Immunology for MRCPCH

Andy Prendergast

Overview
Immunisation
Basic immunology
Immunodeficiency

Immunisation
Changes to UK Immunisation
schedule
Specific vaccine type
Types of vaccine
Live
Killed
Conjugation

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

New 5-in-1 vaccine

Introduced September 2004

DT and acelluler pertussis
Inactivated polio virus
HiB

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

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

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

Adverse reaction:
Neurological
Encephalopathy within 7 days of
vaccine
Identifiable causeY
immunize
N

Full recovery
in 7 days

Y
N

Defer, investiga
immunise once

stable

Febrile convulsions within 72 hours of vaccine:

defer further doses if no underlying cause found
and did not recover within 24 hours

Adverse reaction: General

Immunisation SHOULD proceed despite
history of:

Fever (However high)

Hypotinic-hyporesponsive episode
Persistent screaming > 3 hours
Severe local reaction

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)

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

DoH information on vaccine

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

You are phoned by

community midwife about a
baby with asymptomatic
HIV infection. She wants to
know what vaccination the
baby should receive.

What would your advice?

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

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

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

What would your advice?

Answer D
The child should receive all routine
immunisation except neonatal BCG
and MMR

What would your advice?

Answer E
The child should have no immunisation