20 - Immunizations Flashcards by Karlo Sison

Which Vaccines have

BOTH
Live & Inactivated Agents

Influenza

POLIOmyelitis

Typhoid

Measles

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Which LIVE VACCINE requires a booster?

MMR
Needs a booster

Live Attenuated Vaccines
can replicate inside recipient –> logarithmic growth of Ag’s
typically LIFELONG immunity

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*Which INACTIVATED VACCINES**
*do NOT require REPEATED VAX + BOOSTERS**?

HEP B + *Inactivated* POLIO

In INACTIVATED VACCINES:
such as Tdap / Rabies / Typhoid
they require repeated vaccination + boosters to maintain HIGH AB levels

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Determinants of IMMUNOGENECITY
In VACCINES

Chemical + Physical States
of the Ag

*Characteristics of INDIVIDUAL**
*Genetics / Physical Condition**

HOW antigen is PRESENTED
ROUTE / DOSE
TIMING of dose / ADJUVANTS

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T-Lymphocyte-INdependent Immune Response
Determinants of ImmunoGenicity

no immunologic memory

can NOT be boosted with REPEAT injections

POOR immunogenicity in:*
*Infants / Young Children**

Can be OVERCOME by

*LINKAGE to CARRIER PROTEIN**
*Conjugated Hib / pneumococcal / meningocccal**

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T-Lymphocyte-Dependent Immune Response
Determinants of ImmunoGenicity

IDEAL RESPONSE

Induces:
Immunologic MEMORY

Boosts effects with REPEAT ADMIN

Provides immunogenicity to:
ALL AGE GROUPS

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What determines the BREADTH of an immune response?

Determinants of Immunogenicity

ROUTE of administration

IM & SC routes confer:
a predominantly systemic IgG response

*Oral** or Nasal produces:
*local IgA** & some systemic IgG

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What determines the EXTENT of an immune response?

Determinants of Immunogenicity

AMOUNT of ANTIGEN delivered

Dose-Response relationship
that reaches a certain plateau

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Temporal Course of an IMMUNE RESPONSE

Initial Response

Protective Immune Response ~2 weeks

Circulating Antibodies appear in 7-10 days
low affinity IgM FIRST (imMediate) –> HIGH affinity IgG
IgG AB’s –> neutralize / precipitate / fix complement

*Titer PEAK = 2-6 weeks**
then begins to decrease*

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Temporal Course of an IMMUNE RESPONSE

SECONDARY Response

“Booster”

4-5 days
vs 7-10 days for first response

HEIGHTENED Humoral or CELL-Mediated RESPONSE

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What is the ASSAY OF CHOICE
when measuring VAX Immune Response?

*OPSONOPHAGOCYTIC ACTIVITY**
ideally would be measuring CELL-MEDIATED immunity*

Appearance & Concentration of Serum Antibodies

Measures only the HUMORAL response = B-cell
failure can occur due to loss of circulation AB’s over time

absence of AB does NOT mean lack of protection

but also mere presence of AB does NOT mean immunity
need a SPECIFIC CONCENTRATION

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Vaccine Development

Attenuation = reduced effect / virulence
achieved by serial passage in tissue celll culture lines
but still maintaining immunogenecity

Inactivated Vaccines
developed in bacteria following
concentration / purification / inactivation

NEWER vaccines are developed by:
Recombinant techniques / LIVE vectors / MICROencapsulation into polymers (sustained release)

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Where should we look for
IMMUNIZATION RECOMMENDATIONS?

*ACIP**
*A**dvisory Committee on Immunization Practices

updated ANNUALLY

Decition to admin the vacicine involves:
Risk of Disease
+
Benefit & Risk of Vaccine

Benefit + Risk Balance may change over time
need to continually assess

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Inactivated Flu Vaccine

Production / Content

Primarily manufactured IN EGGS
cell culture vaccine in marine darby CANINE KIDNEY cells (still egg)

Only NON-EGG form = recombinant INSECT CELL LINE

Composed of: inactivated disrupted/split flu viruses
or of purified SURFACE antigens

A Viruses H1N1 + H3N2 & 1 B strain
quadrivalent = 2 B strains, but EQUALLY EFFECTIVE

ANTIGEN DRIFT
is why we require annual changes in vaccine components

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Inactivated Flu Vaccine

Administration / Indications

for INACTIVATED VACCINES =
BENEFIT ALWAYS OUTWEIGHS THE RISK

IntraMuscularly

High Dose = 4x Antigenic Content

given annually for:
EVERYONE > 6 months Old

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Inactivated Flu Vaccine

ADR / Effectiveness

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60% effective at preventing flu in healthy adults < 65 y/o

despite not always PREVENTING infection, still prevents:
50% of Hospitilizations
60% of pneumonias
80% of deaths

ADR is UNCOMMON:*
*3-5% report tenderness** @ inj site or low grade fever
preveious SEVERE allergic reaction = CONTRAINDICATED*

LIVE Attenuated Influenza Vaccine

INDICATION / Admin

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*ADULTS aged 2-49**
WITHOUT:*
*medical complications / PREGNANCY / EGG ALLERGY**
*close contact w/ Pregnant or Immunocompromised adults**

Quadrivalent

*INTRANASALLY**
adrs of Nasal Congestion / HA / fever / myalgia*

Pneumococcal CONJUGATE vaccine
PCV13

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Pneumococcal Capsular PolySaccharide
that is
COVALENTLY LINKED to PROTEIN CARRIER
this link converts a normally INdependent vaccine into….

*T-CELL DEPENDENT VACCINE**
*Dependent (PCV13)** is given FIRST

7 Valent Vaccine = Infants / young children
for INVASIVE DISEASE = bloodstream / meningitis

13 Valent Vaccine = 2010

Pneumococcal CONJUGATE vaccine
PCV13

RECOMMENDATIONS / INDICATIONS

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4 Dose series: 2-4-6 months of age
booster @ 12-15 months

ACIP Recommends that:
ALL ADULTS > 65 y/o get PCV13 –> PPPSV23 after 8weeks

Also recommended for:
Adults >50 y/o with:
Immunocompromised
Renal Failure / Asplenia / CSF leak / Cochlear Implants

adr is mostly fever

Pneumococcal POLYSACCHARIDE Vaccine

PPSV23

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IN-DEPENDENT
Given 8 Weeks AFTER PCV13 (dependent)

Generally effective at preventing:

*INVASIVE**
*pneumococcal bacteremia**

IntraMuscular

Pneumococcal POLYSACCHARIDE Vaccine
PPSV23

Indication / Admin

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*RE-VACCINATION after age 65**
if given:* before 65 or at least 5 years in between

Licensed for PERSONS 2+
primarily for adults that are @HIGH RISK from complications RESPIRATORY TRACT INFECTIONS
Essentially:
Everyone admitted to HOSPITAL
Asthma / immunocompromised / Age >65 / Smokers
cancer / Asplenia / Liver / renal disease

Where to look for recommended
TRAVEL IMMUNIZATIONS?

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CDC** or **WHO

Depends on geographic area & risk

Illinois Pharmacist can administer

WHAT VACCINES @ WHAT AGE?

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any vaccine to patients:
> 10 years old

EXCEPT:*
*HPV Vaccine > 14 y/o**

Immunization considerations for:

IMMUNOCOMPROMISED

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NEVER give LIVE vaccines

Inactivated Flu Vaccine:
should be AVOIDED
during INDUCTION / Consolidation CHEMO

*Efficacy of vaccines may be LESS**
-> require repeated doses

FAMILY MEMBERS
should be vaccinated to minimize exposure

**What TYPE of DISEASE does the** **PCV7 / PCV13 / PPSV23** Vaccines ## Footnote **PROTECT AGAINST?**

**_INVASIVE_** **97% efficacy** for preventing **invasive disease pneumococcal bacteremia ** * not necessarily effective against: * *non-bacteremic pneumonia***

20 - Immunizations Flashcards

(25 cards)