Download Vaccines and Immunizations

Vaccines and
Immunizations
Sidelsky
2007
Immunization
The induction of artifical immunity
by giving preformed antibodies
( immunoglobulins)
• Administration of an antigen ( active
Immunization)
•
Immunity and immunoglobulins
Non Specific - collected from pooled
serum of a high titer
 Effective for short duration( 1-4
months)
 Broken down in protein catabolism and
recycled
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Vaccines
Vaccines contain an antigen to which the
immune system responds
 Vaccines contain weakened or
attenuated viruses or organisms,
inactivated organisms
 Portions of organisms
 Toxoids which are inactivated toxins
that are antigenic, but not harmful
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Mechanism of response
Upon administration of the vaccine
 The immune system reacts to it as
“ foreign”
The response is a weaker version of the one that
would occur in the face of the actual pathogen
The response of the immune system determines the
efficacy of the immunzation and the extent of the
immunity provided
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Boosters
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Required to sustain immunity
The first dose evokes a primary immune
response
The subsequent doses help to stimulate a
secondary immune response
This increases the length of time that
antibodies are present to prevent disease
May also affect the strength of response to
the organism if the individual is exposed
Type of vaccine
The route of administration of a disease
can affect the quality of immunity
 Comparable to the injection of vaccines
into muscle, the response is more
effective if the vaccine is administered
through its normal route of entry
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DTaP
Diptheria, Tetanus, and acellular
Pertussis
 Replaced old DTP
 Safer to administer
 Made by pruifying toxins as well as
proteins
 These are inactivated by formaldehyde
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Protection and side effects
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The DTaP protects vaccine protects against,
Diptheria, Tetanus, and Pertussis
Pertussis is the most problematic aspect of
the disease
Protects agains “ whooping cough”
Hooping cough is an upper respiratory
infection that is caused by Bordatella
pertussis
Whooping Cough ( continued)
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The old vaccine caused fever, redness, at the
injection site, malaise.
Crying persistently was also a side effect
Seizures were observed in some
In Japan they stopped administration of the
vaccine.
A the time they stopped there wer 400 cases
a year, this increased to 13.000 with much
higher mortality
Diptheria
Diptheria is caused by an organism
called Cornybacterium diptheriae
 The disease itself is caused by a toxin
 The toxin causes the formation of a
membrane across the back of the
throat making it difficult to breath
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Diptheria
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Early stages: Sore throat. Low fever.
Swollen neck glands.
Late stages: Airway obstruction and
breathing difficulty. Shock (low blood
pressure, rapid heartbeat, paleness, cold skin,
sweating, and anxious appearance) (Kadirova,
R. et al. Journal of Infectious Diseases,
2000;181:S110-S115; Hadfield, T. L. et al.
Journal of Infectious Diseases,
2000;181:S116-S120.
Diptheria
Tetanus
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Caused by the bacteria, Clostridium tetani
Natural soil baterium
Enters the body through a wound
The bacterium produces a toxin that affects
the skeletal muscle
Vaccine provides immunity
Td
Requires booster every 10 years
Tetanus
Polio
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Caused by an
enterovirus
Enters the body
through the oral
route
Enters through the
gastrointestinal
route
Polio
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Causes fever,
diarrhea,vomiting, and
still neck in some
children
More severe form
paralysis
Usually legs and arms
are paralyzed - some
times chest muscles
that involve breathing.
Global Incidence of Polio - 1995
Polio Pioneers
Philadephia Connection –
Dr. Hilary Koprowski
Polio vaccines
OPV - oral vaccine - changes the
genetics of the virus
 The virus can survive in the GI tract,
but cannot enter the nervous system
 Antibodies are made on the surface of
the gastric mucosa as well as the blood
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IPV
IPV made by inactivating the virus with
formaldehyde
 Administered as an IM shot
 Provides more immunity in blood but
does not protect the gastrointestinal
route
 IPV provides a second line of defense
against the organism
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Vaccine administration and
recommendations
Two doses of IVP followed by two doses
of OVP( new vaccine eIVP) enhanced
potency inactivated polio vaccine)
 Replaces old schedule for just oral
vaccines
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Risks from administration of
polio vaccine
Vaccine( OPV) causes 8-10 cases of
paralysis a year
 Paralysis is transitory in most
 Replicates in gastric mucosa and if it
sustains mutations it can cause disease
 IPV - no serious side effects
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MMR
Measles, mumps, rubella vaccine
 Deaths from measles has dropped from
3000 a year to almost none
 Fever and rash are the most common
side effects
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Mumps
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Paramyxovirus
Transmitted via aerosolized droplets
Infects the parotid glands in the neck( enters
through the ducts of the salivary glands)
Causes fever, extreme swelling of the neck. The
neck becomes very hard
It used to be one of the major causes of
meningitis prior to the development of the
vaccine
Swollen Parotid Glands
Measles
Before the vaccine there were 3-4
million cases of measles per year
 There were 3000 deaths
 Since 1995 there have been no deaths
 240 million doses of the vaccine and no
significant problems
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Measles
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Measles, also called
Rubeola, is a highly
contagious - but rare respiratory infection
that's caused by a virus.
It causes a total-body
skin rash and flu-like
symptoms, including a
fever, cough, and runny
nose.
Worldwide Immunization
Comparison of cases of Measles
Side Effects of Vaccine
Rash
 Fever of 103oF
 Measles vaccine is grown in eggs it
represents a problem for people with
egg allergies
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Initial vaccination
First immunization given between 12-15
months
 Second shot given at 4-6 years
 Boosters may be given before entry to
college
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Rubella – German Measles
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Rubella -commonly
known as German
measles or 3-day
measles —
It is an infection that
primarily affects the
skin and lymph nodes. It
is caused by the rubella
virus
Teratogenic virus
85% of women infected with Rubella in
the first trimester of pregnancy have
children with severe birth defects
 Children are born with blindness,
deafness, and severe heart defects
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Rubella titer
Women of reproductive age if planning a
pregnancy should have a blood test to
determine their status
 Rubella titers measure the antibody
level in the blood
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Rubella
Hib – Vaccine for Haemophilus
influenza
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Haemophilius influenza type B
Licensed for use in children under the age of 5 years
old
Mild symptoms
Redness around the injection site
Low grade fever
For many years it was believed that bactericidal
antibody directed against PRP capsule ofH. influenzae
type b was entirely responsible for host resistance to
infection.
Effects of Haemophilus influenza
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High Fever
Swollen lymph nodes
Headache
Drowsiness
Irritability
Epigottitis
Osteomyelitis
Meningitis
Pathogenicity
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For many years it was
believed that
bactericidal antibody
directed against PRP
capsule of H. influenzae
type b was entirely
responsible for host
resistance to infection.
Vaccine type
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Conjugate vaccine made by binding a
polysaccharide to a protein
Hib vaccine in the Americas
Comparison of vaccinated and non
vaccinated
Hepatitis B
300,000 people in the United States
are infected with Hepatitis B
 Affects the liver and can cause
cirrhosis
 Can also lead to liver cancer
 Vaccine has had a significant impact
 10 million people have been vaccinated
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Transmission
Sexual contact
 Breast milk
 Serum ( used to be called serum
Hepatitis
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Immune Response to Hepatitis B
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Virions consist of an outer lipid envelope and an
icosahedal core, the latter being composed of both
protein and DNA.
The outer envelope contains embedded proteins which
are involved in viral binding of, and release into,
susceptible cells.
Virion shape is generally spherical with a diameter of
40 - 48 nanometers (nm) but pleomorphic forms exist,
including filamentous and spherical bodies lacking a
core. These "subviral" particles are not infectious
Hepatitis B Symptoms
Cycle
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Upon entry into a host cell, the virus' double-stranded DNA genome is
relocated to the cell's nucleus and converted to covalently closed
circular DNA form, from which viral mRNAs are transcribed
These transcripts are exported to cytoplasm for translation of the
envelope proteins (also known as hepatitis B surface antigen, or HBsAg),
hepatitis B e antigen (HBeAg), and the X protein, whose function is still
under debate
A fourth pre-genomic RNA is transcribed, which translates the
polymerase and core proteins.
Polymerase and pre-genomic RNA are encapsidated in the assembling
core particles, where reverse transcription of the pre-genomic RNA to
genomic DNA occurs by the Reverse Transcriptase (RT) protein. The
mature core particle then exits the cell via normal secretory pathway,
acquiring an envelope along the way.
Antigens
Cirrhosis of the liver
World Wide Distribution of
surface antigen
Hepatavax
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Purified (!) HBsAg from the blood of chronic carriers has been
used as a vaccine since 1981 (Hepatavax-B) and continues to be
used in some areas of the world. Recombinant HBsAg vaccines
produced in yeast have been available since 1986 and are now
most widely used (e.g. Engerix-B, Recombivax-HB), e.g. part of
the W.H.O. expanded program on immunization. A combined
hepatitis A and B vaccine (Twinrix® - GlaxoSmithKline
Biologicals) is now licenced for use in persons aged 18 years.
This consists of the antigenic components used in Havrix (HAV)
and Engerix-B (HBV) vaccines. These are vaccines are safe and
effective - one of the few recombinant vaccines to date.
Effective vaccination campaigns could:
New Research
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Lamivudine (3TC - 2'deoxy, 3'thiacytidine - a
reverse transcriptase inhibitor) is currently
being investigated for therapy of chronic
HBV infection. Early results suggest this drug
may be effective in patients who have
previously failed to clear the virus with αIFN.
A number of other nucleoside and nucleotide
analogues are now known to inhibit HBV
replication in vitro and in vivo, including
penciclovir, lobucavir and adefovir
Rotavirus – Infant Diarrhea in
Third World Countries