Therapeutics - Vaccines

Question 1

3 ways that vaccine efficacy can be measured

Answer 1

-prevention from getting disease

-mortality (decreases mortality - ie - influenza)

-does the pt develop antibodies (hep b)

Question 2

true or false

influenza vaccine is not effective in preventing young adults from getting the disease

Answer 2

false- it is 90% effective

Question 3

2 types of immunity and differentiate

Answer 3

passive and active

passive - administering antibodies to a patient. immediate but short term immunity (dont reproduce)

active - administer antigen to induce an immune response

Question 4

example of when we would give a “passive immunization” to a patient

Answer 4

to prevent contagious disease in someone recently exposed and they haven’t been vaccinated for it

ie - someone bit by rabid animal but dont have rabies vaccine - give passive immunization

Question 5

2 ways in which we could give passive immunizations

Answer 5

administering either immunoglobulins (antibodies derived from humans) OR antitoxins (antibodies derived from animals)

human derived better tolerated

Question 6

true or false

active immunizations tend to give long term immunity

Answer 6

true

stimulating own immune system and own memory cells

Question 7

2 ways active immunizations can be administered

Answer 7

vaccines (derived from pathogen)

toxoids (derived from bacterial toxins)

Question 8

2 categories of vaccines

Answer 8

live attenuated (weakened)

killed inactivated

Question 9

live vaccines

Answer 9

weakened microorganism,

they MULTIPLY in the body and spread throughout for around 2 weeks. in this time, antigen is being processed and antibodies formed (MORE than killed AND they last longer)

Question 10

true or false

inactivated vaccines do not replicate

Answer 10

true

thus, need more frequent boosters

Question 11

which type of vaccines typically have adjuvants?

Answer 11

inactivated/killed - gives boost to the immune response

Question 12

true or false

when giving a live vaccine, it is possible that the patient may get a mild form of the disease

Answer 12

TRUE

ie - chicken pox vaccine - may get very small version of a chicken pox rash

Question 13

why can live vaccines not be administered to immunosuppressed patients

Answer 13

the organism may mutate and become pathogenic again – can get the full blown disease

Question 14

true or false

ALL live vaccines should be administered in immunosuppressed patients, including pregnant patients

Answer 14

true

the live vaccine can cross the placenta!! CONTRAINDICATED

Question 15

**which product should not be given to pregnant patient

Answer 15

ANY LIVE VACCINE (coming l8er

Question 16

true or false

inactivated vaccines do not replicate

Answer 16

true

cannot cause disease

any adverse effects will be LOCAL - pain, swelling, etc

Question 17

*name the 6 live vaccines

Answer 17

MMR
varicella
rotavirus
intranasal influenza
yellow fever
oral typhoid capsules

EVERYTHING ELSE IS INACTIVATED

Question 18

name 3 bacteria that have a polysaccharide coating, and thus also have vaccines that are derived from this capsule?

Answer 18

step pneumoniae (pneumovax)
meningococcal vaccine
h. influenzae type b

Question 19

in which population are polysaccharide vaccines not very effective?

what is another issue with polysacchraide vaccines

Answer 19

children less than 2. they dont boost the immune system enough

also, the titers and antibodies produced are very low

Question 20

what was done in attempt to make polysacchradie vaccines more effective

Answer 20

conjugated polysaccharide vaccines were made. the polysaccharide is conjugated to a protein (covalently linked)

tremendously increases the effectiveness in young children

higher antibody levels and longer lasting

Question 21

3 examples of conjugated polysaccharide vaccines

Answer 21

pneumococcal conjugate
meningococcal conjugate (MCV4)
Hib (haemophilius influenza type B)

Question 22

how often are the CDC immunization schedules updated

Answer 22

once a year

Question 23

note to self

Answer 23

you can always given vaccines later than scheduled, even the 2nd in a 2 dose series - you’re just delaying the effects

however, if you give 2nd dose EARLIER than recommended, it doesnt count and doesnt work

Question 24

can you give 2 or more live vaccines at the same time

Answer 24

YES - but has to be same day OR separated by 4 weeks

Question 25

1 vaccine preventable disease that causes fatalities

Answer 25

influenza

Question 26

anyonw ___ and older gets the flu shot

Answer 26

6 months and older

Question 27

true or false

a young person and older person get the influenza vaccine. they work equally as well in both patients at preventing the disease

Answer 27

FALSE - prevention is much better in younger people (~90% effective), but effectiveness decreases as you get older

Question 28

every year, new influenza vaccine formulation comes out. this contains ____ type A strains and ____ type B strains

Answer 28

2 type A
1 type B

Question 29

*general recommendation on when to immunize for flu

Answer 29

start at september, aim to have everyone immunized by end of october

Question 30

name 3 influenza products that are preferred for patients 65 and older

Answer 30

Fluzone High-Dose
Fluad
Flublok

Question 31

differentiate between Fluzone High dose vs fluad vs floblok

Answer 31

all are preferred for ages 65 and older

fluzone high dose is 4x the standard dose (4x the antigen) and thus has more side effects

fluad contains an adjuvant to boost the immune response

flublok is recombinant DNA and has 3x the standard dose (antigen)

Question 32

true or false

we can give any influenza vaccine to a patient 65 and older

Answer 32

TRUE

fluzone high dose, fluad, and floblok are preferred, but not required

Question 33

ONLY live influenza vaccine

Answer 33

flumist - intranasal

Question 34

true or false

flumist produces much less antibodies than the other influenza vaccines

Answer 34

TRUE - even tho it’s the only live one, its given intranasal — can only replicate in the sinus

Question 35

who is flumist indicated for

Answer 35

2-49 years old – only HEALTHY patients

Question 36

differentiate between prevnar vs PPSV23

Answer 36

PPSV23 is a polysacchardie vaccine that produces a low amount of antibodies and is not very effective

prevnar13/20 are CONJUGATED polysaccharide vaccines and are much more effective and produce a better immune response in both children and adults

Question 37

differentiate between prevnar 13 and prevnar 20

Answer 37

prevnar 20 has 7 more strains than prevnar 13 and is much more effective

Question 38

how is polio spread

Answer 38

fecal-oral contamination

ppl got from contaminated water a lot in the past

Question 39

what does polio cause

Answer 39

muscle paralysis

if works way to diaphragm, people stop breathing

Question 40

explain how the live polio vaccine is better than inactivated

Answer 40

live vaccine will replicate in the GI tract. you will now have antibodies against polio lining the GI tract

polio is transmitted via fecal oral route. if you ingest contaminated water, it will NEVER get absorbed into the blood stream because antibodies are lining the GI

also, person is shedding the virus over 2 weeks and giving immunity to others in their household

Question 41

OPV vs IPV

Answer 41

OPV - oral poliovirus vaccine (live)

IPV = inactivated poliovirus vaccine

Question 42

is OPV used in the US

Answer 42

no - it’s a live vaccine, immunosuppressed can get polio still. it’s completely eradicated in the US - not worth the risk

everyone gets inactivated now

Question 43

diptheria

Answer 43

complications from diphtheria toxin

can cause myocarditis, neuritis, and death

Question 44

Tdap in pregnancy

Answer 44

EVERY pregnancy

Question 45

only hepatitis that causes acute infection

Answer 45

hep A only around 30 days

Question 46

how is hep A transmitted

Answer 46

fecal oral