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Vaccines Flashcards

1
Q

What vaccines does the CDC recommend to children to get?

A
  • MMR- measles, mumps, rubella (german measles)
  • varicella (chickenpox)
  • Hepatitis B
  • DTaP- diptheria, tetanus, pertussis (whooping cough)
  • Haemophilus influenza type B (Hib)
  • polio (IPV)
  • influenza (flu)
  • pneumococcal polysaccharide disease
  • Human papilloma virus
  • rotavirus
  • Hepatitis A
  • Meningococcal B
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2
Q

What was one of the first vaccines? live natural viral vaccines? (9)

A
  1. used material from dried pustules of people who got mild smallpox
  2. variolation:
    - widely used in 18th century
    - sometimes successful
    - sometimes induced lethal smallpox
  3. Jenner used dried pox from milkmaids (cowpox)
    - vaccinia or vaccination
    - example of live natural vaccine
    - protects against smallpox (share surface antigens)
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3
Q

What must vaccines do?

A
  1. must induce clonal expansion in T and B cells
  2. induce formation of memory cells
  3. next encounter with antigen induces a secondary response
    - faster, bigger, better
    - prevents serious disease
  4. adaptive immunity is key
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4
Q

Passive immunization?

A
  1. injection of preformed antibodies
    - from recovered patients or from horses
    - used in pre antibiotic days
    - used today when toxins are already circulating (tetanus, diphtheria, snakebite)
    - VZIG (varicella zoster immunoglobulin)
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5
Q

Ebola and passive immunization? would it work?

A
  • maybe
  • take someone who survived the illness, transfer serum to someone who is sick
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6
Q

Live natural viral vaccines?

A
  1. Jenners strategy cannot be applied to most pathogenic because there is no safe counterpart
  2. most viral vaccines used today
    - killed or inactivated
    - live attenuated
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7
Q

Live attenuated viral vaccines? (15)

A
  1. mutated so that it has reduced ability to grow in human cells
    - no longer pathogenic in humans
    - usually made by growing the pathogenic viruses in cells from non human species:
    - select for variants that grow in non human host
    - but less fit to grow in human host
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8
Q

Examples of live attenuated viral vaccines?

A
  • MMR (measles, mumps, rubella)
  • MMRV (proquad with varicella)
  • Sabin (polio)
  • yellow fever
  • Varicella (chicken pox)
  • rotavirus deliver orally
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9
Q

Advantages of live attenuated viral vaccines?

A
  • better immunity because vaccine actually produces a limited infection
  • can spread the attenuated virus to contacts
  • herd immunity: phenomenon where those people who have no immunity against a particular pathogen are largely protected because the majority of population is immune
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10
Q

Disadvantages of live attenuated vaccines?

A
  1. can cause disease in immunosuppressed or immunodeficient individuals
    - VAPP(vaccine associated paralytic polio)- reason OPV is no longer recommended
    - Varicella- vaccine contra indicated in children treated with high dose corticosteroid, cancer, leukemia, lymphoma, non HIV immunodeficiency
    - Rotavirus- rotavirus vaccine, precautions for altered immunocompetence
  2. reversion to wild type or pathogenic virus
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11
Q

Killed viral vaccine?

A
  1. viral particles are chemically treated (formalin) or heated or irradiated
    - influenza vaccine
    - rabies
    - salk polio vaccine
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12
Q

Advantages of killed vaccines?

A
  • safe
  • does not cause disease
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13
Q

Disadvantages of killed vaccines?

A
  • must produce large amounts of virus
  • incomplete inactivation
  • no replication of virus, therefore immunity may not be as good
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14
Q

Polio vaccine?

A
  1. IPV (inactivated injection)
    - no risk of vaccine associated with paralytic polio (VAPP)
    - no mucosal immunity
    - currently recommended in US
  2. OPV (oral attenuated)
    - 95% protection (life long)
    - induces intestinal immunity
    - herd immunity
    - rarely VAPP
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15
Q

Subunit vaccines?

A
  1. include only the antigens that best stimulate the immune system
    - in some cases these vaccines use epitopes, the very specific parts of the antigen that antibodies or T cells recognize and bind to
    - use of only essential antigens decreases the chance of adverse reactions to the vaccine
  2. may contain 1 to 20 or more antigens
    - identifying which antigens best stimulate the immune system may be time consuming process and ambiguous
  3. usually an antigenic surface structure
    - induce neutralizing antibody
    - prevent infection
    - usually made by recombinant techniques
    - Hep B vaccine
    - Human papilloma virus (HPV) vaccine:
    - protects against 6, 11, 16, 18
    - helps protect against genital warts, precancerous cervical lesions and cervical cancer
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16
Q

Bacterial vaccines?

A
  • whole bacteria
  • toxins
  • capsular polysaccharides (very good at stimulating T independent immunity, IgM)
17
Q

Live attenuated bacterial vaccines?

A
  1. very few
    - BCG Mycobacterium bovis (bovine tuberculosis) for TB (Mtb)
    - efficacy varies in different populations
    - not used in US
  2. Salmonella
    - defective in enzyme necessary for LPS synthesis
18
Q

Killed bacterial vaccines?

A
  1. Bordetella pertussis
    - when given with tetanus toxoid and diphtheria toxoid (DTaP), the presence of Bordetella organism causes stronger immune response to toxoids
    - bad reactions
  2. now acellular Bordetella preparation is used
    - toxoid
    - filamentous hemagglutinin, perfactin, fimbrial antigen
19
Q

Toxoid vaccines?

A
  1. these vaccines are used when a bacterial toxin is the main cause of illness
    - inactivates toxins by treating them with formalin
    - such detoxified toxins, called toxoids, are safe for use in vaccines
  2. vaccination with toxoid, results in production of protective antibodies that bind and neutralize the toxin
  3. toxin activity is destroyed (formalin)
  4. retains sufficient antigenic activity to protect agains diseases
    - tetanus
    - diptheria
20
Q

Vaccines against capsular antigens?

A
  • capsules:
    1. contain strain and species specific antigens
  • polysaccharides (B cells)
  • haptin (T cells)
    2. also determine pathogenicity
  • block alternate path complement activation
    3. aim of vaccine is to produce complement fixing anti capsular antibody
    4. antibody response is usually T independent
  • babies don’t make good T independent immune responses, susceptible to infection of encapsulated bacteria
  • polysaccharide is usually conjugated to carrier protein
    5. conjugating the polysaccharide antigen to a protein carrier improves the vaccine (T cell response)
21
Q

Why does conjugation of capsular vaccines improve the vaccine?

A
  1. more chance of class switching from IgM to IgG
  2. higher antibody titers
  3. generation of memory
  4. longer lasting immunity
  5. more effective in younger children
22
Q

Examples of capsular vaccines?

A
  1. streptococcus pneumoniae
  2. Neisseria meningitidis
  3. Hemophilus influenzae
    - conjugated vaccine is effective in reducing incidence and severity of childhood meningitis and pneumonia
23
Q

Adjuvants?

A
  1. adjuvant is a substance that, when added to a vaccine, greatly enhances its protect against infection
    - comes from latin “to help”
  2. Alum, a mixture of aluminum, was the first vaccine adjuvant to be widely be used in US
    - only in use until 2009
    - ASO4- mixture of alum and bacterial lipid molecule that has been modified so that it does not cause disease
  3. strong immune response requires some degree of inflammation
    - during infection initiated by microbial products:
    - activate macrophages
    - increase expression of costimulators (if adjuvant is microbial)
    - recruit inflammatory cells
  4. purified protein vaccines induce poor immunity
    - improved by adjuvants
    - substances that induce non specific inflammation
    - adjuvants also cause soluble antigens to aggregate
    - clear slower
    - increase phagocytosis
24
Q

Benefits of Adjuvants?

A
  1. adding adjuvant reduces the amount of active component required in a vaccine
    - reducing cost per vaccine
    - making more doses available for public use
  2. person may need fewer doses of vaccine containing adjuvant
    - immune response is stronger and lasts longer
  3. people with compromised immune systems, such as elderly or children, benefit from vaccines with adjuvants
    - their immune system require an extra boost to provide protection
  4. adjuvants are especially effective in boosting the immune stimulating effects of newer vaccine, such as those made with purified antigen
25
Q

Newer vaccines: HPV?

A
  1. estimated 80% sexually active women acquire HPV by age 50
  2. quadrivalent vaccine (types 6, 11, 16, 18) licensed in september 2006
    - females 9-26
    - prevents or reduces incidence of:
    - HPV induced cervical cancer
    - cervical precursor lesions (dysplasia)
    - vaginal and vulvar cancer precursors
    - anogenital warts
26
Q

HPV vaccine Gardasil 4?

A
  1. human papilloma virus (HPV)
    - 100 different types
    - low risk types 6 and 11 associated with low grade or benign cervical cell changes (precursors of cervical cancer)
  2. vaccine consists of surface antigen
    - current HPV vaccine (gardasil) licensed in June 2006, contains types 6, 11, 16, 18
    - composed of virus like particles (VLPs) prepared from recombinant L1 capsid protein of HPV
    - in 2009 gardasil was also recommended for boys
27
Q

HPV vaccine Gardasil 9?

A
  • specific for HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58
  • for both genders
28
Q

HPV vaccine cervarix?

A
  • specific for HPV 16 and 18
  • HPV 16 and 18 cause about 70% of cervical cancers, each of the other oncogenic HPV types accounts for a small percentage of all cervical cancers
  • approved for females only
29
Q

Newer vaccines: zoster?

A
  1. vaccine licensed in 2006 for use in people aged 60 and over
    - most effective at ages 60-69
    - vaccine prevents shingles in 50% of vaccinated individuals
    - vaccine prevents post herpetic neuralgia in 67% of vaccinated individuals
  2. does not treat shingles or post herpetic neuralgia
30
Q

What diseases have been eradicated?

A
  1. smallpox officially eradicated
    - official in 1980
  2. polio in the near future
    - last case in US was 1979
    - western hemisphere polio free in 1994
    - last isolated of type 2 was India in 1999
    - global eradication goal keeps getting pushed back
    - goal is 2018-2019
31
Q

Malaria vaccine?

A
  • RTS, S/A01
  • not very successful
  • phase 3 trial
  • limited effectiveness, wanes over time
  • keep adding booster doses, need periodic boosters to be somewhat effective
  • doesnt protect babies
  • phase 4 to be implemented

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