Vaccine (Vaccination)


Article Author:
Angel Justiz Vaillant


Article Editor:
Marc Grella


Editors In Chief:
Niamh Condon
Terry Tressler


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
10/5/2019 3:13:35 AM

Indications

Immunization is a successful use of immunotherapy to treat many infectious diseases by stimulating the immune system to produce specific antibodies or specific lymphocytes to fight off pathogens and more recent to protect against malignant tumors.  This immunotherapy creates an immunological memory that can be long-lasting. The current immunizations protect against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, pneumococcal pneumonia, smallpox, sepsis, meningitis, hepatitis B, varicella-zoster, tuberculosis, cholera, diarrhea caused by rotavirus, salmonellosis, and dengue. However, the development of vaccine technology in recent years, the emergence of HIV, SARS, avian influenza, Ebola, and Zika emphasizes the need for global preparedness for a pandemic.[1]

Mechanism of Action

Live vaccines are most effective than killed vaccines because they retain more antigens of the microbes. However, toxoids, including those that cause tetanus and diphtheria are the most effective bacterial vaccines of all because it bases on inactivated exotoxins that stimulate strong antibody production. Subunit vaccines, including hepatitis B, meningococcal, and Hemophilus influenzae B vaccines are effective when conjugated to carrier proteins such as tetanus toxoid. Vaccinologists produce subunit vaccines either by recombinant DNA technology or by antigen purification from different bacterial strains.[2]

Vaccines contain one or various immunogens (peptides), which antigen-presenting cells can engulf, process, and present along with MCH antigens to CD4+ T cells. These lymphocytes can synthesize cytokines that activate humoral and cellular responses, including antibody production, activation of CD8+ T cells, macrophage stimulation, and other functions.[3] Memory cells can develop in this process. They can proliferate more quickly in further encounters with the antigen. 

B cells can recognize vaccines made of carbohydrates and other compounds except for proteins. Subsequently, B lymphocytes can differentiate into plasma cells that produce specific antibodies to protect against infectious diseases caused by bacteria (including meningitis caused by N. meningitidis and pneumonia caused by S. pneumoniae). This immune response against a non-peptidic antigen does not involve T-cell presentation, class switching, affinity maturation, or generation of memory T cells.[4]

Using adjuvants enhances antibody synthesis and T-cell responses.[5] Certain compounds, including aluminum salts added to immunogens, stimulate immune responses. This effect can mediate by two essential functions: cytokine induction that regulate T and B cell functions and increased antigen presentation in sites where lymphocytes can concentrate. Many bacterial substances can activate pattern recognition receptors[6] that activate cytokine production by antigen-presenting cells. 

Immunological studies for testing the humoral and cellular immunity after immunizing a host: 

Quantitative Serum Immunoglobulins

  • IgG
  • IgM
  • IgA
  • IgE

IgG Sub-Classes

  • IgG1
  • IgG2
  • IgG3
  • IgG4

Antibody Activity 

IgG antibodies (post-immunization)[7]

  • Tetanus toxoid
  • Diphtheria toxoid
  • Pneumococcal polysaccharide
  • Polio

IgG antibodies (post-exposure)

  • Rubella
  • Measles
  • Varicella-zoster

Blood lymphocyte subpopulations

  • Total lymphocyte count
  • T lymphocytes (CD3, CD4, and CD8)
  • B lymphocytes (CD19 and CD20)
  • CD4/CD8 ratio

Microbiological studies

  • Blood (bacterial culture, HIV by PCR, HTLV testing)
  • Urine (testing for cytomegalovirus, sepsis, and proteinuria)
  • Nasopharyngeal swab (testing for rhinovirus)
  • Stool (testing for viral, bacterial or parasitic infection)
  • Sputum (bacterial culture and pneumocystis PCR)
  • Cerebrospinal fluid (culture, chemistry, and histopathology)

Administration

Most human vaccines are administered by injection, although this approach is risky in the developing world where the use of injections can transmit diseases such as HIV infections.[8] Live vaccines can be given orally but not killed vaccines. Alternatively, the use of the oral route and other mucosal surfaces have been explored as immunization route. For example, polio vaccination underwent a successful implementation via the oral route.

Adverse Effects

Attenuated vaccines have several potential safety issues, including:

  • Hypersensitivity to viral antigens (measles)
  • Hypersensitivity to egg antigens (mumps)
  • Persistent infection (varicella-zoster)
  • In an immunodeficient patient, it may cause severe disease (BCG)

Killed vaccine safety issues include:

  • Yeast contaminant (hepatitis B)
  • Contamination with animal viruses (polio)
  • Endotoxin contamination (pertussis)

Contraindications

All vaccines have as contraindications severe allergic reactions (e.g., anaphylactic reaction) after a previous dose or to a vaccine component. DTaP should contraindicate if the child develops encephalopathy within seven days of administration of a prior dose of DTP or DTaP and after ruled out other causes of brain illness. Hepatitis B vaccine contraindicates in patients with hypersensitivity to yeast. Hib vaccine is contraindicated in infants aged less than 6 weeks.

MMR vaccine is avoided in those with a known severe immunodeficiency due to lymphoid malignancies, congenital cause, chemotherapy, family history of immunosuppression, and in patients with HIV/AIDS. Rotavirus vaccine must contraindicate in children with a history of intussusception, and it should use with precaution in altered immunocompetence, other than severe combined-immunodeficiency disorder. Both varicella and zoster vaccines contraindicate in immunocompromised host and pregnancy. Live-attenuated influenza virus vaccine should be avoided when in the previous 48 hours a patient has taken influenza antiviral medication; dosing should proceed with caution in patients who developed Guillain-Barre syndrome within six weeks after a prior dose of influenza vaccine and in patients who have asthma.

Monitoring

Most vaccines have adverse reactions as any drug or medication. For example, BCG vaccination may provoke fever, vomiting, hematuria, lymphadenitis, and redness at the site of injection. HiB vaccine has few adverse reactions, and none of them are dangerous. These reactions include redness, warmth, swelling, and fever over 101 degrees F. A rare and lethal adverse reaction secondary to vaccination is the Guillain-Barre syndrome.[9][10]

Toxicity

Anaphylactic reactions are examples of allergic reaction that can affect individuals that vaccinated. They can treat with aqueous epinephrine 1:1000 dilution intramuscularly (IM), 0.01 mL/kg/dose. The adult dose can range from 0.3 mL to 0.5 mL. Optional treatment is the use of an H1 antihistamine for skin reactions (hives or itching). It can administer diphenhydramine (either orally or IM). Inject a dosage of 1 to 2 mg/kg every 4 to 6 hrs, up to 50 mg) or hydroxyzine 0.5 to 1 mg/kg every 4 to 6 hrs up to 100 mg. 

The dosage of epinephrine can repeat every 5 to 15 minutes for up to 3 doses, depending on the clinical picture. Record the patient’s reaction, the medications, and the health care provided to the patient, and the name of the personnel who administer the drug.

Enhancing Healthcare Team Outcomes

An interprofessional team of scientists and healthcare professionals produces vaccines. Once the FDA approves the vaccines, it can be manufactured a large scale by biotechnologists. In the healthcare setting a pediatrician or family doctor orders or restricts the use of the immunization in a child. Nurses or pharmacists often carry out the immunization procedure.  Side effects of the vaccines can monitor by primary care physicians, pharmacists, and nurses, and when adverse events occur, they need to be communicated to the rest of the team. The emergency service plays a vital role in cases of allergic reactions, including anaphylaxis, where it brings together primary health care services with secondary or tertiary healthcare institutions. The treating clinician, along with nursing and pharmacy, needs to manage the patient's vaccine record and ensure that they remain up to date. Only with this type of collaborative interprofessional effort can vaccinations be as effective as they need to be in preventing disease, both for the individual patient as well as in the public health arena for transmissible pathogens. [Level V]


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Vaccine (Vaccination) - Questions

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A 15-month-old boy is brought for evaluation of a cough and runny nose. He has a fever of 100.2 degrees Fahrenheit, but his examination is only remarkable for the clear nasal discharge, and he is alert and playful. Which of the following is true?



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A 2-year-old child living in a residential institution for developmentally impaired children should receive which of the following vaccinations for prevention of infection?



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Which of the following is not given during routine vaccinations at the 2 month well child visit?



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Which vaccine is not routinely given at two months?



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Which of the following can you primarily used to prevent an infectious disease?



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Which of the following vaccines is contraindicated for patients undergoing chemotherapy?



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Which of the following vaccines is least important for patients with sickle cell disease?



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When should live virus vaccines such as measles, mumps, and rubella be administered to pregnant women?



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Which of the following statements about vaccinations is true?



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A vaccination list for a 9-month-old girl during a routine well-child visit shows that she has only had one DTaP, IPV, and HIB conjugate vaccine at 2 months of age despite regular visits to her previous primary care provider. Her mother reports that vaccines were not given at regularly scheduled times secondary to symptoms of a runny nose or low-grade fever at her 4- and 6-month well-child visits. Which of the following is true regarding childhood vaccination?



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A patient is receiving his second dose of DTaP, IPV, and HIB conjugate vaccine at the age of 6 months. His mother knows he is behind on his vaccines and asks how soon he can get his next dose. What is the best reply?



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Which vaccines are not intended for children?



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Which of the following is true regarding vaccines?



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When vaccinating a child, what interventions are available to ease the pain and fear associated with the procedure? Select all that apply.

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Attributed To: Contributed by the Centers for Disease Control and Prevention (CDC)



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What is meant by immunization or vaccination?



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Which diseases do not have vaccines?



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What is the most effective vaccine technology?



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Against which immunogen do lymphocytes B not develop an immunological immune response?



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Vaccine (Vaccination) - References

References

Rauch S,Jasny E,Schmidt KE,Petsch B, New Vaccine Technologies to Combat Outbreak Situations. Frontiers in immunology. 2018     [PubMed]
Wada H,Shimizu A,Osada T,Tanaka Y,Fukaya S,Sasaki E, Correction: Development of a novel immunoproteasome digestion assay for synthetic long peptide vaccine design. PloS one. 2018     [PubMed]
Liu H,Jia Z,Yang C,Song M,Jing Z,Zhao Y,Wu Z,Zhao L,Wei D,Yin Z,Hong Z, Aluminum hydroxide colloid vaccine encapsulated in yeast shells with enhanced humoral and cellular immune responses. Biomaterials. 2018 Jun     [PubMed]
Gornati L,Zanoni I,Granucci F, Dendritic Cells in the Cross Hair for the Generation of Tailored Vaccines. Frontiers in immunology. 2018     [PubMed]
Zhang S,Zhao S,Jin X,Wang B,Zhao G, Microneedles Improve the Immunogenicity of DNA Vaccines. Human gene therapy. 2018 Sep     [PubMed]
Wajih Ullah M,Qaseem A,Amray A, Post Vaccination Guillain Barre Syndrome: A Case Report. Cureus. 2018 Apr 20     [PubMed]
Principi N,Esposito S, Vaccine-preventable diseases, vaccines and Guillain-Barre' syndrome. Vaccine. 2018 Jun 4     [PubMed]
Boumart Z,Daouam S,Bamouh Z,Jazouli M,Tadlaoui KO,Dungu B,Bettinger G,Watts DM,Elharrak M, Safety and immunogenicity of a live attenuated Rift Valley Fever recombinant arMP-12ΔNSm21/384 vaccine candidate for sheep, goats and calves. Vaccine. 2019 Feb 14;     [PubMed]
Falkard B,Charles RC,Matias WR,Mayo-Smith LM,Jerome JG,Offord ES,Xu P,Kováč P,Ryan ET,Qadri F,Franke MF,Ivers LC,Harris JB, Bivalent oral cholera vaccination induces a memory B cell response to the V. cholerae O1-polysaccharide antigen in Haitian adults. PLoS neglected tropical diseases. 2019 Jan;     [PubMed]
Shojaei Jeshvaghani F,Amani J,Kazemi R,Karimi Rahjerdi A,Jafari M,Abbasi S,Salmanian AH, Oral immunization with a plant-derived chimeric protein in mice: Toward the development of a multipotent edible vaccine against E. coli O157: H7 and ETEC. Immunobiology. 2018 Dec 11;     [PubMed]

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