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immunizations Flashcards

1
Q

what was the first attenuated vaccine used?

A

The first attenuated vaccine given to humans: rabies in 1885, administered to a 9-year-old boy after attack by a rabid dog; the boy did not develop symptoms of rabies and survived

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2
Q

why are vaccines important?

A
  • Infants against the important infectious diseases of childhood(early)
  • Routine infant and childhood immunisation schedules
  • Adults and children against the infectious hazards of travel (timely)
  • Susceptible or “at risk” adults, infants and children
  • Adults against certain infections that may be acquired at work (occupational)
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3
Q

what is the antigen?

A

A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response

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4
Q

what is an adjuvant?

A

– substances that enhance the antibody response.

– Most combination vaccines contain adjuvants such as aluminium phosphate or aluminium hydroxide

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5
Q

what is an adverse reaction to the vaccine?

A

any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine

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6
Q

what are the principles of immunization?

A

• Immunisation:
–the process of inducing or providing immunity to an infectious disease artificially
• Successful immunisation is usually indicated by the presence of antibody
• Very specific to a single antigen
• The artificial induction or provision of immunity may be either passive or active

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7
Q

what is passive vaccination?

A
  • Administration of serum containing a high level of antibody to a specific toxin/pathogen to a person “at-risk”, e.gs., Hep BIg, VZIg
  • Gives immediate protection
  • However, it provides only short term immunity
  • In infancy, the transplacental transfer is the most important source of antibodies= passive immunization
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8
Q

passive immunity is lifelong. True/False

A

False

Short term

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9
Q

give examples of passive immunization?

A

Commonly performed for rubella virus, rabies virus, hepatitis B virus, zoster virus, tetanus toxin, botulinum toxin, and to prevent rhesus incompatibility

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10
Q

what are the sources of antibodies for passive immunization?

A

1)Almost all blood or blood products
(includes transplacental transfer)
2)Homologous pooled human antibody (immune globulin, Ig)
–Pooled IgG antibody fraction from donors
–Comes from many different donors, -> contains antibody to many different antigens
3)Homologous human hyperimmune globulin
–contain high titers of specific antibody
4)Heterologous hyperimmune serum (antitoxin)

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11
Q

what is the most important source of passive immunity in newborns?

A

• In infancy, the transplacental transfer is the most important source of antibodies= passive immunization

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12
Q

what is the active immunity

A

In active immunity, the body’s immune system reacts to the presence of antigens by producing antibodies.
In general, a combination of different active vaccinations is possible.
Immunity usually lasts for years or even a lifetime.

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13
Q

how long immunity lasts with active immunization?

A

and usually is long-lasting/permanent

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14
Q

what are the 2 types of vaccines with active immunization?

A

live-attenuated and killed

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15
Q

what is the live vaccine?

A
  • Attenuated agent (may be unstable)
  • Amplification of response - gradual rise to peak response then decline
  • Variable but “long”duration of immunity - the immune response produced is similar to that produced by the natural infection and includes both humoral and cellular components
  • There will be a booster effect with subsequent exposure
  • There is a possibility of generalised /severe infection in an immunocompromised individual
  • There may be interference from circulating antibody with the “take”of the vaccine
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16
Q

live vaccines are generally recommended after the age of…

A

Not indicated in children < 9 months (the rotavirus vaccine is an exception, which is first given at 6 weeks of age)
maternal antibodies may still be present, which could neutralize the attenuated pathogens

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17
Q

what are the examples of live vaccines?

A 
Viral:
•	Measles
•	Mumps
•	Rubella
•	Varicella
•	Yellow fever
•	Oral polio
•	Rotavirus

Bacterial:
• BCG
• (oral typhoid

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18
Q

what is the most feared side effect of live vaccines?

A

possibility of generalized/severe infection in an immunocompromised individual so contraindicated in pregnant, HIV patients with CD4 count <200

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19
Q

do non-live vaccines cause disease?

A

Non live vaccines cannot replicate and do not cause the disease they are trying to prevent

General Rule: The more similar a vaccine is to the disease-causing form of the organism, the better the immune response is to the vaccine

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20
Q

what are the killed vaccines?

A
  • The whole pathogen killed (by heat or formalin) and injected to induce an antibody response
  • There will be minimal interference from circulating antibody
  • In general, they are not as effective as live vaccines
  • Generally require 3-5 doses
  • The immune response produced is mostly humoral (antibody)
  • Antibody titer falls over time
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21
Q

what is the toxoid vaccine?

A

A type of vaccination in which a bacterial toxin is used to induce an immune response. These toxins are modified to lose their toxicity while maintaining immunogenicity. Examples include the diphtheria and tetanus vaccines.

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22
Q

what are the 2 types of protein-based vaccines?

A

Toxoid and subunit

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23
Q

what is the subunit vaccine?

A

Inactive antigenic particles of a pathogen

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24
Q

give examples of subunit vaccines

A 
Hepatitis B
Influenza
Pertussis (acellular vaccine)
HPV
Anthrax
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25
Q

what are the 2 types of polysaccharide-based vaccines?

A

pure and conjugate

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26
Q

what is the polysaccharide-conjugate vaccine?

A

A type of vaccine in which a weakly immunogenic antigen (usually a polysaccharide) is chemically linked to a strongly immunogenic antigen (usually a protein). This combination dramatically increases the immune response to the polysaccharide, especially in infants and toddlers, in whom the polysaccharide alone would not produce sufficient immunization. Examples of polysaccharide vaccines are: Haemophilus influenzae B, meningococcal, and pneumococcal conjugate vaccines

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27
Q

what is the whole killed vaccine?

A

1) Whole inactivated or dead virus/bacteria, that cannot replicate, examples are:
- -polio (Salk; inactivated vaccine)
- -Hepatitis A
- -Rabies
- -Pertussis (cellular vaccine)
- -Cholera
- -Japanese encephalitis

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28
Q

what is the fractional killed vaccine?

A

Fractional vaccines include subunits (hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax) and toxoids (diphtheria, tetanus). It can be protein based (subunit, toxoid) and polysaccharide based

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29
Q

what is the advantage of conjugate-polysaccharide vaccines?

A

Polysaccharides induce a relative T cell-independent B-cell response and therefore achieve sufficient immunization only in adults and older children.
In conjugate vaccines, the carrier protein activates T-cells, which stimulate a more rapid and long-lasting immune response, especially in infants and toddlers.

30
Q

give examples of whole inactivated vaccines

A 
Viral:	
•	Polio
•	Hepatitis A
•	Rabies
•	Influenza
•	Japanese encephalitis
Bacterial:
•	Whole cell pertussis 
•	Typhoid
31
Q

give examples of fractional subunit and toxoid vaccines?

A 
Subunit
•	Hepatitis B
•	Influenza
•	Acellular pertussis
Toxoid
•	Diphtheria
•	Tetanus
32
Q

what is the importance of vaccination against HBV?

A

1) up to the 90 percent of vertically infected infants may becme chronic carriers
2) 2-20% infected addult become carriers
3) cariers may develop chronic hepatitis, cirrhosis or HCC
4) HBV infection is a major economic burden worldwide

33
Q

what is the immunization schedule of DTaP?

A

1) 1st dose; minimum age 6 weeks
2) 2nd dose and 3rd dose at 4 and 6 months respectively
3) 4th dose at 15-18 months
4) 5th dose 4-6 years
6) Booster doses of Td every 10 years
7) All pregnant women should receive a single dose of Tdap at 27–36 weeks of gestation regardless of the interval since the last Tdap or Td vaccination.

34
Q

what is the childhood immunization schedule?

A 
a)Birth
HepB:  Ideally, the first dose is given within 24 hours of birth, but kids not previously immunized can get it at any age. Some low birth weight infants will get it at 1 month or when they're discharged from the hospital.
b)1–2 months
HepB: The second dose should be given 1 to 2 months after the first dose.
c)2 months DTaP, Hib, IPV, PCV, RV
d)4 months DTaP, Hib, IPV, PCV, RV
e)6 months DTaP, Hib, PCV, RV
f)6–18 months HepB, IPV
g)12–15 months Hib, MMR, PCV, Chickenpox (varicella)
h)12–23 months HepA
i) 15–18 months DTaP
j)4–6 years DTaP, MMR, IPV, Varicella
k)11–12 years HPV
l) 16-18: MenB
35
Q

what are the indications of adult immunizations?

A

•Females seronegative for rubella
– MMR
•Previously non-immunized individuals
– Tetanus
•Pregnant women – varies in different countries
– Influenza, tetanus toxoid x2, pertussis (DTaP)
•Individuals in specific high-risk groups
– HBV, influenza, pneumococcal, typhoid
•Those traveling abroad
– Country-dependent may include hepatitis A, typhoid, Men ACWY

36
Q

a pregnant woman should be vaccinated against?

A

Influenza, tetanus toxoid x2, pertussis (dTaP)

37
Q

abroad travelers should be immunized against?

A

Country-dependent, may include hepatitis A, typhoid, Men ACWY

38
Q

health care workers should be immunized against?

A

1)Hepatitis B
2)Hepatitis A
3)(BCG – no licensed vaccine available at present in this country)
4)Influenza
– Front line staff
– immunize those involved in the long term care of the elderly
5)Pertussis (dTaP)
– For those caring for infants, pregnant women and the immunocompromised

39
Q

polio boosters should receive what health care workers?

A

laboratory staff performing faecal cultures

40
Q

if immunization is interrupted do you need to repeat the course?

A

no

• Resume as soon as possible; it is not necessary to repeat the course

41
Q

what is the disadvantage of vaccination before minimum recommended age or interval

A
  • It should not be considered as part of the primary series as there may be a sub-optimal immune response.
  • The dose should be disregarded and another dose is given at the recommended time, at least 1 month after the disregarded dose
42
Q

what are the contraindications to vaccination?

A

1)All vaccines:
– Anaphylaxis to the vaccine or vaccine components
2)Live vaccines:
– Pregnancy – theoretical risk to the fetus
– Some immunocompromised conditions
– Rotavirus: don’t give after 8 months (risk of intussusception), contraindicated in infants who previously had intussusception or who have an uncorrected GI malformation that may predispose to intussusception (IMPORTANT)

43
Q

what is the risk of rotavirus vaccination after 8 months?

A

don’t give after 8 months (risk of intussusception), contraindicated in infants who previously had intussusception or who have an uncorrected GI malformation that may predispose to intussusception (IMPORTANT)

44
Q

what are the precautions to delay vaccination?

A

1)Acute severe febrile illness
–defer until recovery
2)Recent IVIG
–may impair the efficacy of MMR & varicella live attenuated virus vaccines
3)Topical immunomodulators e.g., tacrolimus
4)Previous type III hypersensitivity reaction
–severe swelling & erythema involving most of the diameter of the upper arm after vaccination: usually occurs in adults following tetanus or diphtheria containing vaccines

45
Q

does IVIG administration requires to delay the vaccination

A

Yes but not always

may impair the efficacy of MMR & varicella live attenuated virus vaccines

46
Q

is prematurity contraindication to vaccination?

A

no
Conditions that are NOT contraindications to vaccination
• Minor infection with fever <38°C
• Prematurity
• Family or personal history of convulsions
• Short term corticosteroid treatment or long-term with less than 20mg/day (0.5mg/kg/day)
• Mild food allergy – MMR is safe in egg allergy
• Asthma/eczema/hayfever

47
Q

MMR is contraindicated in egg allergy. True/False

A

False

MMR is safe in egg allergy

48
Q

all vaccinations in pregnancy are contraindicated. True/False

A

False
Live vaccines are contraindicated
1)Avoid live vaccines in pregnancy because of the theoretical possibility of harm to the fetus
–However, when there is a significant risk of exposure to poliomyelitis (e.g., travel to an endemic area), the need for immunization outweighs any possible risk to the fetus
–Some inactivated vaccines are/may be given
–e.g., tetanus toxoid (2 doses in the first pregnancy, 1 dose in subsequent pregnancies - Malaysia)
–inactivated influenza vaccine (many countries, every pregnancy)
2)Pertussis immunization (as dTaP) is now recommended in several countries including Ireland (27-36 weeks, in every pregnancy)

49
Q

is TDaP CI in pregnancy?

A

no, it is recommended, lie vaccines are CI

50
Q

do all women need to vaccinated against tetanus/

A

yes

51
Q

what are the concepts of vaccinations in pregnancy?

A
  • Should receive all routine vaccinations (+ some additional vaccines) with the EXCEPTION of BCG
  • The timing of vaccination depends on the type of vaccine and the level of immune suppression
  • Administration of Live Vaccines (MMR, varicella) should be delayed until the patient is receiving antiretrovirals (ARVs) and the CD4 count has returned to >200
  • Oral polio vaccine is not recommended in HIV positive patients because of an increased risk of paralytic poliomyelitis with OPV in immunocompromised individuals
52
Q

at what CD4 count HIV patient can receive live vaccine?

A

CD4>200

53
Q

what vaccines are contraindicated in patients with HIV

A

polio and BCG

54
Q

what are the adverse effects of vaccinations?

A

1)Adverse events following immunization may be:
– programme-related e.g. due to wrong dose, incorrect storage, expired vaccine
– vaccine-induced e.g. fever, rash, anaphylaxis
– coincidental
– unknown
2)Harmful effects on immunodeficient hosts e.g. disseminated BCG infection in HIV infected individuals

55
Q

what is the program-related adverse effect of vaccination?

A

due to wrong dose, incorrect storage, expired vaccine

56
Q

what is the importance of vaccination of infants to HBV?

A

Perinatal Transmission
• Due to blood exposure during labour and delivery
• Risk of infant acquiring HBV is 70-90% when the mother has a high viral load
– reduces to 5-20% when the viral load is low
• Many low prevalence countries (including Ireland) now give routine neonatal HBV immunisation, commencing at 2 months of age
– with a birth dose to infants of carrier mothers or mothers who had acute HBV in this pregnancy (+/- HBIG)
– High and Intermediate prevalence countries – immunisation schedule starting at birth

57
Q

what is the schedule for meningococcal vaccination?

A

An inactivated, polysaccharide-based conjugate vaccine. Recommended for children at 11-12 and 16 years of age, as well as for patients at risk for meningococcal infections (e.g., patients with asplenia).

58
Q

travelers to which countries are advised to receive the meningococcal vaccine?

A

Travelers aged ≥ 2 years going to Saudi Arabia on a pilgrimage to Mecca are required by the Saudi government to provide proof of vaccination with a quadrivalent meningococcal vaccine in the last 3 years. Documentation of 2 doses of a meningococcal vaccine against serogroup A is required for travelers aged 3 months to 2 years.

59
Q

describe meningococcal vaccine

A

1)Included as part of routine schedule in some countries and in defined populations
2)Polysaccharide (PS) meningococcal vaccines are no longer recommended
3)MenACWY conjugate vaccine
– travel to high risk areas with epidemics or hyperendemic disease
– Routine schedule Ireland – adolescent booster
– US, 2 doses; 11-12 and 16 years
4)Meningococcal B Vaccine (4C MenB) – multicomponent protein vaccine
– routine childhood schedule in Ireland and UK
5)MenC conjugate vaccines (MenC, Hib/MenC)
– routine childhood schedule in several countries including Ireland, the UK, Spain, Netherlands

60
Q

Meningococcal vaccine is polysaccharide or conjugate?

A

conjugate

61
Q

what is the immunization program for polio?

A

Number of polio-endemic countries in 2019 = 3(Pakistan, Afghanistan and Nigeria)
• The transmission of polio (faecal-oral route of spread), can only be stopped if the immunisation coverage reaches over 95%. The risk cannot be mitigated as long as some children are not vaccinated and especially during an outbreak.

62
Q

what are the high-risk HPV types?

A

16,18 and 31 are themost important ones

63
Q

anogenital warts are caused by what types of HPV?

A

6,11

64
Q

what is the infection is the most common sexually transmitted infection worldwide

A

The genital HPV infection is the most common sexually transmitted infection worldwide; usually cleared by the immune system

65
Q

what are the recommendations for HPV vaccination?

A

Females
• 12-13 years of age as part of the national HPV vaccination programme
• May be given to females from 9 years of age up to 26 years
• Ideally, should be administered before the onset of sexual activity
Males
• HPV4 and HPV9 vaccines may be given from 9 to 26 years
• Should be considered for men who have sex with men (MSM)
3 doses of nine-valent HPV vaccine should be administered for all unvaccinated individuals between the ages of 27 and 45 years.

66
Q

what is the Gardasil?

A

9-valent vaccine (Gardasil®9): protection against high-risk HPV types 16, 18, 31, 33, 45, 52, and 58, as well as against low-risk types 6 and 11

67
Q

with HPV vaccination there is any risk of cervical cancer. True/False

A

False
• 30% of cervical cancers are caused by HPV types not prevented by the available HPV vaccines
• Vaccinated females could subsequently be infected with non-vaccine high-risk HPV types
• Sexually active females could have been infected prior to vaccination
• Cervical cancer screening recommendations have NOT changed for females who receive the HPV vaccine

68
Q

if a female is vaccinated, does she still requires Pap smear?

A

Yes

69
Q

what are the recommendations for influenza vaccination?

A

– US and UK recommend vaccination of all children (from 6 months US; 2 years UK)
– Any individual > 6 months of age at increased risk of influenza or its complications
– Those at increased risk of transmitting influenza to a person at high risk for complications
•Healthcare workers
•Family, carers, household contacts of patients at increased risk
– Pregnant women and up to six weeks postpartum

70
Q

what are the types of influenza vaccine?

A

• Inactivated virus should be given each year in advance of the influenza season (Sept/Oct)
• Seasonal influenza vaccines contain x 3 influenza serotypes, 2 serotype A and 1 serotype B (‘trivalent’)
THIS IS AN INACTIVATED VACCINE THEREFORE IT DOES NOT CAUSE “THE FLU”
• Influenza antibodies take from 10-14 days to reach protective levels following vaccination
• [Live vaccine (intranasal) available in North America and UK (children)]

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