Vaccinations and Nosocomials

Question 1

passive immunity

common uses?

Answer 1

maternal IgG transplacentally
IgA via breast milk

chicken pox
CMV, RSV, snake bit
TSS, rabies, tetanus,
measles, Hep A/B

Question 2

uses:
horse immunoglobulin
pooled human plasma
specific high titer Ig
monoclonal Ab (in vitro)

Answer 2

snake bite anti venom
HepA
Varicella
RSV

Question 3

advantages of passive immunity

disadvantages

Answer 3

rapid onset
not dependent on fxnl immune sys

cost/adverse events (anaphylaxis)
short duration
parenteral administration

Question 4

immunology pathway

Answer 4

antigen –> APC –> B cell activation –> memory B(T), and plasma cell –> antibody

Question 5

attenuated vaccines
advantages?
disadvantages?

Answer 5

live, weakened
retain capacity to reproduce in host
often non-virulent mutants

provide prolonged exposure
good humoral/cellular response
no/few boosters

can produce minor disease
potential to revert to virulent form
recipient may shed vaccine

e.g. polio virus (more vaccine-assoc cases than regular cases)

Question 6

avoid live/attenuated vaccines in whom?

Answer 6

immunocompromised

pregnant women e.g. rubella

Question 7

inactivated vaccine

Answer 7

mainly illicit humoral response
cannot reproduce in host
cannot revert to disease
mixture of antigens (more chance for SE's)
requires boosters

Question 8

purified subunit vaccines

downside?

Answer 8

one or more purified antigens
same as inactivated except lower adverse event rate
e.g. “toxoid” vaccines
may not prevent infection, but prevents disease manifestations

Question 9

purifies subunit vaccines: polysaccharide vaccines

Answer 9

Ab binds to capsule –> phagocytosis and neutralization
e.g. pneumo/meningococcus
kids <2 cannot generate response

SOLUTION: conjugate vaccine; covalent linkage to a protein that fools immune sys and allows for a response (pneumo/meningococc; H flu type B

Question 10

surface antigen vaccines

Answer 10

purified molecules on surface of organism (Hep B/pertussis)

Question 11

adjuvant

Answer 11

inert substance –> causes increased antibody response

increases uptake of antigen by APC’s and also incr synthesis of cytokines e.g. alum

Question 12

other stuff!

Answer 12

preservatives: thimerosol, antibiotics, vector remains

Question 13

goals of vaccination

Answer 13

1) prevent disease (h flu B in kids)
2) prevent disease in a pop (rubella in childbearing women)
3) eradicate disease on earth (small pox)

Question 14

immunogenicity

Answer 14

ability to illicit an immune response (measured as a concentration of Ab in serum)
does not neck mean it will prevent disease (=efficacy)

Question 15

how much of pop immunized to see herd immunity effects?

Answer 15

60% ~in influenza

Question 16

vaccination success?

Answer 16

report all vaccine-preventable diseases to public health office

Question 17

why under-immunization?

Answer 17

parental apathy, lack of knowledge, forgetfulness
doctor ignorance
parental concern
missed opportunity
cost: now cannot (VFC) be denied for inability to pay
# of injections (no upper limit!)
cultural/religious beliefs
logistical (convenience)
vaccine shortage
record keeping (WIR)
fear of lawsuits (vaccine injury comp fund)
access to care

Question 18

how to improve rates?

Answer 18

early and often
get it out of clinic (walgreens)
state/school/daycare passport laws
combine vaccines (5:1)
goal: one injection at birth to cover all