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Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
14
Vaccines and
Immunoglobulins
Immune System
• Rids foreign substances from blood and
lymph, combats infectious diseases,
maintains tissue fluid balance, absorbs
fats
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Lymphatic System
• Vessels: Network of lymphatic vessels
beginning in peripheral tissues and
ending at connections to the venous
system
• Fluid: Lymph flows through lymphatic
vessels
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Lymphatic System
• Lymphoid organs: Lymphoid organs are
connected to lymphatic vessels; contain
large numbers of lymphocytes
– Examples: lymph nodes, spleen, and
thymus
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Figure 14-1 The lymphatic system includes the tonsils, lymph nodes, spleen, and
lymphatic vessels. Within the lymph nodes are the macrophages and lymphocytes.
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Lymphatic System
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Lymphocytes
• Lymphocytes (white blood cells)
respond to:
– Invading pathogens, such as bacteria or
viruses
– Abnormal body cells, such as cancer cells
– Foreign proteins, such as toxins released
by some bacteria
• Lymphocytes produce special proteins
called antibodies.
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Three Classes of Lymphocytes
• T cells (thymus-dependent): attack
foreign cells or body cells infected by
viruses
• B cells (bone marrow–derived): can
differentiate into plasma cells, which
are responsible for the production and
secretion of antibodies
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Three Classes of Lymphocytes
• NK cells (natural killers): attack foreign
cells, normal cells infected with viruses,
and cancer cells that appear in normal
tissue
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Immunity
• State or condition of being resistant to
invading microorganisms
• Normally acquired either by contracting
a disease and then developing
immunity to it, or by being vaccinated
with proteins from the causative agent
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Cell-mediated Immunity
• T lymphocytes are sensitized by first
contact with a specific antigen.
• T cells and macrophages (immune cells
derived from monocytes) destroy
antigen.
• T cells attack antigens directly, rather
than produce antibodies.
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Cell-mediated Immunity
• If cell-mediated immunity is lost, as in
AIDS, the body is unable to protect
itself against many viral, bacterial, and
fungal infections.
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Humoral Immunity
• B cells produce circulating antibodies to
act against an antigen.
• B cells form daughter lymphocytes,
which develop into plasma cells that
produce antibodies and release them
into the circulation at the lymph nodes.
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Humoral Immunity
• Some activated B cells turn into
memory cells, which continue to
produce small amounts of antibody
after infection is overcome.
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Active Immunity
• A form of acquired immunity that
develops in an individual in response to
an immunogen (antigen).
• May be naturally acquired by exposure
to an infectious disease or artificially
acquired by receiving active
immunizing agents (vaccines).
• Vaccination is active immunization.
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Passive Immunity
• Effectors of immunity, which are called
immunoglobulins or antibodies, are
transferred from immune individual to
another.
• Immunoglobulin G (IgG) antibodies
transfer from mother to fetus across
placental barrier.
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Passive Immunity
• Onset of passive immunity is quicker
but of shorter duration than active
immunity.
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Figure 14-2
Types of immunity.
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Immunizing Agents
• A vaccine is a preparation of killed
microorganisms, living attenuated
(reduced virulence) organisms, or living
virulent organisms that are
administered to produce or artificially
increase immunity to a particular
disease.
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Active Versus Passive Agents
• Active: usually administered to patients
prior to disease exposure to provide
long-term, even permanent, protection
against the diseases
• Passive: older than active agents;
comprised various antitoxins derived
from animals; had problems in efficacy
and safety
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Vaccines
• Most bacterial vaccines contain killed
bacteria or their components.
• Another type of vaccine contains
toxoids (protein toxins that have been
modified to reduce their hazardous
properties without significantly altering
their antigenic properties); oldest of
these are diphtheria and tetanus
toxoid.
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Table 14-1
Bacterial Vaccines
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Table 14-1 (continued) Bacterial Vaccines
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Table 14-2
Inactivated Virus Vaccines
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Vaccines: Mechanism of Action
• Exposure to an antigen (a virus or
bacterium) in a relatively harmless
form sensitizes immune cells.
• On reexposure, memory of previous
challenge triggers an immune response
more quickly.
• As immune processes are stimulated by
this agent, active immunity occurs.
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Vaccines: Use
• Used against bacterial infections:
diphtheria, tetanus, pertussis,
pneumonia, tuberculosis, typhoid,
cholera, meningitis, plague, and Q
fever.
• Used against viral infections: measles,
mumps, rubella (MMR), poliomyelitis,
hepatitis A and B, influenza, rabies, and
yellow fever.
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Vaccines: Adverse Effects
• Common: localized inflammation at
injection site, mild fever, headache,
malaise, nausea, dizziness
• Serious: convulsions resulting in brain
damage; allergic reactions that could
lead to anaphylactic shock
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Vaccines: Contraindications
• Avoid in acute febrile illness,
pregnancy, lactation, and in those who
are known to have developed
anaphylactoid reactions with previous
vaccines.
• Interactions: chance increases when
multiple vaccines are given
simultaneously
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Vaccines: Patient Teaching
• Instruct patients to report severe
reaction at injection site.
• Advise patients to seek immediate
medical care for difficult breathing, high
fever, convulsions, or extreme fatigue.
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Standards for
Childhood Immunization
• Childhood immunization remains one of
the most important public health
measures.
• Children should be immunized against
8 infectious diseases, hepatitis A (in
areas of high incidence), and human
papillomavirus (girls aged 10 to 11).
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Routine Immunization
Reduces Disease
• Immunization for diphtheria, tetanus,
and pertussis (DTP) has been routinely
given in the US since the late 1940s,
resulting in dramatic decrease in
incidence of these diseases.
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Childhood Vaccines
• Meningitis caused by Hemophilus
influenzae type b: (HibTiter,
PedvaxHIB)
• Polio: Salk inactivated vaccine (IPV,
IPOL) and Sabin live vaccine (note: the
live oral vaccine is no longer used in
the United States)
• Measles, mumps, and rubella: (MMR
vaccine)
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Childhood Vaccines
• Hepatitis B infection: (Energix B,
Heptava B vaccine) and hepatitis B
immunoglobulin
• Varicella (chickenpox): (Varivax)
• Hepatitis A: (Havrix, VAQTA)
• Human papillomavirus (HPV):
(Gardasil)
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Routine Immunization for
Adults Younger than Age 65
• Immunization recommended for adults
from ages 18 to 65 years is booster
(dose given to increase the
effectiveness of the original medication)
of adult diphtheria and tetanus toxoid
every 10 years.
• New vaccine for shingles (Zostavax)
now recommended for adults 60 and
older.
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Circumstances That Require
Adult Booster Immunization
• Pediatric immunizations should be
updated for those:
– Who travel internationally
– Women of child-bearing age who may
become pregnant
– With chronic illnesses
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Other Adult Immunizations
• Annual influenza immunization
(Fluzone, FluShield): recommended for
those at risk for influenza complications
• Pneumococcal vaccine (Pneumovax 23,
Pnu-Immune 23): for people with any
major immunosuppression condition,
pulmonary or cardiovascular diseases,
chronic hepatic or renal disorders, and
diabetes mellitus
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International Adult
Immunizations
• International Certificate of Vaccination
may be required for:
– Yellow fever
– Hepatitis A (Havrix, VAQTA)
• Cholera, typhoid, and plague vaccines
may occasionally be suggested
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Other Adult Immunizations
• Hepatitis B vaccine (Energix B,
Heptavax B): for health-care workers
with exposure to human blood and
tissues
• BCG vaccine: for extremely high-risk
individuals
– BCG vaccine also used to treat bladder
cancer
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Immunization Standards
for Adults Older than Age 65
• Boosters of diphtheria and tetanus
toxoid every 10 years
• Booster of pneumococcal vaccine
(Pneumovax 23, Pnu-Immune 23):
those at highest risk for fatal
pneumococcal disease every 5 years
after initial dose
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Influenza and Pneumonia
Immunization
• All individuals 65 and older should
receive:
– Annual influenza immunization
– A single dose of pneumococcal vaccine
• Individuals who received pneumococcal
vaccine prior to age 65 should receive a
booster dose if 5 years have passed
since first dose.
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Immunoglobulins (Ig)
• Derived from human plasma containing
antibodies that have been formed by
the body to specific antigens
• Two types: one administered
intramuscularly and one administered
intravenously
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Immunoglobulins: Use
• Passive prevention or modification of
hepatitis A and measles in susceptible
persons (HIV positive)
• Prevention of varicella in
immunocompromised patients if
varicella-zoster immunoglobulin is not
available
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Immunoglobulins: Use
• Prevention of fetal damage in women
exposed to rubella during first trimester
of pregnancy
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Immunoglobulins:
Adverse Effects
• Common: local pain and tenderness at
injection site
• Serious: anaphylactic reactions can
occur
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Immunoglobulins:
Contraindications
• IGIM must not be injected
intravenously because it can cause
serious anaphylactic reactions.
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