Immunization and Vaccinations Flashcards
What types of immunity are there?
Self vs non-self
Protection from infectious disease
Indicated by the presence of antibody
Specific to a single organisms
Antigen
A liven or inactivated substance capable of producing an immune response
Antibody
Protein molecule (immunoglobulin) produced by B lymphocytes to help eliminate an antigen
Passive immunity
Transfer of antibody produced by one human or other animal to another
Temporary protection
What are the most important sources in infancy of passive immunity?
Transplacental transfer and breastfeeding
What are some sources of passive immunity?
All blood or blood products
Homologous pooled human antibody (immune globulin)
Homologous human hyperimmune globulin
Heterologous hyperimmune serum (antitoxin)
Monoclonal antibody
Derived from a single type of antibody-producing cells (B cells)
What are monoclonal antibodies used for?
Used for diagnosis and therapy of certain cancers, autoimmine, and infectious disease
Active immunity
Produced by vaccine
Immunity and immunologic memory similar to natural infection (without disease risk)
1st principle of vaccination
The more similar a vaccine is to the disease-causing form of the organism , the better the immune response to the vaccine
What are some considerations when developing a new vaccine?
Common disease?
Safe and effective production of a vaccine?
Side effects worse than disease?
How long does preclinical testing for a new vaccine last?
2 - 4 years
What must the volunteers for a new vaccine agree to?
Vaccine administration, follow-ups for eval and physical testing, provide blood samples
How long to clinical trials for vaccinations last?
5 - 7 years
What is phase 1 for vaccine clinical trials?
Safety - candidate vax tested in small numbers to healthy adults to assess short term and adverse effects and correct dose
What is phase 2 for vax clinical trials?
Multiple stages of several hundred appropriate-age volunteers in multiple centers which assess expanded safety parameters and provocation of an immune response
What is phase 3 for vax clinical trials?
Thousands required to confirm degree of immune response/side effects, eval of vax in general population and potential value and use of the vaccine for general public health practice
What is phase 4 for vax clinical trials?
Monitoring
Detect rare/unexpected reactions, measure program effects
What is a live attenuated vaccine?
Weakened form of the wild virus or bacterium
Generally works in one dose (exclude oral)
What must a vax do to be considered live attenuated?
Must replicate to be effective, produce immune response similar to natural infection
What are some complications of a live attenuated vax?
Severe rxns, interference from antibodies
Vax is fragile - stored and handled carefully
Examples of live attenuated viral vax
Measles, mumps, rubella, varicella/zoster, yellow fever, rotavirus, intranasal influenza, rotavirus, vaccinia
Examples of live attenuated bacterial vax
BCG, oral typhoid
What parts may be used (fractional) can be used in an inactivated vax?
Protein-base: toxiod, sub-unit
Polysaccharide-based: pure, conjugate
Characteristics of inactivated vax
No replication, less interference by antibodies, 3 -5 doses, humoral response mostly, antibody titer may dimish
Examples of inactivated whole-cell vax
polio, hepatitis A, rabies, influenza
What does a fractional subunit vax contain?
Minimal amounts of nonvirus antigens derived from the culture medium
Less likely to cause adverse reaction than whole version
Examples of fractional inactivated vax
Hepatitis B Influenza Pertussis (acellular) Human papillomavirus Anthrax
What does a fractional toxoid vax contain?
Treated to destroy vax toxic properties, but retain the capacity to stimulate production of antitoxins
Examples of fractional toxoid vax
Diphtheria
Tetanus
What is a polysaccharide vax?
Extracted and purified form of the bacterial outer polysaccharide coat
What are the characteristics of the polysac vax?
Induce formation of circulating antibodies, promote phagocytosis, remove immune system macs
No booster but doesn’t always work for kids younger than 2
Examples of pure polysac vax
Pneumococcal
Meningoccal
Salmonella Typhi (4)
What are conjugated polysac vax?
Polysacs linked to purified protein carriers
Involve helper T cells in the polysac antigen response
Examples of conjugated polysac vax
Tetanus toxoid
Diphtheria toxoid
H. influenzae B
Some forms of Pneumococcal and Meningococcal
What are the general rules of vaccination?
Inactivated vax are generally not affected by circulating antibody to the antigen
Live attenuated vax may be affected by circulating antibody to the antigen
What is the second principle of vaccination?
All vax can be administered at the same visit as all other vax (generally)
When should administration of vax be separated?
2 live parenteral vax
What are the third prinicples of vax?
Increase the interval between doses of multidose vax does not diminish the effectiveness of the vax
Decreasing the interval between doses of a mutlidose vax may interfere with antibody response and protection
When are minimum intervals and ages used for vax?
When a pt is behind schedule on vax series
Vax doses should not be administered at intervals less than the minimum or earlier than minimum age
Adverse rxn
Extraneous effect caused by vax
Side effect
Adverse event
Any event following vax, may be coincidental or true rxn
Local adverse rxn
Pain, swelling, redness at injection site
Common with inactivated vax
Mild, self-limiting
System adverse rxn
Fever, malaise, headache, nonspecific
Maybe unrelated to vax
Live attenuated vax adverse rxn
Must replicate for immunity so there may be symptoms that occur after incubation period (7-21 days)
Allergic adverse rxn
Dude to vax or vax component, rare, risk minimized by screening
Contraindication
Condition in a recipient that greatly inc the chance of a serious adverse rxn or effect the ability of the vax to produce immunity
What are the permanent contraindications for vax?
Severe allergic rxn to vax component after a dose
Encephalopathy (pertussis)
Should live vax be used in pregnant women?
No
In pregger the HPV vax should be….
Deferred
What diseases could cause immunosuppresion?
Congenital immunodeficiency
Leukemia or lymphoma
Malignancy
What chemotherapies could cause immunosupression?
Alkylating agents
Antimetabolities
Radiation
If a person has isolated B-cell deficiency they can have what vax?
Varicella
Which type of vax is safe for an immunosupressed person?
Inactivated vax but possible dec in response
Which vax can you give to an asymptomatic HIV pt?
Varicella, MMR, maybe yellow fever
Does acute illness mean a vax can’t be used?
No, it doesn’t even reduce efficacy but should be delayed until illness is improved
What is a adjuvant?
Pathogens, or parts of one, used to inc vax effectiveness
Why are preservatives used in vax?
The prevent the growth of bacteria or fungi
Always used in multidose vax
