Vaccines, live

Live vaccines are normally weakened strains that do not cause diseases in the host, but stiU can stimulate the immune response. A typical example is the poho vaccine. The weakening of microorganisms or attenuation of the vims or bacteria can be accompHshed by passage through different substrates and/or at different temperatures. Modem genetic engineering techniques can also be used to attenuate a vims or bacterium. 

Although a humoral immune response is the primaiy protection against most viral and some bacterial diseases, protective defense against other pathogens such as HIV, Plasmodium and Mycobacterium tuberculosis requires a cytotoxic response mediated by CD8+ T-cells (CTL response). Since the introduction of the vaccination concept by Jenner almost 200 yeats ago, only few vaccines have been developed that are able to induce a CTL response. These vaccines are usually attenuated live vaccines that are accompanied by certain risks and are not readily available for most pathogens. The immense appeal of DNA vaccines can be attributed to a considerable part to the fact that they are able to induce... 

Live vaccines 8 Immunization of special risk groups... 

Two major advantages stem from the use of live vaccines. Firstly, the immunization mimics a natural infection such that only a single exposure is required to render an individual immune. Secondly, the exposure may be mediated through the natural route of infection (e.g. oral) thereby stimulating an immime response that is appropriate to a particular disease (e.g. secretory antibody as primary defence against poliomyelitis virus in the gut). 

Disadvantages associated with the use of live vaccines are also apparent. Live attenuated vaccines, administered through the natural route of infection, will be replicated in the patient and could be transmitted to others, ff attenuation is lost during this replicative process then irrfectiorrs rrtight result (see poliomyelitis, below). A second, major disadvantage of live vaccines is that the course of their action might be affected by the infeetion and immunological status of the patient. 

Since these vaecines are imable to evoke a natural infection profile with respeet to the release of antigen they must be administered on a number of occasions. Immunity is not complete until the course of immunization is complete and, with the exeeption of toxin-dominated diseases (diphtheria, tetanus) where the immimogen is a toxoid, will never match the performance of live vaccine delivery. Specificity of the immrme resporrse generated in the patient is initially low. This is particularly the case when the vaeeine is composed of a relatively crude cocktail of killed cells where the immime response is direeted only partly towards antigenic components of the cells that are assoeiated with the infeetion process. This increases the possibility of adverse reaetions in the patient. 

A live vaccine strain of measles (Chapter 15) was introduced in the USA in 1962 and to the UK in 1968. A single injection produces high-level immunity in over 95% of recipients. Moreover, since the vaccine induces immunity more rapidly than the natural infection, it may be used to control the impact of measles outbreaks. The measles virus cannot survive outside ofan infected host. Widespread use ofthe vaccine therefore has the potential, as with smallpox, of eliminating the disease worldwide. Mass immunization has reduced the incidence of measles to almost nil, although a 15-fold increase in the incidence was noted in the USA between 1989 and 1991 because of poor compliance. 

IGIM should be injected into a deltoid or gluteal muscle. It does not affect the immune response of inactivated vaccines, oral polio virus, or yellow fever vaccine. The administration of live vaccines [e.g., measles, mumps, rubella (MMR) vaccine] concomitantly with IGIM may decrease the immune response significantly thus, MMR and varicella vaccine should be delayed for at least 3 and 5 months, respectively, after IGIM has been administered. Additionally, IGIM should not be given within 2 weeks of the MMR administration or within 3 weeks of the varicella vaccine to maximize the efficacy of the immunization.1... 

Secondary transmission to household contacts is always a concern with administration of a live vaccine. There are a few cases of possible secondary transmission of varicella following vaccination. Of the cases that varicella typing was done, 62% were wild-type virus, indicating exposure to an unvaccinated person. There are less than 10 confirmed cases of secondary transmission of the Oka vaccine strain following vaccination. A mild rash occurring in less than 5% of persons has been reported following vaccination. The varicella virus may be shed from the rash. Rashes due to the Oka vaccine strain typically occur more than 20 days following vaccination.12... 

Direct determination of Salmonella live-vaccine strains 220... 

Inactivated viral particles rgp 120 subunit vaccines rgp 160 subunit vaccines rp 24 subunit vaccines Live vaccines based on viral vectors Octameric V3 peptide Immune Response Genentech/Vaxgen, Biocine, Chiron/Ciba Geigy MicroGenes Sys. Inc., Immuno-Ag. MicroGenes Sys. Inc. Biocine, Merck, Sanofi Pasteur, Targeted Genetics UBI... 

In general, killed vaccines can be administered simultaneously at separate sites. Killed and live attenuated vaccines may be administered simultaneously at separate sites. If they cannot be administered simultaneously, they can be administered at any interval between doses with the exception of cholera (killed) and yellow fever (live) vaccines, which should be given at least 3 weeks apart. If live vaccines are not administered simultaneously, their administration should be separated by at least 4 weeks. 

In general, severely immunocompromised individuals should not receive live vaccines. 

Patients with active malignant disease may receive killed vaccines or toxoids but should not be given live vaccines. Live virus vaccines may be administered to persons with leukemia who have not received chemotherapy for at least 3 months. 

Inactivated vaccines are generally acceptable (e.g, pneumococcal, meningococcal, and influenza [trivalent inactivated influenza vaccine]), and live vaccines generally are avoided in persons with immune deficiencies or immune suppressive conditions. Information on specific conditions is available at vwvw.cdc.gov/vaccines/pubs/acip-list.htm. 

General contraindications to vaccine administration include a history of anaphylactic reaction to a previous dose or an unexplained encephalopathy occurring within 7 days of a dose of pertussis vaccine. Immunosuppression and pregnancy are temporary contraindications to live vaccines. Whenever possible, transplant patients should be immunized before transplantation. Live vaccines generally are not given after transplantation. 

The vaccine should not be given to immunosuppressed patients (except those infected with HIV) or pregnant women. HIV-infected persons who have never had measles or have never been vaccinated should be given measles-containing vaccine unless there is evidence of severe immunosuppression. The vaccine should not be given within 1 month of any other live vaccine unless the vaccine is given on the same day (as with the MMR vaccine). Measles vaccine is indicated in all persons born after 1956 or in those who lack documentation of wild virus infection either by history or antibody titers. 

J. Havlasova, L. Hemychova, P. Halada, V. Pellantova, J. Krejsek, J. Stulik, A. Macela, P. R. Jungblut, P. Larsson, and M. Forsman. Mapping of Immunoreactive Antigens of Francisella Tularensis Live Vaccine Strain. Proteomics, 2(2002) 857-867. 

Vaccines Yes. TC-83 Live Attenuated Vaccine (IND) and C-84 Formalin inactivation of TC-83 (IND) is available for boosting antibody titers in those initially receiving the live vaccine. 

What is the difference between a live vaccine and a killed vaccine ... 

Live vaccines are made from viruses or bacteria, sometimes called wild, that cause disease. These wild viruses or bacteria are weakened in a laboratory. 

Live vaccine works when the virus replicates in the body of a vaccinated person. This turns on the immune system and prepares the body to fight the disease when exposed to it. The immune response to a live vaccine is almost the same as from natural infection. Sometimes a person getting a live vaccine has mild symptoms of the disease. 

Live vaccines rarely may cause severe or fatal reactions as a result of uncontrolled replication (growth) of the vaccine virus. This may occur in persons with weak immune systems, including persons with leukemia or human immunodeficiency virus (HIV) infection or persons undergoing treatment with certain drugs. This is why it is so important to know a person s health status before giving a live vaccine. 

Currently available live vaccines include measles, mumps, polio, rubella, vaccinia (smallpox), varicella (chickenpox), and yellow fever. All of these are made from viruses. There are two live bacterial vaccines 1) Bacillus of Calmette and Guerin (BCG) vaccine for tuberculosis and 2) oral typhoid. 

These are live vaccines, and strain 13 is known to cause disease in humans. 

Liver cancer, from vinyl chloride contact, 25 651. See also Hepatotoxicity Livestock industry, feed ingredient usage by, 10 837t Live vaccines, 25 487... 

Vaccinations Patients receiving etanercept may receive concurrent vaccinations, except for live vaccines. No data are available on the secondary transmission of infection by live vaccines in patients receiving etanercept. 

X in renal/hepatic impair Caution [D, -] Contra IT administration Disp Caps, inj SE NA (emesis in 10-30%), X BM, alopecia, X BP w/ rapid IV, anorexia, anemia, leukopenia, T risk secondary leukemias Interactions T Bleeding W/ ASA, NSAIDs, warfarin T BM suppression W/ antineoplastics radiation T effects OF cisplatin X effects OF live vaccines EMS Pt has T risk of bleeding when combined w/ ASA, NSAIDs, anticoagulants/anti-plts OD May cause N/V symptomatic and supportive... 

Immunodeficiency 100-200 mg/kg/mo IV at 0.01-0.04 mL/kg/min to 400 mg/kg/dose max UP 400 mg/kg/dose IV daily x 5 d BMP 500 mg/kg/wk X in renal insuff Caution [C, ] Separate administration of live vaccines by 3 mo Contra IgA deficiency w/ Abs to IgA, severe thrombocytopenia or coagulation disorders Disp Inj SE Associated mostly w/ inf rate GI upset Interactions X Effects OF live virus vaccines EMS May cause anaphylactic Rxn OD Unlikely Immune Globulin, Subcutaneous (Vivaglobin) [Immune Serum] Uses Primary immunodeficiency Action IgG supl Dose 100—200 mg/kg BW subq wkly abd, thighs, upp arms, or lat al hip Caution [C, ] Contra Hx anaphylaxis to immune globulin some IGA deficiency Disp Inj SE Inj site Rxns, HA, GI complaint, fevCT, N, D, rash, sore throat EMS May be self administered at home may cause anaphylactic Rxn OD Unlikely to cause life-threatening Sxs... 

Trastuzumab (Herceptin) [Antineeplastic/Monoover express the HERlIneu. protein breast CA adjuvant, w/ doxorubicin, cyclophosphamide, and paclitaxel if pt HER2/neu(+) Action MoAb binds human EGF receptor 2 protein HER2) mediates cellular cytotox Dose Per protocol, typical 2 mg/kg/IV/wk Caution [B, ] CV dysfxn, alla-gy/inf Rxns Contra Live vaccines Disp Inj SE Anemia, cardiomyopathy, nephrotic synd, pneumonitis Interactions t Risk of cardiac dysfxn W/ anthracycline, cyclophosphamide, doxorubicin, epirubicin EMS Cardiomyopathy, ventricular dysfxn and pulm tox have been reported monitor for Sxs of reduced cardiac Fxn OD Sxs unknown... 

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