Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Vaccines and Immunoglobulins 14

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PHARMACOLOGYPHARMACOLOGYESSENTIALS FOR HEALTH PROFESSIONALS

CHAPTER

Vaccines andImmunoglobulins

14

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Multimedia DirectoryMultimedia Directory

Slide 7Lymphatic System Animation


Immune SystemImmune System

• Rids foreign substances from blood and lymph, combats infectious diseases, maintains tissue fluid balance, absorbs fats


Lymphatic SystemLymphatic System

• Vessels: Network of lymphatic vessels beginning in peripheral tissues and ending at connections to the venous system

• Fluid: Lymph flows through lymphatic vessels


Lymphatic SystemLymphatic System

• Lymphoid organs: Lymphoid organs are connected to lymphatic vessels; contain large numbers of lymphocytes – Examples: lymph nodes, spleen, and

thymus


Figure 14-1 The lymphatic system includes the tonsils, lymph nodes, spleen, and lymphatic vessels. Within the lymph nodes are the macrophages and lymphocytes.


Lymphatic System AnimationLymphatic System Animation

Click on the screenshot to view an animation showing the lymphatic system. The animation may take a moment before playing.

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LymphocytesLymphocytes

• Lymphocytes (white blood cells) respond to:– Invading pathogens, such as bacteria or

viruses– Abnormal body cells, such as cancer cells– Foreign proteins, such as toxins released

by some bacteria

• Lymphocytes produce special proteins called antibodies.


Three Classes of LymphocytesThree Classes of Lymphocytes

• T cells (thymus-dependent): attack foreign cells or body cells infected by viruses

• B cells (bone marrow–derived): can differentiate into plasma cells, which are responsible for the production and secretion of antibodies


Three Classes of LymphocytesThree Classes of Lymphocytes

• NK cells (natural killers): attack foreign cells, normal cells infected with viruses, and cancer cells that appear in normal tissue


ImmunityImmunity

• State or condition of being resistant to invading microorganisms

• Normally acquired either by contracting a disease and then developing immunity to it, or by being vaccinated with proteins from the causative agent


Cell-mediated ImmunityCell-mediated Immunity

• T lymphocytes are sensitized by first contact with a specific antigen.

• T cells and macrophages (immune cells derived from monocytes) destroy antigen.

• T cells attack antigens directly, rather than produce antibodies.


Cell-mediated ImmunityCell-mediated Immunity

• If cell-mediated immunity is lost, as in AIDS, the body is unable to protect itself against many viral, bacterial, and fungal infections.


Humoral ImmunityHumoral Immunity

• B cells produce circulating antibodies to act against an antigen.

• B cells form daughter lymphocytes, which develop into plasma cells that produce antibodies and release them into the circulation at the lymph nodes.


Humoral ImmunityHumoral Immunity

• Some activated B cells turn into memory cells, which continue to produce small amounts of antibody after infection is overcome.


Active ImmunityActive Immunity

• A form of acquired immunity that develops in an individual in response to an immunogen (antigen).

• May be naturally acquired by exposure to an infectious disease or artificially acquired by receiving active immunizing agents (vaccines).

• Vaccination is active immunization.


Passive ImmunityPassive Immunity

• Effectors of immunity, which are called immunoglobulins or antibodies, are transferred from immune individual to another.

• Immunoglobulin G (IgG) antibodies transfer from mother to fetus across placental barrier.


Passive ImmunityPassive Immunity

• Onset of passive immunity is quicker but of shorter duration than active immunity.


Figure 14-2 Types of immunity.


Immunizing AgentsImmunizing Agents

• A vaccine is a preparation of killed microorganisms, living attenuated (reduced virulence) organisms, or living virulent organisms that are administered to produce or artificially increase immunity to a particular disease.


Active Versus Passive AgentsActive Versus Passive Agents

• Active: usually administered to patients prior to disease exposure to provide long-term, even permanent, protection against the diseases

• Passive: older than active agents; comprised various antitoxins derived from animals; had problems in efficacy and safety


VaccinesVaccines

• Most bacterial vaccines contain killed bacteria or their components.

• Another type of vaccine contains toxoids (protein toxins that have been modified to reduce their hazardous properties without significantly altering their antigenic properties); oldest of these are diphtheria and tetanus toxoid.


Table 14-1 Bacterial Vaccines


Table 14-1 (continued) Bacterial Vaccines


Table 14-2 Inactivated Virus Vaccines


Vaccines: Mechanism of ActionVaccines: Mechanism of Action

• Exposure to an antigen (a virus or bacterium) in a relatively harmless form sensitizes immune cells.

• On reexposure, memory of previous challenge triggers an immune response more quickly.

• As immune processes are stimulated by this agent, active immunity occurs.


Vaccines: UseVaccines: Use

• Used against bacterial infections: diphtheria, tetanus, pertussis, pneumonia, tuberculosis, typhoid, cholera, meningitis, plague, and Q fever.

• Used against viral infections: measles, mumps, rubella (MMR), poliomyelitis, hepatitis A and B, influenza, rabies, and yellow fever.


Vaccines: Adverse EffectsVaccines: Adverse Effects

• Common: localized inflammation at injection site, mild fever, headache, malaise, nausea, dizziness

• Serious: convulsions resulting in brain damage; allergic reactions that could lead to anaphylactic shock


Vaccines: ContraindicationsVaccines: Contraindications

• Avoid in acute febrile illness, pregnancy, lactation, and in those who are known to have developed anaphylactoid reactions with previous vaccines.

• Interactions: chance increases when multiple vaccines are given simultaneously


Vaccines: Patient TeachingVaccines: Patient Teaching

• Instruct patients to report severe reaction at injection site.

• Advise patients to seek immediate medical care for difficult breathing, high fever, convulsions, or extreme fatigue.


Standards for Standards for Childhood ImmunizationChildhood Immunization

• Childhood immunization remains one of the most important public health measures.

• Children should be immunized against 8 infectious diseases, hepatitis A (in areas of high incidence), and human papillomavirus (girls aged 10 to 11).


Routine Immunization Routine Immunization Reduces DiseaseReduces Disease

• Immunization for diphtheria, tetanus, and pertussis (DTP) has been routinely given in the US since the late 1940s, resulting in dramatic decrease in incidence of these diseases.


Childhood VaccinesChildhood Vaccines

• Meningitis caused by Hemophilus influenzae type b: (HibTiter, PedvaxHIB)

• Polio: Salk inactivated vaccine (IPV, IPOL) and Sabin live vaccine (note: the live oral vaccine is no longer used in the United States)

• Measles, mumps, and rubella: (MMR vaccine)


Childhood VaccinesChildhood Vaccines

• Hepatitis B infection: (Energix B, Heptava B vaccine) and hepatitis B immunoglobulin

• Varicella (chickenpox): (Varivax) • Hepatitis A: (Havrix, VAQTA) • Human papillomavirus (HPV): (Gardasil)


Routine Immunization for Routine Immunization for Adults Younger than Age 65Adults Younger than Age 65

• Immunization recommended for adults from ages 18 to 65 years is booster (dose given to increase the effectiveness of the original medication) of adult diphtheria and tetanus toxoid every 10 years.

• New vaccine for shingles (Zostavax) now recommended for adults 60 and older.


Circumstances That Require Circumstances That Require Adult Booster ImmunizationAdult Booster Immunization

• Pediatric immunizations should be updated for those:– Who travel internationally– Women of child-bearing age who may

become pregnant – With chronic illnesses


Other Adult ImmunizationsOther Adult Immunizations

• Annual influenza immunization (Fluzone, FluShield): recommended for those at risk for influenza complications

• Pneumococcal vaccine (Pneumovax 23, Pnu-Immune 23): for people with any major immunosuppression condition, pulmonary or cardiovascular diseases, chronic hepatic or renal disorders, and diabetes mellitus


International Adult International Adult ImmunizationsImmunizations

• International Certificate of Vaccination may be required for:– Yellow fever – Hepatitis A (Havrix, VAQTA)

• Cholera, typhoid, and plague vaccines may occasionally be suggested


Other Adult ImmunizationsOther Adult Immunizations

• Hepatitis B vaccine (Energix B, Heptavax B): for health-care workers with exposure to human blood and tissues

• BCG vaccine: for extremely high-risk individuals– BCG vaccine also used to treat bladder

cancer


Immunization Standards Immunization Standards for Adults Older than Age 65for Adults Older than Age 65

• Boosters of diphtheria and tetanus toxoid every 10 years

• Booster of pneumococcal vaccine (Pneumovax 23, Pnu-Immune 23): those at highest risk for fatal pneumococcal disease every 5 years after initial dose


Influenza and Pneumonia Influenza and Pneumonia ImmunizationImmunization

• All individuals 65 and older should receive:– Annual influenza immunization– A single dose of pneumococcal vaccine

• Individuals who received pneumococcal vaccine prior to age 65 should receive a booster dose if 5 years have passed since first dose.


Immunoglobulins (Ig)Immunoglobulins (Ig)

• Derived from human plasma containing antibodies that have been formed by the body to specific antigens

• Two types: one administered intramuscularly and one administered intravenously


Immunoglobulins: UseImmunoglobulins: Use

• Passive prevention or modification of hepatitis A and measles in susceptible persons (HIV positive)

• Prevention of varicella in immunocompromised patients if varicella-zoster immunoglobulin is not available


Immunoglobulins: UseImmunoglobulins: Use

• Prevention of fetal damage in women exposed to rubella during first trimester of pregnancy


Immunoglobulins:Immunoglobulins:Adverse EffectsAdverse Effects

• Common: local pain and tenderness at injection site

• Serious: anaphylactic reactions can occur


Immunoglobulins: Immunoglobulins: ContraindicationsContraindications

• IGIM must not be injected intravenously because it can cause serious anaphylactic reactions.

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Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Vaccines and Immunoglobulins 14