2.vaccini 2015:16.1

IGIENE GENERALE Corrado Pipan corrado.pipan@uniud.it

Infermieristica aa 2015-162.Vaccini

© Claudio Stefanini

mucca carnia 2014

edward jenner Berkeley

Albert Bruce Sabincincinnati 1953

Andrew Wakefieldlondon 1998

Jenner damaged the business of his colleagues by offering protection against smallpox

free of charge.

Vaccines became the

victims of their own success

http://autismovaccini.org/2013/11/12/allarme-polio-alcune-considerazioni/

viewing Web sites critical of vaccination for only 5–10

min increased the perception of the risks of being

vaccinated… Betsch C, Renkewitz F, Betsch T, Ulshöfer C. The influence of vaccine-critical websites on perceiving vaccination risks. J Health Psychol. 2010;15:446–55.

…and decreased the perception of the risks of

omitting vaccinations

Betsch C, Renkewitz F, Betsch T, Ulshöfer C. The influence of vaccine-critical websites on perceiving vaccination risks. J Health Psychol. 2010;15:446–55.

Vaccinophobia safety and

effectiveness

Vaccinophobia

complot!!!

Vaccinophobia alternative health

practices

Andrew Wakefieldlondon 1998

Correlation does not prove

causation

Correlation coefficients between 0.9 and 1.0 indicate variables which can be considered very highly correlated.

Imunnizzazione

passiva trasferimento di anticorpi preformati

Prescott−Harley−Klein: Microbiology, Fifth Edition

IX. Nonspecific Resistance and the Immune Response

33. Medical Immunology © The McGraw−Hill Companies, 2002

Types of Vaccines and Their Characteristics

As previously noted, the diseases for which we already havevaccines are ones in which the infection is acute and either re-solves in several weeks or causes death of the infected individ-ual. In the absence of vaccination, many individuals would sur-vive as a result of the immune system defeating the invader. For

766 Chapter 33 Medical Immunology

Age Birth

Bars indicate range of recommended ages for immunization. Ovals indicate vaccine to be given if previousrecommended doses were missed or given earlier than the recommended age.

1mo

2mos

4mos

6mos

12mos

15mos

24mos

18mos

4–6yrs

11–12yrsVaccine

Hepatitis B

Diphtheria,Tetanus,Pertussis

Haemophilus influenzaetype b

Measles, Mumps,Rubella

Chickenpox (Varicella)

Hepatitis A

Polio

14–16yrs

Hep B

Hep B

DTaP DTaP DTaP

Hep B Hep B

MMR

Var

DTaP

Hib Hib Hib Hib

MMR MMR

IPV IPV

TdDTaP

IPV

Var

Hep A in selected areas

IPV

Figure 33.1 RecommendedRegimen and Indications forVaccinations of Children in theUnited States. (Data from TheAmerican Academy of Pediatrics.)

Table 33.2 Immune Globulins and AntitoxinsUsed for Passive Immunizationagainst Specific Organisms andDiseases in the United States

Organism/Disease Agenta

Black widow spider bite Horse antivenomSnakebite Horse antivenomAcute respiratory failure Monoclonal antibodies

(respiratory syncytial virus)Botulism Botulinum antitoxin (equine)Diphtheria Diphtheria antitoxin (equine)Hepatitis A and B Pooled human immune gamma globulinMeasles Pooled human immune gamma globulinRabies Rabies immune globulin administered

around the wound in addition tobeing injected intramuscularly

Tetanus Tetanus immune globulinEczema Vaccinia immune globulinImmunocompromised Varicella-zoster immune globulin

individuals

aImmune globulins and antitoxins are administered intramuscularly unless otherwise noted.

these diseases, the vaccine mimics the pathogen and causes animmune response similar to that raised by the pathogen. Thesevaccines have eradicated smallpox, pushed polio to the brink ofextinction, and spared countless individuals from hepatitis Aand B, measles, rotavirus disease, tetanus, typhus, and otherdangerous diseases.

In contrast, successful vaccines have yet to be developed fortoo many deadly or debilitating diseases (AIDS, herpes, hepatitisC, malaria, tuberculosis) because they are due to chronic infections.In a chronic infection, the pathogen is able to evade the immunesystem or subvert it into making ineffective responses. Successfulvaccines against these chronic diseases must be able to stimulateimmune responses that are similar to those resulting from most nat-ural exposures to the pathogen. To date, this has been an unsolvablechallenge in medical immunology and vaccine development.

In the remainder of this section, various approaches to the de-sign of vaccines, both currently used vaccines and experimentalones, are described and examined in terms of their ability to in-duce humoral and cell-mediated immunity and the production ofmemory cells. Vaccinomics, the application of genomics andbioinformatics to vaccine development, is bringing a fresh ap-proach to the Herculean problem of making vaccines against var-ious microorganisms and parasites.

Whole-Organism Vaccines

Many of the current vaccines in use for humans that are effectiveagainst viral and bacterial diseases consist of whole microorgan-isms that are either inactivated (killed) or attenuated (live butavirulent) (table 33.1). These are termed whole-organism vac-cines. The major characteristics of these vaccines are compared

Imunnizzazione

1. Controllo

riduzione n° casi e complicanze

(vaccinazione antinfluenzale)

2. Eliminazione interruzione trasmissione

endemica (rischio di reintroduzione)

3. Eradicazione

scomparsa dell’agente causale

e della malattia a livello globale

herd immunity

Vaccini 1.SICUREZZA non deve causare la malattia o la morte

Vaccini 2.protezione deve proteggere contro la malattia causata dall’esposizione al patogeno

Vaccini 3.tempo la protezione deve durare nel tempo

Vaccini 4.neutralizzazione indurre la produzione di anticorpi neutralizzanti

Stability

5.pratica

Vaccini

risposta innata presente alla nascita (fagocitosi, lisozima, interferoni, flogosi)

controlla piccole invasioni da parte di microrganismi

risposta adattativa anticorpi e linfociti (in

grado di riconoscere specificamente un solo

antigene.

memoria immunologica

Imunnizzazione

attiva produzione attiva di anticorpi

Vaccini vivi attenuati

Prodotti a partire da agenti infettivi resi non patogeni. L'attenuazione viene effettuata attraverso passaggi multipli in colture cellulari.

Vaccini vivi attenuati

durata costo rapidità risposta simile a quella naturale

Pro

Vaccini vivi attenuati

mutazioni pazienti immunocompromessi

Cons

Vaccini vivi attenuati polio (sabin) BCG Febbre gialla

poliomielite

poliomielite

poliomielite

Vaccini inattivati

no mutazioni buona immunitÀ con richiamo

Pro

Vaccini inattivati minore efficacia costo elevato

Cons

Vaccini inattivati polio (salk) pertosse HAV

Vaccini inattivati Hi B HBV tetano diferite

Dna vaccine

injecting genetically engineered DNA

cells directly produce antigens