PHAR 131 - Introduction to Vaccines

Innate immunity

Immediate, first-line response to pathogens and other invaders.

What is apart of the innate immunity?

Physical barriers, physiological features, processes, and cells of the immune system

Acquired (adaptive) immunity

A learned, specific defense that develops over a person's lifetime in response to encountering foreign substances (antigens) from infections or vaccines. Active or Passive

What is apart of the acquired innate immunity?

Humoral immune response and cell-mediated immune response

Humoral Immune Response

A part of the adaptive immune system mediated by B cells that produce antibodies to neutralize and eliminate extracellular pathogens

Cell-Mediated Immune Response

The body's immune defense that uses immune cells (primarily T-lymphocytes and macrophages) and cytokines, rather than antibodies, to eliminate infected or abnormal cells and intracellular pathogens

What is acquired (adaptive) active immunity?

A long-lasting form of protection where your own immune system produces antibodies to a specific antigen

What is acquired (adaptive) passive immunity?

A type of temporary protection against infectious diseases that is acquired by receiving antibodies from another source, rather than producing them oneself

Example of acquired (adaptive) active immunity

Infection with chicken pox and influenza vaccination

Example of acquired (adaptive) passive immunity

Antibodies in breast milk, anti-venom injection, and immune globulin infusion

Vaccine and Immune Response Overview

Vaccines (contain antigens) --> Antigens recognized and evoke immune response --> B and T cells activated --> B cells results in production of antibodies, they attack and destroy antigen then memory B cells and T cells are formed

Susan gets a flu shot in your pharmacy today and asks, "How long will it take for this shot to take effect?"

Takes about 2 weeks to identify foreign identity and form antibodies

What are live vaccines?

MMR, Varicella, Rotavirus, MMRV, Live attenuated influenza, oral typhoid capsules, yellow fever, chikungunya

What are some inactivated vaccines?

Influenza, COVID-19, RSV, Pneumococcal, Hep A, Hep B, Meningcococcal, chikungunya, DTap, Tdap

What does adjuvant mean?

To increase or enhance the effectiveness of a vaccine to strengthen the body

Why are adjuvants added to vaccines?

To increase the effectiveness or enhance to strength the body's immune system

Why are pure polysaccharide vaccines NOT recommended in children less than 2 years of age?

Children less than 2 do not have the mechanism to respond to polysaccharide

What are polysaccharide vaccines?

Stimulate T-cell independent

immunity. Stimulate B cells without assistance of helper T cells. Short-lived immunity. No booster effect. Not consistently immunogenic in children younger than 2 years

What are conjugate polysaccharide vaccines?

Protein carrier. Stimulate T-cell dependent immunity. Helper T cells involved. Produce immunologic memory. Result in booster effect upon subsequent exposure. Increased immunogenicity in children younger than 2

years

What is the minimum interval for two inactivated vaccines?

No minimum

What is the minimum interval for inactivated vaccine and live vaccine?

No minimum

What is the minimum interval for two live vaccines if not simultaneous?

28-day minimum interval

What is the minimum interval for inactivated vaccines and antibodies?

No minimum

What is the minimum interval for live vaccines followed by blood products?

2 weeks

What is the minimum interval for blood product given before live vaccine?

Minimum varies, look up on CDC

What is the minimum interval for live vaccine followed by PPD skin test?

28-day minimum interval

What is the minimum interval for PPD skin test followed by live vaccine?

Administer vaccine after PPD skin test has read

What is the general rule of thumb for vaccines?

Vaccines maybe co-administered (or simultaneous administered) on the same day. This includes COVID-19 and Influenza

What is the best practice for vaccines?

Separate syringes for vaccines and if administer vaccines in same limbs separate by 1 inch

Can multiple vaccines happen in one day?

Yes

What is a grace period?

Refers to the period of when to give vaccine, "minimum interval" like give vaccine 4 days earlier. Some states do not allow

Can a live vaccine have a grace period?

No

What happens if the interval between vaccines doses in a series is increased or decreased?

Effectiveness goes lower but should be ok

What are some contraindications?

Severe allergy to a vaccine, pregnancy, and immunosuppression.

What does contraindications mean?

A condition that greatly increases the risk of an adverse reaction. Do not vaccinate if vaccine is likely to injure patient

What are some false contraindications?

Minor illness, allergies to products in vaccine, pregnancy in household, breastfeeding.

What are examples of temporary contraindictions?

Pregnancy and immunosuppression

What are several recommended vaccines during pregnancy?

Tdap, inactivated influenza vaccine, and Bivalent RSVPreF

What are some complicated issues with immunosuppression patients and vaccinations?

Timing of vaccine, type of immunosuppression, duration and level. Live vaccines pose an increased risk for adverse effect due to uninhibited replication

What does immunosuppressed mean?

A state where the body's immune system is weakened or suppressed, making it less effective in fighting infections and other diseases

Can you give an immunosuppressed person a live vaccine?

No, because they can pose an increased risk for an adverse effect due to uninhibited replication

When can you give Tdap during pregnancy?

weeks 27 to 36

When can you give bivalent RSVPreF?

weeks 32 to 36

What are the types of immunosuppression?

Congenital immunodeficiency, cancer, hematopoietic stem cell transplant patient, solid organ transplant recipients, asplenia or sickle cell diseases, HIV infection, radiation therapy or chemotherapy, immunosuppressive medications like predisone

What is low-level immunosuppresion?

Prednisone dose of < 2 mg/kg/day or < 20 mg/day (in persons who weigh < 10 kg), Alternate-day corticosteroid therapy, Methotrexate <0.4 mg/kg/week or less, and HIV infection with higher CD4

What is high-level immunosuppression?

Corticosteroid doses higher than those listed for low-level no immunosuppression for >14 days, radiation or chemotherapy, within 2 months of solid organ transplantation, HIV infection with lower CD4 counts

Vaccines should be given before immunosuppression about:

4 weeks prior

Can a person who lives in a household with immunosuppressed get a live vaccine?

Yes