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Poxvirus (variola)
Highly contagious
No treatment once contracted
20 40% fatality rate (variola major)
Edward Jenner
1798: noticed that milkmaids didnt get smallpox
Reasoned that it was due to exposure to cowpox
virus
Inoculated a young boy with some cowpox virus
he didnt develop smallpox when he was
subsequently inoculated with it
Jenner called it vaccination (vacca Latin for cow)
Basic Immunology
The Immune System
Extremely complex
Involves all systems in the body
Broadly composed of:
Immunology
The study of the bodys ability to fight disease
From the Latin immunitas freedom from
Basic Immunology
The Immune System
A. Natural (Innate) Immunity non-specific
Barriers skin and mucous membranes, with
their glands and secretions
Cells macrophages, NK cells, PMN leucocytes
They secrete interferons, lysozyme
Induce other cells to secrete acute phase
proteins, complement, histamine
Basic Immunology
Rhinovirus
Advantages:
Memory repeat infections with the same organism are
dealt with very quickly
Incredibly specific generates antibodies to any
invader it encounters
Basic Immunology
Acquired (Adaptive) Immunity
How it Works:
Invading organism (virus, bacteria etc) has proteins
on the outside of its cells ANTIGENS (Ag)
Proteins on cells of the immune system that can
interact with the antigens are called ANTIBODIES
(Ab)
Ag and Ab react to form the Ag-Ab complex
Activates the immune system to make more of the
right antibodies i.e. those that are specific for
that organism
The antibodies then stick to the antigens on the
invading cells surfaces, marking them as foreign.
The immune system then activates its mechanisms
Passive Immunity
Usually viruses
Give a better immune response
Can cause a mild version of the disease
Can cause active disease in immunosuppressed patients
Risk of reverse mutation back to active form (rare)
E.g. MMR, BCG (attenuated by bile!)
Age
Vaccination
Birth
BCG (Tuberculosis)
2 mths
6-in-1
PCV
4 mths
6-in-1
Meningitis C
6 mths
6-in-1
Meningitis C
PCV
Vaccination
12 mths
MMR
PCV
13 mths
Men C
Hib
PCV
Pneumococcal
conjugate vaccine
6 in 1 Vaccination
Diphtheria
Tetanus
Whooping cough
(Pertussis)
Hib (Haemophilus
influenzae b)
Polio (inactivated
poliomyelitis
Hepatitis B
Schedule Changes
Hib Booster
July 2005, National Immunisation Advisory
Committee recommended that children from
12 mths to 3 years old be given a booster
dose of Hib
This was due to several cases of Hib
meningitis in children who had been fully
vaccinated
Started in November 2005 with catch-up
injections - letters posted to parents, inviting
them to bring children of between 12 -36
months in
Hib b
t
i
ti l t ll hild
4-5 years
4-in-1
MMR
11-14 years
Td
MMR
Measles
Mumps
Rubella
4 in 1 Vaccination
Diphtheria
Tetanus
Whooping cough
Polio
Td
Tetanus
Diphtheria
Schedule Changes
Pneumococcus (Childhood)
Adult vaccine given to at risk groups once
Introduced to childhood schedule for all children
born after 1st July 08
Catch-up programme for children under 2 at that
time.
Aim to reduce pneumococcal pneumonia and
meningitis
19% Streptococcus pneumoniae bacteria in
Ireland are resistant to penicillin
S. pneunmoniae causes 50% of communityacquired pneumonia
Schedule Changes
New Vaccinations
HPV
Hepatitis B
New Vaccinations
Why Bother?
HPV
Pros
Safe side fx generally minor
Concerns
That it will promote early onset sexual activity (no
evidence)
New drug, only limited follow-up available
Sh
t b
ffi
t 45
tl
Tuberculosis
Diphtheria
Disease
Mycobacterium tuberculosis
Usually affects lungs
(consumption), but can affect
other organs
Droplet spread
7% death rate (usually elderly)
Treatment: antibiotics for
minimum 6 months!
Several outbreaks in recent yrs
MDRTB now emerging
Vaccination
Live attenuated; lasts ~ 15 yrs
50% effective (70-80% v. TB
meningitis and miliary TB)
Little evidence of effectiveness
>16 y.o.
Mantoux test
Diphtheria
Corynebacterium
diphtheriae
Severe sore throat and
swelling of tonsils
Droplet spread
Produces a toxin that can
damage heart muscle
Can cause complete
airway obstruction and
death in worst cases (1 in
15 die)
Vaccination gives 95%
protection
Tetanus
Tetanus
Toxin of Clostridium
tetani (bacteria)
Causes muscle
spasm and rigidity;
10-25% death rate
Forms highly resistant
spores, found in soil,
etc.
No cure, just
supportive treatment
until recovery
Booster should be
given every 10 years
Bordatella pertussis
Characteristic cough,
risk of encephalitis
Very severe if < 6
mths
Lasts 8 weeks, no tx
Vaccination
Acellular used in Eire
Controversy in
1970s over
neurological
Polio
Meningitis
Disease
Disease
Polio virus
Faecal-oral and
droplet spread
95% asymptomatic /
mild flu-like illness
2% flaccid paralysis
Vaccination
IPV (Salk inactive)
OPV Sabin live
attenuated (sugar
cubes)
Vaccination
Protects against
Neisseria meningitidis
type C (40%) can still
get A/B
Pneumovax
Men C notified cases:
2000 139; 2005 5
Measles
Disease
Measles virus
Catarrh, conjunctivitis,
rash, misery, fever, cough
Incredibly contagious
Complications ear
infxns, pneumonia,
encephalitis
1/2000 die
Vaccination
Live attenuated; gives
90% protection
Mumps
Disease
Paramyxovirus
20-30% asymptomatic
Inflammation of the
salivary glands esp the
parotid gland
Complications orchitis,
pancreatitis, encephalitis,
deafness
No specific tx
Vaccination
Live attenuated; 90%
ff i
Rubella
MMR Vaccination
Disease
Controversial
Rubella virus
German measles - like mild
measles infection
Main risk is to pregnant
women 25% of babies
born with birth defects if
Mum infected during
pregnancy (congenital
rubella deafness, heart
defects, microcephaly, LD,
cataracts)
Vaccination
Live attenuated; 95%
Herd Immunity
Herd Immunity
What is it?
What is it?
f th di
Unusual
Convulsion (usually febrile) (1/1000)
Prolonged crying after injection (1/100) esp
DTP
Abscess formation at site of injection esp
BCG
Rare
i h th
i k
f th
Mini-mumps
Fever and mild parotid gland swelling 3-4
weeks after the injection
Rash
Bruise-like spots all over the body, anytime in
the first 6 weeks after MMR (very rare)
Persuasive Arguments
Why not give single vaccinations
It takes longer, so the baby is at risk of infection
for longer
Would mean babies are given far more injections
Single vaccines have not undergone the same
rigorous testing as combined vaccination
The current vaccines are known to be safe
Mumps
Encephalitis 1/300
Infertility
Rubella
Congenital Rubella Syndrome (if pregnant)
Persuasive Arguments
I didnt have any vaccinations - Im fine!
The development of vaccinations has moved on:
they just werent available previously
The risks of getting the disease still outweigh the
risks of vaccination
The only way to eventually eradicate these
diseases is by vaccination
The Future
Efforts to Find New Vaccines
Malaria
HIV