Vaccines Flashcards
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
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.
Name the strains in the MMR vaccine
Measles = Schwarz (Priorix) or Enders Edmonston (MMRVaxPro)
Mumps = Jeryl Lynn
Rubella = Wistar RA 27/3
What does that the vaccine Priorix contain?
Measles, mumps and rubella
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
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.
What is the schedule for (pre exposure) rabies vaccination?
Day 0, 7 and 28 (or day 21 if time limited)
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
What is the ACAM2000 vaccine?
First and second generation live vaccinia vaccine for use during smallpox eradication. Still in use outwith UK
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
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
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.
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
What vaccine coverage is required to avoid outbreaks of yellow fever?
80%
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 +
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
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)
What adenovirus vaccines are available and where?
US military use live attenuated oral vaccine
For Ad4 and Ad7 - to reduce respiratory infection outbreaks
What adenovirus vaccines are available and where?
US military use live attenuated oral vaccine
For Ad4 and Ad7 - to reduce respiratory infection outbreaks
Patients with which conditions can have severe reactions to the MVA-BN vaccine?
Patients with atopic dermatitis or history of keloid scarring
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
