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Medical Ethics & Law > Immunisation and Prophylaxis > Flashcards

Immunisation and Prophylaxis Flashcards

1
Q

What is immunisation?

A

Creation of immunity against a disease

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2
Q

What is prophylaxis?

A

Treatment given or taken to prevent disease

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3
Q

Who is immunisation given to?

A
  • Childhood schedule
  • Special patient groups
  • Occupational
  • Travelers
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4
Q

Who is prophylaxis given to?

A
  • Travelers
  • Post-exposure
  • Surgical
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5
Q

What are the different branches of immunity?

A
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6
Q

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

A

Secondary response is much faster

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7
Q

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

A
  • 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
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8
Q

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

A

Smallpox

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9
Q

What are the different kinds of vaccines?

A

Live attenuated

Inactivated (killed)

Detoxified exotoxin

Subunit of micro-organism

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10
Q

What are examples of live attenuated vaccines?

A
  • Measles, mumps, rubella (MMR)
  • BCG
  • Varicella-zoster virus
  • Yellow fever
  • Smallpox
  • Typhoid (oral)
  • Polio (oral)
  • Rotavirus (oral)
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11
Q

What are examples of inactivated (killed) vaccines?

A
  • Polio (in combined vaccine D/T/P/Hib)
  • Hepatitis A
  • Cholera (oral)
  • Rabies
  • Japanese encephalitis
  • Tick-borne encephalitis
  • Influenza
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12
Q

What are examples of detoxified exotoxin vaccines?

A
  • Diphtheria
  • Tetanus
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13
Q

What are examples of subunit of microorganism vaccines?

A
  • Pertussis (acellular)
  • Haemophilus influenzae type b
  • Meningococcus (group C)
  • Pneumococcus
  • Typhoid
  • Anthrax
  • Hepatitis B
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14
Q

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

A

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
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15
Q

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

A

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
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16
Q

Describe the UK immunisation scedule?

A
  • 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
17
Q

What is herd immunity?

A

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

18
Q

What is the target uptake for herd immunity to work?

A

90-95%

19
Q

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

A
  • 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)
20
Q

Who is offered the BCG vaccine?

A
  • 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
21
Q

What are some indications to get the influenza vaccine?

A
  • Age>65
  • Nursing home resident
  • Healthcare worker
  • Immunodeficiency
  • Chronic liver, renal, cardiac or lung disease
  • Diabetes
  • Pregnant
22
Q

What are the 2 pneomococcal vaccines?

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

Who gets the hepatitis B vaccine?

A
  • Part of 6in1 vaccine for new-borns from 2018
  • Healthcare workers
  • Prisoners
  • Chronic liver or kidney disease
24
Q

Who is offered the varicella-zoster vaccine?

A
  • Immunodeficiency
  • Children if in contact with those at risk of severe vzv
  • Healthcare workers (if sero-neg)
25
Q

What is varizella-zoster also known as?

A

Chickenpox

26
Q

What is herpes-zoster also known as?

A

Shingles

27
Q

What is passive immunisation?

A

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

28
Q

Does passive immunisation given permanent or temporary protection?

A

Temporary

29
Q

What immunoglobulins can be given for passive protection?

A

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
30
Q

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

A
  • hepatitis B Ig
  • rabies Ig
  • tetanus anti-toxin Ig
  • Varicella zoster (chickenpox) Ig
  • diphtheria anti-toxin Ig (horse)
  • botulinum anti-toxin Ig
31
Q

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

A
  • Health of Traveller
  • Previous immunisation and prophylaxis
  • Area to be visited
  • Duration of visit
  • Accommodation
  • Activities
  • Remote areas
  • Recent outbreaks
32
Q

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

A
  • British National Formulary (BNF)
  • “Immunisation Against Infectious Diseases” (green book)
33
Q

What are examples of some travel advice?

A
  • 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
34
Q

What are some vaccines maybe offered to travellers?

A
  • Tetanus
  • Polio
  • Typhoid
  • Hepatitis A
  • Yellow fever
  • Cholera
  • In special circumstances:
    • Meningococcus A, C, W, Y
    • Rabies
    • Diphtheria
    • Japanese B encephalitis
    • Tick borne encephalitis
35
Q

What are examples of chemoprophylaxis (antimicrobial prophylaxis)?

A
  • Chemoprophylaxis against malaria
  • Post-exposure prophylaxis
    • Such as ciprofloxacin for meningococcal disease
  • HIV post-exposure prophylaxis
  • Surgical antibiotic prophylaxes
36
Q

Describe malaria prevention advice?

A
  • 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
37
Q

What is some chemoprophylaxis options for malaria?

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

Medical Ethics & Law (52 decks)

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