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MBBS V - Senior Clerkship - Block C CCT > Paediatrics - Childhood immunization > Flashcards

Paediatrics - Childhood immunization Flashcards

1
Q

Hong Kong Childhood Immunization Program.
Vaccines given at:
Newborn?
1 month?

A

Newborn:
B.C.G Vaccine
Hepatitis B vaccine - 1st dose

1 month:
Hepatitis B vaccine - 2nd dose

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2
Q 
Hong Kong Childhood Immunization Program. 
Vaccines given at:
2 months, 
4 months, 
6 months?
A

2 months:
DTaP-IPV - 1st dose
PCV13 - 1st dose

4 months:
DTaP-IPV - 2nd dose
PCV13 - 2nd dose

6 months:
DTaP-IPV - 3rd dose
Hepatitis B - 3rd dose

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3
Q

Hong Kong Childhood Immunization Program.
Vaccines given at:
12 months
18 months

A

12 months:
MMR - first dose
PCV13 - Booster dose
Varicella - 1st dose

18 months:
DTaP-IPV - Booster
MMR - 2nd dose

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4
Q 
Hong Kong Childhood Immunization Program. 
Vaccines given at:
Primary 1 
Primary 5 
Primary 6
A

P1:
DTaP-IPV - Booster

P5:
9-valent HPV vaccine - 1st dose

P6:
9-valent HPV vaccine - 2nd dose

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5
Q

List 2 vaccine not under Hong Kong Childhood Immunization Program.

A

Haemophilus Influenza type B vaccine

Rotavirus vaccine

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6
Q

Difference between active and passive immunization

A 
Active = antigen, elicit immune response and long-term memory 
Passive = Immunoglobulin (Ig), Short-term protection
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7
Q

List 5 types of vaccines

A
  • Live attenuated organism
  • Killed whole organism
  • Inactivated exotoxin
  • Subunit
  • Subunit conjugated
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8
Q

Define and give Example of live attenuated vaccine

A

Attenuated/ weakened form of virus of bacteria that replicate
Immune response similar to natural infection

Varicella
BCG
Chicken pox
MMR

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9
Q

Define and give Example of killed whole organism vaccine

A

Whole cell Pertussis
IPV (polio)
HAV

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10
Q

Define and give Example of inactivated exotoxin vaccine

A

Diphtheria toxoid

Tetanus Toxoid

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11
Q

Define and give Example of Subunit vaccine

A

Acellular pertussis

Pneumovax

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12
Q

Define and give Example of Subunit conjugated vaccine

A

Hemophilus influenzae type B

Pneumococcal vaccine

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13
Q

3 disadvantages of live attenuated vaccines

A

Severe reaction possible
Interference from circulating antibody (e.g. IV Ig can counteract the vaccine effects)
Unstable - require special storage and transport

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14
Q

Advantages and Disadvantages of Inactivated vaccines

A

Advantage:

  • Minimum interference from circulating antibody
  • Cannot replicate, rare severe reaction
  • Humoral immune response

Disadvantages:

  • Less effective than live vaccine
  • Require 3-5 doses (primary + booster)
  • Antibody titer falls over time
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15
Q

Define 2 types of vaccine failure

A

Primary = Vaccine fail (e.g. spoiled from poor storage, contaminated)

Secondary = No host response

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16
Q

Time gap between vaccine and antibody admin.

A

Vaccine given first = Wait 2 weeks before giving Ab

Ab given first = wait >3 months before giving vaccine
High dose Ab need even longer

17
Q

2 reasons why HK has not implemented Hemophilus influenza type B vaccine in program

A

HiB Universal vaccination not implemented because:

  • Low mortality rate and Low disease burden in HK (mostly in middle east and Africa)
  • Cost of vaccines - only available in private sector with 50% coverage
18
Q

Varicella virus:

  • Reservoir
  • Transmission
  • Temporal pattern
  • Communicability
A
  • Reservoir = human
  • Transmission = airborne droplet, direct contact with lesion
  • Temporal pattern = peak in winter, early spring
  • Communicability = 1-2 days before rash until 4-5 days after. Longer if immunocompromised
19
Q

Varicella pathogenesis pathway

A

Repiratory transmission&raquo_space; Replication in nasopharynx and regional lymph nodes&raquo_space; repeated episodes of viremia&raquo_space; Multiple organs and tissue infected (including sensory ganglia)&raquo_space; vesicular rash on skin

4 types of lesions present: red nodule > vesicle > pustule > crust/ scar

20
Q

Reactivation of varicella virus?

A

Dormant in Dorsal root ganglion

> > reappear as shingles: Groups of lesions unlike isolated dots in chickenpox

21
Q

3 complications of Varicella infection

A
  • Bacterial infection of lesions: skin sepsis and impetigo, necrotizing fasciitis
  • CNS: Reye’s syndrome, Cerebellar ataxia
  • Pneumonia
22
Q

Which people have increased risk of complications from Varicella

A

Normal adults infected for the 1st time (young children cope much better)

Immunocompromised

Newborn with maternal rash: onset after delivery

23
Q

Congenital Varicella Syndrome.

  • Cause
  • Period of risk
  • Symptoms
A

Maternal infection during pregnancy > vertical Tx

Period of risk through first 20 weeks to pregnancy

Atrophy of extremities, Skin scaring, Low birth weight, Neurologic abnormalities

24
Q

Varicella Vaccine

  • Composition
  • Efficacy
  • Duration of immunity
  • Schedule in vaccine program
A

Live virus vaccine
95% efficacy (mostly mild reaction illness without complication)
>7 years immunity

1st dose at 1 year old
2nd booster at 18 months

25
Q

Rotavirus vaccine efficacy

A
  • High in industrialized and middle income countries, 96% effective against severe rotavirus gastroenteritis
26
Q

Which populations are most at risk of influenza and require vaccine.

A

Children from 6m to 5 years

Pregnant women

Elderly >= 65 (+/- living in residential care homes)

Healthcare workers

Poultry workers

Chronically ill/ disabled

27
Q

Program for children influenza vaccine?

Efficacy and coverage?

A

School Outreach Vaccination program for all primary schools and kindergartens

Doubles coverage to 70%
Vaccine efficacy = 45.3% against influenza-like-illness

28
Q

3 types of pneumococcal vaccine?

A

PCV7,10,13

Protects against 7,10 or 13 serotypes of pneumococci

29
Q

4 diseases that are associated with pneumococcal infection.

A

Meningitis
Empyema
Necrotizing pneumonia
Septic shock

30
Q

Which pneumococcal serotypes are implicated in Necrotizing pneumonia, empyema, septic shock, fatality rate?

A

Serotype 3** and 19A

31
Q

Which pneumococcal vaccine can protect against empyema?

A

Only PCV13

Coverage for Serotype 1,3,5,7F,8,19A

32
Q

Efficacy of pneumococcal conjugate vaccines against clinical pneumonia vs CXR-positive pneumonia.
How does pneumococcal vaccine protect against infection?

A

Clinical = 8%
CXR +ve = 36%

Direct protection against colonization in nasopharynx, direct protection against disease in lungs or bacteremia

33
Q

Which pneumococcal serotype is causing an increase in invasive pneumococcal disease? Which vaccine type is failing?

A

Serotype 3 is causing increase in invasive pneumococcal disease in aged 2-4 and 5-17

PVC13 failing

34
Q

Pneumococcal vaccine failure is predominant in which serotype?

A

Serotype 3

35
Q

Efficacy of PCV10 vs PCV13?

A

Similar

due to PCV13 serotype 3 failure

36
Q

Major barrier for using PCV vaccines?

A
  • PRICE ***

- Serotype 3 failure

MBBS V - Senior Clerkship - Block C CCT (52 decks)

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