Vaccines Rationale Successes Problems Nester 5 th edition Chapter 17th

Nester Chapter 17 Principles of Immunization Naturally acquired passive immunity Naturally acquired active immunity Artificially acquired passive immunity Artificially acquired active immunity

Principles of Immunization Antiserum –Serum containing antibodies Antitoxin –Serum protects against toxin Immune globulin –Passive immunization preparations contain gamma globulins IgG. Hyperimmune Globulins – Sra of donors with high amount of antibodies

Nester Chapter 17 Herd Immunity - the inability of an infectious disease to spread in a population because of the lack of a critical concentration of susceptible non-immune hosts. Vaccine - a preparation of attenuated or inactivated microorganisms or viruses or their components used to induce active specific immunity.

Herd Immunity Figure 2 Infectious Agent Active Immunization or Recovery from Natural Disease Non-Immune No disease Non-Immune Disease

Vaccines Attenuated vaccine agents –Either organisms or viruses that cause a sub-clinical or mild disease and that produce long lasting immunity. –Antigen is intact, may decrease circulation of wild type –Examples- mumps, measles, rubella, yellow fever and Sabin polio

Nester Chapter 17 Inactivated vaccine agents –Antigen is altered slightly to still produce immunity without the disease –Whole agents Killed micro-organism or inactivated virus Example- cholera, influenza, rabies and Salk vaccine –Toxoid Inactivated toxins Example- Diphtheria and tetanus

Inactivated vs. Attenuated Virus Vaccines Table 1 PropertyAttenuatedInactivated Route of Administration Injection, oral, or nasalInjection Dose of VirusLowHigh Number of DosesSingleMultiple Duration of ImmunityLong-termShort-term Antibody Immune ResponseIgG and IgAIgG Cell-mediated Immune ResponseGoodPoor Heat Lability in TropicsYesNo Reversion to VirulenceRarely, OPVNo CostLowHigh

Nester Chapter 17 Protein sub-unit vaccines –Key protein antigens or antigenic fragments –Examples- acellular pertussis (aP) Recombinant vaccines –Subunit vaccine produced by genetically engineered micoorganism –Example- Hepatitis B

Nester Chapter 17 Polysaccharide vaccines –composed of the polysaccharide that make up capsule –elicit a poor response Conjugate vaccine –improvement over purified – Haemophilus influenza type b and Streptococcus pneumonia

Nester Chapter 17 Adjuvant –Inactivated contain a substance that enhances the immune response to antigens –Currently approved in United States is alum (Aluminum hydroxide and aluminum phosphate)

Comparison of the Antibody Response to Inactivated and Attenuated Vaccines – Figure 1 Time in Days Anti bod y Lev els Serum IgG - Both Serum IgM - Both Nasal IgA m- Atten Serum IgA - Both Duodenal – IgA - Atten Nasal & Duodenal IgA - Inactivated

Nester Chapter 17 Text 17.1 Some important vaccines Text 17.3 Effectiveness of vaccines in US (20th Century) Text 17.4 Recommended schedule in the US (2000) Text 17.5 Diseases for which new vaccines are sought

Vaccines Rationale –To produce, without harm to the recipient, a degree of resistance sufficient to prevent a clinical attack of the natural infection Goals –To increase Herd Immunity –To help limit a present epidemic –To prevent a future epidemic

Pertussis Death Rate/Million Citizens by Century – Figure 3 Penicillin Vaccine Identification

Vaccines Properties of an Ideal Vaccine –Promotes effective immunity –Confers lifelong protection –Has no side effects –Is stable –Is affordable in price not quality –Is seen to be good and effective No vaccine is perfect; some are close.

Prevention Phases of vaccine testing –Phase I testing for safety ability to induce an immune response –Phase II determine optimum dose kinds and duration of responses –Phase III effectiveness

Vaccines Duration of immunity varies: –For different vaccines. –For different groups of people. –Since protection does not always relates to antibody level.

Vaccines Contraindications - Do not give: –Vaccines to someone with an acute disease or neurological disturbance. –Attenuated vaccines to pregnant women. –Vaccines in the first trimester of pregnancy. –Vaccines to people on immunosuppressive drugs or irradiation or with AIDS. –Vaccines made in eggs to people allergic to eggs.

Vaccines Hazards –Mild to moderate pain at the injection site –Fever and malaise for a day or two –Anaphylaxis - rare –Encephalopathy –Guillain-Barre syndrome –Epilepsy

Vaccines Hazards –Death from the vaccine viral strain –Aseptic meningitis –Demyelinating disease –Deafness –Sterility –Arthritis

Vaccines Safety considerations –Use a separate sterile syringe and needle –Avoid errors - check the vial –Consider patient’s history –Consider contraindications –Keep careful records

Virus Vaccine Types MMR – measles, mumps, rubella Polio Chickenpox Hepatitis A Hepatitis B

Measles Disease - Fig – cases/year - U.S. –Death 1-2/1000 up to 150/1000 (15%) –Secondary infections 85% –Encephalitis 1/2000 1/2 die; 1/2 lose a function –Pneumonia 1/20 - (5%) Vaccine –Encephalitis or severe allergic reaction 1/1,000,000 –Thrombocytopenia purpura 3/100,000 –Aseptic meningitis 1/11,000 (mumps) –Death is rare

Mumps Disease –0-2 cases per 100,000 in US –Hearing loss or deafness –Encephalitis –Pancreatitis –Aseptic meningitis 10% –¼ cases in post-pubertal males orchitis –1 in 20 post-pubertal females ovarian involvement pelvic pain Vaccine –Aseptic meningitis 2%

Rubella Disease – cases per 100,000 in US –Congenital rubella Blind Deaf Retarded Heart defects Vaccine –Arthralgia –Transient arthritis 2- 3 weeks –Knee joint arthritis may last 24 months –Same as MMR

Polio Disease –0 cases since 2000 from vaccine in US –Cases come from outside US –Paralytic death rate 1-2 % Vaccine –8 cases/yr –1 case/2,500,000 doses –Guillain-Barre

Chickenpox Disease –10-60,000 cases per year in US –50-90 deaths –Zoster 77/100,000 –Encephalitis –Pneumonia Vaccine –Zoster 18/100,000

Hepatitis A Disease –3-10 cases per 100,000 in US –Long convalescence period of about a month –11% hospitalized Vaccine –Mild or of no consequence –Same as placebo –Soreness and redness at inoculation site

Hepatitis B Disease –3-25 cases per 100,000 in US –Death 0.5-2% –Cirrhosis 4,000/yr. 25% die –Cancer 800/yr. –2-10% adult carriers –Infants 90% become carriers Vaccine –Autoimmune disease Lupus Rheumatoid arthritis

Bacterial Vaccine Types DPT –Diphtheria –Pertussis –Tetanus H. influenzae Pneumococcal pneumonia

Diphtheria Disease –0-5 cases a year in US –Death 1/20 –Heart –Kidney –Nervous system Vaccine –toxoid –Continuous crying then full recovery 1/100 –Guillain-Barre –Brachial neuritis –Anaphylaxis

Pertussis Disease – cases per 100,000 in US –Death 1/200 –Encephalitis 1/20 –Pneumonia 1/8 Vaccine –Acute encephalopathy 0-10 cases/1,000,000 immunizations –Acellular vaccine has far fewer side effects especially of the neurological types

Tetanus Disease –30-50 cases /yr. in US (97% non- vaccinated) –Mortality 30% in US –Mortality 50% or more worldwide Vaccine –toxoid –Convulsions then full recovery 1/1750 –Guillain-Barre –Brachial neuritis –Anaphylaxis

H. influenzae Disease –Age > 5: 0.5/100,000 –Age < 5: 2/100,000 –Death 3-7% neurological disease –Pneumonia - death 50% –Epiglottitis –Septic arthritis Vaccine –Reduced meningitis so much that S. pneumo has replaced H. influenzae –Juvenile diabetes is a side effect

Pneumococcal pneumonia Disease –Death 5-20% untreated –Resistance is a problem 1 state: >401 cases 10: : : rest Vaccine

Health People 2010