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Governance of vaccination in the UK

Joint Committee of Vaccination and Immunisation




JCVI




decide whether populations are vaccinated depending on:


vaccine efficiacy


burden of disease


vaccine safety


cost of vaccination

the ideal vaccine

safe to recipient


-not cause disease


-have no significant Sx


prevent infection in all cases


if virus has serotypes, vaccine should be cross reactive


life long protection


easy to administer


stable


relatively cheap

Natural immunisation

when person comes in contact with pathogen immune memory forms to prevent future infections



Examples of different types of vaccination

Whole microorganism


-live-attenuated


-dead




subunit of microorganisms


-inactivated toxin


-recombinant proteins


-polysaccharide


-conjugate vaccines (polysaccharide combined with more immunogenic conjugate to get T cell help

named vaccines from type of vaccine:


live-attenuated

BCG


yellow fever


VZV (chickenpox/shingles)


MMR



named vaccines from type of vaccine:


dead

Whole cell pertussis


rabies

named vaccines from type of vaccine:


inactivated toxin

tetanus, diphtheria toxoid



named vaccines from type of vaccine:


recombinant proteins

Hep B


HPV

named vaccines from type of vaccine:


Polysaccharide

pneumococcus


meningococcus


haemophilus

Live attenuated vaccines

induce stronger immune respnose than dead


more dangerous


risk of vaccine infection




to ↓ risk pathogen is attenuated (inactivated)




small risk that attenuated → live


this has happened in type 3 Sabin polio vaccine





Adjuvant



materials injected with vaccine → enhance immune response



most common: alum




microbial agent is adsorbed onto alum


soluble protein → particulate material → ↑ tendency to be phagocytosed by APC




also depot of slow release of antigen




phagocytic APCs

DC


macrophage

Co-administring vaccines

enhances response to vaccines




e.g. co-administration of pertussis enhances Ab response to Diptheria and Tetanus

incomplete Freund's adjuvant



Oil-in-water emulsion

complete Freund's adjuvatn

when dead mycobacteria are added to the emulsion → ↑ stimulus for innate system, → enhanced expression of co-stimulatory molecules and cytokines by APCs

Conjugate vaccines

possible to induce Ab response in infants to bacterial capsular polysaccharides




by conjugating polysaccharide to protein antigens like Diptheria + Tetanus toxoids




B cells specific for the polysaccharide internalise conjugate


present peptides from toxoids on surface


Thus B cells can get help from Th2 helper cells primed against the toxoids

Conjugate vaccines diagram

Graph of Ab response to 1º and 2º inoculum of infection/vacciantion

Ab response to 1º and 2º inoculum of infection/vacciantion

1º inoculum


IgM Abs


hours -days to make Abs


low affinity




IgG Abs


4-6 weeks to make Abs


high affinity




2º inoculum


rapid boost of IgG response


days


higher conc. than after 1º exposure

Vaccine safety

allergic reactions can occur but is rare




chicken eggs used to make viral vaccines → egg protein in vaccine → anaphylaxis but this is very rare

Ca. vaccines

HPV vaccine for cervical ca.





Monoclonal Abs for ca.

Herceptin for breast ca.


anti-CD20 for B cell lymphoma




but still very experimental



Passive immune treatments

1. Mother-foetus -


IgG Abs enter foetal blood


last trimester


infant Ab protection for 4-6 months




2. Patients born without B cells/ have Ab deficiency


give Ig IV or subcutaneous


giving protection against range of pathogens




3. patients with immunodeficiency/particular risk


pregnancy, pooled serum from donors with high tires of neutralising Ab


good e.g. VZV hyper immune serum

Passive immune treatments examples

Human serum


-Rabies


-Rhesus D


-VZV




Animal serum


-Tetanus




Monoclonal Abs


Anti Respiratory syncitial virus