Immunization and Vaccinations

Question 1

What types of immunity are there?

Answer 1

Self vs non-self
Protection from infectious disease
Indicated by the presence of antibody
Specific to a single organisms

Question 2

Antigen

Answer 2

A liven or inactivated substance capable of producing an immune response

Question 3

Antibody

Answer 3

Protein molecule (immunoglobulin) produced by B lymphocytes to help eliminate an antigen

Question 4

Passive immunity

Answer 4

Transfer of antibody produced by one human or other animal to another
Temporary protection

Question 5

What are the most important sources in infancy of passive immunity?

Answer 5

Transplacental transfer and breastfeeding

Question 6

What are some sources of passive immunity?

Answer 6

All blood or blood products
Homologous pooled human antibody (immune globulin)
Homologous human hyperimmune globulin
Heterologous hyperimmune serum (antitoxin)

Question 7

Monoclonal antibody

Answer 7

Derived from a single type of antibody-producing cells (B cells)

Question 8

What are monoclonal antibodies used for?

Answer 8

Used for diagnosis and therapy of certain cancers, autoimmine, and infectious disease

Question 9

Active immunity

Answer 9

Produced by vaccine

Immunity and immunologic memory similar to natural infection (without disease risk)

Question 10

1st principle of vaccination

Answer 10

The more similar a vaccine is to the disease-causing form of the organism , the better the immune response to the vaccine

Question 11

What are some considerations when developing a new vaccine?

Answer 11

Common disease?
Safe and effective production of a vaccine?
Side effects worse than disease?

Question 12

How long does preclinical testing for a new vaccine last?

Answer 12

2 - 4 years

Question 13

What must the volunteers for a new vaccine agree to?

Answer 13

Vaccine administration, follow-ups for eval and physical testing, provide blood samples

Question 14

How long to clinical trials for vaccinations last?

Answer 14

5 - 7 years

Question 15

What is phase 1 for vaccine clinical trials?

Answer 15

Safety - candidate vax tested in small numbers to healthy adults to assess short term and adverse effects and correct dose

Question 16

What is phase 2 for vax clinical trials?

Answer 16

Multiple stages of several hundred appropriate-age volunteers in multiple centers which assess expanded safety parameters and provocation of an immune response

Question 17

What is phase 3 for vax clinical trials?

Answer 17

Thousands required to confirm degree of immune response/side effects, eval of vax in general population and potential value and use of the vaccine for general public health practice

Question 18

What is phase 4 for vax clinical trials?

Answer 18

Monitoring

Detect rare/unexpected reactions, measure program effects

Question 19

What is a live attenuated vaccine?

Answer 19

Weakened form of the wild virus or bacterium

Generally works in one dose (exclude oral)

Question 20

What must a vax do to be considered live attenuated?

Answer 20

Must replicate to be effective, produce immune response similar to natural infection

Question 21

What are some complications of a live attenuated vax?

Answer 21

Severe rxns, interference from antibodies

Vax is fragile - stored and handled carefully

Question 22

Examples of live attenuated viral vax

Answer 22

Measles, mumps, rubella, varicella/zoster, yellow fever, rotavirus, intranasal influenza, rotavirus, vaccinia

Question 23

Examples of live attenuated bacterial vax

Answer 23

BCG, oral typhoid

Question 24

What parts may be used (fractional) can be used in an inactivated vax?

Answer 24

Protein-base: toxiod, sub-unit

Polysaccharide-based: pure, conjugate

Question 25

Characteristics of inactivated vax

Answer 25

No replication, less interference by antibodies, 3 -5 doses, humoral response mostly, antibody titer may dimish

Question 26

Examples of inactivated whole-cell vax

Answer 26

polio, hepatitis A,  rabies, influenza

Question 27

What does a fractional subunit vax contain?

Answer 27

Minimal amounts of nonvirus antigens derived from the culture medium Less likely to cause adverse reaction than whole version

Question 28

Examples of fractional inactivated vax

Answer 28

``` Hepatitis B Influenza Pertussis (acellular) Human papillomavirus Anthrax ```

Question 29

What does a fractional toxoid vax contain?

Answer 29

Treated to destroy vax toxic properties, but retain the capacity to stimulate production of antitoxins

Question 30

Examples of fractional toxoid vax

Answer 30

Diphtheria | Tetanus

Question 31

What is a polysaccharide vax?

Answer 31

Extracted and purified form of the bacterial outer polysaccharide coat

Question 32

What are the characteristics of the polysac vax?

Answer 32

Induce formation of circulating antibodies, promote phagocytosis, remove immune system macs No booster but doesn't always work for kids younger than 2

Question 33

Examples of pure polysac vax

Answer 33

Pneumococcal Meningoccal Salmonella Typhi (4)

Question 34

What are conjugated polysac vax?

Answer 34

Polysacs linked to purified protein carriers | Involve helper T cells in the polysac antigen response

Question 35

Examples of conjugated polysac vax

Answer 35

Tetanus toxoid Diphtheria toxoid H. influenzae B Some forms of Pneumococcal and Meningococcal

Question 36

What are the general rules of vaccination?

Answer 36

Inactivated vax are generally not affected by circulating antibody to the antigen Live attenuated vax may be affected by circulating antibody to the antigen

Question 37

What is the second principle of vaccination?

Answer 37

All vax can be administered at the same visit as all other vax (generally)

Question 38

When should administration of vax be separated?

Answer 38

2 live parenteral vax

Question 39

What are the third prinicples of vax?

Answer 39

Increase the interval between doses of multidose vax does not diminish the effectiveness of the vax Decreasing the interval between doses of a mutlidose vax may interfere with antibody response and protection

Question 40

When are minimum intervals and ages used for vax?

Answer 40

When a pt is behind schedule on vax series | Vax doses should not be administered at intervals less than the minimum or earlier than minimum age

Question 41

Adverse rxn

Answer 41

Extraneous effect caused by vax | Side effect

Question 42

Adverse event

Answer 42

Any event following vax, may be coincidental or true rxn

Question 43

Local adverse rxn

Answer 43

Pain, swelling, redness at injection site Common with inactivated vax Mild, self-limiting

Question 44

System adverse rxn

Answer 44

Fever, malaise, headache, nonspecific | Maybe unrelated to vax

Question 45

Live attenuated vax adverse rxn

Answer 45

Must replicate for immunity so there may be symptoms that occur after incubation period (7-21 days)

Question 46

Allergic adverse rxn

Answer 46

Dude to vax or vax component, rare, risk minimized by screening

Question 47

Contraindication

Answer 47

Condition in a recipient that greatly inc the chance of a serious adverse rxn or effect the ability of the vax to produce immunity

Question 48

What are the permanent contraindications for vax?

Answer 48

Severe allergic rxn to vax component after a dose | Encephalopathy (pertussis)

Question 49

Should live vax be used in pregnant women?

Answer 49

No

Question 50

In pregger the HPV vax should be....

Answer 50

Deferred

Question 51

What diseases could cause immunosuppresion?

Answer 51

Congenital immunodeficiency Leukemia or lymphoma Malignancy

Question 52

What chemotherapies could cause immunosupression?

Answer 52

Alkylating agents Antimetabolities Radiation

Question 53

If a person has isolated B-cell deficiency they can have what vax?

Answer 53

Varicella

Question 54

Which type of vax is safe for an immunosupressed person?

Answer 54

Inactivated vax but possible dec in response

Question 55

Which vax can you give to an asymptomatic HIV pt?

Answer 55

Varicella, MMR, maybe yellow fever

Question 56

Does acute illness mean a vax can't be used?

Answer 56

No, it doesn't even reduce efficacy but should be delayed until illness is improved

Question 57

What is a adjuvant?

Answer 57

Pathogens, or parts of one, used to inc vax effectiveness

Question 58

Why are preservatives used in vax?

Answer 58

The prevent the growth of bacteria or fungi | Always used in multidose vax