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1. CP - Core Microbiology > (7a) Immunisation > Flashcards

(7a) Immunisation Flashcards

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1
Q

Vaccination is the most effective medical intervention, second only to what?

A

Access to clean water

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2
Q

What happened in 1796 in the history of immunisation?

A

Edward Jenner - inoculation with cowpox virus for protection against smallpox

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3
Q

What happened in 1860s-1890s in the history of immunisation?

A

Louis Pasteur - produced vaccines against chickenpox, cholera, diphtheria, anthrax and rabies

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4
Q

What happened in the early 20th century in the history of immunisation?

A

Toxoid vaccines against diphtheria and tetanus produced following discovery of effective inactivation with chemicals

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5
Q

What happened post WW2 in the history of immunisation?

A

Successful live viral vaccines developed using cell culture technique

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6
Q

WHO estimated that how many deaths in 2008 in children under 5 were due to diseases that could’ve been prevented by routine vaccination?

A

1.5 million

17% of global total mortality in children under 5 years of age

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7
Q

6.6 million children under 5 died in 2012. 58% were due to what?

A

Infectious diseases - globally biggest cause = pneumococcal infection

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8
Q

What is the strategic aim of vaccination?

A
  • selective protection of the vulnerable
  • elimination (herd immunity)
  • eradication
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9
Q

What is the programmatic aim of vaccination?

A
  • prevent deaths
  • prevent infection
  • prevent transmission (secondary cases)
  • prevent clinical cases
  • prevent cases in a certain age group
  • to reduce mortality and morbidity from vaccine preventable infections
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10
Q

Why immunise?

A
  • prevent individual disease (life-long, not just children)
  • ideally halt carriage and transmission (herd immunity)
  • ideally eliminate then eradicate disease
  • high coverage is operational target
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11
Q

What are the non-specific immune defences?

A
  • unbroken skin
  • mucous membranes of gut and lungs
  • acid and enzymes of gut
  • non-specific metabolism/inactivation
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12
Q

What is involved in innate immunity?

A
  • complement
  • WBCs
  • cytokines
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13
Q

What is involved in immune system memory?

A
  • immunoglobin (initially non-specific)
  • learns specific IgG response
  • lays down immune memory
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14
Q

Give an example of passive immunity?

A

Transfer from mother to unborn baby

Vertical transmission of auto-antibodies from mother to foetus and in breast-feeding

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15
Q

What do “maternal antibodies” do?

A

They can protect the baby for up to a year against illnesses to which the mother is immune

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16
Q

Give an example of a maternal antibody

A

IgG

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17
Q

Give an antibody that can be injected into somebody who needs them

A

IgG

Contains antibodies pooled together from the blood of many donors, can be injected into a person who needs antibodies

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18
Q

Is passive immunity effective?

A

Effective but usually disappears within several weeks or months

Most types of transfused blood contains antibodies

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19
Q

What is active immunity?

A

Long-lasting immunity produced by the immune system in response to antigens

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20
Q

Active immunity responds to antigens. Where can these come from?

A

Can be from natural infection or from vaccinations - the immune system makes antibodies to help destroy these antigens

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21
Q

What is the benefit of vaccination in terms of active immunity?

A

In vaccination, active immunity occurs without disease or disease complications

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22
Q

What is “immunological memory”?

A

The persistence of protection for many years after natural infection or vaccination

B cells persist with the ability to recognise the specific antigen and so can produce IgG antibodies more quickly and in greater numbers

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23
Q

What is an antigen?

A

Anything that can be bound by an antibody

24
Q

Antibodies interact specifically with relatively small parts of molecules. What are these known as?

A

Antigenic determinants or epitopes

25
Q

What is an epitope?

A

An epitope, also known as antigenic determinant, is the part of an antigen that is recognized by the immune system, specifically by antibodies, B cells, or T cells. For example, the epitope is the specific piece of the antigen that an antibody binds to

26
Q

Antibodies are produced to one specific antigen. Give some examples of different antibodies

A

IgM
IgG
IgA
IgE

27
Q

The primary immune response develops in the weeks following the first exposure to an antigen. Which antibody does it involve?

A

Mainly IgM

28
Q

The secondary immune response is faster and more powerful. Which antibody does it involve?

A

Mainly IgG

29
Q

Which cells are antibodies produced by?

A

B lymphocytes

30
Q

What triggers clonal expansion of the antibody?

A

Antigen binds non-specifically to variable region of the antibody molecule - this triggers clinical expansion

31
Q

What happens after antigen binding?

A

1st wave of IgM production

Followed by IgG production

32
Q

What facilitates the destruction of the antigen-bearing micro-organism?

A

IgG binds tightly to antigen and through simultaneous complement binding facilitates the destruction of the antigen-bearing micro-organism

33
Q

What happens when infection resolves?

A

Levels of IgG decline

However, one set of the IgG producing B cells persist with the ability to recognise that specific antigen

34
Q

Passive immunity can be vertical transmission from mother to baby or injection of human immunoglobin. Give examples of injection of human immunoglobin

A
  • HNIG - pooled plasma

- specific - tetanus, botulism, hep B, rabies, varicella

35
Q

Give examples of diseases where the live (attenuated) organisms is used in vaccination

A
  • MMR
  • BCG
  • yellow fever
  • varicella

They act like the natural infection

36
Q

Give examples of diseases where the inactivated organisms are used in vaccination

A
  • pertussis
  • typhoid
  • IPV
37
Q

Give examples of diseases where components of the organisms are used in vaccination

A
  • influenza

- pneumococcal

38
Q

Give examples of diseases where the inactivated toxins are used in vaccination

A
  • diphtheria

- tetanus

39
Q

What are the advantages of using live vaccines?

A
  • single dose often sufficient to induce long-lasting immunity
  • strong immune response evoked
  • local and systemic immunity produced
40
Q

What are the disadvantages of using live vaccines?

A
  • potential to revert to virulence
  • contraindicated in immunosuppressed patients
  • interference by viruses or vaccines and passive antibody
  • poor stability
  • potential for contamination
41
Q

What are the advantages of using inactivated/killed vaccines?

A
  • stable
  • constituents clearly defined
  • unable to cause the infection
42
Q

What are the disadvantages of using inactivated/ killed vaccines?

A
  • need several doses
  • local reactions common
  • adjuvant needed (keeps vaccine at injection site, activated antigen presenting cells)
  • shorter lasting immunity
43
Q

What are the types of local reactions that might occur in vaccination?

A

Local - pain, swelling or redness at injection site, small nodules may form at injection site

44
Q

What are the types of general reactions that might occur in vaccination?

A

Fever, irritability, malaise, fatigue, headache, nausea, vomiting, diarrhoea, loss of appetite

45
Q

In live vaccines, does the frequency of reactions increase or decrease with increasing number of doses?

A

Decreases

Ab produced in response to live vaccine neutralises the small amount of vaccine virus in subsequent vaccine dose

46
Q

In inactivated vaccines, does the frequency of reactions increase or decrease with increasing number of doses?

A

Increases

If Ab levels are good from earlier vaccination, Ab binds to the vaccine antigen in a subsequent dose leading to an inflammatory response

47
Q

When do vaccine reactions normally occur in inactivated vaccines?

A

Generally within 48 hours following vaccination

48
Q

When do vaccine reactions normally occur in live vaccines?

A

Occur according to time taken for virus to replicate

49
Q

When do vaccine reactions occur in the MMR vaccine (live vaccine)?

A

Reactions to measles component - 1st week following vaccination

Reactions to rubella component - 2nd week following vaccination

Reactions to mumps component - 3rd week following vaccination (although may occur up to 6 weeks following vaccination)

50
Q

What reaction does the MMR vaccine cause?

A

Measles component - malaise, fever, rash

Rubella component - pain, stiffness or swelling of joints

Mumps component - parotid swelling

51
Q

What is the routine NHS vaccination programme?

A

2 months = DTaP/IPV/Hib + pneumo + rota

3 months = DTaP/IPV/Hib + Men C + rota

4 months = DTaP/IPV/Hib + pneumo

12 months = HiB/Men C + MMR + pneumo

24-48 months = annual flu

40 months = DTaP/IPV + MMR

12 years = HPV for girls

14 years = Td/IPV + Men C

65 years = penumo + annual flu

70 years = shingles

52
Q

At what age is the first dose of MMR given?

A

12 months

53
Q

Give some recent changes in the UK childhood immunisation schedule

A
  • added more serogroups to pneumococcal vaccination
  • cease universal adolescent BCG
  • HPV (and cervical cancer)
54
Q

Give some relatively new vaccines

A
  • varicella/zostavax
  • menveo
  • men B
  • rotavirus
  • fluenz
55
Q

What is a toxoid?

A

A toxoid is a bacterial toxin (usually an exotoxin) whose toxicity has been inactivated or suppressed

1. CP - Core Microbiology (8 decks)

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