Vaccines Flashcards by Emily Goldstein

Name the smallpox/mpox vaccine, strain, type of vaccine and schedule.

Imvanex

Modified Vaccinia Ankara (MVA-BN) (manufactured by Bavarian Nordic)

Ankara strain

Live attenuated virus (via multiple passage), however should be treated like an inactivated vaccine as it is replication defective

Two doses at least 28 days apart

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Name the licensed dengue vaccine in the UK, the type of vaccine, which serotype(s) it contains, indications, schedule, efficacy, contraindications and pre vaccine requirements.

Name the vaccine which is not licensed in the UK and why.

Qdenga - Live attenuated vaccine, quadravalent on a DENV-2 backbone.

Recommended for age 4+ who have had previous infection, travelling to an area with risk of dengue, or working with dengue.

Main contraindication is no previous dengue infection. Also usual live attenuated virus contraindications - pregnancy/breastfeeding, immunocompromised, hypersensitivity
Two doses 3 months apart. 86% reduction in hospitalisation

Pre vaccine requirements - PCR confirmed dengue infection (UKAS accredited lab) or serology with supporting clinical and travel history.

Dengvaxia is not licensed in the UK (but is in some endemic countries) due to high risk of severe dengue in those not previously infected. This is theoretical for Qdenga but hasn’t been demonstrated.

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Name the strains in the MMR vaccine

Measles = Schwarz (Priorix) or Enders Edmonston (MMRVaxPro)

Mumps = Jeryl Lynn

Rubella = Wistar RA 27/3

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What does that the vaccine Priorix contain?

Measles, mumps and rubella

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What measles genotype is in the MMR vaccine and why is this important?

Genotype A

This means you can differentiate vaccine related infection from natural infection.

Circulating strains are B3, D4, D8, H1

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What is the name of the rabies vaccine licensed in the UK, what type of vaccine is it and what strain does it contain?

Rabipur.

Inactivated, purified chick embryo cell (PCEC), Flury LEP-25.

Human diploid cell vaccine was discontinued in 2022.

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What is the schedule for (pre exposure) rabies vaccination?

Day 0, 7 and 28 (or day 21 if time limited)

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Intervals between MMR and other live vaccines

Yellow fever. Not on the same day - 4 weeks apart

VZV. On the same day or 4 weeks apart

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What is the ACAM2000 vaccine?

First and second generation live vaccinia vaccine for use during smallpox eradication. Still in use outwith UK

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What is the backbone to the influenza A portion of the LAIV?

H2N2

Either A/Ann Arbor/6/60 in USA/Europe or A/Leningrad/134/17/57 in Russia

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What type of vaccine is the varicella (chickenpox) vaccine and what strain?

Name the two licensed vaccines.

Live attenuated vaccine, Oka strain.

Oka is a mix of VZ genotypes and all have 42 SNPs that differentiate it from WT

Varilrix and Varivax

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What is the chickenpox vaccine schedule?

And what is the vaccine effectiveness?

Not for under 9 months

9-12 months primary, second dose 3 months later.

12 months to 12 years primary, second dose 4 weeks later

13+ primary, second dose 6 weeks later

98% protective in child and 75% in adolescents and adults.

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Name the shingles vaccine, type of vaccine and schedule.

Shingrix, recombinant vaccine containing glycoprotein E antigen

Licensed for 2 doses 8 weeks apart, however used with interval of between 2-12 months in immunocompetent 60-79 years.

2-6 months for immunocompromised 50+ years and HCST or CAR-T 18+ years

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What vaccine coverage is required to avoid outbreaks of yellow fever?

80%

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What type of vaccine is the yellow fever vaccine, what is the strain used and what are the contraindications?

Live attenuated 17D strain grown in chick eggs

Complete contraindication - thymectomy, less than 6 months, egg allergy, immunosuppression, pregnant, breastfeeding, 60 years +

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Name the licensed vaccine for HEV, where it is available, what kind of vaccine and genotype.

Hecilon - only available in china

Recombinant vaccine (ecoli) based on ORF-2 of HEV-1

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What type of vaccine is the HAV vaccine, what strain, what is the adjuvant?

Inactivated, grown in MRC5.

All different strains

Aluminium hydroxide (or close enough)

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What adenovirus vaccines are available and where?

US military use live attenuated oral vaccine

For Ad4 and Ad7 - to reduce respiratory infection outbreaks

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What adenovirus vaccines are available and where?

US military use live attenuated oral vaccine

For Ad4 and Ad7 - to reduce respiratory infection outbreaks

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Patients with which conditions can have severe reactions to the MVA-BN vaccine?

Patients with atopic dermatitis or history of keloid scarring

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RSV vaccine in the elderly should not be administered on the same day as which other vaccines?

COVID or influenza

Which groups are eligible for COVID vaccine?

Who gets additional doses?

Over 65 y

> 6 m in clinical risk groups

Adults in care homes

Severely immunosuppressed get an additional dose

Which COVID vaccine(s) is used for:

Adults
Children

Pfizer or Moderna

Pfizer only (due to lower rates of myocarditis)

What type of COVID vaccine is:

Comirnaty (PfizerBioNTech)
Spikevax (Moderna)
Vaxzeveria (AstraZeneca)

mRNA
mRNA
Adenovirus vector

What is the name of the TBEV vaccine available in the UK? What type of vaccine is it? What are the indications and schedule?

Tico-Vac (Neudorfl virus strain) Formalin inactivated whole virus Travel and occupational exposure 1st dose day 0 2nd dose 1-3 m later 3rd dose 5-12 m later Rapid short term protection (giving 90% protection) is provided with second dose at 2 weeks post primary Booster every 3 years

Name the three RSV vaccines (almost) licensed

Abrysvo (Pfizer) - subunit Arexvy (GSK) - subunit mResvia (Moderna) - mRNA

What type of vaccine is Abrysvo? What groups is it licensed in? What is the effectiveness (for reducing severe disease)?

Recombinate, bivalent, non adjuvanted RSV prefusion F protein Licensed in pregnancy and elderly 70% in under 6 months and similar for elderly

What type of vaccine is Arexvy? What groups is it licensed in? What is the effectiveness (for reducing severe disease)?

Recombinate, monovalent, adjuvanted (AS01E) RSV prefision F protein Licensed in elderly only (60+) 92% (but all ages included in trial)

What type of vaccine is mResvia? What groups is it licensed in? What is the effectiveness (for reducing severe disease)?

mRNA vaccine encoding F protein in prefusion configuration inside lipid nano particles Not licensed yet but will be licensed for elderly 80%

Which monovalent HBV vaccine is not produced using HBsAg in yeast cells? And when might this be preferentially be used?

PreHevbri is a cell culture vaccine, expressing S, pre-S1 and pre-S2. This may be preferentially used in patients who are likely to have poorer antibody responses and those who have failed to respond to other monovalent HBV vaccines

Which HBV vaccine should be used in patients with chronic kidney failure?

Fendrix

What is HEPLISAV B? When should it be used over other vaccines?

Hep B monovalent vaccine Two dose schedule so should be used when rapid response required or in those who are less likely to respond (or are non responders) as it is more immunogenic

If HBIG is indicated post exposure when should it be administered?

Preferably within 24 h of vaccine, and ideally within 48 h of vaccine No later than one week after exposure

What is the vaccine schedule for MMR in national program? What age is it licensed from? What indications does vaccination before 1 year have? What is the schedule outside of childhood immunisation schedule?

1st - 12-13 months and 2nd - 3 y 4 m to 5 years Licensed from 6 months Any dose before 1 year should be ignored Over 18 months two doses one month apart (if second dose given before 15 m then third dose at 18 m)

What is the management if MMR is given in pregnancy, or up to 4 weeks before conception?

Advise theoretical risk of transmission but no documented cases so can be reassured. Report to Vaccine in Pregnancy surveillance programme

What are the recommended schedules for HBV vaccination?

1) Routine infant programme: 8,12,16W 2) Accelerated (PrEP/PEP): 0,1,2,12M 3) Super accelerated (travel): 0,7,21D +/- 12M (if ongoing risk) 4) Standard dose: 0,1,6M 5) Adults with renal insufficiency: 0,1,2,6M (extra 2M dose) 6) severe renal insufficiency/HD: 0,1,2,4M

What are the 2 indications of giving a newborn HBV before discharge?

1) Infant born to mother with HBV infection. 2) Infant known to be going home where there is a person living with HBV infection* *Only if 🙄: Concern about immediate risk of exposure or Risk of delay in starting vaccination at 8W.

What vaccines are available against Ebola virus? What strains does it protect against? Is there cross protection? What type of vaccine is it? What is the effectiveness?

ERVEBO Zaire strain only and no cross protection Recombinant VSV delta G 70-100% effective Zabdeno/Mvabea is another option, two doses 8 weeks apart so can be used in adjacent areas

Vaccines available for Arenaviruses

Junin virus vaccine (CANDID#1) used in Argentina to protect agricultural workers Phase 2 clinical trials for Lassa fever using VSV delta G vaccine

Which HBV vaccines are suitable for the first dose in neonates exposed to HBV positive mums?

Engerix B and HBvaxPRO 5ug Must be monovalent and these are only two licensed in neonates

Which live viral vaccines are used in the UK?

LAIV MMR Rotavirus Shingles (zostervax) Varicella Yellow fever Dengue

Which vaccines are whole inactivated vaccines in the UK?

Polio Hep A Rabies JEV TBEV

Which vaccines are recombinant protein or VLP vaccines?

HBV HPV Shingles RSV

Which vaccines are mRNA vaccines used in the UK?

COVID vaccines

Which patients should not receive live vaccines?

Leukaemia and lymphoma AIDS SCID, DiGeroge Haematological malignancies <24 m post HSCT (or GVHD) Pregnancy or breastfeeding Within 6 months of chemo, radiotherapy Within 6 months of immunosuppression for SOT Within 12 months of biologics e.g. anti-TNF, alemtuzumab, ofatumumab, rituximab With 3 months High dose corticosteroids for >1 week (>40 mg pred) Low dose corticosteroids for >14 d (>20 mg pred) Methotrexate >25 mg per week Azathioprine >3 mg/kg/day 6-mercaptopurine >1.5 mg/kg/day

When can you give live vaccines after immunoglobulin

Give vaccine 3 weeks before or 3 months after IgG Yellow fever is exception as low titres of YF IgG in IgG If rubella required after anti-D then give vaccine

Which vaccines shouldn't babies whose mothers were on biologics during pregnancy be given?

Rotavirus or BCG Delay live viruses until 6 months of age Consider exposure to biologics via breastfeeding

Regarding household contacts of immunosuppressed what is rule for: Rotavirus Varicella Influenza

Rotavirus - give but advised good hand hygiene Varicella - give but if post vaccine rash occurs avoid contact with immunosuppressed until lesion have crusted Influenza - if cannot avoid contact with severely immunosuppressed then use inactivated vaccine

Which vaccines are contraindicated in egg allergy?

Egg based flu vaccines TBEV Yellow fever Rabies Hep A

Which vaccines in the UK are live, non-replicating vaccines?

Mpox

How long should you wait after a live vaccine before starting immunosuppression?

4 weeks