Vaccines

Classifying acquired immunity

Active immunity acquired through direct

stimulation of the immune system by an
antigen
oProduces antibodies
oTakes time to develop
oDevelops memory, lasting
 Classifying acquired immunity

Passive immunity acquired indirectly by

the donation of preformed antibodies
produced by another human or animal
oProtection without prior exposure

oActs immediately
oDoes not create memory, short term
 Categories of Acquired Immunity
Acquired Immunity
Natural Immunity Artificial immunity
(acquired as part of normal (acquired through a medical
life experiences) intervention
ie immunization)

Active Passive Active Immunity Passive Immunity

Immunity Immunity (vaccination) (immunotherapy)
Passively Acquired Natural Immunity:
Maternal Antibodies
 Question
These show the levels of antibodies present in active vs
passive immunization by artificial means. One line represents
the immune response to a vaccine and the other to
immunotherapy. Which line represents the immune response
to immunotherapy?

Line A

Line B
 Artificially Acquired Passive Immunity:
Immunotherapy
Specific types of Immunotherapy:
Specific Immune Globulin: serum from
donor(s) who has a known exposure to a
specific pathogen. Ie, HBIG

Antitoxin: An antibody that recognizes and

binds to a bacterial exotoxin or toxin in snake
venom
 Artificially Acquired Passive Immunity:
Immunotherapy
Immunity usually only lasts a few months

Used for :
Patients at risk for rapidly fatal diseases (ie
rabies)
Patients at risk for bacterial diseases
involving exotoxin (ie diphtheria, botulism,
tetanus)
Patients who are immunodeficient (ie HIV
patients, chemotherapy patients)
 Artificially Acquired Active Immunity:
Vaccination
Deliberately expose a person to material that is
antigenic but not pathogenic

Stimulate a primary adaptive response to

prepare the immune system for future exposure
to a virulent pathogen ( ie generate memory
cells)

Response to exposure to the virulent pathogen

will be immediate and powerful due to the
secondary response
How does a vaccine generate an
antibody response?
 Question

B cells need to be activated to become

plasma cells to make antibodies. Which
cells need to be activated for this to
occur?
A. Macrophages
B. NK cells
C. CD8+ T cells
D. CD4+ T cells
 Question

CD4+ T cells recognize antigen

presented on.
A. MHC I
B. MHC II
C. B7
D. BCR
E. TCR
 Question
In order to present on MHC II, antigens
must be processed via
A. The proteasome
B. Lytic enzymes in the phagolysome

Are these antigens endogenous or

exogenous?
 Memory Helper T and B cells
are generated when
APCs engulf antigens and present
peptides derived from this phagocytosed
material to CD4+T cells
B cells engulf antigens and become
activated when they receive T cell help

Are produced efficiently even when the

microbe has not infected an APC
 Question
In order to generate cytotoxic T cells,
APCs need to be infected by the
microbe.
A. True B. False
 Memory Cytotoxic T cells

Are generated when an APC becomes

infected, digests the antigen into peptides
using its proteasome and presents the
peptides to CD8+ T cells (which receive T
cell help)
Are produced when the microbe infects an
APC
 Major Categories of Vaccines
1.Attenuated Vaccines: use a
live/active but weakened form of the
pathogen

2.Inactivated Vaccines: unable to

replicate
a. Inactivated or killed whole agent
b. Subunit
 Attenuated Vaccines
use LIVE but weakened (ie attenuated)
whole bacterial cells or viruses as the
antigen Within the body
Ags Virulence Ags
Administer
is
eliminated
or reduced

Live bacterial cells Alive but Vaccine microbes

or viruses nonpathogenic can multiply. Active
Antigenicity is attenuated viruses can
unchanged infect APCs
 Inactivated Vaccines
Killed or Inactivated whole agent vaccines

Ags Heat or Ags Vaccine

stimulates
chemical Administer
immunity
but the
Bacterial Dead cell or microbe
cell or virus inactivated cannot
virus multiply
Antigenicity
is retained
 Question

Which of the following are advantage to using an

inactivated vaccine over a live attenuated vaccine?
Check all that apply.

A.Good antibody and cell-mediated responses

B.Easy storage (ie doesnt require refrigeration)
C.Requires fewer boosters and a lower initial dose
D.Confers longer-lasting immunity
E.No risk of causing infectious disease
 Major Categories of Vaccines
Characteristic Attenuated Vaccines Inactivated
Vaccines
Antibody response
CMI
Duration of protection

Number of doses
Risk of mutation to
virulence
Risk to immuno-
compromised and
pregnant patients

Stability in warm
temperatures
 Major Categories of Vaccines
Characteristic Attenuated Vaccines Inactivated Vaccines
Antibody response IgG, IgA if oral or nasal IgG
CMI Good Poor
Duration of Long-term Short-term
protection
Number of doses Usually single Multiple
Risk of mutation to
virulence Very low Absent
Risk to immuno-
compromised and Can be significant Absent
pregnant patients

Stability in warm Poor Good

temperatures
Major Types of Inactivated Vaccines
Inactivated or killed whole agent Vaccines-use
killed whole cells or inactivated whole viruses

Subunit Vaccines- use key protein antigens or

antigenic fragments from a pathogen
- Several different types exist
 Subunit Vaccines
Often require adjuvant, a chemical that
enhances antigenicity by stimulating dendritic
cells and macrophages

virus bacteria Microbial antigens

stimulate immunity
but no microbe (no
whole cell or whole
virus) is
present
 Types of Subunit Vaccines
Toxoids: contain inactivated exotoxin (toxin
is modified to no longer have toxicity but
still retain antigenic epitopes)

Polysaccharide vaccines: contain capsule

Conjugate vaccines: polysaccharides (usually

capsule) linked to proteins
 Question

Would a vaccine that contains bacterial

capsule (ie a polysaccharide vaccine)
elicit a robust response in young
children?
A. Yes
B. No
 Conjugate Vaccines

Preparation of conjugates to make T-

independent antigens T dependent

Polysaccharides need to be conjugated to

a protein to enhance their antigenicity in
young children
 Conjugate Vaccines

Preparation of conjugates to make T-

independent antigens T dependent
Polysaccharides need to be conjugated to a
protein to enhance their antigenicity in young
children
 Herd Immunity Protects Public Health

Is achieved when critical portion of population is

immune to disease
Higher the immunization rate in a population, the
less likely an infectious agent can spread due to
insufficient susceptible hosts
Confers indirect protection for those who cant
become immune
Responsible for dramatic declines in childhood
diseases and for prevention of epidemics
Herd Immunity
On average, at least
85%* of the
population is
vaccinated

* Can vary depending

on pathogen and host
population
Who is unable to be immunized?
Herd Immunity is important to those who
cant become immune.

Immunocompromised (AIDS patients,

patients taking immunosuppressive
drugs)
Pregnant women (risk is to the fetus)
Elderly or babies
 Why do we still vaccinate against
uncommon diseases
In The Vaccine Wars, Jennifer Margulis
states Why are we giving children so many
vaccines? There's no more polio in the
United States and there's no more
diphtheria in the United States. And no
one, no child, has contracted wild polio
since 1979 in the United States. So when do
we take polio off the vaccine schedule?
 Why do we still vaccinate against
uncommon diseases?
We continue to vaccinate to maintain herd
immunity so that when a case of a disease occurs,
it wont spread

Breakthrough disease
 Question
The 2008 measles outbreak in San Diego, CA, can
be traced to a 7 year old who contracted the
disease where?
A.United States
B.Puerto Rico
C.Switzerland
D.Nigeria
E.England
Why do we still vaccinate against
uncommon diseases?

Imported disease
 Fear of Vaccines
Rumors of vaccines causing
autism, SIDS numerous
studies have debunked
these claims
 Fear of vaccines but no fear of the
disease?
Some people believe that naturally acquired
immunityimmunity from having the disease
itselfis better than the immunity provided by
vaccines.

However, natural infections can cause severe

complications and be deadly. This is true even for
diseases that most people consider mild, like
chickenpox.
It is impossible to predict who will get serious
infections that may lead to hospitalization or
death
 Question
How are vaccines different from experiencing a
natural infection?
A. Vaccines have the potential to kill the recipient while
a natural infection does not carry this risk
B. Vaccines work faster at establishing immunity than a
natural infection
C. Vaccines provide immunity, while experiencing a
natural infection does not
D. Vaccines consist of weakened or killed pathogens or
pathogen parts as opposed to the fully functional
pathogen whereas a natural infection involves a fully
live functional pathogen
 Risk vs Benefit of Vaccines

Side effects do exist for most vaccines but

serious side effects are extremely rare

Immunization Action Coalition (IAC) in partnership with the Centers for Disease Control and Prevention (CDC)
Potential Adverse Effects of Vaccines
Side effects
Local soreness at the injection site
Fever
Malaise
In young children- febrile seizures
Allergic reactions to chemicals other than
the antigen which may be present in the
preparations
Potential Adverse Effects of Vaccines
Active disease in immunocompromised
individuals or fetuses in pregnant
individuals who receive live attenuated viral
vaccines (very RARE)

Neurological and autoimmune reactions -

perhaps by rare antigen cross reactions or
perturbation of immunoregulatory circuits.
(very RARE)
 Risk vs Benefit of Vaccines
Side effects do exist for most vaccines but serious
side effects are extremely rare

Side effects of the vaccines are less serious than

the risks associated with getting the disease

It may be difficult for

parents to accept any
risks associated with the
vaccine but
 Comparison of the risks associated
with the HiB vaccine and with a HiB
infection

Immunization Action Coalition Vaccine Information. Hib Disease Questions and Answers.
 How do we ensure that vaccines are
safe?
Clinical trials involving thousands of children are
performed to test vaccine safety
If pre-licensure trials conclude the vaccines are
safe, they become licensed by the FDA
Reviewed and recommended by the Centers for
Disease Control and the American Academy of
Pediatrics
Vaccine Adverse Events Reporting system
http://vaers.hhs.gov/index