Immunology Lecture 22 - VZV vaccines (O'Donnell

human herpes virus (1 of 8)

what type of virus is VZV

latency

a period established by VZV where the virus is dormant and not replicating

- chicken pox

- shingles / herpes zoster

what are the disease states that can be caused by VZV

chicken pox

disease state that occurs during the first exposure to VZV

fever

what is the first sign of chicken pox and how long after exposure does it occur

10-21 days

how long after exposure to VZV will a patient experience an itchy rash with papules that can sometimes become blisters

- encephalitis

- pneumonia

- sepsis

- secondary bacterial infections

what are some common complications of chicken pox

after chicken pox but before shingles

when is latency of VZV established

shingles (herpes zoster)

disease that occurs from reactivation of VZV

they are present in bands while in they are presented as bumps in chicken pox

what is different about the rash experienced in shingles than the rash experienced in chicken pox

- post herpetic neuralgia

- vision and hearing loss

- paralysis

- encephalitis

what are common complications of shinges

innate

what immunity is important for recognizing the VZV at the start of the infection (first time)

- cell mediated immunity

- humoral immunity (b cells)

what types of immunity are responsible for resolving chicken pox

cell mediated immunity (memory T cells)

what immunity is important for preventing reactivation of VZV (shingles)

zoster threshold

this is a "line" that decides whether a patient has enough immunity (VZV T cells) to protect them from the shingles virus

live, attenuated

varivax and zostavax are _________ vaccines while shingrix is a ___________ vaccine

low, high

varivax has a very _____ dose of VZV while zostavax has a very ______ dose

2,1,2

varivax is given in ____ doses, zostavax in _____, and shingrix in _______

12-15 months

what is the recommended age to get varivax

60+

what was the recommended age to get Zostavax

50+

what is the recommended age for shingrix

- efficacy decreases with age

- vaccine effectiveness wanes over time

- contraindicated with the immunocompromised

what were the main reasons that Zostavax was discontinued

- gE

- AS01b

what are the two main components of the shingrix vaccine

gE

surface (spike) protein on VZV that is targeted by the immune response (antibodies and CD4 cells)

neutralizing, blocked

the antibodies against gE are ___________. Therefore, the infection is _________

true

T or F - Generally, immunity from a live virus vaccine is better since it will express all of the viral proteins and go through the life cycle

false

T or F - Injecting a single protein (like gE) is usually good enough to generate a protective immune response

AS01b

an adjuvant that was added to the shingrix vaccine to enhance the immune response

- QS-21

- MPL (monophosphoryl lipid A)

what are the two components of AS01b

lipid A

a toxin from gram negative bacteria that induces inflammation

stimulate APCs to lead to greater presentation of gE to T cells to induce a greater interferon response

what is the MOA of AS01b

cell-mediated immunity (memory T cells)

what facet of the immune response is necessary for long-term protection against VZV?

4 years

up to how long can immunity from a VZV vaccine be maintained

false

T or F - The CDC recommended Shingrix unless the patient has already received Zostavax to avoid interaction.

true

T or F - Zostavax could not be used in the immunocompromised but Shingrix can be

true

T or F - You can get shingles more than one time. The CDC recommended getting vaccinated even if you have had shingles before

during an active infection

when is the shingles vaccine NOT recommended