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Medicine - Year 1 > Viral Diseases - Immunology > Flashcards

Viral Diseases - Immunology Flashcards

1
Q

Define herd immunity

A

Resistance/Protection of a group of people to an attack by a disease to which a large propotion of the members of the group are immune

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2
Q

a) Describe immunisation
b) What are the aims?

A

a)

  • The process whereby a susceptibe individual is rendered immune to an infection
  • Can be passive or active

b)

  • Eradication
  • Preventing symptoms
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3
Q

What is passive immunisation?

A

Transfer of pre-formed antibodies to a susceptible individual giving temporary protection from infection

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4
Q

Describe the two types of passive immunity

A
  • Natural – mother to baby via placenta ad breast milk
  • Artificial – antibodies produced by another person’s immune system is given
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5
Q

Describe the antibodies that can be given in passive (artificial) immunisation?

A

Normal immunoglobulin

  • Hepatitis A
  • Measles

Specific immunoglobulin

  • Hepatitis
  • Rabies
  • Varicella zoster
  • Tetanus

Monoclonal antibodies

  • Respiratory syncytial virus (RSV)
  • SAR-CoV-2
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6
Q

Describe active immunisation

A

Exposure to an antigen which stimulates the immune system to produce own antibodies against a particular infectious agent

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7
Q

Describe the two types of active immunisation

A

Natural - body encounters a pathogen

Artfical - Vaccine

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8
Q

What are the types of active artifical immunisations (vaccines)?

A
  • Live attenuated
  • Inactivated whole cell
  • Inactivated tooxin (toxoid)
  • Subunit - recombinant proteins
  • Polysaccharides
  • Conjugated polysaccharide
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9
Q

a) Describe live attenuated vaccines
b) Provide 6 examples
c) Provide 3 advanatges for why they’re highly effective
d) Provide 3 disadvantages

A

a) Traditionally generated by serial passage in tissue culture
b) E.g. Bacille Calmette-Guerin (BCG) for TB, Measleys, mumps, rubella, varicella zoster, rotavirus
c) Pros

  • Replicate in recipient = excellent immune response and more closely resemble natural infection
  • They replicate intracellularly so they deliver antigenic peptides to MHC class I molecules and so stimulate cytotoxic T lymphocytes
  • They replicate at the anatomic site of infection, which further focuses the immune response

Cons

  • Potential for reversion
  • Potential for sustained vacine strain infection
  • Not suitable for all e.g. immunodeficiency, pregnant women
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10
Q

a) Describe inactivated whole cell vaccines
b) Provide 3 examples

A

a) Pathogen killed by chemical or physical processes
b) E.g. Inactivated polio (Salk), Hepatitis A, Rabies

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11
Q

a) Describe inactivated toxin (toxoid) vaccines
b) Provide 2 examples

A

a) Toxins chemically treated to eliminate toxicity whilst maintaining immunogenicity e.g. with formaldehyde
b) E.g. Diphtheria, Tetanus

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12
Q

a) Describe subunit-recombinant proteins vaccines and provide 2 examples
b) Describe subunit vaccines and provide 2 examples

A

a) Specific viral proteins produced in a heterologous expression system (artifically produced in yeast/insect) e.g.Hepatitis B, Papillomavirus
b) Certain components of a pathogen are purified for use in vaccine e.g. Acellular pertussis, Influenza

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13
Q

a) Describe polysaccharide vaccines
b) Provide 3 examples
c) What are the main disadvantages?

A

a) Purified bacterial polysaccharide
b) E.g. some meningococcal vaccines, some pneumococcal vaccines, salmonella
c) T-cell independant and poorly immunogenic in young children

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14
Q

a) Describe conjugated polysaccharide
b) Provide 3 examples

A

a) Purified bacterial polysaccharide linked to a protein
b) H.infleunzae, pneumococcal, meningococcal

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15
Q

a) What are adjuvants?
b) Which two adjuvants are most commonly used?
c) How do they work?
d) What may the development of new adjuvants allow?

A

a) Agents that are given to stimulate/increase the immune system response
b) Aluminium phosphate and hydroxide are commonly used
c) Thought to isolate antigen and cause inflammation
d) May allow modulation of the type of immune response developed

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16
Q

Who are elegible for pre-expoure vaccines?

A
  • Children - according to the UK routine childhood immunisation progamme
  • Adults 65 years +
  • Pregnant women
  • Adults and children at high risk due to underlying health conditions
  • Those at risk due to occuption, lifestyle or contacts
  • Travellers
17
Q

a) What pre-exposure vaccines are used in those of 65 years of age?
b) What pre-exposure vaccine are used in those of 70 years of age?

A

a) Pneumococcal polysaccharide vaccine

Annual infleunza vaccine

b) Varicella zoster (shingles vaccine)

18
Q

What vaccinations are given in pregnant women and at what stage of their pregnancy?

A
  • Infleunza vaccine in any trimester before start of flu season
  • Pertussis (whooping cough) vaccine from 16 weeks gestation
19
Q

What childhood vaccinations are given at 2 months?

A
  • Diphtheria/tetanus/pertussis/polio/haemophilus/hepatitis B (6-in 1 vaccine)
  • Meningococccal B
  • Rotavirus
20
Q

What childhood vaccinations are given at 3 months?

A
  • Diphtheria/tetanus/pertussis/polio/haemophilus/hepatitis B (6-in-1 vaccine)
  • Rotavirus
  • Pneumococcal conjugate
21
Q

What childhood vacciantiones are given at 4 months?

A
  • Diphtheria/tetanus/pertussis/polio/haeomphilus/hepatitis B (6-in-1 vaccine)
  • Meningococcal B
22
Q

What childhood vaccines are given 12-13 months?

A
  • Haemophilus/meningococcal C conjugate
  • Meningococcal B
  • Pneumococcal conjugate
  • Measles/mumps/rubella (MMR)
23
Q

What childhood vaccines are given at 2 years of age?

A

Influenza - annually to age 16 (in process of being rolled out)

24
Q

What childhood vaccines are given at 3 yr 4 months?

A
  • Diphtheria/tetanus/pertussis/polio
  • Measles/mumps/rubella (MMR)
25
Q

What childhood vaccine is given at 12-13 years?

A
  • Pamillomavirus (2 doses 6 months apart)
26
Q

What childhood vaccines are given at 14 years?

A
  • Teteanus/diphtheria/polio
  • Meningococcal ACWY conjugate
27
Q

a) Explain why immunoglobulins and vaccines after exposure are given?
b) Provide 3 examples of situations where immunoglobulins and post-exposure vaccines are given including the immunoglobulins/vaccines given

A

a) They are given to reduce the chance of an individual developing a disease, or reducing disease severity should disease occur

b)

  • Wounds at high risk of tetanus are given specific immunoglobulin
  • Potential rabies exposure & given course of vaccine +/- specific immunoglobulin
  • Unvaccinated contact with confirmed measles case & vaccine given but if contraindicated consider normal immunoglobulin
28
Q

a) What are adverse effects of vaccines related to?
b) What are the most commonly local adverse reactions?
c) What are the general systemic adverse effects?
d) Which vaccines are associated with rash?

A

a) Related to either immunogen or other component of the vaccines
b) Pain, swelling and redness
c) Fever, headache and malaise
d) MMR, varicella vaccine (VZV)

29
Q

a) Is anaphylaxis from taking a vaccine rare or common?
b) What rare adverse reactions can you get from:

  1. Yellow fever
  2. Rubella
  3. BCG (TB)
  4. Rotavirus
A

a) rare

b)

  1. Yellow fever – encephalitis (inflammation of the active tissues of the brain)
  2. Rubella – arthroplasty, thrombocytopaenia (low platelet count)
  3. BCG (TB)– osteitis (inflammation around the centre of the pelvis)
  4. Rotavirus – potential increased risk of intussusception (one part of the intestine slides inside another part)
30
Q

a) What should you consider when given vaccinations?
b) When may immunisations need to be deferred?

A

a)

  • Hx of anaphylaxis to previous vaccine/ vaccine component
  • Immunosuppression
  • Pregnancy

b)

  • Acutely unwell
  • Other vaccines given recently
  • Ig therapy
31
Q

a) What is a primary vaccine failure?
b) What factors, provided with examples can cause primary vaccine failure?
c) What is a secondary vaccine failure?

A

a) Primary vaccine failure – fail to mount an immune response to a vaccine

b)

  • Vaccine factors e.g., administration error, manufacturing error, incomplete strain coverage
  • Host factor e.g., immunodeficiency, immunological
  • Inappropriate vaccine schedule

c) Secondary vaccine failure – immunity develops initially following immunisation but with time immunity wanes

32
Q

Describe the innate immune system, including the physical barriers and cells involved

A
  • 1st line of defence against infection
  • Not specific
  • No memory
  • Relies on interactions between pattern recognition receptors (PRRs) and pathogen associated molecular patterns (PAMPs)
  • Comprises – mechanical barrier, proteins (enzymes, complement), cells (macrophages, neutrophils, NK cells)
33
Q

Describe the adaptive immune system, including the cells involved

A
  • Takes time to develop
  • Specific to a particular pathogen/antigen
  • Has memory
  • Comprises – B cells (antibody production), T cells (CD4 – ‘helper’ cells, CD8 – ‘cytotoxic’ cells)
34
Q

Describe the immune response to immunisation

A
  1. Vaccine injected
  2. Cells of innate immune system recognises foreign antigen/pathogen
  3. They produce pro-inflammatory cytokines, chemokines and attract other cells to the site
  4. Dendritic cells have pathogen associated molecular patterns (PAMPs) and recognise take up of foreign antigen
  5. Dendritic cell is going to mature and migrate to lymph node and interact with a variety of cells (CD8 cytotoxic T cells and CD4 helper T cells)
  6. CD8 T cells develop into effector and memory cells
  7. Naïve B cell and CD4 helper T cell recognise the same antigen you get differentiation into plasma cells (antibodies) and memory cells
35
Q

What are the reasons children/adults will not have a vaccine?

A
  • Parents may have refused
  • Vaccination may have been accidentally missed
  • Misinformation about immunisations e.g. Polio - a western plot to make african women infertile and HPV - a cause of promiscuity in teenagers

Medicine - Year 1 (61 decks)

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