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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
Q

Give examples of viral vectored vaccines

A

Ebola

26
Q

Give examples of nucleic acid vaccines

A

SARS-CoV-2

27
Q

What is a live attenuated vaccine?

A

Pathogen weakened under lab conditions
Can replicate and cause infection in host (mild disease)

28
Q

How is the immune response with a live attenuated vaccine?

A

Robust
Long-lasting

29
Q

In which patients should you take caution with live attenuated vaccines?

A

Immunocompromised

30
Q

What is an example of a live attenuated vaccine that can revert to a pathogenic form?

A

VDPV

31
Q

What are inactivated vaccines?

A

Pathogens killed through physical/chemical process
Not able to replicate -> not able to cause disease

32
Q

How is the immune response with an inactivated vaccine?

A

May not always induce an immune response (several doses required)
May not be long-lived

33
Q

What is the advantage to inactivated vaccines vs live vaccines?

A

Safer
More stable

34
Q

What is a subunit vaccine?

A

Contains only antigenic parts of pathogen (protein based, polysaccharide, conjugate)

35
Q

How is the immune response for a subunit vaccine?

A

Less strong
May require adjuvant

36
Q

What is the advantage to subunit vaccines vs live vaccines?

A

Very safe
Good stability

37
Q

What are monovalent vaccines?

A

Single strain of single antigen

38
Q

Give an example of a monovalent vaccine

A

Measles

39
Q

Give an example of a polyvalent vaccine

A

PCV

40
Q

What are the advantages of a combination vaccine?

A

Decreased administration cost
Fewer hospital visits
Less injections

41
Q

What are routes of vaccine administration?

A

Oral
IM
SC
Intradermal
Intranasal

42
Q

How can vaccines be classified?

A
  1. Type (live, inactivated, subunit, toxoid)
  2. Route of administration
  3. Valency (monovalent vs polyvalent)
43
Q

Discuss the stages of a clinical trial

A
  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
Q

How do we measure how vaccines work?

A
  1. Safety
  2. Immunogenicity
  3. Efficacy
  4. Effectiveness
  5. Impact
45
Q

How is vaccine safety measured?

A

Reactogenicity
Adverse events

46
Q

How is vaccine immunogenicity measured?

A

Antibody titres
Seroconversion
T cell immunity

47
Q

How is vaccine efficacy measured?

A

RCTs

48
Q

How is vaccine effectiveness measured?

A

Real world conditions
Case-control studies

49
Q

How is vaccine impact measured?

A

Ecological studies

50
Q

What are the new changes to the South African EPI?

A

Tdap in pregnancy 26-34w
MR vaccine at 6 and 12m
Targeted HBV at birth

51
Q

What are recommended vaccines in pregnancy currently and in development?

A

Influenza
Tdap
Covid 19
RSV
GBS

52
Q

Name complications of GBS in fetus

A

Spontaneous abortion
Preterm birth
Stillbirth
Pneumonia
Sepsis
Meningitis

53
Q

Name complications of GBS in mother

A

PTL
Spontaneous abortion
Bacteremia
Puerperal sepsis
Mastitis
UTI
Hemorrhage
Death

54
Q

What are new vaccines globally?

A

Malaria (mosquirix)
Ebola (ervebo)
Mpox

55
Q

How is vaccine safety monitored?

A

Brighton collaboration

56
Q

How is vaccine safety in pregnancy monitored?

A

GAIA approach

57
Q
A

DTMH Block 4 (14 decks)

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