MIM 32 Vaccines 2024.pdf

MIM 32 VACCINATION Terri S. Hamrick, PhD Office #167 Levine Hall...

MIM 32 VACCINATION Terri S. Hamrick, PhD Office #167 Levine Hall (910) 893-1705 [email protected] The copyrighted materials available in this class are for educational use only. One copy per student is permitted for educational purposes. Redistribution is not permitted. MIM –Block 1 Fall 2024  Class materials (hereafter including PowerPoints, Handouts and Lecture Recordings) are distributed for the exclusive use of students in the Jerry M Wallace School of Osteopathic Medicine. Student access to and use of materials are conditioned on agreement with the terms and conditions set out below. Any student who does not agree to them is prohibited from accessing or making any use of such materials. 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Audio recording are also not permitted outside of what is provided through the recorded Panopto sessions.  Recommended reading 3 ¨ Immunization Schedules (CDC and ACIP) https://www.cdc.gov/vaccines/hcp/ imz-schedules/index.html ¨ Epidemiology and Prevention of Vaccine-Preventable Diseases, 14th edition (“The Pink Book”) https://www.cdc.gov/pinkbook/hcp /table-of-contents/  Objectives 4 ¨ List the important properties and provide examples of the following types of vaccines: live attenuated, inactivated, subunit, toxoid, pure polysaccharide, and conjugated. ¨ Describe the guidelines for initiating vaccine series for different patient populations ¨ Explain the limitations of pure polysaccharide vaccines and the use of conjugated polysaccharide antigens for some populations ¨ Describe the general trends for vaccine administration in terms of patient population and interval of dosing ¨ List the contraindications and precautions for vaccination and differentiate between permanent and temporary conditions ¨ Determine appropriate prevention of tetanus with respect to vaccination and passive immunity ¨ Provide examples of passive immunity ¨ Describe the use of monoclonal and polyclonal antibody preparations in clinical situations  Vaccine Information Statements & reporting 5 Vaccine information statements Vaccine adverse effects reporting system ¨ Required under the National Childhood ¨ The National Childhood Vaccine Vaccine Injury Act (42 U.S.C. 300A-26) Injury Act of 1986 ¤ Says children, but applies to any child or http://vaers.hhs.gov/index adult ¤ Requires health care providers to report certain adverse events that www.cdc.gov/vaccines/pubs/vis occur following vaccination. The state can ask you to do more, but the ¤ VAERS, established by CDC and Federal requirement says you cannot do FDA in 1990. less (in other words you need to provide a n Also contains a link to the National VIS if it is available for the vaccines that Vaccine Injury Compensation site you administer; if it isn’t available, then similar information should be provided).  Vaccine Adverse Reactions 6 Local Pain, swelling, redness at site of injection Vaccine Common with inactivated vaccines Usually mild and self-limited Adverse Event Systemic Reporting Fever, malaise, headache Nonspecific System (VAERS) May be unrelated to vaccine www.vaers.hhs. Allergic gov Due to vaccine or vaccine component Rare Risk minimized by screening Syncope or Vasovagal Response is not an allergic reaction  Principles of Vaccination 7 Active Immunity Passive Immunity ¨ Protection produced ¨ Protection by the person's own (antibodies) immune system transferred from another person or ¨ Natural infection or animal vaccination ¨ Temporary protection ¨ Usually, permanent that wanes with time  Acquired immunity Naturally acquired Artificially acquired Active Active Passive Passive Ag enter the Ag enter the body body in Preformed Ab Ab pass from vaccines; in immune naturally; Mom to fetus body produces serum body produces via placenta Ab and introduced Ab and or to infant specialized into body specialized in her milk lymphocytes by injection lymphocytes 8  Active immunity 9 ¨ Strongest and longest-lasting immunity ¨ Subclinical infections can also confer immunity ¨ Vaccination is active immunity produced by a vaccine ¤ Immunity and immunologic memory similar to natural infection but without risk of disease General rule: The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine.  Vaccine types 10 Live attenuated Inactivated, whole, viruses ¨ Most like the original ¨ Whole inactivated bacteria infectious agent are not routinely used now ¨ Will elicit full immune ¨ They can’t grow in the body response ¤ Ok for immunocompromised ¨ Must grow in the body ¨ Generates Ab, only ¤ Can be an issue for ¨ Generally, will need multiple immunocompromised doses and/or boosters ¨ Long lasting immunity  Vaccine types (con’t): Subunit 11 Toxoid Polysaccharide ¨ Inactivated version of a toxin ¨ Generally capsule ¤ Will elicit neutralizing Ab polysaccharide ¨ OK for immunocompromised ¨ Pure polysaccharide or conjugated polysaccharide (attached to a protein) Other inactivated/subunit ¨ OK for immunocompromised ¨ Virus capsid proteins Advisory Committee on Immunization ¨ Other virulence factors (adhesins, Practices (ACIP) etc. Decides what vaccine, when, and to ¤ Will elicit neutralizing Ab whom. Recommendations usually ¨ OK for immunocompromised come out ~every year.  Patient populations 12 Babies Elderly General population Special Indications/recommendations  Babies 13 They have a naïve immune system Susceptible to (almost) everything Ab from mom Don’t respond to some vaccine types Diseases can be particularly harmful Decisions about the schedule: What the baby’s immune system is ready for When they need the protection  Vaccination groupings for babies 14 ¨ Earliest initial immunization: birth ¨ Next set of new immunizations: 2 & 6 months ¨ Next set of new immunizations: 12-15 months Thimerosal has been removed from all childhood specific vaccines (since 2001)  Vaccination groupings for babies: birth 15 ¨ First in the hepatitis B series ¤ Virus surface antigen (subunit) ¤ Hepatitis B infection is particularly serious for an infant n It is really important to be sure a newborn doesn’t get hepatitis B n If mom has evidence of Hepatitis B infection, then the baby should get passive immunity, too (hepatitis B immune globulin) ¨ RSV (antibody) if mom is not immune by vaccination– some variation depending on the time of the year  Groupings/babies: 2 months of age 16 Rotavirus: note-- Generally speaking, we don’t give live- Rotavirus: live attenuated virus vaccines to infants– exception attenuated virus Don’t use if SCID or some other GI issues DTaP: Diphtheria, Tetanus, acellular Pertussis Diphtheria toxoid, Tetanus toxoid Pertussis: several purified protein antigens (acellular, because years ago it was whole cell) Capital letter is an indication of the amount of the Ag Order of the letters, also related to relative amount of Ag  Groupings/babies: 2 months of age 17 Capsule polysaccharide Ag: young children don’t mount a good immune response to polysaccharide Ag Protein conjugated to the Ag so it works better for them PCV15, PCV20: Pneumococcal conjugate Hib: Haemophilus influenzae type b This vaccine was made specifically for infants, so it only exists as a conjugate vaccine Inactivated poliovirus (IPV)  Immune system overload? 18 Six antigen-based vaccines, but how many things will the immune system “see”? Haemophilus Think about influenzae: a real ~1750 genes Some doing infection harm  Groupings/babies: 6 months of age 19 COVID-19 Seasonal updates Influenza Inactivated, annual (IIV4) Live Attenuated Influenza (LAIV4) an option after 2 yrs. of age  Groupings/babies: 12-15 months of age 20 ¨ MMR: measles, mumps, ¨ VAR: Varicella rubella ¤ Live attenuated ¤ All 3 are live attenuated ¤ Can have break-through viruses infection ¤ Not given before because n Varicella (chicken pox)– they are live and because the natural infection can baby may still have mom’s lead to serious illness Ab to measles, which ¨ Hepatitis A: inactivated virus would interfere with immune response to vaccine virus  Vaccine impact 21 ¨ Before the vaccine: ¤ >4 million people/yr ¤ >10,000 hospitalizations/yr ¤ ~100 deaths/yr due to chickenpox ¨ Now: ¤ 92% fewer cases (