Questions from S 7 Flashcards
Actual exam question
Complete the virus childhood immunisation table
Age
8, 12, 16 weeks old
Name virus vaccines x 2
Name vaccine type x 2
HBV vaccine - recombinant subunit
Polio - inactivated
Actual exam question
Complete the virus childhood immunisation table
Age
8 and 12 weeks old
Name virus vaccine
Name vaccine type
Rotavirus
Live attenuated
Actual exam question
Complete the virus childhood immunisation table
Age
1 year old
Name virus vaccine
Name vaccine type
MMR
Live attenuated
Actual exam question
Complete the virus childhood immunisation table
Age
3 years 4 months old
Name virus vaccines
Name vaccine type
MMR vaccine booster - live attenuated
Polio vaccine booster - inactivated
When is live oral polio vaccine used?
Only used in developing countries, and in outbreak settings
Actual exam question
Complete the virus childhood immunisation table
Age
12/ 13 years old
Name virus vaccines x 1
Name vaccine type x 1
HPV
Gardasil subunit vaccine
Actual exam question
Complete the virus childhood immunisation table
Age
2 months - 17 years old
Name virus vaccines
Name vaccine type
Influenza A/B
Live intra-nasal vaccine for most children
Inactivated if live vaccine contra-indicated
Actual exam question
In addition to routine childhood immunisation schedule, further vaccines may be offered to at risk children (<18 years old) outside of routine schedule. Give 3 examples of such vaccines, and conditions under which they are offered
LAIV- all school age children
HAV - foreign travel to high risk country, or following exposure
HBV - birth, 1 month, 12 months, plus routine schedule doses. If born to mother who has HBV infection.
Full schedule Birth, 1 month, 2 months, 3 months, 4 months, 12 months
Rabies vaccine - travel to high risk area, or following exposure
Japanese Encephalitis - travel to high risk area
Yellow Fever - travel to high risk area
Tick Borne Encephalitis - travel to high risk area
Actual exam question
In 2022, there was an epidemic of severe hepatitis in young children (<10 years old) in UK.
What was the name of epidemic given by UKHSA?
What was the causative pathogen?
Original name - Acute hepatitis of unknown aetiology in children
After discovery -
Adeno-associated virus 2 infection in children with non-A–E hepatitis
Primary Adeno-associated virus 2 (AAV2) infection
Note this virus was discovered in adenovirus preparations, and thought to be a contaminant. But often found during adenovirus infections
NOT Adenovirus. This is in Adenoviridae family.
AAV2 is in Parvoviridae
Actual exam question
In 2022, there was an epidemic of severe hepatitis in young children (<10 years old) in UK.
What is the leading theory of how the pathogen caused disease?
Which laboratory proposed the leading theory?
Researchers in Glasgow across two teams found that AAV2 (which cannot replicate without a ‘helper’ virus such as an adenovirus or herpesvirus) was present in 96% cases of unknown hepatitis examined across both studies.
Therefore, the researchers believe that coinfection with two viruses – AAV2 and an adenovirus, or less often the herpes virus HHV6 (which has also been found in sample from some patients) – may offer the best explanation for the onset of severe liver disease in affected children.
AAV2 plus a helper virus - Adenovirus F41 or HHV6
Adenovirus F41 is a exam mark
Actual exam question
In 2022, there was an epidemic of severe hepatitis in young children (<10 years old) in UK.
How many children were affected?
What was the clinical picture of disease?
1000 cases in uk
50% hospitalised
Flu-like illness
Diarrhoea/ vomiting/ abdominal pain
acute hepatitis - ALT >1000
jaundice
1 patient required liver transplant
Actual exam question
In 2022, there was an epidemic of severe hepatitis in young children (<10 years old) in UK.
What were hypotheses about why this outbreak occurred?
Post-pandemic
Children had not been exposed to AAV2, Adeno, HHV6, so big population of children acquired these infections at same time
Actual exam question
In 2022, there was an epidemic of severe hepatitis in young children (<10 years old) in UK.
What was the role of SARS-CoV-2 in the clinical picutre
SARS-CoV-2 ruled out as a helper virus - not found in liver biopsies. Co-incidental that a lot of children had covid at similar time
Actual exam question
In 2022, there was an epidemic of severe hepatitis in young children (<10 years old) in UK.
How was the causative virus established?
Metagenomics from blood/ liver
With expertise in metagenomics and adenovirus sequencing, the London team studied 28 cases, including liver samples from five children that required a transplant and blood samples from the remaining children who did not – residual samples were sufficient to test 17 cases for AAV2, 16 of which tested positive. RNA sequencing of liver samples confirmed the presence of AAV2 replication in the liver of children with unknown hepatitis. Patient samples were compared with 132 controls from immunocompromised and immunocompetent patients. The London study showed that AAV2 was present only very rarely in the children who did not have hepatitis (6 out of 100) and at much lower levels, even for immunocompromised children (11 out of 32)
Actual exam question
In 2022, there was an epidemic of severe hepatitis in young children (<10 years old) in UK.
Why does western population seem more at risk of this infection?
HLA-DRB1*04:01 allele
A recent study identified a possible immunogenetic association on the basis of high frequency of the class II HLA-DRB1*04:01 allele associated with the UK hepatitis cases
This allele is more frequently detected in populations in northwestern Europe suggesting that children in Ireland could be particularly vulnerable to UK hepatitis cases
