Immunisations

Question 1

Why isn’t pertussis disappearing?

Answer 1

The vaccine isn’t as immunogenic as other vaccines - protection doesn’t last as long

Question 2

Why is measles coming back?

Answer 2

Return travellers

Anti-vaxxers

Question 3

What is the classic physical sign of diphtheria? How does it kill?

Answer 3

White tonsillar exudate

Airway obstruction
Smooth muscle dysfunction - arrhythmia

Question 4

Why admit whooping cough?

Answer 4

Assist feeding
Oxygen
Apnoea

Question 5

What are you concerned about with whooping cough?

Answer 5

Hypoxic brain injury

Question 6

How do you diagnose pertussis?

Answer 6

Throat/nose swap - PCR - quicker

Blood serology

Question 7

How is pertussis mx?

Answer 7

Macrolides - clarithromycin

- only changes course of illness if caught in early stages, otherwise it only reduces infectivity

Question 8

What is the natural history of pertussis?

Answer 8

Cough lasts months

Question 9

Which vaccinated organism can cause peri-orbital cellulitis?

Answer 9

HiB

Staph and strep otherwise

Question 10

How is Hib treated?

Answer 10

3rd generation cephalosporin

Question 11

How does tetanus present?

Answer 11

Muscular spasm - starts at the jaw, can spread to muscles throughout

Question 12

What be used instead of vaccination in the context of tetanus? When do you use it?

Answer 12

Passive Ig

If unvaccinated in large injury

Question 13

How does mumps present?

Answer 13

Temperatures
Painful, swollen glands
Orchitis
Encephalitis

Question 14

How does polio present?

Answer 14

Flaccid paralysis that may be reversible

Depending where it effects the phenotype will be different

Question 15

How does the rash in VZV appear?

Answer 15

Vesicular rash
Varying size
Pleomorphic
Centrally distributed

Question 16

Why vaccinate against VZV?

Answer 16

Secondary cellulitis in primary infection

Shingles

Question 17

When do you use ZiG? When is it effective?

Answer 17

Pregnant
Immunosuppressed

First 72hours

Question 18

How does measles present?

Answer 18

High fever
Cough
Conjunctivitis 
Coryza
Pneumonia
Encephalitis (1/1000)

Question 19

How can rubella present?

Answer 19

If contracted in utero
Cataracts
Deafness
Heart disease
Growth restriction

Mild temperature, arthralgias, mild illness

Question 20

What age groups are susceptible to meningococcal?

Answer 20

over 5

Teenagers

Question 21

How do you treat meningococcus?

Answer 21

Cefotaxime or ceftriaxone

Benzylpenicillin (penicillin G) if 3rd gen cephalosporin is not available

Question 22

Why can’t you use the meningococcus travel vaccine in kids?

Answer 22

Doesn’t work as it’s a conjugated vaccine

Question 23

Where does strep pneumoniae effect?

Answer 23

Lungs

Brain

Question 24

What are common side effects of vaccines

Answer 24

Local

• swelling, pain, redness
• Lump at the sight - can last for months

Generalised

• Mild fever, irritable, cry/drowsiness
• Muscle aches
• Fainting
• Protracted crying

Rare

• Convulsion - Hypotonic, hyporesponsive episodes - thought to be vasovagal
• Anaphylaxis
• Intussusception

Question 25

Which vaccines are live? How do the side effects differ?

Answer 25

MMR
Varicella
Rotavirus

• SE occurs 7-10 days as it reflects the natural history of the disease mostly

Question 26

How do you vaccine someone on chemo?

Answer 26

Don’t give them the live vaccine as it’s dangerous
Other vaccines won’t work
- Wait 6 months

Household contacts should be given vaccine

Question 27

What are some relative contraindications?

Answer 27

Evolving neurological illness
Temperature >38.5
Egg allergy - still able to given, but give in hospital