Immunisations and Prophylaxis Flashcards
Who receives immunisations?
- Childhood schedule
- Specialist patient groups
- Occupational hazards
- Travelers
Who receives prophylactic medications?
- Travelers
- Post exposure
- Post-exposure HIV
- Surgical
What are the 2 types of immunity?
- Innate immunity
- Adaptive immunity
What are the types of adaptive immunity?
Natural
- Passive (maternal)
- Active (infection)
Artificial
- Passive (antibody transfer)
- Active (immunisation)
What is your innate immune system?
Immunity you are born with
What is adaptive immunity?
Immunity when the body adapts to the environment and stimuli which can be natural or artificial
Who created the smallpox vaccine?
Edward Jenner
What types of vaccines are there?
- Live attenuated
- Inactivated (killed)
- Detoxified exotoxin
- Subunit of micro-organism (purified microbial products or recombinant)
Give examples of live attenuated vaccines.
- Measles, mumps, rubella (MMR)
- BCG
- Varicella-zoster virus
- Yellow fever
- Smallpox
- Typhoid (oral)
- Polio (oral)
- Rotavirus (oral)
Give examples of inactivated vaccines.
- Polio (in combined vaccine D/T/P/Hib)
- Hepatitis A
- Cholera (oral)
- Rabies
- Japanese encephalitis
- Tick-borne encephalitis
- Influenza
How are detoxified exotoxin vaccines created?
Toxin is treated with formalin to form a toxoid
Give examples of detoxified exotoxin vaccines.
- Diphtheria
- Tetanus
Give examples of subunit vaccines.
- Pertussis (acellular)
- Haemophilus influenzae type b
- Meningococcus (group C) (conjugated: capsular polysaccharide antigen & Corynebacterium diphtheria protein)
- Pneumococcus
- Typhoid
- Anthrax
- Hepatitis B
Describe how recombinant vaccines are created using hepatitis B as an example.
- DNA segment coding for HBsAg is removed, purified and mixed with plasmids
- It is inserted into yeast and fermented
- HBsAg is produced
What is a secondary response to an infection known as?
Immunological memory
Describe the primary antibody response to infection
Primary
- Delayed response
- IgM increases followed by IgG
Secondary
- Almost immediate response
- IgM response followed by IgG
- IgG continues to rise after IgM begins to fall
Describe the immune response to killed and live vaccines
Killed
- Response increases and decreases
- After each administration the immune response increases, building immunity
Live
-After first dose immunity grows and plateaus
What are the components of the 6 in 1 Infanrix hexa vaccine?
- 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 months
- 6 in 1
- Pneumococcal conjugate
- Rotavirus
- Men B
UK childhood immunisation schedule: 3 months
- 6 in 1
- Rotavirus
UK childhood immunisation schedule: 4 months
- 6 in 1
- Pneumococcal conjugate
- Men B
UK childhood immunisation schedule: 1 year
- Hip/Men C
- MMR
- Pneumococcal conjugate
- Men B
UK childhood immunisation schedule: 2-8 years
-Influenza nasal
UK childhood immunisation schedule: 3-5 years
- 4 in 1 booster (DTaP/IPV)
- MMR
UK childhood immunisation schedule: girls 12-13
HPV
UK childhood immunisation schedule: 14 years
- 3 in 1 booster (dT/IPV)
- Men ACWY
What is herd immunity?
When sufficient levels of the population are immunised, those who aren’t (unable to be) should be protected as well
What immunisations are associated with special patient and occupation groups?
- BCG
- Influenza
- Pneumococcal
- Hepatitis B
- Varicella-zoster (chickenpox)
- Herpes-zoster (shingles)
Who receives the BCG vaccine?
- Some infants 0-12 months who are in high risk areas or have parents/grandparents born in high risk areas
- New immigrants from high risk areas
- Contacts (<35 years) of respiratory TB patients
- Healthcare workers
- Children screened at school for TB risk factors, tested and vaccinated if appropriate
What are the indications for the influenza vaccine?
- Age >65 years
- Nursing home residents
- Some health care workers
- Immunodeficiency,
- Immunosuppression
- Asplenia/hyposplenism
- Chronic liver disease
- Chronic renal disease
- Chronic cardiac disease
- Chronic lung disease
- Diabetes mellitus
- Coeliac disease
- Pregnant women
- Heath care workers
What is the influenza vaccine?
- A new vaccine each year to protect against Influenza A and B
- A and B change antigenic structure (Haemagluttins,H and neraminidases, N on the surface of the virus)
- Single dose, caution in egg allergies
What are the 2 pneumococcal vaccinations available?
Pneumococcal conjugate polysaccharide vaccine(13 serotypes)
- Childhood immunisation schedule
- 3 doses
Pneumococcal polysaccharide vaccine (23 serotypes)
- For those at increased risk of infection
- Single dose
What are the indications for the pneumococcal polysaccharide vaccine?
- Immunodeficiency
- Immunosuppression
- Asplenia/hyposplenism
- Sickle cell disease
- Chronic liver disease
- Chronic renal disease
- Chronic cardiac disease
- Chronic lung disease
- Diabetes mellitus
- Coeliac disease
Who receives the hepatitis B vaccination?
- All new born children from 2018 (6-in-1)
- 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 receives the varicella-zoster vaccine?
- Patients who have a suppressed immune systems, for examplehaving cancer treatment or organ transplant
- Children if in contact with those at risk of severe vzv
- Health case workers (if sero-neg and in contact with patients)
What type of vaccine is the VZ vaccine?
Live attenuated
What type of vaccine is the herpes-zoster vaccine?
Live attenuated
Who receives the herpes zoster vaccine?
All elderly patients (70-80 years)
What is human normal immunoglobulin?
- Contains antibodies against hepatitis A, rubella, measles
- Used in immunoglobulin deficiencies
- Treatment of some autoimmune disorders, e.g. myasthenia gravis
Give examples of disease specific immunoglobulins (post-exposure).
- Hepatitis B Ig
- Rabies Ig
- Tetanus anti-toxin Ig
- Varicella (chickenpox) Ig
- Diphtheria anti-toxin Ig (horse)
- Botulinum anti-toxin Ig
What risk assessment must be carried out when thinking about immunising travellers?
- Health of Traveller
- Previous immunisation and prophylaxis
- Area to be visited
- Duration of visit
- Accommodation
- Activities
- Remote areas
- Recent outbreaks
Where can you find out information about travel requirements?
- BNF
- Green book
- Internet
- Schools of tropical medicine
What general measures be taken into account when traveling?
- Care with food/water
- Hand washing
- Sunburn / Sunstroke
- Altitude
- Road traffic accidents
- Safer sex
- Mosquitoes - bed nets, sprays, “cover up”
What are common immunisations for travellers?
- Tetanus
- Polio
- Typhoid
- Hepatitis A
- Yellow fever (requires a yellow certificate once received as evidence)
- Cholera
What are some specific immunisations required for some travellers?
- Meningococcus A, C, W, Y
- Rabies
- Diphtheria
- Japanese B encephalitis
- Tick borne encephalitis
What is the ABCD of malaria prevention?
- Awareness of risk
- Bite prevention
- Chemoprophylaxis
- Diagnosis and treatment
How can mosquito bites be prevented?
- Cover-up at dawn and dusk
- Insect repellent sprays, lotions (DEET)
- Mosquito coils
- Permethrin-impregnated mosquito nets
What chemoprophylaxis is there against malaria?
Malarone
-Daily
Doxycycline
- Not for <12 years
- Photosensitivity
Mefloquine
- Weekly
- Side effects: psychosis, nightmares
- Avoid if history of psychosis or epilepsy
Chloroquine
- Weekly and proquanil daily
- For vivax/ovale/malariae only
What is the malaria advice for travellers on return?
- Any illness occurring within 1 year and especially within 3 months of return might be malaria
- Patients should seek medical attention if become they ill particularly within 3 months and mention malaria risk
