Immunisation and Immunodeficiency - Immunology MRCP 1 - 123Doc Education

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Immunisation and Immunodeficiency, as part of the Immunology MRCP 1 course. These are slideshows only. The demonstration with video presentation and explanation that goes along with these slides, as well as free example exam questions and the paid full e-lecture can be viewed at https://www.123doc.com/electures/immunology/

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Immunisation and Immunodeficiency - Immunology MRCP 1 - 123Doc Education

  1. 1. Immunology for MRCPCH Andy Prendergast
  2. 2. Overview • Immunisation • Basic immunology • Immunodeficiency
  3. 3. Immunisation • Changes to UK Immunisation schedule • Specific vaccine type • Types of vaccine – Live – Killed – Conjugation
  4. 4. UK Immunisation schedule BCG Birth Hepatitis B 0, 1, 2, 12 months DTaP/IPV/Hib/Men C 2, 3, 4 months MMR 12-15 months DTaP/IPV/MMR Pre-school BCG(after Heaf) 10 – 14 years Td/IPV School leavers
  5. 5. New 5-in-1 vaccine • Introduced September 2004 • DT and ‘acelluler’ pertussis • Inactivated polio virus • HiB
  6. 6. Research in 5-in-1 vaccine • Inactivated polio vaccine instead of live  low polio prevalence – ‘community’ protection of OPV not requires  Risk of vaccine-associated paralytic polio • Acelluler pertussis  Equal/better protection than whole cell vaccine  Fewer side effects • NO thiomercal  Mercury based preservative
  7. 7. Contraindication • Anaphylactic reaction to pervious dose • Anaphylactic reaction to neomycin, streptomycin or polymyxin B • Postpone if acutely unwell • Evolving neurological condition – If cause identified then immunise – If no cause identified, defer and immunise once condition stabilized
  8. 8. NOT contraindication • Prematurity • Family history of seizures • Well-controlled past history of seizures • Febrile convulsions
  9. 9. Adverse reaction: Neurological • Encephalopathy within 7 days of vaccine Identifiable cause immunize Full recovery in 7 days Defer, investigate, immunise once stable Y YN N • Febrile convulsions within 72 hours of vaccine: – defer further doses if no underlying cause found and did not recover within 24 hours
  10. 10. Adverse reaction: General • Immunisation SHOULD proceed despite history of: – Fever (However high) – Hypotinic-hyporesponsive episode – Persistent screaming > 3 hours – Severe local reaction
  11. 11. Polio vaccination • Salk vaccine – killed (IM) • Sabin vaccine - live (oral) • Both give excellent individual immunity – Local gut immunity – ‘Herd’ immunity • Disadvantages: – 30 cases in UK (1985 – 2002)
  12. 12. Polio Vaccination • Polio worldwide fallen due to WHO polio eradication programme • 677 cases in 2003 • Only five reservoirs left – India, Pakistan, Nigeria, Niger, Afghanistan • OPV not available now for routine use – Only available for outbreak control
  13. 13. DoH information on vaccine • Immunisation against infectious disease 1996(Green book) • New chapter at: http://80.168.38.66/article.php?id=400
  14. 14. You are phoned by community midwife about a baby with asymptomatic HIV infection. She wants to know what vaccination the baby should receive.
  15. 15. What would your advice?
  16. 16. What would your advice? Answer A The baby should receive all routine immunisation including neonatal BCG Babies with HIV infection should not receive: • BCG • Oral typhoid • Yellow fever
  17. 17. What would your advice? Answer B The baby should receive all routine immunisation except neonatal BCG • Risk of disseminated BCG infection (BCGosis) • Other immunisation are safe including MMR • Children with HIV should not receive: – BCG – Oral typhoid – Yellow fever
  18. 18. What would your advice? Answer C The child should receive all routine immunisation except neonatal BCG and should have included rather than oral polio vaccine • IT is true that children with HIV should not receive BCG vaccine • Remember activation polio is now routine in the new 5-in-1 vaccine • Oral polio no longer routinely given
  19. 19. What would your advice? Answer D The child should receive all routine immunisation except neonatal BCG and MMR
  20. 20. What would your advice? Answer E The child should have no immunisation

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