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Paediatrics > Paediatrics Vaccinations > Flashcards

Paediatrics Vaccinations Flashcards

1
Q

What do vaccinations do?

A

Provide immunity to full version of the pathogen

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2
Q

Give some examples of inactivated vaccines?

A

Polio

Flu vaccine

Hepatitis A

Rabies

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3
Q

What do subunit and conjugate vaccines contain?

A

Parts of the organism used to stimulate an immune response

Safe for immunocompromised patients

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4
Q

What are some examples of subunit and conjugate vaccines?

A

Pneumococcus

Meningococcus

Hepatitis B

Pertussis (whooping cough)

Haemophilus influenza type B

HPV

Shingles (herpes-zoster)

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5
Q

What do live attenuated vaccines contain?

A

Weakened version of the pathogen

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6
Q

Give some examples of live attenuated vaccines?

A

Measles, mumps and rubella vaccine: contains all three weakened viruses

BCG: contains a weakened version of tuberculosis

Chickenpox: contains a weakened varicella-zoster virus

Nasal influenza vaccine (not the injection)

Rotavirus vaccine

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7
Q

What are toxin vaccines?

A

Toxin which is normally produced by a pathogen

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8
Q

What kind of immunity do toxin vaccines produce?

A

Immunity to the toxin and not to the pathogen itself

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9
Q

What are some examples of toxin vaccines?

A

Diphtheria

Tetanus

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10
Q

What vaccines are given at 8 weeks?

A

6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)

Meningococcal type B

Rotavirus (oral vaccine)

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11
Q

What vaccines are given at 12 weeks?

A

6 in 1 vaccine (again)

Pneumococcal (13 different serotypes)

Rotavirus (again)

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12
Q

What vaccines are given at 16 weeks?

A

6 in 1 vaccine (again)

Meningococcal type B (again)

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13
Q

What vaccines are given at 1 year?

A

2 in 1 (haemophilus influenza type B and meningococcal type C)

Pneumococcal (again)

MMR vaccine

Meningococcal type B (again)

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14
Q

What vaccines are given yearly from age 2 - 8 years?

A

Influenza vaccine (nasal vaccine)

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15
Q

What vaccines are given at 3 years 4 months?

A

4 in 1 (diphtheria, tetanus, pertussis and polio)

MMR

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16
Q

What vaccine is given at 12-13 years?

A

HPV vaccine (2 doses given 6 to 24 months apart)

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17
Q

What vaccine is given at 14 years?

A

3 in 1 (tetanus, diphtheria and polio)

Meningococcal groups A, C, W and Y

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18
Q

What is the current NHS HPV vaccine?

A

Gardasil (against 6, 11, 16 and 18)

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19
Q

What strain of HPV causes genital warts?

A

Strains 6 and 11

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20
Q

What strains of HPV cause cervical cancer?

A

Strains 16 and 18

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21
Q

When is the BCG vaccine offered?

A

From birth to babies at higher risk of TB

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22
Q

What is sepsis the result of?

A

Systemic inflammatory response

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23
Q

In sepsis what is the causative pathogen recognised by? What do they release

A

Macrophages

Lymphocytes

Mast cells

They release cytokines e.g. interleukins and TNF leadint to further release of chemicals e.g. nitrous oxide which cause vasodilation

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24
Q

What effect fo cytokines have on the endothelial lining of the blood vessels?

A

Become more permeable - causing fluid to leak out of blood into extracellular space causing oedema and reduction in intravascular volume

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25
Q

What is the result of the oedema in sepsis?

A

Create space between blood and tissues reducing oxygen that reaches tissues

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26
Q

How does disseminated intravascular coagulopathy (DIC) occur in sepsis?

A

Activation of coagulation system leads to deposition of fibrin throughout the circulation - causing consumption of platelets and clotting factors as they are being used up to form the blood clots. Causes thrombocytopenia, haemorrhages and an inability to form clots and stop bleeding

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27
Q

Why does blood lactate rise in sepsis?

A

Result of anaerobic respiration in the hypo-perfused tissues with an inadequate oxygen - waste product is lactate

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28
Q

How should septic shock be treated?

A

Aggressively with IV fluids - for bp and tissue perfusion

If bp does respond then escalate to high dependency or ICU where inotropes e.g. noradrenaline can be considered

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29
Q

What are inotropes?

A

Medications which stimulate CVS and improve bp and tissue perfusion

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30
Q

What signs can indicate sepsis in children?

A

Deranged physical observation

Prolonged CRT

Fever or hypothermia

Deranged behaviour

Poor feeding

Inconsolable / high pitched crying

Reduced consciousness

Reduced body tone (floppy)

Skin colour changes (cyanosis, mottled pale or ashen)

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31
Q

What is the traffic light system for assessment of serious illness in child with fever?

A

Green (low risk)

Amber (intermediate risk)

Red (high risk)

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32
Q

What forms part of the traffic light system assessment?

A

Colour: normal vs cyanosed, mottles, ashen

Activity: happy, responsive vs abnormal, drowsy, inconsolable

Respiratory: normal vs respiratory distress, tachypnoea, grunting

Circulation and hydration: normal, moist membranes vs tachycardia, dry membranes or poor skin turgour

Other: fever > 5 days, non blanching rash, seizures or high temp < 6 months

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33
Q

Which infants need to be treated urgently for sepsis?

A

Infants under 3 months with a temperature of 38C or above

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34
Q

What is the immediate management of sepsis?

A
  • Oxygen: if in shock / oxygen sats below 94%
  • Obtain IV access (cannulation)
  • Blood tests: including FBC, U&Es, CRP, clotting screen (INR), blood gas for lactate and acidosis
  • Blood cultures: ideally before giving abx
  • Urine dip: with cultures and sensitivities
  • Abx according to local guidelines, within 1 hour of presentation
  • IV fluids 20ml/kg IV bolus of normal saline if lactate above 2 mmol / L or there is shock
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35
Q

What investigations in suspected sepsis?

A

CXR if pnuemonia

Abdo and pelvic ultrasound if intra-abdo infection suspected

Lumbar puncture if meningitis suspected

Meningococcal PCR blood test

Serum cortisol if adrenal crisis suspected

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36
Q

How long to continue abx for if a bacterial infection is suspected?

A

5-7 days - alter abx if needed once organism is isolated

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37
Q

When should abx be stopped?

A

Low suspicion of bacterial infection - patient is well and blood cultures and two CRP results are negative at 48 hours

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38
Q

What is meningitis?

A

Inflammation of the meninges - lining of the brain and spinal cord (usually due to bacterial or viral infection)

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39
Q

What is neisseria meningitidis?

A

Gram negative diplococcus bacteria - circulae (cocci) that occur in pairs (diplo) aka meningococcus

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40
Q

What is meningococcal septicaemia?

A

Meningocuccus bacterial infection in the bloodstream - cause of classic non-blanching rash

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41
Q

What does a non-blanching rash occur?

A

DIC and subcutaneous haemorrhages

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42
Q

What is meningococcal meningitis?

A

When bacteria infects the meninges and the cerebrospinal fluid around the brian and spinal cord

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43
Q

What are the most common causes of bacterial meningitis in children and adults?

A

Neisseria meningitidis (meningococcus) and streptococcus penumoniae (pneumococcus)

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44
Q

What is the most common cause of meningitis in neonates?

A

Group B strep (GBS) contracted from birth from bacteria that lives harmlessly in mothers vagina

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45
Q

What are the typical features of meningitis?

A

Fever

Neck stiffness

Vomiting

Headache

Photophobia

Altered consiousness

Seizures

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46
Q

Do causes other then maningococcal septicaemia cause the non-blanching rash?

A

Not usually

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47
Q

How do neonates with sepsis present?

A

Non-specific signs

Hypotonia

Poor feeding

Lethargy

Hypothermia

Bulging fontanelle

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48
Q

When is a lumbar puncture performed for a child with fever?

A

Under 1 month with fever

1-3 months with fever and unwell

Under 1 year with unexplained fever and other features of serious illness

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49
Q

What two special tests look for meningeal irritation?

A

Kernig’s test

Brudzinski’s test

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50
Q

How is Kernig’s test performed?

A

Lie patient on back

Flex hip and knee to 90 degrees

Slowly straighten knee whilst keeping hip flexed

Stretch in the meninges produces spinal pain or resistance to movement

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51
Q

How is brudzinski’s test performed?

A

Lie patient on back

Use hands to lift their head and neck off the bed - flex chin to chest

Positive test = involuntary flex of hips and knees

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52
Q

How should bacterial meningitis be treated in GP?

A

If suspected meningitis and non-blanching rash should receive an urgent stat IM/IV benzylpenicillin prior to transfer to hospital - dose is age dependent

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53
Q

What if true penicillin allergy in GP with sepsis?

A

Transfer should be priority rather than finding alternative abx

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54
Q

What is the management of meningitis in hospital?

A

Blood culture and LP for CSF prior to starting abx (if acutely unwell then not to be delayed)

Blood tests for miningococcal PCR if meningococcal disease suspected - tests directly for meningococcal DNA can give result quicker than blood cultures

55
Q

What is the typical abx for meningitis?

A

Under 3 months - cefotaxime plus amoxicillin to cover listeria contracted during pregnancy

Above 3 months - ceftriaxone

Vancomycin - added if risk of penicillin resistent pneumococcal infection e.g. recent foreign travel or prolonged abx exposure

56
Q

What is given to reduce frequency and severity of hearing loss and neurological damage?

A

Steriods - dexamethasone 4 times faily for 4 days to children over 3 month if the LP is suggestive of bacterial meningitis

57
Q

Are bacterial meningitis and meningococcal infection notifiable diseases?

A

Yes, public health need to be informed of all cases

58
Q

When is risk of catching meningococcal infections highest?

A

Close prolonged contact within the 7 days prior to the onset of the illness (risk decreases 7 days after exposure)

59
Q

What is the recommended post-exposure prophylaxis after exposure to meningococcal infections?

A

Guided by public health - usually single dose of ciprofloxacin given asap (ideally within 24 hours of initial diagnosis)

60
Q

What are the common causes of viral meningitis?

A

Herpes simplex virus (HSV)

Enterovirus

Varicella zoster virus

Sample of CSF from lumbar puncture sent for viral PCR testing

61
Q

What is the management of viral meningitis?

A

Tends to be milder than bacterial requiring only supportive

Aciclovir can be used to treat suspected HSV or VZV infection

62
Q

Complete this table:

A
63
Q

What are some complications of meningitis?

A

Hearing loss is a key complication

Seizures and epilepsy

Cognitive impairment and learning disability

Memory loss

Cerebral palsy, with focal neurological deficits e.g. limb weakness or spasticity

64
Q

What is encephalitis?

A

Inflammation of the brain - result of infective or non-infective causes

65
Q

What are non-infective causes of encephalitis?

A

Autoimmune, meaning antibodies against brain tissue

66
Q

What is the most common cause of encephalitis?

A

Viral

67
Q

What is the most common cause of paediatric encephalitis in children and neonates respectively?

A
68
Q

What are some other causes of paediatric encephalitis?

A
69
Q

Why is it important to ask about vaccinations in paediatric encephalitis?

A

Measles, mumps, rubella and polio viruses can cause encephalitis

70
Q

How does paediatric encephalitis present?

A

Altered consciousness

Altered cognition

Unusual behaviour

Acute onset of focal neurological symptoms

Acute onset of focal seizures

Fever

71
Q

What investigations to establish the diagnosis of encephalitis?

A

Lumbar puncture sending CSF for viral PCR

CT scan if lumbar puncture contraindicated

MRI scan after LP to visualise the brain

EEG recording in mild or ambiguous symptoms - not always routinely required

Swabs of throat / vesicles

HIV in all patients with encephalitis

72
Q

What are some contraindications to a lumbar puncture?

A

GCS below 9

Haemodynamically unstable

Active seizures

Post-ictal

73
Q

What is the management of paediatric encephalitis?

A

IV antiviral medications:

  • Aciclovir to treat HSV and VZV
  • Ganciclovir to treat cytomegalovirus

Repeat lumbar puncture to ensure successful treatment prior to stopping antivirals

Aciclovir empirically until results available

Support with complications

74
Q

What are the complications of encephalitis?

A

Lasting fatigue and prolonged recovery

Change in personality or mood

Changes to memory and cognition

Learning disability

Headaches

Chronic pain

Movement disorders

Sensory disturbance

Seizures

Hormonal imbalance

75
Q

What is infectious mononucleosis (IM) caused by?

A

Infection with the Epstein Barr virus (EBV)

76
Q

What is infectious mononucleosis also known as?

A

Kissing disease

Glandular fever

Mono

77
Q

Where is EBV found?

A

Saliva of infected individuals (spread by kissing / sharing cups / toothbrushes)

78
Q

What happens if patient with sore throat - misdiagnosed - takes amoxicillin?

A

Develops itchy rash - mononucleosis causes an intensly itchy maculopapular rash in response to amoxicillin or cefalosporins

79
Q

What are the features of infectious mononucleosis?

A

Fever

Sore throat

Fatigue

Lymphadenopathy (swollen lymph nodes)

Tonsillar enlargement

Splenomegaly and in rare cases splenic rupture

80
Q

What antibodies does the body produce in response to infectious mononucleosis? When?

A

Heterophile antibodies (multipurpose and not specific to the EBV antigens) - takes up to 6 weeks for these antibodies to be produced

81
Q

How can heterophile antibodies be tested for?

A

Monospot test: combine patients blood to RBC from horses - heterophile antibodies - if present will react and give positive result

Paul-Bunnell test: similar to monospot test but ises RBCs from sheep

82
Q

Why are the monospot and paul-bunnell test only 70-80% sensitive but 100% specific for infectious mono?

A

Not everyone who has IM produces heterophile antibodies

83
Q

How to test for specific EBV antibodies?

A

By targetting viral capsid antigen (VCA)

84
Q

What does a rise in IgM and IgG suggest in mono?

A

IgM antibody rises early and suggests acute infection

IgG antibody persists after condition suggesting immunity

85
Q

What is the management of infectious mono?

A

Usually self limiting - acute illness lasts around 2-3 weeks - can leave patient with fatigue several months once infection is cleared

Avoid alcohol as EBV affects liver

Avoid contact sports due to risk of splenic rupture

86
Q

What are some complications of infectious mononucleosis?

A

Splenic rupture

Glomerulonephritis

Haemolytic anaemia

Thrombocytopenia

Chronic fatigue

87
Q

What type of cancer is EBV associated with?

A

Burkitt’s lymphoma

88
Q

What is mumps?

A

Viral infection spread by respiratory droplets

89
Q

What is the incubation period of mumps?

A

14-25 days

90
Q

What protection does the MMR vaccine provide against mumps?

A

80% protection

91
Q

How does mumps present?

A

Prodrome of flu-like illness for a few days

Parotid swelling - unilateral or bilateral

Fever

Muscle aches

Lethargy

Reduced appetite

Headache

Dry mouth

92
Q

How may mumps present with symptoms of the complication?

A

Abdo pain (pancreatitis)

Testicular pain and swelling (orchitis)

Confusion neck stiffness and headache (meningitis or encephalitis)

93
Q

How is the diagnosis of mumps confirmed?

A

PCR testing on a saliva swab (also tested for antibodies to the mumps virus)

94
Q

Is mumps a notifiable disease?

A

Yes, need to notify public health of any suspected and confirmed cases

95
Q

What is the management of mumps?

A

Supportive, rest, fluids, analgesia

Self-limiting condition

96
Q

What are the possible complications of mumps?

A

Pancreatitis

Orchitis

Meningitis

Sensorineural hearing loss

97
Q

What is AIDS referred to as in the UK?

A

Late stage HIV

98
Q

What type of virus is HIV? What are the types?

A

RNA retrovirus

HIV-1 is most common type

HIV-2 is rare outside west africa

99
Q

What does HIV do?

A

Virus enters and destroys the CD4 T helper cells - initial seroconversion flu like illness occurs within a few weeks of infection - infection is then asymptomatic untul patient becomes immunocompromised and develops AIDS defining illnesses

100
Q

How is HIV spread?

A

Unprotected anal, vaginal or oral sexual activity

Mother to child at any stage of pregnancy, birth or breastfeeding (vertical transmission)

Needle sharing, blood splashed in eye

101
Q

What is the mode of delivery to prevent mother to child HIV transmission?

A

Normal vaginal delivery for women with viral load < 50 copies /ml

Caesarean section considered for patients with > 50 copies / ml and in all women with >400 copies / ml

IV zidovudine given during caesarean if >10000 copies /ml

102
Q

For HIV, what prophylaxis treatment can be given to the baby?

A

Low risk (mums viral load < 50 copies per ml) = zidovudine for 4 weeks

High risk (mums viral load > 50 copies per ml) = zidovudine, lamivudine and nevirapine for 4 weeks

103
Q

Is breastfeeding safe if HIV positive?

A

HIV can be transmitted during breastfeedig - even if mother’s viral load is undetectable - never recommended (if mum is adamant and viral load is undetectable then can be attempted with monitoring from HIV team)

104
Q

When may a HIV test be falsely positive?

A

Due to maternal antibodies in children aged under 18 months

105
Q

How is HIV testing performed?

A

HIV antibody screen: standard screening test - can take up to 3 months for antibodies to develop after exposure to the virus

HIV viral load: will never be falsely positive but may come back as“undetectable” in patients on antiretroviral therapy

106
Q

When should HIV be tested for?

A

Babies to HIV positive

Immunodeficiency suspected

Young people who are sexually active - offered testing if concerns

Risk factors e.g. needle stick injury, sexual abuse or IV drug use

107
Q

When are babies to HIV positive parents tested?

A

HIV viral load test at 3 months (if this is negative then not contracted HIV during birth)

HIV antibody test at 24 months (if they have contracted HIV since their 3 month viral load e.g. through breastfeeding)

108
Q

What is the treatment of paediatric HIV?

A

Antiretroviral therapy (ART) to suppress the HIV infection, to achieve normal CD4 count and undetectable viral load

Normal childhood vaccines avoid / delay live vaccines if severely immunocompromised

Prophylactic co-trimoxazole (septrin) for children with low CD4 counts to protect against pneumocystis jirovecii pneumonia (PCP)

Treatment of opportunistic infections

109
Q

What is the role of the paediatric HIV multidisciplinary team?

A
  • Regular follow up to monitor growth and development
  • Dietician input for nutritional support
  • Parental education about the condition
  • Disclose diagnosis when child is mature enough
  • Psychological support
  • Specific sex education in relation to HIV when appropriate
110
Q

What type of virus is Hep B?

A

DNA virus - transmitted by direct contact with blood / bodily fuild

111
Q

What is the prognosis of hep B infection?

A

Most fully recover within 2 months

Portion go on to become chronic hep B carriers (virus DNA has integrated into their own DNA and continue to produce viral proteins)

112
Q

What is the risk of developing chronic hepatitis B after exposure?

A

90% for neonates

30% for children under 5

Under 10% for adolescents

113
Q

What is the progression of chronic hep B infection?

A

Most are asymptomatic with normal growth and development

Less than 5% develop liver cirrhosis

Less than 0.05% develop hepatocellular carcinoma

114
Q

What do the following antibodies and antigens signify?

Surface antigen (HBsAg)

E antigen (HBeAg)

Core antibodies (HBcAb)

Surface antibody (HBsAb)

Hepatitis B virus DNA (HBV DNA)

A

Surface antigen (HBsAg) – active infection

E antigen (HBeAg) – marker of viral replication and implies high infectivity

Core antibodies (HBcAb) – implies past or current infection

Surface antibody (HBsAb) – implies vaccination or past or current infection

Hepatitis B virus DNA (HBV DNA) – this is a direct count of the viral load

115
Q

In what order should hep B be screened for?

A

Test HBcAb (previous infection) and HBsAg (active infection) if positive then do further testing for HBeAg and viral load (HBV DNA)

116
Q

Which immunoglobulins are measured for HBcAb?

A

IgM and IgG

117
Q

What does a high HBeAg imply?

A

Patient is in an acute phase of the infection wherev virus is activelly replicating

118
Q

Which children to test for Hep B?

A

Children of hep B positive mums (screen at 12 months of age)

Migrants from endemic aread

Close contacts

119
Q

How to reduce the risk of the baby contracting hep B at birth?

A

Within 24 hours given:

  • Hep B vaccine (again at 1 and 12 months of age)
  • Hep B immunoglobulin infusion
120
Q

How to check if a baby has contracted hep B during birth?

A

Tested for HBsAg

121
Q

Can hep B positive mothers breastfeed?

A

If is safe for hep B positive mothers provided the babies are properly vaccinated

122
Q

What is the hep B vaccine? When is it given?

A

Injection of hepatitis B surface antigen - requires 3 doses and is part of the UK 6 in 1 vaccine

123
Q

What is the management of chronic hep B?

A

Usually asymptomatic and do not require treatment

Regular follow up to monitor serum ALT, HbeAg, HBV DNA, physical examination and liver ultrasound

If evidence of hepatitis or cirrhosis then treatment with antiviral medication may be considered

124
Q

What type of virus is hepatitis C?

A

RNA virus - spread by blood and bodily fluids

125
Q

How is hep C treated?

A

Curable using direct acting antiviral medications (not yet available for children)

126
Q

What is the progression of hep C in adults?

A

1 in 4 fight off virus

3 in 4 develop chronic hepatitis C

127
Q

What are some complications of hep C?

A

Liver cirrhosis and associated complications

Hepatocellular carcinoma

128
Q

Does hep C transmit from mother to baby in pregnancy?

A

Yes, 5-15% of the time

Hep C antivirals are not recommended in pregnancy

No additional measures are known to reduce risk of transmission

129
Q

What is the testing of Hep C in children?

A

Hepatitis C antibody is the screening test

Hepatitis C RNA to confirm the diagnosis of hep C, calculate viral load and identify genotype

130
Q

When are babies to hep C positive mothers tested?

A

18 months using the hep C antibody test

131
Q

Is breastfeeding permitted in hep C?

A

Yes - but temporarily stop if nippled become cracked

132
Q

What is the management of hep C infection in childhood?

A

Chronic hep B infection doesnt usually cause issues in childhood

Medical treatment in children over 3 years involved pegylated interferon and ribavirin

Treatment is typically delayed until adulthood

133
Q
A

Paediatrics (18 decks)

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