Question

Prioritizing Immunizations

Seventeen-year-old Suzy sniffed deeply as Cory, the nurse, administered the flu vaccine. “You're our first patient vaccinated against the swine flu this season,” commented Cory.

Administration of the nasal spray flu vaccine

1. How is the vaccine administered? Using your knowledge of anatomy, what is the first lymphoid tissue to encounter and react to the vaccine?
2.   INVESTIGATE: The swine flu virus is formally designated as the H1N1 influenza virus. What do the H and the N stand for and what role do they play in influenza morbidity? What year did this virus cause worldwide morbidity and how many people died?

“The first!” Suzy exclaimed.

Dr. Winerman reserved four vaccines for his pediatric type 1 diabetic patients with the county health department. “Because of limited vaccine quantities, you're entitled to priority immunization because you're immune compromised,” explained Cory.

“What do you mean, immune compromised? My pancreas may not be in great shape, but my immune system is just fine,” Suzy responded.

“That's not what medical studies report,” Dr. Winerman said, entering the room. “Let's see how diabetes and immunology connect while I finish up your exam,” Dr. Winerman said.

As Dr. Winerman examined Suzy, he asked lots of questions.

“What do you know about the benefits of inflammation?” he queried.

“I know the heat, redness, and swelling make me feel uncomfortable, but they indicate that neutrophils are phagocytizing invading microbes,” Suzy responded.

“That's right but not necessarily the case for diabetics. Hyperglycemia between 150 and 200 mg/dl impairs neutrophil chemotaxis, phagocytic activity, and intracellular killing. Have you been over 150 mg/dl this week?” Dr. Winerman asked. Suzy nodded yes.

3.   REVIEW: What are neutrophils and how do they act against pathogens? Based on the doctor's statement, how are inflammatory responses affected in diabetics?

“This level of hyperglycemia also increases lymphocyte apoptosis, suppresses C3 activation, and reduces antibody production after pathogen exposure. What do you think, can diabetes have a negative impact on immune function?” he continued.

“I had no idea that hyperglycemia could cause this much trouble with my immune system. What else should I know?” Suzy asked.

What are opportunistic pathogens?”

“I know they are microorganisms that are not usually pathogenic. They only cause infections when the immune system isn't functioning well … like while you're weakened from fighting an earlier infection. I bet they are also more likely to cause an infection in a diabetic since our immune system can be impaired by hyperglycemia,” Suzy responded.

“Absolutely,” Dr. Winerman said. “I want you vaccinated against the swine flu so you don't get this infection. But, think about what might happen if you weren't vaccinated and came down with the flu …”

Suzy responded, “I would really be at risk of getting an opportunistic infection. My immune system would be doubly compromised from fighting the flu and being diabetic.”

4. Identify two opportunistic pathogens. What infections do they cause?
5. Identify two other immune compromised patient cohorts.
6. If you directed the county health department during an influenza outbreak, how you would prioritize immunization of the following personnel groups: geriatric patients, immune-compromised patients, health care providers, police/fire/emergency medical technicians, adults, and children?

Answer 1

1.

Route of administration of vaccines:

• Vaccination generates active immunity in body.
• Vaccine should comprise of antigenic determinant or epitope component of the pathogen.
• Thus, it may be used as live attenuated for, purified components, inactivated whole cell or killed microorganism.
• They are administered as parenteral or by injection, some may be administered orally or through intra-nasal route, depending upon the package instruction associated with each type of vaccine.
• Parenteral route may be: Intra-dermal, intra-muscular or subcutaneous.

Lymphocyte first encountered:

• Immune response is initiated when; the body encounters any foreign molecules, like vaccine antigen.
• Phagocytic cells, engulf the foreign substances by phagocytosis or endocytosis.
• The phagocytosed molecules processed and, then the peptide fragments of antigens are expressed through membrane bound glycoproteins called major histocompatibility complex (MHC).
• . The naïve Helper T-lymphocytes (T_H) cells, with T-cell receptor- cluster of differentiation 3 complexes (TCR CD3), reacts to class II MHC molecules associated with antigenic polypeptide.
• T_H cells are subdivided into T_H2 (activating B-cells), T_H 1 (activating T-cytotoxic cells) and other subtypes, which secretes different cytokines, that induces other immune cells. T_H cells also mediate clonal anargy.