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4th year Paeds > Infections and immunity conditions > Flashcards

Infections and immunity conditions Flashcards

1
Q

Presentation Kawasaki disease

A

Conjunctivitis without discharge

Fever 39C+ and >5days

Strawberry tongue and cracked lips

Peeling skin on palms of hands and soles of feet

Macular erythematous rash on main part of body and genitals

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2
Q

What is a serious complication of Kawasaki?

A

Coronary artery aneurysm

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3
Q

Treatment kawasaki?

A

Ig and aspirin

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4
Q

When do measles symptoms come on in relation to exposure?

A

10-14 days post exposure

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5
Q

Measles presentation

A
  1. cough/coryza
  2. fever (can be as high as 40 and last a week)
  3. conjunctivitis
  4. Irritability
  5. Koplik’s spots
  6. Morbilliform rash starting behind ears and spreading down whole body to hands and feet last. Starts red and turns dark brown (‘staining’)
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6
Q

How long does measles take to resolve?

A

about 3w

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7
Q

Complication measles?

A

Encephalitis

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8
Q

Management measles?

A

Notifiable disease

Stay away from suscpetible- off work for at lest 4 days after rash onset, preferably until fully recovered

Supportive Rx

Safety net for uncontrollable fever, SOB, convulsions or reduced consciousness

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9
Q

Presentation infectious mononucleosis

A

Photophobia

Throat sore and red

Lymphadenopathy

Cough

Fatigue, malaise, loss appetite, headache

Tonsils red, swollen, white patches

Splenomegaly, abdo pain

Nausea and vomiting

Occasionally jaundice

Fever, chills, aches

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10
Q

infectious mononucleosis aka

A

Ebv

glandular fever

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11
Q

what blood cells are seen on a blood film in infectious mononucleosis?

A

Peripheral leucocytosis with atypical lymphocytes (large, irregular nuclei)

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12
Q

How do you diagnose infectious mononucleosis?

A

Serology (monospot test)

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13
Q

What treatment must you avoid in infectious mononucleosis? Why?

A

Amoxicillin causes mac pap rash

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14
Q

What pathogens cause periorbital cellulitis?

A

Staphs, strep pneumoniae, strep pyogenes, milleri

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15
Q

How is periorbital cellulitis caused?

A

Paranasal sinus infection

Eyelid injury/infection

Dental injury/infection

External ocular infection

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16
Q

Management periorbital cellulitis

A

Unless very mild, admit for:

CT

ENT and ophthal opinion

Antibiotics

±surgery

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17
Q

periorbital cellulitis presentation?

A

Inflammation around orbit

Decreased eye mobility

Fever

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18
Q

periorbital cellulitis complications

A

Spread to meninges or cavernous sinus, form abscess

Can = blindness due to pressure on the optic nerve/thrombosis of optic nerve vessels

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19
Q

In any irritable child with unexplained fever you should consider what?

A

Meningitis

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20
Q

When is meningitis most common?

A

Neonatal

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21
Q

which viruses can cause meningitis?

A

Mumps

Coxsackie

Echovirus

HSV

Poliomyelitis (if unvaccinated)

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22
Q

Viral meningitis is preceded by…?

A

Pharyngitis or gi upset

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23
Q

Are complications more common in viral or bacterial meningitis?

A

Bacterial

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24
Q

Is viral or bacterial meningitis generally better?

A

Viral is milder and self-resolving usually.

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25
Q

Treatment for viral meningitis?

A

Generally supportive. If severe HSV/EBV/VZV consider aciclovir

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26
Q

Bacterial causes of meningitis?

A

Neisseria meningitidis

Strep pneumoniae

H. influenza type B

Group B strep

E. coli and listeria

TB

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27
Q

Meningococcal meningitis is caused by what?

A

Neisseria meningitidis

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28
Q

Pneumococcal meningitis is caused by what?

A

Strep pneumoniae

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29
Q

Group B strep, E. coli and listeria are a more common cause of meningitis in which group?

A

Neonates

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30
Q

TB is a more common cause of meningitis in which group?

A

Immunocompromised

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31
Q

As well as the cardinal symptoms, how might a child with meningitis present?

A

drowsy, vacant

irritable

high pitched cry

occas. convulsions

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32
Q

What are early signs of bacterial meningitis?

A

Headache

Fever

Leg pains

Cold hands and feet

Abnormal skin colour

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33
Q

What are later signs of bacterial meningitis

A

Meningism

Reduced GCS, coma

Seizures ±focal CNS signs

Petechial rash (IF MENINGOCOCCAL)

Shock (cap refill, DIC, hypotension)

Bulging fontanelle in infants

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34
Q

Are Kernig’s and Brudzinski’s sign reliable in young infants?

A

No

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35
Q

What signs could you find that the meningitis is caused by HZV?

A

Shingles or chicken pox

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36
Q

What signs could you find that the meningitis is caused by HSV

A

Cold sore

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37
Q

What signs could you find that the meningitis is caused by HIV

A

lymphadenopathy, dermatitis, candidiasis, uveitis

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38
Q

What signs could you find that the meningitis is caused by leptospirosis

A

Bleeding ± red eye

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39
Q

What signs could you find that the meningitis is caused by mumps

A

parotid swelling

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40
Q

What signs could you find that the meningitis is caused by glandular fever

A

sore throat

jaundice

nodes

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41
Q

What signs could you find that the meningitis is caused by immune deficiency

A

Splenectomy scar

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42
Q

Differentials for meningitis?

A

Malaria

Encephalitis

Septicaemia

SAH

Dengue

Tetanus

Tonsillitis and otitis media may mimic neck stiffness

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43
Q

In primary care if you come across a non-blanching rash and suspect meningitis what could you do?

A

Give benzylpenicillin IV, or IM if no vein- as proximally as possible into a warm limb. Before admitting to secondary care.

Don’t do if there is no rash, unless urgent transfer to secondary care not possible.

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44
Q

If someone is penicillin allergic should you still give BenPen in susp meningitis in primary care?

A

If the allergy is just a rash yes, if anaphylactic no

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45
Q

What does of benpen should you give for susp meningitis in primary care?

A

<1y- 300mg

1-9y- 600mg

> 10y- 1200mg

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46
Q

When does meningitis become septicaemia?

A

When features of shock

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47
Q

What should initial management of bac meningitis (without features of shock or raised ICP) be?

A

ABC- fluids, glucose

Blood cultures

Senior help

LP <1hr (as long as no shock, no rash and no raised ICP)

Abx IV after LP (unless LP delayed by >1hr)

Dex 10mg IV

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48
Q

What should initial management of bac meningitis (without features of shock but with signs of raised ICP) be?

A

ICU help

ABx IV (often ceftriaxone 2g/12h)

Dex 10mg/6h IV

Support airway, fluids

Nurse at 30 degrees

Delay LP until stable

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49
Q

What should initial management of bac meningitis with signs of shock be?

A

ICU help

Blood cultures

IV ABx

Airway support, maybe pre-emptive intubation

Fluid resus/inotropes/vasopressors. Aim for MAP >70mmHg, urine output >30ml/h

Delay LP until stable

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50
Q

What is later management for bacterial meningitis (±shock, raised ICP)

A

Careful monitoring

Adjust abx based on sensitivities

Fluid resus/maintenance

Inform PHE

Kissing contacts prophylaxis

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51
Q

What is used for bac meningitis contacts prophylaxis?

A

Rifampicin/ciprofloxacin

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52
Q

Why is dex given in bac meningitis?

A

helps meningism

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53
Q

Should you do LP before antibiotics?

A

Only if:

  • no signs of shock
  • no rash
  • no raised ICP
  • can get within 1h
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54
Q

What other investigations can you do in bac meningitis

A

U&E, FBC (decreased WCC could = immunocompromised), LFT, glucose, coag

Throat swabs for bacteria and virology

CXR

HIV/TB test?

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55
Q

How common are meningitis complications

A

1/3 to 1/2 survivors are left with at least one permanent problem. More common in bac.

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56
Q

What are the complications of meningitis?

A

Total/partial hearing loss (usually get hearing test after a few weeks)

Recurrent seizures (epilepsy)

Problems with memory and concentration

Co-ord/movement/balance problems

Vision loss (total or partial)

Learning dfficulties and behav probs.

Loss of limbs

Bone and joint probs- e.g. arthritis

Kidney probs

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57
Q

How often is bac meningitis fatal?

A

10%

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58
Q

What is waterhouse-friderichsen syndrome?

A

A complication of meningococcal meningitis

Endotoxins –> coagulopathy –> haemorrhagic necrosis of the adrenal glands.

DIC

Acute adrenal gland failure

Resp failure

> 40% mortality

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59
Q

How do you treat waterhouse-friderichsen syndrome?

A

Abx

Fluid and electrolyte management

Coagulopathy treatment

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60
Q

CSF opening pressure is seen initially on the LP, and the CSF should then be sent for?

A

MC&S

Protein

Lactate

Glucose

Virology/PCR

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61
Q

What is the appearance of CSF in:

Normal

Bacterial

Viral

Fungal

TB

A

Normal clear and colourless

Bac cloudy and turbid

Viral clear

Fungal clear or cloudy

TB opaque, fibrin web if left

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62
Q

What is the opening pressure in different types of meningitis

A

Always raised, might be normal in viral

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63
Q

What is the WCC in CSF in the different types of meningitis?

A

Always raised, but to different degrees. Polymorphs are seen in bacterial or early viral/TB

Normal 0-5

Bac: >100

Viral 50-1000

Fungal 10-500

TB 10-1000

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64
Q

What is glucose content of CSF in the different types of meningitis?

A

Low, apart from in viral where it is normal

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65
Q

What is protein content of CSF in the different types of meningitis?

A

Always high

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66
Q

what would signs of raised ICP be in meningitis?

A

papilloedema, FND, seizures, GCS =12

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67
Q

Meningococcal septicaemia with meningitis is when…?

A

Purpuric non-blanching rash with neck stiffness

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68
Q

What is the treatment of infectious mononucleosis?

A

Supportive

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69
Q

What does infectious mononucleosis put you at risk of in future?

A

Lymphoma, gastric and nasopharyngeal cancer

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70
Q

Causes of purpura can be divided into which two groups?

A

Non thrombocytopenic and thrombocytopenic

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71
Q

What are the non thrombocytopenic causes of purpura?

A

HSP

Sepsis (meningococcal or viral)

Trauma

Scurvy

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72
Q

What are the thrombocytopenic causes of purpura?

A

ITP

Leukaemia

DIC

Aplastic anaemia

HUS

TTP (rare in children)

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73
Q

Purpura <3mm is called ?

A

Petechiae

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74
Q

Purpura >1cm is called ?

A

eccymosis

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75
Q

What is HSP (pathophysiologically)

A

Small vessel vasculitis of unknown cause

76
Q

Key features of HSP?

A

Often follows viral illness

Purpuric rash to buttocks and legs, symmetrical

±arthritis

±abdo pain (GI vasculitis) and possibly N&V, diarrhoea

±nephritis (haematuria, proteinuria, HTN, rarely renal failure)

May get bilateral scrotal swelling in boys

33% have some sort of gastric haemorrhage

77
Q

Does HSP need treatment?

A

Generally self limiting (resolves in a few weeks) so supportive only

Steroids may help abdo pain

78
Q

What are complications of HSP?

A

Intusussception

Gastric haemorrhage

1% irreversible kidney damage- CKD

1/3 relapse a few months afterwards

79
Q

Does HSP need follow up?

A

Yes renal

80
Q

HSP investigations?

A

No specific tests but these all may be elevated:

  • creat
  • urea
  • IgA
  • platelets
  • CRP
  • ESR
81
Q

What sort of age gets HSP?

A

Preschool

82
Q

ITP stands for?

A

Immune thrombocytopenic purpura

83
Q

ITP age group?

A

2-10y

84
Q

What is the commonest cause of thrombocytopenia in children?

A

ITP

85
Q

ITP cause?

A

Often preceded by viral infection 1-2w earlier.

Destruction of circulating platelets by IgG autoantibodies.

86
Q

ITP presentation

A

Widespread purpura and superficial bruising. May have problematic bleeding e.g. epistaxis or menstrual.

87
Q

How is ITP diagnosed?

A

Dx of exclusion. Must distinguish from acute leukamia and aplastic anaemia via:

  1. clinical features- hepatosplenomegaly or marked lymphadenoathy should prompt BM investigation.
  2. FBC- anaemia or neutropenia should prompt BM investigation.
  3. Blood film- ITP will show mostly normal and some large platelets.

If no worrying clinical features, only low platelets on FBC and no intention to treat then do not need to examine BM.

88
Q

Does ITP need treatment?

A

Benign and self limiting in 80%. 6-8w course.

Treatment not usually required unless bleeding present. If major bleeding (intracranial or GI) or persistent minor bleeding that is problematic (e.g. nosebleeds, menstrual) then can treat

89
Q

How do you treat problematic bleeding in ITP?

A

Prednisolone PO (NB must do BM sample before as giving it could mask diagnosis of ALL and compromise outcome)

IV anti D

IV Ig

NB all significant SEs

Life threatening haemorrage= platelet transfusion

90
Q

What advice should be given to ITP patients?

A

Avoid trauma and contact sports while plt count still low and parents should have access to 24h hospital

91
Q

Complications ITP?

A

IC haemorrhage if plt vv low (headache, blurred vision, LOC, HTN, bradycardia)

Chronic ITP 20%- plt low after 6m. Mainly supportive Rx.

92
Q

What is HUS?

A

Progressive renal failure

Microangiopathic haemolytic anaemia (RBC fragmentation)

Thrombocytopenia

Microthrombi

93
Q

What is the most common cause of AKI in children?

A

HUS

94
Q

What are the two categories of HUS?

A

Typical and atypical

95
Q

What is typical HUS?

A

Caused by shiga-like toxin (from shigella dysenteriae or E coli) 70% E coli 0157:H7

Children 2-3y

Diarrhoea precedes

Fairly good prognosis

96
Q

What is atypical HUS?

A

5-10%

Adults

No prodromal diarrhoea

Poor prognosis

Not associated with shiga-like toxin

Various triggers: nonenteric infection, virus, drugs, malignancy, pregnancy, transplant

40% strep pneumoniae

97
Q

Investigations in HUS

A

Urinalysis- proteinuria, RBC, RBC cast

Bloods- blood urea nitrogen, creatininte, U&E, FBC, lactate

Blood film

Complement serology testing

Stool culture

98
Q

Management HUS

A

supportive

Only give Abx if septic

Renal transplant if progress to end stage renal disease

Atypical- plasma exchange and eculizumab

99
Q

Complications of HUS

A

Chronic renal failure

Encephalopathy

Colitis

100
Q

What is the most common malignancy in children?

A

Leukaemia

101
Q

What happens in leukaemia?

A

Malignant proliferation of WC precursors in BM. Blast cells –> circulation, may be deposited in lymphoid and other tissue

102
Q

What is the commonest type of leukaemia in childhood?

A

ALL

103
Q

Peak incidence leukaemia in children?

A

2-5y

104
Q

When is the prognosis of leukaemia worse?

A

<2y and >10y

105
Q

Presentation leukaemia

A

Malaise

Anorexia

Pallor

Bruising

Bleeding

Lymphadenopathy

Splenomegaly

Bone pain

106
Q

Investigations of leukaemia

A

FBC (anaemia, thrombocytopenia, raised WCC. Higher WCC = worse prognosis)

Blood film- blast cells

Bone marrow aspirate to diagnose- blast cell infiltration.

107
Q

Management leukaemia?

A

Chemo to induce remission, then chemo to maintain remission

108
Q

What is the general prognosis for leukaemia?

A

Generally good

109
Q

What is the pathophysiology of DIC?

A

Systemic activation of coag –> fibrin generation and deposition –> microvascular thrombi various organs –> multiple organ dysf –> consumption of clotting factors and platelets –> haemorrhage

110
Q

DIC is always ____?

A

secondary to an underlying disorder

111
Q

How do you diagnose DIC

A

Thrombocytopenia

aPTT and PT (prolonged or normal)

Clotting factors reduced

Inhibitors e.g. antithrombin

D-dimer

112
Q

Treatment DIC

A

Underlying disorder

Consider plt transfusion if bleeding

could give tranexamic acid + heparin

113
Q

What is aplastic anaemia?

A

Damage to BM and the stem cells within due to:

drugs/irradiation/infection/immune disease/50% idiopathic

Causes pancytopenia

114
Q

How do you confirm the diagnosis of aplastic anaemia?

A

BM sample

115
Q

Treatment aplastic anaemia

A

Immunosuppressants

Stem cell transplant

116
Q

Is it important to treat aplastic anaemia?

A

yes risk of death if not.

117
Q

How does chicken pox present?

A

Red papule on chest becomes vesicular, then crops of vesicles follow.

These progress: macule, papule, vesicle, crust.

Itchy

Viral prodrome

118
Q

Incubation period of chicken pox

A

10-21 days

119
Q

How long do chicken pox lesions last?

A

6-10 days

120
Q

If the child was in nursery a few days before the rash developed, do they need to tell them? What should a pregnant nursery nurse do?

A

Yes as it is infectious a few days before

If the pregnant person hasn’t had chicken pox or can’t remember then they should get a blood test

121
Q

When can the child with chicken pox return to nursery

A

When lesions scabbed over

122
Q

Complications chicken pox

A

Scars

Secondary infection

Encephalitis (cerebellar signs and ataxia a couple of weeks later)

Thrombocytopenia with haemorrhage into skin

123
Q

Management chicken pox

A

Cool baths and calamine lotion

Promethazine syrup (1st gen antihistamine) if v distressed

Keep fingernails short and clean to reduce infection risk

124
Q

What if an immunocompromised child is exposed to chicken pox?

A

Consider prophylactic zoster Ig. If disease develops admit for IV aciclovir.

125
Q

Is conjunctivitis normally viral, bacterial, allergic, parasitic or chemical?

A

Viral

126
Q

Most common viral cause of conjunctivitis?

A

adenovirus

127
Q

Is it easy to clinically differentiate bacterial and viral conjunctivitis?

A

No

128
Q

What pathogen causes hyperacute conjunctivitis?

A

Neisseria gonorrhoeae

129
Q

Conjunctivitis in the first four weeks of life is called?

A

Ophthalmia neonatorum

130
Q

Is ophthalmia neonatorum always infectious?

A

No but can be

131
Q

Is ophthalmia neonatorum bad?

A

Usually mild but untreated infection (e.g. gonococcus, chlamydia, pseudomonas or herpes) can lead to serious complications e.g. sight loss and mortality

132
Q

Are sticky eyes in first few weeks of life common? How can you manage?

A

Yes

Cleaning and treat with topical antibiotics e.g. neomycin

133
Q

How does chlamydial ophthalmia neonatorum present?

A

Watery/mucopurulent discharge about 5-14 days after birth.

134
Q

Is there a test for chlamydial ophthalmia neonatorum?

A

Monoclonal antibody test on secretions

135
Q

Chlamydial ophthalmia neonatorum treatment?

A

2w oral erythro or topical tetracycline ointment

136
Q

How does gonococcal ophthalmia neonatorum present?

A

First 5 days of life but can be up to 3w after delivery. Copious purulent discharge and eyelid swelling which may be severe.

137
Q

Gonococcal ophthalmia neonatorum Rx?

A

IV Abx- cephalosporin

138
Q

How does viral ophthalmia neonatorum present?

A

Petechial/large subconj haemorrhages and lymphadenopathy

139
Q

What are serious things to r/o in susp conjunctivitis?

A

Acute glaucoma

Keratitis

Iritis

Corneal ulcer

Anterior uveitis

Scleritis

Trauma

140
Q

What is pharyngoconjunctival fever?

A

Due to adenovirus

Conjunctivitis + URTI and pre-auricular lymphadenopathy

141
Q

Things to ask in conjunctivitis history

A

Uni or bilat?

Discharge

Itch

Vision

Eyelid changes

Infectious contact

Pain (incl headache and photophobia)

Hx trauma

Contact lens use

Assoc sx

PMH atopy, similar episodes, immuno-compromise, eye surgery

142
Q

What do you examine in susp conjunctivitis?

A

Look at the conjunctiva, follicles, cornea, sclera, eyelids and peri-orbital area

Assess pupil shape, size, reactivity

Visual acuity and fields

Lymph nodes

Could do fluorescein staining for keratitis and corneal ulcer

143
Q

Do you need to swab in conjunctivitis?

A

Not routinely but may be indicated if fail to respond to initial treatment and doesn’t need ophthal referral

144
Q

Conjunctivitis advice to pt

A

Reassure that usually self limiting (about a week)

Advise contagious (hand washing, use separate towels etc)

If bacterial/severe/require rapid resolution- topical antibiotics. Could do delayed prescription.

Self care: bathe eyelid with cotton wool soaked in saline or boiled and then cooled water. Cool compresses. Lubricating eye drops.

Return if persists beyond 7 days or if red flags

145
Q

What Abx given in bacterial conjunctivitis?

A

Chloramphenicol drops- 1 drop 3-4x daily (depends on severity…could be every 2hrs) and reduce freq as infection controlled. Continue 48hrs after healing

Fusidic acid

146
Q

Red flags of conjunctivitis?

A

Reduced visual acuity

Marked eye pain/headache/photophobia

Red sticky eye in neonate

Hx trauma/foreign body possible

Copious rapidly progressing discharge

HSV infection

Soft contact lens use with corneal Sx (photophobia, watering)

147
Q

Complication conjunctivitis?

A

Periorbital cellulitis

148
Q

HIV usually presents by age ___

A

3

149
Q

5 ways HIV presents

A

FTT

Diarrhoea

Hepato/splenomegaly

Recurrent oral candidiasis

Severe bacterial infections

150
Q

How do you diagnose HIV?

A

Detect HIV antibody or viral load via PCR

151
Q

Vertical transmission HIV ___% without intervention?

A

20-30

152
Q

What is in the 6 in 1 vaccine?

A

Dipth

Tetanus

Pertussis

Polio

Hib

Hep B

153
Q

When is 6 in 1 given?

A

2m, 3m, 4m

154
Q

What does diphtheria cause?

A

throat infection

pharyngeal exudate

membranes form that can obstruct airway

Exotoxin may cause myocarditis and paralysis

155
Q

Is polio caused by a virus or bac?

A

Virus (poliomyelitis)

156
Q

How does polio present?

A

Mild febrile illness progresses to meningitis in some children. Damage to anterior horn SC–> paralysis, pain, tenderness. May also cause resp failure and bulbar paralysis. Residual paralysis common in survivors

157
Q

Hib used to be the main cause of _____ before the vaccine

A

Meningitis

158
Q

Haemophilus influenza meningitis tends to cause what?

A

Severe neuro sequelae- deafness, cerebral palsy and epilepsy in 10-15% and death 3%

159
Q

90% babies affected with hep b go on to get what?

A

Chronic liver disease. Can –> cirrhosis or liver cancer.

160
Q

Pneumococcal disease is caused by what pathogen?

A

Strep. pneumoniae

161
Q

Pneumococcal disease can cause what?

A

septicaemia, meningitis and pneumonia

162
Q

The pneumococcal vaccine is against how many strains?

A

13 serotypes

163
Q

Meningococcal group B vaccine is associated with what?

A

Febrile convulsions

164
Q

What does Rota virus cause?

A

D&V, abdo pain, fever

can = dehydration and death in small baby

165
Q

How is rotavirus vaccine given?

A

Oral

166
Q

Which vaccines are live?

A

Rotavirus

MMR

Influenza nasal spray

BCG

chicken pox

167
Q

What do immunocompromised parents need to be aware of if baby just had rotavirus vaccine?

A

Take care with personal hygiene when changing nappy for 2w following

168
Q

When is MenC given?

A

12-13m and with the other mening. at 13-18y

169
Q

Meningitis C causes what?

A

Purulent meningitis with purpuric rash and septiaemic shock

Mortality as high as 10% and morb can= hearing loss, seizures, brain damage, organ failure, tissue necrosis

170
Q

When is MMR given?

A

1y and 3y4m

171
Q

Who doesn’t get MMR?

A

Immunocomp- high dose steroids, chemotherapy, low CD4, HIV

172
Q

Complications of mumps

A

aseptic meningitis, sensorineural deafness and orchitis. Subfertility in men

173
Q

Why do we want to reduce incidence of Rubella given that it is mild infection in itself?

A

If infected in early pregnancy can = congenital defects such as cataracts, deafness and congenital HD

174
Q

What 3 things do you need to check before giving the MMR?

A

Immunocomp

Egg allergy status

Pregnant in girls

175
Q

What SE is common from the MMR?

A

rash and fever 5-10 days later/mild mumps 2w later

176
Q

Who gets influenza vaccine and how?

A

Annual nasal spray in Sept/Oct for all children 2-9 years

Also if at risk: injection 6m-2y or nasal spray 9-17y

177
Q

HPV is against which strains? Which cause cancer/warts?

A

16 and 18- cancer

and

6 and 11- warts

178
Q

When is HPV given?

A

two doses 6-24m apart in girls aged 12-13

179
Q

Men ACWY is recommended in who?

A

adolescents and students

14y (13-18y)

180
Q

When do children get their first vaccines and which are given?

A

2m

D, T, Polio, pertussis, Hib, Hep B (6in1)

Pneumococcal

Men B

Rotavirus

181
Q

When is the final dose of DTP?

A

14y (13-18y)

182
Q

Which vaccines are given at 3y 4m?

A

DTPP (dose 4)

MMR (dose 2)

183
Q

Which other vaccines are also available in some cases?

A

Chicken pox (sibs have suppressed immune system. From 1y+, two doses 4-8 weeks apart. Live vaccine)

BCG if TB risk (intradermal, live. Birth-16y)

Extra flu vaccine (diff ages)

Extra Hep B if at risk- additional doses at birth, 4w, 1y. May also get Igs at birth if mother particularly infectious. Babies of infected mothers should also be tested at 1y

184
Q

BCG vaccine is less effective in what age group, and against what type of TB?

A

> 35y

Respiratory TB (most common form in adults). Is 70-80% effective against the most severe forms such as TB meningitis in children

185
Q

Do premature babies get vaccines according to their chronological or corrected age?

A

Chronological as mother’s protection wears off after birth

Unless they are too sick

186
Q

DRAW OUT THE VACCINE SCHEDULE

A

see notes

187
Q

What is the injection site before 1y and after 1y?

A

Before 1y is thigh

After 1y upper arm

AT 1y is either (but men B is L thigh)

4th year Paeds (13 decks)

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