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HD > Immunology 15: Immunoprophylaxis - Vaccination > Flashcards

Immunology 15: Immunoprophylaxis - Vaccination Flashcards

1
Q

List the 4 types of immunization?

A

1- natural passive: transplacental transfer of IgG, immunoglobulins in milk (breastfeeding).
2- artificial passive: immunoglobulins and antisera (antitoxins).
3-artificial active: vaccination.
4- natural active: immunity after clinical (subclinical) infection.

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2
Q

List 2 uses of passive immunization?

A

Administration of immunoglobulins/antisera

1- for prophylaxis or therapy.
2- antibodies - immunoglobulins (Ig).

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3
Q

List the properties of passive immunization of prophylaxis or therapy?

A
  • immediate effect.
  • temporary immunity (weeks, months).
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4
Q

List 2 types of antibodies - immunoglobulins (Ig) in passive immunization?

A

1- human immunoglobulins (from blood donors) = humanized Abs.
2- animal (horse) sera (Antisera, antitoxins) = serum therapy.

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5
Q

List properties of humanized Abs = human serum (from blood donors) from passive immunity? And give examples?

A

1- Human serum (gamma) globulin (Ig of various specificity).
E.g. for immunodeficiencies.

2- specific immune globulin (high-titre of specific Ig).
E.g. for hepatitis B, tetanus, rabies.

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6
Q

Give an example of serum therapy = animal (horse) sera (antisera, antitoxins)?

A

For snake venoms, botulism, diphtheria.

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7
Q

List an A/E of serum therapy?

A

Serum therapy has a high chance of anaphylactic shock because of immunity against animal serum itself. Thus, humanized antibodies produced in vitro by cell culture are used instead if available.

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8
Q

List the properties of antibodies as immunization?

A

Work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear.

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9
Q

How do vaccines induce protection against infections?

A

By stimulating the development of Abs, long-lived effector cells and memory cells.

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10
Q

What is the main use of vaccinations?

A

Primarily for prophylaxis.
Requires time (weeks) for induction of immune response.

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11
Q

List the 3 ways of administration of vaccines?

A

1- pre-exposure to pathogen (except: rabies vaccine).
2- post-exposure (in combination with specific Ig).
3- adjuvant: increased immunogenicity.

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12
Q

How is long-lasting immunity of vaccines achieved?

A

Multiple doses needed for most vaccines.

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13
Q

Definition: a form of immunity that occurs when the vaccination of a significant portion of a population provides a measure of protection for individuals who have not developed immunity. To stop the spread of disease in the community?

A

Herd immunity.

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14
Q

What immune response develops after a first injection of a vaccine without prior exposure?

A

Produce slow IgM antibody of antitoxins…. Primary response.

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15
Q

What immune response develops after a second or subsequent injection of a vaccine?

A

Produce higher IgG and antitoxin tire for better protection… secondary response.

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16
Q

Which vaccines promote a full, long lasting antibody response after one dose?

A

Live attenuated virus vaccines such as measles, rubella and mumps.

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17
Q

List the 11 characteristics of an ideal vaccine?

A

1- stable.
2- cheap.
3- lifelong immunity with one administration.
4- protective against all variants of organism.
5- prevent disease transmission.
6- rapidly induce immunity.
7- effective in all ages.
8- safe: no side effect in all populations (disease or death).
9- easy for administration.
10- prevents carrier state.
11- does not complicate diagnostic tests.

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18
Q

List the 8 reasons why vaccines aren’t always effective?

A

1- natural infections persist within the body for a long time so the immune system has time to develop an effective response, vaccinations from dead micro-organisms don’t do this.
2- less effective vaccines need booster injections.
3- some people don’t respond well/at all to vaccinations.
4- defective immune systems.
5- malnutrition particularly protein.
6- no vaccines against some organisms (malaria and sleeping sickness). Many stages to plasmodium life cycle with many antigens so vaccinations would have to be effective against all stages.
7- antigenic variation caused by mutation (antigenic shift).
8- sequestered antigens parasites live inside body cells.

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19
Q

Where does plasmodium live in the body?

A

Liver and blood cells.

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20
Q

Where do parasitic worms live inside the body?

A

Cover themselves in host protein.

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21
Q

Where does HIV live inside the body?

A

Live inside T-helper cells.

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22
Q

List the 6 vaccine types?

A

1- live (attenuated) vaccines; whole organism vaccines.
2- inactivated (killed) vaccines; whole organism vaccines.
3- subunit (antigenic) vaccines.
4- conjugate vaccines.
5- combines (polyvalent) vaccine.
6- recombinant vaccine).

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23
Q

List the characteristics for live (attenuated) vaccines?

A

Contain live, attenuated (weaknd) infectious agents.

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24
Q

List the characteristics for inactivated (killed) vaccines?

A

Contain killed whole infectious agents?

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25
Q

List the characteristics for subunit (antigenic) vaccines?

A
  • Contain structural parts/products of infectious agents.
  • Obtained from pathogens by isolation and purification.
  • Synthetic (genetic engineering).
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26
Q

List the characteristics for conjugate vaccines?

A

Contain T-independent antigen bound to T-dependent antigen.

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27
Q

List the characteristics for combined (polyvalent) vaccine?

A

Contain several antigens of one or more different pathogens.

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28
Q

List the characteristics for recombinant vaccine?

A

Produced by using recombinant DNA technology or genetic engineering.

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29
Q

What are live vaccines made from?

A

Made from live infectious agents without any amendment.

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30
Q

What is the only live vaccine?

A

The only vaccine is “variola” small pox vaccine, made of live vaccinia cow-pox virus (not variola virus) which is not pathogenic but antigenic …. Giving cross immunity for variola.

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31
Q

What is the principle of live (attenuated) vaccines?

A

Immunization with attenuated (weakened) pathogen.

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32
Q

What is the strategy of live (attenuated) vaccines?

A

Pathogen is identified and grown in culture in a way that causes them to lose their virulence but retain the ability to undergo limited replication within the host (antigenic).

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33
Q

Give examples of live (attenuated) vaccines?

A

Several viral vaccines (against polio (oral-sabin), mumps, measles, rubella, yellow fever, varicella, rotavirus) and some bacterial (BCG for TB, vibrio, salmonella).

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34
Q

List the advantages of live (attenuated) vaccines?

A

1- induction of both humoral (Abs) and cellular responses (CTLs).
2- long-lasting immunity (administered in one or two doses).
3- elimination of wild type virus from the community.

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35
Q

List the limitations of live (attenuated) vaccines?

A

1- risk in immunocompromised persons (cancer, pregnancy, radiation, corticosteroids).
2- may convert to its virulent form (very rare).
3- instability (thermolabile) (can’t properly stored).
4- BCG (limited efficacy.

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36
Q

What is the principle of inactivated (killed) vaccines?

A

Immunization with killed (inactivated) whole infective agents.

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37
Q

What is the strategy of inactivated (killed) vaccines?

A

Pathogen causing a disease is isolated, grown in pure culture, killed or inactivated by physical or chemical means, then injected to induce an immune response against that pathogen.

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38
Q

Give examples of inactivated (killed) vaccines?

A

Pertussis, typhoid, polio (salk, injection), influenza, rabies, hepatitis A, plague, cholera.

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39
Q

List advantages of inactivated (killed) vaccines?

A

1- greater stability.
2- safety (no risk of infection, administer to immunocompromised and pregnant women).

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40
Q

List limitations of inactivated (killed) vaccines?

A

1- lower immunogenicity (only Ab induced, adjuvant required).
2- shorter immunity (multiple, booster administration required).
3- the only absolute contraindication is severe local or general reaction to pervious dose.

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41
Q

How are live (attenuated) vaccines vs. inactivated (killed) vaccines produced?

A

Live/attenuated: selection for a virulence.
Inactivated/killed: physical or chemical means.

42
Q

Are boosters needed for live (attenuated) vaccines vs. inactivated (killed) vaccines?

A

Live/attenuated: few or not needed.
Inactivated/killed: multiple.

43
Q

What is the level of stability in live (attenuated) vaccines vs. inactivated (killed) vaccines?

A

Live/attenuated: less stable.
Inactivated/killed: more stable.

44
Q

What is the immunity in live (attenuated) vaccines vs. inactivated (killed) vaccines?

A

Live/attenuated: endogenously and exogenously processed Ab and CMI.
Inactivated/killed: exogenously processed mostly Ab.

45
Q

Which live (attenuated) vaccines vs. inactivated (killed) vaccines has more possibility to revert to virulent form?

A

Live/attenuated: possible.
Inactivated/killed: no.

46
Q

Which live (attenuated) vaccines vs. inactivated (killed) vaccines can be administered to compromised person?

A

Live/attenuated: generally, no.
Inactivated/killed: yes.

47
Q

What is the principle of subunit (Antigenic) vaccines?

A

Immunization with structural antigens (protein or polysaccharide) of pathogens or their products (e.g. toxoid) or surface antigen.

48
Q

Give examples of subunit (antigenic) vaccines?

A

1- vaccines against pertussis (acellular), tetanus and diphtheria (toxoid).
2- influenza (hemagglutinin and neuraminidase), hepatitis B (HBsAG).
3- human papilloma virus (L1 protein); so called virus-like particles (VLP).
4- pneumococcal and meningococcal poly saccharide vaccines.

49
Q

List advantages of subunit (antigenic) vaccines?

A

Same as for inactivated vaccines (greater safety).

50
Q

List limitations of subunit (antigenic) vaccines?

A

Same as for inactivated vaccines (lower immunogenicity).

51
Q

List the principle of conjugate vaccines?

A

Immunization with capsular polysaccharide antigen of one pathogen (weak immunogen) conjugated to protein antigen of another pathogen (strong immunogen).
Usually used to immunize babies and children against bacteria that have polysaccharide capsule (immune system of very young people can’t recognize polysaccharide antigen).

52
Q

Give examples of conjugate vaccines?

A

Vaccine against pneumococcus, meningococcus and H.influenza type B (capsular polysaccharide bound to diphtheria toxoid).

53
Q

List the advantages of conjugate vaccines?

A

1- same as for subunit vaccines.
2- good immune response to capsular antigens.
3- efficient in children in the first two years of life and asplenic persons.

54
Q

List the limitations of conjugate vaccines?

A

1- same for the subunit vaccines.
2- relatively high cost.

55
Q

List the principle of combined (polyvalent) vaccines?

A

Simultaneous immunization with several serotypes of one pathogen (either attenuated strains or antigens) or several different pathogens.

56
Q

Give an example of combined (polyvalent) vaccines?

A

DTP, MMR, polysaccharide or conjugate pneumococcal vaccines.

57
Q

List the advantages of combined (polyvalent) vaccines?

A

1- the same as for appropriate single vaccines.
2- good immune response to every component in vaccine.
3- practical (fewer administration, fewer visits of doctor).

58
Q

List the limitations of combined (polyvalent) vaccines?

A

Same as for single vaccines.

59
Q

What is the principle of recombinant vaccines?

A

The vaccines are produced by using recombinant DNA technology or genetic engineering.
Recombinant vaccines are those in which genes for desired antigens of a microbe are inserted into a vector.

60
Q

Give an example of recombinant vaccines?

A

Hepatitis B, diphtheria, cholera, tetanus.

61
Q

List advantages of recombinant vaccines?

A

1- the vectors are safe, easy to grow and store.
2- antigen that can cause damage response can be eliminated from the vaccine.

62
Q

List limitations of recombinant vaccines?

A

1- the cost of production is high.
2- when engineered vaccinia virus is used to vaccinate, care must be taken to spare immunodeficient persons.

63
Q

List the 2 types of genetic vaccines?

A

1- mRNA vaccines.
2- DNA vaccines.

64
Q

What is the principle of mRNA genetic vaccines?

A

Messenger RNA vaccines make proteins in order to tigger an immune responses.

65
Q

Give an example of mRNA genetic vaccines?

A

COVID-19 vaccines.

66
Q

List the advantages of mRNA genetic vaccines?

A

1- shorter manufacturing times.
2- no risk of integration into host DNA.
3- effectiveness is higher than inactivate vaccines.
4- no risk of causing disease in the person getting vaccinated.

67
Q

List the limitations of mRNA genetic vaccines?

A

1- unstable and easily degraded.
2- strong immunogenicity.
3- safety is lower than inactivated vaccines.
4- effectiveness is lower than DNA vaccines.

68
Q

What is the principle of DNA genetic vaccines?

A

Immunization with viral vectors (e.g. vaccinia virus) with introduced genes for immunodominant peptides of different pathogens.

69
Q

Give an example of DNA genetic vaccines?

A

Ongoing clinical trials for several vaccines (e.g. against HIV) and bird flu DNA vaccine.

70
Q

List the advantages of DNA genetic vaccines?

A

1- DNA is very stable, hence storage and transport are easy.
2- DNA sequence can be changed easily in lab.
3- induction of both humoral (Abs) and cellular immune response (CTLs).
4- possibility of polyvalent vaccine preparation.

71
Q

List the limitations of DNA genetic vaccines?

A

1- induction of autoimmune response: anti-DNA antibodies may be produced.
2- induction of immunologic tolerance: the expression of antigen in the host may lead to specific non-responsiveness to Ag.
3- repeated administration no possible.
4- mechanism of action and possible adverse effects not well understood.

72
Q

What is the principle of anti-idiotypic vaccines?

A

This unique amino acid in the structure in the antibody is known as the idiotype, which can be considered as a mirror of epitope in the Ag.
Antibodies can be raised against the idiotype by injecting the antibody into another animal.
This anti-idiotype antibody mimics part pf the three dimensional structure of the antigen, this can be used as a vaccine.

73
Q

List the advantages of anti-idiotypic vaccines?

A

Antibodies against potentially significant antigen can be produced.

74
Q

List the disadvantages of anti-idiotypic vaccines?

A

1- only humoral immunity is produced. There is no cellular immunity and poor memory.
2- identification and preparation of idiotypes is difficult.

75
Q

List 6 examples of future vaccines?

A

1- naked DNA immunization for various diseases including, malaria, TB, HIV.
2- HPV.
3- new generation smallpox vaccine.
4- new generation anthrax vaccine.
5- an HIV vaccine.
6- new immunoregulatory approaches hold a tremendous promise for treating allergic, autoimmune, and chronic inflammatory conditions.

76
Q

How do DNA vaccines differ from recombinant DNA vaccines?

A

The immunogenic protein associated with a recombinant DNA vaccine is made in the laboratory and injected into the vaccine recipient, while the immunogenic protein associated with a DNA vaccine is generated by the cells of the host.

77
Q

Definition: refers to the number of strains targeted by the vaccine. And, if the vaccine targets a single pathogen, it could refer to the number of antigenic components of that pathogens contained in the vaccine.

A

Monovalent vs. multivalent vaccines.

78
Q

Give an example of monovalent vaccines?

A

Hepatitis B.

79
Q

Give an example of divalent vaccines?

A

Hepatitis A and B.

80
Q

Give an example of trivalent vaccines?

A

MMR (measles, mumps and rubella).

81
Q

Give an example of quadrivalent vaccines?

A

Acellular pertussis.

82
Q

Give an example of 23-valent vaccines?

A

Pneumococcal vaccine: 23-valent - capsule from the 23 most common strains or serotypes of streptococcus pneumoniae.

83
Q

List the routes of vaccine administration? And give an example of each?

A

1- deep SC or IM (most vaccines).
2- oral (sabine vaccine, oral BCG vaccine).
3- intradermal (BCG vaccine).
4- scarification (small pox vaccine).
5- intranasal route (live attenuated influenza vaccine).

84
Q

List the 2 schemes of immunization?

A

1- primary vaccination: one dose or multiple doses.
2- booster vaccination: to maintain immunity levels after it declines after some time has elapsed.

85
Q

List one dose vaccines?

A

BCG, variola, measles, mumps, rubella, yellow fever.

86
Q

List multiple dose vaccines?

A

Polio, DPT, hepatitis B.

87
Q

List vaccines that require a booster?

A

DT and MMR.

88
Q

List the 6 groups of adverse reactions that may occur after vaccinations?

A

1- reactions due to inoculation.
2- reactions due to faulty techniques.
3- reactions due to hypersensitivity.
4- neurological involvement.
5- provocative reactions.
6- others.

89
Q

What does provocative reactions due to vaccines mean?

A

Occasionally following immunization there may occur a disease totally unconnected with the immunizing agent.
The mechanism seems to be that the individual is harboring the infectious agent and the administration of the vaccine shortens the incubation period and produces the disease or what may have been otherwise only a latent infection is converted into a clinical attack.

90
Q

Give an example of provocative reactions?

A

Provocative polio after DPT or DT administration against diphtheria.

91
Q

List the 8 target groups of active immunization?

A

1- infants and children expanded immunization program.
2- active immunization for adult females.
3- for special occupations.
4- for special life styles.
5- for special environmental situations.
6- for special health status persons.
7- for travel.
8- against bioterrorism (anthrax, small pox, plague).

92
Q

List contraindications of vaccines?

A

1- immunocompromised.
2- severe asthma, allergies.
3- use of live organisms in pregnant women.
4- infection/diseases or febrile illnesses.
5- recent immune globulin administration.

93
Q

Which vaccine is compulsory during Hajj in Saudi Arabia?

A

Meningococcal vaccination.

94
Q

List the vaccinations for health care workers and medical students?

A

1- hepatitis B - health care works, who regularly come into contact with blood and various body fluids.
2- hepatitis A - health care workers.
3- rabies - laboratory staff who work with the Lyssa virus.
4- diphtheria - infectious ward staff, laboratory staff, medical students.
5- meningococcus - infectious ward staff, laboratory staff.

95
Q

Which vaccines are given to infants after birth?

A

HepB.

96
Q

Which vaccines are given to infants at 2 months?

A

1- HepB.
2- RV.
3- DTaP.
4- Hib.
5- PCV.
6- IPV.

97
Q

Which vaccines are given to infants at 4 months?

A

1- HepB.
2- RV.
3- DTaP.
4- Hib.
5- PCV.
6- IPV.

98
Q

Which vaccines are given to infants at 6 months?

A

1- BCG.
2- HepB.
3- RV.
4- DTaP.
5- Hib.
6- PCV.
7- IPV.
8- OPV.

9- influenza can start to be given at this age and forever :)

99
Q

Which vaccines are given to infants at 9 months?

A

1- measles.
2- MCV4.

100
Q

Which vaccines are given to infants at 12 months?

A

1- PVC.
2- OPV.
3- MCV4.
4- MMR.

101
Q

Which vaccines are given to infants at 18 months?

A

1- DTaP
2- Hib.
3- OPV.
4- HepA.
5- Varicella.
6- MMR.

102
Q

Which vaccines are given to infants at 24 months?

A

HepA.

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