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Operated by PublicHealth Englande-BugYoung AdultVaccinationsLesson plans, worksheets and activitiesfor 15-18 year olds on vaccinations.An educational resourceKey Stage 4&5 / Science** certain sections may also link with the PSHE curriculum

e-Bug: VaccinationsContentsThis pack contains a series of educational resources for young adults aged 15-18 years on the topic ofvaccinations. The resources are outlined below:Vaccination Lesson PlanTeacher sheets .Page 2Student worksheet 1 .Page 7Student worksheet 2 .Page 10Teacher answer sheets .Page 13Vaccination AnimationTeacher information sheet .Page 22References . .Page 30e-Bug Young AdultContents

e-Bug: VaccinationsLesson PlanIntroductionThis lesson plan covers immunity and vaccinations, and highlights the importance of gettingvaccinated, not just for an individual’s health but for others in the population. Interactive slides helpstudents to clarify common myths and misconceptions about vaccinations. Students learn theimpact the media may have on vaccine uptake through the example of the measles, mumps andrubella (MMR) scare in the early 2000s.Learning outcomeso Vaccination helps individuals to develop immunity against an infection(s) and helps to fightoff the infection(s)o Why vaccines are important to students now and throughout their lifeo The important diseases prevented by vaccines, and why these are important to youngpeople, including studentso How the media, and epidemics, can affect vaccine uptake positively and negativelyExam specification linksThis lesson plan covers several topics found in the AQA, OCR, Edexcel and WJEC examspecifications for A-level Biology, Human Biology and related subjects. For more information, pleasevisit the ‘Examination links’ webpage.Key wordsAntibodies, Antigen, Vaccination, Immunisation, Innate immunity, Acquired immunity, Immunesystem, Herd immunityAvailable web resourcesAnimations, interactive slides, PowerPointpresentations and many other resources are available inthe young adult vaccination section at www.e-Bug.eu.Materials requiredMaterialsrequiredGraph paper for completion of themain activity.e-Bug Young AdultVAC TS1

e-Bug: VaccinationsLesson PlanBackground informationVaccinations have been one of the most effective methods to prevent disease and have helped tolower mortality associated with infectious diseases worldwide.How vaccines provide immunityVaccines are preventative, that is, they only protect the individual before they get an infectiousdisease. When an individual is vaccinated, the processes in the immune system that are stimulatedto mimic the body’s natural immunity include: antigen recognition, antibody production andformation of a memory response. These processes occur without causing the damage that aninfection usually causes because the vaccine contains the antigen of the infectious disease, or atoxoid (an inactive version of a toxin) in an inactive, safe form. These infectious agents have beeninactivated by being killed or denatured by heat, radiation or other harmful conditions. The antigenis the same but the microorganism can no longer cause the infectious disease.Vaccines provide immunity by stimulating the immune system to produce antibodies to fight aparticular infection or prevent the effects of a toxin. These antibodies stay in the body and providelong term protection. Antibodies fight a particular infection or toxin by identifying a matchingantigen. Antigens are a pattern or structure found on the microorganism or toxin, and the antigen isa complimentary match for the antibody that will be produced.Types of immunityIf an individual has not been vaccinated against a disease and they have contact with it, they willusually acquire some natural active immunity through exposure to antigens of the microorganismor toxin. However, there are risks associated with contracting an infection as some can leave theindividual with long term complications, or worse, cause death. Artificial active immunity occursthrough vaccination or inoculation. Passive immunity arises through acquisition of protectiveantibodies (most commonly through injection or transfusion of blood products) that will help fightthe infection without the individual having had exposure to the infection or having been vaccinated.Natural passive immunity can also occur between mum and baby through the placenta duringpregnancy or through breast feeding. In some cases, passive immunity can be artificially acquiredthrough the transfer of antibodies from other humans or animals into an individual’s bloodstream.Passive immunity is used when there is no time for an individual to generate their own specificantibodies to microorganisms. An example of this is after a gardening injury when there is a dangerof tetanus, so a tetanus anti-toxin is given to those who have never had the tetanus vaccination.e-Bug Young AdultVAC TS2

e-Bug: VaccinationsLesson PlanHerd ImmunityIf enough of a population is vaccinated, herd immunity is attained. Herd immunity in a populationprevents outbreaks of an infection. This is due to the inability for the disease to infect vaccinatedindividuals and through the inability for unvaccinated individuals to come into contact with thedisease due to its decreased prevalence.It is important to maintain herd immunity as some people are unable to have vaccinations.Individuals who may not be able to have a vaccine include those who are immune-compromised,individuals with allergies to the components of vaccines and very young children.Routine and other vaccinationsCountries have routine vaccinations for diseases that are considered to be high risk in that country.Some vaccines contain antigens for more than one disease. Examples of these include the polio,diphtheria and tetanus vaccine, and MMR (measles, mumps and rubella). In some cases, onepathogen can cause more than one disease. Human papillomavirus, also known as HPV, can causegenital warts and if left unmonitored in women, can lead to cervical cancer. The new HPVvaccination can prevent cervical cancer in women, but it will also reduce genital warts.International travel is increasingly popular and it is important for students to understand that travelto different regions comes with increased risk of infection. Increased risk can be due to poorsanitation or hygiene, or higher occurrence of different infections in those countries, for examplerabies, meningitis or Japanese encephalitis. Students can visit the e-Bug website for moreinformation, their travel vaccination practitioner at their GP surgery, or visithttp://www.fitfortravel.nhs.uk. Travel vaccinations are important and in some cases are required forentry into a country. An example includes the proof of vaccination against meningitis for entry intoSaudi Arabia for the Hajj pilgrimage.Some diseases require boosters to maintain antibodies at a high enough level to prevent infection.Boosters maintain high antibody levels in the blood. An example is the pneumococcal vaccines. Thegenetic make-up of some microorganisms mutates quickly, leading to changes in their antigenstructure, and so these infections require annual vaccinations. This is why annual flu vaccines aredeveloped to prevent infection from new flu strains circulating in the community.e-Bug Young AdultVAC TS3

e-Bug: VaccinationsLesson PlanIntroduction (15mins)1.Provide an introduction for students, describing that they are going to learn aboutvaccinations, and why vaccination is so important. Students will be learning the truth aboutcommon myths and misconceptions surrounding vaccinations, and the influence of otherswhen making decisions about vaccinations. Students will learn about the influence of themedia on vaccine uptake, subsequent disease rates and herd immunity.2.Ask students what they already know about vaccinations. Questions to be discussed couldinclude: Do you know what a vaccination is? How does a vaccination work?What vaccinations do children usually have, and at what ages?What vaccinations have you had?Why do you think you need vaccinations against diseases such as the flu, or measles, mumpsand rubella (MMR)?Do students know what herd immunity is? Ask students to describe this in their own words.(The herd immunity animation at www.e-Bug.eu could be used if students are still confusedabout herd immunity).Main activity (20-25 mins)1. Present the interactive vaccination myth slides from the e-Bug young adult website. Thesecover five myths and misconceptions about vaccines that young people may have, andprovide answers based on the students views. Involve the students in answering yes or no toeach myth and then review the background information provided.2. Provide students with student worksheet 1, which contains data related to the MMR scareand controversy. Begin the PowerPoint about the influence of the media on vaccines.3. Ask students to complete the worksheet and use the provided data to plot a graph.4. After students have completed the worksheet, finish the PowerPoint and review the correctgraph with the students.e-Bug Young AdultVAC TS4

e-Bug: VaccinationsLesson PlanPlenary (10 mins)Discuss the worksheet answers with the students.What are the student’s different interpretations of the graph?Reflect back on herd immunity. Ask the students to describe how herd immunity was impacted inthis example, and what the result of this was.Extension activity1. There is currently no vaccine for HIV or Ebola. Choose an infection that is prevented byvaccines and write a research report outlining and comparing why some infections, like HIVor Ebola, are still not prevented by vaccines.2. A zombie apocalypse has infected the earth. Public Health England (PHE) is working on avaccine to combat the infection that causes humans to become zombies, and you are avaccine scientist working on this vaccination. Write a news article to describe the plan youand your team at PHE are working on to stop the spread of the zombie apocalypse.3. Assign students to watch the immunisation animation clips available at www.e-Bug.eu ashomework. Ask students to complete student worksheet 2, which accompanies theseanimations.AcknowledgementsThis lesson plan was written by the e-Bug team. The activities were devised by Dr Carwyn Watkins. Veryspecial thanks to Antoaneta Bukasa from the immunisation team at Public Health England.preparationAdvance PreparationLocate and download the interactive vaccination myth slides and the PowerPoint presentation atwww.e-Bug.eu.In preparation for the lesson, you can ask students to complete their own personalised vaccinationtimeline, available at www.e-Bug.eu. This timeline will detail all the vaccinations students should havehad, and they can discuss this at home with their parents. However, the immunisations that studentshave or have not had are not for class discussion. Students may be very surprised at the number ofimmunisations they have had.e-Bug Young AdultVAC TS5

e-Bug: VaccinationsStudent Worksheet 1Student worksheet 11. The table below provides the percentage of children immunised by their second birthdayagainst measles, mumps and rubella (MMR) between 1996 and 2014 (England only). Thisdata is from the Health & Social Care Information Centre (available -immu-stat-eng-2013-14-rep.pdf).Copyright 2014, re-used with the permission of the Health and Social Care InformationCentre. All rights reserved.Year of 2nd 92009-102010-112011-122012-132013-14MMR 1st dose 684.988.289.191.292.392.7e-Bug Young AdultVAC SW1

e-Bug: VaccinationsStudent Worksheet 1The table below provides numbers of confirmed cases of measles in England by age,between 1997 and 2013. This data is from Public Health England.Year 1 96031283587435484110 – 20 43819177740990137011443801087203018431212. Using the data provided, plot a single graph showing MMR vaccination uptake and measlescases in England between 1997 and 2014. Plot the MMR vaccination uptake as a bar graphand the number of measles cases overtop as a line graph.3a. Interpret your graph showing MMR vaccine uptake and measles cases in England. What hashappened?3b. Why do you think there were changes in the vaccination uptake rates and cases of measles?What influenced the changes?e-Bug Young AdultVAC SW1

e-Bug: VaccinationsStudent Worksheet 14. What is the relationship between these two figures? How do they impact each other?5. What were the ages of individuals who had measles in 2002? Explain why that may be?6. Divide the measles cases data into three periods: 1997-2002, 2003-2008 and 2009-2014. Whattrend do you notice in the overall numbers and individual age groups?7. What conclusions can you draw from the ages of the confirmed cases of measles?8. How was herd immunity affected by the media in this example?e-Bug Young AdultVAC SW1

e-Bug: VaccinationsStudent Worksheet 1Student worksheet 21. We have various types of physical barriers to prevent invasion by a microorganism. Namethree of these barriers and explain how they are specialised to prevent infection.2. If a microorganism isn’t cleared from the body by the innate response, what happens next?3. Legionella pneumophila is a bacterium that causes Legionnaire’s disease. In humans it isengulfed by macrophages but is able to evade the normal mechanisms that macrophagesuse to kill it. It is therefore able to live inside the macrophage and use it’s nutrients to stayalive.a) Why can’t B cells recognise the L. pneumophila antigens?b) How would the immune system identify L. pneumophila and how is it removed fromthe body?c) Why would someone with a deficiency in T cells be more prone to intracellularmicroorganism infection?e-Bug Young AdultVAC SW2

e-Bug: VaccinationsStudent Worksheet 14. Once the acquired immune response is initiated, plasma cells can produce antibodies.Explain why antibodies will only be effective against one pathogen.5. Cytokines have many roles in the immune response. From the animation, can you describetwo ways that cytokines help the body fight infection?6. Clostridium botulinum is a bacterium that produces the botulinum neurotoxin. This iscommonly known in the medical industry as Botox. It is the botulinum toxin that is lethal as itcauses flaccid paralysis in humans and animals. Clostridium botulinum that produces ithowever is not considered dangerous by itself. The immune system can recognise toxins aswell as microorganisms.a) How does the immune system recognise and clear toxins?b) Why would a vaccine for the Clostridium botulinum bacterium not be considered aseffective as a vaccine against the botulinum toxin?7. What is the function of the following cells:a) Cytotoxic T cells?b) Helper T cells?e-Bug Young AdultVAC SW2

e-Bug: VaccinationsStudent Worksheet 1c) Plasma cells?8. Explain why vaccines are preventative in protecting against infection.9. Explain how a vaccine results in a memory response in the immune system.10. Herd immunity arises when a significant proportion of the population is vaccinated against adisease. What could happen if the vaccination rates were to fall in a population for thefollowing vaccines? (Hint: think about their transmission methods. Measles is spread throughtouch and in the air through contagious droplets from infected people, and cholera is awater-borne disease).a) MMRb) Cholerae-Bug Young AdultVAC SW2

e-Bug: VaccinationsTeacher SheetStudent worksheet 1 answers1. The table below provides the percentage of children immunised by their second birthdayagainst measles, mumps and rubella (MMR) between 1996 and 2014 (England only). Thisdata is from the Health & Social Care Information Centre (available -immu-stat-eng-2013-14-rep.pdf).Copyright 2014, re-used with the permission of the Health and Social Care InformationCentre. All rights reserved.Year of 2nd 92009-102010-112011-122012-132013-14MMR 1st dose 684.988.289.191.292.392.7e-Bug Young AdultVAC TS6

e-Bug: VaccinationsTeacher SheetThe table below provides numbers of confirmed cases of measles in England by age,between 1997 and 2013. This data is from Public Health England.Year 1 96031283587435484110 – 20 4381917774099013701144380108720301843121e-Bug Young AdultVAC TS7

e-Bug: VaccinationsTeacher Sheet2. Using the data provided, plot a single graph showing MMR vaccination uptake and measlescases in England between 1997 and 2014. Plot the MMR vaccination uptake as a bar graphand the number of measles cases overtop as a line graph.MMR Vaccination uptake and confirmedmeasles cases100250080200070601500504010003020Total MMR cases% of children immunised90% childrenimmunisedagainst MMR by2nd birthdayMeasles cases5001000Year3a. Interpret your graph showing MMR vaccine uptake and measles cases in England. What hashappened?The graph indicates that there was an immediate decline of MMR vaccination rates starting in1998 when the first paper was published. The rates continued to drop until they reached theirlowest point in 2003/04, below 80%. After 2004, the rates steadily increase and in 2014 they areat a historic high of 92.7%.However, in contrast, the general trend in confirmed measles cases is increasing beginning in2002.e-Bug Young AdultVAC TS8

e-Bug: VaccinationsTeacher Sheet3b. Why do you think there were changes in the vaccination uptake rates and cases of measles?What influenced the changes?Media coverage of Andrew Wakefield’s flawed studies influenced the public’s view of the safetyof the MMR jab. As a result, the vaccination rates decreased below the recommended 95%uptake resulting in increase of the pool of susceptible individuals to measles. Parents wereunsure about the safety of the vaccine, and this resulted in not vaccinating their children. Therates of measles in England increased, and there were large outbreaks in 2008 and 2012.4. What is the relationship between these two figures? How do they impact each other?As the vaccination uptake decreases, measles infections in the population begin to increase.Once the vaccination uptake increases, beginning in 2005, the measles infections in thepopulation is affected.5. What were the ages of individuals who had measles in 2002? Explain why that may be?The majority of the measles cases in 2002 were aged 1-9 yrs. These were children that wereoffered at least one dose of the MMR vaccine (1st dose of MMR should be given age 13 months,2nd dose between the ages of 3.5 and 5yrs). Because the vaccination uptake had been falling,fewer children had been vaccinated and therefore caught measles when coming into contactwith the infection.6. Divide the measles cases data into three periods: 1997-2002, 2003-2008 and 2009-2014.What trend do you notice in the overall numbers and individual age groups?period199720022003200820092014 1 year1–9years10 – 19years20 610380656924212303131116605e-Bug Young AdultVAC TS9

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This lesson plan covers several topics found in the AQA, OCR, Edexcel and WJEC exam specifications for A-level Biology, Human Biology and related subjects. For more information, please visit the ‘Examination links’ webpage. Introduction Learning outcomes Exam specification links

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