OSCE: Immunization


Question: 1
What are the recent updates to the IAP Immunization schedule?


Answer 1

DTaP:
Preferably be avoided in primary vaccination series (at 6, 10 and 14 weeks)
IPV:
Instead of OPV at 6, 10, 14 weeks and 15 months, So OPV only at birth, 6 months, 9 months and 5 years
Hepatitis B vaccine:
The final (third or fourth) dose in the Hepatitis B vaccine series should be administered no earlier than age 24 weeks and at least 16 weeks after the first dose
MMR vaccine:
At 9 months and 15 months, No need for booster at 5 years
Typhoid conjugate vaccine:
(TypBar) given at 9 to 12 months, with a booster at 2 years of age
Hepatitis A:
Single dose for live attenuated H2-strain Hep-A vaccine
Two doses for all killed Hep-A vaccines are recommended at 12 months and 18 months
HPV:
Only 2 doses of either of the two HPV vaccines for adolescent/pre-adolescent girls aged 9-14 years
For girls 15 years and older, and immunocompromised individuals 3 doses are recommended
For two-dose schedule, the minimum interval between doses should be 6 months.
For 3 dose schedule, the doses can be administered at 0, 1-2 and 6 months


Question: 2
What are special vaccines you would advise for high risk category children?

Answer: 2

High-risk category of children:
  1. Congenital or acquired immunodeficiency (including HIV)
  2. Chronic cardiac, pulmonary, hematologic, renal and liver disease
  3. Children on long term steroids, salicylates, immunosuppressive or radiation therapy
  4. Diabetes mellitus, CSF leak, Cochlear implant, Malignancies
  5. Children with functional/ anatomic asplenia/ hyposplenia
  6. Laboratory personnel and healthcare workers
  7. Travelers
IAP recommended vaccines for High-risk children
  1. Influenza Vaccine
  2. Meningococcal Vaccine
  3. Japanese Encephalitis Vaccine
  4. Cholera Vaccine
  5. Rabies Vaccine
  6. Yellow Fever Vaccine
  7. Pneumococcal vaccine (PPSV 23)


Question: 3
  1. What is pre-exposure prophylaxis for rabies and for whom should we advise?
  2. What are the advantages of giving it?
    Answer: 3
    1. Children having pets in home
    2. Children perceived with higher threat of being bitten by dogs such as hostellers, risk of stray dog menace while going outdoor
    3. Veterinarians, those who work with animals
    4. Three doses are recommended to be given intramuscularly on days 0, 7 and 28
    Advantage:
    In case of bite,
    Two doses are to be given on days 0 and 3. Rabies immunoglobulin (RIG) are not needed in these children.


    Question: 4
    11 year old boy adopted, no medical records available and BCG scar is not seen. The adoptive parents want to know what vaccines have to be given. What will you advise?

    Answer: 4
    1. TDaP vaccine- single dose
    2. MMR- 2 doses at 4-8 weeks gap
    3. Hep B- 3 doses at 0,1 and 6 months
    4. Hepatitis A- 2 doses at 0, 6 months
    5. Typhoid- 1 dose every 3 years
    6. Varicella- 2 doses at 4-8 weeks


    Question: 5
    Influenza Vaccine
    1. What are the types of influenza vaccines in India?
    2. When is a LAIV not recommended?
    3. What is IAP recommended target prioritization for influenza vaccines?
      Answers: 5

      Types

      Trivalent inactivated vaccines (TIV) and Live Attenuated Influenza vaccines (LAIV).
      LAIV not recommended below 2 years of age, in high-risk individuals and in pregnant women.
      (1-Highest priority, 4-Lowest priority)

      1.Elderly (> 65 years) / nursing-home residents
      2.HIV/AIDS, and pregnant women (especially to protect infants 0–6 months)
      3.Other groups: Health care workers, asthmatics, and children from ages 6 months to 2 years.
      4.Children aged 2–5 years and 6–18 years, and healthy young adults.


      Question: 6
      Meningococcal Vaccine
      What are the categories to be vaccinated as per IAP recommendations?

      Answers: 6

      A.During disease outbreaks
      B. Vaccination of persons with high-risk conditions/situations
      1. Complement component deficiencies
      2. Functional/anatomic asplenia/hyposplenia
      3. HIV
      4. Healthcare workers exposed routinely to Neisseria meningitides
      5. Adjunct to chemoprophylaxis
      C. International travellers – Study abroad/ Hajj/ Sub-Sahara Africa


      Question: 7
      Answers yes or no
      1. Can BCG be given in symptomatic HIV cases
      2. Can OPV be given in symptomatic HIV cases
      3. Can measles, MMR and Varicella be given in symptomatic HIV cases
        Answer: 7
        1. No
        2. Yes – if IPV not affordable
        3. Yes, if CD4+ count > 15%

        Question: 8
        1. What solution is used to swab the site prior to vaccination?
        2. When will you consider the BCG administration technique to be successful?
        3. What is the normal reaction at the vaccine site following successful vaccination?
        4. What condition is associated with BCG vial contamination?
          Answer: 8
          1. Normal saline
          2. A wheal of 5 mm at injection site
          3. A papule develops by 2-3 weeks, increases to size of 4-8mm by 5-6 weeks, ulcerates and heals with scarring by 6-12 weeks
          4. Toxic shock syndrome

          Question: 9
          Which is the Polio vaccine of choice for outbreak control?Which Polio vaccine type is more efficacious – Trivalent OPV or Bivalent OPV?What is enhanced IPV?

          Answer: 9
          1. OPV
          2. Bivalent OPV more efficacious than Trivalent OPV – as competition between different serotypes is eliminated
          3. Enhanced IPV contains
          type 1 – 40 Ag U
          type 2 – 8 Ag U
          type 3- 32 Ag U

          Question: 10
          1. What are the conditions that predispose to VDPV
          2. Name the Polio serotypes more frequently associate with VAPP and VDPV

          Answer: 10

          1.
          a) Dropping immunization coverage
          b) High population densities
          c) Tropical conditions
          d) previous eradication of wild polio virus
          2.
          VAPP – Type 2
          VDPV – Type 3



          Question: 11
          What is VVM and how will you interpret?


          image

          Answer: 12

          image



          Question: 13
          1. What is AEFI and when will you consider it serious?
          2. What are the different types?

          Answer: 13

          AEFI is adverse Event Following immunization
          An AEFI will be considered serious, if it:
          Results in death
          Is life-threatening
          Requires in-patient hospitalization or prolongation of existing hospitalization
          Results in persistent or significant disability/incapacity
          Is a congenital anomaly/birth defect or
          Requires intervention to prevent permanent impairment or damage.
          Types of AEFI:

          1. Vaccine reaction:
          Event caused by the vaccine or precipitated by the vaccine when given correctly eg. VAPP after OPV

          2. Programme error:
          Event caused by an error in vaccine preparation, handling, or administration. Egs- TSS after measles vaccine due to improper storage

          3. Injection reaction:
          Event from anxiety about, or pain from the INJECTION, rather than vaccine. Eg abscesses

          4. Coincidental:
          Event that happens after immunization, but NOT caused by it. Eg SIDS

          5. Unknown:
          The cause of the event cannot be determined.



          Question: 14
          What are the recommended time limits for using vaccines after reconstitution?

          Answer: 14
          1. Varicella : 30 mins (and protect from light)
          2. MMRV: 30 mins (and protect from light)
          3. Yellow fever: 1 hour
          4. MEASLES/MMR : 4 to 6 hours
          5. Meningococcal PS vaccine: 30 mins
          6. DTaP/Hib combination: 30 mins


          Question: 15
          How do you store vaccines in the refrigerator?

          Answer: 15

          image
          1. Freezer: OPV
          2. Top shelf: BCG, Measles, MMR
          3. Middle shelf: T- vaccines, IPV, Hib, Combination vaccines, HPV, Typhoid, Hep A, PCV, influenza, rota virus
          4. Lower: Varicella


          Question:16
          Name some contraindications and precautions for vaccination.

          Answer: 16

          Contraindication:
          A condition in a recipient which greatly increases chances of a serious adverse reaction. Egs- severe allergic reactions
          OSCE Immunisation 1

          Precaution:
          A Condition in recipient which might increase chance or severity of a serious adverse reaction or might compromise ability of vaccine to produce immunity

          osce immunisation 2


          Question: 17
          What is freeze watch indicator?



          Answer: 17

          Small vial of red liquid attached to a white card and covered in plastic.
          Vial breaks if temperature drops below 0 Celsius for >1 hour
          Useful for T vaccine

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