Immunisation

Question 1

what caused the major fall in infant deaths in the 20th century

Answer 1

vaccination

Question 2

who created vaccination

Answer 2

Edward Jenner

Question 3

wha is an example of where vaccines can go wrong

Answer 3

1970s caused children to get side effect due to whooping cough vaccine not working properly

Question 4

why do we have to be careful when giving a vaccine

Answer 4

• usefulness of having protection versus immune system development

Question 5

what vaccine is given at

• two months old
• three months old
• four months old
• 12 month old

Answer 5

• diphtheria, tetanus, peruses, polio and haemophillus influenza type b, Meningitis type B, rotavirus, pneumococcal disease
• dipeteris, teatusmus, peruses, polio and hib, meninggoal C and B, rota virus
• diphtheria tetanus peruses polio hib, pneumococcal disease
• hib B/Men C, pneumococcal disease, measles, mumps and rubella

Question 6

name some vaccines that you have to have if you have certain diseases (targeted vaccines)

Answer 6

BCG – neonatal depending on risk level (area/family)

Hepatitis B – In first year if born to infected mother

Influenza/pertussis – Pregnant women

Question 7

what are some diseases that would mean you have to have vaccines earlier

Answer 7

Chronic respiratory, heart, neurological conditions

Diabetes

Haemophilia

Immunosuppressed (either naturally or drug-induced)

Question 8

when can you not give a vaccine (important)

Answer 8

Anaphylaxis to a previous dose

Immunosuppression – do not give live vaccine (MMR, BCG)- some vaccines are weakened form so it can still cause an immune reaction

Pregnancy (in some cases) don’t give rubella while pregnant

Postpone if acutely unwell

Question 9

several live vaccines can be given…

Answer 9

Several live vaccines can be given concurrently but if spaced, minimal interval = 3 weeks

Question 10

why is it hard to make vaccines for some diseases

Answer 10

• in some diseases the pathogens infect and hide away having latent periods
• these are the diseases that we have problems making vaccines for

Question 11

describe Herd vaccination

Answer 11

• this is when you vaccinate 85-90% of the population in order to prevent the spread of the disease and to protect the people that cannot be vaccinated for reasons such as being immunosuppressed
• if a lower amount of the population is vaccinated then it spreads further through eh population

Question 12

how effective are vaccines

Answer 12

Vaccines have been so effective that many diseases are no longer seen in “rich” countries

Question 13

why do parents withhold vaccination

Answer 13

Some parents may elect to withhold vaccination for fear of side effects, judging risk of vaccine to be higher than the small risk of catching infection

Question 14

what diseases are hard to prevent through herd immunity

Answer 14

Highly contagious infections like chicken pox, whooping cough and measles more difficult to prevent through herd immunity

Question 15

what are the features of an effective vaccine

Answer 15

safety 
protection 
longevity 
neutralising antibodies
protective T cells
practicality

Question 16

describe the features of an effective vaccine

Answer 16

safety - the vaccine must not cause illness or death

protection - the vaccine must protect against exposure to the pathogen

longevity - the vaccine should give long lasting protection

neutralising antibodies - these must be induced to protect against pathogens such as polio, and many toxins and venoms

protective T cells - these must be induced to protect against pathogens such as TB

practicality - the vaccine must be cheap to produce and easy to administer

Question 17

what are the reactions to vaccine administration

Answer 17

Anaphylactic reactions

Fever / febrile convulsion

Local reactions

Reversion of live vaccines to ‘wild type’

Question 18

what are the problems of the vaccine when the pathogen is encountered

Answer 18

Vaccine ineffective

Heightened immune response to illness

Question 19

what are the problems with vaccine and therefore the things that you must test

Answer 19

• reactions to vaccine administration

- problems when the pathogen is encountered

Question 20

what is passive immunisation

Answer 20

• passive is when you receive antibodies

- an example would be the transfer of maternal antibodies from the mother to the baby

Question 21

what is the difference between active and passive immunisation

Answer 21

passive involves receiving antibodies therefore the immune system is not activated whereas active is when you get some form of the disease thus the immune system is activated

Question 22

name some types of active immunisation

Answer 22

• inactivated vaccines
• attenuated vaccines
• recombinant peptide vaccines
• DNA vaccines
• therapeutic vaccines

Question 23

describe how passive antibodies are made

Answer 23

Injected killed pathogen 
Make ian immune response 
10 days layer 
Take serum that contains the antibodies 
Inject mouse 
Challegne with live pathogen 
Shows animal is protected

Question 24

what is passive immunisation used for

Answer 24

This type of immunisation is often given to counteract insect/animal venoms

Question 25

what serum is usually used for passive immunisation

Answer 25

horse

Question 26

what is the problem with passive immunisation and using horse serum

Answer 26

The immunisation effect lasts for as long as the antibody remains active – a few months at most The patient makes an immune response against the serum (can cause “serum sickness”)

Question 27

passive immunisation does not..

Answer 27

give long lasting protection

Question 28

how is polio transmitted

Answer 28

Transmission: faecal – oral

Question 29

what is polio caused by

Answer 29

enterovirus 3 different strains | Incubation period 7-14 days

Question 30

what does polio have a high affinity for

Answer 30

nervous tissue

Question 31

what is the inactivate and active form of disease of polio

Answer 31

inactive - polio Salk - sugar lump | active- polio sabin

Question 32

describe polio Salk

Answer 32

- polio virus is marinated in formalin - virus is unable to replicate thus it is deactivated - generates good humeral immunity - no chance of disease but has side effects

Question 33

describe polio sabin

Answer 33

- a live weakend polio virus is generate - the virus can replicate but does not cause diseae - vaccine generates good humeral and cell mediated immunity - occasionally can get polio in patients

Question 34

why do we go inactivated, attenuated, inactivated in the case of polio

Answer 34

Injection - get rid of it the majority of it Attenuated – stop spreading Injected – prevent it coming back

Question 35

name some inactivated vaccines

Answer 35

- DPT - Diphtheria, whooping cough, tetanus - polio - cholera - influenza - plague

Question 36

name some attenuated vaccines

Answer 36

- MMR - measles, mumps and rubella - polio sabin - chicken pox - tuberculosis - influenza - yellow fever - rabies

Question 37

what is a difference between inactivated and attenuated

Answer 37

- inactivated produces humeral immunity whereas attenuated produces humeral and cell mediated immunity

Question 38

when was MMR introduce

Answer 38

Introduced to the UK in 1988

Question 39

what are the side effects of MMR

Answer 39

malaise, fever, rash (at 1wk), febrile convulsions

Question 40

what are the illnesses of MMR

Answer 40

Acute illness Immunosuppression e.g. steroids, AIDS Another live vaccine within previous 3 weeks Receipt of immunoglobulin within previous 3 months Children who have an anaphylactic reaction to egg should be immunised and observed in hospital for 2 hours

Question 41

what is the cause and incubation period and pathogenesis of diphtheria

Answer 41

Notifiable illness caused by Corynebacterium diphtheria Incubation period: 2-5 days Pathogenesis: disease results from exotoxin-producing strains

Question 42

what are the cause and incubation period of pertuses

Answer 42

Cause: Bordetella pertussis Incubation period: 7-10 days

Question 43

what are the adverse effects of pertusis vacciantion

Answer 43

Local: Redness and swelling Systemic: Inconsolable screaming, high fever, hypotonic, seizures, anaphylaxis, bronchospasm Encephalopathy (very rare, especially with new vaccine – 1.3/10 million

Question 44

what causes tetanus, wha tis its incubation period and who is it transferred

Answer 44

Notifiable illness caused by Clostridium tetani (a spore forming anaerobic gram positive bacillus) Incubation period of 4-21 days (depending on inoculum) Transmission: direct transfer of spores (e.g. from soil)

Question 45

what type of vaccine is tetanus

Answer 45

it is a toxoid

Question 46

describe HpB symptoms

Answer 46

Many cases are asymptomatic, 1-2% develop fulminant hepatic failure with high risk of mortali

Question 47

what are the two vaccines for HpB

Answer 47

Purified from human plasma – HBsAg HBsAg produced in yeast cells by recombinant DNA technology

Question 48

how effective is HpB

Answer 48

Vaccine is 90% effective after a 3-dose series (but this decreases over 40 years of age) Duration of protection is at least 3-5 years – booster if concentration Antibody <50 IU/I

Question 49

what type of pathogen is haemophilia influenzae type B

Answer 49

An encapsulated Gram negative bacterium which has been the major cause of bacterial meningitis and epiglottitis in infants and young children

Question 50

describe how many people effected by haemophilia influenzae type B

Answer 50

70% of cases occur in children <2 years of age 1 in 600 develop disease by 5 years of age An estimated 65 deaths/year in the UK prior to vaccine

Question 51

describe the vaccine used for haemophilia influenzae type b

Answer 51

First vaccine consisted of purified polysaccharide PRP which was poorly immunogenic in children <2 years We now have a conjugate vaccine (protein carrier) – highly protective

Question 52

how does a recombinant peptide vaccine work

Answer 52

Get the virus sequence the gneome of the virus Find a gene molecular clone it Put it into a yeast Purify the viral protein Get lots of the protin and then use it as a vaccine – need to use it as an adjuvant Makes a regulatory response – will not respond to that, desntities it Mix the protein with harmless bactria and makes immune response to bacteria

Question 53

describe benefits of adjuvants

Answer 53

- activate dendritic cells - bias towards Th2 antibody response - stimulate mucosal immunity - bias towards TH1 cell mediated response

Question 54

describe how a DNA vaccine works

Answer 54

- gene is isolated from pathogen - placed in a bacterial plasma - bacterial DNA acts as an adjuvant via TLR9 - add cytokines and the plasmid is then injected into the muscle of a recpipenet - the animal is then protected

Question 55

where do you inject DNA vaccines

Answer 55

they are injected into the muscle of a recipient

Question 56

what is the future of vaccines

Answer 56

- this will occur when the animal is already infected and cannot clear the infection - the sick animal is then vaccinated to boost the immune response and can now clear the infection