Vaccinations Flashcards
Immunity
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
Immune system defense against antigen
Developed and is known as the immune response and usually involves the production of protein molecules by B lymphocytes.
Two basic mechanisms for acquiring immunity
Active and passive
Active immunity
Protection that is produced by the person’s own immune system. This type of immunity is usually permanent.
Passive immunity
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.
Passive Immunity-Mother to infant
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
Passive-immunity-blood products
Many blood products contain antibody
Wash/reconstituted RBC small amount
IVIC/plasma products a large amount
Homologous pooled human antibody (immune globulin)
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.
Homologous hyperimmune globin
High titers of specific antibody
Other antibodies due to donated plasma
Post-exposure prophylaxis for hep B, rabies, tetanus, and varicella
Heterlogous hyperimmune serum (antitoxin)
Produced in animals mostly equine (serum sickness) and contains antibodies only against 1 antigen (botulism and diphtheria)
Monoclonial antibodies
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.
Monoclonial Antibodies- Palivizumab (Synagis)
prevention of RSV
Active immunity- surviving infection
Memory B cells circulate and reside in bone marrow for years
Upon re-exposure to antigen memory B-cells replicate and reestablish protection.
Active immunity- vaccination
Produce an immune response similar to that produced by natural infection but without the dz or complications.
Influences on immune response to vaccination
Presence of maternal antibody, nature and dose of antigen, route of administration, presence of adjuvant, and host factors
Live attenuated vaccine
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
Inactivated vaccine
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
Live attenuated
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
Live attenuated vaccines- viral
MEASLES, MUMPS, RUBELLA, vaccinia (small pox), VARICELLA ZOSTER, yellow fever, ROTAVIRUS, INTRANASAL INFLUENZA, oral polio
Live attenuated vaccines- bacterial
Oral typhoid vacccine
Inactivated vaccine- info
Cannon replicate Less interference from circulating antibodies Generalyl 3-5 doses required Immune response is mostly humoral Antibody titer diminishes with time.
Inactivated vaccines- whole-cell vaccines
Viral- polio, hep A, rabies
Bacterial- typhoid, cholera, plague (not available in the US)
Inactivated vaccines- fractional vaccines
Subunit- hep B, influenza injection, acellular pertussis, human papillomavirus, anthrax
Toxoid- diptheria, tetanus
Inactivated vaccines- polysaccharide vaccines
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.
Vaccination timing
Inactivated vaccines can be administered before, after, or at the same time as antibodies, live vaccines cannot.
Administration
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.
Multi-dosing intervals
Increasing interval b/w doses does not diminish the effectiveness
Decreasing the interval b/w doses MAY interfere w/ antibody response and protection
ADRs-local, systemic, allergic
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
Contraindications
Permanent- severe allergic rxn, encephalopathy occurring 7 days post pertussis vaccine, severe combined immunodeficiency (rotavirus)
Temporary- pregnancy and immunosupression contraindications to live vaccines
Precautions
Moderate or severe actue illness
Recent receipt of an antibody containing blood product
Pregnancy and vaccines
Live vaccines should not be administered
Inactivated vaccines okay when indicated (Except HPV)
Household contacts of pregnant or immunocompromised persons should be vaccinated
Breastfeeding and vaccines
Does not extend of improve passive immunity to vaccine preventable disease that is provided by maternal antibody except for hib.
Diphtheria
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
Diphteria Toxoid
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
Tetanus
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
Haemophilus Influenzae type B (Hib)
Gram (-) coccobacillus, generally aerobic but can grow as a facilitative anaerobe
Management- 3rd gen cephalosporin x 10days
Hib vaccies
Two conjugate hib vaccines for infants >6wks (ActHIB-3 dose series and PEDvaxHIB 2 dose series
One hiberix for >12mo.
Vaccines utilize different carriers
Hepatitis A
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
Hepatitis B
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
Serologic Testing
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.
Polio
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
Measles/Mumps/Rubella- MMR
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
Pertussis
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)
Rotavirus
Live oral vaccine (RV5) containes rotavirus from human and bovin parent strains.
Rotarix (RV1) one strain of live attenuated human rotavirus
Human Papilloma Virus (HPV)
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.
Meningococal
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
Influenza
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
Pneumococcal
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.
Varicella
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.
