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Clinical Immunology > Hepatits & Vaccines > Flashcards

Hepatits & Vaccines Flashcards

1
Q

Viral Hepatitis - overview

A

Hepatits: inflammation of the liver

Primary & Secondary viral agents

Primary: A, B, C, D, E & G (95% of cases)

Secondary: EBV, CMV, Herpes virus

Acute & chronic forms

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2
Q

Hepatitis A

A

Underdeveloped/developing countries

Fecal-oral transmission during early phase of accute illness (shed in feces up to 4 weeks after infection)

Incidence not increased in health care workers or dialysis

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3
Q

Hepatits B

A

Decreasing dramatically in last 15 years in US

Transmission through blood transfusion, needlestick accidents, contaminated needles.

Can be transmitted in the absence of obvious parenteral exposure

It’s a bird, it’s a plane, it’s SUPER INFECTION (with Hep D)

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4
Q

Hepatits C

A

Prevalent in US & Western Europe

Major cause of chronic hepatits worldwide

Transmission primarily by percutaneous contact with infected blood/blood products

Healthcare workers need to take care to avoid needlestick injuries

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5
Q

Hepatits D

A

Severe & rapidly progressive liver disease

No proven effective therapy :(

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6
Q

Hepatits E

A

Fecal-oral tranmission, associated with poor sanitation

Not associated with chonic liver disease

Most infections self-limited, mild.

10-20% of HEV infections in pregnane wormen result in fulminant hepitits (especially in 3rd trimester)

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7
Q

Hepatitis G

A

Blood borne agent.

Transmission via blood transfusion, IV drug users.

Common coinfection HCV. 900-2000 infections per year, most asymptomatic.

Chronic disease rare/may not occur at all.

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8
Q

Goal of Vaccination

A

To produce artificially acquired, active immunity against a specific disease

Vaccination against contagious infectious diseases worldwide has been a positive influence

Promotes herd immunity—majority of population has immunity to specific microbe

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9
Q

What is a Vaccine

A

Purpose is to stimulate active immunity and create an immune memory so exposure of an active disease microorganism will stimulate the immune system to fight the disease

Traditional vaccine—biological suspension of weakened or killed entire pathogens so they cannot cause disease

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10
Q

Vaccine History

A

Vaccination saves approx. 3 million people a year

History actually begins as early as 1000 BCE China with smallpox

Between the 1940s-1980s there was reduced antivaccination movement
-Boom in scientific discovery and production
-Desire to protect children
-Increase in birth rate among more educated and affluent parent who accepted use of vaccines

1970s—more vaccines added to the schedule—antivax movement increased

1990s—suspicion of vaccines causing autism

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11
Q

Inactivated Vaccines

A

Manufactured by killing an infectious microbe with chemicals, heat, or radiations

More stable and safer than live vaccines (can’t mutate back to disease causing state)

Don’t require refrigeration and can be stored and shipped in freeze-dried form

Stimulate a weaker immune response than live viruses

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12
Q

Innactivated Whole Virus Vaccines

A

Polio, influenza, hepatitis A, rabies, Japanese encephalitis

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13
Q

Innactivated Whole Bacteria Vaccines

A

Pertussis, cholera, typhoid

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14
Q

Live, Attenuated Vaccines

A

Due to advances in tissue culture techniques

Created by modifying a disease-producing “wild” virus or bacterium that had been weakened in the lab to prevent the organism from causing disease

Closest thing to exposure to natural infection

Provoke strong cellular and antibody immune response, often life-long immunity

More difficult to create for complex pathogens like bacteria and parasites

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15
Q

Live, Attenuated Viral Vaccines

A

MMR, rotavirus, smallpox, varicella, yellow fever, zoster, polio (oral), influenza (nasal)

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16
Q

Live, Attenuated Bacterial Vaccines

A

Bacillus Calmette-Guerin (BCG) (mycobacterium)

oral typhoid

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17
Q

Nucleic Acid Vaccines

A

Gene-based vaccines simply encode a chosen viral protein in DNA or mRNA

Able to induce both specific humoral and cellular immune responses

Allow a high degree of adaptability to encode for any antigen

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18
Q

DNA Vaccines

A

Dispense with both the whole organism and its components

Use the genes that code for antigens
Evokes a strong antibody response to the free-floating antigen secreted by cell

Stimulates a strong cellular response against microbial antigens displayed on cell surfaces

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19
Q

RNA VAccines - background info

A

Represent the most recently developed technology

Vaccines based on mRNA are an intermediary between DNA and protein

mRNA molecule is composed of nucleotides linked in a unique order to convey genetic information for the cells to produce the proteins or antigens encoded by mRNA

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20
Q

2 major types of RNA vaccines

A

Non-replicating mRNA
-Simply construct, small size of RNA, absence of additional encoded proteins

Self-amplifying mRNA
-High levels of antigen expression—genetic information amplified many times

21
Q

Virus-Like Particle (VLP) Vaccines

A

Multiprotein structures that mimic the organization and conformation of authentic native viruses but lack the viral genome

Prompt an immune response similar to natural virus

Non-infectious—no genetic material

22
Q

Subunit Vaccines & Carriers

A

Don’t contain live components of the pathogen

Contain only antigenic parts of the pathogen

Adjuvants are critical to the protective effects—antigens alone are not sufficient to induce adequate long-term immunity

23
Q

Recombinant Protein Vaccine

A

A small piece of DNA is taken from the virus or bacteria and inserted into manufacturing cells (bacterial or yeast cells), the cells then are able to produce the surface proteins

Examples: Hepatitis B, Influenza, Acellular pertussis, HPV

24
Q

Polysaccharide & Conjugate Vaccines

A

Polysaccharide from a pathogen is attached or “conjugated” to a protein antigen

Can improve outcomes

Conjugation changes the immune response from T cell independent to T cell dependent—produces increased immunogenicity in infants

Examples: Meningococcal, Pneumococcal, Salmonella typhi

25
Q

Replicating and Nonreplicating Viral Vector-Based Vaccines

A

Combine many of the positive qualities of DNA vaccines and live, attenuated vaccines

Vector—using virus or bacterium as a carrier

Uses either live replicating or non-replicating vectors

Common vectors: adenovirus, measles virus, vesicular stomatitis virus

Recombinant vector vaccines are live replicating viruses engineered to carry extra genes derived from a pathogen—these extra genes produce proteins to generate immunity

26
Q

What is the FDA’s Center for Biologics Evaluation & Research responsible for regulating?

A

Vaccines in the US

27
Q

Steps of Vaccine Development

A
  1. Identify and Sequence the Virus
  2. Determine the Target
  3. Conduct Preclinical Trials
  4. Initial Human Trials—4 phases
  5. Obtain Regulatory Approval
  6. Establish Manufacturing and Distribution
28
Q

Host Response to Vaccination

A

Its not clear why the length of acquired protection varies with different vaccines

Booster can be described as a “reminder” to the immune system

Depending on the vaccine, some immunizations must be repeated

A patient’s immune system responds to a vaccine in various ways

B cells and cytotoxic T cell are responsible for regulation on an immune response

29
Q

Types of Vaccine Administration

A

Injection, orally, nasal spray

30
Q

Sites of Vaccine Administration - Intramuscular injection

A

most common; injected into the muscle mass

31
Q

Sites of Vaccine Administration - Subcutaneous (SC)

A

injected into the subcutaneous layer above the muscle and below the skin

32
Q

Sites of Vaccine Administration - Intradermal (ID)

A

administers the vaccine in the topmost layer of skin

Bascillus Calmette-Guerin (BCG) is the only to use this—reduces the risk of neurovascular injury

33
Q

Sites of Vaccine Administration - Intranasal Spray

A

offers a needle-free approach through the nasal mucosa

34
Q

HIV/AIDS Vaccine Development - 3 types being researched

A

Preventative or prophylactic vaccines (to protect individuals from HIV infection)

Therapeutic vaccines (to prevent HIV-infected patients from progressing to AIDS)

Perinatal vaccines (to prevent HIV-infected pregnant women to prevent transmission of HIV to the fetus)

35
Q

HIV/AIDS Vaccine Development - Challenges

A

High rate of viral mutation and recombination

No clearly defined natural immunity to HIV

HIV infects cells that are critical to the immune body defenses; also, it is transmitted as a free virus and within infected cells

36
Q

HIV/AIDS Vaccine Development - Additional Problems

A

Lack of knowledge related to the critical components on the body’s response to HIV infection

High risk of using the entire weakened or inactive HIV in a vaccine

Extensive rate of viral mutation as HIV replicates. Strains vary by as much as 35%

Protective effect may last only a short time

Vaccinated persons could become more susceptible to HIV

No research studies have successfully demonstrated which immune responses correlate with protection from HIV infection

37
Q

Cancer Vaccines - Background

A

Classified as “Biological-response modifiers”

Two types: Preventative/prophylactic (2) or Therapeutic (1)

Cancer treatment vaccines are designed to work by activating B cells and killer T cell and directing them to recognize and act against specific types of cancer

Cancer cells carry self- and cancer-associated antigens

The cancer associated antigens mark the cancer cells as abnormal (non-self) and can cause B cells and killer T cells to mount an attack against them

38
Q

HPV Vaccine

A

Prophylactic

Cervarix
-Bivalent vaccine made from virus-like particles with proteins from HPV types 16 and 18; may provide partial protection against other strains
-For girls and women aged 9-25 years

Gardasil
-Quadrivalent vaccine
-Can prevent cervical cancer and vaginal and vulvar precancers caused by HPV-16 and HPV-18
-Also protects against HPV-6 and HPV-11 which are responsible for 90% of all cases of genital warts in males and females but doesn’t cause cancer

39
Q

Cancer Treatment Vaccine

A

Intended to delay or stop the growth of cancer, to cause shrinkage of tumors, to prevent cancer from coming back, or to eliminate cancer cells that have not been destroyed by other treatments

Made using antigens from malignant cells or modified versions of them

Much more difficult to develop a cancer treatment vaccine than a preventative vaccine

To be effective a cancer vaccine must:
-Stimulate specific responses against the correct target
-Be powerful enough to over come the barriers that malignant cells use to protect themselves from attack by B cells and killer T cells

40
Q

Novel Leukemia Vaccine Therapy - Does it exist?

A

No

As of early 2020, no FDA approved vaccines for prevention of leukemia in humans

41
Q

Vaccines & Biodefense

A

Goal of FDA is to foster the development of vaccines that could be needed for potential products of bioterrorism

Smallpox & Anthrax main two concerns

42
Q

Vaccine Safety Issues

A

Controversial public health issue—no vaccine is totally effective or 100% safe

The same components that make them effective, also may cause serious side effects—may not be possible to develop safer versions without losing essential function

43
Q

FDA Approved vaccines must meet what requirements?

A

Produce protective immunity with only minimal side effects

Be immunogenic enough to produce a strong and measurable immune response

Be stable during shelf life, with potency remaining at a proper level

44
Q

Vaccine Side Effects/Adverse Events

A

Adverse event: possible side effect resulting from a vaccination

Most are mild: soreness, swelling or redness at the injection site

Some are associated with fever, rash, achiness

Serious side effects are rare but can include seizure or life-threatening allergic reaction

Range of possible side effects—each year due to chance alone many babies will experience a medical event in close proximity to a vaccination

45
Q

Monitoring Adverse Vaccine Events

A

1986 Congress enacted the National Childhood Vaccine Injury Act (NCVIA)—established a no-fault compensation system for children who were harmed by adverse events after the administration of a vaccine if there was evidence that the vaccine actually caused the problem

Monitoring programs are systems to monitor and analyze reported adverse event and to determine whether they are likely related to vaccinations
-Vaccine Adverse Events Reporting System (VAERS)
-Rapid Cycle Analysis—used mainly for new vaccines

46
Q

Vaccines against bacterial diseases

A

Cholera

Group A Streptococcus-in development

Lyme Disease

Pertussis

Tuberculosis-in development

47
Q

Vaccines Against Viral Diseases

A

Coronaviruses –in development
Dengue Fever
Ebola
Hepatitis
HIV - in development
Influenza
Respiratory Syncytial Viru (RSV)
Smallpox
West Nile Virus
Zika Virus

48
Q

Review significant epidemics/pandemics etc at end of slideshow

A

if you’re so inclined

Clinical Immunology (14 decks)

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