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CMBM exam 5 > VACCINES!!!! > Flashcards

VACCINES!!!! Flashcards

0
Q

Immunization

A

process by which a person or animal becomes protected against a disease
often interchangeable with vaccination or inoculation

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1
Q

How is it that smallpox was eradicated?

A

Humans are the only host
were able to identify a vaccine target
effective vaccine
virus is stable

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2
Q

Vaccine

A

product that produces immunity therefore protecting the body from the disease

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3
Q

Active immunization

A

directed at a specific organism
injection of killed, weakened or subunit of an infectious organism in order to elicit an immune response which is effective at preventing the disease when encountered

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4
Q

Passive immunization

A

alternative to vaccination for those already infected or are immunodeficient
may be acquired naturally (breatmilk) or artifically (Ab containing preparation)

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5
Q

Two types of Ab preparations are available

A
  1. normal human immunoglobin (pooled sera)
  2. specific hyper immune human immunoglobin
    - preformed antibodies taken from an individual (s) during convalescence or following vaccination
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6
Q

what are requirements for a successful vaccine?

A

safety
induction of protective immune response (effectiveness, proper cell responses must be evoked)
Practical issues - affordable, stable, administration, perception

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7
Q

Vaccine efficacy is related to

A

duration of immunity elicited

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8
Q

Traveler’s vaccines last

A

a short period
months to years for Cholera
Two years for TAB vaccine - typhoid/parathypoid

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9
Q

DTap vaccine

A

lasts 3 to 5 years

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10
Q

BCG vaccine

A

5 or more years

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11
Q

Vaccines that last about ten years

A

Tetanus (Td) yellow fever

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12
Q

Vaccines with solid immunity/lifetime

A

MMR - measles, mumps and rubella

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13
Q

What are efficacies of some vaccines given?

A

Absolutely protective - 100% - yellow fever vaccine
almost abs. protective - Variola, measles, mumps, rubella, diphtheria and tetanus
highly protective - (80-95%) - polio, BC, Hep B, and pertussis
Moderately protective - (40-60%) - TAB, cholera vaccine, and influenza

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14
Q

Herd immunity

A

acts as firewall to block or slow disease transmission
since some vaccines do not cover 100% of people, some people given the vaccine will remain unprotected
some people are not able to receive vaccines - the immunocompromised - so this is most effective way to protect these ppl
for non infectious diseases - there is no herd immunity

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15
Q

Additives used in production of vaccines may include

A

suspending fluid - sterile water, saline, or fluids containing proteins
Preservatives and stabilizers - helps it remain potent and unchanged - albumin, phenols, glycine
adjuvants or enhancers to help the vaccine to be more effective

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16
Q

Some common ingredients in vaccines

A

aluminum gels or salts - adjuvant
antibiotics - no vaccine in the US has penicilllin
Albumin - egg protein in influenza and yellow fever vaccines
Formaldehyde - to inactivate bacterial products for toxoid vaccines (most is removed before packaging)
Monosodium glutamate and 2-phenoxy-ethanol - stabilizers in a few vaccines, help vaccine remain unchanged when exposed to heat, light, acidity or humidity
thimersol - mercury containing preservative, in vials of vaccine that contain more than one dose to prevent contamination, All US vaccines are available with no or trace amounts of thimersol

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17
Q

Types of vaccines

A

Live attenuated vaccines
Non living whole organisms vaccines
Non-living subcellular fragment vaccines
Passive immunization

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18
Q

Live attenuated vaccines

A

microbes with artificially reduced virulence

microbes with naturally reduced virulence for humans

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19
Q

Non-living whole organism vaccines

A

inactivated/killed whole organism

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20
Q

Non-living subcellular fragment vaccines

A

toxoid - inactivated toxin
recombinant vecor expressing protein of interest
surface antigen alone - peptide or capsular polysaccharide
Conjugate vaccines

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21
Q

In live attenuated vaccines where the microbe has artifically reduced virulence usually

A

do not cause serious disease in healthy ppl

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22
Q

Genetic roulette

A

randomly mutated by imposing unusual growth conditions
low temp, abnormal host cell, and select for loss of virulence with continued antigenicity
Measles, mumps, rubella, influenza, VZV, polio (sabin), yellow fever, BCG
site directed mutations and deliberate deletions of virulence genes

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23
Q

Microbes with naturally reduced virulence for humans

A

pathogen from related species can be used to elicit protective response
vaccinia virus for smallpox
rotavirus vaccine - reassortant virus with gene segments from human and animal rotaviruses or an attenuated human rotavirus

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24
Advantages of live attenuated vaccines
elicit a better memory response than killed vaccines, therefore, provide longer-lasting immunity - replication competent (to an extent) - localize to site where protection is required - OPV (sabin) vaccine induces gut immunity (IgA) vs. IPV (Salk) inducing IgG (IM)
25
Disadvantages of Live attenuated vaccines
instability if cold chain not maintained potential for reversion to wild-type and production of disease small probability of causing serious disease in IC/immunodeficient pts -OPV (Sabin) vaccine -Smallpox vaccine in person with eczema (immunodeficient) or HIV pt
26
Attenuation
the process of weakening a pathogen 1. serial passage in cells cultured in vitro (OPV) 2. adaptation to low temperature (intranasal influenza vaccine)
27
What is serial passage?
pathogenic virus is isolated from a pt and grown in human cultured cells then cultured virus is used to infect monkey cells then virus acquires many mutations that allow it to grow well in monkey cells Lastly, the virus no longer grows well in human cells amd may be a candidate for a vaccine
28
Induced immune response from Live attenuated vaccines
virtually identical to that produced by natural infection - leads to more robust immune response overall Humoral immunity - Ab responses to surface proteins Cell mediated immunity - CD4 and CD8 responses
29
Characteristics of non living whole organism vaccines (killed or inactivated)
used where live vaccines are not available could be because attentuation was not achieved or reversion to wild type occurs too easily it loses the capacity to replicate in the host but maintains the antigenic properties of some of its components - Rabies, IPV (salk), Hep A
30
Advantages of Killed/non living whole organism vaccines
non infective, therefore relatively safe
31
Disadvantage of non living, whole organisms vaccines
lower immunogenicity therefore needs several doses (prime boost)
32
Inactivation methods
Beta-propiolactone (rabies, influenza) Formaldehyde/formalin (polio-salk, Hep A, Yersinia pestis) Heat (vibrio cholerae) Heat plus phenol or acetome (salmonella typhi) Heat or formaldehyde (bordetella pertussis) Colicin (E. coli) - endonuclease that destroys chromosomal and plasmid DNA, leaving intact cells with a normal complement of antigens UV irradiation Gamma irradiation
33
Examples of non living subcellular fragment vaccines
acellular pertussis vaccine (aP) Influenza vaccine Polysaccharide capsules of pneumococci, haemo. and meningococci surface coat of hep B, which is produced by recombinant DNA tech fragmented virus or purified surface antigens of influenza virus protein filaments (pili) used by E. Coli and Neisseria gono. to attach to urinary tract epithelium (still experimental)
34
Tetanospasmin
Toxoid vaccine inactivated bacterial toxins that induce neutralizing antibody toxin in activated and used to immunize
35
DTP
Diphtheria, tetanus in combination with killed Bordetella pertussis (diphtheria, tetanus, pertussis) Omission of pertussis component reduces the antibody response to the two toxoids thus pertussis acts as an adjuvant as well as vaccine
36
Recombinant vector vaccine
a variety of viruses and bacteria can be used as vectors for cloned genes (genetic engineering) Expression vector, complete with inserted gene(s), is itself the vaccine Following injection, it will proliferate sufficiently to release an immunizing amount of foreign protein, but without inducing disease itself
37
Successful recombinant vaccines
Hep B, respiratory syncytial virus, EBV, rabies virus, dengue virus and lassa fever virus
38
HPV vaccine includes virus like particle
single viral protein isolated/strain of virus 2 vaccines available provide protection vs. 2 or 4 strains of HPV when proteins are expressed, virus-like particles (VLPs) are created contain no genetic material from the viruses
39
Expression vector vaccine examples
attenuated yellow fever virus, adenovirus, HSV, VZV, VacV, attenuated salmonellae, BCG, S. Typhi
40
Polysaccharide and polypeptide (cellular faction or recombinant) vaccine
prepared from extracted cellular fractions prepped using recombinant technology Their efficacy and safety appear to be high
41
Example of polysaccharide and polypeptide vaccine
Hepatitis B polypeptide vaccine - HbS Ag
42
Example of recombinant vaccine
Influenza (shot) with HA and NA surface antigen proteins as immunogens
43
Method for enhancing immunogenicity of inactivated and subunit vaccines?
Addition of an adjuvant
44
Adjuvant
substance that enhances T cell activation by promoting accumulation of APCs at site of antigen exposure and enhancing co-stimulator and cytokine expression by the APCs
45
Examples of Adjuvants
Aluminum: aluminum hydroxide, aluminum phosphate Alum: potassium salts Mixed aluminum salts ASO4 (is it supposed to be AlSO4?), a mixture of alum and a bacterial lipid molecule (cervarix)
46
Benefits of adjuvants
prolongation of antigen release activation of macrophages mitogenicity on lymphocytes Reduces the amount of the active component required in a vaccine leads to stronger, more sustained immune response, therefore, fewer doses needed Elderly, young and IC require an extra boost to provide protection and adjuvant gives this
47
Mice were given antigen in saline or in Freuds incomplete adjuvant. Which had a greater response? why?
Antigen in freuds incomplete adjuvant elicited a greater response. Freud's adjuvant contains fragment of TB, this helps to elicit a strong and more sustained immune response
48
Conjugate vaccine
made using combination of two different bacterial components bacterial coats chemically linked to a carrier protein used to increase antigenicity Ex. pneumococcal bacterial vaccination
49
Tetanus or diphtheria toxoids as a 'carrier' protein
most ppl have been immunized and posses tetanus-specific memory T cells which will help the peptide-specific B cells make antibody useful for inducing a good primary response not effective for establishing memory response, where T cells need to be recalled by the proteins of the infection rather than by those of tetanus
50
example of Toxoid conjugate vaccine
cholera toxin B subunit in combination with killed organisms licensed in europe as an oral vaccine protects for 4-6 months (effective in about 61-86% of people)
51
safety Problems with Live attenuated vaccines
``` insufficient attenutation reversion to wild type administration to immunodeficient patient persistent infection contamination by other viruses fetal damage ```
52
safety issues with Killed/inactivated vaccines
contamination by toxins or chemicals allergic reactions autoimmunity
53
Safety of vaccine component - Aluminum
``` implicated as a cause of brain damage suspected factor Alzheimer's disease dementia seizures and coma allergic rxns can occur on skin ```
54
Vaccine safety: Formaldehyde (formalin)
poisonous if ingested probable carcinogen suspected GI, liver, immune system, nerve, reproductive system and respiratory poison linked to leukemia, brain, colon, and lymphatic cancer
55
Vaccine safety: Thimerosal
autism scare but debunked since 2001, with exception of some influenza vaccines, is not used as a preservative in routinely recommended childhood vaccines
56
For vaccine development FDA sets rules for the 3 phases. Always tested on adults first Phase 1
``` 20-100 volunteers is this vaccine safe? does this vaccine seem to work? are there any side effects? How is the size of the dose related to side effects? ```
57
Phase 2 of vaccine development
several hundred volunteers what are the most common short term side effects? how are the volunteers immune system responding to the vaccine?
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Phase 3 of vaccine development
``` Hundreds or thousands of volunteers how do ppl who get the vaccine and ppl who do not get the vaccine compare? is the vaccine safe? is the vaccine effective? what are the most common side effects? ```
59
FDA licenses vaccines only if
its safe and effective | benefits outweigh the risks
60
ACIP or advisory committee on immunization practices
group of medical and public health experts members of american academy of pediatrics (AAP) and american academy of family physicians (AAFP) are among some of the groups that also bring related immunization expertise to the committee develop recommendations for vaccine use
61
ACIP recommendations are not official until
the CDC director reviews and approves them and they are published these recommendations then become part of the US official childhood immunization schedule
62
VAERS - Vaccine Adverse event reporting system
collects and analyzes reports of adverse events that happen after vaccination anyone can submit a report, including parents, patients and healthcare professionals
63
Vaccine safety datalink
network of healthcare organizations across of the US healthcare information available of over 9 million ppl scientists use VSD to conduct studies to evaluate the safety of vaccines and determine if possible side effects are actually associated with vaccination
64
Vaccine preventable diseases on the US required vaccine schedule
``` DTaP or TDaP Hep A and B H. Inf - Hib Influenza - seasonal flu MMR Meningococcal Pneumococcal Polio Rotavirus Varicella ```
65
FYI additional vaccine preventable diseases
``` Anthrax Cervical cancer HPV H1N1 flu Japanese Encephalitis Lyme disease Monkey pox Rabies Shingles Smallpox TB Typhoid fever Yellow fever ```
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Examples of Live, attenuated vaccines
MMR varicella Influenza (nasal spray) Rotavirus
67
Examples of inactivated/killed vaccines
Polio (IPV) | Hep A
68
examples of Toxoid (inactivated toxin)
DTaP
70
Examples of subunit/conjugate vaccines
``` Hep B Influenza (injection) Hib Pertussis (in DTaP) Pneumococcal Meningococcal ```

CMBM exam 5 (19 decks)

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