SHOULD I HAVE TAKEN A FLU SHOT?

SHOULD I HAVE TAKEN A FLU SHOT? DR. KELLY SEXTON Joy is a 22-year-old college student. She is typically very healthy. She exercises and eats a varied and healthy diet. She is also an “anti-vaxxer”. She is vehemently against vaccines. She believes that the components of vaccines are a possible reason for many health problems including autism. She has had very few vaccines and none since becoming an adult. On Friday, Joy went to class as normal and felt just fine. She did nothing out of the ordinary. She felt a little tired and went to bed early that night. In the middle of the night, she awoke with a chill. She felt horrible with body aches, a headache, and joint pain. In fact, she felt as if she might just die. She called her Mother to come. Her mother took her temperature and found that Joy had a fever of 103F. Her mother took her to the local Emergency Care Clinic where she was diagnosed with influenza based on her symptoms. She asked the PA to explain what was happening. 1. What is immunity? Discuss “innate immunity” versus “acquired immunity”. What are the advantages and disadvantages of each? 2. What are leucocytes? What are the different types? Discuss each briefly. How are they alike? How are they different? Which are involved in innate immunity? Which are involved in acquired immunity? The PA asked if Joy had taken the “flu shot”. Joy told the PA that she had not and that she did not understand why anyone would. 3. What is a vaccine? What is the “logic” behind giving vaccines? How do they work? Joy then said, “If that is true then why do you have to take the flu vaccine every year?” The PA explained that there are several strains of the virus. There are four types of influenza viruses, named A, B, C, and D. Influenzas A and B are responsible for seasonal flu in humans. Influenza A viruses are further divided into subtypes based on two proteins on the surface of the virus: hemagglutinin (H) and neuraminidase (N). There are 18 different H subtypes and 11 different N subtypes. This year the chosen strains are the H2N1, H3N2, and Type-B strains are the ones in the influenza vaccine. 4. Joy said “That seems useless. What happens if the strain this year is not one of those”? What would you tell Joy? Joy said “Is the flu even that bad? You can’t die from it can you?” The PA then explained that every year somewhere between 12,000 and 50,000 people die and many more are hospitalized. She went on to say that in 1918 there was a worldwide influenza outbreak of H1N1, called the “Spanish Flu” that infected 500 million people around the world and resulted in the deaths of 50 to 100 million (three to five percent of the world’s population), making it one of the deadliest natural disasters in human history. In the first year of the epidemic, life expectancy in the United States dropped by about 12 years. Image transcription text 3,000 2,500 – – – 1911-1917 2,000 1918 Specific death rate 1,500 1,000 500 0 <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 285 Age (y) From the graph above: 5. Analyze the mortality of individuals due to other strains of the flu (1911-1917). Which populations are most at risk? Why do you think these populations are especially susceptible? 6. Analyze the mortality of individuals due to the "Spanish Flu" (1918). Which populations are most at risk? Why would this be unusual? The H1N1 virus was obtained from the bodies of frozen victims. It was then injected into mice. The infection in the animals caused a rapidly progressive respiratory failure and death. This happened through an overreaction of the body's immune system, a cytokine "storm" and massive inflammation. 7. Discuss "inflammation". What are the "cardinal signs of inflammation"? How could massive inflammation lead to rapid pneumonia and respiratory distress followed by death? Joy then asked the PA how does the body kill the virus and heal itself. The PA began by explaining what pathogens and antigens are. 8. What is a pathogen? What is an antigen? How do they differ? To which does the immune system respond? The PA then began to explain the "cells of the immune system". 9. What are Antigen Presenting Cells (APC)? What are the different types of APCs? How do they function in the immune system? 10. What are B cells and T cells? Where do they originate? Where do they mature? Why are they called B cells and T cells? 11. How do B cells work? Place the following in the correct order (circle the right answer). Part 1 1. B cell finds a T helper cell 2. B cell ingests Ag 3. T helper cell hooks up with B cell 4. B cell encounters Ag 5. T helper cell releases interleukins 6. Pieces of Ag are complexed next to MHC II A. 4,2,6,3,1,5 B. 2,4,3,6,1,5 C. 3,4,1,6,2,5 D. 4,6,1,2,3,5 E. 4,2,6,1,3,5 Part 2 1. Some clones become plasma cell and some become memory cells 2. Clones are formed 3. Plasma cells secrete antibodies 4. B cell goes through repeated mitoses 5. Memory cells remain neutral until Ag re-encountered 6. Antibodies inactivate the antigens A. 4,2,1,3,5,6 B. 4,1,3,2,5,6 C. 1,4,3,2,5,6 D. 3,1,4,2,5,6 E. 2,3,1,4,5,6 The PA then described antibodies and antibody production. She then explained how they function. 12. What are antibodies? How many different types are there? Draw a typical antibody. Label the constant region and the variable region. List FIVE ways they inactivate antigens. 13. How does a primary immune response (initial) differ from a secondary immune response (subsequent)? Discuss the lag time and the antibody production levels. Draw a graph showing how they differ. 14. How do T cells work? Place the following in the correct order (circle the right answer). Part 1 1. Thelper cell and Tcytotoxic cell become activated 2. APC phagocytizes Ag 3. APC complexes Ag alongside MHC I and II 4. APC hooks up with Thelper and Tcytotoxic cells 5. APC encounters Ag 6. Tcells go through repeated mitoses A. 5,3,2,1,4,6 B. 3,5,2,1,4,6 C. 4,5,1,6,3,2 D. 3,2,5,4,1,6 E. 5,2,3,4,1,6 Part 2 1. Infected body cells are destroyed 2. Tcytotoxic cells find infected body cells 3. Tcytotoxic cells release perforin and lymphotoxin 4. Thelper cells and T cytotoxic cells are activated 5. Tsuppressor cells tamp down entire immune system 6. Antigen level declines A. 2,3,1,4,6,5 B. 3,2,4,1,6,5 C. 4,2,3,1,6,5 D. 3,1,4,5,2,6 E. 4,2,3,5,1,6 15. Circle the correct answers. B cells acting through antibodies destroy a) free antigens b) antigens within body cells. T cells destroy a) free antigens b) antigens within body cells. The PA asked why Joy has a negative opinion of vaccines. Joy replied that there is mercury in vaccines and that it causes autism. The PA, shaking her head, said "This is a common misconception. One paper by an author named Wakefield in the UK, in 1998, suggested that the Measles/Mumps/Rubella vaccine was linked to autism. Over the next twelve years, the possibility of a link between MMR and autism was studied exhaustively. No reputable, relevant study confirmed Wakefield's findings. Instead, many well-designed studies have found no link between vaccines and autism. In 2004, it was revealed that Wakefield had been paid by attorneys seeking to file lawsuits against vaccine manufacturers. His paper was formally retracted and three months after the retraction Wakefield was banned from practicing medicine in Britain. Incalculable damage was done to public health by a greedy fabrication of data. "Wow" Joy replied. "I didn't know any of that. How come it hasn't been made public?" The PA replied "An entire agency, the Vaccine Safety Datalink (VSD), has been created to study and report findings about vaccines. Even after extensive public outreach there has been no increase in the public's confidence in the safety of vaccines. Despite the work of the VSD, rates of vaccine refusal and vaccine delay have increased over time. There is a lot of misinformation out there and we as health professionals have a duty to present the facts". Joy asked "What sort of flu vaccines are there available?" The PA explained to Joy that there are several types available: Dead virus with 3 strains; Dead virus with 4 strains; a weakened Live virus that is in the form of a mist; vaccine with recombinant virus that is NOT grown in eggs. These all produce a type of immunity called "ARTIFICIAL ACTIVE" immunity. Joy asked "What does that mean"? 16. Define each of the following and give an example of each. A) Naturally Acquired Active Immunity B) Artificially Acquired Active Immunity C) Naturally Acquired Passive Immunity D) Artificially Acquired Passive Immunity Joy's Mother said "I heard something on the news about Llamas and the flu. What's up with that?" The PA explained: "Human antibodies are relatively large and Y-shaped, and they target a part of the influenza virus that tends to change rapidly as it mutates into different strains. That is one reason our existing flu vaccines don't work that well. As the virus mutates, it becomes less recognizable to our antibodies. The antibodies produced by llamas and alpacas are different. They are smaller and straighter, and can target parts of viruses that human antibodies physically can't reach. In the research you heard about, doctors gave llamas a multivalent flu vaccine containing 4 flu viruses. The llamas reacted by making four different antibodies—two that targeted influenza A and two that targeted influenza B. The researchers then "tethered" those four antibodies together to make a kind of super-antibody, which test-tube studies showed were effective at preventing 60 different flu strains. These antibodies were then administered to mice and the mice were protected against those strains of the flu. It has not been tested in humans yet but if it works we may finally have a preventative against the flu that works at 100% year after year. No more trying to "predict" next year's strains!!" 17. Analyze the above statement about llama and alpaca immunity. Which type of immunity ( 16) was conferred on the mice? Would this be permanent? Joy was then given an oral dose of Xofluza and was told to go home and rest, stay hydrated, take ibuprofen for the body aches and fever. The PA said she should begin to feel better in one to two days. SCIENCE HEALTH SCIENCE NURSING BIOL 2402

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