Immunisations

Question 1

What are some success vaccination programs that can be used as examples for patients?

Answer 1

• smallpox
• polio - only remaing in 3 endemic countries
• measles - WHO has significantly decreased its effects in developing countries

Question 2

What are some diseases that are increasing despite vaccination? Why?

Answer 2

• Pertussis is increasing:
  
  • immunity wanes in later life (isn’t lifelong)
  • People after 30 years old are generally not immune
  • you get a modified infection with it being less severe, but you can still transmit the disease.
  • target parents to get the pertussis vaccine.
• Measles:
  
  • travellers bringing it back to australian communities
  • primarily thailand, indonesia, india.

Question 3

What does this picture show? What vaccine protects from this?

Answer 3

Diptheria:

• school aged children, sore throats.
• Respiratory difficulties from obstruction, can have rare outcomes of death
• can affect smooth muscle (heart muscle) and cause arrhythmias

Question 4

What is the diagnosis? What vaccine can prevent this?

Answer 4

Pertussis

• still very common
• cough - whoop at the end, known as the 100 day cough
  
  • get hypoxic encephalopathy
  • cyanosed and hypoxic (oxygen and NG feeding tube)
• petechiae and vomiting in older children
• diagnosis using nasal swab, PCR (NAT), blood test for serology (bordetella specific IgA) or PT antigen
• management:
  
  • antibiotics (make it less infective don’t change the course unless there in catarr stage (before the cough)
    
    • macrolides e.g. clarithromycin

Question 5

What is the disease? What vaccine can prevent this?

Answer 5

Periorbital cellulitis secondary to HiB

• do eye movements, visual acuity
• usually caused by staph or strep but very common with HiB too.
• HiB can also cause meningitis and epiglotitis (pic)
• Treatment:
  
  • flucloxacillin but in unvaccinated use 3rd gen cephalosporin

Question 6

What is the Diagnosis? What vaccine is used? What are the effects of the disease?

Answer 6

Polio

• spread via fecal oral route, an enterovirus.
• most people develop flacid paralysis
• Sabin vs Salk

Question 7

What vaccine can prevent this condition? What is the problem shown here?

Answer 7

Rotovirus

• commonest cause of viral gastro before the vaccine now overtaken by norovirus
• mainly morbidity through admissions through dehydration.
• it is an oral vaccine.

Question 8

What causes this condition? What is the complications of this disease?

Answer 8

Mumps

• virus spread by droplet
• admission because can’t eat or drink due to swelling of the parotids. Often bilaterally but occasionally unilateral.
• Can cause severe disease:
  
  • orchitis (infertility)
  • encepahlitis

Question 9

What is the diagnosis of this picture? What complications are related to this condition?

Answer 9

Measles

• 3Cs and 1 K of Measles:
  
  • conjunctivitis
  • cough
  • coryzal symptoms
  • Koplik spots
• maculopapular rash starts on the face and spreads
• Complications:
  
  • pneumonia
  • encephalitis (1 in 1000)
  • Subacute scelerosis SSPE - happening years later.

Question 10

What is the Diagnosis? What disease causes this process?

Answer 10

Congenital Rubella

• rubella - often seen overseas
• Complications:
  
  • growth retardation
  • deaf
  • intellectual impairment
  • congenital cardiac defect
• only slight disease as an adult (get a cold)

Question 11

What is this disease? What are its effects?

Answer 11

Varicella Zoster Virus (chickenpox/shingles)

• fever and rash,
• come out in crops and get variation of progression
• risk of teratogenic if baby is small
• adults it can be dangerous:
  
  • bacterial infection secondarily
  • post viral cerebellitis

Question 12

What is the disease behind this sick child? What vaccinations can you use?

Answer 12

Meningococcal

• bacterial infection - purpitic non-blanching rash
• we only vaccinate against meningococcal C. Can get B on private health or if immunosuppressed.
• in travellers you get the polysaccharide vaccine due to outbreaks A and W135
• other serotypes are out there now
• if you are exposed prophylactic rifampicin (covers urine and tears)

Question 13

A mother comes in and is concerned about vaccines overwhelming the immune system and is concerned about the side effects of vaccines (esp autism). Counsel her about vaccines.

Answer 13

Pros:

• MMR has been disproven to cause autism in multiple studies
• delaying them means more risk - (pertussis, pneumococcal) but there might be problem giving too many.

Anti:

• herd immunity, but against this argument:
  
  • some need very high amounts,
  • protecting immunodeficient (babies, elderly, others)
  • travel
• complications:
  
  • local (swelling)
  • general - mold fever, irratability/aches
  • might get a mild form of disease:
    
    • MMR - 1 in 10 get maculopapular rash
    • Varicella - unusual but some get vesicles at the site
    • Rotavirus - diarrhoea within a day or 2 and occasionally some vomiting
  • rare:
    
    • hypotonic hyperresponsive episode (scary) - vasovagal
    • anaphylaxis
    • intussusception

Question 14

18 mthh old twins one with neuroblastoma for chemo. Due for a non-live vaccine and a non-live booster (MMRV and DTPa). What should you do? What are the contraindications for immunisations?

Answer 14

• None for neuroblastoma child - Absolute contraindications:
  
  • anaphylaxis
  • unexplained encephalopathy (post pertussis)
  • live vaccines in:
    
    • pregnancy
    • immunosuppression
    • previous live virus
• everyone else in household should get live vaccine and wait 6 months post chemo to give the child his.
• relative contraindications:
  
  • evolving neurological disease
  • high temperature (>38.5)