Immunization

Dr.Fedlu J.Oumer
WU, Faculty of MED and HS.
For HO students.
 Immunization
• Immunity is defined as the ability of the body
to recognize and destroy foreign antigenic
material like bacteria, viruses and proteins
leading to resistance to infection.
• Innate immunity is the natural resistance of
the human being with in his genetic make up
to certain animal infection.
• Innate immunity refers to immune responses
that are present from birth and not learned,
adapted, or permanently heightened as a
result of exposure to microorganisms, in
contrast to the responses of T and B
lymphocytes in the adaptive immune system.
 Goal
• To prevent disease in individuals.
(immediate)
• To eradicate a communicable
disease. (ultimate)
 Type of Immunity
1. Passive (immediate protection, only last for some
wks or month)
a. Natural transplacental immunity
b. Acquired by administration of antibodies
2. Active (protection is produced by individuals)
as result of natural infections(clinical or subclinical
& may be life long) or acquired by administration
of vaccine.
3. Herd immunity:- If the no of people in the
community who have active immunity against an
infection exceeds a critical level.
 Active immunization (vaccination)
• Vaccine is an antigen which when administered
stimulates specific antibody formation with resulting
immunity against the particular disease.
• It is prepared from
1. Live attenuated organism:
bacterial: BCG,oral typhoid
Viral: oral polio vaccine(sabin), measles, rubella, mumps.
2. Killed organism:
bacterial:pertusis, cholera, typhoid(IM)
viral:polio vaccine,rabies
 conte’d
3.Toxoid: diphteria, and tetanus
4. Genetic engineered: hepatitis B
Determinants of the immune
response
• Chemical and physical state of the
antigen
• Mode of administration
• Host factors –
–Age,
–Nutrition
–Preexisting antibodies
 Advantages of immunization
• Saves the lives of millions of children.
• Very cost- effective.
• Led to global eradication of small pox.
• Elimination of poliomyelitis from some continents.
• More than 95% reduction of Haemophilus Influenza
type B desease.
• In USA it eliminated completely congenital rubella
syndrome, tetanus, pertussis, polio and diphtheria
 Expanded Program of
Immunization (EPI)/WHO
• Aims to provide free immunization for children
against the important childhood infections.
• Started in 1974
• Main purpose:
– Prevent childhood diseases
– Provide high quality vaccines
– Surveillance of these diseases
• Schedule of immunization is designed according to
epidemiological terms of diseases together with
sociocultural &economic factors.
 Schedule in Ethiopia
Age Vaccine Route Dose
Birth BCG/OPV0 ID/PO 0.05m,0.1ml/
2drops
6wks Pentavalent1/ IM/PO 0.5ml/2drops
OPV1
10wks Pentavalent2/ IM/PO 0.5ml/2drops
OPV2
14wks Pentavalent3/ IM/PO 0.5ml/2drops
OPV3
9month Measles SC 0.5ml
Schedule in Ethiopia
Birth
6wks
10wks
14wks
9mo
 EPI…
• Any missed dose should be given at any
subsequent visit when indicated and feasible.
• Pertussis is not given after 2 years.
• Infants born to HbSAg positive mothers
should receive 0.5 ml of Hepatitis Immune
globulin (HBIG) and Hepatitis b vaccine with in
72 hours of birth.
 BCG (Bacillus Calmettie Guerin)
• Protects against TB.
• Limits infection and hematogenous spread of
the disease.
• Attenuated M. bovis
• Sensitive to heat and light
• Efficacy as high as 80% for severe form of the
disease and 0-80% for pulmonary TB.
• Given at birth of as soon as possible (3/12 of
life).
• Site :- right upper arm
 S/E
• Small swelling at the site of injection with in
2weeks and after a week it form a small abscess,
ulcerate and leaves a scar.
• The scar has 2 uses
1.Witnesses the child is vaccinated
2.Good degree of immune response
 Other rare S/E
• Deep abscess and involvement of LN (axillary
LAP
• Extension of infection to bones osteomyelitis
 Oral Polio Virus
• Live attenuated viruses of the 3 types (sabin).
• It produce life long local intestinal & systemic
immunity.
• Damaged by heat but not by freeze
Efficacy:- 72-98% in hot climates , lower protection
against type III.
S/E
• Doesn’t have common S/E
• Rarely poliomyelitis has been reported(1:106 va)
Diarrhea give the vaccine and repeat to the dose
because it may not be effective.
 PentavalentVaccine
(Hib+DPT+Hepatitis-B)
• The Pentavalent vaccine combines five different
vaccines in one injection to protect against
Five diseases:
 Haemophilus influenzae type B (Hib) disease
 Diphtheria
 Pertussis
 Tetanus and
 Hepatitis-B
 Tetanus toxoid
• It is inactivated by heat and freeze.
• If the person has previously suffering from the
disease, he should be vaccinated.
• Booster injection should be given after every
5-10yrs.
• Efficacy:- >95% (>80% after 2 doses)
• S/E :- extremely safe preparation.
 Diphteria toxoid
• Damaged by freezing and heat.
• Efficacy:- >80%
• Duration of immunity: variable, probably
around 5 yrs
• S/E :- no significant adverse reaction have
been associated.
 Pertussis vaccine
• It is killed B .pertusis
• Sensitive to heat.
Efficacy:- variable; around 80% for severe
disease
Duration of immunity:- unknown
 Precaution
• Never give to children >5yrs
S/E
• Fever (high grade), local soreness (3-4days),
an abscess at the site of injection, febrile
convulsion 0.3-9/100,000dose
• Permanent brain damage, encephalitis (0.3-
0.6/100,000dose & shock like state are
common >6month age
 C/I
• Convulsion with in 3 days following
vaccine.
• Shock like state
• High grade fever (400C)
• Progressive neurologic deficit
 Hepatitis B vaccine
• It is inactivated product produced by genetic
engineering.
• It protects the child against hepatitis B.
• There is no S/E.
Haemophylus Influenzae Type B vaccine
• It consists of a capsular polysaccharide
conjugated to a protein.
• Keep it at +20C -+80C, don’t freeze
 Measles
• Live attenuated measles virus.
• Damaged by heat.
• 9month is the age if given earlier the maternal
antibody will damage the vaccine.
• Some recommend the vaccine at the age of 6
month because there is risk of acquiring virus
at the age < 9months.
 S/E
• Fever (after 1wk) & a mild measles like rash self
limited.

Cause s of failure
a. Destroyed vaccine by improper storage
b.Sustained transplacental immunity that may
remain for up to 15months of age.
 N.B
• Practically there are no major CI for vaccination.
• No BCG for AIDS patient but can be given for sero
positive children.
• Potentially depends on the Cold Chain (I.e. a
system of storage & T0 maintained all the way b/n
the site of production & site of administration
(+2oC-+0.80C)
 N.B…
• Cold chain requirement consists of
refrigerator, cold box, vaccine carrier,
and ice packs.
• Precautions and contra-indications for
vaccines are based on three factors:
The risk of disease
The benefit of vaccination and
The risk associated with
vaccination
 Immunization coverage
Ethiopia (World Bank Indicators) 2008

• Immunization, DPT3,(% of children ages 12-

24months) = 81
• Immunization, Measles(% of children ages 12-
24months) = 74
 Strategies to Boost the coverage
• If the child is well enough to go home , he so
after immunized, mild or moderate illness,
fever, malnutrition can be vaccinated.
Vaccinate children who come for other illness.
Educate mother very well to reduce the no of
defaulters.
 Mass Immunizations
• Used in regions or countries where the
immunization rate is low.
• Control an unexpected out-breaks.