FAQs on immunisation

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FAQs on immunisation

• Contributor
• Dr C M Ni Bhrolchain
• Wirral

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IMMUNITY
Passive
Active
Immunoglobulins
Inactivated (not live)
Live Attenuated
Cells
Toxoid
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Must have

• Consent
• Storage (cold chain)
• Procedures
• Recording site
• Checking vaccine
• Checking contraindications

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Contraindications

• Acute illness (defined in Green book)
• Anaphylaxis to previous doses or certain
  antibiotics
• Pregnancy
• Live Vaccines
• Immunosuppression e.g. chemotherapy,
  radiotherapy, steroids alone or in combination
• Diseases - SCID
• - Di George
• - HIV
• False contraindications

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Who dies from tetanus in the UK?

• Older females who have never been immunised (men
  who did national service after 1938 were
  immunised)
• Injecting drug users

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Tetanus-prone wounds

• Wounds or burns
• Needing surgical intervention but delayed for 6
  hours or more
• With significant devitalised tissue
• Puncture-type injuries esp if contaminated with
  soil or manure
• Containing foreign bodies
• Where patient has systemic sepsis
• Compound fractures

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TETANUS TABLE
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NATIONAL BCG POLICY

• School children between 10 and 14
• High risk neonates
• Contacts of known active pulmonary TB
• New immigrants from high prevalence countries
• Occupations at risk
• Those staying in high prevalence country for gt 1
  month

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• Universal neonatal BCG is not recommended in the
  UK
• Neonatal BCG should be offered to families from
• South East Asia
• Middle East
• Africa
• South and Central America
• Eastern Europe (except Czech and Slovak
  Republics)
• All these have an incidence of gt40 per 100,000
  population

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Easy mnemonic

• Should have BCG unless family is from
• Western Europe (including Czech and Slovak
  Republics)
• North America
• Canada
• Australia and New Zealand

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HEPATITIS B

• Immunisation is recommended for
• Babies born to mothers who are chronic carriers
  of hepatitis B virus
• Mothers who have had acute hepatitis B during
  pregnancy
• May also consider others at risk e.g. known
  substance misuse

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DOH guidance on vaccine and HBIG
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IMMUNISATION OF PRE-TERM BABIES

• Pre-term babies should be immunised at the
  correct chronological age.
• Oral Polio Vaccine should not be given while
  babies are on SCBU. IPV not a problem.
• Babies receiving Dexamethasone should not receive
  live vaccines (OPV, BCG, MMR)
• Response to inactivated vaccines may be reduced

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WHAT TO DO ABOUT REACTIONS
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MMR IMMUNISATION IN EGG-ALLERGIC CHILDREN
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Conclusion

• Even those with proven allergy to egg are very
  unlikely to have a reaction to MMR vaccine
• Only those with proven anaphylaxis should be
  immunised in hospital

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Useful information

• www.immunisation.nhs.uk
• DOH factsheets (available on the above site in
  the publications section)
• www.mmrthefacts.nhs.uk
• Electronic Green book available on DOH website
  www.dh.gov.uk and use search engine to find
  green book
• www.hpa.org.uk/infections/topics_az/vaccination/va
  c_guidelines.htm has a page of useful links
  including guidance on catch up immunisation for
  those whose imms are incomplete and on immunising
  immunocompromised children

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Useful information (cont)

• Http//www.rcpch.ac.uk/publications/recent_publica
  tions/Immunocomp.pdf for advice on immunising the
  immunocompromised child
• Http//www.hpa.org.uk/infections/topics_az/immunog
  lobulin/menu.htm for advice when immunoglobulins
  may be appropriate
• Http//www.advisorybodies.doh.gov.uk/jcvi/index.ht
  m Joint Committee on Vaccination and Immunisation

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The Centre The Department of Health
The Commissioner PCT
Monitoring Information
Vaccine Policy CCDC with practical advice from
ICs Sets policy Arranges contracts
Clinical background Information Advice
Information Advice
Policy
Imms Coordinator Run the programme on a
day-to-day basis

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