Immunology At A Glance Francina Hyatt Clinical Nurse Trainer Anatomy and Physiology of the Arm 600 skeletal muscles in human body Muscles may be deep or superficial The arm has 9 muscles Skeletal muscles receive 1 litre blood per min When injecting influenza, B12, Pneumovax we usually use the deltoid muscle Underlying structures to be avoided include: Network of nerves Underlying Blood Vessels Humerous Bone Structure of the Skin Epidermis –protein based barrier, has no blood vessels, nerve endings. Dermis – fibrous elastic bed, ranges in thickness 0.5 mm thick eyelids, penis and 4mm thick soles of feet and palms hands. Subcutaneous tissue (fatty layer) Dermis provides nourishment for epidermis and internal structures: hairs, sweat glands, blood vessels, lymphatic vessels and nerve endings. Function of the skin Protection Absorption (fat soluble vitamins, drugs) Sensation Temperature regulation Excretion (gas exchange, urea, sodium chloride in sweat) Synthesis vit D (sunlight causes synthesis of vit D) Energy and water reserve Historical Immunology Jenner and Small pox Vaccination (1749-1823) Louis Pasteur attenuated anthrax vaccines and discovery of rabies vaccine (1822-1895) Development of Human Vaccines 18th Century Small pox 1796 19th Century Anthrax 1881, rabies 1885, diphtheria antitoxin 1891, plague 1897, cholera 1896, typhoid 1898 Early 20th Century BCG 1921, diphtheria toxoid 1923,pertussis 1926,tetanus 1927, yellow fever 1935, influenza 1945 Poliomyelitis(injectable 1955, oral 1961, injectable 2005,Measles 1960, mumps 1967, rubella 1962, pneumoccocal, HIB, hepatitis A 1992, hepatitis B 1981 Post World War Principles behind Immunisation Immunisation protects people against serious illness. An immunisation programme vaccinates people against a specific disease. Herd immunity occurs when sufficient numbers of the population are immunised Cells of the Immune System White blood cells are bodies fighting force Lymphocytes produce antibodies and some become memory cells Phagocytes or Macrophages Lymphocytes attack pathogens/foreign bodies. Phagocytes engulf and absorb or release an enzyme to destroy a pathogen/toxin What is a vaccine? How does it work? Substance that contains weakened or inactivated parts of a disease-causing organism or toxin. It stimulates the immune system to produce antibodies to a specific disease Vaccine Production Some inactivated vaccines contain adjuvants to enhance the antibody response to the antigen To prevent bacterial growth or stabilise antigen, may contain trace amounts antibiotic, chemicals Always ask your patient if they are allergic to any of the components of the vaccine every time, even for the yearly influenza vaccine Possible effect of vaccination on skin Pain due to sensory nerves in dermis Inflammation/ swelling – a local defensive response to tissue damage(Rare) Infection (rare) Allergy – Hives, itching (rare) What is Immunity? Development of relative resistance to an infection. Can be: acquired from mother in utero and during breast feeding (mmr) Actively from a infection/vaccine Passively through the administration of ready made anti-bodies in form of immunoglobulins. Naturally following infection giving lifelong immunity Passive Immunity Only lasts a few weeks or months This is provided when body is given readyformed antibodies from human normal immunoglobulin collected from pooled human blood donations. (Hep A, measles) Or specific immunoglobulin formed from sera from humans/animals recently vaccinated or who have had the infection. (hep b, rabies) Active Immunity Created by giving an antigen as a vaccine, containing organisms that have been: Killed (heat-killed) Attenuated-live organisms with low virulence(mmr, oral polio, BCG) Inactivated bacterial toxins (eg with formaldehyde – diphtheria and tetanus) Active immunity (cont) Inactivated organisms (hepatitis A) Inactivated selected antigens of the organisms (pneumococcal, influenza) Genetically engineered (hep B vaccine) Acquired Immunity Mother passes her antibodies to infectious diseases which she has acquired through infection or vaccination to newborn child via placenta and breast milk. Why give yearly Influenza Vaccines? Influenza viruses quickly mutate changing their surface proteins, therefore a new flu vaccine has to be developed each year to give protection against anticipated flu viruses. At risk groups higher risk of being hospitalised with Influenza or even die. Why give the Pneumonia Vaccine? Pneumococcal vaccination will help protect against pnemococcal disease and its complications. Older people and at risk groups are at increased risk of pneumonia S.pneumoniae is becoming more resistant to common antibiotics and therefore more difficult to treat. Patients who have had pneumonia still should be offered vaccination as it protects against 23 types of pneumonia infection Frequently asked questions by patients What are the side effects to this vaccine? What types of flu does this years vaccine protect against? Do I need the pneumovax if I have had pneumonia? How long before I have immunity to the vaccine? Could the vaccine give me flu or pneumonia? Summary Immunisation is a positive health benefit for patients and does prevent death or serious handicap. The immune system is complex. Vaccines contain weakened or inactivated parts of the disease- causing organism. The benefits of vaccination out way the risks in most instances.