Vaccines Flashcards
inactive toxins (treated with formalin) tetanus, diphtheris
toxoids
live organism vaccine
non-attenutated
vaccinia
smallpox vaccine
limited utility
Ty21a vaccine for typhoid fever
live attenuated vaccines for bacteria
widely used
polio, measles, mumps, rubella, yellow fever, varicella, rotavirus, influenza
live attenuated vaccines for viruses
serial passage through cell cultures of other species (BCG)
temperature-selective mutants (influenza)
gene reassortment mutants (rotavirus)
recombinant viruses (investigational)
attenuation
Bordatella pertussis, hepatitis A, influenza, polio (IPV, Salk), rabies
inactivated/killed vaccines
purified capsular polysaccharide (pneumococcus, meningococcus, HiB) or produced with recombinant DNA (hepB, HPV)
subunit vaccine
special indication
pneumococcal, HiB, meningococcal vaccines
Asplenic
special indication
pneumococcal vaccine
HIV
special indication
influenza, pneumococcal
Elderly
special indication
HepB, influenza, varicella
healthcare workers
special indication
varicella
leukemic children
special indication
hepA/B, yellow fever, Japanese encephalitis, rabies, typhoid
travelers
two surface antigens: hemagglutinin and neuraminidase
IM = inactivated
Intranasal = attenuated
traditionally trivalent (2A and 1B)
quadrivalent now available (2A, 2B)
since 2010, H1N1 “swine flu” has been included
traditionally grown in embryonated hen’s eggs and inactivated with formalin
live attenuated vaccine is cold adapted; may exacerbate asthma/wheezing in children 6 months
seasonal influenza vaccine
monovalent H5N1 vaccine not available commercially, stockpiled by the government in case of pandemic
other strains have been developed so that in an epidemic, properly matched vaccines can be rapidly produced (reassortant virus vaccines)
Avian influenza vaccine
induces T-independent immune response, not very immnogenic, does not result in immunologic memory, no appreciable booster response
capsular polysaccharide vaccine
capsular polysaccharides conjugated with carrier protein to elicit T-dependent response
conjugate vaccines
dramatically reduced with incidence of invasive disease in children
polyribitol phosphate capsular antigen conjugated to diphtheria toxoid, outer membrane protein of N. meningitidis, or tetanus toxoid
antigens from 23 capsular types
licensed for adults and children>2
recommended for 65+, asplenics, cardiopulmonary disease, diabetics, chronic liver disease, nephrotic syndrome, CSF leaks, cochlear implants, immunocompromised
Conjugate HiB vaccine
Gardasil now contains 9 (originally 4) strains: 16, 18, 6, 11, 31, 33, 45, 52, 58
virus-like particles (produced using recombinant DNa in yeast) adjuvanted with aluminum hydroxide
recommended in males and females 11-12, shown to have close to 100% efficacy in preventing pre-cancerous lesions
Cervarix contains virus like particles from 16 and 18 and is only licensed in females; contains novel adjuvant to stimulate immune response
HPV vaccine
Rotashield withdrawn from the market due to risk of intussusception
Rotateq is a live oral human-bovine reassortment vaccine containing 5 reassorted viruses, strains are not cross-protective
Rotarix is a live oral attenuated human virus vaccine, monovalent and attenutated by serial passage, cross-protective against other strains
vaccination recommended for all infants at 2 and 4 months, third dose at 6 months with Rotateq
Rotavirus vaccine
most common adverse side effect
pain, swelling, erythema at injection site; common with killed vaccines; mostly mild and resolve spontaneously
local reactogenicity
adverse side effect
fever, malaise, headache; more common after live attenuated vaccine
systemic reactogenicity
reaction including anaphylaxis to vaccine antigens or vaccine component (residual egg protein or antibiotic) – risk is minimized with proper screening
allergic reaction
rare, serious complication
acute arthropathy
rubella vaccine
rare, serious complication
vesicular rash, may be infectious
varicella vaccine
rare, serious complication
acute encephalopathy
whole cell pertussis vaccine
not acellular
rare, serious complication
vaccine associated poliomyelitis
oral polio vaccine
rare, serious complication
neutrotropic and viscerotropic disease
Neutrotropic = post-vacccination aseptic meningitis/encephalitis, mainly in infants and elderly; thought to be related to genetic predisposition to disease caused by the vaccine strain (17D)
Vescerotropic = post-vaccinaiton jaundice, renal failure, subsequent multi-organ failure, possible death (similar to wildtype virus); increased risk in elderly and thymus disease
yellow fever vaccine
rare, serious complication
Guillain-Barre syndrome has rarely been associated with multiple vaccines - causal link not proven
meningococcal, influenza, tetanus toxoid vaccines
