Public Health Flashcards
What are the aims of immunisation
To control communicable diseases
Prevent the onset of disease through primary prevention
Interrupt transmission of disease
Alter disease progression or limit consequences through secondary prevention
How are vaccines used in primary prevention
Given pre-exposure to antigen to develop immunity
Helps those who are currently healthy to reduce their risk of a specific disease
E.g. childhood schedule, given to older people, travel vaccines, high risk groups, occupational
How do vaccines work
They teach the immune system to recognise bacteria and viruses before the person encounters them naturally
This allows the body to effectively fight the pathogens
What is active immunity
The person has been exposed to the pathogen in the environment or artificially and produced an immune response
What are antigens
Parts of bacteria and viruses, which are recognised by the immune system
Usually proteins or polysaccharides
What are antibodies
Proteins which bind to antigens - very specific
When they bind it alerts other immune cells
Describe B cells
Mature in bone marrow
Triggered to produce antibodies when they encounter a foreign antigen
Describe T cells
Mature in thymus
Exist as CD4 and CD8
Orchestrate response of immune system by binding to other cells and sending out signals
What is passive immunity
Transfer of pre-formed antibodies from one person to another
How can passive immunity occur
Mother to unborn baby via placenta - lasts up to 1 year
From another person or animal - blood donors, human Ig or specific Ig
What are the advantages of passive immunity via immunoglobulin transfers
Rapid action
Can be given post exposure
Can control outbreaks
Used if vaccine is contraindicated
What are the disadvantages of passive immunity via immunoglobulin transfers
Short term protection Short time window Blood derived May trigger hypersensitivity reaction expensive
What is the preferred means of immunisation
Active immunity through vaccination
List the different types of vaccines
Live virus - attenuated so less effective at causing disease but still triggers immune response Inactivated: Killed organism Subunit vaccines Conjugate
What are the benefits of inactivated vaccines
Safer
Suited to bacterial pathogens
List contraindications to vaccines
Confrimed anaphylaxis in response to previous dose
Cannot give live vaccines to immunosuppressed or pregnant patients
Egg allergy - used in production of some vaccines
Severe latex allergy
Acute illness (until resolves)
What is herd immunity
Protect unvaccinated individuals, through having sufficiently large proportion of population vaccinated
Those who are vaccinated stop transmission
Which diseases are routinely vaccinated against in the UK
Diphtheria Whooping cough Tetanus Polio Hib Meningococcal Measles Mumps Rubella Flu Pneumococcal HPV Hep B
What are notifiable diseases
When there is clinical suspicion or a health risk state associated with this specific disease and the doctors have a legal duty to report it to the health board
How do you notify a health board of a disease
In writing within 3 days
Notify ASAP via phone if deemed urgent
What is diphtheria
URTI characterized by sore throat, low grade fever
Get a white membrane of tonsils, pharynx etc
Caused by gram + bacterium
For which meningococcal disease serogroups is a vaccine available
A C W Y135 B
How are meningococcal diseases spread
Spread by person-to-person contact through respiratory droplets of infected people (close contact)
In some people it is part of normal flora
How do the boards decide which vaccines are needed
Is there a need for it (epidemiological factors)?
Does it work?
Costs
Acceptability - any safety issues
What is the under 5 mortality rate
Probability of a child born in a specific year or period dying before reaching the age of 5
(per 1000 live births)
What is the infant mortality rate
Probability of a child born in a specific year or period dying before reaching the age of 1
(per 1000 live births)
What are the top 5 causes of under 5 mortality globally
Preterm birth complications Pneumonia Intrapartum-related complications - obstructed labour/asphyxia Diarrhoea Neonatal sepsis
What are the top 5 causes of under 5 mortality in Africa
Diarrhoea Pneumonia Malaria Preterm birth complications Intrapartum-related complications
what percentage of child deaths are linked to malnutrition
45%
What is considered the most dangerous period of a child’s life
The first 24 hours
Many babies die in this window
What simple measures can be used to decrease neonatal death
Proper antenatal care: tetanus vaccine and treatment of maternal infection (HIV, syphilis)
Steroids for pre-term labour
Skilled birth attendant
Clean delivery, warm baby and able to resuscitate
How do you prevent neonates dying of syphilis that they got from mum
Give a single dose of penicillin to mum when she is pregnant
Why do you give steroid in pre-term births
Helps the lungs develop sufficiently
What are the risk factors for developing pneumonia in kids
Malnutrition
Over-crowding
Indoor air pollution
Parental smoking
How can you prevent pneumonia in kids
Vaccinations
Breastfeeding then complimentary nutrition
Good hygiene
How do you prevent diarrhoea in kids
Safe drinking water, good hygiene and sanitation
Breastfeeding and good nutrition
Vaccination - rotavirus
What is the major cause of diarrhoea in kids
Contaminated water and food sources
How do you treat diarrhoea in kids
Oral rehydration solution (ORS)
Zinc supplements
How do the majority of children get HIV
Mother to child transmission
Can occur in pregnancy, during birth or through breastfeeding
How do you prevent kids getting HIV
Maternal lifelong antiretroviral treatment
Screen for and treat other STDs, especially herpes
Infant prophylaxis for 6 weeks
How does HIV present in kids
Recurrent or severe childhood illnesses or oral candidiasis Failure to thrive or grow Fever Lymphadenopathy Hepatosplenomegaly PJP, Kaposi sarcoma, TB
How do you treat HIV in kids
Highly active antiretroviral therapy (HAART)
2 NRTI’s and NNRTI or protease inhibitor
What are the risk factors for kids developing TB
HIV
Malnutrition
Household contact
How does TB present in kids
Chronic cough or fever lasting more than 2 weeks
Night sweats
weight loss
Lymphadenopathy
How can you prevent TB
BCG vaccine
pre and post exposure isoniazid
What causes malaria
Plasmodium parasite from female anopheles mosquito
Different parasites cause different severities
How does malaria present
Fever
Pallor
Non-specific malaise
Very variable
How do you treat malaria
Artemisinin-based combination therapy (ACT) for 3 days
Severe malaria treat with IM or IV artesunate until can tolerate oral
How do you prevent malaria
Long-lasting insecticidal nets (LLINs)
Pilot projects for malaria vaccine
What causes malnutrition
Lack of access
Poor feeding practices
Infection
What is kwashiorkor
oedema and rounded belly due to lack of protein in the diet
Sign of malnutrition
What is marasmus
Extreme skinniness seen in malnourished children
How do you treat malnutrition
Need to be careful not to overload Treat first for hypoglycaemia, hypothermia and dehydration Balance electrolytes Treat any underlying infection Give micronutrients Initiate feeding and catch-up feeding Sensory stimulation
What is the definition of health inequalities
Differences in health status or in
the distribution of health determinants between
different population groups
Often those in more deprived groups have poorer health
What factors determine health inequalities
Unmodifiable: age, sex and genetics
Modifiable - living and working conditions, water and sanitation, access to services, education, food access
What are the most common causes of death in young men in the UK
Suicide Drugs and alcohol Accidents Violence More common in deprived areas
List some fundamental causes of health inequality
Global economic forces Political priority Social values Unequal distribution of wealth and power Poverty and discrimination NEEDS TO BE UNDONE
List some environmental influences on health inequality
Economy and work
Learning
Services
Needs to prevent inequality in these areas
What are the potential outcomes of adverse childhood experiences
Impairment of social, emotional and cognitive skills
Adoption of risky behaviour
Lower life expectancy
List examples of adverse childhood experience
Abuse - physical, sexual & emotional
Neglect - physical and emotional
Mental illness, substance abuse and violence in the house
Incarcerated relative Divorce
What are indicators of risk for inequalities in childhood and poor health
Family breakdown Lack of family rituals Poor domestic and financial management Neglect Lack of discipline and routine Violence and abuse
What are the symptoms of deprivation/adverse childhood experience
Anti-social behaviour Isolated / withdrawn Behavioural issues Emotional issues Child assuming role of carer
What is the definition of obesity
Abnormal or excessive fat accumulation that may impair health - WHO
Result of long term positive energy imbalance
What is the adult BMI range for overweight
25-30
What is the adult BMI range for obese
> 30
Can you use normal fixed BMI measurements for children
NO
Healthy BMI changes with age
Growth spurts mean height change is not always matched with proportionate weight gain
How do you plot BMI in children (over 2 y/o)
Plot the BMI against age on the centile chart
Need to use the one appropriate for gender
What are the clinical thresholds for overweight and obesity in children
> or equal to 91st centile is overweight
> or equal to 98th centile is obese (clinically)
How do you plot BMI in an under 2 y/o
use BMI conversion chart to provide an approximate BMI centile
Usually measure length rather than height in this age group
Can waist circumference be used in children to diagnose obesity or health risk
NO
Children from deprived areas have a higher prevalence of obesity - true or false
TRUE
List risk factors for obesity by the age of 3
Parental overweight Black ethnicity Greater birthweight Smoking during pregnancy Lone motherhood Pre-pregnancy overweight Maternal employment ≥21 hrs/week Solid foods before 4 months
Is breastfeeding protective against obesity
YES
If breastfed for at least 4 months
What genetic conditions can cause obesity in childhood
Prader-Willi Syndrome
Bardet-Biedl Syndrome
Describe the symptoms of Prader-Willi syndrome
At birth they are floppy, have weak or absent sucking
Childhood: always hungry and looking for food (hyperphagia), reduced energy requirement - prone to obesity
Low muscle tone, learning difficulty, hypogonadism and short stature
Describe the symptoms of Bardet-Biedl Syndrome
Hyperphagia - always hungry
Low activity
Make them prone to obesity
Also have visual impairments, renal abnormalities, polydactyly, learning difficulties and hypogonadism
What are the negative consequences of being overweight or obese in childhood
Poorer health in childhood and adulthood
Low self-esteem
Higher risk of bullying
Poorer school attendance and achievement
Poorer employment prospects
How would you assess an obese child
BMI - plot on chart Eating habits and activity Social and school Emotional issues Family support Family history
List common comorbidities of childhood obesity
Metabolic syndrome Respiratory problems Hip and knee problems Diabetes CHD Sleep apnoea Hypertension
At what point would you refer an obese child for paediatric review
If their is serious comorbidity that requires urgent weight loss - intercranial hypertension, sleep apnoea etc
Suspected underlying medical cause - e.g. endocrine issue
Under 2’s who are severely obese
How can you help control portion sizes
Smaller plates
Cook only what’s required
Parents serve rather than kids serve themselves
Age appropriate servings
How much physical activity should a child get per day
Around 60 mins
Does increased screen time increase risk of being overweight or obese
YES
More than 2 hours per day increases risk
Dose dependant
Does increased sleep duration increase risk of obesity
NO
Decreases sleep duration is associated with obesity
Can you use orlistat in children
Should only be given to >12 if physical or severe psychological comorbidities present
In exceptional circumstances such as life threatening comorbidities it may be considered <12
Is surgery considered in overweight children
Surgery may be considered in post-pubertal adolescents with
very severe to extreme obesity and severe comorbidities
