Immunisation and Prophylaxis

Question 1

Please see diagram explaining immunity:

Answer 1

Question 2

What are the different types of vaccines available?

Answer 2

• live attenuated
• inactivated (killed)
• detoxified exotoxin
• subunit of micro-organism
  
  • purified microbial products
  • recombinant

Question 3

For which pathologies do we use live attenuated vaccines?

Answer 3

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

Question 4

For which infections do we use inactivated (killed vaccines)?

Answer 4

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

Question 5

How do Detoxified exotoxin vaccines work?

Answer 5

Toxin - treat with formalin = toxoid (for dipheria and tetanus)

Question 6

Name some common subunit vaccines:

Answer 6

• Pertussis (acellular)
• Haemophilus influenzae type b
• Meningococcus (group C) conjugated: capsular polysaccharide antigen & Corynebacterium diphtheria protein
• Pneumococcus
• Typhoid
• Anthrax
• Hepatitis B

Question 7

How are recombinant vaccines created?

Answer 7

1. DNA segment coding for HBsAg
2. removed, purified, mixed with plasmids
3. inserted into yeasts
4. fermented
5. HBsAg produced

Question 8

Please explain how immunology memory works:

Answer 8

Question 9

What are the differences between killed and live vaccines?

Answer 9

Question 10

What is contained within the “6 in 1” vaccine: Infanrix hexa?

Answer 10

• 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 11

What is the UK Childhood Immunisation Schedule (1)?

Answer 11

• 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

Question 12

What is the UK Childhood Immunisation Schedule (2)?

Answer 12

• 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 13

What pathologies are immunised against for special groups and occupations?

Answer 13

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

Question 14

Who gets the BCG vaccine?

Answer 14

• Some infants (0-12 months)
• areas of UK with annual incidence of TB >40/100,000
• Parents/grandparents born in a country with annual incidence of TB >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
• Contacts (<35yrs) of resp TB patients
• Healthcare workers

Question 15

What are indications for influenza vaccination?

Answer 15

• 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 16

What are the two pneumococcal vaccines?

Answer 16

• pneumococcal conjugate polysaccharide vaccine (13 serotypes): Prevenar13®
  
  • Part of childhood immunisation schedule
  • 3 doses
• pneumococcal polysaccharide vaccine (23 serotypes) Pneumovax II ®
  • for those at increased risk of pneumococcal infection
  • single dose

Question 17

Who gets Hep B vaccination?

Answer 17

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

Question 18

Who gets varicella-zoster (chickenpox)
vaccine?

Answer 18

• 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 19

Who gets the shingles vaccine?

Answer 19

• All elderly patients (70-80 years)
• Zostavax
• Live attenuated virus

Question 20

When is Human normal immunoglobulin used?

Answer 20

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

Question 21

Which diseases require Disease specific immunoglobulin post-exposure?

Answer 21

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

Question 22

What is included in a risk assessment for a traveler?

Answer 22

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

Question 23

Where can we acquire info about immunisation for travelers?

Answer 23

• Bitish National Formulary (BNF)
• “Immunization Against Infectious Diseases” (Green Book)
• Internet
  
  • www.travax.scot.nhs.uk (registration required)
  • www.fitfortravel.scot.nhs.uk/
  • www.cdc.org
• Schools of Tropical Medicine - telephone advice

Question 24

What general measures do we advise travelers?

Answer 24

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

Question 25

What are common immunisations for travelers?

Answer 25

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

Question 26

What are immunisations for travelers in special circumstances?

Answer 26

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

Question 27

What are common uses of prophylaxis?

Answer 27

* Chemoprophylaxis against Malaria * Post-exposure prophylaxis\* * e.g. ciprofloxacin for meningococcal disease * HIV post-exposure prophylaxis\* * “needle stick” (PEP), sexual intercourse (PEPSI) * Surgical antibiotic prophylaxis\* * perioperative \*covered elsewhere

Question 28

What is the ABCD of Malaria Prevention?

Answer 28

* **A**wareness of risk * **B**ite prevention * **C**hemoprophylaxis * **D**iagnosis and treatment

Question 29

Elaborate on bite protection for malaria?

Answer 29

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

Question 30

Explain the chemoprophylaxis for malaria:

Answer 30

* Malarone ® (proquanil & atovaquone) daily * doxycycline daily * Not for children \<12 years * photosensivity * mefloquine weekly * Side effects: psychosis, nightmares (1:10,000) * Avoid if history of psychosis, epilepsy * chloroquine weekly + proquanil daily * For vivax/ovale/malariae only

Question 31

What malaria advice do we give returning travelers?

Answer 31

* 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