Vaccines & Vaccine-Preventable Diseases PDF

VACCINES & VACCINEPREVENTABLE DISEASES FACILITATOR: DR. SANCHEZ QUOTE  "In 1736 I lost one of my sons, a fine boy of 4 years old, by the smallpox...I long regretted bitterly and I still regret that I had not given it to him by inoculation; this I mention for the sake of parents, who omit that op...

VACCINES & VACCINEPREVENTABLE DISEASES FACILITATOR: DR. SANCHEZ QUOTE  "In 1736 I lost one of my sons, a fine boy of 4 years old, by the smallpox...I long regretted bitterly and I still regret that I had not given it to him by inoculation; this I mention for the sake of parents, who omit that operation on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that therefore the safer should be chosen."  - Benjamin Franklin, The Autobiography of Benjamin Franklin, 1791 https://www.britannica.com/biography/Benjamin-Franklin SMALLPOX  Smallpox is believed to have emerged in the human population around 10,000 BC. The first sign of physical evidence is believed to be the skin lesions on the mummy of Pharaoh Ramses V, who died in 1157 BC.  The use of the term “small pockes” did not come about until the end of the 15th century in England, when it became necessary to distinguish it from syphilis or “great pockes”. HISTORY  Variolation or inoculation was the practice of taking a lancet to a ripe pustule of an infected person and then introducing the infectious material to a non-infected person subcutaneously. This was done because it was known that a person who survived smallpox was immune to it. The practice was brought to Europe and spread to the New World in the 18th century. It quickly became popular, despite a 2%-3% mortality rate (which was more desirable than the mortality of naturally contracting smallpox). In May of 1796, Edward Jenner (who himself was variolated as a young boy) conducted his famous experiment inoculating a boy with infectious material from a fresh cowpox lesion found on a dairymaid. In July 1796, after the resultant infection had subsided for a while, he then inoculated the same boy with infectious material from a fresh smallpox lesion. That boy did not show signs of infection. Jenner then coined the term vaccine as a result of these experiments. https://pixnio.com/science/medical-science/close-up-detailed-image-of-use-of-a-bifurcated-needle https://www.cdc.gov/smallpox/vaccine-basics/who-gets-vaccination.html https://www.healthline.com/health/smallpox-vaccine-scar#vs-bcg-with-photo HISTORY  In 1798 Jenner privately published a booklet discussing what he now called vaccination (after vacca, the Latin word for cow). In 1967, the WHO started a global campaign to eliminate Smallpox. The last reported case was in Somalia in 1977, and in 1980, the WHO declared Smallpox eradicated. The United States stopped routine vaccination in 1972. In response to perceived threat from bioterrorist attacks, the United States has been increasing its stockpiles of the vaccine because of the large population of unvaccinated people in the country. In December 2002, the president announced the Smallpox Vaccine Program, which aimed to voluntarily vaccinate those considered to be at highest risk in the event of an outbreak, such as healthcare professionals and first responders. Additionally, all deployed military personnel and laboratory staff who come into contact with vaccinia (the virus in the smallpox vaccine) and other related viruses continue to be vaccinated. EFFECTIVENESS OF VACCINATION FOR SOME COMMON INFECTIOUS DISEASES IN THE U.S. WHAT IS IMMUNITY? Immunity Active Immunity Passive Immunity Sources of Passive Immunity 1. Many types of blood or blood products used for transfusion a. Whole blood, red cells, platelets 2. Homologous pooled human antibody (immune globulin- IgG) a. From many different donors (thousands of adult donors in the U.S.) b. Contains Abs from many different Ags c. Used for postexposure prophylaxis for hepatitis A and measles; treatment for IG deficiencies 3. Homologous human hyperimmune globulin a. Contain high titers of a specific Ab & other Abs in lesser quantities b. Made from donated plasma of humans with Abs of interest c. Used for postexposure prophylaxis for hepatitis B, rabies, tetanus, and varicella 4. Heterologous hyperimmune serum a. AKA: antitoxin b. Produced in animals (usually horses; sometimes sheep and rabbits) c. Contains Abs against only one Ag d. Antivenin used to treat black widow spider bites and snake bites e. Antitoxin used in treatment of botulism, diphtheria, dysentery, gas gangrene, and tetanus f. Complication: serum sickness HERD IMMUNITY https://imgur.com/a/8M7q8 TYPES OF VACCINES Whole-Pathogen Vaccines Subunit Vaccines Viral Vectors Nucleic Acids TYPES OF VACCINES Live Nonattenuated Adenovirus Inactive Attenuated Whole Cell OPV IPV HepA Rabies (Sabin) (Salk) Influenza (IN) Influenza (IM) Cholera Rotavirus Pertussis JEV TBEV DENV BCG VZV MMR Ebola YFV MPV Typhoid HZ Fractional Subunit: HepB, Influenza (IM), Pertussis, HPV, HZ, Anthrax, Typhoid, Pneumococcus, Group B & A/C/Y/W Meningococcus, SARSCoV-2 Toxoid: Diphtheria, Tetanus Conjugate: Haemophilus influenzae type B, Pneumococcus, Group A/C/Y/W Meningococcus Nucleic Acid: SARS-CoV-2 Vaccination strategies WHAT OTHER INGREDIENTS DO VACCINES CONTAIN? Preservatives Adjuvants Stabilizers Cell culture materials Inactivating ingredients Antibiotics The date shown in the “Date column” of the table is the edition date of the packet inserts in use in February 2020. This information can be found on the FDA’s website at: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm CDC Pediatric Vaccination Schedule https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html CDC Adult Vaccination Schedule https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html LIVE ATTENUATED VACCINES: E.G., INFLUENZA   CDC recommends everyone 6 months & older get vaccinated every flu season.  Children 6 months through 8 years of age may need 2 doses during a single flu season.  Everyone else needs only 1 dose each flu season.  It takes about 2 weeks for protection to develop after vaccination. Three types of influenza vaccine are available in the United States:  Inactivated (subunit) influenza vaccine (IIV)  Administered by intramuscular (IM) injection  Multidose vials contain thimerosal, some products contain residual egg protein  Trivalent vaccine contains three inactivated viruses: type A(H1N1), type A(H3N2), and type B.  Quadrivalent influenza vaccines were first introduced during the 2013–2014 season. They contain the same antigens as trivalent vaccines, with an additional type B strain. LIVE ATTENUATED VACCINES: E.G., INFLUENZA  Three types of influenza vaccine are available in the United States (continued):  Live, attenuated influenza vaccine (LAIV)  Vaccine viruses are grown in chicken eggs  Administered intranasally (IN)  Recombinant influenza vaccine (RIV)  Contains recombinant hemagglutinin proteins  Does not require an egg-grown vaccine virus INACTIVATED VACCINES – SUBUNIT: E.G., HEPATITIS B VIRUS & HPV  Hepatitis B Vaccines:  DTaP-HepB-IPV (Pediarix)    Contains neomycin, polymyxin B, and streptomycin   Contains neomycin HepB (Engerix-B, Heplisav-B, and Recombivax HB) HBV Vaccine Characteristics: Recombinant vaccine (HBsAg)  9vHPV (Gardasil 9) is licensed and currently distributed in the U.S.  HepA-HepB (Twinrix)    DTaP-IPV-Hib-HepB (Vaxelis)   Contains antibiotics neomycin and polymyxin B  HPV Vaccines: Prevents HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58 4vHPV and 2vHPV are licensed but not currently distributed in the U.S.  4vHPV prevents HPV types 6, 11, 16, 18  2vHPV prevents HPV types 16, 18  HPV Vaccine Characteristics:  Contain yeast protein Recombinant vaccine (L1 major capsid protein)  9vHPV contains yeast protein  Administered by intramuscular injection  L1 proteins self-assemble into virus-like particles (VLP)  Contain aluminum adjuvant (Engerix-B and Recombivax HB) or synthetic adjuvant (Heplisav-B)  VLPs are noninfectious and nononcogenic  Administer by IM injection  9vHPV contains aluminum adjuvant  Some presentations contain latex  Ingredients in combination vaccines differ; all contain antibiotics BORDETELLA PERTUSSIS  Aerobic gram-negative  Antigenic and biologically active components:   Pertactin  Filamentous hemagglutinin (FHA)  Fimbria  Dermonecrotic toxin  Tracheal cytotoxin  Pertussis toxin (PT) Pertussis Pathogenesis  Primarily a toxin-mediated disease  Bacteria attach to cilia of respiratory epithelial cells  Toxins cause inflammation which interferes with clearance of pulmonary secretions  Young infants at highest risk Stages of Whooping Cough (Pertussis) INACTIVATED VACCINES – SUBUNIT/WHOLE-CELL: E.G., B. PERTUSSIS  Pertussis-containing Vaccine Characteristics:  Pertussis-containing Vaccines:  Administered by intramuscular injection  DTaP (Daptacel and Infanrix)  Contains aluminum as an adjuvant  Tdap (Adacel and Boostrix)  DTaP-HepB-IPV (Pediarix), DTaP-IPV/Hib (Pentacel),  DTaP-HepB-IPV (Pediarix)  DTaP-IPV/Hib (Pentacel)  DTaP-IPV (Kinrix and Quadracel)  DTaP-IPV-Hib-HepB (Vaxelis) DTaP-IPV-Hib-HepB (Vaxelis), DTaP-IPV (Kinrix), and DTaP-IPV (Quadracel) contain neomycin and polymyxin B as antibiotics  DTaP-IPV-Hib-HepB (Vaxelis) contains streptomycin as an antibiotic. DTaP-HepB-IPV (Pediarix) and DTaP-IPVHib-HepB (Vaxelis) vaccines contain yeast protein  Presentations of some pertussis-containing vaccines contain latex rubber. HAEMOPHILUS INFLUENZAE  Aerobic/facultative anaerobe gram-negative bacteria; coccobacillus/pleomorphic  Fastidious; growth of most species of Haemophilus requires supplementation of media with one or both of the following growth-stimulating factors: (1) hemin (AKA “X factor”) and (2) nicotinamide adenine dinucleotide (NAD; AKA “V factor”)  Although both factors are present in blood-enriched media, sheep blood agar must be gently heated (chocolate agar) to destroy the inhibitors of V factor.  Polysaccharide capsule, IgA proteases  Most common diseases resulting from Hib infection are meningitis, bacteremia, epiglottitis, pneumonia, arthritis, and cellulitis INACTIVATED VACCINES – CONJUGATE: E.G., H. INFLUENZAE  Hib Vaccines  Three conjugate (monovalent) vaccines  PRP-T (ActHIB)  PRP-T (Hiberix)  PRP-OMP (PedvaxHIB)  Two combination vaccines containing Hib  DTaP-IPV/Hib (Pentacel)  DTaP-IPV-Hib-HepB (Vaxelis)  Hib Vaccine Characteristics  PRP-T use a tetanus toxoid carrier protein  PRP-OMP uses a meningococcal outer membrane protein  Administered by intramuscular injection  PRP-OMP doses contain aluminum adjuvant  Monovalent Hib vaccines contain no antibiotic or preservative CORYNEBACTERIUM DIPHTHERIAE  Aerobic or facultatively anaerobic Gram-positive irregularly shaped (“club-shaped”) rods  Non-spore forming  Contain short-chain mycolic acids but NOT acid-fast  Toxin production occurs when C. diphtheriae is infected by corynebacteriophages carrying tox gene  Classified based on site of disease    Respiratory (pharyngeal, tonsillar, laryngeal, nasal)  Non-respiratory (cutaneous and other mucus membranes)  Most common sites of infection are the pharynx and tonsils Toxigenic C. diphtheriae acquired in the nasopharynx  Produces an AB toxin that inhibits cellular protein synthesis, destroys local tissue, and forms a pseudomembrane  Responsible for major complications, including: myocarditis, polyneuropathies, nephritis, and thrombocytopenia Non-toxin-producing C. diphtheriae strains cause mild to severe exudative pharyngitis and sometimes lesions, endocarditis, bacteremia, and septic arthritis INACTIVATED VACCINES – TOXOID: E.G., C. DIPHTHERIAE  Diphtheria Toxoid-containing Vaccines  DT  DTaP (Daptacel and Infanrix)  Td (Tdvax and Tenivac)  Tdap (Adacel and Boostrix)  DTaP-HepB-IPV (Pediarix)  DTaP-IPV/Hib (Pentacel)  DTaP-IPV (Kinrix and Quadracel)  DTaP-IPV-Hib-HepB (Vaxelis)  Diphtheria Toxoid-containing Vaccine Characteristics  Administered by intramuscular injection  Contains aluminum as an adjuvant  DTaP-HepB-IPV (Pediarix), DTaP-IPV/Hib (Pentacel), DTaP-IPV-Hib-HepB (Vaxelis), DTaPIPV (Kinrix), and DTaP-IPV (Quadracel) contain neomycin and polymyxin B as antibiotics  DTaP-IPV-Hib-HepB (Vaxelis) contains streptomycin as an antibiotic. DTaP-HepB-IPV (Pediarix) and DTaP-IPV-Hib-HepB (Vaxelis) vaccines contain yeast protein  Presentations of some pertussis-containing vaccines contain latex rubber. CORONAVIRUSES  ssRNA+, non-segmented, enveloped  Coronaviruses are the second most prevalent cause of the common cold  Coronaviruses have caused outbreaks of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERSCoV)  SARS-CoV and MERS-CoV are zoonoses  Human coronavirus infects and kills epithelial cells of the upper respiratory tract.  A combination of viral pathogenesis and immunopathogenesis causes significant lung, kidney, liver, and gastrointestinal tissue damage and depletion of immune cells. INACTIVATED VACCINES – NUCLEIC ACID: E.G., SARS-COV-2  Three vaccine types are currently approved under a Biologics License Application (BLA) or authorized under an EUA by FDA:  mRNA vaccines  Moderna COVID-19 Vaccine/SPIKEVAX (1) and Moderna COVID-19 Vaccine, Bivalent  Pfizer-BioNTech COVID-19 Vaccine/COMIRNATY (2) and Pfizer-BioNTech COVID-19 Vaccine, Bivalent  Protein subunit vaccine  Novavax COVID-19 Vaccine, Adjuvanted  Adenovirus vector vaccine  Janssen (Johnson & Johnson) COVID-19 Vaccine WHAT DOES IT TAKE TO WIPE OUT A DISEASE? QUESTIONS?