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Infectious diseases > Immunization > Flashcards

Immunization Flashcards

1
Q

PASSIVE immunity

A

Uses pre-formed antibody to protect against infection.

Natural passive immunity: occurs in the placental transfer of maternal antibodies to the foetus.

Acquired passive immunity: includes treatment with immunoglobulins e.g. hepatitis B, rabies, tetanus, varicella zoster.

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2
Q

ACTIVE immunity

A

Follows exposure to an antigen, which generates an adaptive immune response.

Natural active immunity: occurs following infection.

Acquired active immunity: is provided by vaccination.

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3
Q

Vaccination: Overview

A
  • Routine vaccinations in the UK are offered to everyone.
  • Additional vaccines are offered to specific vulnerable groups.
  • Immunosuppression is a contraindication to live vaccines due to the risk of disseminated disease.
  • This includes immunodeficiency, immunosuppressive treatment and HIV.
  • Inactivated vaccines can be given but the antibody response may be less.
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4
Q

UK vaccination summary: Children

A
  • Diphtheria (6-in-1)
  • Tetanus (6-in-1)
  • Pertussis (whooping cough) (6-in-1)
  • Polio (6-in-1)
  • Haemophilus influenza B (Hib) (6-in-1)
  • Hepatitis B (6-in-1)
  • Pneumococcal
  • Rotavirus
  • MenB
  • MenC
  • MMR
  • Influenza
  • HPV
  • MenACWY
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5
Q

UK vaccination summary: Adults

A
  • Pneumococcal
  • Influenza
  • Shingles
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6
Q

UK vaccination summary: Pregnant women

A
  • Influenza (during flu season)

- Pertussis (whooping cough) from 16 wks

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7
Q

Diphtheria: Definition

A

Diphtheria is caused by the Gram positive bacterium Corynebacterium diphtheriae

Pathophysiology

  • releases an exotoxin encoded by a β-prophage
  • exotoxin inhibits protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2

Diphtheria toxin commonly causes a ‘diphtheric membrane’ on tonsils caused by necrotic mucosal cells. Systemic distribution may produce necrosis of myocardial, neural and renal tissue

Possible presentations

  • recent visitors to Eastern Europe/Russia/Asia
  • sore throat with a ‘diphtheric membrane’ - see above
  • bulky cervical lymphadenopathy
  • neuritis e.g. cranial nerves
  • heart block
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8
Q

Tetanus: Definition

A

Tetanus is caused by the tetanospasmin exotoxin released from Clostridium tetani. Tetanus spores are present in soil and may be introduced into the body from a wound, which is often unnoticed. Tetanospasmin prevents release of GABA

Features

  • prodrome fever, lethargy, headache
  • trismus (lockjaw)
  • risus sardonicus
  • opisthotonus (arched back, hyperextended neck)
  • spasms (e.g. dysphagia)

Management

  • supportive therapy including ventilatory support and muscle relaxants
  • intramuscular human tetanus immunoglobulin for high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue)
  • metronidazole is now preferred to benzylpenicillin as the antibiotic of choice
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9
Q

Pertussis (whooping cough): Definition

A

Overview

  • caused by the Gram-negative bacterium Bordetella pertussis
  • incubation period = 10-14 days

Features, 2-3 days of coryza precede onset of:

  • coughing bouts: usually worse at night and after feeding, may be ended by vomiting & associated central cyanosis
  • inspiratory whoop: not always present (caused by forced inspiration against a closed glottis)
  • infants may have spells of apnoea
  • persistent coughing may cause subconjunctival
  • haemorrhages or even anoxia leading to syncope & seizures
  • symptoms may last 10-14 weeks* and tend to be more severe in infants
  • marked lymphocytosis
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10
Q

Polio: Definition

A

Polio, short for poliomyelitis, or infantile paralysis, is an infectious disease caused by the poliovirus. In about 0.5 percent of cases, there is muscle weakness resulting in an inability to move.

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11
Q

Haemophilus influenzae B (Hib): Definition

A

Haemophilus influenzae type b (Hib) Haemophilus influenza type b (Hib) is a bacteria responsible for severe pneumonia, meningitis and other invasive diseases almost exclusively in children aged less than 5 years. It is transmitted through the respiratory tract from infected to susceptible individuals.

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12
Q

Hepatitis B: Definition

A

Hepatitis B is a double-stranded DNA hepadnavirus and is spread through exposure to infected blood or body fluids, including vertical transmission from mother to child. The incubation period is 6-20 weeks.

The features of hepatitis B include fever, jaundice and elevated liver transaminases.

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13
Q

Pneumococcal: Definition

A

Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae and can lead to pneumonia, septicaemia (a kind of blood poisoning) and meningitis.

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14
Q

Rotavirus: Definition

A

Rotavirus is a genus of double-stranded RNA viruses in the family Reoviridae. Rotaviruses are the most common cause of diarrhoeal disease among infants and young children.

Most children recover at home within a few days, but nearly 1 in 5 will need to see their doctor, and 1 in 10 of these end up in hospital as a result of complications such as extreme dehydration.

Since its introduction into the vaccination programme, the rotavirus vaccine has prevented more than 70% of cases.

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15
Q

MenB

A

Meningococcal B

The word “Men” is an abbreviation for the word meningococcal, not meningitis as is often mistaken. Meningitis and meningococcal are not exactly the same.

Meningitis is the inflammation of the membranes that surround and protect the brain and spinal cord. Meningococcal refers to a type of bacteria that can cause meningitis. There are different groups of meningococcal bacteria, for example meningococcal group B which is commonly abbreviated to MenB (other groups include MenA, MenC, MenW and MenY).

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16
Q

MMR vaccine: Overview

A

Children in the UK receive two doses of the Measles, Mumps and Rubella (MMR) vaccine before entry to primary school. This currently occurs at 12-15 months and 3-4 years as part of the routine immunisation schedule

Contraindications to MMR

  • severe immunosuppression
  • allergy to neomycin
  • children who have received another live vaccine by injection within 4 weeks
  • pregnancy should be avoided for at least 1 month following vaccination
  • immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)

Adverse effects
- malaise, fever and rash may occur after the first dose of MMR. This typically occurs after 5-10 days and lasts around 2-3 days

17
Q

Measles: Definition

A

Measles is a highly contagious infectious disease caused by the measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.

Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes.

18
Q

Mumps: Definition

A

Mumps is a viral disease caused by the mumps virus. Initial signs and symptoms often include fever, muscle pain, headache, poor appetite, and feeling generally unwell.

This is then usually followed by painful swelling of one or both parotid salivary glands.

19
Q

Rubella: Definition

A

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild with half of people not realizing that they are infected.

A rash may start around two weeks after exposure and last for three days.

20
Q

Influenza: Overview

A

Seasonal influenza still accounts for a significant morbidity and mortality in the UK each winter, with the influenza season typically starting in the middle of November. This may vary year from year so it is recommended that vaccination occurs between September and early November. There are three types of influenza virus; A, B and C. Types A and B account for the majority of clinical disease.

Prior to 2013 flu vaccination was only offered to the elderly and at risk groups.

Remember that the type of vaccine given routinely to children and the one given to the elderly and at risk groups is different (live vs. inactivated) - this explains the different contraindications

21
Q

Human Papilloma Virus (HPV): Overview

A

It has been known for a longtime that the human papilloma virus (HPV) which infects the keratinocytes of the skin and mucous membranes is carcinogenic.

There are dozens of strains of HPV. The most important to remember are:

  • 6 & 11: causes genital warts
  • 16 & 18: linked to a variety of cancers, most notably cervical cancer

It should of course be remembered that there are other risk factors important in developing cervical cancer such as smoking, combined oral contraceptive pill use and high parity.

22
Q

Human Papilloma Virus (HPV) + Cervical smears

A

Testing for HPV has now been integrated into the cervical cancer screening programme.

If a smear is reported as borderline or mild dyskaryosis the original sample is tested for HPV:

  • if HPV negative the patient goes back to routine recall
  • if HPV positive the patient is referred for colposcopy
23
Q

Human Papilloma Virus (HPV): Vaccination

A

A vaccination for HPV was introduced in the UK back in 2008. As you may remember the Department of Health initially chose Cervarix. This vaccine protected against HPV 16 & 18 but not 6 & 11. There was widespread criticism of this decision given the significant disease burden caused by genital warts. Eventually in 2012 Gardasil replaced Cervarix as the vaccine used. Gardasil protects against HPV 6, 11, 16 & 18. This was initially just given to girls but from September 2019 boys were given the vaccine as well.

From September 2019, all 12- and 13-year-olds (girls AND boys) in school Year 8 will be offered the human papillomavirus (HPV) vaccine.

  • the vaccine is normally given in school
  • information given to parents and available on the NHS website make it clear that the daughter may receive the vaccine against parental wishes
  • given as 2 doses - girls have the second dose between 6-24 months after the first, depending on local policy

Injection site reactions are particularly common with HPV vaccines.

24
Q

MenCAWY: Overview

A 
Meningococcal strains (Men A, B, C, W & Y)
There are five main groups that commonly cause disease in the UK - MenA, MenB, MenC, MenW, MenY.

MenB causes the majority of the disease in the UK.

25
Q

Extra vaccines for people at risk: Univeristy/college

A

If you’re starting college or university you should make sure you’ve already had:

  • the MenACWY vaccine – which protects against serious infections like meningitis. You can still ask your GP for this vaccine until your 25th birthday.
  • 2 doses of the MMR vaccine – as there are outbreaks of mumps and measles at universities. If you have not previously had 2 doses of MMR you can still ask your GP for the vaccine.
26
Q

6-in-1

A
  • Diphtheria
  • Tetanus
  • Polio
  • Pertussis (whooping cough)
  • Hep B
  • Hib
27
Q

NHS vaccination schedule: 2 months

A
  • 6-in-1
  • MenB
  • Pneumococcal
  • Rotavirus
28
Q

NHS vaccination schedule: 3 months

A
  • 6-in-1

- Rotavirus

29
Q

NHS vaccination schedule: 4 months

A
  • 6-in-1
  • MenB
  • Pneumococcal
30
Q

NHS vaccination schedule: 1 year

A
  • MMR
  • Hib and MenC
  • Pneumococcal
  • MenB
31
Q

NHS vaccination schedule: 3 years 4 months

A
  • 4-in-1 (DTaPP - diptheria, tetanus, polio, pertussis)

- MMR

32
Q

NHS vaccination schedule: 12-13 years

A
  • HPV (2 doses 6-24 months apart)
33
Q

NHS vaccination schedule: 14 years (year 9)

A
  • 3-in-1 (tetanus, diptheria, polio)

- MenACWY

34
Q

Does the MMR vaccine cause autism?

A

There’s been some controversy about whether the MMR vaccine might cause autism following a 1998 study by Dr Andrew Wakefield.

In his paper published in The Lancet, Dr Wakefield claimed there is a link between the MMR vaccine and autism or bowel disease.

But Andrew Wakefield’s work has since been completely discredited and he has been struck off as a doctor in the UK.

Subsequent studies in the last 9 years have found no link between the MMR vaccine and autism or bowel disease.

35
Q

BCG vaccine: Overview

A

The Bacille Calmette-Guérin (BCG) vaccine offers limited protection against tuberculosis (TB). In the UK it is given to high-risk infants. Until 2005 it was also routinely given to children at the age of 13 years.

The vaccine contains live attenuated Mycobacterium bovis. It also offers limited protection against leprosy.

Administration

  • any person being considered for the BCG vaccine must first be given a tuberculin skin test. The only exceptions are children < 6 years old who have had no contact with tuberculosis
  • given intradermally, normally to the lateral aspect of the left upper arm
  • BCG can be given at the same time as other live vaccines, but if not administered simultaneously there should be a 4 week interval
36
Q

Travel

A
  • Travel advice = more important than vaccination.
    (food/drink, insect repellent, malaria prophylaxis, condoms)
  • Useful resource: Travel Health Pro
  • Vaccination depends on area of travel and planned activities.

Infectious diseases (8 decks)

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