Immunological Memory and Vaccination Flashcards

1
Q

*Know why memory cells respond more forcefully during second infection

A

memory cells respond more forcefully during secondary infection b/c:

1) pathogen-specific MEMORY cells OUTNUMBER naive cells
2) Memory cells are more READILY ACTIVATED
3) Memory B-cells have already undergone ISOTYPE Switching, Somatic hypermutation and Affinity Maturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

*Know what half-life is with regard to antibodies

A

Half-life describes the time required for half the quantity of antibodies present in one’s body to be eliminated/diminished. Hence having lower antibody levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

*Know why naïve B-cells do not express IgM during a secondary response

A

Naive B cells do NOT express Ig M during secondary response because once naive binds to pathogen with specific antibody, NEGATIVE SIGNAL is given to Naive B cell to prevent its activation.
Hence No production of Low-affinity of IgM antibodies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

*Know why memory T-cells have an increase speed of response compared to
naïve T-cells

A

Memory T cells have an increased speed of response compared to Naive t cells, since they are activated at site of infection already (memory cells are more abundant and react quicker to same antigen).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

*Know the consequence of alternative splicing of the CD45R gene-naïve
versus memory/effector T-cells

A

Due to alternative mRNA splicing, the extracellular domain of CD45RO is SHORTER (less aa) and has BETTER interactions with T-cell receptor than Cd45RA
CD45RA- is LESS able to interact with TCR and activate T cell as well as CD45RO. (The signaling of CD45RA is not as robust because it has more aa, exons, and bigger)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

*Know the role of L-selectin and CCR7

A

L-selectin and CCR7 allow central memory T cells to enter secondary lymphoid organs and be activated by antigen presenting dendritic cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

*Understand why viruses with high mutations make it difficult to vaccinate for life

A

RNA Viruses like INFLUENCE have high mutation rates (making it difficult to make a vaccine to protect for life) the virus constantly replicates and forms multiple new strains. Viruses like influenza CHANGES its EPITOPES every year, so one’s immunity to the virus diminish over time and antibodies made during past infection will no longer recognize current or new viral strains.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

*Know reasons why small pox was able to be eradicated

A

Small pox:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

*Know the following regarding vaccines- killed or inactivated, live-
attenuated, sub-unit vaccine, high-affinity neutralizing antibodies, conjugate
vaccines, and adjuvants

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What two cells result from a primary immune response?

A

Primary immune response results in:

  1. Development of EFFECTOR cells and molecules that ends infection as soon as possible
  2. Immunological MEMORY- long lived memory-pathogen specific B cells and T cells (due to secondary immune response)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain what occurs during a child’s exposure to pathogen and how antibodies aid in protection? What occurs during repeated exposures of pathogen?

A

High levels of antibodies are sustained for months after infection- provide PROTECTIVE immunity- made by PLASMA cells in bone marrow or tissue beneath mucosal surface
After a year, antibody levels drop
Secondary immune response- during second infection of same pathogen, memory T and B cells (pathogen specific) generate stronger/faster response
Repeated exposures to same pathogen during “seasons” (ex: during winter, repeated exposure to pathogen; antibodies made will prevent any reinfection with same virus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What occurs when a child is exposed to pathogen during first and second time?

A

During child’s first infection from pathogen, primary immune response will be made, producing effector T cells (pathogen specific) and antibodies to terminate infection.
antibodies sustained for months (prevent reinfection), then after 1 year, antibodies levels drop.
3rd year after initial infection, pathogen creates second infection that induces second immune response that is faster and stronger than primary response. child has retained memory of first infection ,so secondary response eliminate pathogen before significant disruption of tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Differentiate between short-lived plasma cells and long-lived plasma cells

A

Primary response- plasma cells are SHORT LIVED; antibody production DECREASES over the next year; MAJORITY of plasma cells (short-lived)
LONG-LIVED Plasma cells- MINORITY of plasma cells that make specific antibodies.
They are sheltered in BONE MARROW.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do short vs long-lived plasma cells differ from one another?

A

short lived plasma cells- rapidly proliferate and make many antibodies; shortly die from apoptosis (due inducing cell damage and mutation)
Long-lived plasma cells- once pathogen is defeated and eliminated, clones of long-lived plasma cells made. They do not induce cell damage/mutation
Only die once pathogen clears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do pathogen-specific memory cells resemble other cells? What occurs to B cells that become memory cells? T cells?

A

Pathogen-specific MEMORY cells mirrors that of pathogen-specific EFFECTOR cells.
Components:
CD8 T cells
TFH, TH1, TH2, TH17, CD4 T- cells
B cells are programmed to become plasma cells secreting IgA, IgG, and Ig E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What kind of cells are made during primary immune response?

A

Both EFFECTOR and MEMORY cells are made during primary respnse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

differentiate between how T cells and B cells become memory and effector T cells.

A

T cell:
1. A naive T cell is activated by pathogen
2. a clone of pathogen-specific effector and memory T cells are produced (majority- effector)
3. Effector T cells outnumber memory T cells
B cell:
1. A naive B cells is activated by pathogen and TFH cells
2. a clone of pathogen-specific B cells is produced
3. Effector cells outnumber B cells (only 1 memory cell)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the two phases in primary response, as well as the phase in secondary immune response. Also include what is created as a result.

A

Primary response:
1. Early phase: naive B cell binds pathogen, and be activated to become antibody-producing plasma cell. This plasma cells will secrete low-affinity Ig M.
2. Late phase: Naive B cell binds to pathogen coated with HIGH-AFFINITY Ig G and Naive B cell will receive a NEGATIVE signal from Fc receptor, leading to B cell induced to die (apoptosis)
Secondary response: Memory B cell is activated to become an antibody-producing plasma cell. This plasma cell secretes HIGH-AFFINITY IgG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What occurs when memory cells are activated during a second infection? What process leads to improved antibody response?

A

once memory cells are activated, Pathogen is usually cleared with NO sign of DISEASE
Affinity Maturation- during each subsequent infection continues to IMPROVE Antibody response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the first disease that has been completely eradicated in the world. How did this occur? When did it happen?

A

SMALL POX- 1st disease eradicated via VACCINATION
from 1850s- 1979- 1 billion people died from disease
1972, small pox eradicated worldwide
50% US population has immunity, 50% do not (poses vulnerability for population, since everyone not vaccinated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the role of Vaccinia? How long do antibodies last? How long are pathogen-specific memory B and t cells maintained?

A

Vaccinia- a similar, benign version of small pox vaccine that is sufficient enough to induce a secondary immune
response with an immunological memory to small pox (helps work against small pox)
Vaccinia- specific antibody titres that decrease 99%, but is maintained greater than or equal to 75 years.
Antibody- lasts 6 weeks (memory cells must replenish)
Pathogen-specific Memory B and T cells: maintained for greater or = to 75 years.
many vaccinated individuals still retain populations of Vaccinia- specificCD4 and CD8 T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Specify the half life of antibodies for anti-diphtheria vs anti-measles.

A

Half-life of antibodies varies;
Anti-Diptheria- 19 years
Anit-Measles- 200 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Explain why memory lymphocytes are more resistant to apoptosis than their native counterparts. What are the memory T cells for CD4 and CD8 cells?

A

Memory lymphocytes are more resistant to apoptosis:
1. Individual memory cells have limited-life span, but a small portion DIVIDE and REPLENISH the population
Memory cells for CD4 and CD8 cells:
CD4 T cells: IL-7
CD8 T cells: IL-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where does renewal and replenishment of memory cells occur, and what drives the process?

A

Renewal and replenishment occurs in BONE MARROW and is likely driven by interactions with STROMAL Cells and Cytokines produced by Stromal cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Differentiate between an unimmunized donor of primary response and immunized donor of secondary response. How does frequency of B cells, isotype, and affinity of antibody differ?

A

UNIMMUNIZED donor of primary response
-LOWER frequency of antigen-specific B cells
-Isotype of antibodies: Ig M, IgG, IgA, and Ig E
LOW Affinity of antibody
-LOW Somatic Hypermutation

IMMUNIZED donor of secondary response
-HIGHER frequency of antigen-specific B cells(1 in 10^2-1in 10^3)
-Isotype of antibodies: IgG, IgA and IgE
HIGH AFFINITY of antibody
HIGH Somatic Hypermutation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What kind of response are low-affinity IgM antibodies Not made in? What does Ig G cross link with? What kind of cells is the Fc receptor expressed on?

A

Low-affinity Ig M antibodies are NOT MADE in SECONDARY response (only made in primary response)
IgG-coated pathogen cross-links B cell receptor and inhibitory Fc receptor (FcgammaRIIB1)
Fc receptor (FcgammaRIIBI)- is ONLY expressed on NAIVE B-cells, (Not on memory cells)

27
Q

When are secondary immune responses made? What happens if pathogen is not cleared?

A

Secondary immune response are ONLY made if INNATE immunty and Steady-state pathogenic antigen are NOT sufficient to clear pathogen
If uncleared, DENDRITIC cells will carry pathogenic antigen to secondary lymphoid organs.

28
Q

Differentiate between the memory T-cells and Memory B-cells?

A

Memory T cells:
-increased speed of response compared to Naive T cells- b/c they are in circulation so some are activated at the site of infection (TH1, TH2, TH17 cells), - which are activated by dendritic cells
-DO NOT require co-stimulation via CD28.
Memory B-cells:
-activated in SECONDARY Lymphoid Organs
-Activated by Pathogenic-specific CD4 TFH cells
-AFFINITY MATURATION

29
Q

Distinguish between levels of Ig M and IgG antibody after successive immunizations? how does the concentration and affinity of each antibody change?

A

During the first immunization shot: the concentration of Ig M increases first (even higher than Ig G; possibly due to naive B cell response). The affinity of IgM throughout each immunization stay the same and evenly drops along the way (delaying response)
After second immunization both Concentration and Affinity of Ig G INCREASES.
IgG affinity increases due to affinity maturation and ig G concentration goes up after booster shop (quicker response)

30
Q

Which cells are more readily activated memory, effector T cells or naive T cells?

A

MEMORY and EFFECTOR T cells are more readily activated due to not needing co-stimulator CD28 and also due to tyrosine phosphatase CD45. in alternative splicing, memory and effector T cells express CD45RO which interacts better with T cell receptor.

31
Q

What is CD45? Define which cells express CD45RO vs CD45RA?

A

CD45- tyrosine phosphatase involved in signaling of TCR and BCR.
Memory and effector cells express CD45RO (interacts easier with TCR)
Naïve T cells express CD45RA (has more aa, interacts less with TCR).

32
Q

Which factors are used to distinguish memory T-cells, from naive and effector T-cells?
What are the two main alternative splicing variant proteins?

A
CD45RA, CD45RO, CD62L (L-selectin) and CCR7- are used to distinguish the cells
CD45RA- naive cells
CD45RO- memory and effector cells
CD62L
CCR7
33
Q

What are the two main types of memory T cells?
What are the three subsets of the cells?
How do they differ?

A

Two main types of memory T-cells: Central and effector
three subsets: TEM (effector), TCM (central), TRM(resident)
They are distinguished by the tissues in which they reside in and in which they respond to antigen.

34
Q

Compare and contrast the central memory cells and Effector memory cells in terms of proteins expressed and where they are located.

A
Central memory cells (TCM):
-L-selectin- POSTIVE
-CCR7- POSITIVE
Circulate in LYMPHOID organ
-Stem-cell like; can be activated by antigen and cytokines
Effector Memory cells (TEM):
-L-selectin- Negative
CCR7- Negative
Circulate in NON-LYMPHOID tissues
-Already DIFFERENTIATED; have HIGH levels of effector molecules.
35
Q

Differentiate between the different characteristics of Central memory T and Effector memory T cells.

A

Central memory t cells
-express CD62L (L-selectin) and CCR7- allows them to enter secondary lymphoid organs (TFH CD4 cells) and be activated by antigen presenting dendritic cells
-LOW threshold for activation and HIGH potential for IL-2 production, proliferation, and differentiation. SLOWER process of activation, generates more effector T-cells (compared to TEM)
Effector Memory T cells:
-LACK Cd62L, CCR7- DON’T enter secondary lymphoid organs
- Express CCR6, CCR4, CXCR3, and CCR5 (chemokine receptors)- gain entry to NON-lymphoid tissues
HETEROGENOUS population (CD8, CD4: TH1, TH2, Th17)
-IMMEDIATE response, generates LESS effector T-cells.

36
Q

Describe the different patterns of migration through tissues between the three memory T cells.

A

TCM- central memory T cells- circulate between Blood, Lymph and Secondary Lymph tissue
TEM- Effector memory T cells- circulate from blood to non-lymph tissue
TRM- resident memory T-cells- based in Non-lymph tissue, respond to local infections (Do not go to circulation, blood).

37
Q

Describe the difference in memory and and naive T cells produced during virus infection (CMV)

A

Virus infection: (CMV- cytomegalovirus)
Primary response- 1 activated Naive T cell= 50,000 Cytotoxic T cells
-5% remain as Memory T-cells- those expressing IL-7 receptor
100-1000 fold more memory cells than naive T cells.

38
Q

Describe the disease Newborn hemolytic anemia. Include the changes that occur during the first and second pregnancies. How can this disease be prevented?

A

Newborn hemolytic anemia- Father POSITIVE for Rhesus D (RHD+) antigen and Mother is NEGATIVE (RHD-) for erythrocyte antigen.
During First pregnancy- primary response (RhD- mother carries RhD+ fetus) : antibodies made are mainly IgM (do not cross placenta) and a LOW affinity of IgG that causes MINOR destruction to fetal erythrocytes (by anti-RhD IgG) and a HEALTHY newborn baby
Second pregnancy: with RhD+ fetus, secondary immune response made, providing abundant High-affinity IgG that is carried across placenta to fetal circulation. This results in massive DESTRUCTION of FETAL Erythrocytes triggered by anti-RhD igG and ANEMIC newborn babies.

Newborn hemolytic anemia can be prevented :
During first pregnancy with RhD+ fetus, the RhD- mother can be infused with Anti-Rh Ig G which will allow primary immune response to RhD to be INHIBITED by presence of RhD-specific IgG, Fetal erythrocytes NOT destroyed and HEALTHY newborns are made.
(mother won’t make primary response against RhD antigen)
The disease is more prevalent in European mothers

39
Q

Describe the original antigenic sin theory in response to immune system and infection

A

original antigenic sin- describes the concept that the development of immunity against pathogen/antigens is shaped by first exposure to related pathogen
original antigenic sin will constrain the future response.
The imprint of first infecting strain will only be broken by infection with strain that lacks all of B cell epitopes of original strain.
Hence every year, people will not have immunity against latest/new strain of virus and will lead to infection from virus, stimulate primary B cell response against new epitopes.

40
Q

Describe how antigens are activated on naive CD8 T cells and what is produced as a result.

A
  1. Naive CD8 T cell is activated by specific antigen
  2. Antigen-activated CD8 T cell is reprogrammed and enters MITOSIS
  3. CD8 T cell undergoes ASYMMETRIC DIVISION
  4. Each naive T cell activated gives rise to ONE EFFECTOR T cell and one MEMORY T cell
41
Q

List the differences between primary and secondary immune responses.

A

Primary response:
-SMALL number of pathogen-specific cells that respond at the start
-DELAY before pathogen-specific antibodies are produced
-NON-Isotype Switched antibody having mixture of affinities for pathogen produced at the start
-HIGH threshold of activation
-DELAY before effector T cell are generated and able to enter infected tissues
Innate immunity works ALONE until an adaptive response is generated.

Secondary response
-LARGE number of pathogen-specific cells respond IMMEDIATELY
pathogen-specific antibodies ALREADY present
-Antibodies ARE ISOTYPE Switched and have HIGH-affinity for pathogen
-LOWER threshold of activation
-Effector T cells are PRESENT and can enter infected tissue immediately.
-CLOSE Cooperation between innate and adaptive immunity from the start.

42
Q

What makes small pox so unique?

A

Small pox:
1. Evolves SLOWLY and antigenic epitopes are Reserved (not a lot of mutations)
2. LIVE VIRUS- established infection at injection site, Tissue is affected by natural infection.
3. Infects ONLY HUMANS (no reservoir)
hence small pox easier to eradicate

43
Q

Describe what a subunit vaccine is and provide an example of one.

A

Subunit vaccine- only ONE component or subunit of virus is used for vaccination
example;
HEPATITIS B Virus (HBV)
-FIRST subunit vaccine using RECOMBINANT DNA Technology
-NO viral partilces
-Recombinant yeast

44
Q

Describe the different type of vaccines used for polio. Which countries still have prevalence of polio

A

Polio:
first vaccine was SALK vaccine- inactivated poliovirus given by injection. Injected into skin and killed virus of 3 main strains
Second vaccine for polio was LIVE attenuated Oral virus (weakened)- that had 3 strains.
Pakistan and Afghanistan still endemic with Polio

45
Q

What are the main types of vaccines?

A
  1. Oral
    - Good for viruses that infect MUCOSAL Tissue
    - Challenge: have to suffer the GUT
    - taken by mouth
  2. SALK Vaccine- Killed virus of 3 main strain
    - injected into skin
  3. Live Attenuated Virus- (weakened)- 3 strains
46
Q

Discuss the characteristics of Killed or inactivated virus vaccines and examples.

A

Killed or inactivated Virus vaccines:
-Virus particles are treated chemically with Formalin or Physically with Heat/irradiation (so virus will not replicate or cause disease)
-Virus must be COMPLETELY and Reliably INACTIVATED
Example: RABIES and INFLUENZA

47
Q

Discuss the characteristics of Live-attenuated Virus vaccines

A

Live-attenuated Virus vaccines:
-Mutant Viral Form that GROWS POORLY in Human cells and is No longer Pathogenic
-some naturally occurring variants (Poliovirus strain 2)
-BETTER PROTECTIVE Immunity than killed virus (MIMICS real infection better)
- produced in NON-HUMAN cells- selective against those that grow well in humans
example; MEASLES and MUMPS.

48
Q

Define the word vaccination

A

Vaccination: routine medical procedure that provides people with immunological memory without having to be infected by pathogen and suffer disease

49
Q

What is a vaccine?

A

Vaccine: Non-infectious material containing the pathogen’s antigens. That mimics PRIMARY immune response.

50
Q

Distinguish between First and second immunization.

A

First immunizatinon- mimicks PRIMARY response

Secondary immunization- mimics SECONDARY response

51
Q

What saved more human lives than any other medical procedure?

A

VACCINATIONS

52
Q

Describe the first medical prescribed vaccine and how it came about?

A

SMALL POX- first medically prescribed vaccine
vaccine contained live material of pathogenic small pox taken from dried pustules (from patients with mild form of disease)
-This vaccine was delivered intranasally or intradermally (scratch of skin)- form of Variolation
This vaccination caused high frequency of serious disease (1 in 100 people died)

53
Q

What was the solution created for small pox? who discovered it and how did it work?

A

Jenner discovered COW POX virus as a vaccine for small pox.
Cow pox would cause mild disease in humans and produce immune protection for small pox and also cow pox since they had antigens in common.
hence cow pox vaccine albe to eradicate small pox in 20th century.

54
Q

How does cowpox help create protective immunity for small pox?

A

Cow pox and small pox viruses share some antigens

  • immunization with cowpox, induces antibodies against cowpox surface antigens
  • cowpox antibodies bind to and neutralize small pox virus (since they share some antigens)
55
Q

What is an example of a live-attenuated virus that occurs naturally. Explain how this process occurs.

A

Live attenuated virus that occurs NATURALLY:
Poliovirus strain 2
As polio infection passes through human population, polio will diversify by mutation and create strain with reduced pathogenicity.
Process:
attenuated viruses are obtained by growing pathogenic human viruses in non-human cells
Steps:
1. Pathogenic virus is isolated from patient grown in human tissue cultured cells
2. Virus is then isolated and grown in non-human cell like monkey cell (until it adapts in monkey cells and grows poorly in human cells)
3. The virus acquires a variety of mutations that allow it to grow well in monkey cells.
4. Virus no longer grows well in human cells (attenuated) and can be used as vaccine.
rubella: example of natural live attenuated vaccine.

56
Q

Describe the vaccines created for rotavirus and how they came about.

A

Rotavirus- wheel-shaped virus that lead to major cause of childhood diarrhea.
Rotaviruses frequently mutate
42 natural variants (5 most common variants account for 90% of infections)
Rotarix- ATTENUATED human rotavirus with most common VP4 and VP7 proteins
RotaTeq- mixture of 5 cattle rotaviruses-NON pathogenic in humans. and engineered to express VP4 and VP7.
EASY to make in POOR countries.

57
Q

Describe the major vaccines made against bacteria and how it works.

A

Some vaccines against bacteria:
Diphtheria toxin from Corynebacterium diptheriae
tetanus toxin from Clostridium tetani
Secreted toxin proteins cause disease for some bacteria
High-affinity neutralizing antibodies to toxin can prevent disease
process: by toxin purified and treated with Formalin to form toxoid (inactivated form of toxin)
Some toxoids are antigenic without being toxic.

58
Q

what are combination vaccines?

A

Vaccine that provides protection against more than one pathogen
ex: DTP (diptheria and tetanus/pertussis) and MMR (Measles, Mumps, Rubella?)

59
Q

What are adjuvants?

A

Adjuvants- helper cells that triggers the innate immune response and establishes state of INFLAMMATION at site of vaccination- adaptive immune response (more robust)
-adjuvants help create stronger immune response in people with vaccine

60
Q

What are RNA viruses? What are examples? What is hemagglutinin and neuraminidase used for?

A

RNA viruses- more Prone to ERRO during replication
-has mutations
ex: HIV, INFLUENZA
-new strains of influenza every year
Hemagglutinin and Neuraminidase- SURFACE GLYCOPROTEINS of influenza that allow binding to respiratory epithelium.

61
Q

Differentiate between polysaccharide vaccines and conjugate vaccines

A

Polysaccharide vaccines- NO CD4 TFH cell response (No peptides present via MHCII molecules to naive CD4 T cells)-
-High Affinity IgG antibodies that require pathogen to be recognized by Both B and T cells
Conjugate vaccines- Different epitopes recognized by B and T cells are synthetically linked together.

62
Q

Describe the process of how vaccines are made against bacteria

A

process
1. B cell binds bacterial polysaccharide component of vaccine conjugate
2. conjugate is internalized and degraded
3. Peptides from toxoid are presented to T cell, which activates B cell.
4, Activated B cell differentiates into a plasma cell proudcing anti-polysaccharide antibodies that bind to bacteria.

63
Q

Why are chronic infections an issue for vaccination?

A

Chronic infectious diseases remain a problem for vaccination
plasmodium falciparum (MALARIA), HIV, HEPATITIS C-chronic, HERPES SIMPLEX VIRUS (HSV) integrate into genome, can be replicated again causing infection
less than 30% of Hepatitis C infection- eliminated virus, developed protective immnity
greater than 70% chronic infection of hepatocytes cause liver damage,