Paediatrics Vaccinations Flashcards
(133 cards)
1
Q
What do vaccinations do?
A
Provide immunity to full version of the pathogen
2
Q
Give some examples of inactivated vaccines?
A
Polio
Flu vaccine
Hepatitis A
Rabies
3
Q
What do subunit and conjugate vaccines contain?
A
Parts of the organism used to stimulate an immune response
Safe for immunocompromised patients
4
Q
What are some examples of subunit and conjugate vaccines?
A
Pneumococcus
Meningococcus
Hepatitis B
Pertussis (whooping cough)
Haemophilus influenza type B
HPV
Shingles (herpes-zoster)
5
Q
What do live attenuated vaccines contain?
A
Weakened version of the pathogen
6
Q
Give some examples of live attenuated vaccines?
A
Measles, mumps and rubella vaccine: contains all three weakened viruses
BCG: contains a weakened version of tuberculosis
Chickenpox: contains a weakened varicella-zoster virus
Nasal influenza vaccine (not the injection)
Rotavirus vaccine
7
Q
What are toxin vaccines?
A
Toxin which is normally produced by a pathogen
8
Q
What kind of immunity do toxin vaccines produce?
A
Immunity to the toxin and not to the pathogen itself
9
Q
What are some examples of toxin vaccines?
A
Diphtheria
Tetanus
10
Q
What vaccines are given at 8 weeks?
A
6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
Meningococcal type B
Rotavirus (oral vaccine)
11
Q
What vaccines are given at 12 weeks?
A
6 in 1 vaccine (again)
Pneumococcal (13 different serotypes)
Rotavirus (again)
12
Q
What vaccines are given at 16 weeks?
A
6 in 1 vaccine (again)
Meningococcal type B (again)
13
Q
What vaccines are given at 1 year?
A
2 in 1 (haemophilus influenza type B and meningococcal type C)
Pneumococcal (again)
MMR vaccine
Meningococcal type B (again)
14
Q
What vaccines are given yearly from age 2 - 8 years?
A
Influenza vaccine (nasal vaccine)
15
Q
What vaccines are given at 3 years 4 months?
A
4 in 1 (diphtheria, tetanus, pertussis and polio)
MMR
16
Q
What vaccine is given at 12-13 years?
A
HPV vaccine (2 doses given 6 to 24 months apart)
17
Q
What vaccine is given at 14 years?
A
3 in 1 (tetanus, diphtheria and polio)
Meningococcal groups A, C, W and Y
18
Q
What is the current NHS HPV vaccine?
A
Gardasil (against 6, 11, 16 and 18)
19
Q
What strain of HPV causes genital warts?
A
Strains 6 and 11
20
Q
What strains of HPV cause cervical cancer?
A
Strains 16 and 18
21
Q
When is the BCG vaccine offered?
A
From birth to babies at higher risk of TB
22
Q
What is sepsis the result of?
A
Systemic inflammatory response
23
Q
In sepsis what is the causative pathogen recognised by? What do they release
A
Macrophages
Lymphocytes
Mast cells
They release cytokines e.g. interleukins and TNF leadint to further release of chemicals e.g. nitrous oxide which cause vasodilation
24
Q
What effect fo cytokines have on the endothelial lining of the blood vessels?
A
Become more permeable - causing fluid to leak out of blood into extracellular space causing oedema and reduction in intravascular volume
25
What is the **result** of the **oedema** in **sepsis**?
Create space between blood and tissues **reducing oxygen that reaches tissues**
26
How does **disseminated intravascular coagulopathy** (DIC) occur in sepsis?
Activation of **coagulation system** leads to deposition of **fibrin** throughout the circulation - causing **consumption** of **platelets** and **clotting factors** as they are being used up to form the blood clots. Causes **thrombocytopenia**, **haemorrhages** and an inability to form clots and stop bleeding
27
Why does **blood lactate** rise in sepsis?
Result of **anaerobic respiration** in the hypo-perfused tissues with an inadequate oxygen - **waste product** is lactate
28
How should **septic shock** be **treated**?
Aggressively with **IV fluids** - for bp and tissue perfusion
If bp does respond then escalate to **high dependency** or **ICU** where **inotropes** e.g. noradrenaline can be considered
29
What are **inotropes**?
Medications which **stimulate CVS** and **improve bp** and tissue perfusion
30
What **signs can indicate sepsis** in children?
**Deranged** physical observation
Prolonged **CRT**
**Fever** or hypothermia
Deranged **behaviour**
**Poor feeding**
**Inconsolable** / high pitched crying
**Reduced consciousness**
**Reduced body tone** (floppy)
**Skin colour changes** (cyanosis, mottled pale or ashen)
31
What is the **traffic light system** for assessment of serious illness in child with fever?
**Green** (low risk)
**Amber** (intermediate risk)
**Red** (high risk)
32
What forms part of the **traffic light system** assessment?
**Colour**: normal vs cyanosed, mottles, ashen
**Activity**: happy, responsive vs abnormal, drowsy, inconsolable
**Respiratory**: normal vs respiratory distress, tachypnoea, grunting
**Circulation and hydration**: normal, moist membranes vs tachycardia, dry membranes or poor skin turgour
**Other**: fever \> 5 days, non blanching rash, seizures or high temp \< 6 months
33
Which infants **need to be treated urgently for sepsis**?
Infants **under 3 months** with a **temperature** of **38C** or **above**
34
What is the **immediate management** of **sepsis**?
- **Oxygen**: if in shock / oxygen sats below 94%
- Obtain **IV** **access** (cannulation)
- **Blood tests**: including FBC, U&Es, CRP, clotting screen (INR), blood gas for lactate and acidosis
- **Blood cultures**: ideally before giving abx
- **Urine dip**: with cultures and sensitivities
- **Abx** according to local guidelines, within **1 hour** of presentation
- **IV fluids** 20ml/kg IV bolus of normal saline if lactate **above 2 mmol / L** or there is **shock**
35
What **investigations** in suspected sepsis?
**CXR** if pnuemonia
**Abdo and pelvic ultrasound** if intra-abdo infection suspected
**Lumbar puncture** if meningitis suspected
**Meningococcal PCR** blood test
**Serum** cortisol if adrenal crisis suspected
36
How long to **continue abx** for if a **bacterial infection** is suspected?
**5-7 days** - alter abx if needed once organism is isolated
37
When should **abx** be stopped?
**Low suspicion** of bacterial infection - patient is well and blood cultures and **two CRP** results are **negative at 48 hours**
38
What is **meningitis**?
Inflammation of the **meninges** - lining of the brain and spinal cord (usually due to **bacterial** or **viral** infection)
39
What is **neisseria meningitidis**?
**Gram negative diplococcus** bacteria - circulae (cocci) that occur in pairs (diplo) aka **meningococcus**
40
What is **meningococcal septicaemia**?
Meningocuccus bacterial infection in the **bloodstream** - cause of classic **non-blanching rash**
41
What does a **non-blanching rash** occur?
**DIC** and **subcutaneous haemorrhages**
42
What is **meningococcal meningitis**?
When bacteria **infects the meninges** and the **cerebrospinal fluid** around the brian and spinal cord
43
What are the **most common causes** of **bacterial meningitis** in children and adults?
**Neisseria meningitidis** (meningococcus) and **streptococcus penumoniae** (pneumococcus)
44
What is the **most common cause** of meningitis in **neonates**?
**Group B strep** (GBS) contracted from birth from **bacteria** that lives harmlessly in mothers vagina
45
What are the **typical features of meningitis**?
**Fever**
**Neck stiffness**
**Vomiting**
**Headache**
**Photophobia**
**Altered consiousness**
**Seizures**
46
Do causes other then **maningococcal septicaemia** cause the non-blanching rash?
Not usually
47
How do **neonates** with **sepsis** present?
**Non-specific signs**
Hypotonia
Poor feeding
Lethargy
Hypothermia
**Bulging fontanelle**
48
When is a **lumbar puncture** performed for a child with fever?
**Under 1 month with fever**
**1-3 months** with fever and unwell
**Under 1 year** with **unexplained fever** and other features of serious illness
49
What **two special tests** look for **meningeal irritation**?
**Kernig's test**
**Brudzinski's test**
50
How is **Kernig's test** performed?
Lie patient on back
**Flex hip** and **knee** to 90 degrees
Slowly straighten knee whilst keeping hip flexed
**Stretch in the meninges** produces spinal pain or resistance to movement
51
How is **brudzinski's test** performed?
Lie patient **on back**
Use hands to **lift their head** and neck off the bed - flex chin to chest
**Positive test** = involuntary flex of hips and knees
52
How should **bacterial meningitis** be treated in GP?
If **suspected** meningitis and **non-blanching rash** should receive an urgent stat IM/IV **benzylpenicillin** prior to transfer to hospital - dose is **age dependent**
53
**What if true penicillin allergy** in GP with sepsis?
**Transfer** should be **priority** rather than finding alternative abx
54
What is the **management** of **meningitis** in hospital?
**Blood culture** and **LP** for CSF prior to starting abx (if acutely unwell then not to be delayed)
Blood tests for **miningococcal PCR** if meningococcal disease suspected - tests directly for **meningococcal DNA** can give result quicker than blood cultures
55
What is the **typical abx** for meningitis?
**Under 3 months** - **cefotaxime** plus **amoxicillin** to cover listeria contracted during pregnancy
**Above 3 months** - **ceftriaxone**
**Vancomycin** - added if risk of **penicillin resistent pneumococcal** infection e.g. recent foreign travel or prolonged abx exposure
56
What is given to **reduce frequency and severity** of hearing loss and neurological damage?
**Steriods** - dexamethasone 4 times faily for 4 days to children **over 3 month** if the LP is suggestive of **bacterial meningitis**
57
Are **bacterial meningitis** and **meningococcal infection** notifiable diseases?
**Yes**, public health need to be **informed of all cases**
58
When is **risk of catching meningococcal infections** highest?
**Close prolonged contact** within the **7 days** prior to the onset of the illness (**risk decreases 7 days after exposure**)
59
What is the recommended **post-exposure prophylaxis** after exposure to meningococcal infections?
Guided by **public health** - usually **single dose** of **ciprofloxacin** given asap (ideally within 24 hours of initial diagnosis)
60
What are the **common causes** of **viral meningitis**?
**Herpes simplex virus** (HSV)
**Enterovirus**
**Varicella zoster virus**
Sample of CSF from lumbar puncture sent for **viral PCR testing**
61
What is the **management** of **viral meningitis**?
Tends to be **milder** than **bacterial** requiring only supportive
**Aciclovir** can be used to treat suspected **HSV** or **VZV** infection
62
Complete this table:
63
What are some **complications** of **meningitis**?
**Hearing loss** is a key complication
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
**Cerebral palsy**, with focal neurological deficits e.g. **limb weakness** or **spasticity**
64
What is **encephalitis**?
**Inflammation** of the brain - result of **infective** or **non-infective** causes
65
What are **non-infective** causes of **encephalitis**?
Autoimmune, meaning antibodies against brain tissue
66
What is the most common cause of encephalitis?
**Viral**
67
What is the most common cause of **paediatric encephalitis** in **children and neonates** respectively?
68
What are some **other causes** of paediatric encephalitis?
69
Why is it **important** to ask about **vaccinations** in **paediatric encephalitis**?
Measles, mumps, rubella and polio viruses can cause **encephalitis**
70
How does **paediatric encephalitis** present?
**Altered consciousness**
**Altered cognition**
**Unusual** behaviour
Acute onset of **focal neurological symptoms**
Acute onset of **focal seizures**
**Fever**
71
What investigations to establish the **diagnosis** of **encephalitis**?
**Lumbar puncture** sending CSF for **viral PCR**
**CT scan** if lumbar puncture contraindicated
**MRI scan** after LP to visualise the brain
**EEG recording** in mild or ambiguous symptoms - not always routinely required
**Swabs** of throat / vesicles
**HIV** in all patients with encephalitis
72
What are some **contraindications** to a **lumbar puncture**?
GCS **below 9**
Haemodynamically **unstable**
**Active seizures**
**Post-ictal**
73
What is the **management** of **paediatric** encephalitis?
**IV antiviral medications**:
* **Aciclovir** to treat **HSV** and **VZV**
* **Ganciclovir** to treat **cytomegalovirus**
**Repeat lumbar puncture** to ensure successful treatment prior to stopping antivirals
**Aciclovir** empirically until results available
**Support** with complications
74
What are the **complications of encephalitis**?
**Lasting fatigue** and **prolonged recovery**
**Change in personality** or **mood**
**Changes to memory** and cognition
**Learning disability**
**Headaches**
Chronic **pain**
**Movement disorders**
**Sensory disturbance**
**Seizures**
**Hormonal imbalance**
75
What is **infectious mononucleosis** (IM) caused by?
Infection with the **Epstein Barr virus** (EBV)
76
What is infectious mononucleosis also known as?
**Kissing disease**
**Glandular fever**
**Mono**
77
Where is EBV found?
**Saliva** of **infected individuals** (spread by kissing / sharing cups / toothbrushes)
78
What happens if patient with sore throat - misdiagnosed - takes amoxicillin?
Develops **itchy rash** - mononucleosis causes an **intensly itchy maculopapular rash** in response to **amoxicillin** or **cefalosporins**
79
What are the **features** of **infectious mononucleosis**?
Fever
Sore throat
Fatigue
**Lymphadenopathy** (swollen lymph nodes)
Tonsillar enlargement
**Splenomegaly** and in rare cases **splenic rupture**
80
What **antibodies** does the body produce in response to **infectious mononucleosis?** When?
**Heterophile antibodies** (multipurpose and not specific to the EBV antigens) - takes up to **6 weeks for these antibodies to be produced**
81
How can **heterophile antibodies** be tested for?
**Monospot test**: combine patients blood to **RBC** from **horses** - heterophile antibodies - if present will react and give positive result
**Paul-Bunnell test**: similar to **monospot test** but ises RBCs from **sheep**
82
Why are the **monospot** and **paul-bunnell test** only 70-80% sensitive but 100% specific for infectious mono?
Not everyone who has IM produces heterophile antibodies
83
How to test for **specific EBV antibodies**?
By targetting **viral capsid antigen** (VCA)
84
What does a rise in IgM and IgG suggest in mono?
**IgM antibody** rises early and suggests acute infection
**IgG antibody** persists after condition suggesting immunity
85
What is the **management** of **infectious mono**?
Usually **self limiting** - acute illness lasts around 2-3 weeks - can leave patient with **fatigue** several **months once infection is cleared**
**Avoid alcohol** as EBV affects liver
**Avoid contact sports** due to risk of splenic rupture
86
What are some **complications of infectious mononucleosis**?
**Splenic rupture**
**Glomerulonephritis**
**Haemolytic anaemia**
**Thrombocytopenia**
**Chronic fatigue**
87
What type of **cancer** is EBV associated with?
**Burkitt's lymphoma**
88
What is **mumps**?
**Viral infection** spread by **respiratory droplets**
89
What is the **incubation period** of **mumps**?
14-25 days
90
What protection does the **MMR vaccine** provide against mumps?
**80% protection**
91
How does **mumps present**?
**Prodrome** of flu-like illness for a few days
**Parotid swelling** - unilateral or bilateral
Fever
Muscle aches
Lethargy
Reduced appetite
Headache
Dry mouth
92
How may **mumps** present with **symptoms** of the **complication**?
**Abdo pain** (pancreatitis)
**Testicular pain** and swelling (**orchitis**)
**Confusion** neck stiffness and headache (**meningitis** or **encephalitis**)
93
How is the diagnosis of **mumps** confirmed?
**PCR testing** on a saliva swab (also tested for **antibodies** to the mumps virus)
94
Is **mumps a notifiable disease**?
Yes, need to notify **public health** of any suspected and confirmed cases
95
What is the **management** of mumps?
**Supportive,** rest, fluids, analgesia
Self-limiting condition
96
What are the **possible complications** of **mumps**?
**Pancreatitis**
**Orchitis**
**Meningitis**
**Sensorineural hearing loss**
97
What is **AIDS** referred to as in the UK?
**Late stage HIV**
98
What type of virus is HIV? What are the types?
**RNA retrovirus**
**HIV-1** is most common type
**HIV-2** is **rare outside west africa**
99
What does HIV do?
**Virus** enters and destroys the **CD4 T helper cells** - initial **seroconversion** flu like illness occurs within a few weeks of infection - infection is **then asymptomatic** untul patient becomes **immunocompromised** and develops **AIDS defining illnesses**
100
How is **HIV spread**?
Unprotected **anal, vaginal or oral** sexual activity
Mother to child at any stage of **pregnancy, birth** or **breastfeeding** (vertical transmission)
Needle sharing, blood splashed in eye
101
What is the **mode of delivery** to prevent mother to child HIV transmission?
**Normal vaginal delivery** for women with viral load \< 50 copies /ml
**Caesarean section** considered for patients with \> 50 copies / ml and in **all women** with \>400 copies / ml
**IV zidovudine** given during caesarean if \>10000 copies /ml
102
For HIV, what **prophylaxis treatment** can be given to the baby?
**Low risk** (mums viral load \< 50 copies per ml) = **zidovudine** for 4 weeks
**High risk** (mums viral load \> 50 copies per ml) = **zidovudine, lamivudine** and **nevirapine** for 4 weeks
103
Is **breastfeeding safe if HIV positive**?
HIV can be transmitted during breastfeedig - even if **mother's viral load is undetectable** - **never recommended** (if mum is adamant and viral load is undetectable then can be attempted with monitoring from HIV team)
104
When may a HIV test be falsely positive?
Due to **maternal antibodies** in children aged **under 18 months**
105
How is **HIV testing performed**?
**HIV antibody screen**: standard screening test - can take up to **3 months** for **antibodies to develop** after exposure to the virus
**HIV viral load**: will never be falsely positive but **may come back as**"undetectable" in patients on antiretroviral therapy
106
When should HIV be tested for?
**Babies** to **HIV positive**
**Immunodeficiency suspected**
Young people who are **sexually active** - offered testing if concerns
Risk factors e.g. **needle stick injury**, **sexual abuse** or **IV drug use**
107
When are **babies to HIV positive parents** tested?
**HIV viral load** **test** at 3 months (if this is negative then not contracted HIV during birth)
**HIV antibody test** at **24 months** (if they have contracted HIV since their 3 month viral load **e.g. through breastfeeding**)
108
What is the **treatment** of **paediatric HIV**?
**Antiretroviral therapy** (ART) to suppress the HIV infection, to achieve normal CD4 count and undetectable viral load
**Normal childhood vaccines** avoid / delay live vaccines if severely immunocompromised
**Prophylactic co-trimoxazole** (septrin) for children with **low CD4 counts** to protect against **pneumocystis jirovecii pneumonia** (PCP)
**Treatment of opportunistic infections**
109
What is the role of the **paediatric HIV** multidisciplinary team?
- Regular **follow up to monitor growth** and development
- **Dietician input** for nutritional support
- **Parental education** about the condition
- Disclose diagnosis when child is mature enough
- Psychological support
- Specific **sex education** in relation to HIV when appropriate
110
What type of virus is **Hep B**?
**DNA virus** - transmitted by direct contact with blood / bodily fuild
111
What is the **prognosis** of **hep B infection**?
Most fully **recover** within **2 months**
Portion go on to become **chronic hep B carriers** (virus DNA has integrated into their own DNA and continue to produce viral proteins)
112
What is the **risk of developing chronic hepatitis B after exposure**?
90% for neonates
30% for children under 5
Under 10% for adolescents
113
What is the progression of **chronic hep B infection**?
Most are asymptomatic with normal growth and development
Less than **5% develop liver cirrhosis**
Less than **0.05% develop hepatocellular carcinoma**
114
What do the following antibodies and antigens signify?
Surface antigen (**HBsAg**)
E antigen (**HBeAg**)
Core antibodies (**HBcAb**)
Surface antibody (**HBsAb**)
Hepatitis B virus DNA (**HBV DNA**)
**Surface antigen** (HBsAg) – active infection
**E antigen** (HBeAg) – marker of viral replication and implies high infectivity
**Core antibodies** (HBcAb) – implies past or current infection
**Surface antibody** (HBsAb) – implies vaccination or past or current infection
**Hepatitis B virus DNA** (HBV DNA) – this is a direct count of the viral load
115
In what order should hep B be screened for?
Test **HBcAb** (previous infection) and **HBsAg** (active infection) if positive then do **further testing** for **HBeAg** and **viral load** (HBV DNA)
116
Which **immunoglobulins** are measured for **HBcAb**?
**IgM** and **IgG**
117
What does a high **HBeAg** imply?
Patient is in an **acute phas****e** of the infection wherev virus is activelly replicating
118
Which **children to test** for Hep B?
Children of **hep B positive mums** (screen at 12 months of age)
**Migrants** from endemic aread
Close contacts
119
How to **reduce the risk** of the **baby** contracting **hep B at birth**?
Within **24 hours** given:
- Hep B **vaccine** (again at 1 and 12 months of age)
- Hep B **immunoglobulin infusion**
120
How to check if a baby has contracted hep B during birth?
Tested for **HBsAg**
121
Can **hep B positive** mothers **breastfeed**?
If is **safe** for hep B positive mothers provided the babies are properly **vaccinated**
122
What is the **hep B vaccine**? When is it given?
Injection of **hepatitis B surface antigen** - requires 3 doses and is part of the UK 6 in 1 vaccine
123
What is the **management** of **chronic hep B**?
Usually **asymptomatic** and do not require treatment
Regular **follow up** to monitor **serum ALT, HbeAg, HBV DNA**, physical examination and **liver ultrasound**
If evidence of **hepatitis** or **cirrhosis** then treatment with **antiviral medication may be considered**
124
What type of virus is **hepatitis C**?
**RNA virus** - spread by blood and bodily fluids
125
How is **hep C treated**?
**Curable** using **direct acting antiviral** medications (not yet available for children)
126
What is the **progression** of **hep C** in **adults**?
1 in 4 fight off virus
**3 in 4** develop **chronic hepatitis C**
127
What are some **complications of hep C**?
**Liver cirrhosis** and associated complications
## Footnote
**Hepatocellular carcinoma**
128
Does hep C transmit from mother to baby in pregnancy?
Yes, **5-15%** of the time
**Hep C antivirals** are **not recommended** in pregnancy
No additional measures are known to reduce risk of transmission
129
What is the **testing** of **Hep C** in **children**?
**Hepatitis C antibody** is the screening test
**Hepatitis C RNA** to confirm the diagnosis of hep C, calculate viral load and identify genotype
130
When are babies to hep C positive mothers tested?
**18 months** using the **hep C antibody test**
131
Is **breastfeeding** permitted in hep C?
Yes - but **temporarily stop** if nippled become cracked
132
What is the **management** of **hep C infection** in **childhood**?
Chronic hep B infection doesnt usually cause issues in childhood
**Medical treatment** in children over **3 years** involved **pegylated interferon** and **ribavirin**
Treatment is typically **delayed until adulthood**
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