Vaccine Components and Immunity Types

Vaccinations and Immunity

• Immunity can be acquired via exposure to a disease, transfer of antibodies from mother to baby, administration of immunoglobulin, or immunization.
• Immunization provides protection from infectious diseases.

Passive vs Active Immunity

• Passive immunity involves receiving antibodies, offering immediate but short-lived protection (weeks to months) and is acquired through maternal transmission or immunoglobulin/blood products
• Active immunity occurs when exposure to a disease organism activates the immune system, providing long-lasting protection over time (weeks).
• Active immunity is acquired either through natural infection or vaccine-induced immunity.

Antigens vs Antibodies

• Antigens induce an immune response from bacteria or viruses.
• Antibodies are made by the immune system to fight infections and are produced by the humoral arm of the immune system.
• Antibodies protect the body from harmful germs, and their levels indicate successful vaccination or previous infection conferring immunity.
• Immunoglobulin is another name for antibodies.

Immunoglobulins

• Immunoglobulins are also known as antibodies

• IgA: Found in mucous membranes and prevents colonization by pathogens.

• IgE: Involved in allergic responses and anaphylaxis.

• IgD: Appears on the surface of B cells and may signal when immature B cells are ready to be activated.

• IgM: The first antibody to appear in response to an antigen, antigen non specific, has a large structure that keeps it to the intravascular space only.

• IgG: Antigen-specific, found in intravascular and extravascular spaces, provides the majority of the immune response, and is measured in titers.

Booster Doses

• Booster doses are often needed to maintain immunity with inactivated vaccines by eliciting memory responses from B cells that produce IgG, resulting in a rapid and intense antibody response that is long-lasting.

Vaccine Types

• Inactivated vaccines are created by killing a pathogen through heat or chemicals like formaldehyde but keeping it "intact" for immune recognition; these vaccines cannot replicate or revert to a virulent form.
• Live attenuated vaccines contain weakened organisms achieved by passing the disease-causing virus through cell cultures or animal embryos, which allows them to replicate better in non-human cells and confers lifelong immunity with generally one dose.
• Messenger RNA (mRNA) vaccines: mRNA is enveloped in a lipid sphere that causes the body's immune cells to take up the vaccine particles and reveal the mRNA to make proteins that trigger an immune response, allowing it to be manufactured quickly.
• Subunit, recombinant, polysaccharide, and conjugate vaccines contain pieces of the pathogen (protein, capsule) to elicit a strong immune response while requiring multiple doses (booster).
• Toxoid vaccines use an inactivated toxin made by the pathogen to create immunity to the parts of the pathogen that cause disease.
• Viral vector vaccines use a modified, harmless virus to deliver genetic material from the virus that causes the disease you're being protected from, teaching your immune system how to recognize and fight the real virus if it shows up.

Other Vaccine Components

• Adjuvants stimulate a strong, short-lived inflammatory and immune response.
• Vaccines containing adjuvants should be given intramuscularly to avoid irritation.
• Suspending agents, like water, saline, or complex fluid containing proteins (albumin), act as the vehicle for the vaccines.
• Preservatives, stabilizers, and antibiotics may be added to maintain the integrity of the product. Adjuvants can cause more local and systemic reactions, the newer ones trigger a longer and stronger protection.

Vaccine Safety

• Thimerosal is a mercury-based preservative containing ethylmercury, used in multi-dose vials.
• It has been shown to be safe in vaccines, causes redness and swelling at the injection site, was removed from childhood vaccines in the US in 2001, and ethylmercury is cleared from the human body more quickly.
• Prevention of adverse effects: ask screening questions and provide aftercare instructions, and have an emergency kit containing Epi pens, Diphenhydramine, a resuscitation mask, and a CPR summary sheet.

Tdap vs DTaP

• DTaP has a higher diphtheria and pertussis antigen dose and is for children less than 7 years old.
• Tdap has a lower diphtheria and pertussis antigen dose and is for booster doses in older children and adults.

Conjugate vs Polysaccharide Vaccines

• Polysaccharide vaccines use sugar molecules (polysaccharides) from the surface of bacteria to trigger an immune response; although effective, they may not work as well in young children.
• EXAMPLES: hib, PCV13, MenACWY.
• Conjugate vaccines use molecules (polysaccharides) attached (conjugated) to a protein boosting the immune response, in young children.
• EXAMPLES: PPSV23, MPSV4.

OSHA Requirements

• OSHA holds agencies who pay staff and assign them to work in a healthcare facilities responsible for:
• Exposure control plan, Hep B vaccination, post-exposure evaluation and follow-up, and recordkeeping/training.
• All body fluids are potentially infectious.
• Employees expected to perform CPR must have appropriate resuscitator devices readily available and accessible.
• It's recommended to do antibody testing, 1-2 months after the vaccination series, and revaccinate if the titer is low.
• Record keeping and training is required for anyone giving vaccines and should document participation in bloodborne pathogen education, handling/disposal of biohazard material, and exposure control plan.

North Dakota Legal Requirements

• An ND pharmacist is required to have intern license, complete appropriate training, maintain CPR or BLS certification, complete attestation with the board, and maintain continued competency.
• An authorized pharmacist may delegate subq or intramuscular injectable medication to a qualified pharmacy tech.
• Who is required to have a completed board-approved training program, and maintain a continuing competency injections of medications which are expected to be performed, and maintain CPR or BLS training.
• Pharmacists can authorize patients 3 years or older.

Vaccine Administration

• Any immunization recommended by ACIP or CDC and any other emergency immunization response can pharmacists administer
• Requirements for physical locations include ensuring privacy, aseptic conditions, and access to emergency response equipment.
• Must document vaccinations in NDIIS within 14 days and maintain records of all vaccines.

Vaccine Injury Compensation Program (VICP)

• The VICP is a vaccine injury compensation program that may include lost wages, pain and suffering, attorney fees and mandates vaccine information statements (VIS) before each dose of vaccines.

Communicating with Vaccine-Hesitant Individuals

• Use the CASE approach: C (corroborate), A (about me), S (science), and E (explain/advise).
• Motivational interviewing techniques: consider what they are specifically afraid of and summarize their thoughts.

Explore viral vectors, adjuvants, and suspending agents in vaccines. Learn about mercury compounds, screening questions, and emergency kits. Understand DTaP indications, polysaccharide sources, and toxoid inactivation. Differentiate between passive and active immunity and identify key immune response substances.