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DTMH Block 4 > Vaccines > Flashcards

Vaccines Flashcards

1
Q

Discuss improved life expectancy with vaccination

A
  1. No intervention other than clean water has saved more lives against infectious diseases
  2. 154 million deaths averted since 1974
    - 146 million children <5y
    - 101 million infants <1yo
  3. Vaccines responsible for 40% of decline in global infant mortality (52% in Africa)
  4. 2024 children <10yo 40% more likely to survive to next birthday
  5. Increase survival probability into late adulthood
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2
Q

What was the first vaccine created?

A

Edward Jenner - cowpox used to make smallpox vaccine

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3
Q

What was the second vaccine created?

A

Louis Pasteur - rabies

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4
Q

Which vaccines were developed in the 1930s?

A

Typhoid
Cholera
Plague
Diphtheria
Tetanus
Pertussis
BCG

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5
Q

What factor in the 20th century resulted in increased vaccine discoveries and innovations?

A

Ability to grow viruses in the lab

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6
Q

Define a vaccine

A

Biological product that can be used safely to induce an immune response that confers protection against infection/disease on subsequent exposure to the pathogen

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7
Q

Which clinical end points are measured in clinical trials to assess vaccine protection?

A

Infection prevention
Disease severity reduction
Decreased hospitalisation rate

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8
Q

What are the 2 adaptive immune responses and what are they mediated by?

A

Humoral - B cells
Cellular - T cells

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9
Q

Which vaccines mainly confer protection through B cell response?

A

All except BCG
Most also induce T cell

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10
Q

What are correlates of protection?

A

Biomarker validated to reliably predict vaccine efficacy
Measurable immune responses associated with protection

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11
Q

What are examples of vaccines that use correlates of protection?

A

Influenza
Typhoid

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12
Q

Discuss herd protection

A

Herd = indirect protection of individuals who would otherwise be susceptible if
a) enough individuals in the population are vaccinated
b) vaccination prevent disease AND infection

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13
Q

What is an example of how herd protection resulted in infection eradication?

A

1999 UK campaign capsular group C meningococcal vaccine <19yo

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14
Q

Name 2 highly transmissible pathogens that require high vaccine coverage (>95%)

A

Measles
Pertussis

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15
Q

Name less transmissible pathogens that require a lower vaccine coverage (<86%)

A

Polio
Rubella
Mumps
Diphtheria

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16
Q

Define a live vaccine

A

Contains attenuated replicating strains of the relevant pathogen

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17
Q

Define a non-live vaccine

A

Contains only components of a pathogen OR killed whole organism

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18
Q

Give examples of live attenuated vaccines

A

MMR
YF
Influenza
Oral polio
Typhoid
Rotavirus
BCG
VZV
Japanese encephalitis

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19
Q

Give examples of killed whole organism vaccines

A

Whole cell pertussis
Polio
Influenza
Hepatitis A
Rabies
Japanese encephalitis

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20
Q

Give examples of toxoid vaccines

A

Diphtheria
Tetanus

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21
Q

Give examples of subunit vaccines

A

Pertussis
Influenza
Hepatitis B
Meningococcal
Pneumococcal
Typhoid
Hepatitis A

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22
Q

Give examples of virus-like particle vaccines

A

HPV

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23
Q

Give examples of outer membrane vesicle vaccines

A

Group B meningococcal

24
Q

Give examples of protein-polysaccharide conjugate vaccines

A

Haeif B
Pneumococcal
Meningococcal
Typhoid

25
Give examples of viral vectored vaccines
Ebola
26
Give examples of nucleic acid vaccines
SARS-CoV-2
27
What is a live attenuated vaccine?
Pathogen weakened under lab conditions Can replicate and cause infection in host (mild disease)
28
How is the immune response with a live attenuated vaccine?
Robust Long-lasting
29
In which patients should you take caution with live attenuated vaccines?
Immunocompromised
30
What is an example of a live attenuated vaccine that can revert to a pathogenic form?
VDPV
31
What are inactivated vaccines?
Pathogens killed through physical/chemical process Not able to replicate -> not able to cause disease
32
How is the immune response with an inactivated vaccine?
May not always induce an immune response (several doses required) May not be long-lived
33
What is the advantage to inactivated vaccines vs live vaccines?
Safer More stable
34
What is a subunit vaccine?
Contains only antigenic parts of pathogen (protein based, polysaccharide, conjugate)
35
How is the immune response for a subunit vaccine?
Less strong May require adjuvant
36
What is the advantage to subunit vaccines vs live vaccines?
Very safe Good stability
37
What are monovalent vaccines?
Single strain of single antigen
38
Give an example of a monovalent vaccine
Measles
39
Give an example of a polyvalent vaccine
PCV
40
What are the advantages of a combination vaccine?
Decreased administration cost Fewer hospital visits Less injections
41
What are routes of vaccine administration?
Oral IM SC Intradermal Intranasal
42
How can vaccines be classified?
1. Type (live, inactivated, subunit, toxoid) 2. Route of administration 3. Valency (monovalent vs polyvalent)
43
Discuss the stages of a clinical trial
1. Exploratory phase - antigen identification 2. Pre-clinical testing - cell culture - animal models 3. Phase 1 - safety - immunogenicity 4. Phase 2 - safety - immunogenicity - dose - schedule - efficacy 5. Phase 3 - safety - efficacy 6. Post licensing monitoring - safety - impact
44
How do we measure how vaccines work?
1. Safety 2. Immunogenicity 3. Efficacy 4. Effectiveness 5. Impact
45
How is vaccine safety measured?
Reactogenicity Adverse events
46
How is vaccine immunogenicity measured?
Antibody titres Seroconversion T cell immunity
47
How is vaccine efficacy measured?
RCTs
48
How is vaccine effectiveness measured?
Real world conditions Case-control studies
49
How is vaccine impact measured?
Ecological studies
50
What are the new changes to the South African EPI?
Tdap in pregnancy 26-34w MR vaccine at 6 and 12m Targeted HBV at birth
51
What are recommended vaccines in pregnancy currently and in development?
Influenza Tdap Covid 19 RSV GBS
52
Name complications of GBS in fetus
Spontaneous abortion Preterm birth Stillbirth Pneumonia Sepsis Meningitis
53
Name complications of GBS in mother
PTL Spontaneous abortion Bacteremia Puerperal sepsis Mastitis UTI Hemorrhage Death
54
What are new vaccines globally?
Malaria (mosquirix) Ebola (ervebo) Mpox
55
How is vaccine safety monitored?
Brighton collaboration
56
How is vaccine safety in pregnancy monitored?
GAIA approach
57

DTMH Block 4 (14 decks)

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