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Immunology Block 2 > Vaccines/Nutrition > Flashcards

Vaccines/Nutrition Flashcards

1
Q

Crosstalk:

A

there is significant communication between metabolism and the immune system. An efficient immune response requires tremendous amounts of energy.

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2
Q

Describe the broad consequences of being undernourished:

A

Have insufficient energy to generate effective immunity, and are more prone to microbial infections

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3
Q

Describe the broad consequences of being overnourished:

A

Have impaired or overactive immunity, and are more prone to microbial infections and excess inflammation

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4
Q

Malnutrition:

A

General term for lack of some or all nutritional elements necessary for human health

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5
Q

Most common micronutrient deficiency:

A

iodine, iron, vitamin A, zinc

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6
Q

Two types of protein-energy malnutrition:

A

Kwashiorkor and Marasmus (can have symptoms of both at the same time)

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7
Q

Kwashiorkor:

A

Insufficient protein, which leads to edema and bloating

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8
Q

Marasmus:

A

Energy deficiency, generally acute, wasting

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9
Q

Describe the relationship between nutrition and infection:

A

-Malnutrition depresses immune function and increases susceptibility to infection. -Diarrhea and vomiting increase nutrient losses. -Fever increases energy needs. -Infection disrupts nitrogen balance and increases protein needs. -Infection causes anorexia.

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10
Q

______ has the largest effect on aspects of innate immunity than any other nutrient deficiency (explain).

A

Protein-energy malnutrition. PEM reduces epithelial and physiological barrier functions as well as the function of macrophages and neutrophils. NK activity is also affected.

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11
Q

Iron deficiency affects the function of WHAT

A

neutrophils, macrophages, thymic function. Also inhibits the proliferation of T cells and somewhat B cells. Results in a decrease in pro-inflammatory cytokines like TNF-alpha and IL-6

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12
Q

Describe the host-pathogen battle for iron:

A

Free iron/heme is aberrant state. Iron status (especially iron overload) influences bacterial, viral, and protozoal infections. Variants in iron-regulatory genes affect susceptibility to infections (these require iron for growth, replication, etc.). Optimum level of iron is key. Both iron deficit and excess impair host immunity.

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13
Q

Vitamin A deficiency skews the immune system towards a _____ response and away from a _____ response.

A

Vitamin A deficiency skews the immune system towards a Th1 response and reduces Th2-driven antibody response to vaccines: Vitamin A supplementation will revert these responses.

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14
Q

Which disease diagnosis calls for an immediate supplementation of Vitamin A?

A

Measles (also diarrheal diseases)

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15
Q

_____ is associated with low grade chronic inflammation

A

Obesity

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16
Q

Obesity is associated with alterations in ______, which are linked to increases in WHAT

A

Obesity is associated with alterations in T CELL SUBSETS, which are linked to increases in TNF-ALPHA and other PRO-INFLAMMATORY CYTOKINES

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17
Q

Obesity enhances thymic _____ and reduces the _____

A

Obesity enhances thymic AGING and reduces the T-CELL REPERTOIRE DIVERSITY

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18
Q

Does obesity increase susceptibility to infection? explain

A

Yes - obese patients are more likely to develop secondary infections and complications. Higher incidence of surgical site infections, increased risk of wound complications, increased length of hospital stay and increase of death. Increased risk for pulmonary aspiration and community-related respiratory tract infections.

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19
Q

Increasing BMI associated with increased susceptibility to _______ in children

A

respiratory infections

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20
Q

_____ has been associated with increased peridontal infections

A

obesity

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21
Q

Obesity is an independent risk factor for hospitalization and death from infection with ______

A

influenza

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22
Q

In obese patients, there is a_____ of the immune system after infections, making patients less effective at fighting off other infections.

A

dampening

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23
Q

Name 4 broad modifiers of immune function:

A
  1. nutrition. 2. Acquired immune deficiencies 3. genetics 4. maturation of immune system/aging
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24
Q

Describe the PROs of breastfeeding:

A
  1. maternal antibodies coat pathogens and reduce infectivity as well as tag them for destruction by immune cells. 2. Maternal antibody-coated pathogens are more easily taken up by phagocytes that express Fc receptors. Antigen presentation to T cells is improved in this way. 3. Maternal antibody coated antigen is trapped by follicular dendritic cells that express Fc receptors and facilitate priming of B cells.
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25
Q

Describe the CONS of breastfeeding:

A
  1. Maternal antibodies can reduce vaccine efficacy when using live replicating vectors. 2. Epitopes can be masked by maternal antibody and interfere with B cell priming.
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26
Q

Describe the changes in Ig levels with age (for pediatrics)

A

Have maternal IgG until 6 months. Start making low levels of IgM at birth.

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27
Q

Describe the difference in innate immune response in neonates:

A

Engagement of TLRs of dendritic cells promotes the secretion of IL-6, IL-1B, IL-10, and IL-23. Secrete very little/no IL-12. Promotes Th2 and Th17 cell differentation instead of Th1.

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28
Q

Infant immune system is characterized by slow maturation of physiologic barriers (explain, list 4):

A
  1. physical barriers - skin
  2. stomach acidity, production of pepsin and trypsin - protection GI tract suboptimal
  3. Normal flora not yet established
  4. No IgA initially in respiratory or urinary tracts - GI tract IgA begins if breastfeeding
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29
Q

Describe the immaturity of cellular response in infant immunity:

A
  1. Decreased ability of leukocytes to concentrate
  2. Cells less bacteriocidal and less phagocytic
  3. Antigen presenting cells / dendritic cells produce altered cytokine profile, impacting T cell stimulation
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30
Q

Breastmilk is a source of WHAT:

A

IgA, IgM, IgG; some Ab-producing B cells.

IgG and some IgA is transported into circulation; IgM and IgA bind gut antigens

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31
Q

Cytokines and co-stimulatory molecule deficiency leads to diminished capacity _____ to provide help to ____, thus delay in _____ and ______

A

Cytokines and co-stimulatory molecule deficiency leads to diminished capacity CD4 cells to provide help to B cells, thus delay in Ig synthesis and class switching

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32
Q

Deficiency of surface/co-stimulatory molecules leads to impairment of _______, especially in the first 5-6 months

A

antiviral CD8 cytotoxic T cells

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33
Q

Serum ____ and ____ levels reach “adult levels” after age 5-6. ____ is slower to rise.

A

IgG and IgM

IgA slower to rise

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34
Q

Effects of aging include reduced production of _____ and diminished function of _____

A
  • reduced production of B and T cells in bone marrow and thymus
  • diminished function of maturing lymphocytes in secondary lymphoid tissues
35
Q

Elderly have a reduced number of ____ and of those that are there, they function less well.

A

Reduced number of naive CD4 cells. These aren’t as good at interacting with other cells.

Macrophages also don’t work as well with T cells.

36
Q

_______ is a primary cause of T cell dysfunction in the elderly

A

thymic involution

37
Q

THere is an age-related over-representation of _______ cells vs. ____ cells in the elderly.

A

There is an age-related over-representtion of EFFECTOR or MEMORY T cells vs. NAIVE T cells in the elderly.

The naive T cells are less functional in response to antigen than those in young individuals

38
Q

______ responses are impaired with aging, leading to problems such as immune responses to ______.

A

antibody responses; responses to vaccinations

39
Q

Aging is associated with a dampening of ______ and attenuated _______

A
  • dampening of B cell lymphopoiesis
  • attenuated CD4+ T cell help
40
Q

Potent B cell-mediated antibody responses require help by CD4+ T cells and findings show that aging causes defects in the function of ______ upon antigen stimulation

A

CD4+ T cells

41
Q

Elderly individuals have been shown to accumulate mutation in the _______ in peripieral B cells

A

accumulate mutations in the immunoglobulin heavy chain genes in peripheral B cells

42
Q

Aging changes of B cells:

A
  • reduced function
  • blunted vaccine responses
43
Q

Aging changes of CD4+ T cells:

A
  • Reduced function and IL-2 production
  • Dampened costimulation
44
Q

Aging changes with CD8+ T cells:

A
  • Narrowing of repertoire
  • More memory cells
45
Q

Aging changes with T-regulatory cells:

A
  • Retain some suppressive activity
  • Altered repertoire
46
Q

Advanced age has been associated with a change in not only the differentiation but also the phenotype of ______

A

Dendritic cells

47
Q

Macrophages have reduced expression of _____ and other proteins, which ultimately has an impact on the function of those cells and their response to lipopolysaccharide

A

MHC Class II

48
Q

Aging also affects the ______ of dendritic cells, and impairs the function of ______ and ______

A

Aging also affects the co-stimulation of dendritic cells, impairs the function of neutrophils (decreased effector functions), and NK cells

49
Q

TLR signaling pathways, particularly ___, ____, and ____ is altered in the elderly:

A

TLR 7, 8, and 9

50
Q

Which cells do we especially see a decline in function in aging?

A

Macrophages, neutrophils, dendritic cells, and NK cells

51
Q

a chronic ___ occurs with age

A

chronic low-grade inflammation

52
Q

chronic inflammation is associated with the development of:

A

various chronic diseases

53
Q

cells of both the innate and adaptive immune systems initiate and regulate _______ responses to pathogens and mediate chronic inflammation in aging

A

inflammatory

54
Q

Vaccine definition:

A

A substance designed to induce a potent and protective immune response to potential microbial pathogens by exposing the host to antigenic, but non-pathogenic material

55
Q

Purpose of immunization:

A

Prevention of the multiplication of invading microorganisms, neutralization of their toxins

56
Q

Active immunity:

A

The body’s response to exposure to a potential pathogen (via immunization, natural infection or exposure), hopefully leading to a long-term protective response

57
Q

Passive immunity:

A

Created via the transfer of pre-formed antibodies to an individual.

Products include: pooled polyclonal antibody, hyper-immune antibody preparations, monoclonal antibodies.

Short lived, does not induce memory.

Common uses include situations when immediate protection is needed, when the host is unable to produce an adequate immune response, or selected situations when no safe or effective vaccine is available to provide active immunity.

58
Q

Describe the treatment for a patient who was bitten by an animal and is at risk for rabies:

A

There is a vaccine for rabies - but these might take 7-10 days to develop antibodies from the vaccine. In the meantime, because rabies is fatal and can be fatal within a week, patient is given RIG at the site of the bite as well as systemically. This provides passive immunity for the patient while they can ramp up their antibodies against the virus.

Alternatively, rabies can have a latent period of months, so it’s important to get the vaccination in addition to the antibodies, because the antibodies only offer protection for a short period of time.

59
Q

What type of therapy would a patient who has very low serum IgG, IgA, and IgM, as well as low CD19+ (B cell) quantitation need?

A

This patient has an underlying deficiency with decreased immunoglobulin production - needs Ig replacement therapy for the rest of his life.

60
Q

What treatment should be provided for an infant who was born premature and often develops respiratory syncytial virus:

A

RSV can cause significant disease in premature infants with chronic lung disease. No vaccine, so an RSV monoclonal antibody prepaation is available for monthly injection to prevent severe RSV infections.

61
Q

Name 4 common situations in which passive immunization is used:

A
  1. protection against toxins, such as tetanus, botulism, diptheria, snake venom
  2. use of rho-gam to prevent Rh- mothers from becoming sensitized to fetal Rh+ erythrocytes
  3. Administration of polyclonal gamma globulin for serious deficiencies of the humoral immune system
  4. Use of antibody products directed against specific viral antigens (e.g. Hep A, cytomegalovirus, rabies, RSV)
62
Q

Inactivated vaccines:

A

produced by growing large numbers of virus or bacteria and killing (inactivating) them using heat or chemical fixation

63
Q

Attenuated vaccines:

A

produced by repeated passages of the organism through cell culture or laboratory animals until a non-virulent organism is isolated

64
Q

Inactivated bacterial vaccines:

A
  • Usually generate limited protection, short lived
  • Some inactivated bacterial vaccines are used in other countries; none are part of the routine recommended vaccines in US
65
Q

Inactivated viral vaccines:

A
  • may not produce as good or as long-lived protection
  • e.g. inactivated influenza, rabies, polio (Salk) vaccine
66
Q

Attenuated, live viral vaccines:

A
  • effective, generate long term protection (although booster recommended for some)
  • e.g. oral polio (Sabin - not used in US), measles, mumps, rubella, chickenpox, rotavirus, live nasal spray flu vacccine, and yellow fever
67
Q

Attenuated bacterial vaccines examples:

A

e.g. BCG organism for tuberculosis

68
Q

What are the pros and cons of attenuated vaccines?

A

PRO: attenuated, live viruses can infect cells; an advantage is the generation of both an antibody response and a good CTL response.

CON: contain live organisms, therefore safety is a concern for select patients (e.g. with immune deficiency)

69
Q

What are examples of purified antigen/subunit vaccines?

A

Toxoids, purified polysaccharide antigens

70
Q

Toxoids:

A

Inactivated toxins, usually by chemical modification. Very effective immunogens.

E.g. Diptheria, tetanus

71
Q

Purified polysaccharide antigens:

A

Not efficient at inducing long term protection because these are T independent. More effective with used with Conjugate vaccines, where the polysaccharie is coupled with a protein to induce T cell dependent pathway.

e.g. Haemophilus influenza Type B (Hib) chemically conjucated to tetanus toxoid

72
Q

Pros and cons of purified antigen/subunit vaccines:

A

PRO: very safe

CON: short shelf live, difficulty in producing the vaccine, failure to stimulate CTL response since they are mostly recognized as exogenous antigens.

73
Q

Synthetic/Recombinant Antigen Vaccines:

A

Active part is a synthesized protein/amino acids (could be amino acid polymer corresponding to antigenic determinants, large peptide, or entire protein). Technology requires identification of antigenic epitopes on a particular molecule.

E.g. Hep B vaccine

74
Q

Pros and cons of synthetic/recombinant antigen vaccines:

A

PRO: safe

CON: short shelf life, difficulty in producing the vaccine, failure to stimulate significant CTL response

75
Q

What are some examples of polyvalent/combination vaccines:

A
  • Diptheria, tetanus, pertussis combination vaccine
  • Newest addition: pentavalent vaccine with antigens for diptheria, tetanus, pertussis (acellular vaccine), hep B (recombinant protein), and haemophilus influenzae B (Hib)
76
Q

Pros and cons of polyvalent/combination vaccines:

A

PRO: reduction in number of injections

CON: not all vaccines can be combined, because the ris of interference with the immune response generated by another vaccine component. Not often available worldwide.

77
Q

What are the categories of additional substances/components in a vaccine?

A
  • Adjuvants
  • Dilutent
  • Stabilizers
  • Antibiotics
  • Preservatives
78
Q

Adjuvants:

A

Substances added to vaccine to improve or stimulate the immune response.

  • Some substances used as adjuvants in animal vaccines induce severe inflammation in humans
  • Common example: aluminum salts
79
Q

Dilutent:

A

Usually water or saline

80
Q

Stabilizers:

A

maintain vaccine potency

e.g. monosodium glutamate, albumin, phenols, gelatin, glycine

81
Q

What general types of diseases are harder/easier to eradicate?

A
  • Immunization against microorganisms that are limited to human hosts and are invariant in their surface structures are effective (e.g. smallpox has been eradicated).
  • Vaccination programs against microorganisms that have animal reservoirs and exhibit diversity in their surface structures and which have animal reservoirs are likely to be less effective (e.g. can’t eradicate flu because so many animal reservoirs)
82
Q

Challanges associated with routine childhood immunizations:

A
  • Cost for routine injections
  • The number of injections required
  • Acceptance of vaccines/immunization
  • Variable rates of immunization in US populations
  • Vaccine shortages
83
Q

Risks of vaccines:

A
  • local reactions (e.g. erythema, tenderness at injection site)
  • Mild systemic reactions (e.g. mild fever, irritability, fatigue, headaches)
  • Varied allergic reactions
  • ongoing concerns about vaccine safety (lengthy mandated process for vaccine safety including FDA, CDC, and legislature approval, followed by continuous monitoring by CDC and pharmaceutical companies)
84
Q

Thimerosal:

A
  • Compound previous used as a vaccine preservative.
  • Contains ethylmercury, which caused concerns that it may lead to neurologic disease and play a role in autism development.
  • no current evidence that thimerosal has caused any disease in children, however most vaccines don’t contain it anymore or contain only minute quantities

Immunology Block 2 (9 decks)

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