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AKT - Lizzie Bain > Vaccinations > Flashcards

Vaccinations Flashcards

1
Q

What are the general contra-indications to vaccination?

A
  • Acute illness: delay until fully recovered. Minor illness withoutfever or systemic upset - no need to postpone.
  • Severe local reaction to the previous dose. Expansive area of redness/swelling that involves much of the antero-lateral surface of thigh or major part of circumference of upper arm.
  • Severe generalised reaction to a previous dose. fever >39.5 <48h after, anaphylaxis, bronchospasm, laryngeal oedema, collapse, prolonged high pitched/inconsolable screaming >4h, convulsions/encephalopathy 72h after.
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2
Q

Live vaccinations may need to be avoided in which groups of patients? (may need to delay vaccine/alternative measures considered/benefit may outweigh risk)

A
  • primary or acquired immunodeficiency
  • on current or recent immunosuppressive or biological therapy
  • infants born to a mother who received immunosuppressive biological therapy during pregnancy (delay live vaccine for 6 months)
  • those in contact with an individual with immunodeficiency/ on immunosuppressive therapy (live flu vaccine in those with direct close contact)
  • pregnant women - delay live vaccines.
  • Immunoglobulin treatment - do it 3 weeks before or wait for 3 months to give live vaccine.
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3
Q

Those with egg allergy should not receive which vaccines (as they contain egg allergen)?

A
  • Influenza
  • Tick-borne encephalitis
  • Yellow fever
  • Hepatitis A
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4
Q

Those with Neomycin, streptomycin or polymyxin B allergies should not receive which vaccines?

A
  • Pertussis
  • Polio
  • Tetanus
  • Shingles
  • Varicella
  • Measles, Mumps and Rubella
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5
Q

Those with gelatine allergy should not receive which vaccines?

A
  • Shingles
  • Varicella
  • Measles, Mumps and Rubella
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6
Q

Those with severe (anaphylaxis) latex allergy should not receive the following vaccines which have latex in their packaging (UK):

A
  • one of the Hepatitis B vaccines (HBVaxPro)
  • one of the MenC vaccines (Menjugate)
  • MenB vaccine (Bexsero)

If they have allergy other than anaphylaxis (e.g. contact allergy to latex gloves), then these vaccines can still be given.

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7
Q

Most live vaccines should not be administered to individuals with primary or acquired immunodeficiency. Which conditions does this include?

A
  • immunosuppression due to acute and chronic leukaemias and lymphoma
  • severe immunosuppression due to HIV/AIDS (BCG vaccine is contraindicated in all HIV positive individuals)
  • cellular immune deficiencies e.g. SCID, Wiskott-Aldrich syndrome, 22q11 deficiency/DiGeorge syndrome (with this syndrome seek specialist advice - as may be able to receive if not severely immunocompromised).
  • patients under follow up for chronic lymphoproliferatve disorder e.g. haem malignancies, indolent lymphoma, CLL, myeloma, plasma cell dyscrasias
  • those who have had an allogenic stem cell transplant (cells from donor) in last 2 years. After that only if they have no ongoing immunosuppression or GVHD.
  • received an autologous (own stem cells) stem cell transplant in past 2 years. After that only if in remission.
  • are on or recently received high doses of immunosuppressive or biological therapies (risk of severe/fatal infections) - consult specialist if lower dose/less recent
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8
Q

Which ‘live’ vaccines are currently given in the UK?

A
  • live nasal influenza vaccine (for children and adolescents)
  • Measles, Mumps and Rubella vaccine
  • Rotavirus vaccine (Rotarix)
  • Shingles vaccine (Zostavax) but Shingrix is not live.
  • BCG vaccine (indicated in special groups)
  • Varicella vaccine - against chicken pox (indicated in special groups)
  • Yellow Fever vaccine and Oral typhoid vaccine (Ty21a) - travel vaccines.

*rotavirus vaccine benefit may exceed risk (except for in those with SCID)

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9
Q

Which immunosuppresive therapies mean live vaccines should not be given?

A
  • chemotherapy or radiotherapy in the last 6 months
  • immunosuppressive therapy for solid organ transplant in last 6 months
  • biological therapy in last 12 months (e.g. anti-TNF rituximab)
  • Higher dose DMARDs / non biological oral immune modulating drugs e.g. MTX >25mg/week, azapthioprine, 6-mercaptopurine in past 3 months
  • high dose steroids >40mg Prednisolone/day for >1 week - in last 3 months
  • lower dose steroids >20mg prednisolone/day for >2 weeks - in last 3 months.

Those on long term low dose DMARD and low dose steroids can receive live vaccines.
Replacement corticosteroids for adrenal insufficiency do not cause immunosuppression.

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10
Q

Thos with CSF leaks should have which additional vaccine?

A

●● pneumococcal vaccine

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11
Q

Those with asplenia or dysfunction of the spleen (including sickle cell) should have which additional vaccines?

A

●● influenza vaccine
●● meningococcal vaccines
●● pneumococcal vaccine (also for individuals with coeliac disease)

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12
Q

Those with chronic heart disease should have which additional vaccine?

A

●● influenza vaccine
●● pneumococcal vaccine

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13
Q

Those with CKD (incl haemodialysis) should have which additional vaccines?

A
  • influenza vaccine
  • pneumococcal vaccine
  • hepatitis B vaccine
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14
Q

Those with chronic liver disease should have which additional vaccines?

A

●● hepatitis A vaccine
●● hepatitis B vaccine
●● influenza vaccine
●● pneumococcal vaccine

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15
Q

Those with chronic neurological disease should have which additional vaccines?

A
  • influenza vaccine
  • pneumococcal vaccine
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16
Q

Those with chronic respiratory disease should have which additional vaccines?

A

●● influenza vaccine
●● pneumococcal vaccine

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17
Q

Thos with cochlear implants should have which additional vaccine?

A

●● pneumococcal vaccine

18
Q

Those with complement disorders should have which additional vaccines?

A

●● influenza vaccine
●● meningococcal vaccine (also for those on complement inhibitors)
●● pneumococcal vaccine

19
Q

Those with diabetes should have which additional vaccines?

A

●● influenza vaccine
●● pneumococcal vaccine

20
Q

Those with haemophilia should have which additional vaccines?

A
  • hepatitis A vaccine
  • hepatitis B vaccine
21
Q

Those with immunosuppression due to disease or treatment should have which additional vaccines?

A

influenza vaccine
pneumococcal vaccine

22
Q

Those with morbid obesity should have which additional vaccine?

A

●● influenza vaccine

23
Q

Adverse effects following immunisation (AFEIs) can be classified into 4 main groups:

A
  • programme-related
  • vaccine-induced
  • coincidental
  • unknown.
24
Q

What are programme related AEFIs?

A
  • adverse events due to inappropriate practices in the provision of vaccination.
  • e.g. wrong dose, used beyond expiry date, inappropriate intervals, wrong preparation/diluent
25
Q

What are vaccine induced AEFIs?

A
  • reactions specifically caused by the vaccine or it’s component parts.
26
Q

What are the common vaccine induced AEFIs?

A
  • pain/swelling/redness at site of injection - should be anticipated
  • systemic adverse reactions: fever, malaise, myalgia, irritability, headache, loss of appetite. Fever starts within a few hours of tetanus vaccine, but occurs 7-10 days after measles vaccine.
  • These do NOT contraindicate futher doses of the vaccine.
27
Q

How should fever after vaccine be managed in children?

A
  • it is very common after MenB vaccine
  • for the MenB vaccine - 3 doses of paracetamol are advised: dose 1 as soon as possible, dose 2 4-6 hours later, dose 3 4-6 hours after that.
  • If MenB is not being given - don’t give paracetamol to prevent fever. But if pain/fever is problematic after vaccination - paracetamol or ibuprofen can be used.
  • contact Dr if temp is 39-40 or child has a seizure.
28
Q

What should parents be told to expect after MMR vaccination?

A
  • at 6-10 days - measles vaccine starts to work and can cause fever, measles rash, loss of appetite (they are not infectious to others).
  • 2-3 weeks after vaccination - mumps vaccine can cause mumps symptoms - fever and swollen glands (parotitis)
  • 12-14 days after - rubella vaccine can cause brief rash and fever, rash can sometimes occur up to 6 weeks later.
29
Q

What are rare vaccine-induced AEFIs?

A
  • seizures
  • hypotonic-hyporesponsive episodes
  • ITP
  • acute arthropathy
  • allergic reactions & anaphylaxis.
30
Q

Which legal requirement means employers must assess risks from exposure to hazardous substances and pathogens, and protect workers & others from those risks?

A

The Control of Substances Hazardous to Health (COSHH) Regulations 2002

  • All employees should undergo a pre-emloyment health assessment, including review of immunisation needs.
  • Employers must have an effective immunisation programme in place (must arrange and pay for this).
31
Q

For staff involved in direct patient care, which vaccinations should they have?

A
  • all routine vaccinations, including tetanus, diptheria, polio and MMR
  • BCG - especially staff in maternity,paeds, and immunocompromised patients (e.g. oncology)
  • Hepatitis B - antibody titres should be checked 1-4 months after completion of primary course of vaccine.
  • influenza
  • varicella - for staff with a negative/uncertain history of chicken-pox should be tested and vaccine offered to those without varicella zoster antibody
32
Q

Which vaccinations are required for non-clinical staff in healthcare settings? e.g. ward clerks, receptionists, porters, cleaners

A
  • routine vaccinations.
  • HepB if at risk of injury from sharps, or risk of being injured/bitten by patients.
  • Varicella - for those without varicella zoster antibody
33
Q

What is a patient specific direction? (PSD)

A
  • a written instruction from an independent prescriber to another healthcare professional - to supply and/or administer a medicine directly to a named patient , or several named patients.
34
Q

What are patient group directions? (PGDs)

A
  • written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment
  • Not a form of prescribing but provide a legal framework for the supply and/or administration of medicines by a range of health professionals (nurses, midwives, pharmacists, ambulance paramedics etc)
  • Employing organisations must ensure that all users of
    PGDs are fully competent and trained in their use.
35
Q

When is a PSD appropriate?

A
  • PSDs are used once a patient has been assessed by a prescriber (doctor/dentist/independent nurse prescriber)
  • that prescriber instructs another healthcare professional in writing to supply/administer a medicine directly to that named patient or to several named patients.
  • preferred to PGD as is specifically tailored to the patient.
  • PSD is the usual method in routine childhood imms - prescribed by the GP at the 6-8 week check - as an instruction in the Person Child Health Record (Red Book) - allows the imms to be given in GP surgery.
36
Q

When is a PGD appropriate?

A
  • nurse led travel clinics
  • nurse led imms sessions in schools and prisons
  • nurses working with disadvantaged groups e.g. refugees, looked after children.
  • black triangle vaccines can be included in PGDs as long as they are used in line with the Joint Committee on Vaccination and Immunisation (JCVI).
  • unlicensed vaccines cannot be included in a PGD (must be a PSD). e.g. imported vaccines.
37
Q

Who should be involved in the development of a PGD?

A
  • a senior doctor
  • a senior pharmacist
  • a senior person in each profession required to operate within the direction
  • the clinical governance lead or their equivalent
    organisational authority.
38
Q

What information must a PGD contain?

A
  • the name of the business to which the direction applies (i.e. primary care organisations (PCOs)
  • the date the direction comes into force and the date it expires (should be reviewed every 2 years
  • a description of the medicine(s) to which the direction applies
  • the class of healthcare professional who may supply or administer the medicine
  • signatures of a doctor and a pharmacist
  • signature of a representative from an appropriate health organisation
  • the clinical condition or situation to which the direction applies
  • a description of those patients excluded from treatment under the direction
  • a description of the circumstances in which further advice should be sought from a doctor and arrangements for referral
  • details of the appropriate dose and maximum total dosage, quantity, pharmaceutical form and strength, route and frequency of administration and minimum or maximum period over which the medicine should be
    administered
  • warnings, potential adverse reactions
  • necesarry follow-up actions
  • Should be in line with CMO letters and updates
39
Q

Which vaccinations are indicated in HIV?

A
  • influenza (annually)
  • Hepatitis B (if non-immune)
  • HPV (female)
  • pneumococcal

BCG is contraindicated

40
Q

Who is eligible for shingles vaccine?

A
  • Age >=50 and severely immunocompromised - shingrix
  • 70-79 already eligible for zostavax until age 80
  • Patients turning 65 and 70 - shingrix (eligible until age 80).
41
Q

Which vaccines are indicated in pregnancy?

A
  • inactivated flu
  • pertussis
  • covid-19

AKT - Lizzie Bain (55 decks)

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