMR vaccine given?
1 year
3 years 4 months
What type of vaccine is the MMR?
Live attenuated
