Transcript IMMUNISATIONS

IMMUNISATIONS
Immunisations
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The immunisation programme in the UK
evolves
Population immunity if high enough
enables the unimmunised to be protected
Vaccination enabled smallpox to be
eradicated in 1980
WHO is working towards global polio
eradication
Active immunity
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Is specific to a single or a group of closely
related organisms
Active immunity can be acquired by
natural disease or immunisation
Is either antibody or cell mediated
Passive Immunity
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Is the transfer of active humeral immunity in the
form of ready made antibody
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Passive transfer occurs when antibody passes
from mother to child
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Artificially acquired transfer occurs when
antibody or antitoxin from an immune individual
(or animal) is given to an individual at risk
Passive Immunity
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Normal Immunoglobulin eg for replacement
therapy of agammaglobulinaemia
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Specific Immunoglobulin eg tetanus, VZV,
rabies, HepB and palivizumab for RSV
protection
Attenuated Virus/Bacteria Vaccines
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Live virus/bacteria
Low virulence
Replicate but locally or slowly
MMR
BCG
Nasal Influenza
Rotavirus
Inactivated Virus/Bacteria Vaccines
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Virus/bacteria cultures then killed
Viral capsid/bacterial cell wall ptns intact
enough to be recognised by immune system
Non infectious
No reproduction therefore boosters required
Inactivated polio vaccine
Trivalent Influenza
Virus like Particle Vaccines
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Viral proteins which self reassemble into
particles resembling virus
Lack nucleic acid
Non infectious
HPV and Hepatitis B vaccines
Subunit Vaccines
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Present Ag to immune system without
introduction of viral particles
Isolation of specific proteins
Illicit a immune response which is not as
strong
Boosters required
Tetanus
UK VaccinationSchedule
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2 months
5-in-1 (DTaP/IPV/Hib) vaccine – this single jab contains vaccines to protect against
five separate diseases: diphtheria, tetanus, whooping cough (pertussis), polio and
Haemophilus influenzae type b (known as Hib – a bacterial infection that can cause
severe pneumonia or meningitis in young children)
Pneumococcal (PCV) vaccine
Rotavirus vaccine
3 months
5-in-1 (DTaP/IPV/Hib) vaccine, second dose
Meningitis C
Rotavirus vaccine, second dose
4 months
5-in-1 (DTaP/IPV/Hib) vaccine, third dose
Pneumococcal (PCV) vaccine, second dose
Between 12 and 13 months
Hib/Men C booster, given as a single jab containing meningitis C (second dose) and
Hib (fourth dose)
Measles, mumps and rubella (MMR) vaccine, given as a single jab
Pneumococcal (PCV) vaccine, third dose
UK Vaccination Schedule 2
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2, 3 and 4 years
Children's flu vaccine (annual)
3 years and 4 months, or soon after
Measles, mumps and rubella (MMR) vaccine, second dose
4-in-1 (DTaP/IPV) pre-school booster, given as a single jab containing vaccines against diphtheria,
tetanus, whooping cough (pertussis) and polio
Around 12-13 years (girls only)
HPV vaccine, which protects against cervical cancer – two injections given between six months and 2 years apart
Around 13-18 years
3-in-1 (Td/IPV) teenage booster, given as a single jab and contains vaccines against diphtheria, tetanus and polio
Around 13-15 years
Meningitis C booster
18-25 years
Men C vaccine for students
65 and over
Flu (every year)
Pneumococcal (PPV) vaccine
70 years (and 78 and 79 year-olds as a catch-up)
Shingles vaccine
Vaccines for special groups
There are some vaccines that aren't routinely available to everyone on the NHS, but that are available for people
who fall into certain risk groups, such as pregnant women, people with long-term health conditions and healthcare
workers.
Additional ones include hepatitis B vaccination, TB vaccination and chickenpox vaccination
MEASLES
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Viral, droplet spread, incubation 10 days
Coryza, conjunctivitis, fever, rash
Complications: pneumonia,encephalitis,death
Notifiable
Catch up programme offered to those with
incomplete immunisation because of
increasing notifications
Current measles prevelence
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First 6 months 2011------497 cases in UK
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First 6 months 2012------964
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Significant increase in South Wales 2013
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Most in the 10-12 age group
MUMPS
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Viral,droplet spread, incubation 14-21 days
Parotid swelling
Complications: oophritis, orchitis,
pancreatitis, and meningitis
Notifiable
RUBELLA
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Viral, droplet spread incubation 14-21 days
Mild illness with rash and lymphadenopathy
Maternal rubella, 1st trimester 90% foetal
damage ( microcephaly, deafness, cataracts,
PDA etc)
History needs confirmation with saliva or
serology
Chickenpox
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Varicella virus
Highly contagious droplet, direct contact
Incubation 14 to 21 days
Infectious 48 hours before rash until last
lesion scabbed
Generally mild, more serious in adults,
pregnant and immunocompromised
HZ : reactivation of individuals varicella
DIPHTHERIA
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Corynebacteria diphtheriae
Incubation 2-5 days Infectious for four weeks
Inflammatory exudate causing grey
membrane in resp tract. Potential obstruction
Toxin mediated damage to myocardium,
nervous system and adrenals
TETANUS
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Toxin mediated from tetanus bacillus
Incubation 4-21 days
Spore spread
Muscular rigidity with spasms ---(lock jaw)
POLIO
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Polio virus
Faecal/oral spread, Incubation 3-21 days
Virus may be shed for 6 weeks
Range of severity--- asymptomatic to
paralysis
PERTUSSIS
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Bordetella pertussis
Incubation 7-10 days
Infectious until 3 weeks after onset of
paroxysms
Paroxysmal cough can be associated with
apnoea and /or vomiting
‘The 6 month cough’
Complications--- SUDI, bronchopneumonia
and cerebral hypoxia
HAEMOPHILUS INFLUENZAE
Type B
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Hib
Meningitis with high incidence of
complications +/- bacteraemia
Epiglottitis
Osteomyelitis
MENINGOCOCCAL DISEASE
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Neisseria meningitidis
Type C vaccine, Type B recently
developed(also available Type A for
travelers)
Incubation 2-3 days
Onset can be fulminant
Meningitis / septicaemia
Fever, vomiting, purpuric rash
Contraindications To Vaccination
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General – Febrile illness
Anaphylaxis to previous dose or to components of
vaccine
Severe local reaction
Inconsolable unexplained crying >3 hrs within 72hrs
Encephalopathic illness (hypotonic-hyporesponsive
episode (HHE) within 72 hours
Intramuscular route should not be used for children
with bleeding disorders—use s.c. route
Live Vaccines – Immunosuppressed, e.g.
prednisolone therapy, chemotherapy, HIV (note
MMR can be if not severely imunocompromised),
BMT within 6 months. Pregnancy
DTaP/IPV/Hib and MenC
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Diptheria, Tetanus, acellular pertussis,
Inactivated polio , Haemophilus influenzae
and Meningitis C
Recent changes are inactivated polio (im)
and acellular pertussis
Well tolerated, minimal side effects
For children over 10 years adsorbed
diphtheria (low dose),Tetanus and inactivated
polio vaccine only if have received primary
immunisations
MMR
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Measles, Mumps and Rubella
Serious illnesses associated with significant
mortality
Fever common 6 to 10 days post vaccination
1:1000 febrile convulsion
Can be given to egg allergic children
NOT associated with Autism and IBD
BCG
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Administered to at risk babies in neonatal
period ( where incidence is greater than 40
per 100,000)
Given intradermally
Since 2006 risk-based programme for other
children as well
Local Side effects common--- ulceration or
abscess
Do not give to HIV + or immunocompromised
Mantoux induration > 6mm
Previous BCG or past/
present TB.
PNEUMOCOCCAL VACCINES
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Prevenar < 2yrs
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Since 2010 13-valent available
Part of the routine schedule.
Pneumovax > 2years 23- valent
polysaccharide
Indications for Pneumovax
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not previously immunised, asplenia, SS disease,
chronic lung or heart disease
Rotavirus Vaccine
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Rotavirus is responsible for 1 in 10 hospital
admissions in children
Immunisation in UK introduced September
2012, routine from July 2013
Live attenuated oral vaccine
Two doses four weeks apart
Effective after 6 weeks of age
To be offered at 2 and 3 months in the
vaccination Schedule
Influenza vaccine
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Trivalent inactivated influenza vaccine(TIV)
licenced from 6 months
Live attenuated influenza vaccine available
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nasal spray (LAIV), licenced in Europe for 2-17s
LAIV contains 3 strains.
Not licenced for <2s
2 doses one month apart, unless previously
immunised when one is sufficient.
Piloted 2013, roll out to <5s this year and all
children 2015
OTHERS
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RSV - passive immunisation—Palivizumab(Synargis) –given during RSV season to high risk
groups. Monoclonal antibody given monthly.
HepBV – at risk groups (at present)
HPV – Human Papilloma Virus vaccine -3 doses
Given to 12-13 year olds –due to increase coverage
to 17-18 year olds in September 2008
Cervarix—effective against Type 16 &18 HPV
Protects against 75% of cervical cancers
Gardasil introduced Sept 2012—effective against
Type 6,11, 16 &18 –hence against 90% genital
warts as well
Others (cont)
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Chicken pox routine in USA at 12-15
months/top up at 5/6years. Available but
not routine in UK.
Meningococcal B vaccine available from
January 2013, but not in immunisation
schedule yet.
Pertussis vaccine now advised for every
pregnant woman between 28 and 38
weeks ( new recommendation)
Vaccine ANAPHYLAXIS
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ABC
Adrenaline 10 mcg/kg (0.01ml/Kg 1:1000)
Hydrocortisone 4mg/kg
Chlorphenamine
Beware neomycin and gelatin anaphylaxis –
omit MMR