Vaccines

Question 1

inactive toxins (treated with formalin)
tetanus, diphtheris

Answer 1

toxoids

Question 2

live organism vaccine
non-attenutated
vaccinia

Answer 2

smallpox vaccine

Question 3

limited utility

Ty21a vaccine for typhoid fever

Answer 3

live attenuated vaccines for bacteria

Question 4

widely used

polio, measles, mumps, rubella, yellow fever, varicella, rotavirus, influenza

Answer 4

live attenuated vaccines for viruses

Question 5

serial passage through cell cultures of other species (BCG)

temperature-selective mutants (influenza)

gene reassortment mutants (rotavirus)

recombinant viruses (investigational)

Answer 5

attenuation

Question 6

Bordatella pertussis, hepatitis A, influenza, polio (IPV, Salk), rabies

Answer 6

inactivated/killed vaccines

Question 7

purified capsular polysaccharide (pneumococcus, meningococcus, HiB) or produced with recombinant DNA (hepB, HPV)

Answer 7

subunit vaccine

Question 8

special indication

pneumococcal, HiB, meningococcal vaccines

Answer 8

Asplenic

Question 9

special indication

pneumococcal vaccine

Answer 9

HIV

Question 10

special indication

influenza, pneumococcal

Answer 10

Elderly

Question 11

special indication

HepB, influenza, varicella

Answer 11

healthcare workers

Question 12

special indication

varicella

Answer 12

leukemic children

Question 13

special indication

hepA/B, yellow fever, Japanese encephalitis, rabies, typhoid

Answer 13

travelers

Question 14

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

Answer 14

seasonal influenza vaccine

Question 15

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)

Answer 15

Avian influenza vaccine

Question 16

induces T-independent immune response, not very immnogenic, does not result in immunologic memory, no appreciable booster response

Answer 16

capsular polysaccharide vaccine

Question 17

capsular polysaccharides conjugated with carrier protein to elicit T-dependent response

Answer 17

conjugate vaccines

Question 18

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

Answer 18

Conjugate HiB vaccine

Question 19

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

Answer 19

HPV vaccine

Question 20

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

Answer 20

Rotavirus vaccine

Question 21

most common adverse side effect

pain, swelling, erythema at injection site; common with killed vaccines; mostly mild and resolve spontaneously

Answer 21

local reactogenicity

Question 22

adverse side effect

fever, malaise, headache; more common after live attenuated vaccine

Answer 22

systemic reactogenicity

Question 23

reaction including anaphylaxis to vaccine antigens or vaccine component (residual egg protein or antibiotic) – risk is minimized with proper screening

Answer 23

allergic reaction

Question 24

rare, serious complication

acute arthropathy

Answer 24

rubella vaccine

Question 25

rare, serious complication

vesicular rash, may be infectious

Answer 25

varicella vaccine

Question 26

rare, serious complication

acute encephalopathy

Answer 26

whole cell pertussis vaccine

not acellular

Question 27

rare, serious complication

vaccine associated poliomyelitis

Answer 27

oral polio vaccine

Question 28

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

Answer 28

yellow fever vaccine

Question 29

rare, serious complication

Guillain-Barre syndrome has rarely been associated with multiple vaccines - causal link not proven

Answer 29

meningococcal, influenza, tetanus toxoid vaccines