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I&I year 3 > Vaccination, A Clinical Perspective > Flashcards

Vaccination, A Clinical Perspective Flashcards

1
Q

what is diphtheria?

A

an infectious respiratory disease

-caused by toxigenic strains of bacteria Corynebacterium diphtheriae or Corynebacterium ulcerans

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2
Q

how is diphtheria transmitted?

A

airborne droplets

-bacteria infect the throat and sometimes the skin

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3
Q

incubation period meaning?

A

the period between exposure to an infection and the appearance of the first symptoms

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4
Q

diphtheria incubation period?

A

2-7 days

-patients with untreated disease may be infectious for up to 4 weeks.

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5
Q

groups diphtheria infects?

A

affects people of all ages - most serious in young infants and the elderly.

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6
Q

symptoms of diphtheria?

A

early signs: mild fever, swollen neck glands, anorexia, malaise, cough.

2-3 days: membrane of dead cells forms in throat, tonsils, larynx or nose - may narrow or occlude the airway leading to respiratory distress.

Severe Symptoms…
Toxin can travel through bloodstream causing extensive organ damage, neurological and heart complications.
Death occurs in 5-10% of cases.
Milder infection can still occur in people who are partially vaccinated or were vaccinated a long time ago.

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7
Q

Diphtheria Vaccine Recommendations…

A

Minimum of 5 diphtheria doses given at appropriate intervals.

Ten-yearly boosters recommended for travel to endemic areas or people exposed in the course of their work.

Part of combination vaccine with tetanus and pertussis.

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8
Q

what is tetanus caused by?

A

caused by bacterium Clostridium tetani - may occur if a wound or cut is infected by soil or manure
-bacteria form spores that can survive in the environment for years

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9
Q

tetanus and vaccinations

A

Non-communicable therefore vaccination required for protection (no herd immunity)
-people who recover from tetanus do not have natural immunity therefore need to be immunised

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10
Q

tetanus incubation period?

A

4-21 days

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11
Q

which group of people does tetanus affect?

A

People of all ages

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12
Q

Symptoms of Tetanus?

A

Initially: muscle stiffness of the jaw (“Lockjaw”) 50% cases

Followed by: neck stiffness, difficulty swallowing, stiffness of stomach muscles, muscle spasms, sweating and fever

Complications: Fractures, hypertension, laryngospasm, pulmonary embolism, aspiration, and death.

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13
Q

Neonatal Tetanus…

A

More frequent in developing countries.
Infant born without protective passive immunity.
Infection of the umbilical cord stump.
High fatality rate without therapy.
Rates can be reduced by improving birth conditions and vaccinating pregnancy mothers.

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14
Q

Cases of tetanus…

A

Overall reduction in number of cases of tetanus. Higher prevalence in developing countries.

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15
Q

Tetanus Vaccine Recommendations…

A

5 doses of tetanus at appropriate intervals.
Early treatment with tetanus immunoglobulin for heavily contaminated wounds.
Early recognition of potential tetanus wounds.
Continued vigilance for early signs and symptoms of tetanus in IDUs.

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16
Q

what is Pertussis (Whooping Cough)?

A

Disease of the respiratory tract caused by Bordatella pertussis.

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17
Q

how is Pertussis spread?

A

Spread easily from person-to-person in droplets produced by coughing or sneezing
-Infectious from 6 days after exposure to 3 weeks after onset of cough

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18
Q

Pertussis incubation period?

A

Incubation period 6-20 days with a range of 4 - 21 days

-Duration of illness can be 2-3 months.

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19
Q

Symptoms of Whooping Cough…

A

Initially: cold-like symptoms - runny nose, watery eyes, sneezing, fever and a mild cough

Followed by: gradually worsening cough, which develops to paroxysms of coughing followed by characteristic whoop

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20
Q

Pertussis complications

A

Respiratory – collapsed lung and/or pneumonia.

Neurological – lack of oxygen leading to altered consciousness, convulsions, permanent brain damage, death.

Severe weight loss and dehydration due to vomiting.

Sudden death - babies may stop breathing, apnoeic attacks.

Late 1970s – There was a paper published that linked the pertussis vaccine with a chronic neurological condition. Similar to autism-MMR scare.

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21
Q

Pertussis Vaccines…

A

Whole cell vaccine (wP) – suspension of whole killed Bordetella pertussis organisms.

Acellular vaccines (aP) – contain 2, 3, or 5 highly purified components from the B pertussis organism.

From Sept 2004, 5aP vaccine used in UK:
Is as efficacious as previously used whole cell vaccine.

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22
Q

Poliomyelitis - how many types?

A

3

I, II and III

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23
Q

Polio - method of entry?

A

Virus enters via the mouth, replicates in pharynx and GI tract, invades local lymph tissue and enters blood stream - may infect cells of CNS causing aseptic meningitis.

More rarely replicates in and destroys the motor neurones which activate the muscles (~1:100 infections) – paralytic polio.

Transmitted through contact with the faeces or pharyngeal secretions of an infected person. Virus can be excreted for up to six weeks in the faeces and two weeks in saliva.

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24
Q

Polio incubation period

A

3 – 21 days

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25
Q

Polio infectiousness

A

Not precise but transmission is possible as long as virus is excreted

Most infectious immediately before and 1-2 weeks after onset of paralytic disease.

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26
Q

Paralytic Polio?

A

Less than 1% of all polio infections result in flaccid paralysis.

Paralysis develops 1-10 days after prodromal illness and progresses for 2-3 days.

The degree of recovery varies from person to person.

The use of one or both arms or legs may be lost and breathing may not be possible without help of a respirator.

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27
Q

when was the polio vaccine switched and what was it switched to?

A

Switched from inactivated vaccine to live polio vaccine in 1962.
However, some individuals whose immune systems were compromised were not able to cope with the new vaccine.

Until Oct 2004, live polio vaccine, given by mouth was used in UK. Very effective and stimulates immune response in the blood and gut.

Very rarely (1 in a million) vaccine virus reverts back to wild type causing Vaccine Associated Paralytic Polio (VAPP).
Cases of VAPP have been reported in recipients of OPV (Oral poliovirus vaccines) and in contacts of the recipients
OPV replaced by IPV (Inactivated polio vaccine).

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28
Q

Haemophilus influenzae type b (Hib) disease:

A

Caused by infection with Haemophilus influenzae bacteria.
Transmission occurs from coughing, sneezing, close contact with infected person.

Healthy individuals can carry Hib bacteria in their nose and throat without symptoms.

15% of cases present with epiglottitis.

29
Q

Incubation period for Hib?

A

Incubation period less than 10 days.

30
Q

Hib presentation?

A

Most common presentation of invasive Hib is meningitis, frequently accompanied by bacteraemia (60%).

31
Q

Meningococcal C Disease caused by?

A

-Caused by infection with Bacteria Neisseria meningitides.

This is a Gram negative diplococci, divided into 13 serogroups.
-Groups B and C are most common in the UK.
Less common serogroups include A, Y, W135, and Z.

32
Q

how is Men C spread?

A

Transmission occurs through frequent and prolonged contact with respiratory secretions of a carrier from coughing, sneezing, kissing.

Healthy individuals carry the bacteria in their nose and throat without symptoms

33
Q

Symptoms of Meningitis or Septicaemia…

A 
Rash
 Fever/ Vomiting
 Cold hands and feet
 Rapid breathing
 Joint/ stomach/ muscle ache
 Drowsiness/ LOC
 Stiff neck
 Dislike of bright lights
34
Q

MenC Vaccine…

A

UK 1st country to use MCC. Vaccination programme began in November 1999.
Routine vaccination at 2,3 and 4 months.

Aimed to offer vaccine to all children under 18 years old through catch up campaigns, centred around schools, with GP appointments for the under 5’s and those not in education.

Vaccine schedule - 3 doses for infants under 4 months, 2 doses for 5-12months and 1 dose for children older than 1 year.

Part of the routine childhood immunisation programme given at the same time as DTP/Hib and polio at 2,3,4 months.
MenB for infants and Men ACWY for adolescents.

35
Q

Pneumococcal Disease - caused by?

A

Caused by infection with Bacteria Streptococcus pneumoniae.

Over 90 serotypes identified (based on differences in polysaccharides in outer coating).

Not all 90 serotypes cause disease – about 80% invasive infections in UK children caused by just 8-10 of these types.

Higher prevalence in vulnerable groups – elderly and infants.

36
Q

Pneumococcal Disease - transmission?

A

Transmitted through infected droplets through coughing, sneezing & close contact.

Carried in the nose and throat.

37
Q

what controls whether Pneumococcal disease develops?

A

Whether infection develops or not depends on immune system and on virulence of serotype acquired.

38
Q

Pneumococcal Meningitis…

A

2nd most common cause of bacterial meningitis after the meningococcus (serogroup B) in the UK.

Associated with a high fatality rate (over 15% in affected children).

Significant number of survivors (30-50%) will suffer residual physical and neurological complications e.g profound deafness, seizure disorder, memory impairment and mental retardation, lowered IQ.

Clinical after effects in survivors of pneumococcal meningitis significantly higher and more severe than those seen after Hib or meningococcus meningitis.

39
Q

Pneumococcal Vaccines

A

Polysaccharide and Conjugate

Poly:

  • not effective in under 2 year olds
  • does not induce immunologic memory
  • does not protect against non-invasive disease
  • does not reduce nasopharyngeal carriage

Conjugate

  • effective in under 2 year olds
  • induces immunological memory
  • protect against non-invasive disease
  • reduce carriage, inducing herd immunity
40
Q

Rotavirus

A
  • Most common cause of diarrhoea in children aged ≤5 years worldwide
  • Highly infectious: only 10-00 virus particles needed for infection.
41
Q

rotavirus transmission

A

Transmission mainly through the faeco-oral route:
Contaminated food/water
Contact with contaminated objects or surfaces
Can live for hours on hands and get spread from by human contact

May remain viable in the environment for months if not disinfected
Sometimes through respiratory droplets: by sneezing and coughing.

Children can spread rotaviruses both before and after they become sick with diarrhea - increased risk in daycare facilities.
Contagiousness period 8 days (>30 days if immunocompromised

42
Q

rotavirus symptoms

A

Sudden onset abdominal pain & vomiting - usually lasts 24-48 hours.
Profuse watery diarrhea - lasting 3 to 8 days (median 6 days).
Mild to Severe dehydration – if untreated can result in death
Fever
Adults and older children can also become infected – mild symptoms, often asymptomatic.

43
Q

diagnosing and treating rotavirus

A

DIAGNOSIS: often based on symptoms and physical examination, but can test stools for rotavirus antigen.
TREATMENT: supportive care, rehydration (preferably orally), may need hospital admission for IV fluids.

44
Q

Measles (MMR) - caused by and transmission

A

Extremely contagious viral illness caused by Morbillivirus.
Most common in 1-4 year olds.
Spread by contact with nose and throat secretions and in airborne droplets released when an infected person sneezes or coughs.
Transmission period is from beginning of first symptoms to 4 days after appearance of the rash.
Incubation period ranges from 7 to 18 days.

45
Q

Symptoms of Measles:

Early and Late

A 
Early…
Runny nose 
Cough 
Red and watery eyes and 
Small white spots inside the cheeks (Koplik’s spots)

Late…
A slightly raised rash develops, spreading from the face and upper neck to the body and then to the hands and feet over a period of three days.
Rash lasts 5-6 days.
Loss of appetite and loose stools.

46
Q

Measles: complications

A

Complications occur in approximately 30% of reported cases. Infants, adults and immunocompromised are at highest risk of severe complications.

Severe diarrhoea may be a problem especially for infants, causing dehydration (8 per 100 cases).
Pneumonia affects 1-6 per 100 cases and is the commonest cause of death.
Otits media (7-9 per 100 cases), convulsions (1 in 200).
Encephalitis may also develop (1 per 1000 cases).

Subacute sclerosing panencephalitis (SSPE) is a rare but fatal complication of measles infection (1 per 25,000 all cases; 1 per 8000 <2yrs).

Death (1 in 5,000 cases in UK).
Large increase in number of cases due to MMR-autism scare.

47
Q

MMR Vaccine…

A

MMR vaccine is offered at 12-13 months and again pre-school (around 3½ years) of age.
A single dose offers around 95% protection.
Two doses offer >99% protection.
Measles is one of the most infectious diseases known to man.
High levels of immunity are required to eliminate measles.
Lower levels are sufficient in younger children (85%-90%).
Higher levels (>95%) are required in older children (secondary schools) and adults.

Mumps MMR
Two doses of MMR are required for full protection from mumps.
Cases still occurring in Universities since 2005 outbreak.
Opportunistic vaccination at “teenage” booster and university entrance for those who have only received 1 MMR vaccine.

48
Q

Mumps (MMR): caused by and transmission

A

Acute viral illness caused by paramyxovirus.
Transmitted through the air when infected person coughs or sneezes.
Incubation period 14-25 days.
Transmissible for several days before the parotid swelling to several days after it appears.

49
Q

Mumps symptoms:

A

Headache and fever
Parotid swelling which may be unilateral or bilateral
Photophobia, neck stiffness (meningism) can develop
At least 30% of cases in children have no symptoms and presents most severely in adults.

50
Q

Mumps complications

A

Pancreatitis (4%)
Oophoritis (5% of post-pubertal women)
Orchitis (25% of post-pubertal men)
Neurological complications including meningitis and bilateral or unilateral deafness.
Nephritis, cardiac abnormalities and rarely death have been reported.

51
Q

Rubella (MMR): caused by, transmission and incubation period

A

Also, known as German measles.
Caused by Toga virus.
Transmitted through direct or droplet contact with nasopharyngeal secretions.
Incubation period is 14 – 21 days.
Infectivity period from 1 week before until 5-7 days after the onset of rash.
The peak incidence of infection is late winter and early spring.

52
Q

Rubella symptoms:

A

Often a mild illness.
May begin with swollen lymph glands, low grade fever, malaise & conjunctivitis.
Maculo-papular discreet rash develops on face, neck and body.
Swollen joints and joint pain common in adults.

53
Q

Complications of Rubella in Pregnancy…

A 
Congenital rubella syndrome (CRS).
Risk of foetal damage is estimated at…
90% in first 10 weeks
10-20% by 16 weeks
Rare after 20 weeks
Defects include cardiac, auditory, ophthalmic, neurological problems.
54
Q

Human Papilloma Virus (HPV):

A

Human Papillomavirus is a DNA virus - over 100 different types. Most common are HPV18 and HPV16 which together account for 70% of all cervical cancers.
Infects skin and mucosal sites (squamous epithelium) through skin-to-skin contact.
HPV infections are often asymptomatic.
Can resolve spontaneously…
70% new high-risk infections will clear within a year.
90% new infections clear within 2 years.
Persistent infection can cause cell changes often leading to lesions, warts or ano-genital cancers e.g. cervical cancer.

55
Q

HPV Vaccine:

A

Two licensed vaccines:
Gardasil: protects against HPV 6,11,16,18 (ROUTINELY USED IN UK SINCE 2012)
Cervarix: protects against HPV 16,18
Clinical trials show very high efficacy and well tolerated.
Both vaccines over 99% effective at preventing pre-cancerous lesions associated with HPV types 16 and 18.

Vaccination protocol:
0.5ml IM injection in 3 doses over 6 months (0,1-2, 6m)
Booster not currently thought necessary

56
Q

Hepatitis B:

A

Infection of the liver caused by Hepatitis B virus.

The incubation period ranges from 40 to 160 days.

Extremely infectious (x100 more infectious than HIV).

World-wide, about 1 million people die from acute and chronic HB infection, making it one of the major. causes of morbidity and mortality in humans.

57
Q

Hepatitis B transmission:

A

The virus is transmitted by exposure to infected blood or body fluids.

Transmission most commonly occurs:
Perinatal transmission: mother to child.

Parenteral transmission: exposure to blood/other infective fluids.

Sexual transmission: contact with an infected person.

58
Q

HepB Selective Vaccination for Neonates…

A

Babies born to infected mothers at high risk of acquiring infection at birth.

Development of chronic HepB can be prevented in over 90% through vaccination started at birth.

Hepatitis B vaccine should be given to:
Babies born to mothers who are chronically infected with HBV or who have had acute hepatitis B during pregnancy.

Babies born to highly infectious mothers should also receive HepB Immunoglobulin (HBIG).
HepB vaccine is highly effective at preventing infection if given shortly after exposure.

HBIG is used after exposure to give rapid protection until HepB vaccine becomes effective.

Whenever immediate protection is required, the vaccine should always be given. When appropriate (high risk exposure/known non-responder), HBIG should be given simultaneously at a different site.

59
Q

Tuberculosis:

A

Caused by Mycobacterium tuberculosis.
Usually attacks the lungs (pulmonary – 60% of UK cases), but other parts of the body, including the bones, joints and brain can also be affected (extra-pulmonary).

Only the pulmonary form of TB disease is infectious.
Transmission occurs through coughing of infectious droplets and usually requires prolonged close contact with an infectious case.

Initial infection may be eliminated, progress to active TB over following weeks or months or remain latent (no symptoms, bacteria remain in body).
People of all ages can contract tuberculosis.

Risk of disease is highest in children <3yrs, older people and with weakened immunity.

60
Q

TB symptoms

A

General weakness, weight loss, fever and night sweats.

Pulmonary TB: persistent cough, haemoptysis, chest pain.

In young children, the only sign may be stunted growth or failure to thrive.

Other symptoms depend on the part of the body that is affected.

TB of the bones and joints may cause swelling, pain and crippling effects in the hips, knees and spine.
TB weakens the body generally. It may cause affected person to contract other diseases or cause existing diseases to become more severe.

61
Q

BCG Vaccine for Tuberculosis…

A

2005: Universal programme of offering BCG to school age children replaced by a targeted neonatal and other risk group-based programme. This was because firstly, the BCG vaccine was not very effective in older children and adults and secondly, because case rates in older children and younger adults had declined massively so routine vaccination for these age groups were not necessary.

62
Q

BCG vaccine is recommended for…

A

All babies, at or soon after birth, living in areas where the incidence of TB is 40/100,000 or greater
Children (<16yrs) whose parents or grandparents have lived in a country with a TB prevalence of 40/100,000 or higher
Previously unvaccinated new immigrants from high prevalence countries countries for TB
Contacts of cases of TB
Travellers (<16yrs) to countries with high TB prevalence for >3m
Occupational e.g. Healthcare workers <35yrs

63
Q

Influenza:

A

An acute infection of the respiratory tract caused by type A, B or C influenza virus.

Influenza A usually causes more severe illness than B.
Transmitted by aerosol, droplets or direct contact with respiratory secretions of an infected person.
Highly infectious with an incubation period of 1-3 days.
There are seasonal and annual variations in incidence.
Most cases occur within 6-8 week winter period (peak Dec-March).

64
Q

Influenza Epidemiology…

A

Flu activity usually between September to March (weeks 37 and 15).
Impact of flu varies from year to year.
Moderate levels of influenza activity seen in 2014/15 season
ICU/HDU admissions in 2014/15 higher than seen in the previous few seasons.

The impact of flu on the population varies from year to year and is influenced by changes in the virus that, in turn, influence the proportion of the population that may be susceptible to infection and the severity of the illness.

The graph shows the rate of influenza/influenza-like illness episodes in England and Wales per 100,000 consultations in primary care from 2008/9 flu season to 2014/15 season. The data show that flu viruses circulate each winter season, but the degree of activity varies substantially.

65
Q

Influenza symptoms

A 
fever
chills
headache
myalgia
extreme fatigue 
dry cough, sore throat and stuffy nose
-In healthy individuals: unpleasant illness but recover 2-7 days.
66
Q

Influenza complications

A 
In more vulnerable individuals can lead to complications of:
secondary bronchitis
bacterial pneumonia 
otitis media (in children)
In severe cases, may lead to:
meningitis
encephalitis
meningoencephalitis
death (at least 3000-4000 each winter)
67
Q

Influenza Vaccines…

A

Current Trivalent Inactivated Vaccine (TIV):
Variable efficacy/effectiveness
Transient protection
Immunity tends to be subtype-specific
Given as an injection
Local reactions at site & possible systemic reactions

Live attenuated influenza vaccines (LAIV) – HERD IMMUNITY:
Nasal administration: more acceptable for children
Fewer side-effects (mainly nasal congestion / rhinorrhoea, but also decreased appetite, headache & malaise)
LAIV is sprayed into the nose using a simple syringe-like device that delivers a 0.1-mL volume of a large-particle aerosol into each nostril for a total volume of 0.2 mL

68
Q

Varicella and Zoster (Chickenpox and Shingles):

A

Acute highly infectious disease caused by varicella-zoster virus.
Transmitted by personal contact, droplet spread, contact with infected articles.
Most common in children under 10 years.
Seasonal with peak March-May.
Shingles vaccine is cost-effective – optimal age to vaccinate is at 70 years despite lower efficacy if protection only lasts about 5 years.

I&I year 3 (25 decks)

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