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/

1. Immunology for MRCPCH
Andy Prendergast

2. Overview
• Immunisation
• Basic immunology
• Immunodeficiency

3. Immunisation
• Changes to UK Immunisation schedule
• Specific vaccine type
• Types of vaccine
– Live
– Killed
– Conjugation

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. New 5-in-1 vaccine
• Introduced September 2004
• DT and ‘acelluler’ pertussis
• Inactivated polio virus
• HiB

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. 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. NOT contraindication
• Prematurity
• Family history of seizures
• Well-controlled past history of seizures
• Febrile convulsions

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. Adverse reaction: General
• Immunisation SHOULD proceed despite history of:
– Fever (However high)
– Hypotinic-hyporesponsive episode
– Persistent screaming > 3 hours
– Severe local reaction

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. 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. DoH information on vaccine
• Immunisation against infectious disease
1996(Green book)
• New chapter at:
http://80.168.38.66/article.php?id=400

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. What would your advice?

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. 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. 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. What would your advice?
Answer D
The child should receive all routine
immunisation except neonatal BCG and MMR

20. What would your advice?
Answer E
The child should have no immunisation