Immunisation and Prophylaxis

Question 1

What is immunisation?

Answer 1

Creation of immunity against a disease

Question 2

What is prophylaxis?

Answer 2

Treatment given or taken to prevent disease

Question 3

Who is immunisation given to?

Answer 3

• Childhood schedule
• Special patient groups
• Occupational
• Travelers

Question 4

Who is prophylaxis given to?

Answer 4

• Travelers
• Post-exposure
• Surgical

Question 5

What are the different branches of immunity?

Answer 5

Question 6

How does the antibody response to infection differ in the primary and secondary response?

Answer 6

Secondary response is much faster

Question 7

Vaccines can be killed or alive, how does their mechanism of action differ?

Answer 7

• Killed causes production of antibodies, which decreases over time so needs a few doses to produce immunological memory
• Live vaccine replicates to more antibodies are produced and only one dose needed

Question 8

What is an example of a disease eradicated by a vaccine?

Answer 8

Smallpox

Question 9

What are the different kinds of vaccines?

Answer 9

Live attenuated

Inactivated (killed)

Detoxified exotoxin

Subunit of micro-organism

Question 10

What are examples of live attenuated vaccines?

Answer 10

• Measles, mumps, rubella (MMR)
• BCG
• Varicella-zoster virus
• Yellow fever
• Smallpox
• Typhoid (oral)
• Polio (oral)
• Rotavirus (oral)

Question 11

What are examples of inactivated (killed) vaccines?

Answer 11

• Polio (in combined vaccine D/T/P/Hib)
• Hepatitis A
• Cholera (oral)
• Rabies
• Japanese encephalitis
• Tick-borne encephalitis
• Influenza

Question 12

What are examples of detoxified exotoxin vaccines?

Answer 12

• Diphtheria
• Tetanus

Question 13

What are examples of subunit of microorganism vaccines?

Answer 13

• Pertussis (acellular)
• Haemophilus influenzae type b
• Meningococcus (group C)
• Pneumococcus
• Typhoid
• Anthrax
• Hepatitis B

Question 14

What is the “6 in 1” vaccine that children get?

Answer 14

Children get a “6 in 1” vaccine, called the infanrix hexa:

• 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 15

What is in the 6 in 1 vaccine that children get?

Answer 15

Children get a “6 in 1” vaccine, called the infanrix hexa:

• 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 16

Describe the UK immunisation scedule?

Answer 16

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

Question 17

What is herd immunity?

Answer 17

Resistance of the spread of contagious disease that results if a high proportion of individuals are immune to the disease

Question 18

What is the target uptake for herd immunity to work?

Answer 18

90-95%

Question 19

What are examples of immunisations for special patients and occupational groups?

Answer 19

• BCG (Bacille Calmette-Guerin)
  
  • Some infants (0-12 months), where incidence in area of TB is >=40/100,000, or have parents/grandparents born in country with annual incidents of TB >=40/100,000
  • Children with TB risk factors
  • New immigrants from high prevalence countries
  • Healthcare workers
• Influenza
  
  • Influenza A and B constantly change antigenic structure so new vaccine every year
  • Indications includes
    
    • Age>65
    • Nursing home resident
    • Healthcare worker
    • Immunodeficiency
    • Chronic liver, renal, cardiac or lung disease
    • Diabetes
    • Pregnant
• Pneumococcal
  
  • 2 vaccines
  • Pneomococcal conjugate polysaccharide vaccine (13 serotypes)
    
    • Part of childhood immunisation schedule
  • Pneomococcal polysaccharide vaccine (23 serotypes)
    
    • Those at increased risk of pneumococcal infection
• hepatitis B
  
  • Part of 6in1 vaccine for new-borns from 2018
  • Healthcare workers
  • Prisoners
  • Chronic liver or kidney disease
• varicella-zoster (chickenpox)
  
  • Immunodeficiency
  • Children if in contact with those at risk of severe vzv
  • Healthcare workers (if sero-neg)
• herpes-zoster (shingles)
  
  • All elderly patients (70-80 years)

Question 20

Who is offered the BCG vaccine?

Answer 20

• Some infants (0-12 months), where incidence in area of TB is >=40/100,000, or have parents/grandparents born in country with annual incidents of TB >=40/100,000
• Children with TB risk factors
• New immigrants from high prevalence countries
• Healthcare workers

Question 21

What are some indications to get the influenza vaccine?

Answer 21

• Age>65
• Nursing home resident
• Healthcare worker
• Immunodeficiency
• Chronic liver, renal, cardiac or lung disease
• Diabetes
• Pregnant

Question 22

What are the 2 pneomococcal vaccines?

Answer 22

• Pneomococcal conjugate polysaccharide vaccine (13 serotypes)
  
  • Part of childhood immunisation schedule
• Pneomococcal polysaccharide vaccine (23 serotypes)
  
  • Those at increased risk of pneumococcal infection

Question 23

Who gets the hepatitis B vaccine?

Answer 23

• Part of 6in1 vaccine for new-borns from 2018
• Healthcare workers
• Prisoners
• Chronic liver or kidney disease

Question 24

Who is offered the varicella-zoster vaccine?

Answer 24

• Immunodeficiency
• Children if in contact with those at risk of severe vzv
• Healthcare workers (if sero-neg)

Question 25

What is varizella-zoster also known as?

Answer 25

Chickenpox

Question 26

What is herpes-zoster also known as?

Answer 26

Shingles

Question 27

What is passive immunisation?

Answer 27

Antibody formed in one person is given to another who is at risk of infection

Question 28

Does passive immunisation given permanent or temporary protection?

Answer 28

Temporary

Question 29

What immunoglobulins can be given for passive protection?

Answer 29

Human normal immunoglobulin is normally given: * Contains antibodies against hep A, rubella and measles * Used in immunoglobulin deficiencies or treatment of some autoimmune disorders such as myasthenia gravis Disease specific immunoglobulin can be given post-exposure, such as for: * hepatitis B Ig * rabies Ig * tetanus anti-toxin Ig * Varicella zoster (chickenpox) Ig * diphtheria anti-toxin Ig (horse) * botulinum anti-toxin Ig

Question 30

What are examples of diseases where disease specific immunoglobulins can be given post-exposure for?

Answer 30

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

Question 31

What does the risk assessment for immunisation and prophylaxis for travellers involve?

Answer 31

* Health of Traveller * Previous immunisation and prophylaxis * Area to be visited * Duration of visit * Accommodation * Activities * Remote areas * Recent outbreaks

Question 32

Where can sources of information about immunisation and prophylaxis for travellers be found?

Answer 32

* British National Formulary (BNF) * “Immunisation Against Infectious Diseases” (green book)

Question 33

What are examples of some travel advice?

Answer 33

* General measures * Care with food/water * Hand washing * Sunburn / Sunstroke * Altitude * Road traffic accidents * Safer sex * Mosquitoes - bed nets, sprays, “cover up * Immunisation * Tetanus * Polio * Typhoid * Hepatitis A * Yellow fever * Cholera * In special circumstances: * Meningococcus A, C, W, Y * Rabies * Diphtheria * Japanese B encephalitis * Tick borne encephalitis * Chemoprophylaxis (antimicrobial prophylaxis) * Chemoprophylaxis against malaria * Post-exposure prophylaxis * Such as ciprofloxacin for meningococcal disease * HIV post-exposure prophylaxis * Surgical antibiotic prophylaxes

Question 34

What are some vaccines maybe offered to travellers?

Answer 34

* Tetanus * Polio * Typhoid * Hepatitis A * Yellow fever * Cholera * In special circumstances: * Meningococcus A, C, W, Y * Rabies * Diphtheria * Japanese B encephalitis * Tick borne encephalitis

Question 35

What are examples of chemoprophylaxis (antimicrobial prophylaxis)?

Answer 35

* Chemoprophylaxis against malaria * Post-exposure prophylaxis * Such as ciprofloxacin for meningococcal disease * HIV post-exposure prophylaxis * Surgical antibiotic prophylaxes

Question 36

Describe malaria prevention advice?

Answer 36

* Awareness of risk * Know risk in country * Bite prevention * Cover up at dawn and dusk * Insect repellent sprays * Mosquito coils * Chemoprophylaxis * Malarone daily * Doxycycline daily * Not for \<12 years * Mefloquine weekly * Side effects: psychosis, nightmares * Chloroquine weekly and proquinil daily * Diagnosis and treatment

Question 37

What is some chemoprophylaxis options for malaria?

Answer 37

* Malarone daily * Doxycycline daily * Not for \<12 years * Mefloquine weekly * Side effects: psychosis, nightmares * Chloroquine weekly and proquinil daily