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302 > Case of Vaccine Refuser > Flashcards

Case of Vaccine Refuser Flashcards

1
Q

Different in active and passive vaccine?

A

active- cause organism to mount an immune response- as if real infection had taken place

passive- prefabricated immune response (an antibody concentrate)

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2
Q

immunisation for diptheria?

A

horses injected with cornyebacterium diphteriae toxin- then horse serum collected and the antitoxin us used for human use

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3
Q

horse serum problems?

A

horse protein will induce anti-antibodies in patient resulting in formation of complexes… secondary immune complex disease

horse igG is 5 days and human is 20 days, rapidly eliminated. Repeat administration can lead to anaphylactic shock. may soon be replaced by human igG produced in bio-reactors

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4
Q

who should not get live vaccines?

A

compromised immune system people, may not be able to contain that infection,

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5
Q

examples of life vaccine?

A

shingles, BCG, MMR nasal spray influenza and rubeola, produce stronger immune responses

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6
Q

what does inactivated vaccines require?

A

repeat doses, booster
examples influenza, pertussis, poliomyleitis, typhoid

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7
Q

what is unique about polysaccharide vaccines?

A

combined to a carrier to increase imunogenicity

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8
Q

subunit vaccine example

A

hepatitis b

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9
Q

virus like particle vaccine example

A

HPV

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10
Q

Subunit conjugate vaccine example

A

haemophilus influenza B

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11
Q

toxoid vaccine for

A

tetanus, diphteria

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12
Q

DNA/RNA vaccines for?

A

COVID- vector based AstraZeneca
liposomal vaccine- Pfizer/ moderna

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13
Q

what do adjuvants do?

A

increase local immunity to vaccine and attract other immune cells

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14
Q

routine vaccinations start at?

A

8 weeks

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15
Q

post exposure prophylaxis?

A

hepatitis B, tetanus and rabies, anti venoms and antitoxins

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16
Q

what should be given to baby whose mother develops varicella 1 week before or after delivery?

A

VZV hyperimmune globulin

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17
Q

where does SARS Cov2 protein bind?

A

ACE-2 and Nrp1 (neuropilin1)

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18
Q

what is the issue if one antibody or competing antibodies are given?

A

novel spike mutation

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19
Q

RNA vaccine does not ?

A

interfere with host cells genes

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20
Q

mRNA needs to be stable enough to be translated so hence requires?

A
  1. A specially modified nucleotide positioned at the 5’ cap
  2. a poly A tail length
  3. the composition and structure of the 3’ untranslated region
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21
Q

advantages of mRNA vaccine?

A

safety- no pathogen particles, RNA strand is degraded when protein is made, not integrated in host genome

efficacy- reliable immune response, well-tolerated and few side effects

production- rapid, standardised, scaled to meet needs of pandemic

can be effective for cancer vaccines

22
Q

herd immunity?

A

infection is no longer effectively transmitted across population because too many individuals are immune

23
Q

herd immunity level?

A

r naught, in covid 19, 5-6
this would cause hundred thousands of death

24
Q

original antigenic sin?

A

antigen exposure causes recruitment of b cells- make antibodies and t cells . second times- t cells and igG peak at 5-10 days

but with slightly changed virus- existing memory response is ineffective, with antibodies not neutralising the changed virus

if similar enough, same antobodies can bind to an extent and the existing memory b cells may expand further but no new immune response is made

25
Q

narcolepsy is

A

severe sleep disruption, loss of concentration, social difficulties and complete loss of muscle control

26
Q

narcolepsy was attributed to?

A

AS03- adjuvant in GSK vaccine
1/55,000

26
Q

narcolepsy was attributed to?

A

AS03- adjuvant in GSK vaccine
1/55,000

27
Q

adjuvants?

A

mineral salt: aluminium hydroxide
micro-fluidised detergent, emulsions and saponins- MF59, AS03
TLR agonist- CpG and flagellin

28
Q

EFFICACY?

A

works in lab like conditions

29
Q

how do RCTs protect against confounding?

A

temporal precedence

30
Q

higher risk of bias in?

A

case reports, whereas RCT has the lowest risk of bias

31
Q

clinical equipoise

A

genuine uncertainty in the expert medical community over whether one treatment will be more beneficial

32
Q

what makes a good RCT?

A

internal validity- is the exposure causing the outcome in the study

external validity- are the findings generalised to others

33
Q

bias?

A

partiality that prevents objective consideration of an issue or situation

34
Q

bias is independent of?

A

sample size and statistical significance

35
Q

bias is concerned with?

A

systematic error

36
Q

selection bias?

A
  1. not adequately capturing relevant population
  2. systematic difference in comparison groups at outset
37
Q

performance bias?

A

introducing differences between groups in care provided/ exposures encountered

38
Q

attrition bias?

A

difference between groups in drop outs

39
Q

observer, detection bias?

A

not adequately capturing the outcome of interest

systematic differences in the way information is collection for the groups being studied

40
Q

how to minimise selection bias?

A

inclusion/exclusion criteria and sampling strategies
randomisation and allocation procedures

41
Q

how to minimise performance, attrition, observer, detection bias?

A

blinding/ masking

42
Q

open RCT?

A

everyone involved in trial knows

43
Q

Intention to treat?

A

analyse outcome for everyone randomised irrespective of whether they have/adhere to interventions allocated

44
Q

per protocol?

A

analyse outcomes for only those who received dose of intervention as specified in protocol

45
Q

Type I error?

A

there is no true difference but an observed difference
accepted at 5%

46
Q

Type II error?

A

There is a true difference but no observed difference accepted at 10/20%

47
Q

what is p value?

A

probability that the difference observed could have occurred by chance if the groups were really alike

48
Q

confidence interval?

A

range of values within a given probability (95%) that the true value of a variable is contained within that range

49
Q

RCT advatanges?

A

safety, efficacy
best single study for causal association
temporal precedence
deals with confounding

50
Q

RCT disadvantages?

A

time consuming, laborious
expensive
internal validity issues
issues with external validity

302 (24 decks)

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