Immunisation

Question 1

Who gets immunisation?

Answer 1

• Childhood schedule
• Special patient groups
• Occupational
• Travelers

Question 2

Who gets prophylaxis?

Answer 2

• Travelers
• Post-exposure
• Post-exposure (HIV)
• Surgical

Question 3

What are the two forms of immunity?

Answer 3

Adaptive and innate

Question 4

What are the two forms of adaptive immunity?

Answer 4

Natural and artificial

Question 5

What are the passive and active forms of natural and artifical immunity?

Answer 5

Question 6

How did edward jenner discover the smallpox vaccination?

Answer 6

He noticed that people who suffered mild disease of cowpox never contracted smallpox

Inserted pus from a cowpox pustule into a boys arm

He proved that the boy having been inoculated with cowpox was now immune to small pox

(1798)

Question 7

Where can you find out information about vaccinations?

Answer 7

Green book

BNF

Question 8

What are the different types of vaccines?

Answer 8

• live attenuated
• inactivated (killed)
• detoxified exotoxin
• subunit of micro-organism

–purified microbial products

–recombinant

Question 9

Give examples of live attenuated vaccines

Answer 9

MMR

BCG

Varicella-zoster virus

Question 10

What are examples of inactivated (killed) vaccines

Answer 10

Polio

Hep A

Cholera

Rabies

Question 11

Give exmamples of detoxified exotoxin vaccines

Answer 11

Diptheria

Tetanus

Question 12

Give examples of subunit vaccines

Answer 12

Pertussis

Hamophilus infulenzae type b

Typhoid

Pneumococcus

Hep B

Question 13

How is the recombinant hep B vaccine made?

Answer 13

The DNA segment coding for HBsAg is removed purified and mixed with plasmids

The plasmids are inserted into yeasts

Yeasts are fermeted

HBsAg is produced

Question 14

What is the primary antibody response to infection?

Answer 14

Increase in total Ab

Early increase in IgM

Later increase in IgG

Question 15

How does dosing differ between killed vaccine and live vaccine?

Answer 15

Killed vaccine requires multiple doses

Live vaccine - 1 dose

Question 16

What is within the infranrix hexa vaccine?

Answer 16

• D = purified diphtheria toxoid
• T = purified tetanus toxoid
• aP = purified Bordetella pertussis
• IPV= inactivated polio virus
• Hib= purified component of Haemophilus influenzae b
• HBV= hepatitis B rDNA

Question 17

What is the UK childhood immunisation schedule?

Answer 17

• 2 months: 6-in-1 vaccine + pneumococcal conjugate + rotavirus + Men B
• 3 months: 6-in-1 vaccine + rotavirus
• 4 months: 6-in-1 vaccine + pneumococcal conjugate + Men B
• 1 year: Hib/Men C+ MMR + pneumococcal conjugate + men B
• 2 -8 years: influenza nasal
• 3 - 5 years: 4-in-1 booster (DTaP/IPV) + MMR
• Girls, 12-13 yrs: Human papilloma virus
• 14 years: 3-in-1 booster (dT/IPV) + Men ACWY

Question 18

What other demographic may be offered the HPV virus?

Answer 18

Gay men

Question 19

What is the greatest reservoir of influenza?

Answer 19

Children - giving children influenza nasal spray at ages of 2-8 is trying to eliminate the risk of a pandemic

Question 20

What immunisations are offered to special patient and occupational groups?

Answer 20

• BCG
• influenza
• pneumococcal
• hepatitis B
• varicella-zoster (chickenpox)
• herpes-zoster (shingles)

Question 21

Who is offered BCG vaccine?

Answer 21

Some infants (0-12 months) - in areas of high TB incidence, if parents or grandparents are born in a country with annual incidence of TB greater than 40/100,000

• Children screened at school for TB risk factors, tested and vaccinated if appropriate
• New immigrants (previously unvaccinated) from high prevalence countries for TB – may be offered BCG
• Contacts (<35yrs) of resp TB patients
• Healthcare workers

Question 22

Describe the influenza vaccine

Answer 22

Influenza A and B constantly change (haemaglutinins and neuraminidases)

New vaccine each year

Single dose

Caution in egg allergy

Question 23

What are the indications for influenza vaccine?

Answer 23

• Age >65 years
• Nursing home residents
• Some health care workers
• Immunodeficiency,
• Immunosuppression
• Asplenia/hyposplenism
• Chronic liver disease
• Chronic renal disease
• Chronic cardiac disease
• Chronic lung disease
• Diabetes mellitus
• Coeliac disease
• Pregnant women
• Heath care workers

Question 24

Who is given the pneumococcal conjugate polysaccharide vaccine?

Answer 24

Part of childhood immunisation schedule

3 doses

Question 25

Who is given the pneumococcal polysaccharide vaccine?

Answer 25

Those with increased risk of pneumococcal infection ## Footnote Indications Immunodeficiency Immunosuppression Asplenia/hyposplenism Sickle cell disease Chronic liver disease Chronic renal disease Chronic cardiac disease Chronic lung disease Diabetes mellitus Coeliac disease

Question 26

Who gets the Hep B vaccination?

Answer 26

* All new born children from 2018 (6-in-1) * Children at high risk of exposure to HBV * Health care workers, PWID (people who inject drugs), MSM, prisoners, ch. liver disease, ch. kidney disease, * Given at 0, 1 month, 2 months and 1 year

Question 27

Who is given varicella zoster vaccine?

Answer 27

* patients who have a suppressed immune systems, for example having cancer treatment or organ transplant * children if in contact with those at risk of severe vzv * Health case workers (if sero-neg and in contact with patients) * Live attenuated virus * 2 doses, 4-8 weeks apart

Question 28

Who gets herpes-zoser vaccine?

Answer 28

All elderly patients - 70-80 years zostavax - live attenuated virus

Question 29

What is human normal immunoglobulin?

Answer 29

–contains antibodies against **hepatitis A**, **rubella**, **measles** –used in immunoglobulin deficiencies treatment of some autoimmune disorders, e.g. **myasthenia gravis**

Question 30

What post exposure diseases require immunoglobulins?

Answer 30

* **hepatitis B** Ig * **rabies Ig** * **tetanus anti-toxin Ig** * varicella (chickenpox) Ig * diphtheria anti-toxin Ig (horse) * botulinum anti-toxin Ig

Question 31

What are sources of information for travellers seeking vaccinations?

Answer 31

BNF Immunization against infectious diseases (green book) Internet

Question 32

General measures for travellers

Answer 32

* Care with food/water * Hand washing * Sunburn / Sunstroke * Altitude * Road traffic accidents * Safer sex * Mosquitoes - bed nets, sprays, “cover up”

Question 33

What are the common immunisations for travellers?

Answer 33

* Tetanus * Polio * Typhoid * Hepatitis A * Yellow fever * Cholera

Question 34

What are immunisations for travelers in special circumstances?

Answer 34

Meningococcus A, C, W, Y Rabies Diptheria Japanese B encephalitis Tick borne encephalitis

Question 35

When might prophylaxis be indicated?

Answer 35

Chemoprophylaxis against malaria Post-exposure prophylaxis (ciprofloxacin for meningococcal disease) HIV post-exposure prophylaxis (needle stick) Surgical antibiotic prophylaxis (perioperative)

Question 36

What is malaria prevention?

Answer 36

ABCD Awareness of risk Bite prevention Chemoprophylaxis Diagnosis and treatment

Question 37

How do you prevent bites?

Answer 37

Cover-up at dawn and dusk Insect repellant sprays, lotions (DEET) Mosquito coils Permethrin-impregnated mosquito nets

Question 38

What are the available chemoprophylaxis measures against malaria?

Answer 38

Malarone Doxycycline Melfloquine (SE include psychosis, nightmares. Avoid if there is a history of psychosis or epilepsey) Chloroquine weekly and proquanil daily

Question 39

What is malaria advice for travellers on return?

Answer 39

* Any illness occurring within 1 year and especially within 3 months of return might be malaria * Patients should seek medical attention if become they ill particularly within 3 months and mention malaria risk