Updated: 6/22/2018

Vaccines

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Newborn 2 months 4 months 6 months 12 months 15 months 2 years 4-6 years 11-12 years
Hep B #1 Hep B #2   Hep B #3          
  DTaP DTaP DTaP   DTaP   DTaP  
  PPV PPV PPV          
  HiB HiB HiB HiB        
  Polio #1 Polio #2 Polio #3       Polio #4  
  Rota Rota            
        VCZ        
        MMR     MMR  
            HAV    
                Meningitis
 
Introduction
  • Immunization allows for individuals to be protected against disease
  • Immunity can be conferred in two ways including
    • active immunity that is maintained by the immune system
    • passive immunity that is given transiently from outside
  • Vaccinations are a major source of conferring immunity outside normal infection and include
    • viral vaccines divided into
      • killed vaccines
      • live attenuated vaccines 
    • bacterial vaccines
  • Often vaccinations require an adjuvent that
    • enhances the immune reaction against the vaccine provided
    • increases the development of memory to non inflammatory antigens
    • can be of several types including
      • aluminum potassium sulfate
      • muramyl dipeptide
      • LPS/polyribonucleotides
  • Though vaccines are generally safe, contraindications to their use include
    • people with egg allergies who should avoid 
      • yellow fever vaccine and other vaccines made in eggs
    • pregnant women who should avoid 
      • rubella vaccines
    • immunocompromised individuals who should avoid
      • all live vaccines
Active vs Passive Immunity
  • Immunity can be either active or passive with several notable differences
Differences Between Active and Passive Immunity
Feature Passive
Active
Acquisition method
  • Receiving preformed antibodies
  • Exposure to infection or to foreign antigens
Examples
  • Maternal IgG crossing placenta
  • Babies getting IgA in breast milk
  • Administration of antitoxin
  • Infection with the specific pathogen
  • Administration of a vaccine
Onset
  • Immediate upon administration
  • Slow to allow for development of full immune response      
Duration
  • Very short with a half life between two weeks and four weeks
  • Long or even lifetime
  • Due to generation of memory
 
Viral Vaccines
  • Viral vaccines can either be live attenuated or killed with several notable differences
Differences Between Live and Killed Vaccines
Feature Live
Killed
Production method
  • Design a nonpathogenic version of a virus that can still grow transiently in the host
  • Inactive pathogen or pathogen antigens by treatment with heat or chemicals
Pros
  • Induce both cellular and humoral responses
  • induces lifelong immunity (usually)
  • Safer than live vaccines because they cannot revert to pathogenic state
Cons
  • Cannot give to immunocompromised patients
  • Small chance of reverting to pathogenic state
  • Weaker response (usually only humoral)
  • May require booster shots      
Examples
  • Everything else
  • MMR
  • VZV
  • Polio (Sabin)
  • Etc
  • Rest In Peace Always 
  • Rabies
  • Influenza
  • Polio (Salk)
  • Hepatitis A
Bacterial Vaccination
  • Bacterial vaccination involves administration of characteristic protein which can be
    • inactivated toxin produced by pathogen called a toxoid
    • coat protein that surrounds the pathogen called a capsule
    • other important proteins that are conserved by the pathogen 
  • Select examples of vaccines against pathogenic bacteria include
    • DTaP that is composed of
      • C. diptheriae toxoid
      • C. tetani toxoid
      • B. pertussis toxoid
    • H. influenzae capsular type B
    • S. pneumoniae that comes in two forms including
      • a pediatric version with
        • 7 capsule types
        • think: a 7 year old gets PCV
      • an adult version with
        • 23 capsular types
    • N. meningitidis with 4 capsular proteins

 

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Questions (1)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

(M1.MC.74) Two patients are vaccinated for poliomyelitis. Patient A receives the Sabin oral vaccine, and Patient B receives the Salk intramuscular vaccine. Six weeks after their initial vaccinations, which of the following would be the greatest difference regarding these two patients? Review Topic

QID: 106656
1

Patient A has a higher level of duodenal IgA antibodies

63%

(118/187)

2

Patient B has a higher level of duodenal IgA antibodies

5%

(10/187)

3

Patient A has a lower level of serum IgA antibodies

5%

(9/187)

4

Patient B has a lower level of serum IgM antibodies

7%

(14/187)

5

Patient A has a higher level of serum IgG antibodies

18%

(34/187)

M1

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