Vaccine (Vaccination)

Article Author:
Angel Justiz Vaillant
Article Editor:
Marc Grella
Updated:
6/18/2019 6:21:32 PM
PubMed Link:
Vaccine (Vaccination)

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[8] although this approach is risky in the developing world where the use of injections can transmit diseases such as HIV infections. Live vaccines can be given orally but not killed vaccines. Alternatively, the use of the oral route and others mucosal surfaces explored as immunization route. For example, polio vaccination was successfully implemented by 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 contraindicates in age <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. It should be dosed with precaution in patients who developed Guillain-Barré syndrome within six weeks after a prior dose of influenza vaccine and in patients who have asthma, aged 5 or older.

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°F. A rare and lethal adverse reaction secondary to vaccination is the Guillain-Barré 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 1–2 mg/kg every 4–6 hrs, up to 50 mg) or hydroxyzine 0.5–1 mg/kg every 4–6 hrs up to 100 mg. 

The dosage of epinephrine can repeat every 5–15 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. 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. 


References

[1] Rauch S,Jasny E,Schmidt KE,Petsch B, New Vaccine Technologies to Combat Outbreak Situations. Frontiers in immunology. 2018     [PubMed PMID: 30283434]
[2] 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 PMID: 30773401]
[3] 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 PMID: 30286206]
[4] 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 PMID: 30703094]
[5] 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 PMID: 29554479]
[6] Gornati L,Zanoni I,Granucci F, Dendritic Cells in the Cross Hair for the Generation of Tailored Vaccines. Frontiers in immunology. 2018     [PubMed PMID: 29997628]
[7] 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 PMID: 30579628]
[8] Zhang S,Zhao S,Jin X,Wang B,Zhao G, Microneedles Improve the Immunogenicity of DNA Vaccines. Human gene therapy. 2018 Sep     [PubMed PMID: 29968486]
[9] Wajih Ullah M,Qaseem A,Amray A, Post Vaccination Guillain Barre Syndrome: A Case Report. Cureus. 2018 Apr 20     [PubMed PMID: 29930889]
[10] Principi N,Esposito S, Vaccine-preventable diseases, vaccines and Guillain-Barre' syndrome. Vaccine. 2018 Jun 4     [PubMed PMID: 29880241]