Case of Vaccine Refuser Flashcards

1
Q

Different in active and passive vaccine?

A

active- cause organism to mount an immune response- as if real infection had taken place

passive- prefabricated immune response (an antibody concentrate)

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2
Q

immunisation for diptheria?

A

horses injected with cornyebacterium diphteriae toxin- then horse serum collected and the antitoxin us used for human use

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3
Q

horse serum problems?

A

horse protein will induce anti-antibodies in patient resulting in formation of complexes… secondary immune complex disease

horse igG is 5 days and human is 20 days, rapidly eliminated. Repeat administration can lead to anaphylactic shock. may soon be replaced by human igG produced in bio-reactors

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4
Q

who should not get live vaccines?

A

compromised immune system people, may not be able to contain that infection,

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5
Q

examples of life vaccine?

A

shingles, BCG, MMR nasal spray influenza and rubeola, produce stronger immune responses

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6
Q

what does inactivated vaccines require?

A

repeat doses, booster
examples influenza, pertussis, poliomyleitis, typhoid

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7
Q

what is unique about polysaccharide vaccines?

A

combined to a carrier to increase imunogenicity

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8
Q

subunit vaccine example

A

hepatitis b

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9
Q

virus like particle vaccine example

A

HPV

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10
Q

Subunit conjugate vaccine example

A

haemophilus influenza B

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11
Q

toxoid vaccine for

A

tetanus, diphteria

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12
Q

DNA/RNA vaccines for?

A

COVID- vector based AstraZeneca
liposomal vaccine- Pfizer/ moderna

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13
Q

what do adjuvants do?

A

increase local immunity to vaccine and attract other immune cells

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14
Q

routine vaccinations start at?

A

8 weeks

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15
Q

post exposure prophylaxis?

A

hepatitis B, tetanus and rabies, anti venoms and antitoxins

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16
Q

what should be given to baby whose mother develops varicella 1 week before or after delivery?

A

VZV hyperimmune globulin

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17
Q

where does SARS Cov2 protein bind?

A

ACE-2 and Nrp1 (neuropilin1)

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18
Q

what is the issue if one antibody or competing antibodies are given?

A

novel spike mutation

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19
Q

RNA vaccine does not ?

A

interfere with host cells genes

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20
Q

mRNA needs to be stable enough to be translated so hence requires?

A
  1. A specially modified nucleotide positioned at the 5’ cap
  2. a poly A tail length
  3. the composition and structure of the 3’ untranslated region
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21
Q

advantages of mRNA vaccine?

A

safety- no pathogen particles, RNA strand is degraded when protein is made, not integrated in host genome

efficacy- reliable immune response, well-tolerated and few side effects

production- rapid, standardised, scaled to meet needs of pandemic

can be effective for cancer vaccines

22
Q

herd immunity?

A

infection is no longer effectively transmitted across population because too many individuals are immune

23
Q

herd immunity level?

A

r naught, in covid 19, 5-6
this would cause hundred thousands of death

24
Q

original antigenic sin?

A

antigen exposure causes recruitment of b cells- make antibodies and t cells . second times- t cells and igG peak at 5-10 days

but with slightly changed virus- existing memory response is ineffective, with antibodies not neutralising the changed virus

if similar enough, same antobodies can bind to an extent and the existing memory b cells may expand further but no new immune response is made

25
narcolepsy is
severe sleep disruption, loss of concentration, social difficulties and complete loss of muscle control
26
narcolepsy was attributed to?
AS03- adjuvant in GSK vaccine 1/55,000
26
narcolepsy was attributed to?
AS03- adjuvant in GSK vaccine 1/55,000
27
adjuvants?
mineral salt: aluminium hydroxide micro-fluidised detergent, emulsions and saponins- MF59, AS03 TLR agonist- CpG and flagellin
28
EFFICACY?
works in lab like conditions
29
how do RCTs protect against confounding?
temporal precedence
30
higher risk of bias in?
case reports, whereas RCT has the lowest risk of bias
31
clinical equipoise
genuine uncertainty in the expert medical community over whether one treatment will be more beneficial
32
what makes a good RCT?
internal validity- is the exposure causing the outcome in the study external validity- are the findings generalised to others
33
bias?
partiality that prevents objective consideration of an issue or situation
34
bias is independent of?
sample size and statistical significance
35
bias is concerned with?
systematic error
36
selection bias?
1. not adequately capturing relevant population 2. systematic difference in comparison groups at outset
37
performance bias?
introducing differences between groups in care provided/ exposures encountered
38
attrition bias?
difference between groups in drop outs
39
observer, detection bias?
not adequately capturing the outcome of interest systematic differences in the way information is collection for the groups being studied
40
how to minimise selection bias?
inclusion/exclusion criteria and sampling strategies randomisation and allocation procedures
41
how to minimise performance, attrition, observer, detection bias?
blinding/ masking
42
open RCT?
everyone involved in trial knows
43
Intention to treat?
analyse outcome for everyone randomised irrespective of whether they have/adhere to interventions allocated
44
per protocol?
analyse outcomes for only those who received dose of intervention as specified in protocol
45
Type I error?
there is no true difference but an observed difference accepted at 5%
46
Type II error?
There is a true difference but no observed difference accepted at 10/20%
47
what is p value?
probability that the difference observed could have occurred by chance if the groups were really alike
48
confidence interval?
range of values within a given probability (95%) that the true value of a variable is contained within that range
49
RCT advatanges?
safety, efficacy best single study for causal association temporal precedence deals with confounding
50
RCT disadvantages?
time consuming, laborious expensive internal validity issues issues with external validity