* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download immunisations - mededcoventry.com
Survey
Document related concepts
Viral phylodynamics wikipedia , lookup
Transmission (medicine) wikipedia , lookup
Gastroenteritis wikipedia , lookup
Social history of viruses wikipedia , lookup
Virus quantification wikipedia , lookup
History of virology wikipedia , lookup
Globalization and disease wikipedia , lookup
Eradication of infectious diseases wikipedia , lookup
Meningococcal disease wikipedia , lookup
Poliomyelitis wikipedia , lookup
Neisseria meningitidis wikipedia , lookup
Transcript
IMMUNISATIONS Immunisations 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 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 Is the transfer of active humeral immunity in the form of ready made antibody Passive transfer occurs when antibody passes from mother to child Artificially acquired transfer occurs when antibody or antitoxin from an immune individual (or animal) is given to an individual at risk Passive Immunity Normal Immunoglobulin eg for replacement therapy of agammaglobulinaemia Specific Immunoglobulin eg tetanus, VZV, rabies, HepB and palivizumab for RSV protection Attenuated Virus/Bacteria Vaccines Live virus/bacteria Low virulence Replicate but locally or slowly MMR BCG Nasal Influenza Rotavirus Inactivated Virus/Bacteria Vaccines 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 Viral proteins which self reassemble into particles resembling virus Lack nucleic acid Non infectious HPV and Hepatitis B vaccines Subunit Vaccines 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 • • • • • • • • • • • • • • • 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 • • • • • • • • • • • • • • • • • • • • • 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 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 First 6 months 2011------497 cases in UK First 6 months 2012------964 Significant increase in South Wales 2013 Most in the 10-12 age group MUMPS Viral,droplet spread, incubation 14-21 days Parotid swelling Complications: oophritis, orchitis, pancreatitis, and meningitis Notifiable RUBELLA 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 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 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 Toxin mediated from tetanus bacillus Incubation 4-21 days Spore spread Muscular rigidity with spasms ---(lock jaw) POLIO Polio virus Faecal/oral spread, Incubation 3-21 days Virus may be shed for 6 weeks Range of severity--- asymptomatic to paralysis PERTUSSIS 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 Hib Meningitis with high incidence of complications +/- bacteraemia Epiglottitis Osteomyelitis MENINGOCOCCAL DISEASE 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 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 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 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 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 Prevenar < 2yrs Since 2010 13-valent available Part of the routine schedule. Pneumovax > 2years 23- valent polysaccharide Indications for Pneumovax not previously immunised, asplenia, SS disease, chronic lung or heart disease Rotavirus Vaccine 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 Trivalent inactivated influenza vaccine(TIV) licenced from 6 months Live attenuated influenza vaccine available 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 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) 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 ABC Adrenaline 10 mcg/kg (0.01ml/Kg 1:1000) Hydrocortisone 4mg/kg Chlorphenamine Beware neomycin and gelatin anaphylaxis – omit MMR