Vaccines Flashcards
At what CD4 count is there an increased risk of vaccine-associated disease with replicating vaccines?
<200
What is the recommended time for spacing between administration of replicating vaccines?
4 weeks
If blood products are or have been administered when can replicating vaccines be given?
FOURTEEN days before transfusion
or
THREE months after
What impact does CD4 have on the response to non-replicating vaccines?
REDUCED response
What impact does vaccination have on viral load?
transient INCREASE
no clinical significance
Which type of vaccines can be given in pregnancy?
NON-REPLICATING
What organism causes ANTHRAX?
Bacillus anthracis
Gram positive bacterium
How is ANTHRAX acquired?
Handling of infected herbivorous animals live or dead
When is ANTHRAX vaccine recommended for PLWHIV?
if significant risk of anthrax exposure
- occupational
- member of ministry of defence
- as part of post exposure prophylaxis
What is the recommended ANTHRAX vaccine regimen?
FOUR doses + BOOSTER
0, 3, 6 WEEKS
SIX months
ANNUAL booster
What organism causes CHOLERA?
Vibrio cholerae
Non-invasive toxin secreting
Gram negative bacterium
How is the CHOLERA vaccine administered?
ORAL
What is the recommended CHOLERA vaccine regimen?
TWO doses oral
1 week apart
+
single BOOSTER
When is CHOLERA vaccine recommended for PLWHIV?
if significant risk of cholera exposure and unable to take adequate precautions
- assisting in disaster relief
- visiting remote areas
What organism causes DIPHTHERIA?
Corynebacterium diphtheriae or ulcerans
Gram positive bacterium
What two other vaccines is diphtheria given in combination with?
TETANUS toxoid
Inactivated POLIO vaccine
What is the recommended DIPHTHERIA vaccine regimen?
Combination diphtheria/tetanus/polio THREE doses 1 month apart then TWO BOOSTERS 5 & 10 years
Vaccinated individuals who are then exposed to diphtheria what is the recommended post exposure prophylaxis?
Antibiotics
+
BOOSTER dose vaccine
What organism is HAEMOPHILUS INFLUENZAE SEROTYPE b?
Gram negative coccobacillus
When is Hib vaccine recommended for PLWHIV?
Asplenia
Splenic dysfunction
Complement deficiency
What is the recommended Hib vaccine regimen?
ONE dose
What is the recommended hepatitis A vaccine regimen for PLW HIV?
CD4 >350
TWO doses 0 & 6 months
CD4<350
THREE doses 0, 1 & 6 months
What difference does CD4 count make to hepatitis A vaccination schedule?
THREE doses if CD4<350, 2 doses if >350
If a PLWHIV has CD4<200 and requires urgent PRE-EXPOSURE prophylaxis to hepatitis A what should be given?
Human immunoglobulin
and
Vaccination
What is the POST-EXPOSURE prophylaxis regimen for hepatitis A?
Vaccination within FOURTEEN days
if CD4 <200 add IMMUNOGLOBULIN
What is the recommended regimen for HEPATITIS B vaccination?
FOUR doses 0, 1, 2 and 6 months Double dose ENGERIX 40mcg or Fendrix 20mcg
When can ultra-rapid hepatitis B vaccination be considered in PLW HIV?
CD4 >500
When should HBsAb be checked after hepatitis B vaccination?
4-8 weeks after last dose
If HBsAb is <10 after full course of vaccination what is the next step for PLW HIV?
THREE further doses
DOUBLE dose 40mcg
or
Fendrix 20mcg
When should hepatitis B revaccination of non-responders be delayed?
If CD4<350, wait until increased
If HBsAb is 10-100 after full course of vaccination what is the next step for PLW HIV?
ONE further DOUBLE dose
Which PLW HIV are recommended to have HPV vaccine?
Unvaccinated
- men + women aged up to 26
- MSM to 40 yrs
- Women to 40 yrs
What is the recommended HPV vaccine course for PLW HIV?
THREE doses
0, 1 and 6 months
What are the 3 types of INFLUENZA?
A, B, C
Which INFLUENZA types cause the most disease?
A and B
When is the INFLUENZA season in Northern hemisphere?
October to May
When is the INFLUENZA season in Southern hemisphere?
April to September
When is the INFLUENZA season in the tropics?
ALL year round
What are the two types of flu vaccine formulation used in the UK?
Inactivated
and
Live attenuated
How is the live attenuated flu vaccine administered and to whom?
INTRANASAL
to children
What allergy needs to be screened for before administering inactivated flu vaccine?
EGG allergy
vaccine cultured inside hen egg
When in the year is the optimum timing for flu vaccination?
September to November
benefit until March
Which flu vaccine type is recommended for PLWHIV?
QUADRIvalent
In which regions of the world can Japanese encephalitis virus occur?
South east Asia
Western pacific
What is the vaccination schedule for Japanese encephalitis?
TWO doses
1 month apart
then
BOOSTER 12 months
How might MEASLES present differently in people with advanced HIV?
No RASH
complications DELAYED up to several months from initial infection
What type of vaccine is the MMR?
replicating LIVE attenuated
What is the MMR vaccine schedule for ADULTS?
TWO doses
1 month apart
What is contraindicated following the MMR vaccine?
PREGNANCY for 1 month
Who is the MMR contraindicated in?
Severe immunocompromised
- CD4 <200
Pregnant
What is the post exposure prophylaxis for contact with MEASLES?
within THREE days CD4 >200 -check Measles IgG -if negative, give human normal IG CD4 <200 - give IG regardless of measles IgG
Which PLW HIV should be given the MMR?
IgG negative
- CD4 >200
- established on ART
What is the recommendation for meningococcal vaccination in PLW HIV?
Follow national guidance
- <25 years + never vaccinated
- asplenia
- travel risk
What is the MENINGOCOCCAL vaccine schedule?
TWO doses
2 months apart
What THREE other vaccines is PERTUSSIS combined with?
DIPHTHERIA
TETANUS
POLIO
What is the recommendation for pertussis vaccination for PLW HIV?
National guidance
- pregnant
ONE dose
What TWO pneumococcal vaccines are used in the UK?
Pneumococcal polysaccharide vaccine (PPV) 23
and
Pneumococcal protein-conjugated vaccine (PCV) 13
How many serotypes are covered with pneumococcal vaccine PCV 13?
THIRTEEN
What is the recommended pneumococcal vaccination schedule for PLW HIV?
SINGLE dose
PCV-13
then
PPV-23 as per national guidance (>65 years old)
Should pneumococcal vaccination be repeated?
NO
however should receive PPV23 when older
What is the recommended POLIO vaccination schedule for PLW HIV?
if never/uncertain vaccinated - THREE doses 1 month apart then TWO doses 5 & 10 years
Is rabies vaccine inactivated or live?
INACTIVATED
What is the RABIES vaccination schedule?
THREE doses
0, 7 and 28 days
What is the RABIES post-exposure prophylaxis recommendation for PLW HIV?
No previous vaccine
FIVE doses
0, 3, 7, 14, and 30 days (ie roughly double interval between each)
and
Immunoglobulin around bite site in select cases
At what CD4 count level might response to RABIES vaccine be reduced?
CD4 <500
What is the recommendation for people with CD4 <500 and receiving rabies vaccine?
Check serology 2-4 weeks after third dose
Ab<0.5 IU/mL offer BOOSTER (DOUBLE dose)
What is the TETANUS vaccination schedule?
FIVE doses total THREE 1 month apart then 5 & 10 years
What is post exposure prophylaxis for TETANUS?
Vaccination if >10 years since last dose
If high risk wound add immunoglobulin
What is the TICK-BORNE ENCEPHALITIS vaccination schedule?
THREE doses
0, 1 and 2 months
then
BOOSTER 9-12 months
What is the recommended vaccination schedule for SALMONELLA TYPHI (typhoid)?
NON REPLICATING
ONE dose
2 weeks before risk
What is the recommendation for BCG vaccination in PLW HIV?
DO NOT give
increased risk of local and systemic complications
no clear benefit of vaccine
How is chickenpox spread?
RESPIRATORY
or
direct contact with skin LESIONS
What type of vaccine are the VARICELLA vaccines?
LIVE replicating vaccines
How many VARICELLA vaccines are there?
TWO
chicken pox and shingles
What are the UK national guidelines for SHINGLES vaccination?
Vaccinate >70 yrs old
+
immunocompetent
What is the recommendation for VARICELLA vaccination in PLW HIV?
If seropositive - NATIONAL age based shingles vaccine If seronegative + CD4>200 - TWO dose CHICKENPOX vaccine 3 months apart
Which group of PLW HIV are recommended to have YELLOW FEVER vaccination?
Travel to high risk country
Age <60
CD4 >200
Why is YELLOW FEVER vaccine contraindicated in PLW HIV with CD4 <200 or age >60?
Higher risk of
VACCINE INDUCED NEUROLOGICAL DISEASE
