Pharmacology
Immunoglobulins and Vaccines
Which of the following is NOT an example of a live vaccine:
Answer:
The pertussis vaccine is prepared from an inactivated preparation of the bacteria. The varicella-zoster, rotavirus, BCG and MMR vaccines are live attenuated vaccines.Active Immunity
Pharmacology / Immunoglobulins and Vaccines
Last Updated: 26th March 2019
Active immunity can be acquired by natural disease or by vaccination.
Vaccines stimulate production of antibodies and other components of the immune response.
Types of Vaccine
Vaccines may consist of:
- A live attenuated form of a virus or bacteria
- Inactivated preparations of the virus or bacteria
- Detoxified exotoxins produced by the microorganism
- Extracts of a microorganism, which may be derived from the organism (e.g. pneumococcal capsular polysaccharide) or produced by recombinant DNA technology (e.g. hepatitis B surface antigen)
| Vaccine Type | Type Examples |
|---|---|
| Live attenuated | BCG, MMR, varicella-zoster, rotavirus, influenza (nasal spray), polio (oral) |
| Inactivated preparation | Hepatitis A, influenza, polio, pertussis, rabies |
| Detoxified exotoxins | Tetanus, diphtheria |
| Extracts | Men A & C, pneumococcus, Hib, hepatitis B |
Key Differences
| Vaccine Type | Live Attenuated | Inactivated |
|---|---|---|
| Cell-mediated immunity | Yes | Weak or none |
| Humoral immunity | IgA and IgG | IgG |
| Duration of response | Boosting often unnecessary | Boosting often required |
| Immunogenicity | Potent | Poor (often requires adjuvant) |
| Safety of vaccine | Possible reversion to virulence, possible spread to non-immune individuals, unsafe in immunocompromised individuals (and pregnant women) | Safe if completely inactivated |
| Stability at room temperature | Low | High |
Contraindications
Vaccines are contraindicated in individuals with an allergy to a vaccine component or a history of a reaction to a previous dose of vaccine.
Immunocompromised individuals should not be given live vaccines. Live vaccines should not be administered routinely to pregnant women because of the theoretical risk of fetal infection but where there is a significant risk of exposure to disease, the need for vaccination usually outweighs any possible risk to the fetus.
Vaccination may be postponed if the individual is suffering from an acute illness; however, it is not necessary to postpone immunisation in patients with minor illnesses without fever or systemic upset.
Side Effects
Common side effects of vaccines include: fatigue; fever; gastrointestinal disturbances; headache; irritability; loss of appetite; lymphangitis; malaise and myalgia. Anaphylaxis, angioedema, bronchospasm and hypersensitivity reactions may occur very rarely. Induration, inflammation, pain, redness and sterile abscess may develop at the injection site.
Post-Immunisation Pyrexia
In infants the parent should be advised that if pyrexia develops after childhood immunisation, and the infant seems distressed, paracetamol can be given or ibuprofen can be used if paracetamol is unsuitable. They should be warned to seek medical advice if the pyrexia persists.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
