questions 2

Immunization

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Topic updated on 04/08/17 9:51am

Schedule
 
Newborn
2 months
4 months
6 months
12 months 15 months 2 years 4-6 years 11-12 years
Hep B #1 Hep B #2   Hep B #3          
  DTaP DTaP DTaP   DTaP   DTaP  
  PPV PPV PPV          
  HiB HiB HiB HiB        
  Polio #1 Polio #2 Polio #3       Polio #4  
  Rota Rota            
        VCZ        
        MMR     MMR  
            HAV    
                Meningitis
 
Basic Science
  • Active immunization 
    • produce a host immune response to create memory
    • slow onset, long duration
    • types
      • natural
        • getting infected with a pathogen and recovering
      • artificial
        • vaccines
  • Passive immunization
    • produce transient protection without creating memory
    • fast onset, small duration
    • types
      • natural
        • mother to infant
          • placental IgG crossing into fetal circulation
          • colostrum
      • artificial
        • antivenom
        • antitoxins
        • pooled human Ig against viral strains
        • monoclonal antibodies
    • risks
      • type I hypersensitivity
        • anaphylaxis against introduced proteins
      • type III hypersensitivity
        • complex formation with introduced proteins and IgG/M and deposition
  • Adjuvants
    • ↑ immunogenicity of all antigens nonspecifically
    • given with vaccines
    • examples
      • aluminum potassium sulfate
        • ↑ persistence
      • muramyl dipeptide
        • ↑ costimulatory signals
      • LPS/polyribonucleotides
        • induce lymphocyte proliferation
Viral Vaccines
  • Attenuated (Live)
    • pros
      • high immunogenicity
        • involves both HMI & CMI
    • cons
      • may revert to active form
      • has a risk of causing infections in immunocompromised recipient
      • must be stored in correct conditions
      • high potential for contamination with other viruses
    • examples (MRS. V.Z. RAMPY)
      • mumps
      • rotavirus
      • small pox
      • varicella-zoster
      • rubella
      • adenovirus (unattenuated)
      • measles
      • polio (Sabine)
      • yellow fever
    • must be given after 12 months of age because passive immunity from mother would inhibit infant from creating memory
    • required for enveloped viruses
  • Killed
    • pros
      • cannot revert to active form
      • no risk of infecting immunocompromised recipient
      • no special storage conditions
    • cons
      • chance of contamination with other viruses
      • lower immunogenicity
    • examples (Rest IPeace Always)
      • rabies
      • influenza
      • polio (Salk)
      • hep A
    • most naked capsid viruses
  • Component
    • pros
      • cannot revert to active form
      • no risk of infecting immunocompromised recipient
      • no special storage conditions
      • no chance of contamination with other viruses
    • cons
      • moderate immunogenicity
    • examples
      • hep B
      • HPV
      • N. meningitidis
  • Recombinant
    • yeast engineered to produce bacterial component
    • examples
      • hep B
      • HPV
      • N. meningitidis 
Bacterial Vaccatination
  • DTaP
    • C. diptheriae
      • toxoid
    • C. tetani
      • toxoid
    • B. pertussis
      • toxoid + hemagglutinin
  • Hib
    • H. influenzae capular type b
      • polysaccharide and protein carrier
        • bound protein insures T-cell recognition and memory generation
        • from N. meningitidis or diptheria toxoid
  • PCV
    • S. pneumoniae
    • pediatric version
      • 7 capsule types + protein
        • like Hib, protein stimulates T-cells
      • think: a 7 year old gets PCV
  • PPV
    • S. pneumoniae
    • adult version
      • 23 capsular types
      • think: a 23 year old gets PPV
  • MCV
    • N. meningitidis
      • 4 capsule types
Precautions & Contraindications
  • Persons with egg allergies
    • yellow fever
  • Pregnant women
    • rubella
  • Immunocompromised
    • all live vaccines

References



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(M1.IM.78) A young man about to leave for his freshman year of college visits his physician in order to ensure that his immunizations are up-to-date. Because he is living in a college dormitory, his physician gives him a vaccine that prevents meningococcal disease. What type of vaccine did this patient likely receive? Topic Review Topic

1. Live, attenuated
2. Killed, inactivated
3. Toxoid
4. Conjugated polysaccharide
5. Killed, attenuated

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