Immunology - Viral Diseases

Question 1

Immunisation

Answer 1

The process whereby a susceptible individual is rendered immune to an infection
Can be passive or active
Aims of immunisation can range from eradication to preventing symptoms

Question 2

Passive immunisation

Answer 2

Transfer of pre-formed antibodies to a susceptible individual giving temporary protection from infection

Question 3

Natural, passive immunisation

Answer 3

Mother to baby via the placenta and breast milk

Question 4

Diseases requiring normal immunoglobulins - passive immunisation

Answer 4

Hep A

Measles

Question 5

Diseases requiring spp immunoglobulins - passive immunisation

Answer 5

Hep B
Rabies
Varicella Zoster
Tetanus

Question 6

Diseases requiring monoclonal immunoglobulins - passive immunisation

Answer 6

RSV

Question 7

Molecules used in active immunisation

Answer 7

Live attenuated
Inactivated whole cell 
Toxoid 
Subunit 
Polysaccharides 
Conjugated polysaccharide

Question 8

Live attenuated vaccines

Answer 8

Traditionally generated by serial passage in tissue culture

Question 9

Examples of live attenuated vaccines

Answer 9

TB (BCG)
Measles 
Mumps
Rubella
Varicella Zoster
Rotavirus

Question 10

Pros of live attenuated vaccines

Answer 10

Replicates in recipients = excellent immune response

More closely resembles natural infection = mucosal immunity as appropriate

Question 11

Cons of live attenuated vaccines

Answer 11

Potential for reversion
Potential for sustained vaccine strain infection
Not suitable for all

Question 12

Inactivated whole cell vaccines

Answer 12

Pathogen killed by chemical or physical processes

Question 13

Examples of inactivated whole cell vaccines

Answer 13

Inactivated polio (Salk)
Hep A
Rabies

Question 14

Toxoid vaccine

Answer 14

Inactivated toxin

Toxins chemically treated to eliminate toxicity whilst maintaining immunogenicity e.g. w/ formaldehyde

Question 15

Examples of toxoid vaccines

Answer 15

Diphtheria

Tetanus

Question 16

Types of subunit vaccines

Answer 16

Recombinant proteins

Chemically purified

Question 17

Subunit vaccines - recombinant proteins

Answer 17

Spp viral protein produced in a heterologous expression system

Question 18

Recombinant proteins examples

Answer 18

Hep B

Papillomavirus

Question 19

Subunit vaccines - chemically purified

Answer 19

Certain components of a pathogen are purified for use in a vaccine

Question 20

Examples of chemically purified subunit vaccines

Answer 20

Acellular pertussis

Influenza

Question 21

Polysaccharide vaccines

Answer 21

Purified bacterial polysaccharide

T cell independent and poorly immunogenic in young children

Question 22

Examples of polysaccharide vaccines

Answer 22

Some meningococcal vaccines
Some pneumococcal vaccines
Salmonella

Question 23

Conjugated polysaccharide vaccines

Answer 23

Purified bacterial polysaccharide linked to a protein

Question 24

Examples of conjugated polysaccharides

Answer 24

H. influenzae
Pneumococcal
Meningococcal

Question 25

Adjuvants

Answer 25

Agents that stimulate the immune system | Thought to sequester antigen and cause infl

Question 26

Commonly used adjuvants

Answer 26

Aluminium phospahte | Aluminium hydroxide

Question 27

Pre exposure vaccines in adults

Answer 27

65 yrs of age - pneumococcal polysaccharide vaccines 65 yrs of age - annual influenza vaccine 70 yrs of age - varicella zoster (shingles)

Question 28

Pre exposure vaccines in pregnant women

Answer 28

Influenza vaccine in any trimester prior to start of flu season Pertussis vaccine from 16 weeks' gestation

Question 29

Childhood vaccines at 2 months

Answer 29

Diphtheria/ tetanus/ pertussis/ polio/ haemophilus/ hep B Meningococcal B Rotavirus

Question 30

Childhood vaccines at 3 months

Answer 30

Diphtheria/ tetanus/ pertussis/ polio/ haemophilus/ hep B Rotavirus Pneumococcal conjugate

Question 31

Childhood vaccines at 4 months

Answer 31

Diphtheria/ tetanus/ pertussis/ polio/ haemophilus/ hep B | Meningococcal B

Question 32

Childhood vaccines at 12-13 months

Answer 32

Haemophilus/ meningococcal C conjugate Meningococcal B Pneumococcal conjugate MMR

Question 33

Childhood vaccines at 2 years

Answer 33

Influenza - annually to age 16 (in process of being rolled out)

Question 34

Childhood vaccines at 3yr 4 months

Answer 34

Diphtheria/ tetanus/ pertussis/ polio | MMR

Question 35

Childhood vaccines at 12-13 yrs

Answer 35

Papillomavirus (2 doses 6 months apart)

Question 36

Childhood vaccines at 14 years

Answer 36

Tetanus/ diphtheria/ polio | Meningococcal ACWY conjugate

Question 37

Post-exposure vaccines

Answer 37

Ig and some vaccines can be given after exposure to reduce the chance of an individual developing a disease of reducing disease severity

Question 38

Examples of post-exposure vaccines

Answer 38

Wounds at risk of tetanus - spp Ig Potential rabies exposure - course of vaccine +/- -spp Ig Unvaccinated contact w/ confirmed measles case - vaccine, in contraindicated - consider normal Ig

Question 39

Adverse effects to immunisations

Answer 39

Related to either immunogenicity or other component of the vaccine Most commonly local reactions - pain, swelling and redness General systemic effects - fever, headaches and malaise

Question 40

Examples of adverse effects to immunisations

Answer 40

Yellow fever - encephalitis Rubella - thrombocytopenia BCG - osteitis Rotavirus - potential increased risk of intussusception

Question 41

Contraindications considerations for immunisations

Answer 41

Hx of anaphylaxis to previous vaccine/ vaccine component Immunosupression Pregnancy

Question 42

When may an immunisation need to be deferred

Answer 42

Acutely unwell Other vaccines given recently Ig therapy

Question 43

Immunisation failure

Answer 43

Primary vaccine failure | Secondary vaccine failure

Question 44

Primary vaccine failure

Answer 44

Failure to mount an immune response to a vaccine

Question 45

Causes of primary vaccine failure

Answer 45

Vaccine factors Host factors Inappropriate vaccine schedule

Question 46

Vaccine factors leading to primary vaccine failure

Answer 46

Administration error Manufacturing error Incomplete strain coverage

Question 47

Host factors leading to primary vaccine failure

Answer 47

Immunodeficiency | Immunological issues

Question 48

Secondary vaccine failure

Answer 48

Immunity develops initially following immunisation but w/ time immunity wanes

Question 49

What does the innate immune system rely on

Answer 49

Interaction between PRR's and PAMPs

Question 50

What does the innate immune system comprise

Answer 50

Mechanical barrier Proteins (enzymes, complement) Cells (macrophages, neutrophils, NK cells)

Question 51

What does the adaptive immune system comprise

Answer 51

``` B cells - antibody production T cells (CD4 - 'helper' cels and CD8 - 'cytotoxic' cells) ```

Question 52

Why do we need 2 vaccines for live attenuated virus vaccines

Answer 52

We go from sero-ve to seroprotective but the virus-app antibody titre drops so we become sero+ve, therefore requiring a booster

Question 53

Sero+ve

Answer 53

Partial or no protection

Question 54

Why don't wild - type viruses require a booster

Answer 54

Despite virus-app antibody titre drops, it is still enough to be seroprotective

Question 55

Why might a child not have been vaccinated

Answer 55

Parents may have refused | Vaccination may have been accidentally missed

Question 56

Examples of misinformation about immunisations

Answer 56

Polio (a Western plot to make African women infertile) | HPV (a cause of promiscuity in teenagers)