chapter 27

Copyright © 2012, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

Chapter 27Chapter 27

VaccinesVaccines


Vaccine Matching Divide the class into teams. Give each team a photocopy of a list of vaccine and toxoid agents (from Tables 28-2 and 28-3) and have them fill in the name of the disease the agent treats. The first team to fill in all the diseases correctly wins. As a follow-up, have the students correct their matching lists and quiz them on the various routes of administration.


ObjectivesObjectives

Describe the importance of vaccines.Describe the importance of vaccines. Explain how vaccines are produced.Explain how vaccines are produced. List the most common vaccines.List the most common vaccines. Explain how the body builds up immunity Explain how the body builds up immunity

against diseases.against diseases.


Objectives Objectives (cont’d)(cont’d)

Describe where immune cells are produced Describe where immune cells are produced and what their function is.and what their function is.

Differentiate between active and passive Differentiate between active and passive immunity.immunity.

List the schedule for administering vaccines.List the schedule for administering vaccines.


Objectives Objectives (cont’d)(cont’d)

Explain why some vaccines need boosters, Explain why some vaccines need boosters, whereas others do not.whereas others do not.

Explain under which circumstances adults Explain under which circumstances adults should receive vaccines.should receive vaccines.


IntroductionIntroduction

Vaccines:Vaccines: Prevent infection.Prevent infection. Have contributed to longevity in humans.Have contributed to longevity in humans. Developing countries still face higher risk of Developing countries still face higher risk of

contracting bacterial and viral infections.contracting bacterial and viral infections.


The Lymphatic SystemThe Lymphatic System Body’s built-in defense mechanismBody’s built-in defense mechanism Helps protect from invading organismsHelps protect from invading organisms Primary source of immune cell productionPrimary source of immune cell production Referred to as immune systemReferred to as immune system Lymph nodes produce arsenal of weaponsLymph nodes produce arsenal of weapons Organs: thymus, tonsils, spleenOrgans: thymus, tonsils, spleen


ThymusThymus

Located in upper chest and middle of neck Located in upper chest and middle of neck regionregion

Primary function—produce lymphocytesPrimary function—produce lymphocytes Production begins before birthProduction begins before birth Organ larger in childhood than adulthoodOrgan larger in childhood than adulthood


Overview of the Major Overview of the Major Lymphatic OrgansLymphatic Organs


TonsilsTonsils

Lymphoid tissueLymphoid tissue Tonsils and adenoidsTonsils and adenoids Located in throat, noseLocated in throat, nose Help fight off infection; filter bacteria, other Help fight off infection; filter bacteria, other

infective materialinfective material


SpleenSpleen

Located in left side of upper abdomenLocated in left side of upper abdomen Largest lymphatic organ in bodyLargest lymphatic organ in body Function: filter large amount of blood cells at Function: filter large amount of blood cells at

end of their life cycleend of their life cycle Macrophages in spleen remove cellular Macrophages in spleen remove cellular

debrisdebris


Types of Immune CellsTypes of Immune Cells

On first contact with foreign body On first contact with foreign body (antigen)—antibodies form(antigen)—antibodies form

Lymphocytes:Lymphocytes: Major fighting cells of body; patrol body Major fighting cells of body; patrol body

circulating through bloodstreamcirculating through bloodstream Reside in lymph nodes and tissues waiting to Reside in lymph nodes and tissues waiting to

attack foreign bodiesattack foreign bodies


Types of Immune Cells Types of Immune Cells (cont’d)(cont’d)

Two types: Two types: B cells—have antibodiesB cells—have antibodies T cells—perform cell mediated immune response T cells—perform cell mediated immune response

(direct killing of attached cell)(direct killing of attached cell)


Major Immune Response CellsMajor Immune Response CellsMajorMajor Origin of Origin of LocationLocationCell TypesCell Types ProductionProduction in Bodyin Body FunctionFunction

T lymphocytesT lymphocytes Lymph nodesLymph nodes Lymph nodesLymph nodes Produces more Produces more T lymphocytes T lymphocytes that are that are sensitized to sensitized to specific specific antigensantigens

B lymphocytesB lymphocytes Bone marrowBone marrow Lymph nodesLymph nodes ProducesProduces(prenatal,(prenatal, specific specific produced inproduced in

antibodiesantibodies

liver) liver) Plasma cellsPlasma cells Lymph fromLymph from BloodstreamBloodstream AntibodiesAntibodies

B cellsB cells


Major Immune Response CellsMajor Immune Response Cells (cont’d)(cont’d)

MajorMajor Origin of Origin of LocationLocationCell TypesCell Types ProductionProduction in Bodyin Body FunctionFunction

Memory cellsMemory cells Lymph fromLymph from Lymph nodesLymph nodes Creates aCreates aB cells B cells memorymemory

antibodyantibody

T cellsT cells Thymus glandThymus gland Bloodstream, Bloodstream, Binds to Binds to lymph nodes lymph nodes a specific a specific

antigenantigen


Immunizations are given to stimulate antibodies Immunizations are given to stimulate antibodies to protect body from disease (whooping cough, to protect body from disease (whooping cough, tetanus, polio).tetanus, polio).

Centers for Disease Control and Prevention—Centers for Disease Control and Prevention—recommends course of vaccinations for children.recommends course of vaccinations for children.

ImmunizationsImmunizations


Children at risk for contracting:Children at risk for contracting:

Children and adults better protected against Children and adults better protected against diseasesdiseases

Higher risk—persons with weakened immune Higher risk—persons with weakened immune systems, transplants, AIDSsystems, transplants, AIDS

− MeaslesMeasles − Chicken poxChicken pox

− MumpsMumps − Whooping coughWhooping cough

− RubellaRubella − PolioPolio

Immunizations Immunizations (cont’d)(cont’d)


ImImmunizations munizations (cont’d)(cont’d)

What are some ways that diseases can be What are some ways that diseases can be transmitted?transmitted?

High risk pop—people from countries High risk pop—people from countries where immunizations not givenwhere immunizations not given


Types of ImmunityTypes of Immunity

Active natural immunity:Active natural immunity: Occurs when body is exposed to a disease and Occurs when body is exposed to a disease and

actively produces antibodies to respond to the actively produces antibodies to respond to the diseasedisease

Occurs when vaccines administeredOccurs when vaccines administered Two types of vaccine: Two types of vaccine:

Live, attenuated (weakened)-small risk of developing Live, attenuated (weakened)-small risk of developing full blown infectionfull blown infection

Disadvantage: Need booster shots to keep the Disadvantage: Need booster shots to keep the antibodies at a high enough levelantibodies at a high enough level

Passive immunityPassive immunity


How Vaccines Are PreparedHow Vaccines Are Prepared

Viral vaccines:Viral vaccines: Live vaccines must be attenuated (weakened) Live vaccines must be attenuated (weakened)

before given to patients.before given to patients. Virions—weakened or diffused so as not to cause Virions—weakened or diffused so as not to cause

full-blown disease.full-blown disease. Antigen: virus or any known foreign Antigen: virus or any known foreign

substance.substance.


Boosters—vaccines given in a series—outer Boosters—vaccines given in a series—outer shell of virus usedshell of virus used

Bacterial antigens—cholera, typhoid—require Bacterial antigens—cholera, typhoid—require boostersboosters

How Vaccines Are Prepared How Vaccines Are Prepared (cont’d)(cont’d)


Common Viral Vaccines, Diseases Common Viral Vaccines, Diseases Treated, Route of AdministrationTreated, Route of Administration

Vaccine AgentsVaccine Agents Disease TreatedDisease Treated Route of AdministrationRoute of AdministrationHavrixHavrix Hepatitis AHepatitis A Intramuscular (IM)Intramuscular (IM)Engerix, Engerix, Hepatitis BHepatitis B IMIMRecombivax HBRecombivax HBFluzoneFluzone InfluenzaInfluenza IMIMMMR IIMMR II Measles, mumps,Measles, mumps, Subcutaneous (SC)Subcutaneous (SC)

and rubellaand rubellaAttenuvaxAttenuvax MeaslesMeasles SCSCMumpsvaxMumpsvax MumpsMumps SCSCMeruvax IIMeruvax II RubellaRubella SCSCIPOLIPOL PolioPolio SC or IMSC or IMVarivaxVarivax Chicken poxChicken pox SCSCYF-VaxYF-Vax Yellow feverYellow fever SCSC


How Vaccines Are Prepared How Vaccines Are Prepared (cont’d)(cont’d)

Toxoids:Toxoids: Inactivated bacterial toxinsInactivated bacterial toxins Can induce an antibody response in bodyCan induce an antibody response in body

Adult vaccines—tetanus (every 10 years) Adult vaccines—tetanus (every 10 years) throughout lifethroughout life


Common ToxoidsCommon Toxoidsand Route of Administrationand Route of Administration

ToxoidToxoid DiseaseDisease Route of Route of AgentsAgents TreatedTreated AdministrationAdministrationTetanus toxoidTetanus toxoid TetanusTetanus SCSC

IMIM

Diphtheria Diphtheria Diphtheria,Diphtheria, IMIMand tetanusand tetanus tetanustetanus

DPTDPT Diphtheria,Diphtheria, IMIMtetanus,tetanus,pertussispertussis

DPTDPT, diphtheria, pertussis, and tetanus; , diphtheria, pertussis, and tetanus; IMIM, intramuscular; , intramuscular; SCSC, subcutaneous., subcutaneous.


Development of VaccinesDevelopment of Vaccines

To develop a vaccine, large number To develop a vaccine, large number of contagious cells must be collectedof contagious cells must be collected

Comes through use of lab animalsComes through use of lab animals For diseases that only occur in human, culture For diseases that only occur in human, culture

cells from humanscells from humans Research being done on HIVResearch being done on HIV Danger present with vaccine administration-may Danger present with vaccine administration-may

repeat polio vaccine incident of the 1950srepeat polio vaccine incident of the 1950s


Development of Vaccines Development of Vaccines (cont’d)(cont’d)

Less common vaccines include:Less common vaccines include: Subunit, Antiidiotypic, Acellular and conjugatedSubunit, Antiidiotypic, Acellular and conjugated

Only two types of vaccines available:Only two types of vaccines available: BacterialBacterial ViralViral

No vaccine available for parasitic, No vaccine available for parasitic, fungal infectionsfungal infections


Childhood ImmunizationChildhood Immunization

United States recommends a series of United States recommends a series of vaccinations for children.vaccinations for children.

No school registration without immunizations.No school registration without immunizations. Childhood immunization schedule should be Childhood immunization schedule should be

followedfollowed Side effects include: fever, rash, soreness, Side effects include: fever, rash, soreness,

swelling and redness at the site of the injectionswelling and redness at the site of the injection


National Childhood Vaccine Injury National Childhood Vaccine Injury Act of 1986Act of 1986

Act passed 1986 by congress.Act passed 1986 by congress. Act is compensation program for those injured Act is compensation program for those injured

after receiving routine vaccines.after receiving routine vaccines.


Autism and Vaccines Autism and Vaccines

Many studies have looked to see if there is a Many studies have looked to see if there is a direct relationship between childhood autism direct relationship between childhood autism and vaccines.and vaccines.

To date, all scientifically sound studies have To date, all scientifically sound studies have failed to find an association between vaccines failed to find an association between vaccines and the occurrence of autism.and the occurrence of autism.


Diphtheria, Pertussis, Diphtheria, Pertussis, and Tetanus (DPT) Vaccineand Tetanus (DPT) Vaccine

Diphtheria causes breathing problems from Diphtheria causes breathing problems from thick mucus covering back of throat.thick mucus covering back of throat.

Pertussis: whooping cough Pertussis: whooping cough (traumatic coughing spasms), can lead to (traumatic coughing spasms), can lead to pneumonia, death.pneumonia, death.

Tetanus: lockjaw, painful muscle spasms.Tetanus: lockjaw, painful muscle spasms.


DPT vaccines given in 5 doses.DPT vaccines given in 5 doses. Doses spread out over several years.Doses spread out over several years. Pertussis only given to children younger than Pertussis only given to children younger than

7 years.7 years. Tetanus boosters must be given every Tetanus boosters must be given every

10 years. 10 years.

Diphtheria, Pertussis, and Tetanus Diphtheria, Pertussis, and Tetanus (DPT) Vaccine (DPT) Vaccine (cont’d)(cont’d)


Polio VaccinePolio Vaccine

Main polio symptom is paralysis of muscles of Main polio symptom is paralysis of muscles of legs, respiratory system.legs, respiratory system.

Mid-1950s polio vaccine developed.Mid-1950s polio vaccine developed. Oral dose no longer used (can cause infection).Oral dose no longer used (can cause infection). Injectable form used currently—four Injectable form used currently—four

immunizations.immunizations.


Measles, Mumps, and Rubella (MMR) Measles, Mumps, and Rubella (MMR) VaccineVaccine

Measles: serious with flulike symptoms.Measles: serious with flulike symptoms. Can progress to major infection—Can progress to major infection—

pneumonia, brain damage, death.pneumonia, brain damage, death.


Mumps—affects parotid glands of Mumps—affects parotid glands of body—visibly enlarged, fever.body—visibly enlarged, fever.

Can cause meningitis and deafnessCan cause meningitis and deafness


Measles, Mumps, and Rubella (MMR) Measles, Mumps, and Rubella (MMR) Vaccine Vaccine (cont’d)(cont’d)

Rubella—also called German measlesRubella—also called German measles Pregnant women—contagious to fetus; vaccine Pregnant women—contagious to fetus; vaccine

given 3 months before pregnancygiven 3 months before pregnancy Symptoms: rash, feverSymptoms: rash, fever MMR—two shotsMMR—two shots


Chickenpox VaccineChickenpox Vaccine

Varicella (chickenpox) vaccineVaricella (chickenpox) vaccine Very contagious disease; rarely causes deathVery contagious disease; rarely causes death Symptoms: skin blisters, fever, itchy rashSymptoms: skin blisters, fever, itchy rash Severe effects: brain damage, infection, death Severe effects: brain damage, infection, death

(rarely)(rarely)


Chickenpox Vaccine Chickenpox Vaccine (cont’d)(cont’d)

Shingles is disease caused by chicken pox virus Shingles is disease caused by chicken pox virus

(herpes zoster) in adulthood.(herpes zoster) in adulthood. Symptoms include: painful lesions along nerves.Symptoms include: painful lesions along nerves. Treatments: valacyclovir (Valtrex); acyclovir Treatments: valacyclovir (Valtrex); acyclovir

(Zovirax)—7-day period to reduce pain.(Zovirax)—7-day period to reduce pain. 2006: Single dose developed for adults older 2006: Single dose developed for adults older

than 60 yrs.than 60 yrs.


Hepatitis VaccinesHepatitis Vaccines

Hepatitis A: rare, but does have a vaccineHepatitis A: rare, but does have a vaccine Hep A spread through contaminated water Hep A spread through contaminated water

supplysupply Hepatitis B—has many side effects:Hepatitis B—has many side effects:

Diarrhea, vomiting, jaundice, lack of energyDiarrhea, vomiting, jaundice, lack of energy Can lead to liver damage, death.Can lead to liver damage, death. Virus contagious via blood and body fluids.Virus contagious via blood and body fluids. Contracted through unprotected sex, sharing Contracted through unprotected sex, sharing

syringes, infected needles.syringes, infected needles.


Hepatitis Vaccines Hepatitis Vaccines (cont’d)(cont’d)

Series of four doses:Series of four doses: First dose—newborns immunized First dose—newborns immunized

right after birthright after birth Second dose—1 month after firstSecond dose—1 month after first Third dose—4 months laterThird dose—4 months later Last dose—child is 6 months oldLast dose—child is 6 months old


Hepatitis Vaccines Hepatitis Vaccines (cont’d)(cont’d)

Hepatitis CHepatitis C May not show any symptomsMay not show any symptoms No vaccineNo vaccine

Treatment: peginterferon (Pegasys) and Treatment: peginterferon (Pegasys) and ribavirin ribavirin


HPV VaccineHPV Vaccine

Human papillovirus (HPV) common around Human papillovirus (HPV) common around world, affects both genders.world, affects both genders.

There are 100 types HPV.There are 100 types HPV. Most vulnerable age: teens through 20sMost vulnerable age: teens through 20s Virus causes cervical cancer, genital warts.Virus causes cervical cancer, genital warts.


HPV Vaccine HPV Vaccine (cont’d)(cont’d)

Vaccine: persons 9 to 26 yrsVaccine: persons 9 to 26 yrs Best time: before sexual activity occursBest time: before sexual activity occurs Three injections: over 6 monthsThree injections: over 6 months Side effect: soreness at injection siteSide effect: soreness at injection site Not safe for pregnant womenNot safe for pregnant women


Pneumonia VaccinePneumonia Vaccine

Pneumococcal conjugate vaccine—given for Pneumococcal conjugate vaccine—given for Streptococcus pneumoniae Streptococcus pneumoniae (causes pneumonia)(causes pneumonia)

Serious disease—causes pneumonia, brain Serious disease—causes pneumonia, brain damage, deathdamage, death

Vaccine—three doses @ 2, 4, 6 months then Vaccine—three doses @ 2, 4, 6 months then between 12 and 15 monthsbetween 12 and 15 months

Pneumococcal polysaccharide—adult vaccine Pneumococcal polysaccharide—adult vaccine (meningitis, pneumonia)(meningitis, pneumonia)


Haemophilus InfluenzaHaemophilus Influenza Type B (HiB Vaccine)Type B (HiB Vaccine)

HiB—to prevent bacterial infection HiB—to prevent bacterial infection Haemophilus influenzae Haemophilus influenzae type Btype B

Symptoms mild if infection remains in nose Symptoms mild if infection remains in nose and throatand throat

May spreads to lungs—may cause May spreads to lungs—may cause pneumonia, meningitis, brain damage, pneumonia, meningitis, brain damage, systemic infectionsystemic infection

Series of four shotsSeries of four shots


Influenza VaccinesInfluenza Vaccines

Protect against persons at high risk for Protect against persons at high risk for influenza.influenza.

FDA (2003) approved new intranasal spray FDA (2003) approved new intranasal spray vaccine: FluMist.vaccine: FluMist.

Side effects include: runny nose, nasal Side effects include: runny nose, nasal congestion, headache, sore throat, chills, cough.congestion, headache, sore throat, chills, cough.


Influenza Vaccines Influenza Vaccines (cont’d)(cont’d)

Use only on healthy children older than 5 yrs Use only on healthy children older than 5 yrs and adults up to 49 yrs.and adults up to 49 yrs.

Fluvin, Fluzone vaccine given IM.Fluvin, Fluzone vaccine given IM. Side effects include: soreness, fever, myalgia, Side effects include: soreness, fever, myalgia,

malaise.malaise. Fluzone: children 6 to 23 months; 2-50+ yrs.Fluzone: children 6 to 23 months; 2-50+ yrs.



Do not give to children younger than 6 months, Do not give to children younger than 6 months, or persons with egg allergy.or persons with egg allergy.

CDC: only vaccine for persons over 50 yrs is CDC: only vaccine for persons over 50 yrs is killed trivalent influenza vaccine (TIV).killed trivalent influenza vaccine (TIV).



Swine flu (H1N1)is very different from Swine flu (H1N1)is very different from previous human seasonal influenza viruses previous human seasonal influenza viruses (2009).(2009). Caused severe illness and deaths especially in Caused severe illness and deaths especially in

high-risk groups. high-risk groups. Vaccine recommended for high-risk groups.Vaccine recommended for high-risk groups.


Passive ImmunityPassive Immunity

Passive immunity:Passive immunity: Does not require any work on part of bodyDoes not require any work on part of body Receives protection from other sources Receives protection from other sources

(immune globulins)(immune globulins)


Travel Medicine and ImmunizationsTravel Medicine and Immunizations

Adults receive immunizations for travel Adults receive immunizations for travel outside of United States.outside of United States.

U.S. military—vaccinates against 12 top U.S. military—vaccinates against 12 top contagions.contagions.

Adults needing vaccines include: scientists, Adults needing vaccines include: scientists, researchers, lab animal caretakers.researchers, lab animal caretakers.


Example of VaccinesExample of VaccinesVaccineVaccine Disease or OrganismDisease or Organism RecommendationRecommendation

CholeraCholera Vibrio choleraeVibrio cholerae Persons living or Persons living or traveling to endemictraveling to endemic areas where the areas where the

disease occurs; disease occurs; militarymilitary

PlaguePlague Yersinia pestisYersinia pestis Persons protecting Persons protecting against wild rodents against wild rodents in endemic areas; militaryin endemic areas; military

Yellow feverYellow fever Endemic areasEndemic areas Persons living in or Persons living in or traveling to endemic traveling to endemic areas; militaryareas; military

AnthraxAnthrax AnthraxAnthrax Military only at Military only at this timethis time


Antitoxins and AntiveninsAntitoxins and Antivenins

Antitoxins, antivenins:Antitoxins, antivenins: Passive immunity system for short-term Passive immunity system for short-term

protection from serious symptomsprotection from serious symptoms Contain antibodies to neutralize dangerous toxinsContain antibodies to neutralize dangerous toxins

Stepping on rusty nail—Stepping on rusty nail—Clostridium tetaniClostridium tetani Tetanus antitoxin givenTetanus antitoxin given


Antitoxins and Antivenins Antitoxins and Antivenins (cont’d)(cont’d)

Antivenins counteract poison from snakes, Antivenins counteract poison from snakes, spiders, and so forthspiders, and so forth

Common antitoxins:Common antitoxins: DiphtheriaDiphtheria RabiesRabies BotulismBotulism

Common antivenins:Common antivenins: Black widow spiderBlack widow spider RattlesnakeRattlesnake


Storage of VaccinesStorage of Vaccines

CDC&P – guidelines on storage for vaccines; CDC&P – guidelines on storage for vaccines; preserve effectivenesspreserve effectiveness

Most vaccine stored between 2Most vaccine stored between 2°-8°°-8° FluMist – frozen in specially made freeze boxFluMist – frozen in specially made freeze box


Immune TherapiesImmune Therapies

Biological therapy or biotherapyBiological therapy or biotherapy Biological response modifiers (BRMs): Biological response modifiers (BRMs):

suppress or stimulate the immune systemsuppress or stimulate the immune system Body produces small amountBody produces small amount Scientists produce large amounts in labScientists produce large amounts in lab Cancer, rheumatoid arthritis, Crohn’s diseaseCancer, rheumatoid arthritis, Crohn’s disease


Immune Therapies Immune Therapies (cont’d)(cont’d)

Side effects: if severe, patient admitted to Side effects: if severe, patient admitted to hospitalhospital

Table 28-7Table 28-7


Special Situations Special Situations for Vaccination—Pregnancyfor Vaccination—Pregnancy

Pregnant women—contracting hepatitis Pregnant women—contracting hepatitis poses high risk to fetus.poses high risk to fetus.

High-risk women—given DT, hepatitis B, High-risk women—given DT, hepatitis B, influenza vaccines.influenza vaccines.

chapter 27

Documents