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57 Cards in this Set
- Front
- Back
What is the goal of Immunization?
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To protect against disease upon subsequent exposure to the infection
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Immunization Timing
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-Must immunize before exposure
-Childhood and adult immunization schedules updated frequently and published annually. |
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What makes an ideal vaccine?
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-Induces protective immune response in all individuals
-No adverse events -Cheap to produce -Not temperature sensitive |
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What is active immunity?
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-Stimulate the host to produce a protective response to a pathogen. (e.g. natural infection, immunization)
-Relies on immunologic memory |
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What are the immune globulins?
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IgA: found in secretions
IgE: involved in allergy and anaphylaxis; immune response to parasites IgG: found in large amounts in serum; major antibody of secondary response IgM: predominant early antibody |
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What are the characteristics of the secondary antibody response?
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-No maturation of IgM response
-Antibodies response after secondary exposure -higher affinity - appear more quickly - persist longer - attain higher concentration - predominantly IgG) |
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What are the three characteristics of live attenuated vaccines?
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1. Contain live organisms
2. Undergo limited replication in host 3. Produce immune response without causing disease |
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What are examples of live attenuated vaccines?
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-measles
-mumps -rubella -varicella, zoster -rotavirus -influenza (nasal) -oral polio -typhoid -yellow fever |
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What are the issues with live vaccines?
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-Single dose to produce long-lasting immunity
-Repeat doses do not boost -Timing -Contraindicated in pregnancy, immunosuppressed |
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What are whole, inactivated vaccines?
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-grown in culture
-exposed to heat, chemical to inactivate -Sometimes purified to contain only portion needed to induce immunity |
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What are examples of whole, inactivated vaccines?
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-hepatitis A
-Influenza -polio -rabies |
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What are the three issues with inactivated vaccines?
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1. Multiple doses to produce positive immunity
2. Generally require booster doses 3. Minimal interference from circulating antibody. |
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What are fractional vaccines?
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-Portion of pathogen that induces protective immunity
-Reduce adverse effects associated with vaccine administration -injection site soreness, redness, systemic reactions |
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What are examples of fractional vaccines/
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-Polysaccharide vaccines
-Recombinant DNA vaccines -Toxoids -other examples -influenza -acellular pertusis |
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What are the five characteristics of polysaccharide vaccines?
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1. Composed of long chains of sugar molecules from bacterial capsule
2. Immune response T cell independent (stimulate B cells without T helper cells) 3. ineffective in children <2 years 4. No booster response 5. Predominant antibody response is IgM |
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What are examples of polysaccharide vaccines?
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-Pneumococcal (PPSV23)
-Meningococcal (MPSV4) |
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What are the characteristics of conjugate vaccines?
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1. polysaccharide linked to protein making it a more potent vaccine.
2. Conjugation overcomes the disadvantages of polysaccharide vaccines. |
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What are the examples of conjugate vaccines?
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-Haemophilus influenzae type b
-Pneumococcal (PCV13) -Meningococcal conjugate (MCV4) |
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What is recombinant DNA technology?
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-Insert gene for antigen in microorganism
-Microorganism produces antigenic protein -Antigenic protein harvested and purified for use a vaccine. |
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What is the advantage of recombinant DNA vaccines?
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-large amount of pure antigen
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What is the disadvantage of recombinant DNA vaccines?
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-expensive
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What are the examples of recombinant DNA vaccines?
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-Hepatitis B
-Human papillomavirus |
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What are toxoids?
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-Inactivated bacterial toxins
-Immune response to toxin produced by infecting bacteria |
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What are examples of toxoids?
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-tetanus
-diphtheria |
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What are nucleic acid vaccines?
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-Immune response to the protein encoded by plasmid DNA.
-Induces cell mediated and antibody response. |
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What are the three nucleic acid vaccine characteristics?
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1. Easy to manufacture
2. Inexpensive 3. Numerous trials (prophylaxis, therapeutic) |
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How does a nucleic acid vaccine work?
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-Gene for antigenic portion of a pathogen
-host cells... -take up foreign DNA -express the pathogen gene -produce antigenic pathogen protein |
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What is the immune response to nucleic acid vaccines?
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-Myocytes likely play secondary role
-Myocytes may be antigen producers -Antigen presenting cells induce immune response -Antigen presenting cells directly transfected -Lysed myocytes supply additional DNA for macrophages |
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Nucleic Acid Vaccines
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-Because pathogen protein originates inside cell, strong cell-mediated immunity elicited
-Long-lasting immunity |
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What are the three advantages of nucleic acid vaccines?
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1. Cell mediated and antibody responses
2. Pure 3. No infectious risk |
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What are examples of nucleic acid vaccines?
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-hepatitis C virus
-Herpes simplex virus -Human Immunodeficiency virus -Parasites -Cancer |
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What cautions should be taken with DNA vaccines?
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-safety profile
-human efficacy -administration strategy -stability |
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What are adjuvants?
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-Substance that enhances the immune response to the antigen with which it is mixed
-Aluminum-containing materials only approved adjuvant in U.S. |
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What is the mechanism of adjuvants?
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-not completely determined
-make antigen less soluble; stays at injection site longer -enhance immune stimulatory signals -cause inflammatory response |
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Thimerosal in vaccines
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-effective preservative that contains ethyl mercury
-Thimerosal-free preparations now available in U.S |
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Vaccine preparation
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-vaccine should be prepared at the time of administration
-pre-filling syringes is strongly discouraged |
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what is intramuscular administration?
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-vaccine delivered into muscle
-Needle size -adults 1 to 1.5 inches; 22-25 gauge -children 5/8 to 1.25 inch; 22-25 gauge |
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What is subcutaneous administration?
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-delivered to fatty tissue under skin
-tissue pinched for administration to avoid slipping into muscle -Needle size -5/8 inch; 23-25 gauge for all |
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What are the characteristics of oral administration?
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-oral or muscosal pathogens
-live attenuated pathogens -IgA production |
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What are the characteristics of edible vaccines?
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-Transgenic plants
-Oral administration -inexpensive to produce -Rapid upscale of production -Minimization of storage problems -Plant produced antigens -Plant cell walls may protect vaccine antigen from stomach acid |
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What are the advantages of edible vaccines?
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1. Edible
2. Relatively stable 3. Production scale up 4. Mucosal immunity |
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What is transdermal immunization?
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-Needle-free delivery
-Patch application |
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What makes up the skin immune system?
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-Barrier stratum corneum (disrupt with hydration (occlusion))
-Langerhans cells -close proximity to stratum corneum - carry antigen to lymph nodes |
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Intradermal Influenza Vaccine
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-injection site reactions common
-Well-accepted by healthy adults |
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What is nasal or mucosal administration?
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-Antigen delivered to mucosal surface.
-IgA production -nasal -vaginal or rectal administration under investigation |
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What are the three critical issues of vaccine handling and storage?
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1. exposure to temperatures outside recommended ranges can reduce potency
2. errors cost money 3. loss of patient confidence |
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Storage Temperatures
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-Each vaccine has recommended storage temperature
-Most live vaccines can tolerate freezing -Inactivated vaccine damaged by heat or freezing -Temperature excursions: out of range temperatures |
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Freezer Temperatures
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-Consider defrost cycles
-Recommended freezer temperatures -between -58 and 5 F -between -50 and -15 C |
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-Refrigerator Temperatures
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Recommended
-Between 35 and 46 F -Between 2 and 8 C |
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Monitoring Temperature
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-Twice daily recording of temperatures
-Graphing thermometers |
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Thermometers
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-Placed in each compartment
-Calibrated thermometer with periodic recalibration as recommended by the manufacturer |
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What are two methods for continuous monitoring of temperature?
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-alarms when closed
-notification sent to email or cell phone |
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How to handle temperature excursions?
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-Do not discard
-vaccine delivered that may have been exposed to heat or cold -vaccine inadvertently left out -equipment malfunction or power outage -Separate from other inventory -Call vaccine manufacturer for guidance - call health department for guidance |
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What to do for clinical immunization program plans?
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-Designate an individual and back-up to handle vaccines
-Written plan for ordering and deliveries -Emergency back-up written plan -natural disaster or other power outage -back up generator -alternate site |
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What is the appropriate storage equipment?
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-Refrigerator/Freezer
-standard household combination with separate sealed doors is ok -dorm-style refrigerator should not be used unless it is only temporary storage -Stand alone refrigerators and freezers preferred - use only to store biologics -consider size |
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Where should vaccines be placed in the storage unit?
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-NOT IN THE DOOR
-middle of unit on shelves -spaced for adequate air circulation -strategic storage to minimize error -Store jugs of water or frozen gel packs to maintain temperature |
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What is the global immunization issue?
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-Vaccine integrity in areas of the world with no or unreliable electricity supply.
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