Vaccine-Table 1 Flashcards
What is immunity?
the ability of the human body to tolerate self and to eliminate foreign (“nonself”) material
What is the immune response?
a defense against the antigen
usually involves the production of protein molecules by B lymphocytes
What is active immunity?
Protection that is produced by the person’s own immune system. This type of immunity is usually permanent.
What is passive immunity?
Protection by products produced by an animal or human and transferred to another human, usually by injection.
When are antibodies transported across the placenta?
last 1-2 months of pregnancy
What can be given for post-exposure prophylaxis for Hep A and measles?
Homologous pooled human antibody (immune globulin)
What can be given for post-exposure prophylaxis for Hep B, rabies, tetanus, and varicella?
Homologous human hyperimmune globin
What can be used to tx botulism and diptheria?
Heterologous hyperimmune serum (antitoxin)
What are monoclonal antibodies produced from?
Single clone of B cells
What are monoclonal antibodies used for?
Diagnosing certain types of CA, tx of CA, prevention of transplant rejection, and tx of autoimmune dz
What monoclonal antibody is used for prevention of RSV?
Palivizumab
What are ways you can obtain active immunity?
Surviving infection and vaccination
What factors influence immune response to vaccination?
Presence of maternal antibody Nature and dose of antigen Route of administration Presence of adjuvant (aluminum-containing material) Host factors
What are live attenuated vaccines produced from?
Produced by modifying a disease-producing (wild type) virus or bacterium
Resulting organism retains ability to grow and produce immunity but usually does not cause illness
What are inactivated vaccines composed of?
whole viruses or bacteria or fractions of either (protein based or polysaccharide based)
What are the protein based inactivated viruses?
Toxoids (inactivated bacterial toxin)
Subunit or subviron products
What are the polysaccharide based inactivated viruses composed of?
pure cell wall polysaccharide from bacteria
Why are severe rxns possible in live attenuated viruses?
uncontrolled replication in pts with immunodef
How are live attenuated viruses destroyed?
By heat and light
What are the viral live attenuated vaccines?
Measles, mumps, rubella, vaccinia (small pox), varicella zoster, yellow fever, rotavirus, intranasal influenza, oral polio
What are the bacterial live attenuated vaccines?
Oral typhoid vaccine
How many doses does an inactivated vaccine typically require?
3-5 doses
First dose primes immune system, immune response develops after 2nd or 3rd dose
The immune response to inactivated vaccines is what?
Usually humoral
What are the viral whole cell vaccines?
Polio, hepatitis A, rabies
What are the bacterial whole cell vaccines?
Typhoid, cholera, plague – Not available in US
Wbat are the fractional subunit inactivated vaccines?
Hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax
What are the fractional toxoid vaccines?
Diptheria, tetanus
What are the types of pure polysaccharide vaccines?
Pneumococcal
Meningococcal
Salmonella Typhi (Vi)
What are the types of conjugate polysaccharide ( Tcell dependent) vaccines?
×Haemophilis influenzae type B (Hib)
×Pneumococcal
×Meningococcal
When should vaccines not be administered?
Do not administer before the minimum age
Do not administer before the minimum interval between doses
Do not restart series
Does coadmin of vaccines overload the immune system?
no
If live vaccines are administered together, should they be separated?
Yes, by 4 weeks
what is the timing for administering inactivated vaccines and antibodies?
before, after, or at the same time as each other
Can oral vaccines be affected by circulating antibodies?
No, live influenza and rotavirus are not believed to be affected by antibodies
How long should you wait after a live vaccine before giving antibodies?
2 weeks- this is the incubation period
How long should you wait to give a live vaccine after distributing antibodies?
3 mo
Does increasing the interval btwn dosing of multi dose vaccines diminish the effectiveness?
Nope, but DECREASING may interfere with antibody response and protection
What are the local ADRs of vaccines?
Pain, swelling, redness at site of injection
Common with inactivated vaccines
Usually mild and self limiting
What are the systemic ADRs of vaccines?
Fever, malaise, headache- nonspecific
These s/s May be unrelated to vaccine
How long after live vaccines do systemic ADRs tend to occur?
7-21 days after vaccine
What are CI to receiving live vaccines?
Malignancy, radiation, chemotherapy Immunosuppressive therapy >20mg/d of prednisone TNF and non-TNF biologics (e.g. infliximab, rituximab)1 HIV adult patients with CD4
What are not actual CI to live vaccines?
Mild disease –low-grade fever, URI, otitis media, mild diarrhea
Antibiotic therapy
Breastfeeding
Premature birth
Pregnancy or immunosuppression in household
Warfarin
What are permanent CI to live vaccines- by permanent, they will never receive the vaccine for the rest of their life?
Severe allergic reaction to a vaccine component or following a prior dose (all vaccines)
Allergic reaction to eggs no influenza vaccine
Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccine
Severe combined immunodeficiency (rotavirus)
When should you take precaution when administering vaccines?
- mod to severe acute illness- delay all vaccine until illness has improved
- if pt recently received antibody containing blood products, hold odd on MMR and varicella
What are the guidelines for pregnancy and vaccinations?
1) live vaccines are a no
2) inactivated are ok when indicated
3) household contacts should be vaccinated
Does breastfedding extend or improve passive immunity to vaccine preventable dzs?
NO
All preterm infants born to hepatitis B surface antigen positive mothers and mothers with unknown HBsAg status must receive what within 12 hours after birth?
immunoprophylaxis with hepatitis B vaccine and Hepatitis B immunoglobulin (HBIG)
What causes the toxin-mediated dz diptheria?
Corynebacterium diphtheriae
Aerobic gram positive bacillus
What is the medical management for diptheria?
Diphtheria antitoxin neutralizes circulating (unbound toxin) –available from CDC
Antibiotics- ERY or procaine PEN G
How can diptheria be prevented?
Close contacts of ill: diphtheria booster and antibiotics
How is the diptheria toxoid available?
Combo with tetanus- different adult and peds
Or combined with tetanus and pertussis
What is the difference btwn DT and Td?
DT contains 3-4 times as much diphtheria toxoid, but same amounts of tetanus toxoid
At what age should pts receive DT vs Td?
7 years should receive adult Td
Do DTaP and Tdap contain thimerosal as a preservative?
NOPE
What produces toxins in tetanus?
Clostridium tetani
How should you manage wounds with concern of tetanus?
Uncertain history or 0-2 prior doses of tetanus toxoid should receive TIG as well as Td or Tdap
TIG provides temporary immunity
How is the tetanus vaccine given?
DT pediatric
Td for children 7 years and up
How is pertussis tx?
Management- Primarily supportive
Erythromycin drug of choice
What are the 2 adult acellular pertussis vaccines?
Boostrix and Adacel – these have reduced diptheria toxoid
What should Tdap be administered?
1) Single dose of Tdap vaccine for previously unvaccinated individuals ≥ 11years of age
2) Td booster q 10 yrs
3) Preggos need Tdap at 27-36 weeks in each preggo
What was the leading cause of bacterial meningitis before the vaccine was introduced?
Haemophilus influenzae type B
Gram negative coccobacillus, generally aerobic but can grow as a facilitative anaerobe
How is bacterial meningitis managed?
Third generation cephalosporin X 10 days
What are the H B vaccines?
1) Two conjugate Hib vaccines are licensed for use in infants as young as 6 weeks (ActHIB-3 dose series and PedvaxHIB- 2 dose series)
2) One (Hiberix) approved only for the last dose of the schedule among children 12 months and older (booster regardless of which primary vaccine)
What type of vaccine is Hep A?
Inactivated whole virus vaccines (HAVRIX and VAQTA)
both available in pediatric(up to 18)and adult formulations
Who should be vaccinated for Hep A?
International travelers, men who have sex with men, illegal drug users, clotting factor disorders, occupational risk (those who work with hep A infected primates or with Hep A virus in a lab setting), chronic liver disease
What are the Hep B vaccine options?
Recombivax HB and Engerix-B – adult and peds
Comvax (combination Hib and Hep B)-not used under 6weeks or for the first schedule either at birth or 1 mo
Pediarix- DTaP, Engerix-B, and inactivated polio, cant be used for birth dose of hepB
When can an infant born to a HBsAg-positive women be considered protected?
if HBsAg not present and anti-HBs antibody is present following at least 3 doses of a Hep B series
What does the polio vaccine contain?
Inactivated Polio vaccine 1 vaccine IPOL contains trace amounts of neomycin, streptomycin, and polymixin B
What is the issue with the oral poliovirus vaccine?
shed in stool for up to 6 weeks (transmission possible)
What live attenuated viruses are conservative free and contain a small amount of albumin, neomycin, sorbitol, and gelatin
Measles/mumps/rubella
What are the types of rotavirus?
1) RotaTeq a live oral vaccine (RV5) contains rotaviruses from human and bovine parent strains
2) Rotarix (RV1) one strain of live attenuated human rotavirus
What are the 2 types of HPV vaccines?
Gardasil- Quadrivalent HPV (HPV4)
Cervarix- Bivalent HPV (HPV2) Contains type 16 and 18
What does gardisil protect against?
types 16 and 18 (high risk-cervical cancer) and types 6 and 11 (low risk-genital warts)
What is gardisil approved for use for?
Approved for use in females and males age 9-26 years
What does cervarix protect against?
Types 16/18
What is cervarix approved for?
use in females age 10-25
What is the leading cause of bacterial meningitis and sepsis in the US?
Neisseria meningitidis -Aerobic gram negative bacteria
How is Neisseria meningitidis managed?
Empiric broad spec abx after cultures obtained, then more narrow PCN
What are the 2 vaccines for Neisseria meningitidis ?
Menactra and Menveo for persons 2 through 55 years of age
What are the types of egg based influenza?
Live attenuated (LAIV)- pts 2-49
Inactivated (IIV)- standard dose IM>6mo
High dose IM >/=65
