Term
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Definition
-to protect against disease upon subsequent exposure to the infection
-immunization was among the top 10 public health accomplishments in the last century |
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Term
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Definition
must immunize before exposure
childhood and adult immunization schedules updated frequently and published annually |
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Term
| What is the "ideal vaccine"? |
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Definition
-induces protective immune response in all individuals
-no adverse events
-cheap to produce
-not temperature sensitive |
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Term
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Definition
-stimulate the host to produce a protective response to a pathogen (natural infections, immunization)
-relies on immunologic memory |
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Term
| What is the general framework of the immune system? |
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Definition
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Term
| What are the 4 immune globulins? |
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Definition
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Term
What does each one do?
iga, ige, igg,igm |
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Definition
IgA: found in secretions
IgE: involved in allergy andanaphylaxis immune response to parasites
IgG: found in large amounts in serum, major antibody of secondary response
IgM: predominant early antibody |
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Term
| What is the booster response? |
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Definition
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Term
| What is the secondary antibody response? |
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Definition
-No maturation of IgM reponse
-Antibodies response after secondary exposure |
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Term
| What is the secondary antibody response characteristics? |
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Definition
-higher affinity
-appear more quickly
-persist longer
-attain higher concentration
-predominantly IgG |
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Term
| What are products of immunization? |
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Definition
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Term
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Definition
-contain live organisms
-undergo limited replication in host
-produce immune response without causing disease |
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Term
| What are examples of live attenuated vaccines? |
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Definition
measles
mumps
rubella
varicella, zoster
rotavirus
influenza (nasal)
oral polio
typhoid
yellow fever |
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Term
| What are issues with live vaccines |
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Definition
-single dose to produce long-lasting immunity (repeated doses do not boost, but second chance for seroconversion
-timing (there are many issues, maternal antibody interferes with infant's immune repsonse so not administered until after 1st birthday)
-contraindicated in pregnancy immunoppressed |
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Term
| what are whole, inactivated vaccines? |
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Definition
-they are vaccines that are grown in culture
-they are exposed to heat chemical to inactivate
-sometimes purified to contain only portion needed to induce immunity |
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Term
| What are examples of whole inactivated vaccines |
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Definition
hepatitis A
influenza (though most are split or subunit products)
polio
rabies |
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Term
| Issues with inactivated vaccines |
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Definition
-multiple doses to produce protective immunity
-generally require booster doses
-minimal interference from circulating antibody |
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Term
Fractional vaccines- what is it?
what are the advantages? |
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Definition
-portion of pathogen that induces protective immunity
- advantage: reduces adverse effects associated with vaccine administration- (injection site soreness, redness, systemic reactions) |
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Term
| what are examples of Fractional vaccines? |
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Definition
polysaccharide vaccines
recombinant DNA vaccines
toxoids
other examples (influenza, acellular pertussis) |
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Term
| What are polysaccharide vaccines? |
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Definition
| they are composed of long chains of sugar molecules from bacterial capsule |
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Term
| what are polysaccharide vaccines independent of? |
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Definition
| stimulate B cells without T helper cells |
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Term
| Where are polysaccharide vaccines ineffective for? |
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Definition
| children for those younger 2 years |
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Term
| What kind of booster response is needed for polysaccharide vaccines? |
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Definition
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Term
| what is the predominant antibody response of polysaccharide vaccine? |
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Definition
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Term
| what are examples of polysaccharide vaccines?P |
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Definition
pneumococcal
meningococcal |
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Term
What are conjugate vaccines?
what is the advantage? |
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Definition
Polysaccharide linked to protein making it a more potent vaccine
conjugation overcomes the disadvantages of polysaccharide vaccines (pathogens important causes of disease in infants, elicit memory response) |
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Term
| examples of conjugate vaccines? |
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Definition
haemophilus influenzae type B (hib)
pneumococcal (PCV13)
Meningococcal conjugate (MCV4) |
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Term
| What is recombinant DNA technology? |
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Definition
-inserting a gene for antigen in microorganism (yeast/bacteria)
-microorganism produces antigenic protein
-antigentic protein harvested and purified for use as vaccine |
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Term
| What is the advantage of recombinant DNA vaccine |
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Definition
| large amount of pure antigen |
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Term
| What is the disadvantage of DNA vaccine? |
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Definition
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Term
| examples of recombinant DNA vaccines |
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Definition
| hepatitis B, Human papillomavirus |
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Term
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Definition
-inactived bacterial toxins
-immune response to toxin produced by infecting bacteria |
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Term
| What are examples of toxoids? |
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Definition
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Term
| What are nucleic acid vaccines? |
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Definition
immune response to protein encoded by plasmid DNA
induces cell mediated and antibody responses |
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Term
| What are nucleic acid vaccines |
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Definition
| easy to manufacture, inexpensive, numerous trials (prophylaxis, therapeutic) |
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Term
| Nucleic acid vaccines: what is the gene for? |
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Definition
| Gene for antigenic portion of a pathogen |
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Term
| what do host cells do in nucleic acid vaccines? |
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Definition
-take up foreign DNA
-express the pathogen gene
-produce antigenic pathogen protein |
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Term
| What role do myocytes play in NA vaccines? |
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Definition
play a secondary role, may be antigen producers
lysed myocytes supply additional DNA for macrophages |
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Term
| What role do antigen presenting cells play for NA vaccines? |
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Definition
they induce an immune response
they are directly transfected |
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Term
| what are the advantages of nucleic acid vaccines? |
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Definition
-because pathogen protein originates inside the cell, strong cell-mediated immunity elicited
-long-lasting immunity
-cell mediated and antibody responses
-pure
-no infectious risk |
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Term
| What are candidate infections for nucleic acid vaccines? |
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Definition
hepatitis C virus
herpes simplex virus
human immunodeficiency virus
parasites
cancer |
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Term
| what are cautions of DNA vaccines? |
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Definition
safety profile
human efficacy
administration strategy
stability |
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Term
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Definition
| Substance that enhances the immune response to the antigen with which it is mixed |
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Term
| what is the only approved adjuvant in the US? |
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Definition
| aluminum containing material |
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Term
| what are development efforts focus for adjuvants? |
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Definition
| oil-based emulsions containing biodegradable materials |
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Term
| What are the mechanisms for improvement of immune response of adjuvants? |
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Definition
not completely determined:
-make antigen less soluble, stay @ injection site longer
-enhance immune stimulatory signals
-cause inflammatory response |
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Term
| How much is the content of acceptable exposure limits compared to toxic levels? |
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Definition
| far below those of toxic levels |
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Term
| what is thimersol? what does it contain? |
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Definition
| effective preservative that contains ethyl mercury |
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Term
| immunization could expose how much of mercury/kg/day? |
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Definition
| greater than 0.1 mcg of mercury/kg/day |
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Term
what is the half life of ethyl mercury?
methyl mercury? |
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Definition
ethyl: t1/2= 3-8 days
methyl: 50 days |
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Term
| does thimersol cause autism? |
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Definition
large studies in several contries found no links between thimersol exposure and development of autism
since 2011 when thimerosal was removed from childhood vaccine, the incidence of autism continues to rise |
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Term
| Are thimersol-free preparations available in US? |
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Definition
yes, but the world health organization deemed thimersol use safe for multidose vials of vaccine
thimersol- doesnt seem to be a lot it |
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Term
| Where were the vaccine delivered into the muscle? |
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Definition
deltoid for adults and children
anterolateral aspect of thigh for infants
never gluteus |
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Term
What are needle sizes for intramuscular administration?
for infants and adults? |
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Definition
adults 1 to 11/2 inches, 22-25 gauge
infants and children 5/8 to 1 1/4 inch, 22-25 gauge |
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Term
what is Subcutaneous administration?
where are they administered for adults vs infants |
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Definition
delivered into fatty tissue under the skin
over the triceps for adults
over anterolateral aspect of the thigh for infants |
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Term
| why is the tissue pinched for administration of subcutaneous administration? |
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Definition
| avoids slipping into muscle |
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Term
| what is the needle size for subcutaneous administration? |
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Definition
| 5/8 inch, 23-25 gauge for all |
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Term
| what are methods for oral administration of vaccines? |
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Definition
oral or mucosal pathogens
live attenuated pathogens
IgA production |
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Term
| What would be methods for edible vaccines? |
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Definition
transgenic plants (express vaccine antigen)
- the plant produced antigens
the plant cell walls may protect vaccine antigen from stomach acid |
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Term
| What would be benefits of edible vaccines? |
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Definition
oral administration
inexpensive to produce
rapid upscale of production
minimization of storage problems
edible
relatively stable
production scale up
mucosal immunity??? |
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Term
| what are benefits of transdermal immunization? |
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Definition
needle free delivery
patch application |
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Term
| What vaccination methods are new and currently being worked on? |
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Definition
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Term
| What are components of the skin immune system? |
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Definition
barrier stratum corneum
-disrupt with hydration (occlusion)
Langerhans cells
-close proximity to stratum corneum
-carry antigen to lymph nodes |
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Term
who are intradermal influenza vaccine for?
how much volume is delievered? |
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Definition
for adults aged 18-64 years
0.1mL volume delievered with 1.5mm needle into skin over deltoid
-patented micro-injection system
-27mcg influenza antigens |
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Term
| are injection site reactions for intradermal vaccine common? whow long do they take to resolve? how well accepted as they by healthy adults? |
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Definition
common reactions occur
minor to moderate
resolve in 3-7 days
well accepted by healthy adults |
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Term
| What is nasal or mucosal administration? |
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Definition
-antigen delievered to mucosal surface
-nasal
vaginal/rectal administration under investigation
-IgA production |
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Term
| what bad things can happen if you mess up storage and handeling of vaccines? |
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Definition
exposure to temperatures outside recommended ranges can reduce potency
errors cost $$
loss of patient confidence |
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Term
| Storage temperatures for vaccines |
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Definition
-each vaccine has recommeded storage temp (protected from light)
-most live vaccines can tolerate freezing
-inactivated vaccine damaged by heat or freezing
-temperature excursions: out of range temperatures |
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Term
| What are vaccine storage equipment |
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Definition
new recommendation for stand-alone freezers and refrigerators
refrigerator compartment can be used for vaccine storage
-freezer compartment not used for vaccine storage
-avoid storing vaccine near vent from freezer
-water jugs to maintain constant temperature |
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Term
| what are things to consider for vaccine storage? |
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Definition
-use only store biologics
-consider size
-stores jugs of water or frozen gel packs to maintain temperature |
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Term
| where do you place vaccines in the storage unit? |
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Definition
-not in the door!- remove vegetable or deli drawers
-middle of unit on shelves
-spaced for adequate air circulation
-strategic storage to minimize error
--tdap distinguished from DTap |
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Term
what are options of freezer storage?
what are recommended freezer temperatures? |
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Definition
-stand alone freezer
-frost-free automatic defrost cycle preferred
between -58 and 5 degrees
between -50 and -15 degrees |
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Term
| refrigerator temp recommendation |
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Definition
between 35 -46 deg f
between 2 and 8 deg f
averag 40 f (5 deg c) |
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Term
| how do you monitor the temperature for vaccines? |
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Definition
twice daily recording of temperatures
digital thermometers with downloading capabilities
alarms when closed
notifications sent to email or cell phone |
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Term
| what type of thermometers are used for vaccines? |
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Definition
calibrated digital thermometer with biosafe glycol-encased probe
more accurately reflects temperature of liquid vaccine |
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Term
| what is proper handling of temperature excursions? |
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Definition
do NOT discard (vaccines delivered that may have been exposed to heat/cold, vaccine inadvertently left out, equipment malfunction or power outage)
separate from other inventory
-call vaccine manufacture for guidance
-call health department for guidance |
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Term
| Clinical immunization program plans |
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Definition
designate an individual and back-up
written plan for ordering and deliveries= manage inventory
emergenC back-up written plan
-natural disaster or other power outage
-back up generator
-alternate site |
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Term
| Global immunization issues |
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Definition
consider vaccine integrity in areas of the world with no or unreliable electricity supply
WHO |
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