- Immunization monitoring program ACTive) - across Canada - pediatric hospital-based surveillance network

Canadian adverse events following immunization surveillance system - national monitoring (PHAC)

- killed by heat, chemical, irradiation - stable - humoral response - side effects - requires boosters (need to see Ag over and over to get plasma cells to produce memory B cells)

- same parent organism, just not pathogenic (avirulent strain) - good efficacy (one repeat) - poor stability (needs refrigeration) - humoral and cell-mediated response - few side effects - may revert to virulent form - immunosuppressed/immunocompromised

- component of organism used (purified macromolecule) - fewer side effects - polysaccharide requires conjugate - many capsular polysaccharide strains

Vaccination Flashcards by Richen Basig

What is the purpose of vaccination?

disease prevention = for individual and community

prevention of common diseases or prevent spread of outbreaks

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passive prevention of disease

maternal antibodies (placental transfer, breastmilk), antitoxins (tetanus fo ex), IVIg (specific and broad)

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active prevention of disease

natural infection
vaccines
toxoids

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T or F. Passive immunity can be artificial or natural

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characteristics of a good vaccine

effective = elicit correct response for the organism
safe = minimal side effects; no disease
inexpensive
long term protection
manufactured quickly
easy to administer (1 dose, no refrigeration)

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immune response required for viruses

cell-mediated
- cytotoxic T cells
- Th1, IL-2, IFNy, TNF

antibody
- can aid in prevention and spread of virus
- neutralization (bind surface to prevent attachment)
- complement activation

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describe the antibody-mediated response to extracell bacteria

toxin neutralization
complement-mediated lysis
opsonization and phagocytosis (Ig + Comp)
anaphylatoxin = mast cell degranulation
chemotaxis

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define efficacy

ability of vaccine to elicit a response

measured in the individual (Ab level)

clinical trials

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define effectiveness

ability of vaccine to reduce disease in the community

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IMPACT

Immunization monitoring program ACTive)
across Canada
pediatric hospital-based surveillance network

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CAEFISS

Canadian adverse events following immunization surveillance system

national monitoring (PHAC)

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vaccine complications

adverse rxns
vaccine additives - allergens
> egg protein, latex, gelatin
> neomycin, streptomycin, gentamycin, polymyxin
> thimerosal

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inactivated vaccine

killed by heat, chemical, irradiation
stable
humoral response
side effects
requires boosters (need to see Ag over and over to get plasma cells to produce memory B cells)

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whole organism vaccines

bacteria or viral particles

inactivated

live attenuated

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live attenuated

same parent organism, just not pathogenic (avirulent strain)
good efficacy (one repeat)
poor stability (needs refrigeration)
humoral and cell-mediated response
few side effects
may revert to virulent form
immunosuppressed/immunocompromised

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subunit vaccine

component of organism used (purified macromolecule)
fewer side effects
polysaccharide requires conjugate
many capsular polysaccharide strains

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types of subunit vaccine

inactivated exotoxin (toxoid)
polysaccharide
recombinant microbial antigen

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this outlines policy and regulations regarding publicly funded immunizations

Alberta Immunization Policy
- Alberta Ministry of Health
- Provincial Legislation (Public Health)

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these governing bodies ensure access, safety, education, training, reporting, research, and evaluation

CMOH with government and AHS

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DTaP-IPV-Hib-HB

DIPHTHERIA, TETANUS, ACELLULAR PERTUSSIS

INACTIVATED POLIO VIRUS

HAEMOPHILUS INFLUENZAE TYPE B

HEP B

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how often do you get a tetanus shot as an adult?

every ten years

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HiB

Haemophilus influenzae type B
- encapsulated = phagocytosis and complement resistant
- bacteremia, pneumonia, epiglottitis, meningitis
- most common cause of bacterial meningitis in children under 5 prior to vaccine
- conjugate vaccine

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T or F. HiB vaccine is a polysaccharide vaccine

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Disadvantages of HiB polysaccharide vaccine

no memory
IgM response only
T-independent
does not work in children under 2 y/o

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pneumococcal disease

- S. pneumoniae - pneumonia, sepsis, meningitis - multiple strains/serotypes - polysaccharide - vaccine must be conjugated and include serotypes causing disease - polysaccharide vaccines ineffective in children under 2 - PNEU-C13

rotavirus route of admission

fecal-oral route risk group: 3 months - 3 yrs

symptoms of rotavirus

fever, vomiting, severe diarrhea

this can cause severe dehydration/hospitalization

rotavirus

T or F. Rotorix is available for risk groups only

F! Available for everyone in AB; oral vaccine

what type of vaccine is Rotorix?

live attenuated virus - lots of side effects = GI upset - leads parents not to get second dose

MMR-Var

- live attenuated - 95% effective at one dose; 2 doses = 100% - less effective before 6 mos of age - 12-18 mos - 4 yrs if only one dose

side effects of MMR-Var

mild fever, rash that can look like disease

rare but serious side effects of measles

encephalitis

rare but serious side effects of mumps

sterility, deafness, encephalitis

rare but serious side effects of rubella in pregnancy

miscarriage, deafness

complications of chickenpox

CELLULITIS, GROUP A STREP, PNEUMONIA, ENCEPHALITIS

Shingles

reactivation of virus as an adult = painful, time off work, $

N. meningitidis

meningococcal disease - septicemia, meningitis - risk groups: children <2, 15-24 elderly - conjugate vaccine (MenCC); 4-24 mos > protection vs type C - gr 9 = ACYW-135 = teens, young adults = close contact, dorms, etc.

T or F. HPV self-resolves

cancers caused by HPV

cervical, anal, vaginal, penile, head, and neck

when is the HPV vaccine administered?

grade 6 = males and females

strains of HPV

9 HPV-9

non-routine vaccines purpose

travel occupation high risk group = lifestyle, health group living facility **must pay/not free**

Hep A vaccine

Havrix = 1 dose = inactivated virus Twinrix = 3 doses HAV inact/HBV recomb

Hep A route of admission

fecal/oral non-endemic to Canada

high-risk for Hep A

travel to endemic areas military occupational workers liver disease high risk sexual behaviour

Hepatitis B DNA

positive for virus and infectious

Hepatitis B HBs Ag

positive for virus - early stage

Hepatitis B Anti-HBs

end-stage of infection and immunity

Anti-HBc

previous or chronic infection - Anti-HBc IgM/Total (see if really chronic or right afer infection)

HBe (enveloped) Ag and anti-HBe

chronic infection

HBV vaccine - we are positive for this

HBs Ag

what kind of vaccine is HBV vaccine

recombinant subuit

this titre for anti-HBs is considred protective

>/= 10 IU/L

Dukoral

V. cholerae - inactivated Vibrio strains (heat/formalin) - recombinant cholera B toxin subunit - oral = IgA production = also provides protection to TEC

T or F. Labile toxin for Vibrio and ETEC are similar

T, antibody response will neutralize

T or F. Dukoral is self-administered

how many doses for Dukoral

2 doses 1 wk apart prior to travel

limitations of Dukoral

- traveller's diarrhea can be caused by other organisms - side effects = 50% ab pain, diarrhea - requires boosters

at risk populations that require vaccines

transplantation workup splenectomy pt pregnancy senior in long term care

why are live attenuated vaccines not recommended for children under 12 mos

less effective de to passive maternal immunity

why are live attenuated viruses not recommended for immunosuppressed individuals?

virus might be strong enough to cause disease

this vaccine leads to long lasting, effective immunity (cellular, humoral) with often 1 dose

live attenuated virus two doses almost 100% protection

this vaccine requires refrigeration

live attenuated - short expiry to ensure viability

T or F. Live attenuated virus vaccines may have more pronounced side effects such as fever, rash, respiratory due to live virus

inactivated virus vaccines characteristics

safe, effective, minimal side effects produce humoral response rather than cellular response may require multiple doses

conjugate, subunit recomb, toxoid vaccines characteristic(s)

- strong humoral responses to specific aspects of pathogen (cell wall, protein, etc.) - requires multiple doses and booster shots - toxoid provides protection against toxin, and not the organism itself

AstraZeneca vs J&J DNA COVID vaccine

- modified non-replicating chimp adenovirus - E1 gene replaced with Covid19 spike gene (J&J Ad26.COV2) - similar = only human adenovirus vs. chimp)

side effects of AstraZeneca vaccines

- rare but serious - vaccine-induced immune thrombotic thrombocytopenia (VITT) - antibodies produced against PF4 - incidence 0.000019

COVID mRNA vaccines

Pfizer and Moderna

how do mRNA vaccines work?

- mRNA encapsulated in lipid nanoparticle fuse with cells - mRNA produces spike protein - MHC I presentation - secreted antigen taken up by macs = MHC II presentation - TLR 3 = RNA

safety and effectiveness of Pfizer and Moderna

95% EFFICACY AFTER TWO DOSES = PHASE 3 TRIALS

side effects of Pfizer

- pain, swelling, fatigue (mild-moderate) - 1-3 day duration - rare myocarditis in males 12-17 y/o

T or F. Polysaccharide vaccines are not effective in children under 2 years of age

T! unless conjugated

pure polysaccharide vaccines - why are they not recommended?

only T indenpdent immunity = no memory, lss specific, IgM only short-lived (~2 yrs) targets specific strains only

pros of DNA vaccibues

- induces cell mediated immunity - prolongs expression, enhances memory

AstraZeneca vaccine

- non-replicating virus enters cell - cDNA into nucleus => mRNA - spike proteins produced - MHC I display - secreted antigen taken up by macs (MHC II) - cellular and humoral - TLR 9