SPR L15 Vaccines and Immunotherapy 2 Flashcards
Learning Outcomes
- Be able to describe the current UK vaccination schedule
- Be able to give examples and rationale for risk groups that require additional vaccinations
- Be able to describe post exposure vaccination with examples
- Be able to describe use of specific passive immunotherapy and normal immunoglobulin therapy
Vaccine Delivery
How can vaccines be delivered? Give examples
- Oral: o e.g. poliovirus vaccine
- Nasal spray e.g live attenuated influenza vaccine
- Subcutaneous or scarification: sc e.g. smallpox
- Intramuscular: IM –most given this route E.g. “5 in 1” given as IM injection into the thigh
What is used to guide the vaccinations given?
UK Vaccination Schedule
UK Vaccine Schedule
Outline the childhood vaccination schedule
- 2 months
- 3 months
- 4 months
- 12-13 months
- Pre school
UK Vaccine Schedule
Outline the schedule after early childhood
- Girls 12-14 years - HPV
- 14 Years - Boosters
- >65 years - Pneumococcal and Influenze
- 70 years - Shingles
Some key vaccines
What is the ‘5 in one vaccine’?
5-in-1 = (DTaP/IPV/Hib) vaccine
- inactivated vaccine combination
- Injection
- @ 2, 3 & 4 months
diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b
pertussis used to enhance the others
Key Vaccines
MMR
What is this? What type of vaccine? When is it given?
Measles, mumps and rubella (MMR)
- Live vaccine
- Injection
12-13 months and preschool (2 doses)
Won’t work if given in presence of maternal antibodies - need a productive infection of myocytes. Need an immune response to occur.
Key Vaccines
Rotavirus Vaccine
- When was this introduced?
- What type of vaccine is it?
- How is it given?
- When is it given?
- Introduced 2013
- Live vaccine
- Oral
- @ 2 months and 3 months age
Can’t me given any later - as side effects on GI increase. No catch up if child misses, becomes problematic to give.
Key Vaccines
Live attenuated influenza vaccine
- When is it given and to whom?
- What type of vaccine is it?
- How is it given?
- Who can’t it be given to?
- annually to children 2-16 years of age
- Live vaccine - better than inactivated one given to adults. Temperature adapted vaccine, only grows at temp within the nose, can’t cause a RTI
- Nasal application
- In immunodeficiencies, congential or acquired (haemotological deficiency)
Childhood Vaccination Schedule
Outline the childhood vaccination schedule at the following stages
- 2 months
- 3 months
- 4 months
- between 12-13 months
- 3 years and 4 months/ soon after
see picture
know timescales
note 5in1 vaccine, see other vaccines are given also
MMR
Opportunities for boosting at 14 and HPV
Start of vaccination schedule
- When is it started
- What is given?
2 months
- Diphtheria, tetanus, pertussis, polio and Hib (DTaP/IPV/Hib)
- Pneumococcal conjugate (PCV)
- Rotavirus
Older Children and Adults
Outline the vaccines given at the following ages
- 12-13 years
- 13-18 years
- 65 and over plus risk groups
- 70+
- (Travel vaccines)
Additional Vaccinations
What are the important additional vaccines?
What is the mantoux test?
- Hepatitis B vaccination is sometimes offered to high risk cases.
- Varicella-Zoster – offered to health care workers in UK (routine vaccination in USA)
-
Tuberculosis BCG vaccination is no longer part of a universal programme delivered through schools, but is targeted for those who are at greatest risk. Mantoux test (tuberculin senitivity)
- Mantoux skin test consists of an intradermal injection of exactly one-tenth of a milliliter (ml) of PPD tuberculin.
Mantoux test injection site in a subject without chronic conditions or in a high risk group clinically diagnosed as negative at 50 hours
PROBLEMS WITH VACCINE SAFETY
Both living and non-living vaccines require rigorous quality and safety control. What are the potential problems?
- Live attenuated vaccines
- Non-living vaccines
- Insufficient attenuation
Reversion to wild type
Administration to immunodeficient patient
Persistent infection
Contamination by other viruses
Fetal damage
- Contamination by toxins or chemicals
Allergic reactions
Autoimmunity
1. (Genetically engineered vaccines
Possible inclusion of oncogenes)
Multiple Vaccines Do Not Overwhelm the immune system
What does the research show?
- Child’s immune system can cope with multiple immunological challenges at once
- < 0.1% of the immune system is “used” after MMR
- although today’s children can receive 11 or more different vaccines, the total number of antigens these contain is still probably less than the large number of antigens that were contained in the smallpox vaccine
Vaccination is Not Always Possible
Why?
- The patient may already be infected and so a more rapid build-up of immune effector mechanisms than occurs naturally may be needed (e.g. rabies post exposure vaccination).
- The patient’s immune system may be inadequate and unable to respond either to the infection or to a vaccine
- through immunodeficiency
- or some specially resistant property of the parasite.
Who are the at risk groups?
Suscepable and at risk of severe disease e.g. influenza
- Immunodeficiency
- HIV positive
- Asthma
- Chronic Lung Disease
- Congenital Heart Disease
- Definite hypersensitivity- Severe or Generalised Reaction to Preceding Dose
- Down’s Syndrome
- Avoid live vaccines in pregnancy
- Small For Dates infants
- Premature infants
Post Exposure Vaccination
- What is the most successful form of immunotherapy?
- What does this do?
- Give an example
- vaccination if possible - Vaccine in some cases can be given post exposure to infection.
- This helps to boast the immune response and may clear the infecting pathogen or reduce the severity of the disease.
- Examples: MMR in measles exposures, HBV vaccination in HBV exposure
Post Exposure Vaccination
Explain the following examples
- MMR in measles exposures e.g in an outbreak
- HBV vaccination in HBV exposure
- needs to be given within a few days of exposure (Immunoglobulin can also be given)
- Needs to be given within a week of exposure (Immunoglobulin can also be given) - longer incubation period)
Post Exposure Vaccination
HBV prophylaxis post exposure
- Give examples of when this is carried out
- What are the options?
- Sexual exposure
Babies born to mothers
Needle stick exposures
- Immunoglobulin (specific HBIG)
HBV vaccine – accelerated course, 3 doses
Vaccine and immunoglobulin can be used together
PASSIVE IMMUNISATION WITH ANTIBODY
- What did this involve?
- How can complications be avoided?
- Give an example
- Use of antiserum raised in horses or rabbits - largely abandoned because of the immune response to the foreign antigens ‘serum sickness’
- Complications can be avoided by using human serum taken: during convalescence or following vaccination - to prevent infection after exposure (e.g. rabies) or to minimise its severity (e.g. varicella or measles in immunodeficient children).
- Passive immunisation for tetanus
Passive Antibody Therapy
Explain the 3 key examples and when they are indicated
Antibodies harvested from blood donors (eg. given to leukaemia pt, or pregnant woman)
- Varicella-zoster- Prophylaxis of exposures in immunodeficiencies and pregnancy
- Hep B - post-exposure
- Measles - post-exposure (normal immunoglobulin, hasn’t been selected, everyone has these)
Antibody in Pooled Normal Serum can Provide Protection Against Infection
With common infections, it can be assumed that most normal people have antibody to the pathogen in their serum.
Proof of this is?
- Patients with hypogammaglobulinemia can be kept free of recurrent infection by regular injections of IgG from pooled normal serum,
- immunodeficient children can be protected against measles in the same way
- Immunoglobulin is prepared from batches of plasma from 1000-6000 healthy donors after screening for hepatitis B and C and HIV.
Production of Humanised Antibodies
- How is this carried out?
- Give an example
- Who is this used for?
- Mouse antibodies - can be isolated using hybridoma or recombinant approaches - Can be “humanised” to improve utility.
- E.g Palivizumab
- used for RSV – given as IM injections to babies at risk. (e.g premature, congenital cardiac disease) 5 monthly injections of this is given
