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Jackson: Vaccination Flashcards

1
Q

Active Immunization

What does administration of vaccine elicit?
Natural infection elicits:

A

Administration of a vaccine that elicits a protective immune response

Natural infection that elicits an active response

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2
Q

Passive Immunization

A

Transfer of maternal Abs to infant via placenta or colostrums

Therapeutic administration of Abs to protect host

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3
Q

Post-Exposure Immunization

Type of immunization
Use:

A

Passive + active immunization

Used for diseases that have potentially acute onset and fatal outcomes

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4
Q

Post-Exposure Immunization

For Diphtheria
For Rabies

A

Toxoid + antitoxin for diphtheria exposure

Immunoglobulin + vaccine for rabies exposure

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5
Q

Induction of secondary response

What is rapid amamnestic response important for?

A

Rapid amamnestic response important for prevention of diseases with short incubation periods

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6
Q

Induction of secondary response

Example:

A

Multiple injections of tetanus toxoid given to children (DTaP) to boost production of protective levels of circulating Abs (boosters to raise titers)

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7
Q

Role of innate response

Acquired immunity can function both independent of and in concert with innate defenses

A

Acquired immunity can function independent of innate defenses (Ab to toxoid directly neutralizes toxin)

Acquired immunity can function in concert with innate defenses (Ab can opsonize infectious particles/interact with complement to induce lysis of infecting agent)

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8
Q

Age of Immunization

What protects fetus and newborn?
Why is vaccine delayed until 1 year of age?

A

Maternal Ig protects fetus and newborn (newborn can mount responses to toxoids and polio vaccine)

Circulating maternal Ab can interfere with immunization against measles (vaccine delayed until 1 year of age)

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9
Q

Herd Immunity results from:

Results in:

A

Results from the vaccination of a significant portion of the population

Results in a net decrease in the spread of disease, preventing epidemics

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10
Q

Vaccines must induce the right type of immune response

TB:

A

TB: requires a vaccine that elicits a cell-mediated response (not an overly effective vaccine because of this)

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11
Q

Vaccines must induce the right type of immune response

Streptococcal pneumonia:

A

Streptococcal pneumonia: requires a vaccine that elicits an anti-capsular Ab (but body does not respond well to polysaccharide antigen)

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12
Q

Vaccines must induce the right type of immune response

Poliovirus:

A

Poliovirus: having high levels of serum Ab are unlikely to protect from poliovirus mucosal infection (need IgA response in GI tract)

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13
Q

Must induce memory to protect against future infections

Natural boosting:

Paradox of vaccination:

A

Natural boosting: Occurs during periodic outbreaks in the community

Paradox of vaccination: the less disease there is (ie. as a result of vaccination), the more there is a need for vaccination

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14
Q

Must be stable and relatively inexpensive

Cold chain:

A

Cold chain: refers to the need to keep vaccines refrigerated for stability (some countries may lack the resources to do so)

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15
Q

Live Attenuated

In general:

A

In general: induce a stronger and longer lasting immunity than non-living vaccines

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16
Q

Live Attenuated
Preparation

How is the pathogen virulence reduced?
Used for:
Example:

A

Passage in culture: pathogen is repeatedly passed in culture until its virulence is reduced

Used for the development of many viral vaccines

Example: BCG (TB vaccine) is the best example- 10 year passage in culture

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17
Q

Live Attenuated
Preparation

Cold adaptation:

A

Cold adaptation: forces virus to be less viable at body temperature

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18
Q

Live Attenuated
Risks

Insuffcient attenuation:

A

Insufficient attenuation/reversion to wild type: mutations induced in the vaccine strain during attenuation are entirely at random and not predictable

However, it is possible to use genetic engineering to construct vaccine strains with defined mutations

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19
Q

Live Attenuated
Risks

What can be induced by living viruses?
Risks to what populations?

A

Persistent infection induced by living virus

Risks to immunocompromised or a fetus/newborn

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20
Q

Killed Organisms

In general:
Use:
Example:

A

In general: safer but have reduced immunogenicity and require multiple doses

Use: if attenuation of the pathogen has not been achieved or if the risk of reversion to the wild type is too high

Example: poliovirus vaccine exists in both inactivated (Salk) and attenuated (Sabin) forms; has returned to the use of the inactivated form to avoid the risks associated with reversion

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21
Q

Subcellular

Use
Examples

A

Use: when protective immunity may be induced against some component of the pathogen

Examples: capsular polysaccharides and inactivated toxins (toxoids)

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22
Q

Conjugate Vaccines:

Example:

A

Conjugate Vaccines: may be used due to the poor immunogenicity of some subcellular fractions; made of a toxoid conjugated to the capsular material of a bacterial pathogen

Example: Haemophilus influenza b (Hib) capsular polysaccharide conjugated to tetanus or diphtheria toxoid or Neisseria outer membrane protein

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23
Q

Recombinant Vector Candidates: (4)

What could be used for antigens of pathogens like Vibrio cholera?

What elicits T cell response; could be used for persistent intracellular pathogens like Toxplasma and Listeria?

A

Adenovirus

Vaccinia virus

Salmonella typhi (enteric pathogen that could be used for antigens of pathogens like Vibrio cholera)

BCG (elicits T cell response; could be used for persistent intracellular pathogens like Toxplasma and Listeria)

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24
Q

DNA Vaccines:

A

Designed to protect against disease by injecting naked DNA that expresses Ag to produce an immunological response; subject not injected with actual Ag, but with DNA encoding the Ag

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25
Attenuated vaccines Advantages Best for what age? Localized to where? What do T cells process?
Best prevent childhood diseases that induce effective long-term immunity following recovery from infection Localize to the natural site of infection and replicate there T cells process the peptide Ags and associate them with MHC class I molecules using the native route
26
Attenuated vaccines Disadvantages Risk of: What would be more effective for diseases with high antigenic diversity?
Risk of reversion Are not useful against diseases caused by agents with high antigenic diversity (ie. influenza) - Would be more effective to use a subcellular vaccine containing Ags required for viral attachment or entry
27
Live Vaccine Preparation Administration Dosage
Preparation: Attenuation Administration: May be natural (ie. oral) Dosage: Single dose possible
28
Live Vaccine Adjuvant Risks Stability
Adjuvant: Not required Risks: Reversion possible Stability: Cold storage required
29
Live Vaccine Cost Duration of Protection Immune Response
Cost: Low Duration of Protection: May be years Immune Response: IgG, IgA, cell-mediated
30
Non-Living Preparation Administration Dosage
Preparation: Inactivation Administration: Injection Dosage: Multiple required
31
Non-Living Adjuvant Risks Stability
Adjuvant: Usually required Risks: Allergic reaction Stability: Relatively stable
32
Non-Living Cost Duration of Protection Immune Response
Cost: High Duration of Protection: Boosting required Immune Response: IgG, little cell-mediated
33
Vaccine Associated Complications Polysaccharide Antigens If they fail to stimulate T cells: Ineffective at what ages? Typically, what is done to induce a secondary response?
That fail to stimulate T cells and induce only a primary response, regardless of dosage Particularly ineffective in children under 2 years of age Typically conjugated to protein to induce a secondary response
34
Vaccine Associated Complications Polysaccharide Antigens In asplenic individuals:
Asplenic Individuals: need to be vaccinated against encapsulated pathogens (pneumococcus, Hib) due to increased risk of infection
35
Vaccine Associated Complications Living Vaccines Immunocompromised: Exception:
Immunocompromised: especially vaccinia and BCG in patients with severe T cell deficiency Exception: recommended that HIV-infected patients without severe disease receive MMR vaccine; risk of vaccine complications less than the risk of dying from natural infection
36
Pathologic Consequences of Vaccines may be due to: Monkey cell lines potential:
Pathologic Consequences of Vaccines may be due to contaminated preparations of unintended immune responses Monkey cell lines used to make attenuated vaccines, resulting in potential for contamination with lethal monkey virus
37
Pathologic Consequences of Vaccines Hypersensitivity Why egg allergies?
To egg proteins contaminating influenza vaccines (grown in eggs)
38
Pathologic Consequences of Vaccines Hypersensitivity Severe type III hypersensitivity reaction :
Severe type III hypersensitivity reaction due to non-neutralizing Ab induced by older killed measles vaccine; induces immune complex formation during measles infection (has since been replaced)
39
What potential complication must any new vaccine take into account?
Any new vaccine must take into account the potential complication of an autoimmune reaction induced by an Ag that cross reacts with host protein
40
Examples of other complications (rare): (3)
Pertussis/Measles: convulsions, encephalitis Mumps: meningitis Rubella: arthritis
41
Vaccination and Autism:
No conclusive scientific evidence that any part of a vaccine, any combination of vaccines, or any preservative (ie. thimerisol) plays any role in autism
42
Diphtheria, Tetanus and Pertussis (DTaP or Tdap) Vaccine Diphtheria component:
Diphtheria component: inactivated form of diphtheria toxoid | - Targeted to toxin but also decreases Corynebacterium diphtheriae colonization rates
43
Diphtheria, Tetanus and Pertussis (DTaP or Tdap) Vaccine Tetanus toxoid:
Tetanus toxoid: highly effective; boosters recommended every 10 years - Antitoxin plus toxoid administered in cases of suspected exposure (ie. dirty wound)
44
Diphtheria, Tetanus and Pertussis (DTaP or Tdap) Vaccine Pertussis Vaccine:
Pertussis Vaccine: acellular vaccine with both pertussis toxin and filamentous hemagluttinin in it - Controversy surrounding the potential SEs led to diminished use and epidemic in the UK in the 70s - Acellular vaccine has reduced efficacy in comparison to the original whole cell vaccine
45
Measles, Mumps and Rubella (MMR) What are all components? What does age of administration depend on? When is it given at 1? 6 mo. and 1 year?
All components are live, attenuated vaccines Age of administration depends on incidence: - Given at 1 year of age in developed countries (relatively low occurrence of disease) - Given at 6 months and at 1 year in developing countries (diseases still widespread)
46
Measles, Mumps and Rubella (MMR) Debate regarding rubella in boys: Why is it still given?
Debate regarding whether or not to give it to them (mild disease; only a real concern if passed to fetus) Still given because vaccine program in the US is tailored toward eradication of disease (requires immunization of greater than 50% of the population)
47
Measles, Mumps and Rubella (MMR) Rubella and the paradox of immunization What happens to natural immunization as disease rates delcine? When might rubella occur? What could this increase the incidence of?
As disease rates decline due to effective vaccination, natural immunization process that normally occurs during outbreaks also declines Rubella may therefore occur at later ages (when protection from childhood immunization wanes), increasing the incidence of congenital rubella
48
Polio Vaccine Two forms: What does OPV induce? What does IPV induce?
Two forms: inactivated (IPV; Salk) and attenuated oral (OPV; Sabin) OPV: induces secretory immunity to intercept the virus at portal of entry IPV: induces immunity to viremic stage
49
IPV (Salk) Advantages: (2)
1. Cannot revert to virulence | 2. Use in immunocompromised
50
OPV (Sabin) Advantages: (4)
1. Oral administration 2. Inexpensive 3. Natural infection route 4. Induces herd immunity
51
IPV (Salk) Disadvantages: (3)
1. Parenteral administration 2. Expensive 3. No gut immunity
52
OPV (Sabin) Disadvantages: (3)
1. Reversion to virulence 2. No use in immunocompromised 3. Requires refrigeration
53
Calmette and Guerin’s Attenuated BCG Used for protection against: Effect on skin test:
Used for protection against Mycobacterium tuberculosis Destroys the diagnostic value of the tuberculin skin test
54
Calmette and Guerin’s Attenuated BCG Effective? Given to what populations in the US? Effective as:
Debate regarding effectiveness; only give at birth to high-risk populations in the US Effective as an adjuvant (vector for recombinant vaccines?)
55
Hepatitis A Vaccine Type of vaccine: Administration:
Inactivated vaccine Administration: two doses administered IM 6 months apart, between the ages of 12-23 months
56
Hepatitis B What is now routinely administered at birth and to infants in the US beginning at 2 mos.? What if the mother is HBsAg-positive?
Recombinant HBV surface antigen (HBsAg) - Administration: to infants beginning at 2 months of age If mother is HBsAg-positive: immunize infant with HBsAg and HBV immune globulin at time of birth
57
Hepatitis B Also recommended for high-risk adults:
* Medical staff in high risk situations * Family contacts of known carriers * Men who have sex with men * IV drug users * Immunocompromised * Patients receiving repeated blood transfusions
58
Haemophilus Influenza b (Hib) Immunogenicity of capsule: What is it conjugated to?
Polyribitol phosphate capsule is poorly immunogenic Conjugated to diphtheria /tetanus toxoid or outer membrane protein of meningococcus
59
Varicella Zoster Vaccine Type of vaccine: Why is it in use?
Attenuated vaccine In use due to occasional severe complications with varicella (chickenpox); however, controversy regarding use due to potential risk for latency (zoster)
60
Influenza What makes this vaccine only partly effective? What does the chemically inactivated virus contain? Who is it recommended for?
Antigenic shift and drift: makes these vaccines only partially effective Chemically inactivated virus: contains hemagluttinin and neuraminadse types anticipated in the population Recommended for high risk individuals: elderly and those with chronic respiratory illness
61
Pneumococcal Vaccine How many serotypes of S.pneumocniae? How many immunizations? Pneumovax: Prevnar 13 (PCV13):
90 serotypes of S.pneumoniae: two different kinds of immunizations are possible Pneumovax: contains a subset of 23 serotypes; for adults 65 and older and high risk individuals Prevnar 13 (PCV13): contains a subset of 13 serotypes; for children under 5
62
Pneumococcal Vaccine Vaccine is composed of polysaccharide capsule: How is immunogenicity increased? Conjugate all 23 serotype: Recommended for:
Vaccine is composed of polysaccharide capsule: poorly immunogenic (not useful for children under 2) Can be conjugated to a protein carrier to increase immunogenicity Difficult to conjugate all 23 serotypes Recommended for high risk individuals: same as influenza vaccine
63
Meningococcal Vaccine Capsular polysaccharide serotypes: Serotype B:
Composed of capsular polysaccharide: serotypes A, C, Y, and W-135 Serotype B: not included due to high concentration of sialic acid (poor immunogen that can induce autoimmune response because it is a component of the human nervous system)
64
Meningococcal Vaccine Recommendations for adolescents: Conjugation:
Recommendations: for adolescents, those traveling to endemic areas (Africa and India), and military recruits Conjugation: often conjugated to a meningococcal protein to improve immunogenicity
65
What is the leading cause of severe acute gastroenteritis in children worldwide?
Rotovirus
66
Rotavirus Vaccine How does RotaShield Vaccine work? What type of vaccine are RotaTeq and Rotarix? Administration:
RotaShield Vaccine: removed due to association with intussusceptions RotaTeq and Rotarix now used: attenuated vaccines Administration: 2-3 doses; recommended between ages 2-6 months
67
Genital Human Papillomavirus (HPV) Recommendations: Administration:
Recommendations: for 11-12 year old girls (can be administered as young as 9) Administration: 3 IM injections over a 6 month period
68
Several reasons why there are no vaccines for some pathogens Serotypic diversity: Risk of latency:
Serotypic diversity: adenovirus, rhinovirus, Neisseria gonorrhoeae Risk of latency: no live herpesvirus vaccine
69
Several reasons why there are no vaccines for some pathogens Lack of immunity to natural infection: Extensive antigenic variation:
Lack of immunity to natural infection: no attempt to make a Treponema pallidum vaccine Extensive antigenic variation: slows production of vaccine for AIDS (HIV glycoprotein 160)

Micro Exam 2 (18 decks)

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