Vaccinations
Latex is sap from the commercial rubber tree. Latex contains naturally occurring impurities (e.g., plant proteins and peptides), which are believed to be responsible for allergic reactions.
If a person reports a severe (anaphylactic) allergy to latex, vaccines supplied in vials or syringes that contain natural rubber should not be administered unless the benefit of vaccination clearly outweighs the risk of an allergic reaction to the vaccine.
Precaution to a vaccine
May increase the risk of adverse reaction to the vaccine or compromise the ability of the vaccine to produce immunity such as administering measles vaccine to a person with passive immunity to measles from a blood transfusion)
Vaccine doses administered up to 4 days before the minimum interval or age can be counted as valid. This does not apply to what kind of vaccine?
This 4-day recommendation does not apply to rabies vaccine because of the unique schedule for this vaccine.
in children with functional or anatomic asplenia (without a spleen) , pneumococcal conjugate vaccine (PCV13) and Menactra brand meningo coccal conjugate vaccines should not be administered at the same visit; separate these vaccines by at least 4 weeks. Why?
This is because children with functional or anatomic asplenia are at very high risk of pneumococcal invasive disease and Menactra is thought to interfere with the antibody response to pneumococcal conjugate vaccine.
Antibody induced by polysaccharide vaccines has less functional activity than that induced by protein antigens. Why?
This is because the predominant antibody produced in response to most polysaccharide vaccines is IgM, and little IgG is produced.The immune response to a pure polysaccharide is typically T-cell independent, which means that these vaccines are able to stimulate B cells without the assistance of T-helper cells.
Vaccine-Preventable Diseases VAR - Varicella (Chicken Pox)
Varicella is caused by a virus that causes a rash, itching, fever, and tiredness. While chickenpox is usually a mild illness, it also can lead to severe skin infections, scars, pneumonia, brain damage, or death.
Vaccine-Preventable Diseases Polio
a disease caused by a virus which can cause paralysis (cannot move arms or legs). It can kill people who get it, usually by paralyzing the muscles that help them breathe.
In addition to blood products, 3 Major sources of antibody used in human medicine
homologous pooled human antibody (combination of donors' IGg), homologous human hyperimmune globulin(combination of donated human plasma with high titers of specific antibody), and heterologous hyperimmune serum aka antitoxin(produced in animals usually horses that contains antibodies against only 1 antigen. In US, antitoxin is for treating botulism and diphtheria. Issue with antitoxin-serum sickness due to immune response to the horse protein.
titers tell us what
how many b memory cells floating around
In general, once you recover from an infectious disease, you will have a lifelong immunity to that disease. The persistence of protection for many years after the infection is known as
immunologic memory.
Antigen
live or inactivated substance (e.g. viruses or bacteria) capable of producing an immune response.
Acute vaccine adverse reactions fall into three general categories:
local, systemic, and allergic
Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine.*However, what may happen if Decreasing the interval between doses of a multidose vaccine
may interfere with antibody response and protection
11 Vaccine-Preventable Diseases in the Routine Adult Immunization Schedule
pneumococcal, diphtheria, pertussis, tetanus, zoster, chickenpox(varicella), measles, mumps, rubella, human papilloma virus, influenza
Pure polysaccharide vaccines
pneumococcal, meningococcal, Salmonella Typhi (Vi). Not consistently immunogenic in children younger than 2 years of age, No booster response, Antibody with less functional activity, Immunogenicity improved by conjugation
Passive Immunity
protection transferred from another animal or human, effective protection that wanes/disappear in weeks to months such as mother to infant.
Antibody
protein molecules (immunoglobulins) produced by B-lymphocytes to help eliminate an antigen
Not all inactivated vaccines require boosting throughout life. Why?
For example, additional doses of Hib vaccine are not required after completion of the infant primary series and 12-15 month old booster dose because Hib disease is very rare in children older than 5 years of age. Hepatitis B vaccine does not require boosting because of immunologic memory to the vaccine and the long incubation period of hepatitis B (which can produce an "autoboost").
Recombinant Vaccines
Genetic engineering technology, Viral: hepatitis B, human papillomavirus, influenza (one brand), live attenuated influenza, Bacterial-Salmonella Typhi (Vi)
Vaccine-Preventable Diseases Hib - Haemophilus influenzae type b
Hib is a bacteria that can cause serious problems including meningitis (an infection of the brain and spinal cord covering), brain damage, deafness, pneumonia, infections of the blood, joints, bone, and heart covering, and death
10 great public health achievements in US
1) Motor-vehicle safety , 2) Safer workplaces , 3) Control of infectious diseases , 4) Decline in deaths from coronary heart disease, 5) Safer and healthier foods , 6) Healthier mothers and babies, 7) Family planning, 8) Fluoridation of drinking water , 9) Recognition of tobacco use as a health hazard, 10) vaccination
Inactivated Vaccines
1) Whole ( viruses & bacteria) 2)Fractional- protein-based(toxoid & subunit), polysaccharide-based (pure & conjugate ). Cannot replicate, Less affected by circulating antibody than live vaccines, Always require multiple doses , Immune response mostly humoral, Antibody titer diminish with time, May require periodic supplemental booster doses, Whole-cell vaccines, viral- polio, hepatitis A, rabies, influenza* bacterial: pertussis*, typhoid*, cholera*, plague* , Fractional vaccines, Subunits: hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax Toxoids- diphtheria, tetanus
The necessary interval between an antibody-containing product and MMR or varicella-containing vaccine (except zoster vaccine) depends on the concentration of antibody in the product, but is always what time interval
3 months or longer.
Every pregnant woman should get inactivated Tdap vaccine in which trimester regardless if they had it before
3rd trimester because the infant can get antibody from mom
Live Attenuated Vaccines
Attenuated (weakened) form of the "wild" virus or bacterium, Must replicate to produce an immune response, Immune response virtually identical to natural infection, Usually produce immunity with one dose, Severe reactions possible, Interference from circulating antibody, Fragile - must be stored and handled carefully, Viral: measles, mumps, rubella, vaccinia, varicella, zoster, yellow fever, rotavirus, intranasal influenza, oral polio** , Bacterial: BCG**, oral typhoid Live attenuated vaccines in the US mostly contain viruses. Only 1 live attenuated bacterial vaccines is available in the US
Vaccination
Active immunity produced by vaccine, Immunity and immunologic memory similar to natural infection but without
Severe allergic reaction
Anaphylaxis due to vaccine or a component in the vaccine, rare, screen to minimize the risk, All providers who administer vaccines should have a emergency protocol in place in treat anaphylaxis
Asplenia and Adult Vaccination
Asplenia increases risk of sepsis from polysaccharide encapsulated bacteria. Encapsulated bacteria inhibit binding of complement or prevent complement assembled on the capsule from interacting with macrophage receptors. Natural antibodies are required for phagocytosis, which are immunoglobulins that facilitate phagocytosis either directly or by complement deposition on the capsule. They are produced by IgM memory B cells in the marginal zone of the spleen. Splenectomy greatly diminishes the frequency of memory B cells.
Why are vaccines given to babies and infants when they are so young?
Babies and infants are more likely to catch infectious diseases.(Inexperienced) immune system, The immature immune system requires "education" to mount a rapid defense against infectious pathogens.Vaccines provide a safe education for the infant immune system.
Live vaccination should not be administered to a woman known to be pregnant because it may
Cause fetal infection. Inactivated vaccine is ok as it doesn't replicate
Monoclonal Antibody
Derived from a single type, or clone, of antibody-producing cells (B cells), Antibody is specific to a single antigen or closely related group of antigens , Used for diagnosis and therapy of certain cancers and autoimmune and infectious diseases, as well as prevention of transplant rejection
Vaccine-Preventable Diseases DTaP - Diphtheria, Tetanus, Pertussis
Diphtheria is an infectious disease of the nose and throat that can lead to serious breathing problems, heart failure, paralysis and even death. Tetanus (also called Lockjaw) is caused by the action of a potent neurotoxin produced during the growth of the bacteria in dirty wounds a person usually becomes infected with tetanus when dirt enters a wound or cut. Tetanus germs are likely to grow in deep puncture wounds caused by dirty nails, knives, tools, wood splinters, and animal bites. High case-fatality rate. Pertussis, also called whooping cough, causes coughing spells so bad that it is hard for infants to eat, drink, or breathe. These spells can last for weeks. It can lead to pneumonia, seizures, brain damage, and death. It is not easily treated and can result in permanent brain damage and death.
Systemic adverse reactions
Fever, malaise, headache, nonspecific, may not be due to the vaccine
Barriers to flu immunization
Flu vaccine is only offered in the fall and early winter months, Children that had their annual exam in other months would need to return to their doctor for an additional visit, Doctors have difficulty seeing all such patients in the months with increased ill visits, Stocking the, required doses of flu vaccine is problematic. Unlike other vaccines flu vaccination must repeated annually
Conjugate polysaccharide vaccines
Haemophilus influenzae type b (Hib), pneumococcal, meningococcal. Repeat doses of polysaccharide vaccines usually do not cause a booster response. Antibody induced with polysaccharide vaccines has less functional activity than that induced by protein antigens. This is because the predominant antibody produced in response to most polysaccharide vaccines is IgM, and little IgG is produced. Conjugation changes the immune response from T-cell independent to T-cell dependent, leading to increased immunogenicity in infants and antibody booster response to multiple doses of vaccine.
Examples of encapsulated bacteria
Hemophilus influenzae type b (Hib), Streptococcus pneumoniae , pneumococcus), Neisseria meningitidis (meningococcus), Group B streptococcus (GBS), Klebsiella pneumoniae, Salmonella typhi. Vaccine preventable- Hib, Pneumococcus, Meningococcus
Vaccine-Preventable Diseases HepA
Hepatitis A is a serious liver disease that is usually spread by close personal contact or by eating contaminated food or water. Hepatitis A can cause mild, "flu-like" illness, jaundice (yellow skin or eyes), and severe stomach pains and diarrhea.
16 Vaccine-Preventable Diseases in the Routine Childhood Immunization Schedule (U.S.)
Hepatitis A, Hepatitis B, Pneumococcal, Diphtheria, Pertussis, Tetanus, Rotavirus, Polio, Chickenpox (Varicella), Measles, Mumps, Rubella, Human Papilloma Virus, Haemophilus Influenzae type b(Hib), Meningococcal, Influenza
Vaccine-Preventable Diseases HepB - Hepatitis B
Hepatitis B is a serious liver disease that can cause short-term (acute) illness and may lead to appetite loss, diarrhea, vomiting, fatigue, jaundice, and/or pain in muscles, joints, and stomach.
Circulating antibody affect antigen in the inactivated vaccine and live attenuated vaccine?
Inactivated vaccines are generally not affected by circulating antibody to the antigen so they can be administered before, after, or at the same time as the antibody. Live attenuated vaccines may be affected by circulating antibody to the antigen. If the live vaccine is given first, it is necessary to wait at least 2 weeks (i.e., an incubation period) before giving the antibody to allow enough time for viral replication. If the interval between the vaccine and antibody is less than 2 weeks, the recipient should be tested for immunity or the vaccine dose should be repeated.
Contraindication to a vaccine
Increase the risk of an adverse reaction to a vaccine in a person that might have the condition
Vaccine-Preventable Diseases Influenza-IIV or LAIV
Influenza is a contagious disease. It is caused by the influenza virus, which spreads from person to person through coughing or sneezing. Influenza can lead to pneumonia and can be dangerous for young children and people with heart or breathing conditions.
HPV vaccine should be deferred for pregnant women due to
It's lack of safety and efficacy data for this vaccine in preg woman
If live vaccine is given, it's necessary to wait for 2 weeks before giving antibody. Why?
It's the incubation period for the live antigen to replicate to cause an immune response. It antibody was given before the 2 weeks, antibody mah interfere with the viral/ bacterial replication and may cause a vaccine failure.
Classification of Vaccines
Live attenuated - viral, bacterial. Inactivated
Vaccine-Preventable Diseases MMR - Measles, Mumps, Rubella
Measles causes fever, runny nose, cough and a rash all over the body. According to the Centers for Disease Control and Prevention (CDC), about one out of 10 children with measles also develop an ear infection and up to one out of 20 develops pneumonia. For every 1,000 children who get measles, one or two will die. Mumps causes fever, headache, and swollen glands. It can lead to deafness, meningitis (infection of the brain and spinal cord covering), painful swelling of the testicles or ovaries, and, rarely, death. rare conditions such as swelling of the brain, nerves and spinal cord can lead to serious side effects such as paralysis, seizures, and fluid in the brain. Rubella (German Measles) is caused by a virus that usually leads to mild fever and a rash. However, if a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects.
What is Community immunity(herd)
Need a high percentage of the community to be to vaccinated to prevent a disease outbreak. Protects individuals who cannot be vaccinated. Cocooning is used to protect an infant, where all individuals in contact with an infant have been vaccinated. (Tdap and pertussis)
Local Adverse reactions to vaccines
Pain, redness, swelling at injection site, occur within a few hours of injection, usually mild and self-limited
Antibody for Prevention of Respiratory Synctial virus (RSV )
Palivizumab (Synagis) - monoclonal, contains only RSV antibody, will not interfere with the response to a live-virus vaccine
Vaccine-Preventable Diseases PCV - Pneumococcal Pneumonia
Pneumococcal Pneumonia is the leading cause of bacterial meningitis in the United States. It causes many health problems in children under 5, including meningitis, blood infections, and ear infections. Pneumococcal disease is responsible for about 200 deaths each year among children under 5 years old.
Immunity
Protection from infectious disease by the presence of antibody.
Active Immunity
Protection produced by one's own immune system and often is lifetime, Immune system produces antigen-specific humoral and cellular immunity, Lasts for many years, often lifetime , Sources- infection with disease-causing form of organism and vaccination
General Recommendations on Immunization
Recommendations of the Advisory Committee on Immunization Practices. These recommendations are revised every 3 to 5 years as needed; the most current edition was published in January 2011
Vaccination - from the six prevention and control strategies
Reduce fraction susceptible by Increasing herd immunity (population-level effects), Vaccination considered the Naturally-acquired immunity, Fraction vaccinated (vaccine coverage), Vaccine efficacy (fraction fully protected)
Natural infection with measles does induce a stronger immune response and longer lasting protection for measles, however it also carries with it significant risks
These risks are much greater following the natural infection when compared to the risk from the vaccine.
What happens when an unfamiliar antigen is detected in the body
T helper cell will release cytokine to activate B cell to produce IgM antibodies which can take up to two weeks before plasma cells can generate enough antibodies to counteract the specific antigen. Once IgM has reached a certain amount, IgG takes over. Once the infection is under control, antibody production decreases and a small sample of antibodies remain in circulation. If this particular antigen should appear again, the antibody response will be much quicker and more forceful.
The most important issues in the appropriate use of vaccines are
Timing and spacing of vaccine does
Ten Great Public Health Achievements United States, 1900 - 1999
Vaccination, Motor-vehicle safety , Safer workplaces , Control of infectious diseases , Decline in deaths from coronary heart disease, Safer and healthier foods , Healthier mothers and babies , Family planning , Fluoridation of drinking water , Recognition of tobacco use as a health hazard
What are vaccines
Vaccines are biological preparations designed to elicit an immune response and induce protection from infection (immunity) against a pathogen (bacteria or virus) which causes a disease. Vaccines are specific and each vaccine induces immunity to a specific pathogen - some protect a single pathogen(polio, chk pox). Combination vaccines are against multiple pathogens
What are vaccines
Vaccines are biological preparations designed to elicit an immune response and induce protection from infection (immunity) against a pathogen (bacteria or virus) which causes disease. Vaccines are specific. Each vaccine induces immunity to a specific pathogen(s). Some vaccine protect against a single pathogen (Polio, Chickenpox) Combination vaccines are against multiple pathogens (DTaP, MMR)
Ways to get immunized
active immunity and passive immunity - naturally or artificially acquired
What does vaccine contain
all vaccines contain microbial antigens. It may also contain adjuvant (only aluminum gels or salts are used as adjuvant in the US). Adjuvant are added to some vaccines to make them more immunogenic or visible to the immune system. Some antigens do not elicit a strong immune response, irrespective of the dose because of their size and structure, e.g. tetanus toxoid. Thus to make vaccine against tetanus an adjuvant is added. Vaccines may contain a preservative usually to prevent contamination of vaccines. Thimerosal is used as a preservative in multi-dose influenza vaccines
What are the 2 greatest public health interventions that have had the greatest impact on world's health
clean water and vaccines
The two public health interventions that have had the greatest impact on the world's health are
clean water and vaccines."
To make the polysaccharide vaccines to have more functional activity, conjugation is developed:
conjugation, in which the polysaccharide is chemically combined with a protein molecule. Conjugation changes the immune response from T-cell independent to T-cell dependent, leading to increased immunogenicity in infants and antibody booster response to multiple doses of vaccine.
The herd immunity threshold is
the percentage of the community that needs to vaccinated to prevent transmission of disease.
Providers should report any clinically significant adverse event that occurs after the administration of any vaccine licensed in the United States
to the Vaccine Adverse Event Reporting System (VAERS),
