Download TABLE 3.1. Antigen Recognition by B and T Cells

T A B L E 3.1. Antigen Recognition by B and T Cells
Characteristic
Antigen interaction
Nature of antigens
Binding soluble antigens
Epitopes recognized
B cells
T cells
B-cell receptor (membrane
Ig) binds Ag
Protein, polysaccharide,
lipid
Yes
Accessible, sequential, or
nonsequential
T-cell receptor binds Ag ⫹ MHC
Peptide
No
Internal linear peptides produced
by antigen processing
(proteolytic degradation)
T A B L E 4.1. The Most Important Features of Immunoglobulin Isotopes
Isotype
IgG
Molecular weight
150,000
Additional protein subunits
Approximate concentration in
serum (mg/ml)
Percent of total Ig
Distribution
—
12
Half-life (days)
Placental passage
Presence in secretion
Presence in milk
Activation of complement
Binding to Fc receptors on
macrophages,
polymorphonuclear
cells, and NK1 cells
Relative agglutinating
capacity
Antiviral activity
Antibacterial activity (gramnegative)
Antitoxin activity
Allergic activity
1
Natural killer.
IgA
IgM
IgD
IgE
160,000 for
monomer
J and S
1.8
900,000
180,000
200,000
J
1
—
0–0.04
—
0.00002
0.002
On basophils and mast
cells present in saliva
and nasal secretions
2.0
—
—
—
—
—
80
⬃Equal:
intravascular and
extravascular
23
⫹⫹
—
⫹
⫹
⫹⫹
13
Intravascular and
secretions
6
Mostly
intravascular
5.5
—
⫹⫹
⫹
—
—
5
—
—
0 to trace
⫹⫹⫹
—
0.2
Present on
lymphocyte
surface
2.8
—
—
—
—
—
⫹
⫹⫹
⫹⫹⫹
—
—
⫹⫹⫹
⫹⫹⫹
⫹⫹⫹
⫹⫹ (with
lysozyme)
—
—
⫹
⫹⫹⫹ (with
complement)
—
—
—
—
—
—
—
—
—
⫹⫹
⫹⫹⫹
—
T A B L E 4.2. Important Differences Between Human IgG Subclasses
IgG1
Occurrence (% of total IgG)
Half-life
Complement binding
Placental passage
Binding of monocytes
70
23
⫹
⫹⫹
⫹⫹⫹
IgG2
20
23
⫹
⫾
⫹
IgG3
IgG
7
7
⫹⫹⫹
⫹⫹
⫹⫹⫹
3
23
—
⫹⫹
⫾
T A B L E 8.1. Association of Diseases and HLA Types
Disease
HLA molecule
Rheumatoid arthritis
Multiple sclerosis
Myasthenia gravis
Celiac disease
Insulin-dependent diabetes mellitus
Ankylosing spondylitis
Reiter’s disease
Narcolepsy
DR4
DR2
DR3
DR3, DR7
DR3 and DR4
B27
B27
DR2
T A B L E 8.2. Comparison of the Properties and Function of MHC Class I and Class II
Molecules
MHC class I
MHC class II
Structure
Domains
Constitutive cellular
expression
␣ chain ⫹ ␤2m
␣1, ␣2 and ␣3 ⫹ ␤2m
Nearly all nucleated cells
Peptide binding groove
Closed, binds 8–9 amino
acid peptides formed
by ␣1 and ␣2 domains
Endogenous antigens,
catabolized in the
cytoplasm
CD8⫹ T cells
␣ and ␤
␣1 ⫹ ␣2 and ␤1 ⫹ ␤2
Antigen presenting cells (B cells,
dendritic cells, thymic
epithelial cells)
Open, binds 12–20 amino acid
peptides formed by ␣1 and ␤1
domains
Exogenous antigens, catabolized
in acid compartments
Peptides derived from
Peptide presented to
CD4⫹ T cells
T A B L E 10.1. The Synthesis of Cytokines by the TH1
and TH 2 Subsets of CD4⫹
Cytokine
IL-2
IFN-␥
TNF-␤ (lymphotoxin)
IL-4
IL-5
IL-6
IL-10
IL-13
IL-3
GM-CSF
TH1
TH2
⫹
⫹
⫹
–
–
– (⫹)
– (⫹)
– (⫹)
⫹
⫹
–
–
–
⫹
⫹
⫹ (⫹⫹)
⫹ (⫹⫹)
⫹ (⫹⫹)
⫹
⫹
The pluses in parentheses indicate that in humans IL-6, IL-10,
and IL-13 are also made by TH1 cells, but at lower levels than
by TH2 cells.
T A B L E 12.1. Selected Cytokines and Their Functions
Cytokine
Produced by
Interleukin-1 (IL-1)
Monocytes, many other
cell types
Interleukin-2 (IL-2)
Interleukin-3 (IL-3)
TH0 and TH1 cells
TH cells, NK cells, mast
cells
TH2, CD4⫹ T cells, mast
cells
Interleukin-4 (IL-4)
Interleukin-5 (IL-5)
TH2 cells, mast cells
Interleukin-6 (IL-6)
T cells and many others
Interleukin-7 (IL-7)
Interleukin-11 (IL-11)
Bone marrow and thymic
stromal cells, some T
cells
T cells
TH2 cells and
macrophages
Fibroblasts
Interleukin-12 (IL-12)
B cells and macrophages
Interleukin-13 (IL-13)
T cells
Interleukin-14 (IL-14)
T cells
Interleukin-15 (IL-15)
Interferon-gamma (IFN-␥)
T cells and epithelial cells
TH1 cells
Transforming growth factor
␤ (TGF-␤)
TNF-␣
Lymphocytes,
macrophages, platelets,
mast cells
Macrophages, mast cells
TNF-␤ (lymphotoxin)
T cells
Granulocyte-monocytestimulating factor (GMCSF)
Macrophage-stimulating
factor (M-CSF)
Granulocyte-stimulating
factor (G-CSF)
T cells and monocytes
Interleukin-9 (IL-9)
Interleukin-10 (IL-10)
Major functions
Produces fever, stimulates acute-phase protein
synthesis, promotes proliferation of TH2
cells
T cell growth factor
Growth factor for hematopoietic cells
Growth factor for B cells and TH2 CD4⫹ T
cells, promotes IgE and IgG, synthesis;
inhibits TH1 CD4⫹ T cells
Stimulates B-cell growth and Ig secretion;
growth and differentiation factor for
eosinophils
Induces acute-phase protein synthesis, T-cell
activation, and IL-2 production; stimulates
B-cell Ig production and hematopoietic
progenitor cell growth
Growth factor for pre-T and pre-B cells
T cells and monocytes
Mast-cell activation
Inhibits production of TH1 cells and
macrophage function
Stimulates megakaryocyte (platelet precursor)
growth
Activates NK cells and promotes generation of
TH1 CD4⫹ T cells
Shares characteristics with IL-4 such as Ig
switch to IgE synthesis, but does not affect
T cells; growth factor for human B cells
Involved in the development of memory B
cells
T-cell growth factor, similar to IL-2
Activates NK cells, macrophages, and NK
cells; inhibits TH2 CD4⫹ T cells; induces
expression of MHC class II on many cell
types
Enhances production of IgA; inhibits activation
of monocyte and T-cell subsets; active in
fibroblast growth and wound healing
Involved in inflammatory responses; activates
endothelial cells and other cells of immune
and nonimmune systems; induces fever and
septic shock
Involved in inflammatory responses; also plays
a role in killing target cells by cytotoxic
CD8⫹ T cells
Promotes growth of granulocytes and
macrophages; growth of dendritic cells in
vitro
Promotes macrophage growth
T cells and monocytes
Promotes granulocyte growth
T A B L E 12.2. Selected Chemokines and Their Functions
Chemokine
Interleukin-8 (IL-8)
Regulated on activation normal
T cell expressed and secreted
(RANTES)
Monocyte chemotactic protein-1
(MCP-1)
Macrophage inflammatory
protein-1␣ (MIP-1␣)
Macrophage inflammatory
protein-1␤, (MIP-1␤)
Produced by
Monocytes, macrophages,
fibroblasts, keratinocytes,
endothelial cells
T cells, endothelial cells, platelets
Chemoattracted cells
Attracts neutrophils, naive T cells
Attracts monocytes, NK and T cells,
basophils, eosinophils
Monocytes, macrophages,
fibroblasts, keratinocytes
Attracts monocytes, NK and T cells,
basophils, and dendritic cells
Monocytes, macrophages, T cells,
mast cells, fibroblasts
Monocytes, macrophages,
neutrophils, endothelium
Attracts monocytes, NK and T cells,
basophils, and dendritic cells
Attracts monocytes, NK and T cells,
and dendritic cells
Major functions
Mobilizes and activates
neutrophils; promotes
angiogenesis
Degranulates basophils, activates T
cells
Activates macrophages, stimulates
basophil histamine release,
promotes TH2 immunity
Promotes TH1 immunity, competes
with HIV-1
Competes with HIV-1 for
chemokine receptor binding
T A B L E 13.1. Components of the Human Complement System
Component symbol
C1q
C1r
C1s
C2
C4
C3
C5
C6
C7
C8
C9
MBL (mannan-binding
lectin)
MASP1
MASP2
C3b or C3 ⭈ H2O
D (factor D)
B (factor B)
P (properdin)
C1-inhibitor
Factor I (I, C3b-Ina,
KAF)
H (factor H, ␤1H)
C4-binding protein
CFI (CPB-N)
SP40,40
S (vitronectin)
C4a
C4d
C3a
iC3b
C5a
Bb
SC5b-9 TCC
Concentration
in plasma
(␮g/ml)
Molecular
weight
(dalton)
180
462,000
100
110
25
640
1200
80
75
55
80
50
0.1–5
92,000
86,000
117,000
206,000
185,000
180,000
120,000
110,000
163,000
71,000
540,000
ND
ND
Trace
2
200
25
25
35
94,000
90,000
170,000
25,000
93,000
220,000
110,000
88,000
500
250
35
50
500
1.6
8.9
0.6
8.5
0.01
0.4
0.3
150,000
550,000
310,000
80,000
83,000
12,000
30,000
11,000
170,000
11,000
60,000
>1,000,000
Number of
chains in
native
form
18 (6 ea A,
B, C)
1
1
1
3
2
2
1
1
3
1
18
1
1
2
1
1
1
1
1
7
1
1
1
Associated
pathway*
Enzymatic
activity
CP
No
CP
CP
CP, MBL
CP, MBL
CP, MBL, AP
Terminal
Terminal
Terminal
Terminal
Terminal
MBL
Yes
Yes
Yes
Cofactor
Cofactor
Cofactor
Yes?
No
No
No
No
MBL
MBL
AP
AP
AP
AP
CP control
Control, all
pathways
AP control
CP control
Control
Terminal control
Terminal control
CP split prod.
CP split prod.
TP split prod.
TP split prod.
TP split prod.
AP split prod.
Terminal C
complex
Yes
Yes
Cofactor
Yes
Yes
No
No
Yes
*CP, classical pathway; MBL, mannose-binding lectin pathway; AP, alternate pathway; TP, terminal pathway.
Cofactor
Cofactor
Yes
No
No
No
No
No
No
No
No
No
T A B L E 13.2. Substances That Activate Human Complement
Substance
Antigen–antibody complexes
␤ Amyloid (Alzheimer’s plaques)
DNA, polyinosinic acid
Polyanion–polycation complexes (heparin–protamine)
C-reactive protein complexes
Enveloped viruses (some)
Monosodium urate crystals
Lipid A of bacterial lipopolysaccharide
Plicatic acid (from Western red cedar)
Ant venom polysaccharide
Mannose-rich bacterial cell walls, etc.
Inulin
Yeast cell walls (zymosan)
Sephadex
Endotoxin (bacterial lipopolysaccharide)
Rabbit erythrocytes
Desialylated human erythrocytes
Cobra venom factor (CVF)
Phosphorothioate backbone oligonucleotides
Aggregated immunoglobulins
Subcellular membranes (mitochondria)
Cell- and plasma-derived enzymes
Plasmin, kallikrein
Activated Hageman factor (XII)
Neutrophil elastase, cathepsins
C Pathway activated
Classical
Classical
Classical
Classical
Classical
Classical
Classical
Classical
Classical
Classical
MBL
Alternative
Alternative
Alternative
Alternative
Alternative
Alternative
Alternative
Alternative
Classical and alternative
Classical and alternative
Classical, alternative, terminal
T A B L E 16.1. Cytokines Involved in DTH Reactions
Functional effects1
Cytokine
IFN-␥
Chemokines
MCP-1
RANTES
MIP-1␣
MIP-1␤
TNF-␣
TNF-␤
1
Activates macrophages to release inflammatory mediators
Recruit macrophages and monocytes to the site
Causes local tissue damage
Increases expression of adhesion molecules on blood vessels
Additional functional effects are described in Chapter 12.
T A B L E 18.1. The Major Levels of Immune Disorders
Disorder
Deficiency
B-lymphocyte deficiency—deficiency in
antibody-mediated immunity
T-lymphocyte deficiency—deficiency in
cell-mediated immunity
T- and B-lymphocyte deficiency—
combined deficiency of antibody- and
cell-mediated immunity
Phagocytic cell deficiency
NK cell deficiency
Complement component deficiency
Unregulated excess
B lymphocytes
T lymphocytes
Complement components
Associated disease
Recurrent bacterial infections, e.g., otitis
media, recurrent pneumonia
Increased susceptibility to viral, fungal,
and protozoal infections.
Acute and chronic infections with viral,
bacterial, fungal, and protozoal
organisms
Systemic infections with bacteria of
usually low virulence; infections with
pyogenic bacteria; impaired pus
formation and wound healing
Viral infections, associated with several
T-cell disorders and X-linked
lymphoproliferative symptoms
Bacterial infections; autoimmunity
Monoclonal gammopathies; other B-cell
malignancies
T-cell malignancies
Angioneurotic edema due to absence of
C1 esterase inhibitor
T A B L E 18.2. AIDS-Associated Diseases Defined by CDC
Infections—frequently disseminated
Fungal
Pneumocystis
Candidiasis
Cryptococcosis
Histoplasmosis
Coccidioidomycosis
Parasitic
Toxoplasmosis
Cryptosporidiosis
Microsporidiosis
Leishmaniasis
Bacterial
Mycobacteriosis, including ‘‘atypical’’ Salmonella
Viral
Cytomegalovirus
Herpes simplex virus
Varicella zoster virus
Neoplasms
Sarcoma
Kaposi’s sarcoma
Lymphoma
Burkitt’s lymphoma
Diffuse large B-cell lymphoma
Effusion based lymphoma
Primary CNS lymphoma
Cancer
Invasive cancer of the uterine cervix
T A B L E 18.3. World Health Organization Classification for Lymphoid Neoplasms
B-cell neoplasms
Precursor B-cell lymphoblastic leukemia/lymphoma
Mature B-cell neoplasms
Chronic lymphocytic leukemia/small lymphocytic lymphoma/prolymphocytic leukemia
Follicular lymphoma
Mantle cell lymphoma
Marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type
Nodal marginal zone lymphoma
Splenic marginal zone lymphoma
Hairy cell leukemia
Diffuse large B-cell lymphoma (including subtypes: mediastinal, primary effusion,
intravascular)
Burkitt’s lymphoma
Plasmacytoma
Plasma cell myeloma
Lymphoplasmacytic lymphoma
T-cell neoplasms
Precursor T-cell lymphoblastic leukemia/lymphoma
Mature T/NK cell neoplasms (selected)
T-cell large granular lymphocytic leukemia
NK cell leukemia
Peripheral T-cell lymphoma (unspecified)
Mycosis fungoides
Sézary syndrome
Primary cutaneous anaplastic large cell lymphoma
Systemic anaplastic large cell lymphoma
Extranodal NK/T-cell lymphoma, nasal type
Intestinal T-cell lymphoma
Hepatosplenic ␥␦ T-cell lymphoma
Adult T-cell leukemia/lymphoma
Hodgkin’s lymphoma
Nodular lymphocyte predominant Hodgkin’s lymphoma
Classical Hodgkin’s lymphoma
Nodular sclerosis
Mixed cellularity
Classical, lymphocyte-rich
Lymphocyte-depleted
T A B L E 19.1. Transplantation of Specific Organs and Tissues
Organ/Tissue
Clinical uses
Skin
Burns, chronic wounds, diabetic ulcers,
venous ulcers
Kidney
End-stage renal failure
Liver
Hepatoma and biliary atresia
Heart
Cardiac failure
Lung
Advanced pulmonary or cardiopulmonary
diseases
Incurable leukemias and lymphomas,
congenital immunodeficiency diseases
Bone marrow
Cornea
Blindness
Pancreas
Diabetes mellitus
Comments
Commonly autologous grafts; increasing
use of artificial skin consisting of
stromal elements and cultured cells of
allogeneic or xenogeneic origin
Graft survival now exceeds 85% at one
year even with organs from unrelated
donors.
Successful in about two-thirds of
recipients at 1 year.
Survival rates in excess of 80% at 1
year.
Sometimes performed together with heart
transplantation
Risk of GVHD a unique feature of bone
marrow transplantation; increasingly,
transplantation of hematopoietic stem
cells being used.
HLA matching not advantageous since
this is a ‘‘privileged’’ site that
normally lacks lymphatic drainage.
Pancreas and kidney transplantation
sometimes performed together.
Success rates approaching that seen
with kidney transplants.
T A B L E 19.2. Cases of Mixed Lymphocyte Reaction Associated With Different Transplantation Situations
Transplantation
situation
HLA
relationship
Treatment of reacting
leukocytes
MLR
Tissue between
identical twins
HLA
identical
(syngeneic)
No treatment
(⫺) No reaction
Tissue between
nonrelated donor
and recipient
HLA different
(allogeneic)
No treatment
(⫹) Reaction intensity
depends on the degree of
HLA difference between
donor and recipient
Tissue between
nonrelated donor
and recipient
HLA different
(allogeneic)
Donor’s cells are treated
with a mitotic inhibitor,
thus testing reactivity of
only recipient cells
(performed to test for
donor–recipient match)
(⫹) This is a one-way
MLR; reaction intensity
depends on the degree of
HLA difference between
donor and recipient
Bone marrow
transplantation, or
tissue grafting to an
immunoincompetent
recipient
HLA different
(allogeneic)
Recipient’s cells are treated
with a mitotic inhibitor,
thus testing reactivity of
only donor’s cells
(performed to avoid
graft-versus-host reaction)
(⫹) This is a one-way
MLR; reaction intensity
depends on the degree of
HLA difference between
donor and recipient
T A B L E 19.3. Standard and Experimental*
Immunosuppressive Drugs Used in Transplantation
Inhibitors of lymphocyte gene
expression
Inhibitors of cytokine signal
transduction
Inhibitors of nucleotide
synthesis
Corticosteroids
Cyclosporine
(Neoral)
FK-506
Anti-CD25*
Rapamycin*
Leflunomide*
Azathioprine (Imuran)
Mercaptopurine
Chlorambucil
Cyclophosphamide
T A B L E 19.4. Possible Side Effects of the Major Immunosuppressive
Agents
Immunosuppressive agent
Cyclosporin A (Neoral)
Azathiaprine (Imuran)
Prednisone
Possible side effects
Decreases kidney and liver function
Trembling and shaking of the hands
High blood pressure
Tingling in extremities
Seizures
Decreases white blood count
Nausea/vomiting
Unusual bleeding or bruising
Nausea/vomiting
Weight gain
Bruising
Restlessness, insomnia
Mood changes, depression
Muscle weakness
Osteoporosis
Diabetes
T A B L E 20.1. Categories of Tumor Antigens
Category
Normal cellular
gene
products
Type of antigen
Embryonic
Oncofetal antigens
Name of antigen
MAGE-1
MAGE-2
CEA
AFP
Differentiation
Clonal amplification
Mutant cellular
gene
products
Viral gene
products
Point mutations
Transforming viral
gene
Normal intracellular
enzymes
Oncoprotein
PSA
Tyrosinase
HER-2/neu
Carbohydrate
Immunoglobulin
idiotype
Oncogene product
Suppressor gene
product
Cycline-dependent
kinase (CDK)
Nuclear proteins
Lewis
Specific antibody of B
cell clone
Mutant RAS proteins
Mutant p53
Types of cancer
Several
Several
Lung
Pancreas
Breast
Colon
Stomach
Liver
Testis
Prostate
Melanoma
Breast
Ovary
Lymphoma
Lymphoma
Several
Several
Mutant CDK-4
Melanoma
E6 and E7 proteins of
HPV
Cervical
T A B L E 20.2. Malignant Neoplasms With an Increased Incidence in
Immunodeficiency Patients
Type of
immunodeficiency
Primary (congenital)
Secondary drug-induced
AIDS
Cancer
Associated virus
Hepatocellular carcinoma
B-cell lymphoma
B-cell lymphoma
Squamous cell carcinoma (skin)
Hepatocellular carcinoma
Cervical carcinoma
Cellular carcinoma
Cloagenic or oral carcinoma
B-cell lymphoma
HBV
EBV
EBV
HPV
HBV
HPV
HBV
HPV
EBV
EBV, Epstein-Barr virus; HBV, hepatitis B virus; HPV, human papilloma virus; UV, ultraviolet light.
T A B L E 20.3. Effector Mechanisms in Cancer Immunity
Effector mechanism
Antibodies and B cells (complement-mediated
lysis, opsonization)
T cells (cytolysis, apoptosis)
NK cells (cytolysis, ADCC, apoptosis)
Lymphokine-activated killer (LAK) cells
(cytolysis, apoptosis)
Macrophages and neutrophils (cytostasis,
cytolysis, phagocytosis)
Cytokines (apoptosis, recruitment of
inflammatory cells)
Comments
Role in tumor immunity poorly understood
Critical for rejection of virally and chemically-induced
tumors
Tumor cells not expressing one of the MHC class I
alleles are effectively rejected by NK cells
Antitumor responses seen in certain human cancers
following adoptive transfer of LAK cells
Can be activated by bacterial products to destroy or
inhibit tumor cell growth
Growth inhibition can occur using adoptively
transferred tumor cells transfected with certain
cytokines (e.g., G-CSF)
T A B L E 20.4. Mechanisms of Tumor Escape from Immunologic Destruction
Tumor-related
Failure of the tumor to provide a suitable target
(a) Lack of antigenic epitope
(b) Lack of MHC class I molecule
(c) Deficient antigen processing by tumor cell
(d) Antigenic modulation
(e) Antigenic masking of the tumor
(f) Resistance of tumor cell to tumoricidal effector pathway
Failure of the tumor to induce an effective immune response
(a) Lack of antigenic epitope
(b) Decreased MHC or antigen expression by the tumor
(c) Lack of costimulatory signal
(d) Production of inhibitory substances (e.g., cytokines) by the tumor
(e) Shedding of antigen and tolerance induction
(f) Induction of T-cell signaling defects by tumor burden
Host-related
Failure of the host to respond to an antigenic tumor
(a) Immune suppression or deficiency of host including apoptosis and
signaling defects of T cells due to carcinogen (physical, chemical),
infections, or age.
(b) Deficient presentation of tumor antigens by host antigen-presenting
cells
(c) Failure of host effectors to reach the tumor (e.g., stromal barrier)
(d) Failure of host to kill variant tumor cells because of
immunodominant antigens on parental tumor cells
T A B L E 21.1. Protection of Humans by Diphtheria
Antitoxin Given on Indicated Day of Disease
Day
1
2
3
4
5 (or later)
Number of cases
Fatality rate
225
1,445
1,600
1,276
1,645
9
4.2
11.1
17.3
18.7
From Pappenheimer AM Jr (1965): The diphtheria bacilli and the
dipththeroid. In Dubos RJ, Hirsch JG (eds): Bacterial and Mycotic
Infections of Man, 4th ed. Philadelphia: Lippincott, with permission.
T A B L E 21.2. Examples of Active and Passive Immunization
Type of immunity
Active
Natural (unintended)
Artificial (deliberate)
Passive
Natural
Artificial
How acquired
Infection
Vaccination
Transfer of antibody from mother to infant in placental
circulation or colostrum
Passive antibody therapy (serum therapy,
administration of immune human globulin)
T A B L E 21.3. Schedule for Active Immunization of Children and Adults
Age
Birth
1–2 months
2 months
4 months
6 months
12–15
months
4–6 years
11–12 years
25–64 years
>65 years
Vaccine
Hepatitis B (Hep B)
Hep B
Diphtheria and tetanus toxoids and acellular pertussis (DTP),
Haemophilus influenzae type b (Hib), inactivated polio (IPV)
DTP, Hib, IPV, rotavirus (Rv)
Hep B, DTP, Hib, IPV, Rv
Oral poliovirus vaccine (OPV), measles, mumps, rubella (MMR),
varicella vaccine for susceptible children
DTP, OPV, MMR
Hep B, MMR, varicella
Measles, rubella
Influenza, pneumococcal disease
Adapted from JAMA, Vol 281:601–603, with permission.
T A B L E 21.4. Selective Use of Vaccines Under Limited Circumstances
Occupational or other exposure
Susceptible health-care personnel,
homosexual males, intravenous drug
users
Susceptible health-care personnel
Health-care personnel in close contact
with tuberculosis patients
Veterinarians, animal handlers, and
animal bite victims
Handlers of imported animal hides,
furs, bonemeal, wool, and animal
bristles
Military personnel
Includes individuals who live and work
in grassy and wooded regions
containing ticks infected with
Borrelia burgdorferi
Travelers to certain areas
Vaccine
Hepatitis B
Measles, mumps, influenza, varicella,
rubella
BCG
Rabies
Anthrax
Meningococcus, yellow fever,
anthrax
Lyme
Meningococcus, yellow fever,
cholera, typhoid fever, plague,
Japanese B encephalitis, polio
T A B L E 21.5. Levels of Immunoglobulin in Colostruma
Day postpartum
Class
1
2
3
4
Approximate
normal adult
IgAb
IgGc
IgM
600
80
125
260
45
65
200
30
58
80
16
30
200
1,000
120
a
After Michael JR, Ringenback R, Hottenstein S. (1971): J Infect Dis 124:445.
80% of this is secretory IgA.
c
IgG4 represents 15% of colostral IgG and 3.5% of serum IgG.
b
T A B L E 21.6. Comparison of Human Immune Serum Globulin
Immunoglobulin (mg/100 ml)
Source
Whole serum
Immune serum globulin
Intravenous immunoglobulin
Placental immune serum globulin
IgG
IgA
IgM
1,200
16,500
3000–5,000
16,500
180
100–500
trace
200–700
200
25–200
trace
150–400