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Bacterial And Viral Vaccines Flashcards

1
Q

What is the adaptive immune response?

A

Direct recognition of antigens by B cells, neutralisation of circulating antigens, production of antibodies.
Activation of B cells by T cells, production of long lived plasma and memory B cells

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2
Q

What is involved in T cell mediated immunity?

A

Activation of T cells by APC
Multiplication of T cells into effector T cells
Cytotoxicity, activation of B cells, memory T cells

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3
Q

What is the principle of vaccine?

A

Prime immune response so on subsequent encounter the memory response allow a more rapid and rigorous response to be made.

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4
Q

What is active immunity?

A

Induce and adaptive immune response in the host

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5
Q

What is passive immunity?

A

Transfer of immune effectors only eg immunoglobulin

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6
Q

What is antisera immunity?

A

Passive immunity, animal derived, specific for a certain toxin

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7
Q

What are the aims of vaccine?

A

Produce same immune protection which follows natural infection
Long lasting
Stop spread of infection
equally effective in all individuals

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8
Q

What are examples of immunoglobulin vaccine?

A

Varicella zoster ig
Human normal ig
Hep b ig
Tetanus ig

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9
Q

What are examples of anti toxins?

A

Diphtheria anti toxin

Botulinum anti toxin

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10
Q

What are examples of inactivated subunit vaccine?

A 
Diphtheria, tetanus, acellular pertussis, inactivated polio, h influenzae b
Influenza
Meningococcal C 
Pneumococcal PCV, PPV
HPV 
HAV
HBV
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11
Q

What are examples of live attenuated vaccine?

A

MMR, opv, rotavirus, yellow fever

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12
Q

What is a live vaccine?

A

Attenuated strains which replicate in the host, cannot cause disease.
Ilicit good strong long lasting immunity

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13
Q

What are the advantages of live vaccines?

A

Single dose often sufficient
Strong immune response evoked
Local and systemic immunity

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14
Q

What are the disadvantages of live vaccines?

A 
Potential to revert to virulence
Contradicted in immunosuppressed
Interference by viruses or vaccines and passive antibody 
Poor stability 
Potential for contamination
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15
Q

What are inactivated vaccines?

A

Suspension of whole intact killed organisms, pertussis, influenza, rabies, hepA
Acellular and subunit vaccines contain one or few components of organism important in protection

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16
Q

What are the advantages of inactivated vaccines?

A

Stable
Constituents clearly defined
Unable to cause the infection

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17
Q

What are the disadvantages of inactivated vaccines?

A

Need several doses
Local reactions common
Adjuvant needed
Shorter lasting immunity

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18
Q

What are combination vaccines?

A

Give several vaccines at one time
Ensure that immune responses are equivalent to single vaccines
Adverse effects are no worse or frequent

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19
Q

What is SSPE?

A

Sub acute sclerosing pan encephalitis associated with measles
ITP associated with MMR

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20
Q

What is the relationship of adverse events with live and inactivated vaccines?

A

Live- frequency of adverse events falls with number of doses
Inactivated- frequency of adverse events increases with number of doses

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21
Q

What is the timing of inactivated vaccine reactions?

A

Generally within 48 hrs following vaccination

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22
Q

What is the timing of live vaccine reactions?

A

According to time taken for virus to replicate
Measles- malaise, fever, rash, 6-11 days
Rubella- pain, stiffness, swelling of joints, 2nd week
Mumps- parotid swelling, 3rd-6th week

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23
Q

When should you avoid live vaccines? Especially bcg, polio

A

Patients having chemo for malignancy
Patients less than 6 months after BMT
Children on high dose steroids or cytotoxics
Pregnant women (no evidence of harm from MMR)

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24
Q

What vaccines can be given to HIV positive patients?

A

MMR, inactivated HIB,DTP, HBV
Not BCG
Not yellow fever vaccine

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25
How do immunoglobulins work?
Provide passive antibody and can be used prophylactically before or after exposure Cannot be used to test established disease Can attenuate disease (antitoxins can treat)
26
What are examples of immunoglobulin therapy?
VZIG- used in susceptible pregnant women, neonates or immunosuppressed patients exposed to chicken pox HBIG- prevention of HBV, in conjunction with vaccine NHIG- prevention of HAV, rubella and polio
27
How is rotavirus given?
Oral liquid vaccine
28
What is the primary failure of a vaccine?
Individual failures to make adequate immune response to the initial vaccination
29
What is the secondary failure of vaccine?
Individual makes an adequate immune response but then immunity wanes over time- inactived vaccines, need boosters
30
Why are live vaccines deferred after 1 yrs old?
Concerned about side fx | Passive maternal antibody will make vaccine ineffective
31
What is diphtheria?
Resp disease, toxigenic strains of corynebacterium diphtheria or corynebacterium ulcerans Airborne droplets, infect throat and skin Incubation 2-7 days Untreated disease- infectious up to four weeks Young and elderly
32
What are the features of diphtheria?
Early signs, mild fever, swollen neck glands, anorexia, malaise, cough Membranes of dead cells forms in throat,tonsils, larynx or nose May narrow or occlude the airway leading to respiratory distress
33
What are the severe symptoms of diphtheria?
Toxin can travel through bloodstream causing extensive organ damage, neurological and heart complications Death- occurs in 5-10% cases
34
Current state of diphtheria in UK?
Associated with recent travel to endemic countries Can make a comeback if immunisation is not maintained Approx 50% of UK adults over 30 years have antibody titres below lower protection threshold
35
What is tetanus?
Clostridium tetani Non communicable, no herd immunity Form spores, can survive in environment for years Can occur if wound or cut is infected by soil or manure Incubation 4-21 days, all ages Recovered ppl still need immunisation
36
Where the vernalised symptoms of tetany?
Lock jaw, neck stiffness, difficultly swallowing, stiffness of stomach, spasms, sweating and fever Complications- fractures, hypertension, laryngospasm, pulmonary embolism, aspiration and death
37
What is the prevention of tetanus?
5 doses of tetanus at appropriate intervals Early treatment with tetanus immunoglobulin for heavily contaminated wounds Early recognition of potential tetanus wounds Continued vigilance for early signs
38
What is pertussis?
``` URI, paroxysmal coughing of >14-21 days duration Bordatella pertussis/parapertussis Vaccine-preventable Immunity is incomplete UK resurgence ```
39
What are the 3 phases of pertussis?
Catarrhal phase- indistinguishable from other URI, infectious Paroxysmal phase- coughing, inspiratory whoop, vomiting, seizures, apnoeic episodes Convalescent phase- resolution, but dry cough may persist for months 3 times 2 weeks
40
What pertussis vaccine is used?
Sept 2004- 5aP vaccine, as efficacious as previously used whole cell vaccine Incidence of local and systemic reactions lower with aP than wP
41
What are the current issues for pertussis?
High vaccine coverage, some evidence of waning with age Good control in those most vulnerable, remains most common vaccine preventable disease in less than 1 year old Recommended for pregnant women 28 weeks
42
What is poliomyelitis?
Types 1-3, transmitted via faeces, or pharyngeal secretions of infected person Incubation 3-21 days Virus can be excreted for up to six weeks in faces and 2 weeks in saliva Most infectious- before and 1-2 weeks after onset of paralysis
43
What are symptoms of poliomyelitis?
Can be asymptomatic Mild influenza like symptoms Neck stiffness, back and legs- aseptic meningitis
44
What is paralytic polio?
Less than1% results in flaccid paralysis 1-10 days after prodromal illness and progresses Loss of limb use, lungs Degree of recovery variable
45
What polio vaccine is used?
Inactivated,not avoid risk of vaccine associated paralytic polio from live Opv available for outbreak control
46
What is meningococcal disease?
NM, gram negative diplococci, 13 serogroups, B and C common in UK Recent increase in severe death from men W Nasal carriage Meningitis and septicaemia, 1 in 8 long term sequlae
47
What vaccine is used for MenC?
Conjugate- purified capsular polysaccharides chemically joined to tetanus or diphtheria carrier proteins Generates T cell dependant immune response and produces memory Recombinant meningococcal vaccine b intro in September 2015, may provide pan meningococcal protection
48
What is IPD?
Sp invades lung parenchyma, bloodstream and CNS, joint fluid, pleural fluid, pericardial fluid Non invasive- otitis media, sinusitis, bronchitis
49
When does IPD occur?
5000-6000 cases reported to HPA, occur in December and jan
50
What are the risk factors for IPD?
``` Male more than female, under 1 year more than50 Winter viral RTi association Chronic lung disease Smoking Alcoholism Immunosuppressed ```
51
What is the leading cause of meningitis in the UK?
Pneumococcal
52
What is the immunity to strep pneumonia?
``` Colonisation- indices protective capsular serotype specific antibody Cd4 T cell immunity important for immune memory and class switching Cd4 T cell deficient conditions show increased susceptibility to pneumo ```
53
What is PPV?
Purified polysaccharide vaccine, 23 serotypes covering 90% isolates encountered in IPD Safe and immunogenic after single dose 60% effective, DOESNT work in children Polysaccharide antigens can activate B cells by t independent means only resulting in igM production
54
What vaccine is now used for pneumo?
Prevenar 13- not recommend for adults or children more than 5 years old, use pneumovax
55
What is measles?
Caused by morbillivirus 1-4 year olds, nose and throat secretions Transmission period- beginning of symptoms to 4 days after rash Incubation- 7-18 days
56
What are the symptoms of measles?
Cough, runny nose, conjunctivitis, koplik's spots on buccal mucosa Rash, spreads from face to body, hands and feet over 3 days Lasts 5-6 days Diarrhoea Neurological involvement
57
What are the complications of measles?
``` Severe diarrhoea, dehydration Pneumonia, commenest cause of death Encephalitis also develops SSPE Death ```
58
What is mumps?
Acute viral illness caused by paramyxovirus Transmitted through airborne droplets, incubation 14-25 days Transmissible for several days before the parotid swelling and several days after it
59
What are the symptoms of mumps?
Headache, fever, parotid swelling Photophobia, neck stiffness can develop Some asymptomatic, severe in adults
60
What are the complications of mumps?
Pancreatitis, oophoritis, Orchitis, Neurological, deafness, nephritis Cardiac abnormalities
61
What is rubella?
German measles, caused by Togavirus Direct or droplet contact with nasopharyngeal secretions Incubation 14-21 days Infecvtiviry- 1 weeks before, 5-7 days after onset of rash Peak incidence of infection- late winter, early spring
62
What are the symptoms of rubella?
Mild illness, swollen lymph glands, low grade fever, malaise, conjunctivitis Maculo- popular discreet rash develops on face, neck and body Swollen joints and joint pain common in adults
63
What are the complications of rubella in pregnancy?
Risk of foetal damage greatest at 10 weeks | Cardiac, auditory, ophthalmic, neurological problems
64
What is contained in the MMR vaccine?
Enders Edmonston strain measles RA27/3 rubella Jeryl Lynn mumps
65
What is hepatitis B virus?
Infection of liver, incubation from 40-160 days | Extremely infectious
66
What are the modes of transmission for hep B?
Exposure to infected blood or body fluids | Perinatal transmission, parenteral, sexual
67
When should neonates be vaccinated?
Babies born to infected mothers, at birth Chronically infected mothers, or acute episode during pregnancy Babies born to highly infectious mothers should also receive hep B immunoglobulin
68
What vaccines do we want?
``` HIV HCV CMV DENGUE MALARIA Diarrhoea, RSV ```
69
What is the innate immunity response?
Entry of pathogens into tissue | Recruitment of specific effector cells, phagocytes, macrophages, neutrophils, recognition and internalisation

Microbiology (15 decks)

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