Vaccines, Anaesthesia and Poisoning MHRA alerts Flashcards
Due to the concerns over desensitising vaccines, in what circumstances may they be used?
It is recommended that they are used only be specialists and only for the following indications:
Seasonal allergic hay fever (caused by pollen) that has not responded to anti-allergic drugs
Hypersensitivity to wasp and bee venoms
They should generally be avoided of used with particular care in patients with asthma.
Who should not receive live vaccines?
Live attenuated vaccines should not routinely be given to people who are clinically immunosuppressed (either due to drug treatment or underlying illness)
Specialists with responsibility for an immunosuppressed patient who may be in a group eligible for a live attenuated vaccine should include in their correspondence with primary care a statement of their opinion on the patient’s suitability for the vaccine
If primary care professionals are in any doubt as to
whether a person due to receive a live attenuated vaccine may be immunosuppressed at the time, immunisation should be deferred until secondary care specialist advice has been sought, including advice from an immunologist if required
Remember that close contacts of immunosuppressed individuals should be fully immunised to minimise the risk of infection of vaccine-preventable diseases in immunosuppressed individuals
What is the advice surrounding live vaccines in infants who were exposed to immunosuppressants esp TNF-alpha?
Any infant who has been exposed to immunosuppressive treatment from the mother either in utero during pregnancy or via breastfeeding should have any live attenuated vaccination deferred for as long as a postnatal influence on the immune status of the infant remains possible.
PHE advise if there is any doubt as to whether an infant due to receive a live attenuated vaccine may be immunosuppressed due to the mother’s therapy. Including exposure through breast-feeding, specialist advice should be sought.
When should live vaccines be deferred to in an infant who has been exposed to immunosuppressive treatment in utero?
PHE advise that any live attenuated vaccination (e.g BCG vaccine) should be deferred until the infant is age 6 months.
Which patient groups require stronger precautions with the yellow fever vaccine?
- Those with weakened immune systems.
- Those aged 60 years or older
Who should not get the yellow fever vaccine?
- who have had their thymus gland removed for any reason
- who are taking biological drugs that are immunosuppressive or immunomodulating
o who have a first-degree family history of YEL-AVD (viscerotropic disease) or YEL-AND (neurotropic disease_ following vaccination that was
not related to a known medical risk factor (i.e. in case of an unidentified genetic
predisposition).
How should most anaesthetics be administered?
Should only be administered by or under the direct supervision of personnel experienced in its use, with adequate training in anesthesia and airway management, and when resuscitation equipment is available.
What is the max dose/concentration of adrenaline when given with anaesthesia?
. The total dose of adrenaline should not exceed 500 micrograms and it is essential not to exceed a concentration of 1 in 200,000 (5micrograms/mL) if more than 50mL of the mixture is to be injected
How many acetylcysteine infusions are required for a full course?
Authorised dose regimen is 3 consecutive IV infusions over 21 hours. Continued treatment (at the dose and rate of the 3rd infusion) may be necessary depending on the clinical evaluation of the individual patient.
