Preventive Medicine
Preventive medicine in family practice covers immunisation beyond childhood, post-exposure prophylaxis, chemoprophylaxis, notification of communicable disease and occupational health. The Board tests schedules, doses, timing and the difference between active and passive immunity.
Core rules
- Active immunity: vaccine induces the person's own response; needs time and boosters. Passive immunity: ready-made antibody (immunoglobulin, antitoxin, transplacental IgG) gives immediate but short-lived protection.
- Vaccine types: live attenuated (BCG, MMR, oral polio, varicella) generally contraindicated in pregnancy and severe immunosuppression; inactivated, toxoid, subunit and conjugate vaccines are safe in these groups.
- Adult tetanus: complete primary course then boosters every 10 years; for a contaminated wound give a booster if more than 5 years since the last, plus immunoglobulin if the course is incomplete or unknown.
- Hepatitis B: post-exposure prophylaxis is hepatitis B immunoglobulin plus vaccine started within 24 hours, ideally within 12 hours for perinatal exposure.
- Rabies: wash the wound with soap and running water for 15 minutes, apply antiseptic, then give vaccine on days 0, 3, 7, 14 and 28 for category II bites, adding rabies immunoglobulin infiltrated into the wound for category III exposures. Do not suture immediately.
- Meningococcal chemoprophylaxis for household contacts (rifampicin, ciprofloxacin or ceftriaxone) within 24 hours of diagnosis.
- Notifiable diseases must be reported to the local health authority so surveillance and control can follow; the exact list is set nationally and updated.
- Cold chain: vaccines kept at 2 to 8 °C, never frozen unless the product requires it; monitor with a vaccine vial monitor and temperature log.
Worked example
A child sustains a deep hand bite from a stray dog. Reasoning: category III exposure, so irrigate with soap and water for 15 minutes, apply povidone-iodine, do not suture, give rabies vaccine on days 0, 3, 7, 14 and 28 plus rabies immunoglobulin infiltrated around the wound, and assess tetanus status and antibiotics for the bite itself.
Traps that cost marks
- Giving live vaccines to a pregnant or severely immunosuppressed patient.
- Delaying rabies immunoglobulin while waiting for vaccine.
- Believing a tetanus booster is unnecessary because a childhood course was completed.