S1: Immunization & Vaccination Flashcards
Prevention concept
- The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress.
- These goals are embodied in the word “prevention”
Another Name of Passive Immunization
Seroprophylaxis
Methods of Passive Immunization
Using serum contains (antibody) immunoglobulin (Ig) or lymphocytes
Why & When is Passive Immunization used?
- Used in prophylaxis or treatment & before or after exposure to infection
Adv & Disadv of Passive Immunization
Gives rapid but short-time protection
Types of Passive Immunization
Animal or human preparation.
Another Name of Active Immunization
Vaccination
Def of Vaccines
- Weapons to prevent diseases, made of microorganisms (similar to ones cause diseases) or of toxins produced by the microorganisms (antigenic non toxigenic) that cannot harm people.
Types of Vaccines
1.Live attenuated vaccine
2. Killed vaccines
3. Toxoids
4.Subunit/conjugate
Preparation & MOA of Live Attenuated Vaccines
- Wild viruses are attenuated or weakened in a laboratory usually by repeated culturing to produce an immune response.
- A relatively small dose of virus is administered, which replicates in the body and creates enough of the organism to stimulate an immune response.
- Wild viruses are attenuated or weakened in a laboratory usually by ……. to produce an immune response.
repeated culturing
A relatively small dose of virus is administered, which replicates in the body and creates enough of the organism to stimulate an immune response.
..
Anything that either damages the live organism in the vial (e.g., heat, light) or interferes with replication of the organism in the body (circulating antibody) can cause the vaccine to be ineffective
…
Examples of LAV
- Sabin vaccine for polio infection
- measles vaccination
- Yellow Fever Vx
- BCG
Preparation & MOA of Killed vaccines
- Inactivated vaccines are produced by growing the virus in culture media, then inactivating it with heat and or chemicals (usually formalin).
- Most inactivated vaccines, however, stimulate a weaker immune system response than do live vaccines.
- So it would likely take several additional doses, or booster shots, to maintain a person’s immunity.
Inactivated vaccines are produced by growing the virus in culture media, then inactivating it with ……
heat and or chemicals (usually formalin).
Most inactivated vaccines, however, stimulate a weaker immune system response than do live vaccines. So it would likely take several additional doses, or booster shots, to maintain a person’s immunity
…
Examples of Killed vaccines
- Salk
- Sinopharm
- Influenza
- Typhoid
- Cholera
Introduction of tetanus toxoid pathology
- Some bacterial diseases are not directly caused by a bacterium itself, but by a toxin produced by the bacterium.
- One example is tetanus: its symptoms are not caused by the Clostridium tetani bacterium, but by a neurotoxin it produces (tetanospasmin).
Preparation & MOA of TT
- Immunizations for this type of pathogen can be made by inactivating the toxin that causes disease symptoms.
- As with organisms or viruses used in killed or inactivated vaccines, this can be done via treatment with a chemical such as formalin, or by using heat or
other methods.
Examples of Toxoids
Tetanus toxoid vaccination
Both subunit and conjugate vaccines contain …….
only pieces of the pathogens they protect agains
Prep & MOA of Subunit vaccines
- use only part of a target pathogen to provoke a response from the immune system
(This may be done by isolating a specific protein from a pathogen and presenting it as an antigen on its own)
Examples of Subunit vaccines
- Acellular pertussis vaccine and influenza vaccine (in shot form)
Another type of subunit vaccine can be created via …..
genetic engineering
Subunit Vx by genetic engineering
- Another type of subunit vaccine can be created via genetic engineering.
- A gene coding for a vaccine protein is inserted into another virus, or into producer cells in culture.
- When the carrier virus reproduces, or when the producer cell metabolizes, the vaccine protein is also created.
- The end result of this approach is a recombinant vaccine
- The immune system will recognize the expressed protein and provide future protection against the target virus.
Example of Subunit Vx by genetic engineering
Hepatitis B vaccine , HPV Vaccine
Prep & MOA of Conjugate vaccines
- Are made using pieces from the coats of bacteria.
- These coats are chemically linked to a carrier protein, and the combination is used as a vaccine.
- Conjugate vaccines are used to create a more powerful, combined immune response: typically the “piece” of bacteria being presented would not generate a strong immune response on its own, while the carrier protein would.
- The piece of bacteria can’t cause illness, but combined with a carrier protein, it can generate immunity against future infection.
Example of Conjugate vaccines
pneumococcal bacterial vaccine.
Compare between LAV & Killed Vx in terms of
- Dose
- No. of Doses
- Need For Adjuvant
- Duration of Immunity
- Antibody Response
- Cell Mediated Immunity
- Reversion to virulence
Def of adjuvant
- It is an ingredient used in some vaccines that helps create a stronger immune response in people receiving the vaccine. In other words, adjuvants help
vaccines work bette
Examples of adjuvant
- Aluminum-containing adjuvants, Small amounts of aluminum are added to help the body build stronger immunity against the germ in the vaccine
Characteristics of an Ideal Vaccine
Def of Expanded Program of Immunization (EPI)
It is program adopted by WHO since l974, it includes child immunization & vaccination of pregnant women
Objectives of Expanded Program of Immunization (EPI)
Target diseases of Expanded Program of Immunization (EPI) in Egypt
- T.B. –Poliomyelitis – Diphtheria – Pertussis – Tetanus - Hepatitis B – Measles – Mumps – Rubella conginital rubella syndrome) and Vit. A deficiency.
Expanded Program of Immunization (EPI)
- At Birth
Expanded Program of Immunization (EPI)
- 2 Months
Expanded Program of Immunization (EPI)
- 4 months
Expanded Program of Immunization (EPI)
- 6 Months
Expanded Program of Immunization (EPI)
- 9 Months
Expanded Program of Immunization (EPI)
- 12 Months
Expanded Program of Immunization (EPI)
- 18 Months
Expanded Program of Immunization (EPI)
- Dose of Sabin
2 drops
Expanded Program of Immunization (EPI)
- Dose of BCG
0.05 CM
Expanded Program of Immunization (EPI)
- Dose of Others
0.5 CM
Expanded Program of Immunization (EPI)
- Route of Sabin
Oral
Expanded Program of Immunization (EPI)
- Route of BCG
Intradermal in left deltoid
Expanded Program of Immunization (EPI)
- Route of MMR
Subcutaneous right arm
Expanded Program of Immunization (EPI)
- ## Route of Salk
- Intramuscular left thigh
Expanded Program of Immunization (EPI)
- Route of Penta
Intramuscular right thigh
Expanded Program of Immunization (EPI)
- Rote of HBV Vx
Intramuscular right thigh
Expanded Program of Immunization (EPI)
- Route of DPT
intramuscular left thigh
Vitamin A in EPI
Schedule of non compulsory vaccinations
- Subjects
- Pregnant Women
- Food Handlers
- Military Groups
- International Immunization
Schedule of non compulsory vaccinations
- Pregnant Women
Tetanus toxoid
Schedule of non compulsory vaccinations
- Food Handlers
- TAB vaccine against typhoid and paratyphoid.
- Hepatitis A vaccine
Schedule of non compulsory vaccinations
- Military Groups
- Tetanus toxoid
- Meningococcal polysaccharide vaccine
- BCG for non reactors.
Schedule of non compulsory vaccinations
- International Immunization
- Cholera vaccine: for travelers coming from or going into endemic area
- Yellow fever vaccine: for travelers coming from or going to endemic area (Yellow fever belt) -validity (10days -10 years).
- meningococcal vaccine for pilgrims
Vaccination of the pregnant women
Doses of TT
Time of TT
Eff. of TT
Period of Protection of TT
T.T is given during pregnancy to ….
- To protect the mother against puerperal tetanus and the baby against tetanus neonatorum.
The first dose of T.T is given after 1st trimester to ……
Avoid false beliefs that T.T cause abortion.
Contraindications for immunization
Contraindications for immunization
- All vaccines should be given on schedule, even when a child has ……
- low-grade fever, a mild cold, diarrhea or other mild illness.
If a child has diarrhea when you give OPV, ……..
administer an extra dose (see before).
DPT vaccine should …….. be given to …… Instead, ……. may be given .
- NOT
- Children over 5 years or to children suffered a severe reaction to a previous dose of this vaccine (shock or convulsions )
- D.T
BCG vaccine should not be given to children who have signs and symptoms of …..
of AIDS.
What damages vaccines?
Def of Cold chain system
- It is a system for distributing vaccines in a potent state from the manufacture to the actual vaccination site.
What does Cold chain system consist of?
- It consists of a series of transportation links during which adequate refrigeration is required to maintain the vaccine potency
Route in Cold chain system
- From site of manufacture —-> Air port —–> Central vaccine store —-> Regional vaccine store (governorate) —–> District store ——> Site of vaccination (Health center or Health officer or Maternal Child Health center
Components of Cold chain system
- People
- Equipments
Cold chain equipment used in health facilities
- ideal refrigerator
- Cold Boxes
- Vaccine Carriers
- Foam Pads
- Ice-Packs
Characters of ideal refrigerator
Cold boxes
- A cold box is an insulated container lined with ice-packs to keep vaccines & diluents cold during transportation and /or short period storage
- (from 2-7 days)
Vaccine carriers
- Vaccine carriers are insulated containers lined with frozen ice-packs, keep Vaccines and diluents cold during transportation and/or temporary storage
- (maximum for 48 hours with the lid closed ) .
Foam pads
A foam pad is a piece of soft foam that fits on top of the ice packs in a vaccine carrier
Ice-packs
- Ice-packs are flat square plastic bottles filled with water and kept frozen.
- Ice-packs are used to keep vaccines cool inside the vaccine carrier or cold box
Cold chain monitoring equipment used in health facilities
- Vaccine vial monitor
- Vaccine cold chain monitor card
- Thermometers
Def of vaccine vial monitor
- A vaccine vial monitor VVM is a label that changes in colour when the vaccine vial exposed to heat over a period of time.
- Before opening a vial, the status of the VVM must be checked to see whether the vaccine has been damaged by heat
…
Vaccine cold chain monitor card
- The monitor card contains chemical substances behind visible plastic rubber (window A, B, C, D) that change their color gradually and irreversibly with
heat exposure
How can you read the cold chain monitor card?
How can you read the cold chain monitor card?
- If windows A, B, C and D are all white ➔
use the vaccine normally
How can you read the cold chain monitor card?
- If windows A to C are completely blue, but window D is still white, it means ……
How can you read the cold chain monitor card?
- If window A only ➔ 2-3 day
- if A & B ➔ 6-8 days
- if A, B & C ➔11-14 days
(where A window is a monitor for the polio vaccine, B window for the measles vaccine and C window monitor for B.C.G- DPT- T.T and DT. vaccines).
You should use the vaccines within ….. of change of its window indicator to the blue colour unless the expiry date of the vaccine requires a shorter period.
3 months
If window D is blue, it means ……
that the vaccines have been exposed to a temperature > 34°C for at least 2 hours and you should test the cold chain
(the clod chain has been broken).
Every vaccine storage unit must have a ……, An accurate temperature history that reflects actual vaccine
TMD.
- CDC recommends a specific type of TMD called a “digital data logger” (DDL).
…
- A DDL provides the most accurate storage unit temperature information, including details on how long a unit has been operating outside the recommended temperature range (referred to as a “temperature excursion”).
…
- Unlike a simple minimum/maximum thermometer, which only shows the coldest and warmest temperatures reached in a unit, a DDL provides detailed information on all temperatures recorded at preset intervals
…
How to load vaccines in a refrigerator?
Vaccine refrigerators have two compartments:
Vaccine refrigerators have two compartments:
- A main compartment (the refrigerator): for storing vaccines & diluents, in which the temperature should be between 2°C and +8°C (thermostat is used to
adjust the temperature). - The freezer: for freezing ice-packs. If the refrigerator is working properly, this section will be between -50°C and -15°C.
Load a vaccine refrigerator as follows:
Freeze & store ice-packs in the …….
freezer compartment.
- All vaccines & diluents stored in the ….. compartment
- If there is not enough space, diluents stored at …..
- refrigerator
- ambient temperature
- Put polio & measles vaccines in the …..
- Excess amount of polio & measles vaccines could …..
- top shelf under the freezer.
- be kept in the freezer
Put B.C.G. vaccine in the …..
middle shelf
Other vaccines as TT, DT, DPT hepatitis B & diluents put in …..
lower shelf
Vaccine and diluents packed in rows with 1-2 cm in between (for air circulation).
…
DPT, DT & TT ➔ shouldn’t touch evaporator plate at the back (may freeze).
…
Separate different types of vaccine clearly
…
Newest vaccine is put on the ….., remove oldest one from the …..
right, left
Keep vials with VVMs showing more heat exposure than others in the box labelled “use first” .Use these vials first in the next session.
…
Put thermometer inside the refrigerator to adjust the temperature, check the temperature inside the refrigerator twice per day
…
Put salt water bottles in the ….. of the refrigerator (help to keep temperature cool in case of a power cut).
lower compartment
Do not put vaccines on the door shelves (temperature is too warm to store vaccines)
…
- Do not keep expired vaccines
- NOR vaccines with VVMs reached or beyond discard point.
- NOR reconstituted vaccines for more than 6 hours in the refrigerator.
- Discard them immediately according to your national guidelines.
…
Don’t store food & drinks in a vaccine refrigerator
..
Done
..
