vaccines

Question 1

what is the main contraindication for live attenuated vaccines

Answer 1

immunosuppression

Question 2

who is the chickenpox VZV vaccine offered to

Answer 2

1. healthcare workers who are not immune
2. contacts of an immunosuppressed family member e.g. child or a parent who is getting chemotherapy

Question 3

what are the live attenuated vaccines

Answer 3

BCG
MMR
Influenza (intranasal)
Oral rotavirus
Oral polio
Yellow fever
Oral typhoid
VZV (shingles + chickenpox) - subcut

Question 4

who is eligible for shingles vaccine

Answer 4

age 70 until 79

Question 5

Toxoid (inactivated toxin) vaccines

Answer 5

tetanus
diphtheria
pertussis

Question 6

Subunit and conjugate vaccines

Answer 6

pneumococcus (conjugate)
haemophilus (conjugate)
meningococcus (conjugate)
hepatitis B
HPV

Question 7

Inactivated preparations vaccinations

Answer 7

Rabies
Influenza (IM)
Hep A

Question 8

Valency of vaccines definition

Answer 8

the number of antigenic components or serotypes it can protect against

Question 9

difference between monovalent and multivalent/polyvalent vaccines with examples

Answer 9

monovalent - works against one strain or subtype of a pathogen e.g. measles vaccine

multi/polyvalent - works against various strains or subtypes of pathogen e.g. influenza vaccine

Question 10

over the course of 0 to 18 years, how many tetanus vaccinations do you get

Answer 10

FIVE

at 2 months, 3 months, 4 months, 3-5 years, and 13-18 years

Question 11

Patient has wound injury
Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago

What is the treatment?

Answer 11

No vaccine
No tetanus immunoglobulin needed

Question 12

Patient has wound injury
Patient has had a full course of tetanus vaccines, with the last dose OVER 10 years ago

What is the treatment?

Answer 12

If tetanus prone wound: give tetanus vaccine
If high risk wound: give tetanus vaccine AND tetanus immunoglobulin

Question 13

Patient has wound injury
Patient is unsure of vaccination history in terms of tetanus.

What is the treatment?

Answer 13

Give tetanus vaccine regardless

If tetanus prone and high risk wound: give tetanus vaccine AND tetanus immunoglobulin

Question 14

What are the 3 categories of tetanus types of wound

Answer 14

1. clean wound - less than 6 hours old, no tissue damage
2. tetanus prone wound - puncture type injury in contaminated environment, foreign bodies, compound fractures, sepsis, bites and scratches
3. high-risk wound - heavy contamination with tetanus spores e.g. soil, manure. wounds or burns with extensive devitalised tissue, or need surgical intervention

Question 15

there are 2 types of pneumococcal vaccine. which one is offered to who?

Answer 15

1. pneumococcal conjugate vaccine (PCV) - given to children as part of routine imms (at 3 and 12-13 months)
2. pneumococcal polysaccharide vaccine (PPV) - given to all over age 65, and chronic conditions e.g. COPD, splenectomy

Question 16

Adults over age of 65 with risks usually require just one dose of pneumococcal polysaccharide vaccine (PPV). Which cohorts need a vaccine every 5 years?

Answer 16

Asplenia
Splenic dysfunction (including coeliac!)
Chronic kidney disease

Question 17

who is influenza vaccine offered to

Answer 17

over 65 years old with:
- respiratory disease (including asthma inhaled steroids)
- heart disease (IHD, heart failure)
- CKD
- chronic liver disease
- chronic neuro disease e.g. stroke
- diabetes including diet controlled
- immunosupressed
- asplenia/splenic dysfunction
- pregnant women

or at risk individuals in care homes, carers, or healthcare staff

Question 18

Which groups of adults over age of 65 require pneumococcal polysaccharide vaccine (PPV) (regardless of every year or 5 years)?

Answer 18

• asplenia/splenic dysfunction
• chronic resp disease e.g. COPD, CF (asthma only if ORAL steroids)
• chronic heart disease - controlled HTN does not count
• CKD
• chronic liver disease
• DM if needs medication
• immunosuppresion
• cochlear implants
• patients with CSF leaks

Question 19

who is the BCG vaccine recommended for:

Answer 19

• infants (0-12 months) in UK where TB annual incidence is >40/100,000
• infants (0-12 months) who parent or grandparent was born in country where TB annual incidence is >40/100,000
• previously unvaccinated tuberculin-negative contacts of resp TB
• previously unvaccinated tuberculin-negative new entrants <16 years who lived or were born in country with annual TB incidence >40/100,000
• healthcare workers
• prison staff
• carehome workers
• ppl who work with homeless people

Question 20

if an infant is older than 6 years but parent/grandparent is from a high incidence TB country, what needs to be done before deciding if they need BCG vaccine

Answer 20

tuberculin test

Question 21

what does the BCG vaccine contain

Answer 21

live attenuated Mycobacterium bovis

Question 22

Any person being considered for the BCG vaccine must first be given a tuberculin skin test. The only exceptions is what..?

Answer 22

children < 6 years old who have had no contact with tuberculosis

Question 23

How is BCG vaccine given

Answer 23

Intradermally
Lateral aspect of L upper arm

Question 24

What are the rules for BCG vaccines for timing of vaccination

Answer 24

Can be given at the same time as other live vaccines
If it is not, there should be a 4 week interval

Question 25

6 contraindications to BCG vaccination

Answer 25

1. previous BCG vaccination 2. past history of tuberculosis 3. HIV 4. Pregnancy 5. positive tuberculin test (Heaf or Mantoux) 6. Age over 35

Question 26

MMR vaccine When are the doses given

Answer 26

12-15 months 3-4 months

Question 27

What are the 5 contraindications to MMR

Answer 27

1. Immunosuppresion 2. Allergy to neomycin 3. Children who received another live vaccine by injection within 4 weeks 4. Pregnancy - avoid for at least 1 month after vaccination 5. Immunoglobulin therapy within last 3 months

Question 28

When should Men B vaccines be given?

Answer 28

2 months 4 months 12-13 months

Question 29

Adverse effects of MMR vaccine after 1st dose - when do they occur and how long do they last for

Answer 29

Malaise Fever Rash Typically occurs after 5-10 days, lasts around 2-3 days