Delivery 3 - Vaccines

Front 1

goal of immunization

Back 1

-protect against disease upon subsequant exposure to the infection

Front 2

T or F
immunization was among the top 10 public health accomplishements in the last century

Back 2

true

Front 3

importance of immunization timing

Back 3

-must immunize before exposure

Front 4

T or F
childhood and adult immunization schedules are published annually

Back 4

true

Front 5

ideal vaccine

Back 5

-induces protective immune response in ALL

Front 6

goal of immunization

Back 6

-protect against disease upon subsequant exposure to the infection

Front 7

T or F
immunization was among the top 10 public health accomplishements in the last century

Back 7

true

Front 8

importance of immunization timing

Back 8

-must immunize before exposure

Front 9

T or F
childhood and adult immunization schedules are published annually

Back 9

true

Front 10

ideal vaccine

Back 10

-induces protective immune response in ALL individauls
-NO adverse events
-cheap to produce
-not temperature sensitive

Front 11

current vaccine characteristics

Back 11

-some do not reach seroprotection
-mild effects at injection site
-most are cheap, some exceptions
-all must be refrigerated or frozen!

Front 12

active immunity

Back 12

stimulate the host to produce a protective response to the pathogen

Front 13

two ways to achieve active immunity

Back 13

-natural infection -- once the person has had the infection, less likely to get again
-immunization -- doesn't cause disease, just elicits immune response -- safer!!!

Front 14

active immunity relies on?

Back 14

immunologic memory

-allows for a quicker immune response in subsequent infections

Front 15

the humoral side of the immune systems includes what components?

Back 15

-t-helper cells
-cytokines
-b-cells
-plasma cells
-antibodies

Front 16

the cell mediated side of the immune system includes what components

Back 16

-t-thelper cells
-cytokines
-cytotoxic t-cells
-cytolysis

Front 17

roles of:
t-cells
b-cells
plasma cells
cytotoxic t cell

Back 17

t = directly interacts w/ the antigen and makes decision on what type to response to mount
b = Ab producing cells
plasma = mature b-cells that are specialized Ab producers
cytotox = kills virally infected cells w/ cytotoxic chemicals

Front 18

different types of immune globulin?

Back 18

A, E, G, M

Front 19

IgA

Back 19

found in secretions -- interface of environment and body
-resistant to degradation
-locations = GI, respiratory, genito/uro, conjunctiva

Front 20

IgE

Back 20

involved in allergy and anaphylaxis

immune response to parasites

Front 21

IgG

Back 21

-found in large amounts in the serum
-major antibody of the secondary response

Front 22

IgM

Back 22

-predominant early antibody
-pentavalent structure = 5 abs, 10 fingers
-not specific, but a quick immune response

Front 23

importance of immune globulin w/ respect to vaccine

Back 23

current vaccines promote humoral/Ab promoting response and not cell mediated response

Front 24

steps of the booster response

Back 24

primary antigen challenge

secondary antigen challenge

Front 25

primary antigen challenge

Back 25

-IgM is the first Ab made
-there is a small delay and then production of IgG specific for the infection

-both IgM and IgG are not produced at super high levels

Front 26

Ab levels between primary and secondary antigen challenge?

Back 26

waning of Ab levels, but not to zero!

Front 27

secondary antigen challenge

Back 27

-IgG production is quick and at high levels!
-IgM is also produced at the exact same rate and concentration as the primary challenge

Front 28

during the secondary challenge the IgG is considered a __________ response and the IgM is not

Back 28

matured response

Front 29

antibody response after secondary exposure

Back 29

-higher affinity
-appears more quickly
-persist longer
-attain higher concentrations
-perdominantly IgG

Front 30

different types of vaccines

Back 30

-live attenuated
-whole, inactivated
-fractional
-polysaccharide
-conjugated
-recombinant DNA technology
-toxoids
-nucleic acid

Front 31

live attenuated vaccines

Back 31

-contains live organism that is attenuated in the lab
-undergoes limited replication in the host
-produces immune response w/o causing disease

Front 32

examples of live attenuated

Back 32

measles
mumps
rebella
varicella, zoster
rotavirus
influenza -- nasal
oral polio
typhoid
yellow fever

Front 33

issue w/ live vaccines

Back 33

-single dose to produce long-lasting immunity
-timing
-contraindicated in some populations

Front 34

live vaccines:
explain what is meant by single dose for long-lasting immunity

Back 34

-repeated doses will not boost
-they are more of a public health stragety to ensure everyone vaccinated is able to reach seroconversion
-second chance at reaching immunity

Front 35

live vaccines:
timing issues

Back 35

must be seperated from other Abs

Front 36

live vaccines:
maternal abs and vaccinating in children under the age of 1

Back 36

-maternal abs are given to child and they will nuetralize live vaccines administered in the first year of life

Front 37

live vaccines:
contraindicated in what populations

Back 37

-pregnancy and immunosuppressed

Front 38

Whole, inactivated vaccines:
how made

Back 38

-grown in culture
-exposed to heat -- chemically inactivated
-sometimes purified to contain only portion needed to induce immunity

Front 39

Whole, inactivated vaccines:
examples

Back 39

hepatitis A
influenza -- often subunits
polio
rabies

Front 40

Whole, inactivated vaccines:
issues

Back 40

-multiple doses to produce protective immunity
-generally require a booster dose

Front 41

Whole, inactivated vaccines:
pro

Back 41

minimal interference from circulating antibodies, so can be given to young infants

Front 42

fractional vaccines:
what they are

Back 42

portion of pathogen that induces protective immunity

Front 43

fractional vaccines:
pros

Back 43

reduces adverse effects associated w/ vaccine adminstration
-injection site soreness, redness, systemic reactions (fever, aches)

Front 44

fractional vaccines:
different forms of fractional vaccines

Back 44

-polysaccharide vaccines
-recombinant DNA vaccines
-toxoids

Front 45

fractional vaccines:
other examples of these

Back 45

-influenza
-acellular pertusssis

Front 46

polysaccharide vaccines:
composition

Back 46

long chains of sugar molecules from bacterial capsules

Front 47

polysaccharide vaccines:
immune response is t-cell independent -- explain

Back 47

stimulate B cells without t- helper cells

Front 48

polysaccharide vaccines:
ineffective in children....

Back 48

< 2 years of age

Front 49

polysaccharide vaccines:
booster response?

Back 49

no

Front 50

polysaccharide vaccines:
predominant Ab response

Back 50

IgM

-no maturation/booster response so same response w/ every exposure
-need t-cell for maturation to occur

Front 51

polysaccharide vaccines:
downfalls of these vaccines

Back 51

-not useful in children
-not as potent
-most determential infections in children are due to polysaccharide organisms

Front 52

polysaccharide vaccines:
examples

Back 52

pneumococcal (PPSV23)
menigococcal (MPSV4)

Front 53

conjugate vaccines:
composition

Back 53

polysaccharide linked to protein making it a more potent vaccine

Front 54

conjugate vaccines:
overcomes what disadvantage of polysaccharide vaccines

Back 54

-use in children
-elicits a memory response w/ IgG

Front 55

conjugate vaccines:
examples

Back 55

-haemophilus influenza type B
-pneumococcal (PCV13)
-minigococcal conjugate (MCV4)

Front 56

recombinant DNA vaccines:
how made

Back 56

-insert gene for antigen in mo such as yeast or bacteria
-mo produces the antigenic protein
-harvest antigenic protein
-purify and use in vaccine

Front 57

recombinant DNA vaccines:
advantages

Back 57

large amount of pure antigen can be made by mo

Front 58

recombinant DNA vaccines:
disadvantage

Back 58

expensive

Front 59

recombinant DNA vaccines:
examples

Back 59

hepatitis B
human papillomavirus

Front 60

Toxoid vaccines:
what are they

Back 60

inactivated bacterial toxins

Front 61

Toxoid vaccines:
immune response is to what

Back 61

the toxin produced by the infecting bacteria

Front 62

Toxoid vaccines:
examples

Back 62

tetanus
diphtheria

Front 63

nucleic acid vaccines:
discovered when

Back 63

1990

Front 64

nucleic acid vaccines:
produces what kind of immune response

Back 64

-immune response to the protein encoded by plasmid DNA
-induces CELL MEDIATED and antibody response

Front 65

nucleic acid vaccines:
characteristics

Back 65

-easy to manufacture
-inexpensive
-numerous trials

Front 66

nucleic acid vaccines:
prophylaxis vs therapeutic

Back 66

proph = used to prevent infection

therap = has infection and vaccinate to cause an immune response the might by curative or improve the condition

Front 67

nucleic acid vaccines:
what is introduced in the host

Back 67

gene for antigentic portion of a pathogen

Front 68

nucleic acid vaccines:
host cells response

Back 68

-take up the foreign DNA vector
-express the pathogen gene by RNA transciption
-produce antigentic pathogen protein
-present on surface of HLA-class1
-can elicit cell mediated immune response by cytotoxic t-cells

Front 69

nucleic acid vaccines:
role of myocytes

Back 69

-secondary role
-may be antigen producers
-can be lysed and supply additional DNA for the macrophages

Front 70

nucleic acid vaccines:
role of antigen presenting cells (macrophages)

Back 70

induce the immune response by presenting t-cells w/ antigen

directly transfected

Front 71

nucleic acid vaccines:
how is it possible to elicit a strong cell mediated immunity

Back 71

b/c the pathogen protein originates from inside the cell

Front 72

nucleic acid vaccines:
T or F
provides long lasting immunity

Back 72

true!

Front 73

nucleic acid vaccines:
advantages

Back 73

-cell mediated and antibody reponse
-pure DNA can be produced
-no infectious risk b/c only the gene from the pathogen is being introduced

Front 74

nucleic acid vaccines:
candidate infections

Back 74

-hep C
-herpes simplex
-HIV
-parasites
-cancer

Front 75

nucleic acid vaccines:
cautions

Back 75

-safety profile -- can we inadvertently make cancer?
-human efficacy -- not effective in human models thus far
-administration strategy -- gene guns used now
-stability -- can cause chronic inflammatory response?

Front 76

adjuvants

Back 76

vaccine ingredients

substance that enhances the immune response to the antigen w/ which it wi mixed

Front 77

adjuvants
only approved one in the US

Back 77

aluminum-containing materials

Front 78

adjuvants
newer agents

Back 78

-in development

-use of oil-based emulsions containing biodegradable materials

Front 79

adjuvants
mechanism for improvement in immune repsonse?

Back 79

-not complete determined

-make antigen less soluble, so stays in injection site longer
-enhances immune stimulatory signlas
-causes inflammatory response

Front 80

thimerosal in vaccines:
what act called for a review of all mercury containing foods and drugs

Back 80

-FDA modernization act of 1997

Front 81

thimerosal in vaccines:
why a problem for some vaccines

Back 81

some contain ethyl mercury as a perservative, but at much lower levels that the toxic levels

Front 82

Thimerosal in vaccines:
amount of mercury immunizations could expose some infants to

Back 82

> 0.1mcg/kg/day

Front 83

Thimerosal in vaccines:
the half life of ethyl mercury =
the half like of methyl mercury =

Back 83

ethyl = 3-8 days

methyl = 50 days

Front 84

Does thimerosal cause autism?

Back 84

no!!

large studies in several countries found no links b/w thimerosal exposure and development of autism

Front 85

has thimerosal been removed from childhood vaccines?

Back 85

yes!

and the incidence of autism still continues to rise

Front 86

T or F
WHO deemed thimerosal use safe for multidose vials of vaccine

Back 86

true

Front 87

when should vaccines be prepared

Back 87

at the time of administration

-drawn from vial
-reconstitued and then drawn from the vial

Front 88

pre-filled syringes are strongly discourages, unless

Back 88

they are manufacturer pre-filled syringes

Front 89

IM administration of vaccines:
what muscles for adults and children

Back 89

deltoid

Front 90

IM administration of vaccines:
what muscle for infants

Back 90

anterolateral aspect of the thigh

Front 91

IM administration of vaccines:

needle sizes used

Back 91

adults = 1 to 1 1/2 inches = 22-25 gauge

infants and children = 5/8 to 1 1/4 inch = 22-25 gauge

Front 92

SC administration of vaccines:
where are they delivered to

adults vs children

Back 92

the fatty tissue under the skin

-over tricpes for adults
-over anterolateral aspect of the thigh for infants

Front 93

SC administration of vaccines:
what is done to avoid slipping into the muscle

Back 93

tissue is pinched

Front 94

SC administration of vaccines:
need size

Back 94

5/8 inches = 23-25 gauge for all

Front 95

oral administration of vaccine:
used for delivery of

Back 95

oral or mucosal pathagens

Front 96

oral administration of vaccine:
types of pathogens

Back 96

live attenuated

Front 97

oral administration of vaccine:
promotes the production of what antibody

Back 97

iGA

Front 98

edible vaccines:
how done

Back 98

use of trangenic plants that express the vaccine antigen

Front 99

edible vaccines:
pros

Back 99

-oral adminstration
-inexpensive to produce
-rapid upscale production is possible
-minimization of storage problems
-mucosal immunity

Front 100

edible vaccines:
plants that are being researched

Back 100

-carrots
-black eyed peas
-corn
-potatoes

Front 101

transdermal immunization:
how done

Back 101

needle free delivery
patch application

Front 102

transdermal immunization:
vaccinations w/o a needle

Back 102

-investigational delivery system

-debride the skin w/ embory board or sand paper to remove the stratum corniym
-place patch on the skin and diffuses into the immune rich areas of the skin

Front 103

skin immune system:
barrier

Back 103

stratum corneum

-possible to disrupt w/ hydration

Front 104

skin immune system:
importance of the langerhans cells

Back 104

-close proximity to the stratum corneum
-carry antigen to lymph nodes

Front 105

Intradermal influenza vaccine:
ages licensed for?

Back 105

18-64 years old

Front 106

Intradermal influenza vaccine:
how it works

Back 106

0.1 ml volume is delivered w/ 1.5mm needle into skin over deltoid

-uses a patented micro-injection system

Front 107

Intradermal influenza vaccine:
why beneficial

Back 107

only a small volume is needed due to the effecive immune system located under the skin

Front 108

Intradermal influenza vaccine:
are injection site reactions common?

Back 108

yes!
-minor to moderate
-resolves w/i 3-7 days

-well accepted by healthy adults

Front 109

Nasal or mucosal administration:
possible sites

Back 109

vaginal, rectal, and nasal

vaginal = sexually transmitted pathogens
rectal = GI pathogens

Front 110

Nasal or mucosal administration:
Abs that are produced

Back 110

IgA

Front 111

Storage and Handling:
the biggest issue

Back 111

-exposure to temperatures outside recommended ranges can reduce the potency of the vaccine

-high cost
-loss of patient confidence when it doesn't work

Front 112

Storage and Handling:
the cold chain

Back 112

-cold temperatures can not be broken during

-manufactoring
-distribution
-provider's office
-given to the patient

Front 113

Storage and Handling:
storage temperatures

Back 113

-each vaccine has a recommended temp
-protect from light

Front 114

Storage and Handling:
freezing -- live vs inactivated

Back 114

live = can tolerate freezing

inactivated = can be damaged by heat or freezing

Front 115

Storage and Handling:
temperature excursions

Back 115

times when the vaccine is left out of refrigeration for extended periods of time

Front 116

Storage and Handling:
dangers w/ temperature excursions

Back 116

-cant visually determine if the vaccine is less potent

Front 117

Storage and Handling:
freezer temperatures

Back 117

-consider defrost cycles that your freezer may have

-recommended = -58-5 F and -50- -15C

Front 118

Storage and Handling:
recommended refrigeration temps

Back 118

average of 40F (5C)

Front 119

Storage and Handling:
monitoring temperature

Back 119

-twice daily recording of temperatures
-graphing thermometers

Front 120

Storage and Handling:
thermometers

Back 120

-placed in each compartment
-calibrated w/ period recalibration as recommended by the manufacturer

Front 121

Storage and Handling:
continuous monitoring

Back 121

-alarms when closed
-notifications sent to email or cell phone

Front 122

How to handle temperature excursions

Back 122

-do not through away -- manufacturers have temps that the vaccine can stay w/i

-seperate from other inventory

Front 123

designing clinical immunization program plans

Back 123

-place someone in charge
-designate a back up
-written plan for handle once the shipment arrives

Front 124

proper refrigerators and freezers that should be used

Back 124

-standard household combination w/ seperate seals
-no dorm style!
-stand alones are preferred
-no food

Front 125

where should the vaccines be placed in the refig/freezer

Back 125

-not in the doors!

-middle of the unit on the shelves
-spaced for adequate air circulation
-seperate similar vaccines such as children and adult doses

Front 126

global imminization issues

Back 126

-searching for vaccines that do not need to be refigerated!