Immunisation and Prophylaxis

Question 1

Who is immunisation given to?

Answer 1

Childhood schedule
Special patient groups
Occupational
Travelers

Question 2

Who is prophylaxis given to?

Answer 2

Travelers
Post exposure
Post exposure (HIV)
Surgical

Question 3

Two types of immunity

Answer 3

Adaptive

Innate

Question 4

Types of adaptive immunity

Answer 4

Natural 
- passive (maternal)
- active (infection)
Artificial 
- passive (antibody transfer)
- active (immunisation)

Question 5

What type of immunity are you born with?

Answer 5

Innate immunity

Question 6

What childhood immunisations are given at 2 months?

Answer 6

6 in 1 vaccine
Rotavirus
Men B
Pneumococcal conjugate

Question 7

What childhood immunisation can be given at 3 months?

Answer 7

6 in 1 vaccine

Rotavirus

Question 8

What childhood immunisation can be given at 4 months?

Answer 8

6 in 1 vaccine
Pneumoccocal conjugate
Men B

Question 9

What childhood immunisation can be given at 1 year old?

Answer 9

Hib/Men C
MMR
pneumococcal conjugate
Men B

Question 10

What childhood immunisation can be given at 2-8 years?

Answer 10

Influenza nasal

Question 11

What childhood immunisation can be given at 3-5 years?

Answer 11

4-in-1 booster (DTaP/IPV)

MMR

Question 12

What immunisations are given at 12-13 years?

Answer 12

HPV

Question 13

What immunisations are given at 14 years old?

Answer 13

3-in-1 booster (dT/IPV)

Men ACWY

Question 14

What is the BCG (bacilli Calmette-guerine vaccine) an immunisation for?

Answer 14

TB

Question 15

Who gets the BCG vaccine?

Answer 15

Some infants (0-12 months)
- areas of UK with certain incidence
- parents/grandparents born in a country with annual incidence
New immigrants (Not previously vaccinated) for high prevalence countries of TB
Contacts (<35 years) of resp TB patients
Healthcare workers

Question 16

Indications for the influenza vaccine

Answer 16

Age > 65 y/o 
Nursing home residents
Healthcare workers
Immunodefiency/suppression 
Asplenia/hyposplenism 
Chronic liver/renal/cardiac/lung disease
DM
Coeliac disease
Pregnant women

Question 17

What is to be cautioned in the influenza vaccine?

Answer 17

Egg allergy

Question 18

Two types of pneumococcal vaccine

Answer 18

Prevenar 13
- Pneumoccocl conjugate polysaccharide vaccine
Pneumovax II
- Pneumococcal polysaccharide vaccine

Question 19

When is prevenar 13 given? (conjugate)

Answer 19

Part of childhood immunisation schedule - 3 doses

Question 20

When is pneumonax II given?

Answer 20

For those at increased risk of pneumococcal infection - 1 dose

Question 21

Indications for pneumococcal vaccine

Answer 21

Immunodeficiency/suppression 
Asplenia/hyposplenism 
Sickle cell disease
Chronic liver/renal/cardiac/lung disease
DM
coeliac disease

Question 22

Who is given Hepatitis B vaccine?

Answer 22

All newborne children from 2018 (6 in 1)
Children at high risk of exposure to HBV
Healthcare workers
PWID
MSM
prisoners
chronic liver/kidney disease

Question 23

What does PWID stand for?

Answer 23

People who inject drugs

Question 24

When is the Hep B vaccination given?

Answer 24

0, 1 month, 2 months + 1 year

Question 25

Who is given the varicella-zoster (chicken pox) vaccine?

Answer 25

Patients with suppressed immunity e.g. cancer treatment or organ transplant Children if in contact with those at risk of severe VZV Healthcare workers (if sero negative and in contact with patients)

Question 26

What type of vaccination is VZV and how often is it given?

Answer 26

Live attenuated vaccination | 2 doses, 4-8 weeks apart

Question 27

What does the varicella zoster virus cause?

Answer 27

Chicken pox

Question 28

Who is given the herpes-zoster (shingles) vaccination?

Answer 28

all elderly patients (70-80 years)

Question 29

What does the herpes-zoster virus cause?

Answer 29

Shingles

Question 30

Types of vaccines

Answer 30

Live attenuated Inactivated (killed) Detoxified exotoxin Subunit of microorganism

Question 31

What do live attenuated vaccines do?

Answer 31

More likely to stimulate the immune system to bring about an immune response

Question 32

When is a live attenuated vaccine relatively contraindicated?

Answer 32

In immunocompromised e.g. HIV or chemo

Question 33

Examples of a live attenuated vaccine

Answer 33

MMR Rotavirus (oral) Varicella-zoster (chicken pox) BCG

Question 34

Examples of an inactivated (killed) vaccine

Answer 34

Rabies Influenza Hep A Cholera (oral)

Question 35

Examples of detoxified exotoxin vaccines

Answer 35

Diptheria | Tetanus

Question 36

Examples of subunit vaccines

Answer 36

Hep B Thyphoid Pneumococcus

Question 37

Example of a recombinant vaccine

Answer 37

Hep B

Question 38

In antibody response to infection, what does the second response represent?

Answer 38

Immunological memory

Question 39

How many doses of killed vaccines are usually given and why?

Answer 39

2 or 3 doses - as need to build up the response

Question 40

How many doses of live vaccines are usually given and why?

Answer 40

1 dose - does not need multiple doses as the immune system is stimulated

Question 41

What does the "6 in 1 vaccine" contain?

Answer 41

``` D = purified T = Purified tetanus toxin aP = purified boraetella pertussis IPV = Inactivated polio viruses Hib = purified component of haemophilus, influenza b HBV = hepatitis B rDNA ```

Question 42

Herd immunity targets what amount of coverage?

Answer 42

90-95%

Question 43

Examples of disease specific immunoglobulins used for post exposure (passive immunisation)

Answer 43

Hepatitis Ig Rabies Ig Varicella (chicken pox) Ig

Question 44

What does human normal immunoglobulin contain?

Answer 44

Antibodies against - hep A - rubella - measles

Question 45

When is human normal immunoglobulin used?

Answer 45

Immunoglobulin deficiencies | treatment of some autoimmune disorders e.g. myesthesia gravis

Question 46

Types of passive immunisation

Answer 46

Human normal immunoglobulin | Disease specific immunoglobulins (post exposure)

Question 47

Risk assessment for travellers look at....

Answer 47

``` Health of traveller Previous immunisation and prophylaxis Areas visiting Duration of visit Accommodation activities Remote areas Recent outbreaks ```

Question 48

General safety measures for health of travellers

Answer 48

``` Care with food/water Hand washing Sunburn/stroke Altitude RTAs Safe sex Mosquitos (bed nets, sprays, cover up) ```

Question 49

Travellers are commonly immunised for....

Answer 49

``` Tetanus Polio typhoid Hep A Yellow fever (need certificate) Cholera ```

Question 50

Travelers may need immunised with these in special circumstances....

Answer 50

``` Meningococcus A, G, W, Y Diptheria Jap B encephalitis Rabies Tick borne encephalitis ```

Question 51

ABCD prevention of malaria

Answer 51

``` A = awareness of risk - location of travel B = bite prevention - cover up at dawn and dusk - insect repellent sprays, lotions - mosquito coils - nets C = Chemoprophylaxis (choice depends on country) - malanone, doxycycline, mefloquine D = diagnosis and treatment ```

Question 52

Malaria advice to returning travellers

Answer 52

Any illness occurring within 1 year and especially within 3 months of return might be malaria

Question 53

Who should have their immunisation withholded?

Answer 53

Immunosuppression - for VZV, MMR, BCG History of anaphylaxis

Question 54

How many doses of tetanus provide life long protection?

Answer 54

5

Question 55

Who are live attenuated vaccines contraindicated in? (One of the groups)

Answer 55

HIV positive patients