immunisation

Question 1

what are the two single most effective medical public health interventions so far?

Answer 1

clean water and vaccination

Question 2

what are the characteristics of public health interventions?

Answer 2

they are put in place to protect individuals and communities from infection, reflect the NHS and professional quality, proactive measures for well people and have a long history

Question 3

what milestones occurred in 1796 and 1860s-90s?

Answer 3

in 1796 Edward Jenner innoculated with cowpox virus for protection against smallpox
in the 1860s-90s Louis Pasteur produced vaccines against anthrax, rabies, cholera, diptheria, and chickenpox

Question 4

what happened in the early 20th century?

Answer 4

toxoid vaccines against diptheria and tetanus following successful inactivation of pathogen with chemicals

Question 5

when were the first live vaccines developed and how?

Answer 5

post WW2 using cell culture techniques

Question 6

which infectious disease is now rising again?

Answer 6

measles/mumps

Question 7

in 2012, 6.6 million under 5s died, what were a large proportion of these caused by and what is this a big cause of?

Answer 7

58% by infectious disease - this is the biggest cause of worldwide pneumococcal infection

Question 8

how many under 5 deaths could be prevented by routine vaccines?

Answer 8

around 17%

Question 9

what are the two types of aims that goals use?

Answer 9

programmatic and strategic

Question 10

what does a strategic aim comprise?

Answer 10

selective protection of the vulnerable, herd immunity using elimination and then eradication

Question 11

what does the programmatic aim comprise?

Answer 11

to reduce morbidity and mortality from vaccine preventable infections by:
preventing deaths
preventing infection
preventing transmission - secondary cases
preventing clinical cases
prevent cases in a certain age group

Question 12

why should we immunise?

Answer 12

to prevent individual disease that is life long and not just in children, ideally want to halt carriage and transmission producing herd immunity as a side effect, eliminate to eradicate the disease

Question 13

what is the operational target?

Answer 13

they are objectives that help to achieve long term goals - they are specific and measurable - in this case will be high coverage to induce herd immunity

Question 14

what are the mechanisms of protection in an individual?

Answer 14

the non specific defences, innate immunity and the immune system

Question 15

what comprises non specific defences?

Answer 15

unbroken skin, mucous membranes of the lung and gut, acid or enzymes of the gut and non specific metabolism or inactivation

Question 16

what comprises innate immunity?

Answer 16

complement system, cytokines and WBC

Question 17

what comprises the immune system?

Answer 17

initially the non specific immunoglobulins, the learned specific IgG response and then laying down the immune memory

Question 18

what is an example of passive immunity?

Answer 18

transfer from mother to baby

Question 19

how do maternal antibodies work?

Answer 19

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

Question 20

what is a second example of passive immunity?

Answer 20

immunoglobulin can be administered to someone who needs ABs because it contains antibodies pooled together from different donors

Question 21

how effective is immunoglobulin transplant?

Answer 21

it is effective but is only for a few weeks or months before it disappears

Question 22

what do most transfused bloods contain?

Answer 22

ABs

Question 23

what is active immunity?

Answer 23

it is usually long lasting immunity produce by the body’s immune system in response to antigens

Question 24

where are the antigens in active immunity from?

Answer 24

from infection or vaccination

Question 25

what does the immune system do in response to antigens?

Answer 25

it produces complementary antibodies

Question 26

what is a benefit of vaccination over infection for immunity?

Answer 26

the active immunity occurs without the disease or the complications of the disease

Question 27

what is immunologic memory?

Answer 27

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

Question 28

what forms the immune response?

Answer 28

the interaction between the antibody and the antigen

Question 29

what is an antigen?

Answer 29

it is anything that can be bound by an antibody

Question 30

what do ABs interact with?

Answer 30

a relatively small part of the antigen molecule. This is known as the antigenic determinants or the epitopes

Question 31

what does complementary mean with regards to ABs?

Answer 31

ABs are produced to one specific antigen

Question 32

how many different types of antibody are there?

Answer 32

5 | IgG, IgM, IgA, IgE, IgD

Question 33

what is the primary immune response?

Answer 33

it is the response that develops in the weeks following the first exposure to an antigen and is mainly the IgM antibody

Question 34

what is the secondary immune response?

Answer 34

it is the response that is faster and more powerful after exposure - it is learnt it is mainly IgG

Question 35

where do antibodies originate from?

Answer 35

B lymphocytes

Question 36

where does the antigen originally bind in first exposure?

Answer 36

non specifically binds to the variable region of the antibody molecules which triggers clonal expansion

Question 37

what are the first ABs to be produced following the clonal expansion trigger?

Answer 37

IgM followed by IgG

Question 38

what does IgG do?

Answer 38

it binds tightly to the antigen and then facilitates the destruction of the antigen bearing microorganism

Question 39

what aids the IgG?

Answer 39

the simultaneous complement binding

Question 40

what happens once the infection is resolved?

Answer 40

the levels of IgG decline

Question 41

what is a secondary response to infection?

Answer 41

one set of the IgG producing B lymphocytes persist with the ability to recognise the same antigen again - immunological memory

Question 42

how can active immunity be induced?

Answer 42

natural infection or inactivated or attenuated live organisms

Question 43

how can passive immunity be induced?

Answer 43

vertical transmission of autoantibodies from mother to foetus and through breast feeding and injection of human immunoglobulin

Question 44

for active immunity what are live vaccines?

Answer 44

they act like the natural infection and are MMR, BCG, varicella and yellow fever

Question 45

for active immunity, what are inactivated organisms, components of organisms and inactivated toxins examples?

Answer 45

inactivated organisms - pertussis, typhoid, IPV inactivated toxins - diptheria and tetanus components of organisms - influenza and pneumococcal

Question 46

for human immunoglobulin injections, what is HNIG?

Answer 46

pooled plasma

Question 47

for human immunoglobulin injections, what are specific ones?

Answer 47

tetanus, botulism, hep B, rabies and varicella

Question 48

what are advantages of live vaccines?

Answer 48

single dose is often sufficient to produce long lasting immunity as a strong immune response is evoked and local and systemic immunity are produced

Question 49

what are disadvantages of live vaccines?

Answer 49

there is potential to revert to virulence, contraindications in the immunosupressed, interference by viruses, vaccines or passive antibodies, poor stability and potential for contamination

Question 50

what are advantages for inactivated vaccines?

Answer 50

they are stable, the constituents are clearly defined and they cannot cause infection

Question 51

what are disadvantages of inactivated vaccines?

Answer 51

shorter lasting immunity, multiple doses, adjuvant needed - keep vaccine at injection site and activate the APCs and local reactions are common

Question 52

what is an adjuvant?

Answer 52

it is a pharmaceutical that modifies the effect of another agent

Question 53

what types of reactions are there?

Answer 53

local and general

Question 54

what are the symptoms for a local reaction?

Answer 54

red, pain and swelling and small nodules at the site

Question 55

what are the symptoms for a general reaction?

Answer 55

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

Question 56

why may reactions decrease with more live virus dose?

Answer 56

the antibody produced in response to the live vaccine will neutralise the small amount of vaccine virus in subsequent doses

Question 57

why may reactions increase with more live virus dose?

Answer 57

if the antibody doses are good from an earlier vaccination then the antibody will bind to the vaccine antigen in a subsequent dose leading to an inflammatory response

Question 58

when do reactions occur after inactivated vaccines?

Answer 58

around 48hours after

Question 59

when do reactions occur for live vaccines?

Answer 59

it depends according to the time taken for a virus to replicate

Question 60

what are the reaction timescales for the live MMR virus?

Answer 60

reaction to the measles component will be malaise, fever and rash that tend to occur in the first week following vaccination reaction to the rubella part will be joint pain, stiffness or swelling that tend to occur in the second week following vaccination reaction to the mumps part will be parotid swelling and they tend to occur in the third week but can occur up to six weeks following the vaccination

Question 61

what changes have been made to the childhood pneumococcal vaccination?

Answer 61

more serogroups added