Immunization Flashcards by Adrian Tiglao

💡Resistance to disease specifically infectious disease

IMMUNITY

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Collection of cells, tissues and molecules that 💡mediate resistance to infections

IMMUNE SYSTEM

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💡Coordinated reaction of cells and molecules to infectious microbes

IMMUNE RESPONSE

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Live or inactivated substance 💡capable of producing an immune response

ANTIGEN

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Protein molecules produced by 💡B lymphocytes to help 💡eliminate an antigen

ANTIBODY

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CONCEPTS ON IMMUNITY

SEE ANKI

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Types of Immunity

A. NATURAL/INNATE IMMUNITY

B. ADAPTIVE/ACQUIRED IMMUNITY

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▪ 💡First line of defense
▪ 💡Immediate protection against microbial invasion
▪ Rapidly mobilized at the site of infection but 💡lacks immunologic memory
▪ 💡Natural or 💡Native Immunity
▪ Innate immune responses 💡enhance adaptive immune responses against the infectious agent
▪ 💡Non-specific resistance of the body against infection.

NATURAL/INNATE IMMUNITY

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NATURAL/INNATE IMMUNITY

▪ Non-specific resistance of the body against infection.
▪ 💡Barriers: skin, GIT and respiratory epithelium, mucous membranes
▪ 💡Dendritic Cells: Antigen presenting function
▪ 💡NK Cells: Destroy irreversibly stressed and abnormal cells
▪ 💡Phagocytic cells:
○ 💡Monocytes - cytotoxic ability
○ 💡Macrophages - antigen presenter
○ 💡Polymorphonuclear cells/Neutrophils - kills extracellular pathogens
○ And 💡auxiliary cells- involved in inflammation process
○ 💡Mast cells
○ 💡Basophils
○ 💡Platelets

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3 Important Cells in Phagocytosis:

○ 💡Neutrophils
   • Circulating pool
   • Marginated pool
○ 💡Circulating monocytes
○ 💡Fixed tissue macrophages

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▪ 💡Second defense system
▪ Develops more 💡slowly and provides more 💡specialized defense against infections
▪ 💡SPECIFIC IMMUNITY or 💡ACQUIRED IMMUNITY
▪ 💡Specific for the pathogen and confers protective immunity to reinfection with the pathogen
▪ Specifically 💡recognize and destroy the pathogen because lymphocytes carry specialized cellular receptors and produce specific antibodies
• 💡Highly specific resistance of the body against infections

ADAPTIVE/ACQUIRED IMMUNITY

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What are the cells that mediates ADAPTIVE/ACQUIRED IMMUNITY?

B lymphocytes

T lymphocytes

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Categories of Acquired Immunity:

Cell-mediated immunity

Humoral immunity

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Specific immunity mediated by 💡T-cells
Most T cells recognize only 💡protein antigens
Acts against foreign bodies/ tissues and defense against intracellular microbes
💡Activates other cells in immune system

Cell-mediated immunity

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What are the cells that mediate Cell-mediated immunity?

HELPER T CELLS
CYTOTOXIC T CELLS
NATURAL KILLER CELLS

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💡Antigen Presenting Cells – activation of macrophages/ inflammation and activation of T and B lymphocytes

HELPER T CELLS

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Killing of Infected Cells

CYTOTOXIC T CELLS

NATURAL KILLER CELLS

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o 💡Long-term resistance
o 💡Antibodies
o 💡B lymphocytes
o Enter the circulation and mucosal fluids
o Neutralize and eliminate microbes and microbial toxins
o Outside host cells, in the blood, extracellular fluid derived from plasma, and in the lumens of mucosal organs
o 💡Slow onset of action specific immunity
o Antibodies produced by B-cells

Humoral immunity

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IMMUNOGLOBULINS

IgG
IgM
IgA
IgE
IgD

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💡Cross the placentae
Most abundant immunoglobulin in 💡newborns
Persists 💡longer in secondary response
Indicate 💡past infection

IgG

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💡First produced in response to an antigen
Most efficient immunoglobulin in 💡agglutination, 💡complement fixation and 💡antigen antibody reactions
Defense in bacteria and viruses
Indicate 💡acute or current infection

IgM

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💡Mucosal immunity

* Milk, saliva, tears (Respiratory, GIT, GUT)

IgA

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Parasitic Infections

* Allergic Reactions

IgE

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IMMUNE SYSTEM

A. GENERAL LYMPHOID ORGANS

B. PERIPHERAL LYMPHOID ORGANS

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GENERAL LYMPHOID ORGANS

THYMUS | BONE MARROW

💡Maturation and 💡education site of lymphoid cells allowing T cells to develop the important attribute known as 💡self-tolerance

THYMUS

Site of origin of red blood cells, white blood cells and platelets

BONE MARROW

PERIPHERAL LYMPHOID ORGANS

LYMPH NODES SPLEEN MUCOSA-ASSOCIATED LYMPHOID TISSUE (MALT)

Small bean shaped structures lying along the course of lymphatic and are aggregated in the neck, axillae, groins and para-aortic region

LYMPH NODES

Located in the upper left quadrant of the abdomen

SPLEEN

o Tonsils o Adenoids (Waldeyer’s ring) o Peyer’s patches • Organized to concentrated antigens, APC and lymphocytes for adaptive immune responses

MUCOSA-ASSOCIATED LYMPHOID TISSUE (MALT)

o Protection produce by the 💡person’s own immune system | o 💡Lifetime

Active Immunity

o Protection 💡transferred from another animal or human

Passive Immunity

o The 💡process whereby a person is made💡 resistant to an infectious disease, typically usually by the administration of a vaccine. o 💡Stimulate the immune system to develop long-lasting immunity against antigens from specific pathogens o Elicit an immune response against an antigen so that when the individual is again exposed to the antigen, a much stronger immune response will result.

IMMUNIZATION

It stimulate the immune system to develop long-lasting immunity against antigens from specific pathogens.

Vaccines

o Vaccines promote health o Vaccines have an expansive reach: they protect individuals, communities, and entire populations o Vaccines have rapid impact: the impact of most vaccines on communities and populations is almost immediate o Vaccines save lives and costs

VACCINATION

IMMUNIZING AGENTS

o Immunoglobulins | • Antibodies

Antisera

o Materials prepared from animals

💡Slower response with 💡lower level of immunity

Primary Immune Response

Exposed to a certain antigens there will be 💡immediate response and 💡higher level of immunity.

Secondary Immune Response

The main vaccine preventable diseases targeted by the EPI and the associated vaccines

See anki

💡Immuno-biological substance designed to produce specific protection against a given disease.

VACCINES

VACCINES Types:

``` LIVE ATTENUATED VACCINE INACTIVATED VACCINE SUBUNIT VACCINE TOXOID VACCINE RECOMBINANT VACCINE ```

o Attenuated (💡weakened) form of the “wild” virus or bacterium o 💡Must replicate to produce an immune response o Immune response virtually 💡identical to natural infection o Usually produce immunity with 💡one dose* o 💡Severe reactions possible o Interference from circulating antibody o 💡Fragile – must be stored and handled carefully

LIVE ATTENUATED VACCINE

LIVE ATTENUATED VACCINE Examples:

``` o Viral: • Measles • Rotavirus • Oral polio o Bacterial: • BCG ```

Five WHO recommended vaccines using LAV Technology

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o 💡Inactivated microorganisms grown in a culture o 💡Cannot replicate o Less affected by circulating antibody than live vaccines o Always require 💡multiple doses o Immune response mostly 💡humoral o 💡Antibody titer diminish with time o May require periodic supplemental 💡booster doses

INACTIVATED VACCINE

Adverse reactions associated with inactivated whole-cell vaccines

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INACTIVATED VACCINE

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o 💡No live component of the pathogen | o Only 💡antigenic parts

SUBUNIT VACCINE

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SUBUNIT VACCINE Types:

PROTEIN BASED SUBUNIT VACCINES POLYSACCHARIDE SUBUNIT VACCINES CONJUGATE SUBUNIT VACCINES

Uses a specific 💡isolated protein of the pathogen o May bind to different antibodies than the protein of the pathogen Examples: o 💡Acellular pertussis (aP) – inactivated pertussis toxin o 💡Hepatitis B – HBsAg of purified plasma of Infected Individuals

PROTEIN BASED SUBUNIT VACCINES

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o 💡Polysaccharide capsule of the bacteria o Not consistently immunogenic in children younger than 2 years of age o Induce only 💡short-term immunity o 💡No booster response o Antibody with 💡less functional activity o💡IgM with little IgG o 💡Pneumococcal, 💡Meningococcal

POLYSACCHARIDE SUBUNIT VACCINES

o Polysaccharide is bonded with a 💡carrier protein | o Increases immunogenicity with 💡antibody booster response

CONJUGATE SUBUNIT VACCINES

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▪ Based on the 💡toxin produced by certain bacteria ▪ Protein based toxin is rendered harmless and used as an antigen in the vaccine to elicit immunity ▪ Adsorbed to 💡adjuvants (aluminum or calcium salts)

TOXOID VACCINE

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TOXOID VACCINE

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Whole-cell vaccines Examples:

``` o Viral: • Polio • Hepatitis A • Rabies • Influenza o Bacterial: • Pertussis • Typhoid • Cholera • Plague ```

Fractional vaccines Examples:

o Subunits: hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax

Toxoids Examples:

Diphtheria, tetanus

▪ 💡Genetic engineering technology | ▪ Insertion of a segment of the respective 💡viral gene in to the gene of a yeast cell or virus

RECOMBINANT VACCINE

RECOMBINANT VACCINE Examples:

▪ Viral: hepatitis B, human papillomavirus, influenza (one brand), live attenuated influenza ▪ Bacterial: Salmonella Typhi (Ty21a)

It aims to build a 💡Region free from vaccine-preventable diseases. It was established in 1976 to ensure that infants/children and mothers have access to routinely recommended infant/childhood vaccines.

Expanded Programme on Immunization (EPI)

The immunization goals for the Western Pacific Region are:

o Sustaining polio-free status o Eliminating maternal and neonatal tetanus o Eliminating measles o Accelerating control of hepatitis B o Eliminating rubella o Introducing new vaccines o Meeting regional vaccination coverage targets o Accelerating control of Japanese encephalitis

Six vaccine-preventable diseases were initially included in the EPI:

``` o Tuberculosis o Poliomyelitis o Diphtheria o Tetanus o Pertussis o Measles ```

Vaccines under the EPI:

``` o BCG birth dose o Hepatitis B birth dose o Oral Poliovirus Vaccine o Pentavalent Vaccine o Measles Containing Vaccines (Anti measles Vaccine o Measles, Mumps, Rubella) o Tetanus Toxoid ```

In 2014, __ was included in the routine immunization of EPI.

Pneumococcal Conjugate Vaccine 13

Fully immunized child is?

▪ One dose of BCG ▪ 3 doses of OPV, DPT and Hepatitis B Vaccine ▪ Measles ▪ Before reaching one year old **Recently one dose of IPV

DOH

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``` ▪ Mycobacterium tuberculosis ▪ Area of Infection: o Lungs o Bones o Joints o Brain ▪ Mode of Transmission: o Airborne ▪ Risk Factors: o Overcrowding o Poor access to health care o Immunocompromised o Malnutrition ▪ Symptoms: o Weight loss o General weakness o Fever and night sweats o Hemoptysis o Persistent cough o Chest pain o Failure to thrive o Swelling o Pain and crippling effects on the hips, knees or spine ```

TUBERCULOSIS

TUBERCULOSIS Treatment:

BCG Vaccination before 1 year old prevents TB Meningitis and other severe forms of TB in children less than 5yo

o Freeze dried solution o +2 –to +8 ℃ after reconstitution o Small raised lump → 2 weeks red sore → 2 weeks small scar (5mm)

Bacillus Calmette-Guerin

BCG Vaccine Summary

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``` ▪ Corynebacterium diphtheriae ▪ Mode of Transmission: o Person-to-person o Respiratory contact ▪ Signs and Symptoms o Sore throat o Loss of appetite o Bluish-white or grey membrane in the throat o Severe weakness o Swollen neck o Respiratory obstruction o Cardiac complications - Arrhythmia - Heart failure ```

DIPTHERIA

DIPTHERIA Treatment:

``` o Anti-toxin and antibiotics o Diphtheria containing vaccine o Diphtheria with tetanus toxoid (DT/dT) o Diphtheria/tetanus and pertussis (DTP) o Diphtheria/tetanus/pertussis/hepatitis B and Hemophilus influenzae B ```

Pentavalent (DTP + HepB + Hib)

Diphtheria/tetanus/pertussis/hepatitis B and Hemophilus influenzae B

DIPTHERIA Vaccine handling:

o +2 to +8 ℃ freeze dried (lyophilized) | o Freeze sensitive

DIPTHERIA Vaccine Summary

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``` ▪ Caused by Clostridium tetani ▪ Soil-infected wound; Deep wounds, burns and crush injuries ▪ Signs and Symptoms: • Trismus • Stiffening of muscles of neck, abdomen or back • Difficulty of swallowing • Muscle spasms • Sweating • Fever ```

TETANUS

It is the most common life-threatening consequences of unclean deliveries and umbilical cord care practices

Maternal and Neonatal Tetanus

TETANUS Incubation Period:

3 to 21 days after infection

TETANUS Treatment

* Anti-tetanus immunoglobulin, Antibiotics, Wound care, and Supportive measures * Tetanus toxoid containing vaccine (TTCV) * Diphtheria with Tetanus toxoid (DT/dT) * Diphtheria/tetanus and Pertussis (DTP) * Diphtheria/Tetanus/Pertussis/Hepatitis B and H. influenzae b - Pentavalent (DTP + HepB + Hib)

Tetanus Toxoid Guidelines:

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Tetanus Toxoid Summary

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▪ Caused by Bordetella pertussis ▪ “Whooping Cough” o Mode of Transmission: Droplet transmission o Signs and Symptoms: • Common colds with mild cough • Worsening cough → High pitched whoop • Cyanosis • Vomiting and exhaustion after coughing attacks • Pneumonia • Convulsions and seizures

PERTUSSIS

PERTUSSIS Treatment:

* Antibiotics * Pertussis-containing vaccine * Diphtheria/tetanus and Pertussis (DTP) * Diphtheria/Tetanus/Pertussis/Hepatitis B and H. influenzae b - Pentavalent (DTP + HepB + Hib)

PERTUSSIS Summary:

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▪ Hepatitis B Virus - infects the liver ▪ May progress to a chronic disease for infants infected during birth or before 1 year of age ▪ Cirrhosis and liver cancer, liver failure o Signs and Symptoms: • Fatigue, nausea, vomiting • Abdominal pain • Jaundice

HEPATITIS B

HEPATITIS B Treatment:

* Interferon and antiviral agents * Hepatitis B vaccine * Diphtheria/Tetanus/Pertussis/Hepatitis B and H. influenzae b – pentavalent (DTP + HepB + Hib)

HEPATITIS B Summary:

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▪ Nose and throat of children ▪ Severe pneumonia, meningitis for children less than 5 years ▪ Person to person droplets ○ Signs and Symptoms: • Fever, cough, rapid breathing and chest wall retractions • Meningitis sign: Epiglottitis, septicemia • Mental retardation, brain damage, hearing loss

HAEMOPHILUS INFLUENZA B

HAEMOPHILUS INFLUENZA B Treatment:

Antibiotics | • Diphtheria/Tetanus/Pertussis/Hepatitis B and H. influenzae b - Pentavalent (DTP + HepB + Hib)

Diphtheria/Tetanus/Pertussis/Hepatitis B and H. influenzae b - Pentavalent (DTP + HepB + Hib) Handling:

Freeze dried (Freeze sensitive) +2 to +8 ℃

▪ Highly infectious disease caused by Poliovirus types 1,2 and 3 (WPVs) ▪ Children < 5years of age ▪ Irreversible paralysis (Spinal cord nerve cells) ○ Mode of Transmission: Fecal-oral route ○ Signs and Symptoms: • Fever, headache, and sore throat, paralysis

POLIOMYELITIS

POLIOMYELITIS Treatment:

* No cure * Supportive and symptomatic care * Ventilator, orthopedic tx, regular physiotherapy * OPV (Oral Polio Vaccine) + IPV (Inactivated Polio Vaccine)

* Heat sensitive and kept frozen | * After thawing +2 to +8 degrees Celsius for a maximum of 6 months or can be refrozen

OPV (Live attenuated, 1, 2, 3)

* Stable outside the cold chain * +2 to +8-degree Celsius * It should not be frozen

IPV in combination with pentavalent or stand alone

POLIOMYELITIS Summary:

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▪ Streptococcus pneumoniae ▪ Pneumonia and meningitis ▪ Septicemia, Otitis media, sinusitis ▪ Mode of Transmission: Direct contact with respiratory secretions ○ Signs and symptoms depend on the affected part

PNEMOCOCCAL DISEASE

PNEMOCOCCAL DISEASE Treatment:

* Antibiotics * Pneumococcal vaccine with other control measures * Pneumococcal polysaccharides (23 serotypes) * Pneumococcal conjugate vaccine

PNEMOCOCCAL DISEASE Summary:

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▪ Highly infectious disease ▪ Occur as an epidemic ○ Mode of Transmission: Contact with nose and throat secretions/airborne droplets ▪ Infective several days before and after symptoms ▪ Cough, coryza, and conjunctivitis, Koplik spot ▪ Rash (head-trunk-feet) ▪ Malnutrition, middle ear infection, pneumonia, encephalitis, blindness

MEASLES

MEASLES Treatment:

* No antiviral * Antibiotics * Nutritional support and rehydration * Vitamin A supplementation * Measles containing vaccines

Measles containing vaccines

- MMR - Measles, Mumps, and Rubella - Freeze dried - Heat and Light Sensitive

MEASLES Summary

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``` ▪ Infectious parotitis ▪ Mumps orchitis ▪ Mode of Transmission: Airborne droplets, direct contact ○ Signs and Symptoms: • Pain on chewing and swallowing • Fever and weakness • Swelling on the salivary glands • Sterility • Encephalitis, Meningitis and hearing loss ```

MUMPS

MUMPS Treatment:

``` • Supportive treatment • Mumps Containing Vaccine - MMR - Measles, Mumps, and Rubella - Freeze dried - +2 to +8 degrees Celsius - Heat sensitive but not damaged by freezing ```

MUMPS Summary:

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▪ Mild in children and adults ▪ Congenital Rubella syndrome ▪ Deafness, eyes, heart and brain ○ Mode of Transmission: Airborne droplets • Mild fever, Conjunctivitis, swollen neck lymph nodes • Erythematous maculopapular rash • Encephalitis, Guillain-Barre Syndrome

RUBELLA

RUBELLA Treatment:

• Supportive measures • Rubella vaccine in combination with Measles (MR) or • MMR -Measles, mumps, rubella - Freeze dried - +2 to +8 degrees Celsius - Heat sensitive but not damaged by freezing

RUBELLA Summary:

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▪ System used for 💡storing vaccines in good condition ▪ 💡Vaccine supply chain ▪ 💡Immunization supply chain ▪ Series of links designed to keep vaccines within WHO recommended temperature changes ▪ Store vaccines and diluents within the required temperature range at all sites ▪ Pack and transport vaccines to and from outreach sites according to recommended procedures ▪ Keep vaccines and diluents within the recommended cold chain conditions during immunization sessions

VACCINES COLD CHAIN

The Cold Chain

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Recommended vaccine storage temperatures

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Vaccine heat sensitivity

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Freeze Sensitive Vaccines

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Vaccines that are as sensitive to light:

BCG, measles, measles-rubella

Vaccines that are sensitive to light handling:

▪ Keep vaccines in an appropriate vaccine refrigeration equipment ▪ Use a temperature monitoring device to ensure temperatures remain between +2 °C and +8 °C ▪ Transport vaccines to immunization sessions in a vaccine carrier, correctly packed, using coolant pack that have been properly prepared ▪ During immunization sessions, fit a foam pad (if available) at the top of the vaccine carrier ○ Water packs • Frozen ice packs -10 and -25 °C • Conditioned ice packs 0 °C • Cool water +5 °C • Warm water +18 °C to 24 °C ○ Vaccine Vial Monitors • Temperature monitoring device through the entire chain • Chemical indicator label • VVM2, VVM7, VVM14, VVM30 • 37 °C • Heat damaged vaccines are not administered

VVM

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○ Freeze sensitive vaccines have been exposed to temperatures below 0°C

Shake Test

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ADVERSE EVENT FOLLOWING IMMUNIZATION

``` A. ADVERSE VACCINE REACTION B. VACCINE PRODUCT-RELATED REACTION C. VACCINE QUALITY DEFECT-RELATED REACTION D. IMMUNIZATION ERROR-RELATED REACTION E. IMMUNIZATION ANXIETY-RELATED REACTION F. COINCIDENTAL EVENT G. CAUSES H. CONTRADICTION ```

▪ Subset of AEFI ▪ Refers to vaccine-related event caused or precipitated by a vaccine when given correctly ▪ Rate of adverse vaccine reactions is very much lower than the rate of health damaging complications resulting from the disease in unvaccinated individuals

ADVERSE VACCINE REACTION

▪ An AEFI that is caused or precipitated by a vaccine due to one or more of the inherent properties of the vaccine product ▪ Extensive limb swelling following DTP vaccination

VACCINE PRODUCT-RELATED REACTION

▪ An AEFI is caused or precipitated by a vaccine that is due to one or more quality defects of the vaccine product including its administration device as provided by the manufacture. ○ Example: The failure by the manufacturer to completely inactivate a lot of inactivated polio vaccine leads to cases of paralytic polio.

VACCINE QUALITY DEFECT-RELATED REACTION

▪ This kind of AEFI is caused by the inappropriate vaccine handling, prescribing or administration and hence by its nature is preventable. ○ Example: Transmission of the infection can be cause by the use of contaminated multi-dose vial.

IMMUNIZATION ERROR-RELATED REACTION

▪ The type of AEFI which arises from anxiety about the immunization. ○ Example: Vasovagal syncope in an adolescent during/following vaccination

IMMUNIZATION ANXIETY-RELATED REACTION

▪ An AEFI that is caused by something other than the vaccine product, immunization error or immunization anxiety ▪ A fever occurs at the time of the vaccination (temporal association) but is in fact caused by malaria)

COINCIDENTAL EVENT

``` ▪ Components of vaccine ▪ Potential risk ▪ Different type of antigens ▪ Adjuvants and conjugated ▪ Antibiotics, stabilizers, and preservatives to reduce contamination during manufacturing process and to maintain their effectiveness during transport and storage ```

CAUSES

▪ Rare condition in a recipient that increases the risk for a serious adverse reaction ▪ Most are temporary ▪ Severe allergic reaction prior or to a constituent

CONTRADICTION

Contraindication of vaccine

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Immunization Flashcards

(134 cards)