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Pharmacology

Immunoglobulins and Vaccines

Question 165 of 180

Which of the following is NOT an example of a vaccine produced from polysaccharide extracts:

Answer:

The meningococcal groups A and C, pneumococcus and Haemophilus influenzae type b (Hib) vaccines are prepared from capsular polysaccharide.

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:

  1. A live attenuated form of a virus or bacteria
  2. Inactivated preparations of the virus or bacteria
  3. Detoxified exotoxins produced by the microorganism
  4. 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

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