Vaccination Flashcards
Your next patient is a 4 year old girl who was brought in by her mother to discuss about the influenza vaccine.
Tasks:
Take a history
Explain about the influenza vaccine recommendations
Open-ended question
D: Hi, my name is ____. I’ll be taking care of you today. How can I help you today?
R: I’m here to discuss about the influenza vaccine and I don’t understand why she needs it
D: I appreciate you coming in to discuss about this. Before we go any further, do you have any specific concerns that you want me to address today?
R: Yes, she has an egg allergy, she is asthmatic, and recently she had a course of steroids
D: I understand this, we’ll address these concerns in our discussion. But is it okay if I ask you a few questions first to better understand the situation?
Egg allergy
D: Can you describe the allergic reaction when it happened the first time?
R: She developed some lip swelling. We went to the ED, they said it’s anaphylaxis and she now has an epi pen
D: How soon did the reaction happen after eating eggs?
D: Any other allergies that the child has?
D: Has she had any history of anaphylaxis to influenza vaccination or any other vaccine?
D: Any personal history of any medical conditions?
D: Is she taking any medications?
D: Does she currently have a fever, or is she feeling sick right now?
D: Can I ask your overall opinion and feeling on vaccinations?
Counselling
Let me explain about the influenza vaccine. A vaccination exposes your immune system to part of the virus and this triggers an immune response and prepares your immune system to fight future infections more efficiently. The vaccine usually contains only a part of the virus and it has no live virus in it. The best time to get the flu vaccination is before flu season (May - September)
Your next patient is a 70 year old man who has presented to your general practice requesting the shingles vaccine
Tasks:
Take history for 4 minutes
Explain and educate about the shingles vaccination
Open-ended question
D: Hi, my name is ____. I’ll be taking care of you today. How can I help you today?
D: I appreciate that you have come in today to discuss more about the vaccine. Is it okay if I ask you a few questions first?
D: Can you tell me how much you know about the shingles vaccine?
Key Questions
D: Have you ever had chickenpox before?
D: Have you ever had shingles before? (space 12 months from shingles episode)
D: Have you received any shingles vaccine in the past?
D: Any history of allergies to any vaccines?
D: Any other allergies that you have?
D: Any history of medical conditions that weaken the immune system like Diabetes, any cancers?
D: Are you using any medications? (steroids, methotrexate)
D: Any concerns about the vaccine that you’d like me to address?
Geriatric Screening
Counselling
The shingles vaccine protects you against an episode of shingles which is the reactivation of the chickenpox virus and causes a painful rash and blisters on one side of your body.
We have 2 vaccines approved in Australia. The older version is Zostavax and the new one is Shingrix.
Zostavax was the older version that we used to have in the national immunization program (NIP). It contains a live virus, and this is the reason that we are not able to use it in people who have weak immune system like people who have cancer, diabetes, or on special medications.
Shingrix is the newer version of the shingles vaccine. It does not contain any live virus, and we can use it in people who have weak immune systems. It works better than Zostavax and provides longer protection against shingles. It is free on the NIP for people above the age of 65 or any adult that has an immunocompromised state.
Minor side effects of the vaccine is swelling, redness, pain, tiredness, muscle aches, fever, tummy upset.
Major side effect is a severe allergic reaction to the vaccine called anaphylaxis
We are unable to use this vaccine if you have any history of severe allergic reaction to shingrix, or to any component of the vaccine
We will do the first dose now, then give the 2nd dose at 2-6 months (if immunocompetent), or 1-2 months (if immunocompromised)
I’ll give you reading materials about the vaccine from the Australian Immunization handbook. You can think about it and whenever you are ready, you can come and we can get the vaccine done.
Your next patient is a 13 year old teenager who has been brought in by her mother. She has been offered Gardasil vaccination at school and her mother is here to discuss about the vaccine.
Tasks:
Counsel the mother about the Gardasil vaccine and address her concerns
Open-ended question
D: Hi, my name is ____. I’ll be taking care of you today. How can I help you?
D: Thank you for coming in and have a discussion about this. May I know how much you know about the vaccine?
D: Do you have any specific concerns that you want me to address?
Counselling
Vaccinations are a useful prevention method for many infections. The Gardasil vaccine protects us against the HPV virus and prepares the immune system to fight the virus more efficiently. HPV is a sexually transmitted infection, transmitted during sex, and is the main cause of cervical cancer and warts in the private parts.
The vaccine is made of small proteins which are similar to the proteins on the outer surface of the virus. The vaccine does not contain any live virus, nor killed virus, nor DNA from the virus, and does not cause an infection or any symptoms.
Gardasil covers against the 9 high risk strains of HPV, especially 16 and 18, which are the high risk strains that cause cervical cancer.
We just 1 dose as part of the national immunization program, usually at the age of 12-13, in school. Catch-up vaccine can be given up to the age of 25. However, the vaccine works best when it is given before exposure to the virus, as it is a preventive vaccine and prevents infection in the event of coming into contact with the virus.
It is most effective when given at 9-14 years of age, as their immune system is stronger and gives a better antibody response compared to older children.
Mother’s concern:
The vaccine is not meant to encourage teenagers to have sex. We still educate them about having safe sex, and importance of consent in sexual activity. We prefer to do it before exposure and at this age because it gives us the best response.
Side effects: pain, swelling, redness at injection site; major side effect: very rarely, anaphylaxis, which is the same for all vaccines
Contraindications: anaphylaxis to HPV vaccine, yeast allergy, severe bleeding disorder
I will give you reading materials about the vaccine from Australian immunization handbook. I want you to read them and think about it. We can have another family meeting to discuss this.
Any other questions that you want me to address?
Your next patient is a 12 month old child who is brought in by his mother. His mother is refusing vaccination today as her friend told her that vaccination is harmful.
Tasks:
Take history for 2 minutes
Counsel the mother about her concerns
Open-ended question
D: Hi, my name is ___. I’ll be taking care of your child today. How can I help you today?
R: Agenda: MMR causing autism
D: Is there any specific concerns that you want me to address?
D: Is it okay if I ask you a few questions?
D: Has he received any vaccinations so far?
D: Any side effects with any of the vaccinations?
D: Has he had any history of anaphylaxis or severe allergic reaction to any vaccination?
D: Can I ask you how you feel about vaccination and how much you know about their function?
Counselling
Non-judgmental approach
I understand that hearing and reading about the link between MMR vaccination and autism can be distressing. This was suggested in a study years ago, but it was later reviewed and the researchers found no links between the vaccine and autism, and later on it was shown that the initial research was done incorrectly.
The MMR vaccine covers against measles, mumps and rubella, which are viruses that can cause serious infections in childhood. Measles can cause a severe fever and rash in children and it can lead to severe lung infection and inflammation of the brain, and this can be life threatening.
Before vaccinations became available, we had breakouts of measles which had significant rate of complications and death in children.
By having a high rate of vaccination, we have achieved herd immunity which means that the virus will be spread less as most children are now immune to it.
This vaccine can have some side effects. Minor ones are fever, swelling, redness in the injection site. Rarely, it can cause a severe allergic reaction that we call anaphylaxis, which is why we observe him after each vaccination to make sure no allergic reactions develop, and in case he has a reaction, we can treat it immediately. Very rarely, it can cause encephalopathy, which is an inflammation of the brain.
Overall, we consider the benefits of vaccination vs the rare possibility of side effects. In this case, preventing a serious infection like measles outweighs the rare possibility of the side effects.
I’ll give you reading materials from Royal Children’s hospital. I can book another consultation to discuss this with your partner and if you have any further questions or concerns, I can address them.
Schedule:
2 doses: 12 months (MMR) and 18 months (MMRV)
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Boostrix Counselling
Your next patient is a 20 week pregnant lady who has come to you today to discuss the required vaccinations for pregnancy.
Task:
Counsel the patient
