Vaccines and Refugees Flashcards
Which vaccines can you not give in immunocompromised patients?
Yellow fever
MMR
Polio (oral)
BCG
Influenza (one type)
Typhoid - oral only
Rotavirus
You mustn’t prescribe BCG incase they rip.
Any live vaccine. Can give varicella if CD4 <200.
Which routine immunisations are always given?
*Tetanus/diphtheria/ pertussis
* Measles (mumps/rubella)
* Polio
* Pneumococcal
Sometimes:
* Varicella
* Influenza (separate lecture)
* HPV
* Zoster
What type of vaccine produces B and T cell response?
Conjugate vaccines
(polysaccharide - only B cell, most discontinued)
When do you give booster in T/D/P for travellers?
Booster: 10 yrs with Tdap for travelers
5 year rule for long termers
How many doses of measles vaccine do you need to be protected? How spread out?
2
28 days
Varicella vaccine - how many?
2 doses spaced by 4-8 weeks
Not in UK - just wait and get chicken pox :)
What is Shringex?
Zoster vaccine
Who gets Shringex?
*All immunocompetent persons aged ≥ 50 years.
*Under 18 yo and immunocompromised - HIV (any CD4) but delay until CD4 >200 and virologically suppressed.
– Zoster vaccine is not indicated for the prevention of chickenpox, and varicella vaccine is not indicated for the prevention of shingles.
How long do you wait after an episode of herpes zoster before vaccine?
Wait 1 yr if recent Zoster episode
What types of polio can you?
WPV1
VDPV - vaccine derived polio vaccine (which is a type 2)
Other strains are extinct
Who should be vaccinated against pneumococcal?
> =65 years who have not previously received
a pneumococcal conjugate vaccine should receive a
pneumococcal conjugate vaccine - PCV20
Adults >18 with HIV, certain underlying medical conditions - RESP DISEASE- or other risk factors who have not previously received a pneumococcal conjugate
vaccine should receive either PCV20 or PCV15.
If give PCV15, need to follow with PCV23.
How many doses of the PCV20 do you need?
1 and 1 only!
What are the 3 vaccines would pretty much always be recommended?
Hepatitis A
Typhoid
Hepatitis B
How many months does Hep A
2 doses 1 month apart
Booster: after 6-18 months, offers long-term protection
What types of typhoid vaccine exist?
Live oral and killed injectable
How many hepatitis B vaccines is there usually in a series?
3
How do you administer the oral typhoid vaccine?
4 x 1 capsule at 2 day intervals
Yellow Fever vaccine - how many days in advance should you give if travelling to a country that requires it?
Must be given >10 days before entry
Who do you not give the YF vaccine to?
- Autoimmune thymus dysfunction is risk factor
- primary immunodeficiencies
– Transplantation
– immunomodulatory drugs
Cholera vaccine - who do you give it to?
Indicated only in aid and refugee workers
Cholera vaccine also protects you from?
Efficacy against ETEC is 50% with duration of
efficacy of 3 months
Which meningococcal is vaccinated against in the primary series?
A,C,Y,W135
Booster at 5 yrs
Who should get Men B vaccine?
Asplenism
Sickle cell
Complement deficiency
Men B outbreak
Permissive use in adolescents 16-18yr
Why vaccinate with rabies?
PrEP dramatically simplifies the PEP (post-exposure prophylaxis)
schedule to 2 injections spaced by 3 days and eliminates the need for RIG
(rabies immune globulin), which may be expensive and is often very difficult to access abroad.
PrEP may provide some protection if PEP is delayed or an unrecognized
exposure to rabies has occurred.
What do you give if not vaccinated and get bitten by a dog? and what if vaccinated?
RIG plus
4 x 1 ml IM vaccine
doses over 14 days
–Days 0, 3, 7,14
Vaccinated
2 injections spaced by 3 days
Who would you advise to get a JE vaccine?
Going to rural area in Endemic country or outbreak
For >4 weeks
During the JE season
How many doses are there in a JE vaccine?
2 (0, 28 days)
Who would you vaccinate against dengue?
People who have had dengue previously
Vaccine induced allergy?
*Egg - yellow fever, measles, mumps, flu - can have vaccine If have egg allergy
* Neomycin - measles, mumps, rubella,
varicella
* Streptomycin – OPV
* PEG—COVID vaccines
If Breastfeeding, cannot give 1 vaccine?
Yellow Fever
What do you need to have herd immunity within a community?
> 95% of people are immune
What do you do if a refugee doesn’t have vaccination records? And children?
Vaccinate all adult immigrants without
immunization records using one dose of
MMR
Vaccinate all immigrant children with missing
or uncertain vaccination records using age-
appropriate vaccination for measles, mumps
and rubella.
Varicella vaccine and refugees - do you vaccinate?
Vaccinate all immigrant children < 13 years
of age with varicella vaccine without prior
serologic testing.
Screen all immigrants and refugees from
tropical countries ≥ 13 years of age for
serum varicella antibodies, and vaccinate
those found to be susceptible
What to do for refugees without vaccine records for DTP and polio?
Vaccinate all adult immigrants without immunization records using a primary series of tetanus, diphtheria and inactivated polio vaccine (three doses)
Why would you vaccinate someone who has previously been infected with Hep B?
Prevent reactivation later in life
Most common infections in refugees from Africa?
Children - malaria
Adults - Latent TB
Both schistosomiasis and strongy is common
Most common infections in refugees from Asia?
Children - malaria
Hep B and Hep C, latent and active TB adults
Strongy
Most common infections in refugees from Latin America?
Chagas
NCC
Latent TB
Which imms do you not give in pregancy?
MMR
Varicella
Typhoid
Influenza
HPV
Which imms do you not give in HIV?
MMR
Varicella
Typhoid
