Lec36 Viral Vaccines Part 2

Question 1

How efficacious are viral MMR and polio vaccines?

Answer 1

> 99% reduction in yearly morbidity

Question 2

Antiv

Answer 2

antiviral –> humoral immunity

Question 3

What are two principal mech of specific antiviral immunity?

Answer 3

1. humoral: neutralize by specific antibodies made by B cells with help from CD4 against viral proteins [prevents or limits infection of host cells]
2. cell mediated: target virus-infected host cells by cytotoxic T cells [CD8] specific for immunogenic viral peptide [eliminates infected host cells, resolves infection]

Question 4

Which types of vaccines initiate cell mediated [CD8] immune response?

Answer 4

• live only

Question 5

Which type of vaccines initiate humoral [CD4/antibody] immune response?

Answer 5

• live
• killed
• protein subunit

Question 6

What type of vaccine is Hep B vaccine?

Answer 6

protein subunit vaccine [recombinant]

Question 7

What type of vaccine is hep A vaccine?

Answer 7

inactivated whole virus

Question 8

What type of vaccine is polio? How is it administered?

Answer 8

• in US: inactivated whole virus [IM]

- in developing countries/some of europe its live attenuated [oral]

Question 9

What type of vaccine is rotavirus? How is it administered

Answer 9

oral virus
either:
1. live pentavalent human-bovine reassortment rotavirus
2. live human attenuated

Question 10

What type of vaccine is MMR? how is it administered?

Answer 10

• all live attenuated

- give IM

Question 11

What type of vaccine is influenza?

Answer 11

two types

• inactivated whole virus [IM}
• live attenuated/cold adapted [intranasal]

Question 12

What type of vaccine is HPV?

Answer 12

• reassembled virus-like particles [look like whole virus but don’t contain nucleic acid or genome DNA, made of combined protein subunits]

Question 13

What is benefit of live polio vaccine [OPV] vs inactivated PV?

Answer 13

• provides intestinal immunity [prevent shedding of polio in stool and other secretions]
• prevents secondary spread of vaccine to unprotected contacts

Question 14

What is influenza vaccine composed of?

Answer 14

• inrfluenza undergoes antigenic drift and sometimes shift –> yearly repeat doses required for optimal immunity
• composed of 2 prevalent strains of influenza A [one H1N1 and one H3N2] and the single most prevalent strain of influenza B isolated during the previous year

Question 15

What are properties of measles vaccine? Who should get it?

Answer 15

• vaccinate at 1 yr then booster at 4-6 yrs
• live vaccine that temporarily suppresses CMI [cell mediated immunity] –> so don’t test someone for tuberculin reactivity within 6 wks of vaccine
• pre-existing antibody interferes with immune response to vaccine [ie maternal antibodies in infants, intravenous Ig]

Question 16

What are properties of rubella vaccine?

Answer 16

• live vaccine

- don’t give during pregnancy due to concern for congenital rubella

Question 17

What are properties of mumps vaccine? How effective?

Answer 17

• live vaccine
• highly effective
• recent cases have occurred in vaccinees

Question 18

What are the properties of varicella vaccine? side effect?

Answer 18

• live vaccine
• may produce mild vaccine-associated disease
• give higher dose to vaccinate against zoster for > 60 y.o.

Question 19

Who should not get live vaccines?

Answer 19

• patients with defective CMI because may cause illness

Question 20

What are properties of HPV vaccine?

Answer 20

• composed of reassembled virus-like particle

- 2 versions

Question 21

What types of HPV does HPV4 cover? HPV2?

Answer 21

HPV4 covers types 6, 1, 16, 18

HPV2 covers 16,18 only

Question 22

What diseases associate with types 6 and 11 HPV?

Answer 22

• papillomatosis [genital warts] including respiratory papillomatosis in infants

Question 23

What types of HPV cause genital warts?

Answer 23

types 6 and 11

Question 24

What diseases associated with types 16 and 18 HPV?

Answer 24

cervical cancer

Question 25

What types of HPV most associated with cervical cancer?

Answer 25

types 16 and 18

Question 26

How is HPV transmitted?

Answer 26

direct [usually sexual] contact

Question 27

When do you give HPV vaccine?

Answer 27

ideally before onset of sexual activity [11-12 yo]

Question 28

What are examples of passive immunizations? 5 known diseases that get prevented with it?

Answer 28

passive immunization = prep immune globulin or monoclonal antibodies to prevent infection

hep A – standard human immune globulin

hep B – hep B IG

rabies – rabies IG

RSV – [palivizumab, Synagis]

Intravenous Immune globulin [for pt with humoral immunodeficiency]

varicella immune globulin

maternal antibodies across placenta or via breast feeding

Question 29

What is palivizumab [synagis]?

Answer 29

Ig for RSV give to premature babies to keep them from getting RSV = passive immunity

Question 30

What are common adverse events to vaccines?

Answer 30

• commonly mild to moderate: fever, injection site rxn

Question 31

What is potential rare complication of live oral polio vaccine?

Answer 31

paralytic polio

Question 32

What is potential rare complication of tetanus vaccine?

Answer 32

guilain-barre

Question 33

What is potential rare complication of varicella vaccine?

Answer 33

acute cerebellar ataxia

Question 34

What is contraindication to getting DTaP vaccine?

Answer 34

encephalopathy within 7 days of prior dose

Question 35

What is contraindication to getting influenza vaccine

Answer 35

severe allergic rxn to eggs

Question 36

What are contraindications to getting MMR[V] vaccine?

Answer 36

• pregnancy
• deficient CMI
• prior anaphylaxis to neomycin or gelatin