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Vaccinology - Background of vaccines Flashcards

1
Q

What was the first vaccine?

A

Cowpox live virus against smallpox

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2
Q

Which virus causes smallpox?

A

Variola major

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3
Q

What is the mortality of smallpox?

A

30%

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4
Q

By which means is smallpox transmitted? (2)

A
  1. Direct contact
  2. Aerosols
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5
Q

To which virus family does the smallpox virus belong?

A

Orthopox

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6
Q

What was the first smallpox intervention? When was it invented?

A

Variolation, ~15th century

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7
Q

What was the method of smallpox variolation?

A

Intranasal inoculation of dried scabs from patients with mild disease

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8
Q

Why does variolation for smallpox cause less disease than natural smallpox infection?

A

Intranasal instead of lower respiratory tract infection

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9
Q

What was the case fatality rate of variolation for smallpox?

A

2%

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10
Q

For which diseases, in addition to smallpox, was the method of variolation used?

A
  1. Rinderpest
  2. Measles
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11
Q

Who discovered the possibility of using inonculation with cowpox material to protect individuals against smallpox? When did this take place?

A

Edward Jenner, 1796

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12
Q

Which transmission route/sources were used for cowpox material for smallpox vaccination/inoculation? When were each of these methods used?

A
  1. Arm-to-arm (until mid-19th century)
  2. Production in cattle (1805 onwards)
  3. Freeze-dried (1940 onwards)
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13
Q

When were bifurcated needles for smallpox vaccination introduced?

A

1961

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14
Q

What is the rationale of the use of bifurcated needles in smallpox vaccination?

A

Making scratches in the skin to allow for local cowpox infection

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15
Q

What was the case fatality rate of smallpox vaccination?

A

<0,0001%

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16
Q

Which conditions make smallpox eradicable? (5)

A
  1. Limited pathogen variability
  2. No animal reservoir
  3. No persistent infections
  4. Effective vaccine available
  5. Good diagnostic methods
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17
Q

When did the WHO smallpox eradication campaign start?

A

1967

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18
Q

When was the last smallpox case?

A

1978

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19
Q

When was smallpox declared eradicated?

A

1980

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20
Q

What are complications of vaccinia vaccination? (7)

A
  1. Progressive vaccinia
  2. Generalized vaccinia
  3. Contact vaccinia
  4. Secondary infections
  5. Post-vaccine encephalitis
  6. Ezcema vaccinia
  7. Foetal vaccinia
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21
Q

What is contact vaccinia?

A

From inoculated pustule to other parts of the body and/or other individuals

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22
Q

What are common secondary infections of a vaccinia vaccination?

A

Herpesviruses

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23
Q

When was the last smallpox outbreak in The Netherlands?

A

1952

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24
Q

When was vaccinia vaccination stopped in The Netherlands?

A

1971

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25
Q

What is the danger of cessation of smallpox vaccination in many countries?

A

No vaccine-mediated immunity to poxviruses, creating a potential new niche for animal poxviruses

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26
Q

Against which situations can vaccines ‘protect’? (4)

A
  1. Infection
  2. Transmission
  3. Disease
  4. Death
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27
Q

Who discovered vaccine attenuation?

A

Louis Pasteur

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28
Q

How did Louis Pasteur discover vaccine attenuation?

A

By heat-inactivation of bacteria

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29
Q

To which diseases was vaccine attenuation applied by Louis Pasteur & his close colleagues? (4)

A
  1. Anthrax
  2. Rabies
  3. Tuberculosis
  4. Diphtheria
30
Q

To which virus family does polio virus belong?

A

Enterovirus

31
Q

What is the genome type of poliovirus?

32
Q

How many serotypes of poliovirus are there?

33
Q

Where in the body does poliovirus replicate? (3)

A
  1. Pharynx
  2. GI-tract
  3. Local lymphatics
34
Q

How does poliovirus reach the CNS?

A

Haematologic spread

35
Q

What is the effect of polio infection of the CNS?

A

Viral spread among the nerve fibres, leading to destruction of motor neurons

36
Q

What is an important problem in the detection and prevention of polio outbreaks?

A

Polio infections are frequently asymptomatic

37
Q

Which two vaccines are available against polio? What kind of vaccine are they?

A
  1. Salk vaccine: inactivated intramuscular
  2. Sabin vaccine: live attenuated oral
38
Q

What is the problem with polio eradication?

A

The high number of asymptomatic cases -> makes it hard to assess whether polio has truly disappeared from the population

39
Q

When was a global eradication campaign for polio started?

40
Q

Which is the only currently persisting natural polio serotype?

A

Serotype 1

41
Q

What is the cause of most polio cases worldwide?

A

Vaccine-induced polio

42
Q

How was measles virus attenuated?

A

Passaging in different human and chicken embryonic cell lines at reduced temperature

43
Q

Vaccine-induced immunity to measles is [worse than/as good as/better than] immunity induced by natural infection

A

Vaccine-induced immunity = worse than natural infection

44
Q

Does measles meet he criteria to be eradicated?

45
Q

What is a major safety problem around the administration of vaccines?

A

Needle accidents

46
Q

What can needle accidents lead to? (2)

A
  1. Transfer of disease
  2. Injury
47
Q

What was the estimated yearly incidence of needle accident-induced hepatitis B/C or HIV, prior to the WHO vaccination safety programme?

A

~2 million cases of hepatitis B/C or HIV per year

48
Q

Why is injection safety still a problem? (3)

A
  1. Lack of knowledge about the danger of injection
  2. False belief that injections are more effective than oral medications
  3. Monetary incentives for clinicials to use injections
49
Q

Why does false belief that injections are more effective than oral medication cause problems surrounding injection safety?

A

Over-use of injections

50
Q

What are common practices surrounding injection that harm injection recipients? (5)

A
  1. Keeping freeze-dried vaccine for >6 hours after reconsitution
  2. Mixing two partially-used vials of vaccine
  3. Storing mediations & vaccines in the same refrigerator
  4. Applying pressure to bleeding sites with used material/finger
  5. Use of unsterile needles & syringes
51
Q

What are common practices surrounding injection that harm healthcare workers? (4)

A
  1. Re-using needles & syringes
  2. Carrying needles/placing them on a surface prior to disposal
  3. Re-capping of needles
  4. Reaching into a container of used needles/syringes
52
Q

What is the chief solution to reduce injection safety risk?

A

Education campaigns & training

53
Q

What are common mild adverse effects of vaccine administration? (5)

A
  1. Local redness/swelling
  2. Pain
  3. Headache
  4. Fever
  5. Nausea
54
Q

What are common severe adverse effects of vaccine administration? (2)

A
  1. Life-threatening allergic reactions/seizures
  2. Systemic disease
55
Q

When was predisposition to enhanced first shown for vaccinations? For which types of vaccines?

A

1960s, with formalin-inactivated RSV and measles vaccines

56
Q

What is the result of formalin-inactivated (FI) RSV vaccine-induced disease enhancement?

A

High hospitalization rate during first RSV season after vaccination

57
Q

What are the symptoms of formalin-inactivated (FI) RSV vaccine-induced disease enhancement? (3)

A
  1. Febrile pneumonia
  2. Bronchiolitis
  3. Pulmonary infiltrates
58
Q

What was the major predictor for severity of disease in formalin-inactivated (FI) RSV vaccine-induced disease enhancement?

A

Age -> severity of disease is inversely correlated with age

59
Q

What causes younger individuals to have more severe disease in formalin-inactivated (FI) RSV vaccine-induced disease enhancement?

A

Younger individuals are less likely to have experienced prior RSV exposure -> disease enhancement is more severe when no natural immunity was present before vaccination

60
Q

How does formalin-inactivated (FI) measles virus vaccine-induced disease enhancement manifest?

A

Atypical measles syndrome developing several years post-vaccination

61
Q

What causes the effects of formalin-inactivated (FI) measles virus-induced disease enhancement to appear much later than those for RSV?

A

Measles virus is more susceptible for neutralizing antibodies than RSV is -> takes a longer time for immunity to wane enough to allow a measles virus infection

62
Q

What are the symptoms of formalin-inactivated (FI) measles virus vaccine-induced disease enhancement? (3)

A
  1. High fever
  2. Petechial rash
  3. Pneumonia with cellular infiltrates
63
Q

What is the mechanism of disease enhancement of formalin-inactivated vaccines?

A

Skewing towards a Th2-response without inducing a CD8+ response ->

This results in a secondary Th2 response with a primary CD8+ response upon infection ->

Rapid accumulation of MV/RSV-specific Th2s in the lung up infection ->

Th2’s cause immune-mediated pneumonia -> allergic-type hypersensitivity response to these viruses

64
Q

Is there an established link between auto-immune disease and vaccination?

65
Q

For which auto-immune diseases is there an established link to vaccination? (3)

A
  1. Narcolepsy
  2. Bell’s palsy
  3. GBS
66
Q

What is the caveat of the link between GBS and vaccination?

A

GBS is seen in association with (large) vaccination campaigns, but the incidence of GBS is much higher in natural infections -> vaccination is actually protective of GBS

67
Q

What is an example of an epidemiological risk of vaccination? Explain.

A

Rubella -> prior to vaccination, (nearly) everyone got infected in their childhood

Now: infections happen at a later age -> can happen in (unvaccinated) pregnant people -> higher risk of congenital rubella syndrome

68
Q

What is the main goal of rubella vaccination?

A

To protect pregnant people (and not necessarily to protect the infected children)

69
Q

How does rubella manifest during childhood?

A

Mild disease

70
Q

How does rubella manifest during pregnancy?

A

Risk of congenital rubella syndrome

I&I WC2 (25 decks)

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