Vaccines And Immunotherapy

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Active immunization

Back 1

a. Administration of a vaccine to which the recipient mounts his own adaptive immune response

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Passive immunization

Back 2

a. Transfer of pre-formed antibodies or lymphocytes from an immune individual to an immunologically naïve recipient
b. Antibodies are mostly human

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Natural passive immunity

Back 3

a. IgG antibodies that pass through placenta from mother to fetus
b. Antibodies also present in breast milk and colostrum

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Artificial passive immunity

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a. A patient becomes infected by a microorganism capable of producing a harmful toxin
b. Pre-formed antibodies must be given shortly after the infection to neutralize the toxin

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Adoptive immunity

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a. Passive transfer of lymphocytes
b. Seen in recipients of bone marrow transplants

Front 6

Contact immunity

Back 6

a. A vaccinated individual spreads a live vaccine to other individuals
b. Inadvertent vaccination

Front 7

Herd immunity

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a. 90% of a population must be vaccinated to halt the spread of disease to the remaining 10%

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Live, attenuated vaccines

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i. Most efficient

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Live viral vaccines induce what kind of response?

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1. Tc
2. Antibody production

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Intranasal/oral vaccines induce what response?

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1. sIgA production
2. Serum IgG response

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Concerns with live vaccines

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1. Can convert back to wild-type
2. May cause disease in IC, fetus, or children
3. Some live vaccines are associated with persistent infections
4. Some live vaccines may contain components to which the recipient may be allergic

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Killed vaccines

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i. Inactivated by heat, chemical treatment, or gamma irradiation→ virus cannot replicate
ii. Administered in deltoid of adult or thigh of infant
iii. Induce an IgG response

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Subunit vaccines V

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i. Toxoids, subcellular fragments, surface antigens, or capsular polysaccharids from target microorganism
ii. Administered parenterally
iii. Induce mainly IgG

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What type of microparticle makes the best vaccine?

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1. Large proteins
2. 2nd-- polysaccharide

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Haptens

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1. Antigens too small to induce an immune response
2. Must be linked to larger carrier proteins in order to be immunogenic

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Toxoids

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1. Toxins that have been modified to no longer cause pathology
2. Still induce an active immune response in recipient
3. Often used as a carrier for haptens
4. Tetanus/diphtheria

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Capsular polysaccharides

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1. Used as vaccines to protect against bacteria
2. S. pneumoniae
3. H. influenza b
4. Neisseria meningitides

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T-independent antigens

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1. Do not need T cell help in order to produce antibodies to polysaccharides
2. Stimulate mainly IgM production
3. Do not elicit the formation of memory B cells

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In children under 2 years.....

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a. Polysaccharides are hardly immunogenic
b. Can be made more immunogenic by chemically linking them to T-dependent antigens

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T-dependent antigens

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i. Do require T cell help in order to stimulate antibody synthesis in B cells
ii. Induce class-switching
iii. Induce formation of memory B cells

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What type of vaccines do children under 2 receive?

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1. Conjugate vaccines
a. Capsular polysacchardides are linked to diphtheria toxoid or other strong protein antigen

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Oral polio vaccine

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i. Sabin vaccine
ii. Now used only in endemic areas of countries where paralytic polio still exists
iii. Composed of 1 or 2 serotypes
iv. Not used generally because strains returned to wild type

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MMR

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i. Administered at 12-15 months
ii. Again at 4-6 years before entry into kindergarten
iii. Need to be redone due to waning maternal IgM

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VZV vaccine

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i. Administered at 12-15 months
ii. Again at 4-6 years

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Herpes-Zoster vaccine

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1. Over 60 y/o
2. 14-fold concentration of VZV vaccine

Front 26

Rotavirus vaccine

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i. Attenuated virus oral vaccine
ii. Given in 2 doses at 2 and 4 months

Front 27

Live, attenuated influenza virus, quadrivalent (LAIV4, FluMist)

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i. Protects healthy persons 2-49 y/o from 4 serotypes of influenza virus
ii. Virus cannot replicate at temperatures 37 C or higher

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BCG vaccine

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i. Attenuated strain of M. bovis
ii. Used against tuberculosis
iii. Not routinely administered in USA→ positive test for PPD due to vaccine

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Inactivated polio vaccine

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i. Salk vaccine
ii. Injected vaccine
iii. Protects against 3 serotypes of poliovirus

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Hep A vaccine

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i. Now recommended for all children and unvaccinated adults

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Inactivated influenza vaccine, quadrivalent (IIV4)

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i. Recommended for everyone 6 months and older
ii. Virions isolated from eggs inactivated by UV light and formaldehyde

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Rabies vaccine

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i. Administered pre- and post-exposure
ii. Rabies immune globulin is administered post-exposure as well

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DTaP

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i. Combination vaccine containing tetanus and diphtheria toxoids
ii. Structural of B. pertussis
iii. Children 2 months to 6 y/o

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Td

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i. Employs toxoids
ii. Provoke excellent immunity without pathology
iii. Protects against C. tetani and C. diphtheria
iv. ADMINSITERED AT 10-YEAR INTERVALS

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Tdap

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i. One dose is recommended for children 11-12 y/o
ii. Subsequent boosters should be with Td

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Haemophilus influenzae type B (Hib)

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i. Conjugate vaccine→ capsular polysaccharide conjugated to a carrier protein
ii. Protects young children from pneumonia, OM, and meningitis caused by H. influenzae serotype B
iii. Administered beginning at 2 months

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Pneumococcal conjugate vaccine (PCV, PCV13)

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i. Capsular polysaccharides from 13 serotypes of S. pneumoniae
ii. For all children younger than 5
iii. 4 doses at 2, 4, 6 and 12-15 months

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Pneumococcal polysaccharide vaccine (PPSV, PPSV23)

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i. Capsular polysaccharides from S. pneumoniae
ii. No protein carrier
iii. Persons 65 y/o or older
iv. Booster after 5 years
v. Smokers 19-64 y/o

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PPSV 23 underlying medical conditions

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1. Cochlear implant
2. Weakened immunity→ asplenia, HIV, steroid use, organ transplant, cancer
3. Chronic medical conditions→ heart disease, lung disease, kidney disease, alcoholism, diabetes, cirrhosis, CSF leaks, sickle cell disease
4. A 2nd dose after 5 years may be required

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Meningococcal conjugate vaccine

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i. Capsular polysaccharides from serotypes A, C, Y and W-135 of N. meningitides
ii. All children 11-12 y/o
iii. Booster at age 16

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Most at risk (in need) of meningococcal conjugate vaccine

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1. College freshmen
2. Military recruits

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Meningococcal conjugate vaccine only give before 11 years of age because....

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1. Asplenic
2. Complement deficiency

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Meningococcal polysaccharide vaccine

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i. Contains same 4 serotypes as MCV4
ii. No protein carrier
iii. 56 y/o and older