Immunisation and prophylaxis

Question 1

2 types of adaptive immunity

Answer 1

natural and artificial

Question 2

2 types of natural adaptive immunity

Answer 2

passive - maternal

active - infection

Question 3

2 types of artificial adaptive immunity

Answer 3

passive - ab transfer

active - immunisation

Question 4

Briefly describe the significance of Edward Jenner

Answer 4

pioneer of smallpox vaccine in 1798

those with cowpox never got smallpox so injected pus from cowpox pustule into boy

Question 5

4 types of vaccine

Answer 5

live attenuated
inactivated - killed
detoxified exotoxin
subunit of microorganism eg recombinant

Question 6

5 live attenuated vaccines

Answer 6

MMR 
BCG 
VZV 
smallpox 
yellow fever

Question 7

who may live attenuated vaccines cause infection in?

Answer 7

immunocompromised

Question 8

How do live attenuated vaccines work?

Answer 8

live and replicating and stimulate the immune system

Question 9

5 inactivated vaccines

Answer 9

polio 
hep A 
cholera 
rabies 
influenza

Question 10

What is used to change the toxin to a toxoid?

Answer 10

formalin

Question 11

2 examples of detoxified exotoxin vaccines

Answer 11

diphtheria and tetanus

Question 12

list some subunit vaccines

Answer 12

H influenza B
pneumococcus
hep B
typhoid

Question 13

Briefly explain the process of creating a recombinant vaccine eg hep B

Answer 13

DNA segment coding HBsAG which is removed, purified and mixed with plasmids - insert into yeast
fermented and HBsAG produced

Question 14

Briefly explain immunological memory

Answer 14

primary response is slow and small and IgM raises and then IgG
secondary response is a faster and larger response

Question 15

Difference in killed and live vaccine response

Answer 15

killed need 2 or 3 doses to build up the response

live vaccine replicated and stimulates host immune system

Question 16

name the 6 in 1 vaccine

Answer 16

purified diphtheria toxoid 
purified tetanus toxoid 
purified bordetella pertussis 
inactivated polio virus 
purified component of H influenza B 
hep B rDNA

Question 17

Some immunisations used for special patient and occupational groups

Answer 17

pneumococcal, BCG, influenza, hep B, HZV and VZV

Question 18

Special groups given BCG

Answer 18

TB risk is high

Question 19

Indications for influenza vaccine

Answer 19

pregnancy 
coeliac
chronic kidney, liver, cardiac, lung disease 
DM 
healthcare workers 
immunosuppression 
over 65

Question 20

2 types of pneumococcal vaccine

Answer 20

conjugate and non conjugated

Question 21

conjugated pneumococcal vaccine info

Answer 21

13 serotypes given in 3 doses

childhood immunisation schedule

Question 22

Non conjugated pneumococcal vaccine info

Answer 22

23 serotypes given in a single dose

increased risk of pneumococcal infection

Question 23

conjugate

Answer 23

bound with something else to make it more immunogenic

Question 24

Who is Hep B vaccine given to?

Answer 24

children - 6 in 1 - 0,1,2 months and 1 year

healthcare workers, IVDU, MSM, high risk children

Question 25

Who is given the VZV vaccine?

Answer 25

suppressed immune systems sero negative healthcare workers children in contact

Question 26

treatment scheme of VZV vaccine

Answer 26

live attenuated vaccine given 2 doses 4 weeks apart

Question 27

Who is given the HZV vaccine?

Answer 27

elderly (70-80)

Question 28

When is human normal Ig given?

Answer 28

ab for hep A, rubella, measles | Ig deficiencies, autoimmune disorders eg myaesthenia gravis

Question 29

Disease specific Ig examples

Answer 29

hep B, rabies, tetanus, varicella, diphtheria, botulinum

Question 30

Risk assessment of travellers

Answer 30

``` area of travel, duration, remote areas previous immunisations and prophylaxis health of traveller accommodation and activities recent outbreaks ```

Question 31

General measures for travellers

Answer 31

``` care with food and drink handwashing sunburn and sunstroke altitude eg Peru road traffic accidents safer sex mosquitos ```

Question 32

Common immunisations for travellers

Answer 32

``` tetanus polio hep A typhoid cholera yellow fever ```

Question 33

Special circumstances immunisations for travellers

Answer 33

``` rabies diphtheria Japanese B encephalitis tick borne encephalitis meningococcus ACWY ```

Question 34

4 examples of antimicrobial prophylaxis

Answer 34

chemoprophylaxis against malaria PEP eg ciprofloxacin for meningococcal HIV PEP surgical antibiotic

Question 35

ABCD of malaria

Answer 35

awareness of risk bite prevention chemoprophylaxis diagnosis and treatment

Question 36

bite prevention measures

Answer 36

permethrin impregnated mosquito nets cover up dusk and dawn mosquito coils insect repellent sprays and lotions (DEET)

Question 37

Chemoprophylaxis regime for malaria

Answer 37

malarone (proquanil and atovaraquone) doxycycline mefloquine chloroquine

Question 38

Doxycycline CI

Answer 38

photosensitivity and not in children under 12

Question 39

Mefloquine CI

Answer 39

psychosis and nightmares | not in those with epilepsy or psychosis

Question 40

Advice to travellers on return re. malaria

Answer 40

illness within 1 year back and especially first 3 months can be malaria