Application of Basic Biomedical Sciences to Immunization

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1. The Immune System and Vaccines

Competency: Explains how vaccines work using basic knowledge of immune system.

Learning Objectives

The health professional will be able to perform the following:

1. Compare and contrast innate and adaptive immunity.
2. Differentiate between the primary and memory immune response to a vaccine.
3. Differentiate between passive and active immunity.
4. Explain why some vaccines induce a memory response while others do not.
5. Name some host- and vaccine-related factors that affect the immune response to vaccines.
6. Explain how the immunization schedule accommodates factors that affect the immune response to vaccines.
7. Respond to the concern that giving too many vaccines will overload the immune system.
8. Discuss the pros and cons of immunity gained through immunization as opposed to wild-type infection.

Key Terms: Active immunity, antibody, antigen, B-lymphocyte (B-cell), booster, cell-mediated immunity (CMI), herd/community immunity, humoral immunity, memory response, passive immunity, primary immune response, protective level, T-lymphocyte (T-cell).

Suggested Content for Training

• Antigens and antibodies
• Cell-mediated and humoral immunity
• Active and passive immunity
• Primary and secondary immune responses
• Conditions that affect immunity and the immune response to vaccines

2. Vaccine-Preventable Diseases

Competency: Demonstrates an understanding of the rationale and benefit of immunization, as relevant to the practice setting.

Learning Objectives

The health professional will be able to perform the following:

1. Describe the key clinical features, including acute and long-term complications, of each vaccine-preventable disease.
2. Describe the key epidemiologic features of each vaccine-preventable disease.
3. Describe the historical impact of immunization on the epidemiology of vaccine-preventable disease.
4. For each of the vaccines administered in the practice setting, formulate a response to the question "Why should I be immunized when vaccine-preventable diseases are so rare in Canada?"
5. Explain why accurate diagnosis of vaccine-preventable diseases is important.

Key Terms:Key Terms: Carriage, clinical features, communicability, complications, contagiousness, endemic, epidemic, epidemiology, incubation period, imported, natural infection, pandemic, reservoir, serotypes, serogroups, transmissibility, vaccine-preventable disease.

Suggested Content for Training

• Epidemiology, signs and symptoms, and mode of transmission of each disease
• Potential complications/long-term sequelae of vaccine-preventable diseases; the nature and rates of each
• Historical impact of immunization programs and the premature withdrawal of these programs, including reduced coverage
• Concepts of control, elimination, and eradication of vaccine-preventable diseases

3. Vaccine Development and Evaluation

Competency: Integrates into practice knowledge about the main steps in vaccine development and evaluation.

Learning Objectives

The health professional will be able to perform the following:

1. Describe, in general terms, the process to obtain marketing approval for vaccines in Canada.
2. Describe what can be learned about vaccines after they are approved for marketing, via surveillance activities and more formal post-marketing studies.
3. Characterize, in broad terms, the key roles and responsibilities for each of the following relative to the post-marketing assessment of vaccine safety and effectiveness:
   • Vaccine manufacturers
   • Canadian regulatory authority (Biologics and Genetic Therapies Directorate)
   • Public Health Agency of Canada
   • Provincial/territorial Health departments
   • Vaccine providers
   • Healthcare providers who don't administer vaccines
   • Vaccine recipients or their parents/caregivers

Key Terms:Key Terms: Effectiveness, efficacy, immunogenicity, package insert, post-marketing, product monograph, reactogenicity, surveillance.

Suggested Content for Training

• Stages of vaccine trials before and after licensure
• Steps in the process of obtaining approval of vaccines for sale in Canada
• Post-marketing surveillance and immunization safety
• The role of surveillance in designing and monitoring immunization programs

4. The Types of Immunizing Agents and Their Composition

Competency: Applies the knowledge of the components and properties of immunizing agents as needed for safe and effective practice.

Learning Objectives

The health professional will be able to perform the following:

1. Classify each immunizing agent used in practice as live attenuated, inactivated, or subunit.
2. Demonstrate the ability to describe live attenuated, inactivated, and subunit immunizing agents to an audience with minimal or no science knowledge.
3. Compare the major advantages and disadvantages of live attenuated versus inactivated/subunit immunizing agents.
4. Identify key differences in the immune response to purified polysaccharide versus polysaccharide protein conjugate vaccines.
5. Describe, in general terms, the purpose, action and potential concerns of each of the following components that may be present in a given vaccine product: adjuvant, preservative, additives, glass vial, stopper, and pre-filled syringe.
6. Locate and utilize current information resources on the types and content of immunizing agents used in practice.

Key Terms:Key Terms: Active immunizing agent, additive, adjuvant, allergens, combination vaccine, inactivated vaccine, live attenuated vaccine, passive immunizing agent, polysaccharide, preservative, protein conjugate, purified protein, subunit vaccine, toxoid.

Suggested Content for Training

• Immunoglobulins, live and inactivated vaccines, polysaccharide and conjugate vaccines and combination vaccines
• Composition of a vaccine, use of adjuvants and other additives
• Efficacy, reactogenicity, compatibility

5. Population Health

Competency: Applies relevant principles of population health for improving immunization coverage rates.

Learning Objectives

The health professional will be able to perform the following:

1. Use specific examples to show how immunization is a population-based health strategy.
2. Explain the concept of herd immunity (also called community immunity) in non-scientific terms.
3. Explain, using examples, why vaccine-preventable diseases return when immunization coverage rates decrease.
4. Explain how immunization registries can benefit not only individuals but also populations.
5. Present the case for the importance of having a highly immunized healthcare workforce.
6. Use health promotion planning model to identify barriers (economic, educational, system-based, and social factors) to immunization uptake.
7. Use health promotion strategies to improve immunization coverage rates.

Key Terms: Active immunizing agent, additive, adjuvant, allergens, combination vaccine, inactivated vaccine, live attenuated vaccine, passive immunizing agent, polysaccharide, preservative, protein conjugate, purified protein, subunit vaccine, toxoid.

Suggested Content for Training

• Concept of herd immunity and the effect of vaccination on the community as a whole
• How herd immunity protects individuals
• Identification of barriers and obstacles that may prevent uptake of vaccination
• Development of strategies to overcome barriers and improve immunization services
• Consideration of environmental factors such as the clinic environment, appointment timings, and length and attitudes of staff to immunization

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