Vaccinations

Question 1

Immunity

Answer 1

The ability of the human body to tolerate self and to eliminate foreign “nonself” material.
Provides protection from infectious disease
Interacting cells whose primary purpose is to identify foreign substances refereed to as antigens

Question 2

Immune system defense against antigen

Answer 2

Developed and is known as the immune response and usually involves the production of protein molecules by B lymphocytes.

Question 3

Two basic mechanisms for acquiring immunity

Answer 3

Active and passive

Question 4

Active immunity

Answer 4

Protection that is produced by the person’s own immune system. This type of immunity is usually permanent.

Question 5

Passive immunity

Answer 5

Protection by products produced by an animal or human and transferred to another human, usually by injection.
Provides effective protection, but this protection disappears with time, usually occurring within a few weeks or months.

Question 6

Passive Immunity-Mother to infant

Answer 6

Antibodies transported across the placenta during last 1-2 mo. of pregnancy
Full term has same antibodies as mom for protection from some diseases up to a year.
Better protection for measles, rubella, tetanus than polio, pertussis

Question 7

Passive-immunity-blood products

Answer 7

Many blood products contain antibody
Wash/reconstituted RBC small amount
IVIC/plasma products a large amount

Question 8

Homologous pooled human antibody (immune globulin)

Answer 8

Pooling of IgG antibody fraction from thousands of donors
Antibodies to many different antigens
Post exposure prophylaxis for Hep A and measles, tx of certain congenital immunoglobulin deficiencies.

Question 9

Homologous hyperimmune globin

Answer 9

High titers of specific antibody
Other antibodies due to donated plasma
Post-exposure prophylaxis for hep B, rabies, tetanus, and varicella

Question 10

Heterlogous hyperimmune serum (antitoxin)

Answer 10

Produced in animals mostly equine (serum sickness) and contains antibodies only against 1 antigen (botulism and diphtheria)

Question 11

Monoclonial antibodies

Answer 11

Produces from single clone of B cells
Antibody to one antigen or closely related antigen
Used for dx of certain cancers, prevention of transplant rejection, and tx of autoimmune dz.

Question 12

Monoclonial Antibodies- Palivizumab (Synagis)

Answer 12

prevention of RSV

Question 13

Active immunity- surviving infection

Answer 13

Memory B cells circulate and reside in bone marrow for years

Upon re-exposure to antigen memory B-cells replicate and reestablish protection.

Question 14

Active immunity- vaccination

Answer 14

Produce an immune response similar to that produced by natural infection but without the dz or complications.

Question 15

Influences on immune response to vaccination

Answer 15

Presence of maternal antibody, nature and dose of antigen, route of administration, presence of adjuvant, and host factors

Question 16

Live attenuated vaccine

Answer 16

Produced by modifying a disease-producing (wild type) virus or bacterium
Resulting organism retains ability to grow and produce immunity by usually does not cause illness

Question 17

Inactivated vaccine

Answer 17

Composed of whole viruses or bacteria or fractions of either
Protein based- toxoids and subunit or subviron products
Polysaccharide based- pure cell wall polysaccharide from bacteria

Question 18

Live attenuated

Answer 18

Weakened in lab therefore dz does not usually occur but a milder version.
Severe rxns possible due to uncontrolled replication in immunodeficient pts
Interfere w/ circulating antibodies (measles move sensitive polio and rotavirus least affected)
Usually require one does
Destroyed by heat and light

Question 19

Live attenuated vaccines- viral

Answer 19

MEASLES, MUMPS, RUBELLA, vaccinia (small pox), VARICELLA ZOSTER, yellow fever, ROTAVIRUS, INTRANASAL INFLUENZA, oral polio

Question 20

Live attenuated vaccines- bacterial

Answer 20

Oral typhoid vacccine

Question 21

Inactivated vaccine- info

Answer 21

Cannon replicate
Less interference from circulating antibodies
Generalyl 3-5 doses required
Immune response is mostly humoral
Antibody titer diminishes with time.

Question 22

Inactivated vaccines- whole-cell vaccines

Answer 22

Viral- polio, hep A, rabies

Bacterial- typhoid, cholera, plague (not available in the US)

Question 23

Inactivated vaccines- fractional vaccines

Answer 23

Subunit- hep B, influenza injection, acellular pertussis, human papillomavirus, anthrax
Toxoid- diptheria, tetanus

Question 24

Inactivated vaccines- polysaccharide vaccines

Answer 24

Pure polysaccharide- not consistently immunogenic in children <2. No booster response, antibody with less functional activity. Types: pneumococcal, meningococcal, salmonella typhi
Conjugated polysaccharides- improves upon immunogenicity, T cell dependent. Types: haemophilis influenzae type B (HIB), pneumococcal, meningococcal.

Question 25

Vaccination timing

Answer 25

Inactivated vaccines can be administered before, after, or at the same time as antibodies, live vaccines cannot.

Question 26

Administration

Answer 26

Separate MMR and varicella vaccines should be admin children 12 through 47 months of age for first dose
Individual vaccines SHOULD NOT be mixed in the same syringe.

Question 27

Multi-dosing intervals

Answer 27

Increasing interval b/w doses does not diminish the effectiveness
Decreasing the interval b/w doses MAY interfere w/ antibody response and protection

Question 28

ADRs-local, systemic, allergic

Answer 28

Local- 80% swelling, pain, redness at site of injection, common in inactivated vaccine, mild and self limiting
Systemic- fever, malaise, HA, may be unrelated to vaccine, live vaccines usually produce mild effects 7-12 days after
Allergic- very rare should be noted in the chart

Question 29

Contraindications

Answer 29

Permanent- severe allergic rxn, encephalopathy occurring 7 days post pertussis vaccine, severe combined immunodeficiency (rotavirus)
Temporary- pregnancy and immunosupression contraindications to live vaccines

Question 30

Precautions

Answer 30

Moderate or severe actue illness

Recent receipt of an antibody containing blood product

Question 31

Pregnancy and vaccines

Answer 31

Live vaccines should not be administered
Inactivated vaccines okay when indicated (Except HPV)
Household contacts of pregnant or immunocompromised persons should be vaccinated

Question 32

Breastfeeding and vaccines

Answer 32

Does not extend of improve passive immunity to vaccine preventable disease that is provided by maternal antibody except for hib.

Question 33

Diphtheria

Answer 33

Cause- bacterium cornybacterium diphtheriae (aeoribic gram positive bacillus)
Med management- Diphtheria antitoxin neutralizes circulating, antibiotics: ERY or procain Pen G
Prevention- close contacts of ill- diphtheria booster and abx

Question 34

Diphteria Toxoid

Answer 34

Pediatric diphtheria-tetanus toxoid (DT) or adult tetanus-diphtheria (Td)
< 7 yrs should receive DT > 7 yrs should receive adult Td
DTap (peds) and Tdap (adult) do not contain thimerosal as preservative

Question 35

Tetanus

Answer 35

Clostridium tentani produces toxins
Wound management- uncertain hx or 0-2 doses priot of tetanus toxoid should receive TIG as well as Td or Tdap
Vaccine- DT pediatric, Td for children >7

Question 36

Haemophilus Influenzae type B (Hib)

Answer 36

Gram (-) coccobacillus, generally aerobic but can grow as a facilitative anaerobe
Management- 3rd gen cephalosporin x 10days

Question 37

Hib vaccies

Answer 37

Two conjugate hib vaccines for infants >6wks (ActHIB-3 dose series and PEDvaxHIB 2 dose series
One hiberix for >12mo.
Vaccines utilize different carriers

Question 38

Hepatitis A

Answer 38

Inactivated whole virus vaccines for peds 12mo-18 yrs and adult formulas
COmbinations for hep A and B (Twinrix) for 18 and older
Risks- international travlers, men having sex w/ men, illegal drug users, clotting factor disorders, occupational risk, chronic liver disease

Question 39

Hepatitis B

Answer 39

Recombivax HB and engerix-B (contains aluminum hydroxide) in peds and adults
Comvax (combination Hib and hep B) not for 6wks and younger
Pediarix- contains DTap, engerix-B and inactivated polio vaccines

Question 40

Serologic Testing

Answer 40

Infants born to HBsAg-positive women should be tested after completion of at least 3 doses of hep B series, if HBsAg not present and anti-HBs antibody is present child can be considered to be protected.

Question 41

Polio

Answer 41

Inactivated Polio vaccine (IPV)
DTap-IPV/Hib (pentacel)
oral poliovirus vaccine in live attenuated and can be shed in the stool for up to 6 wks and transmitted

Question 42

Measles/Mumps/Rubella- MMR

Answer 42

Live attenuated available in combincation with rubella as MMR or in combination w/ rubella and varicella MMRV (MMR and varicella are live attenuated vaccines)
Both vaccines are preservative free, and contain small amounts of albumin, neomycin, sorbitol, and gelatin

Question 43

Pertussis

Answer 43

Whooping cough- primarily supportive management
Erythromycin drug of choice
Vaccine- 3 pediatric acellular vaccine and 2 adult acellular pertussis vaccines (BOTH W/ REDUCED AMOUNTS OF DIPHTHERIA TOXOID WHEN COMPARED TO PEDIATRIC FORMS)

Question 44

Rotavirus

Answer 44

Live oral vaccine (RV5) containes rotavirus from human and bovin parent strains.
Rotarix (RV1) one strain of live attenuated human rotavirus

Question 45

Human Papilloma Virus (HPV)

Answer 45

2 vaccines
Gardasil-Quadrivalent HPV- approved for femals and males 9-26 y/o. Protects against tupes 16, 18. (high risk) 6 and 11(low risk)
Cervarix-bivalent (HPV) for females aged 10-25. Protects against types 16 and 18.

Question 46

Meningococal

Answer 46

Neisseria meningitis is the leading cause of bacterial meningitis and sepsis in the US
Aerobic gram (-)
Manage-empiric broad spec abx after cultures, then more narrow PCN
Two vaccines- Menactra and Menveo for ages 2-55

Question 47

Influenza

Answer 47

Trivalent inactivated infleunza vaccine (3 inactivated viruses: type A H1N1 type A H3N2 and type B.
Live attenuated influenza vaccine- nasal spray approved for health, non-pregnant persons 2-49.
Vaccinated children can shed vaccine viruses in nasopharyngeal secretions for up to 3 wks

Question 48

Pneumococcal

Answer 48

Streptococcus pneumoniae- gram (+) bacteria
Pneumovaz 23- polysaccharide vaccine- routinely for >65 and indicated for >2 with normal immune systems and chronic illness or >19 years w/ asthma or smokers
PCV13- pneumococal conjugate vaccine- all children 2-59 months of age.

Question 49

Varicella

Answer 49

Varicella Zoster
Primary infection is chickenpox (varicella) and recurrent infection is herpes zoster (shingles)
Varicella vaccine is live attenuated (varivex)
Herpes Zoster vaccine- >60 yrs, contains same varicella zoster virus used in varicella and MMRV vaccines but a much higher titer.