Immunization

2016
 Immunity
Specific defenses
Immunity

Active immunity Passive immunity

Following clinical infection Natural/ Transfer of maternal

Antibodies Through placenta
Innate
Following subclinical infection Transfer of maternal
Antibodies Through milk
Acquired
Following vaccination Following administration of
Immunoglobulin or antiserum
 Immunity
Innate Acquired*

Passive Active*

Artificial Natural Artificial* Natural

*Modes of immunization
Innate and Adaptive immunity
 Innate and Adaptive Immunity
Non-specific Immunity (innate)
Its response is antigen-
independent.
There is immediate
response.
It is not antigen-specific.
Exposure does not result in
induction of memory cells.
Some of its cellular
components or their products
may aid specific immunity
Specific Immunity (adaptive)
Its response is antigen-
dependent.
There is a lag time between
exposure and maximal response.
It is antigen-specific.
Exposure results in induction
of memory cells.
Some of its products may aid
non-specific immunity.
 Passive Immunity
• Transfer of antibody produced by one
human or other animal to another
• Temporary protection
• Transplacental most important source in
infancy
 Sources of Passive Immunity
Almost all blood or blood products
Homologous pooled human antibody
(immune globulin)
Homologous human hyperimmune
globulin
Heterologous hyperimmune serum
(antitoxin)
 Active Immunity
Antibody or sensitive lymphocyte produced by the body
following exposure to antigens-- VACCINE

Naturally (natural infection with a microorganism)

Active Immunity
Artificially (administration of vaccine)
 Vaccination
• Vaccination: Process of inoculating the
vaccine or the antigen
• Vaccination is a method of giving antigen
to stimulate the immune response through
active immunization.
• A vaccine is an immuno-biological
substance designed to produce specific
protection against a given disease.
• A vaccine is “antigenic” but not “pathogenic”.
 Vaccination
• Active immunity produced by vaccine
• Immunity and immunologic memory
similar to natural infection but without
risk of disease
• Seroconversion: Change from antibody
negative state to antibody positive state.
• Seroprotection: The state of protection
(from disease) due to presence of humoral
immunity or antibody detectable in serum
 IMMUNIZATION
Immunization: Process of inducing immune
response, humoral or cell mediated.
Immunization is the means of providing

specific protection against most

common and damaging pathogens.
Specific immunity can be acquired either by
passive or by active immunization and both
modes of immunization can occur by natural
or artificial means
 Immunizing agents

Immunizing agents

vaccines immunuglobulins antisera

 Passive Immunization

• Administration of preformed human or

animal antibodies to individuals already
exposed or about to be exposed to certain
infectious agents
– Tetanus antitoxins
– Immune globulins
 Active Immunization

• When it produces the desired beneficial

effects by stimulation of antibody
production by the patient
– Tetanus toxoid
– MMR
– BCG
 THE IMMUNE SYSTEM

A. Humoral Immunity:
This type of immunity is due to circulating Abs
(Gamma - globulin's also called immunoglobulins).
It is a major defense against bacterial infections.
On stimulation, B-lymphocytes divide and its
daughter cells are transformed into plasma-cells.
The latter secrete the Antibodies into the circulation.
 B. CELLULAR IMMUNITY:
Another way of establishing host resistance is through
T-lymphocytes.
These cells synthesize and release pharmacologically
active substances ("lymphokines") which can kill
cells carrying foreign Antigens.
T-lymphocytes also act against the invader by
stimulation of macrophages.
This activity of the immune system is known as cell
mediated immunity. The peak of activity occurs
around the tenth day.
What is…
Antigen
• A live or inactivated substance (e.g.,
protein, polysaccharide) capable of
producing an immune response
Antibody
• Protein molecules (immuno-globulin)
produced by B lymphocytes to help
eliminate an antigen
Immune responses
Immune responses
 Antigens (Ag)
Bind with BCR,
and induce the
antibody releases

Bind with TCR

and activates the
T cell

Activated B cell

Memory T cell Activated T cell Antibody Memory B cell

Immune system plays an active role—
proliferation of antigen-reactive T and B cells results
in the formation of memory cells.
Gene for antigenic protein

Plasmid yield
antigenic
protein
Plasmid vaccine

antigenic
peptides

Activated
Memory cytotoxic T cell Antibodies Memory
T cell B cell

cellular immunity humoral immunity

 THE IMMUNE RESPONSE:
When an antigen (Ag) is introduced into human body:

It stimulates production of antibodies (Ab).

Micro-organisms (and their toxins) and vaccines are

antigens which evoke an immune response.

Immune response is two types:-

1) The primary response: when an Ag is introduced into the

body for the first time, there is a latent period of 3-10 days
before Abs appear in the blood.

2) Peak is reached quickly then level of Abs falls gradually over

next few weeks or months.
Immune responses
Immune responses
2) The secondary (booster) response: the
response to a booster dose of the same Ag
differs in a number of ways from the primary
response:
- has a shorter latent period and more rapid
production of Abs.
- Abs are produced in abundance and
a high level is maintained for a longer period.
- Abs produced tend to have a greater
capacity to bind to the Ags.
The accelerated response is attributed to
the immunological memory.
Immune response -secondary
Immune responses
 Types of vaccines
Tissue Live Killed Toxoids Cellular fraction Recombinant
culture Attenuated Inactivated vaccines vaccines
vaccine vaccines vaccines

•Rabies •BCG •Pertussis •Diphtheria •H Influenza B •Hepatitis B

•Oral polio •Salk polio •Tetanus conjugate vaccine
•Yellow •Intra- •Typhoid Vi
fever muscular polysaccharide/
•Measles influenza conjugate
•Mumps •Japanese •Meningococcal
•Rubella encephalitis polysaccharide/
•Cholera conjugate
•Varicella vaccine
•Intranasal •Plague
•Pneumococcal
Influenza polysaccharide/
•Typhus conjugate
•Plague vaccine
 Cold chain
Vital link in immunisation
 The system of transporting, distributing and storing
vaccines from the manufacturers right up to the point of
use under refrigeration using any convenient method is
referred to as cold chain

 If not maintained, vaccine efficacy will grossly suffer

 Safe temp. zone – mandatory to maintain potency

 Short term storage (1-2 months)is 2-8 deg C.
 Long term storage –20 degC for BCG,OPV,Measles/MMR

 The T series of vaccine(DPT,DT,TT),typhoid Vi,Hep B

should not be frozen as once frozen the aluminium salts
used as adjuvant will be desiccated and will act as
irritantsterile abcess
REFRIGERATOR SHOWING VACCINES STORED
CORRECTLY IN CLINIC SETUP
 National Immunisation Schedule
Age Vaccine
Birth BCG, OPV – 0/Hep B
6 wks DPT –1, OPV –1,
Hep B, HiB
10 wks DPT – 2, OPV – 2,HepB
14wks DPT – 3,OPV–3,HepB
9 months Measles
15-18 months DPT – 4, OPV –4,MMR
5 years DPT
10 years TT
16 years TT
Pregnant women 2 TT at 4 wks interval
 Where to inject?
General rules:
• For children < 1 year old – lateral thigh
• For children > 1 year old - deltoid
• Buttocks should not be used for active
vaccinations because of the potential
risk of injury to the sciatic nerve
• If the buttocks are to used –
use only upper outer quadrant
NAME BCG-LAV. Danish bovine strain
Content BCG strain of bovine mycobacterium-
3-10 million bac/dose
Preparation Lyophilised
Initiation At birth/first contact
Schedule Single dose
Booster Nil
Dose 0.1 ml
Administration Intra dermal left deltoid
Efficacy 0-80%
Contraindications Immunodeficiency
Adverse Events Abscess, Axillary adenitis
 BCG

• Normal course • Accelerated reaponse

– Wheal disappear in 30 – 91-100% correlation
mins with TB infection
– Induration – after 2-3 – Induration – after 2 – 3
wks days
– Pustular formation – – Pustular formation –
after 4 – 6 wks after 5 – 7 days
– Full scarification – – Scar – after 2 -3 wks
after 6 – 12 wks
NAME DPT-killed pertusis+toxoid diph& OPV-LAV
tetanus
Content Diph tox 20 Lf,Tet tox 5 Lf.Pertusis SABIN, type 1-106(CCID
6 IU(40,000 million killed bacteria 50),type-2-105(CCID
+ALPO4-3 mg 50),type-3- 105(CCID50
Preparation Liquid Liquid
Initiation 6 wks Birth
Schedule 3 doses 6,10,14 wks Birth,6,10,14 wks
Booster 15- 18 mo,5 yrs 15- 18 mo,5 yrs
Dose 0.5 ml 2 drops
Administration I/M lat thigh Oral
Efficacy P80%D80%T100% 80-90%
Contraindications Prog neuro dis, anaphylxis, Immunodeficiency,HIV
*Relative encephalopathy,
contraindications *uncontrolled cry, convulsion,
Adverse events Fever, local indurn, pain, Hypotonic Vaccine assoc. paralytic
hyporesponsive episode, seizures polio
NAME DPT wc+HB combination DPT wc+Hib

Content D and T toxoid+PWC+ D &T toxoid

yeast derived r-DNA PWC+capsular
HBsAg polysaccharide of Hib
Preparation Liquid Lyophilised/liquid
Initiation 6 weeks 6 wks
Schedule 6,10,14 wks 6,10,14 wks

Booster Nil Nil

Dose 0.5 ml 0.5 ml
Adminstration IM IM
Efficacy 90-100% 90-100%
Contraindications Same as DPT Same
Adverse events Fever,pain,local induration Mild fever,local
induration
NAME H Infl B(conjugate) TYPHOID(Vi
PRPD/PRPT/HBOC polysaccharide/
Content H.Infl capsular conjugate
oligosaccharide –b Vi capsular polysach
Preparation Liquid/freeze dried S.typhi/conjugate
Initiation 6 wks Liquid
>2 yrs(P) <2yrs(C)
Schedule 6,10,14 wks/2,4,6 mo
Single dose
Booster After 1 yr Every 3 yrs(P)
Dose 0.5 ml.10 mcg 25-50 mcg(0.5 ml)
Administration SC/IM-deltoid/ant lat thigh I/M
Efficacy 90-100% 70%
Contraindications None
None
S/E Local rxn,fever Fever,pain,induratn
NAME Pneumococcal Measles(LAV)
Content Capsular poly saccharide/ 1000TCID50.Schwarz or
Conjugate Edmonston Zagreb strain
1000 TCID/CCID
Preparation Lyophilised Lyophilised
Initiation < 2yrs (Conj.) >9 mo
>2 yrs(polysaccharide)
Schedule 3+Boost (C),Single (P) 1 dose at 9-12 mo.
Booster Every 3-5 yrs(P) As MMR
Dose 0.5 ml 0.5 ml
Adminstration SC/IM over Ant. Lat thigh S/C deltoid
Efficacy 85-90 % 95%
Contraindications First trimester pregnancy Imm def,anaphylaxis,egg
protein allergy
Adverse events none Fever ,rash after a week
NAME MMR(LAV) Mumps(LAV)
Content Measles as L-Zagreb/Jerry Lynn
above,Mumps5000 TCID of strain 5000TCID
Urabe AM-9,Rubella 1000
TCID of Wistar RA/3M
Preparation Lyophilised Lyophilised
Initiation 15 mo 15 mo with M&R or
later yrs
Schedule Single dose Single dose
Booster For measles and Mumps School entry
Dose 0.5ml 0.5 ml
Adminstration SC deltoid SC deltoid
Efficacy 95% 90-95%
Contraindications As in measles+pregnancy Imm def
As in measles Fever
NAME Hepatits B(HBsAg) HEP-A (inactivated
vaccine)
Content Plasma derived/yeast derived HM 175 of HAV 720
r-DNA/CHO cells derived r- ELU antigen/ml
DNA

Preparation Liquid Liquid

Initiation Birth w/ I 48 hrs6 wks >2 yrs
Schedule Birth,6,10,14 wks/ 2 doses 0, 6 mo
0,1,6 months
Booster Nil Nil
Dose 10 microgram,0.5 ml(<10 0.5 ml
yrs), 1 ml(>10 yrs)
Adminstration I/M deltoid IM antero lat thigh
Efficacy >90% 99%
Contraindications None None
Adverse events Local pain,erythema Mild reaction
NAME Varicella vaccine Meningococcal
Content OKA strain of varicella N.meningitidis
zoster103(3 PFU) gp.A,C,Y,W 50 mcg
each
Preparation Lyophilised Lyophilised
Initiation >1 yr For use only in endemic
areas during
epidemics.>2 yrs
Schedule 1-12 yrs(single dose),>13 yrs Single dose
2 doses 1 mo apart
Booster Nil 5 yrs
Dose 0.5 ml 0.5 ml
Adminstration SC deltoid SC/IM-deltoid/Ant lat thigh
Efficacy 95-100% 90-100%
Contraindications None None
Adverse events Varicella type rash after 1 wk Local rxn, mild fever
with fever
NAME Rabies (tissue culture)-inactivated

Content 1. HDCV(virus grown in Human Diploid

fibroblasts)
2. PCEC (Chick embryo cells)
3. Vero cell(vervet monkey kidney cell)
Preparation Lyophilised
Initiation Any age-/after dog bite
Schedule Pre expo:0.7,21 days.
Post expo:0,3,7,14,28.
Re expo0,7(<5 yrs), full course(>5 yrs)
Booster First after 1 year then every 3 yrs
Dose 0.5 ml/1ml depending on preparatn
Adminstration S/C deltoid/ ant lat thigh
Efficacy 90-100%
Contraindications None
Adverse events Local pain, rarely encephalopathy
NAME Japanese encephalitis(killed Influenza
monovalent) vaccine(inactivated-split
virion)
Content Mouse brain(Nakayama/NIH 1.5 mcg hemaglutinin of
strain) or Baby hamster each of the chosen strain as
kidney(P-3) or Recombinant suspension
DNA vaccine
Preparation Freeze dried /liquid Liquid
Initiation Same as meningo cocci All ages
Schedule 2 doses 1-2 wks interval Single dose
Booster After 3-4 yrs Every year with current
strain
Dose 1 ml 0.5 ml
Admnstration SC-deltoid/ant lat thigh SC/IM
Efficacy 60-80%,100% after booster 80-90%
Contraindications None Egg protein allergy
Adverse events Local swelling,fever,malaise Local reaction,fever
 These are NOT
contraindications
 Minor illnesses such as: URI, diarrhea, low-grade fever in
an otherwise well child
 Recovery from an illness
 Current antibiotic use
 Previous local reaction from immunization
 Preterm birth
 Pregnancy in a household contact
 Immunosuppression of a household contact
 FH Seizures for Pertussis/Measles
 Severe allergic reactions (not anaphylaxis)
 These are NOT
contraindications
• Family history of any adverse reactions
following immunisation
• Previous history of pertussis, measles, rubella or
mumps infection
• Stable neurological conditions such as cerebral palsy
and Down’s syndrome
• Contact with an infectious disease
• Asthma, eczema, hay fever or ‘snuffles’
• Locally-acting (eg topical or inhaled) steroids
• ‘Replacement’ corticosteroids
• Child’s mother is pregnant
• Child being breast fed
• History of jaundice after birth
• Over the age recommended in immunisation schedule
 Contraindications
• Vaccination in moderately or severely
unwell individuals

• Live vaccines in immunocompromised

individuals

• Anaphylaxis to previous dose of vaccine

or a vaccine component
Definition of anaphylaxis:
• Typically rapid and unpredictable with variable severity and clinical
features including cardiovascular collapse, bronchospasm,
angioedema, pulmonary oedema, loss of consciousness and
urticaria
 Contraindications

• MMR may be given on HIV patients with CD4 >15%

• Consider Varicella on patients with CD4 at least
25% (2 doses, 3 months apart)
• Prednisone (>2mg/kg or 20 mg/day for >2 weeks)
• Chemotherapy pt. – should be delayed until after 3
months of therapy
• Egg allergy – skin test for influenza (severe
anaphylaxis w/ eggs), MMR can be given without
skin test
 Contraindications

• Live attenuated vaccines is

contraindicated in:
– Pregnant woman
– Immunocompromised person
leukemia, lymphoma, malignancy,
therapy with steroids, alkylating agents,
antimetabolites
– Radiotherapy
 Interruption of Schedule
What to do?

• Interruption with a delay between doses

does not interfere with the final immunity
achieved
• No need to start the series again
Happy New Year

Thank You