Vaccination Flashcards
A 52 year old lady is travelling to Western Africa in two months time. She requires a Yellow Fever vaccine. In her history she tells you she received a kidney transplant 4 years previously and is being treated with cyclosporin. Do you vaccinate her? Why?
No. Immunosuppressants are contraindications for Live Attenuated vaccines. Only 6 months post immunosuppressant treatment can someone receive a Live vaccine.
A 2 month old boy attends your clinic for a routine DTaP vaccine. His mother tells you he’d been suffering febrile convulsions 3 weeks previously. Do you vaccinate? Why?
Yes, vaccinate now. So long as the fever has now subsided there is no reason to delay.
A 30 month old girl has been brought in for a Hep B vaccination. Her mother is very worried as her daughter received a needle stick at her uncle’s house who is an intravenous drug user and known to be a Hep B carrier. The child has a temperature of 38.2 and a runny nose. Do you vaccinate?
Yes! Risk of Hep B too serious to delay. Hep B can be given post infection to prevent chronic Hepatitis. Would likely give combination of Ig as immediate Tx plus vaccination.
65 yo male comes to obtain his free flu vaccination. His history tells you that he experienced an anaphylactic reaction to intramuscular kanamycin treatment 40 years previously. Do you administer the influenza vaccine?
You would need to check the contents and use only a brand of the Influenza vaccine that does not contain kanamycin.
12 month old child comes for routine vaccination: MMR + HiB + Men C + Pneumococcal. He has a 3 day Hx of runny nose, cough, fever and small spots in his mouth with bluish centre on red erythematous base. A red blotchy rash appeared today on his tummy and face. Do you vaccinate?
He likely has measles. You should delay the vaccine until his fever has subsided.
65 yo female in for a pneumococcal polysaccharide vaccine. She suffers with rheumatoid arthritis and is being treated with methotrexate and penicillamine. Do you vaccinate?
Yes. Methotrexate is an immunosuppressant which would only be contraindicated in the vaccine was Live. This Pneumococcal polysaccharide vaccine is an inactivated (dead) vaccine.
A female 21 yo nurse is required by occupation to have her BCG. She is 8 weeks pregnant. What do you do?
Do not vaccinate her. It is not advised to give pregnant women Live vaccines. Wait until after delivery.
A 20 yo male is about to travel to India. He is comes in for a 2nd dose of Hep A but says that the last one caused a large, red, sore area covering almost his entire upper arm. Do you give the 2nd dose?
Yes. This is a normal local reaction to a vaccination, not an anaphylactic reaction.
A 68 yo male is due an Influenza vaccine. He is a heavy smoker, suffers with COPD and was diagnoses several years ago with diabetes mellitus. He said that last year he felt “fluey” after his vaccination: tired, achey, feverish and suffered headaches. Do you give him the vaccination?
Yes. Although COPD is a relative contraindication for Influenza vaccination the risk of contracting flu is a greater one.
Also advise that this will be a different strain to the last one.
A male 19 yo is working as a health care worker and has started his haematology rotation. He has come to get is MMR vaccine. The only treatment his is currently receiving a salbutamol inhaler for his asthma. Do you vaccinate?
Yes. Inhaled steroids are not a contraindication for Live vaccines unlike oral steroids.
What is prednisolone used to treat? What is the relevant information you must consider in relation to vaccines regarding use of prednisolone?
Prednisolone is a corticosteroid used to treat inflammatory and allergic conditions such as asthma, rheumatoid arthritis and colitis. Live vaccines should not be administered to patients on Prednisolone until 3 months after Tx has stopped.
A 3 yo girl has come for her routine DTaP + polio + MMR. She has been suffering an undiagnosed neurological illness causing fits, developmental regression and loss of motor skills. Should you vaccinate?
No; delay until official diagnosis made otherwise there is a chance any progression of the illness may be blamed on the vaccine.
In what ways can one acquire passive immunity?
Maternal - via placenta
Vaccination - Injection of immunoglobulins
In what ways can one acquire active immunity?
Exposure to infectious agent (antigen/pathogen)
Vaccination - live attenuated or inactivated organisms or their products
Name 4 mythical contraindications to vaccination
Asthma
Eczema
Febrile convulsions (although ought to delay until subsided)
Epilepsy (or family Hx of)
