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Patho & Pharm > vaccination > Flashcards

vaccination Flashcards

1
Q

_________ Pathway triggered in the “BOOSTING” immunization process

A

Classic Complement Pathway

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2
Q

what’s herd immunity

A

when a large portion of a community becomes immune to a disease, making the spread of disease from person to person unlikely.

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3
Q

Herd immunity can be produced in two ways

A
  1. natural infection
  2. vaccination
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4
Q

Threshold Herd Immunity

A

when enough people in the population have recovered from a disease and have developed protective antibodies against future infection

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5
Q

factors impacting herd immunity through natural infection

A

reinfection(susceptibility/rates/transmissibility), mutation of the organism

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6
Q

factors impacting herd immunity through vaccination

A

contagiousness and efficacy of the vaccine/waning immunity/mutation of the organism to the vaccine

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7
Q

what are three ways of producing vaccine? (type of vaccine, vaccine platform)

A

whole virus
part of the virus
only the genetic material

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8
Q

what are the two types of whole organism vaccine?

A

live attenuated e.g. MMR, Monkey Pox
inactive unattenuated e.g. polio (IPV), hepatitis A, influenza

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9
Q

what are the pros and cons of the live attenuated vaccine?

A

pros: highly effective and long duration of immunity
cons: takes a long time for develop
theoretical risk for immunocompromised and pregnant

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10
Q

what are the pros and cons of the inactive unattenuated vaccine?

A

produces less effective immune response vs live vaccine, need for boosting
need adjuvant to stimulate the immune response

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11
Q

Specific Isolate Protein Acellular Vaccines

A

Subunits (acellular) contain purified parts of the virus or bacteria are used not the entire organism
Contain only the essential antigen and incapable of causing disease
e.g. acellular pertussis (whooping cough), hepatitis B (+/- conjugate)

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12
Q

Polysaccharide Vaccines

A

some organisms (often bacteria) have antigens with an outer coating of polysaccharides disguising, the antigen making it harder for the T&B Lymphocytes to detect and respond
e.g. pneumococcal polysaccharide vaccine

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13
Q

Conjugated Vaccines

A

bind a polysaccharide chain to a carrier protein to try to boost the immune response.
e.g. Conjugated: DTaP, pneumococcal conjugated

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14
Q

Virus-Like Particles vaccines

A

structural viral proteins necessary to form a virus particle but lack the viral genome (RNA/DNA) and non-structural proteins
e.g. HPV

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15
Q

Toxoids vaccine

A

Toxins are “weakened” so they do not cause serious illness.
Triggers the same immune response as live vaccines and immunological memory is formed against the molecular markers of the toxoid without resulting in toxin-induced illness
e.g. DTap

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16
Q

what are the pros and cons of protein based vaccine

A

Pro: Effective immune response, very safe and less side-effects
Cons: less effective than live, short-term immunity needs boosting and/or adjuvant added or conjugate (polysaccharide with subunit) to boost the response,
Ineffective in infants ≤ 2 years

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17
Q

mRNA based vaccine

A

Stretch out the viral RNA and only take the portion that produces the spikes on the outer membrane of the virus that attaches to pulmonary epithelium
Problem is that mRNA is not very stable, so it requires a carrier molecule is necessary to enable entry of the mRNA into cells; lipid nanoparticles are most used (produced in Canada)

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18
Q

what are the pros and cons of mRNA_based vaccine?

A

Pro: Fast manufacturing and interchangeable antigen
No mRNA vaccine has been commercially authorized until 2020 so data is still being collected and NACI guidelines are constantly being updated.

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19
Q

Immunoglobulin & Monoclonal Antibodies
RSV vaccine

A

B-Cell specific plasma proteins create RSV specific antibodies – harvested and create vaccine.
Human monoclonal antibody IgG class
F-hRSV targets the fusion protein F blocking RSV fusion to epithelial cells in the respiratory tract.

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20
Q

what’s the only live vaccine that’s given orally?

A

rotavirus vaccine

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21
Q

rotavirus vaccine are given at ____

A

2 months and 4 months

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22
Q

contraindication of rotavirus vaccine

A

Severe combined immunodeficiency (SCID) or other immune compromised conditions, - - intussusception
anaphylaxis or hypersensitivity

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23
Q

adverse events of rotavirus vaccine

A

Rare: vomiting, diarrhea (7 days), Intussusception, monitor for any hematochezia in conjunction with abdominal pain.

24
Q

Tetanus/Diphtheria/Pertussis/Polio/Hib Vaccines schedule

A

DTaP-IPV-Hib
Routine: 2, 4, 6 and 18 months

Tdap-IPV
Routine booster: 4 years

Tdap
Routine booster 14, 24 years

One dose in every pregnancy, ideally btw 27-32 weeks gestation

Td vaccine
Routine booster: adults every 10 years after their Tdap

25
Q

Pneumococcal vaccine
(Pneu-C 15 & PNEU-C 20)

A

Routine vaccination childhood [not high-risk: [Pneu-C-15] in the routine vaccine schedule @ 2, 4, 12 months [3 doses]

Routine vaccination for children at high-risk NACI recommends switching to the Pneu-C-20 in the routine vaccine schedule @ 2, 4, 6, 12 [4 doses]

Routine vaccination 65 years and older. [Pneu-C-20] [replacing Pneu-P-23] – single dose with no recommended boosting

High risk for individuals aged 6 weeks and older. [Pneu-C-20] [replacing the Pneu-C-13 & Pneu-P-23] – single dose with no recommendations for boosting

26
Q

Pneumococcal: High Risk Populations [6 weeks +]
(18 conditions)

A
  1. Asplenia
  2. Congenital (primary) immunodeficiencies
  3. HIV infection
  4. Immunocompromising therapy
  5. Malignant neoplasms
  6. Sickle-cell disease and other sickle cell hemoglobinopathies
  7. Solid organ or islet cell transplant (recipient)
  8. Hepatic cirrhosis due to any cause
  9. Chronic renal disease
  10. Chronic cardiac disease
  11. Chronic liver disease
  12. Chronic respiratory disease, excluding asthma, except those treated with high-dose corticosteroid therapy
  13. Chronic neurologic conditions that may impair clearance of oral secretions
  14. Diabetes mellitus
  15. Cochlear implant recipients (pre/post implant)
  16. Chronic cerebral spinal fluid leak
  17. Residents of nursing homes, homes for the aged and chronic care facilities or wards
  18. Hematopoietic stem cell transplant (HSCT) (recipient)
27
Q
A
28
Q

3 types of Meningococcal Vaccines

A
  1. Monovalent: Men-C-C (given in infancy)
  2. Quadrivalent: (Men-C ACYW-135) (given teens) (high risk populations)
  3. Serogroup B: 4CMenB (Meningococcal Serogroup B) is newly available in Canada (2020) (high risk populations/household contacts)
29
Q

High risk groups for meningococcal

A

persons with functional or anatomic asplenia, including sickle cell disease

persons with congenital complement, properdin, factor D or primary antibody deficiencies

persons with acquired complement deficiency due to receipt of the terminal complement inhibitor eculizumab (Soliris™)

individuals with HIV, especially if it is congenitally acquired

30
Q

Increased Risk Groups for meningoccocal

A

Travelers to areas with high rates of endemic meningococcal disease
research, industrial and clinical

Laboratory personnel who are potentially routinely exposed to N. meningitidis.

Military personnel during recruit training and on certain deployments

Close contacts of a case of IMD and for outbreak control, if the disease is caused by a serogroup contained in the vaccine

31
Q

Meningococcal vaccine schedule

A

Monovalent Vaccines:
Men-Conjugate-C (Menjugate®) (NeisVac-C®) vaccine:
Childhood 12 months

Quadrivalent Vaccines: Boosts C and adds protection for A, Y, W-135
Men-C-ACYW (Menactra®) (Menveo®) (Nimenrix®) vaccine given:
Teens 14 years (7-12 grade school programs with Hep B and HPV)

Populations that fall into the high-risk groups:
Routine + the following:
Serogroup B Meningococcal vaccine (4CMenB) for 2 months – 17 years
Quadrivalent Men-C-ACYW for 9 [now 2 months] months and older * may require booster doses

32
Q

MMR vaccine schedule

A

MMR (M-M-R®II)(PRIORIX® ) given:
Childhood @ 12 months [Note: can be given early 6-11 months if the child travels to an endemic country]
2nd booster dose is recommended > 26 years [health care workers, post-secondary students, travel to endemic areas, or at-risk populations - clinical judgement]
Varicella (VARIVAX®III) (VARILRIX® ) given:
Childhood @ 15 months
MMRV (PRIORIX-TETRA® ) (ProQuad™) given:
Booster: Childhood 4 years

Avoid in pregnancy:
If exposed in pregnancy and not immune, consider Varicella Immune Globulin options.

33
Q

high risk for varicella

A

All persons born in or prior to 1999 require 2 dose catch up:

Susceptible child/adult given chronic salicylic acid therapy

Susceptible individuals with cystic fibrosis

Susceptible household contacts of immunocompromised individuals

Susceptible individuals receiving low dose steroid therapy or inhaled/topic steroids

Susceptible immunocompromised individuals as outlined by the PHAC (see below)

34
Q

Shingle vaccine schedule

A

Shingrix® (approved Canada Jan 2018)
Publicly funded for people between the ages of 65-70 (2 doses before 71 birthday)
Recombinant subunit (adjuvanted), 2 dose (2-6 months apart, up to 12 month is acceptable)
95% better coverage (released Jan 2018, now the primary vaccine in most provinces, ON)
* If a person has had shingles, they are still eligible just wait 12 months post exposure to shingles. [Note: Monitor them for increased risk of stroke and MI events as they are high risk post shingles for min 12 months]

35
Q

Hepatitis B vaccine schedule

A

Routinely for min 14 year or all grade 7 to 12 students (school programs with HPV and Men-C-ACYW)

36
Q

High Risk for Hep B

A

Newborns of mothers who have hepatitis B and premature infants

Children attending childcare programs and their caregivers

People travelling to countries where there is a risk of contracting hepatitis B

Children under 7 years of age who have immigrated to Canada from areas with high rates of hepatitis B(at risk for traveling to endemic countries and/or socializing in populations from endemic countries)

Household or close contacts (sexual) of an infected person, multiple sexual contacts

People who are at higher risk of contact with blood, such as: health care workers [needle stick], patients on hemodialysis (treatment for kidney disease), blood products (e.g., Hemophilia)

Liver disease including Hep C infection

IVDU

Men who have sex with men

37
Q

HPV serotypes

A

Gardasil®9 (9vHPV) 6, 11, 16, 18, 31, 33, 45, 52, 58
Routine: publically funded for:
All children grades 7 can be up to 12 (routinely give in grade 7-8 school programs) (2 dose month 0-6)
High-risk 9-26 years males (men who have sex with men)
Immune compromised individuals in high-risk categories (require 3 dose schedule)

38
Q

RSV season __ to __ month

A

October to April

39
Q

three seasonal vaccines include

A

Influenza
COVID-19
RSV [monoclonal antibodies and the vaccine]

40
Q

influenza vaccine

A

All individuals 6 months to 64 years of age
Quadrivalent Inactivated Vaccines

41
Q

most common allergen in influenza vaccine

A

Egg Protein
Thimerosal

42
Q

Influenza Vaccines for 65 years and older

A

Fluzone® High-Dose Quadrivalent

43
Q

Do not administer influenza vaccine to:

A

Anyone who has developed Guillain-Barré Syndrome (GBS) within six weeks of a previous influenza vaccination, HOWEVER, this should be weighed against the risks of not being vaccinated against influenza.

Persons with a history of serious allergic reaction (anaphylaxis) to a previous dose of influenza vaccine, and/or
P
ersons with proven immediate or anaphylactic hypersensitivity to any ingredient in the vaccine, *except for egg.

44
Q

RSV Immunoglobulin

A

SYNAGIS®(palivizumab) is a passive immunizing agent (humanized monoclonal antibody). AstraZeneca Canada Inc. [multiple doses – once monthly] phased out

BEYFORTUSTM(nirsevimab) is a passive immunizing agent (human monoclonal antibody). Sanofi Pasteur Ltd. [single dose for season]

45
Q

RSV Vaccine in pregnancy

A

RSV Monoclonal antibody [Beyfortus®] is the preferred product to protect all infants
32 to 36 weeks pregnant and who will deliver near the start of or during the RSV season.
The vaccine triggers mom’s active immunity [innate/adaptive] to produce antibodies to cross the placenta and breast milk.
THUS provides passive immunity to the infant through the placenta and breastfeeding from birth until 6 months old.

46
Q

RSV vaccine for seniors

A

AREXVY(RSVPreF3) RSV subunit adjuvanted vaccine, GlaxoSmithKline Inc.
ABRYSVOTM(RSVpreF) RSV subunit vaccine, Pfizer Canada.

if possible, RSV vaccine should be given at least 6 weeks before or after non-seasonal vaccines, for example, shingles or diphtheria-tetanus vaccines, to avoid inadvertently attributing an adverse event from another vaccine to the RSV vaccine.

47
Q

Treatment for Monkey Pox

A

Tecovirmat antiviral

47
Q

MPOX Vaccines

A

Imvamune® is authorized in Canada for protection against mpox
A two-dose series, given 28 days apart.

Pre-exposure and post exposure vaccination

48
Q

Hepatitis A vaccine recommended for persons:

A

IVDU, Chronic liver disease including Hep B and C and Men who have sex with men.

49
Q

All vaccines contraindicated (CI)

A

Anaphylactic or other serious allergic reaction to vaccine components after receiving a vaccine is a contraindication to further doses of that vaccine
Guillain-Barre Syndrome within 6 weeks post-vaccination

50
Q

Live Vaccines contraindication

A

Avoid immune system compromise conditions (e.g., congenital immune deficiencies), or medical treatments (e.g., chemotherapy, a bone marrow or other organ transplant, or high doses of steroids)
Avoid during pregnancy, except when expected benefits to mother and baby outweigh risk

51
Q

Delay giving vaccine if

A

Moderate to severe illness
People treated with blood products should not get a live vaccine (e.g., measles, mumps, rubella, varicella) for 3 months or more. Depending on the blood product and dose received, these vaccines may not work

52
Q

vaccine components Adjuvant

A

↑ vaccine effectiveness by stimulating antibody production
e.g. Aluminum salts

53
Q

vaccine components Antibiotics

A

Prevent bacterial contamination
e.g. Neomycin**

54
Q

what are the vaccine components ?

A

adjuvant
abx
preservatives
stabilizer

Patho & Pharm (37 decks)

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