Case 11 - vaccination Flashcards
(21 cards)
When is BCG indicated?
- All infants 0-12 months at increased risk of developing severe disease and/or exposure to TB
- Eg parents/grandparents born in coutnry with higher incidence TB (40/100,000)
- Living in area in UK where annual incidence is same as above
- Aged 1-5 yrs previously vaccinated who are in risk groups above
When is varicella vaccine indicated?
- Healthcare workers of all kinds not immune to varicella
- Healthy family members and contacts of immunocompromised individuals - they can’t have it themselves as it is a live vaccine
When is tick-borne encephalitis vaccine given?
- If high risk of exposure to virus via travel/employment
Contraindications for vaccination
- Previous anaphyalxis to a vaccine or vaccine component
- Primary/acquired immunodeficiency - live vaccines contraindicated
- Immunosuppressive therapy - steroids, chemo
- Contact with individuals with immunodeficiency or current/recent immunosupressive therapy
When are vaccines temporariluy deferred?
- If acutely unwell with fever over 38.5
- Immunoglobulin therapy - interefere with immune response to live vaccines
Live vaccines in UK
- BCG
- Influenza
- MMR
- Rotavirus
- Typhoid
- Varicella and shingles
- Yellow fever
Vaccines routinely administered at 12 months
- MMR
- Hib
- MenC
- Pneumococcal (PCV booster)
- MenB
Which vaccines can people with severe egg allergy not have?
- Only rabies and yellow fever
- Live influenza contains minute traces
- MMR is cultured in chick embryo fibroblasts
Flu MMR rabies and yellow fever contain egg but MMR and flu are safe to give.
What is DiGeorge syndrome?
- Microdeletion of chromosome 22 portion
- = developlemtal defect in 3rd pharyngeal pouch and 3rd branchial cleft
- = incomplete thymus gland development
Features of DiGeorge
Catch22
* Congenital heart disease
* Abnormal facies
* Thymus gland incomplete
* Cleft palate
* Hypoparathyroidism –> hypocalcaemia
* 22 chromosome affcted
Live vaccines part of immunisation schedule
- Rotavirus
- MMR
- Nasal flu
- if BCG eligible this is too
Adverse events following immunisation (AEFI) categories
- Programme related - inappropriate practice eg wrong dose, incorrect prep/store
- Vaccine induced - reaction to vaccine/components
- Coincidental - not true AEFI, timing of cold overlaps
- Unknown - insufficient evidence to classify
Common general vaccine induced AEFIs
- Local - pain, swelling, redness
- Systemic - fever, malaise, headache, irritable, myalgia, loss of appetite, vomitting
These DO NOT contraindicate further vaccines
Common vaccine specific vaccine induced AEFI’s
- Local reaction + fever <48hrs of 6 in 1
- Rash and fever 10 days after MMR
- Parotitis 3 weeks after MMR
- High fever (more than 38) very common with 4CMenB vaccine - give paracetamol prophylactically
Uncommon rare vaccine related AEFIs
- Unusual high pitched cry
- Seizures
- Immune thromboctyopenic purpura
- Guillain Barre syndrome
Facts about AERIs
- They are common
- Can be vaccine specific or differ between vaccines
- Paracetamol and ibuprofen can be used to lower fever and ease distress but there is no evidence they prevent febrile convulsions
- Systemic AEFIs eg fevers and irritability do not contraindicate further vaccination
Children who are at risk of under vaccination:
- Large families
- Lone or single parent
- Looked after schildren
- Mobile families
- Migrant/asylum seeking children
- Disabling/chronic condition
- Ethnic minority group
Types of vaccines
- Live
- Inactivated
- Conjugate
- Recombinant
Examples of inactivated vaccines
- Whole - inactivated polio
- Toxoid - diptheria, tetanus, pertussis
Conjugate vaccine examples
- Hib
- MenC
- PCV
- MenACWY
Examples of recombinant vaccines
- Hepatitis B
- HPV
- MenB
