PRIMARY HEALTH CARE -1

11/4/2018
2018 – 2017

LECTURE—6-

IMMUNIZATION
Dr Mahdi Saad

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 At the end of this lecture :
• Immunity :Definition and types
• Why we do Vaccines
• Immunization and Vaccine
• Vaccination :
•Types
• Hazards
• Routes of administration
• Periods
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• Schedule and Scheme
• COLD CHAIN
Immunity
Specific defenses
Immunity

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Active immunity
Passive immunity

Following clinical infection natural Transfer of maternal

Antibodies Through placenta

Following subclinical infection Transfer of maternal

Antibodies Through milk

acquired
Following vaccination
Following administration of
Immunoglobulin or antiserum
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 Active and passive immunity
• Active immunity:
Resistance developed in response to stimulus by an antigen

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(infecting agent or vaccine) and is characterized by the
production of antibodies by the host.
Could be acquired by:
1. A clinical infection (measles, chickenpox, rubella…)
2. In-apparent infection (Diphtheria, polio, …)

3. Vaccination with an antigen

(a killed vaccine, or a live weakened vaccine, or toxoid)
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 Passive immunity :
Immunity conferred by an antibody produced in
another host.
it is induced by:

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A. Giving preparation containing ready-made ABs.
B. Transferring Maternal ABs from mother to fetus across
the placenta.
Baby’s Protective Biological Shield :gets lost in 3 – 6 months.

C. Transferring ABs to newborns over breast milk

(IgG + IgM).
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 This is why we do Vaccines
Annual Cases – Annual Cases Percent
Disease Pre-Vaccine Era Since Vaccine Reduction
Diphtheria 175,885 0 100%

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Tetanus 1314 28 98%

Measles 503,282 43 99.9%

Mumps 152,209 800 99.5%

Rubella 47,745 12 99.9%

Congenital Rubella 823 0 100%

Syndrome
Polio 16,316 0 100%

Haemophilus influenzae b 20,000 54 99.7% 4

Immunization
is the process where by a person is made
immune or resistant to an infectious disease,

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typically by the administration of a vaccine.
Vaccines
stimulate the body’s own immune system to
protect the person against subsequent
infection or disease. 7
 Vaccination
Vaccination is a method of giving antigen to stimulate
the immune response through active immunization.
A vaccine is “antigenic” but not “pathogenic”.
How Vaccines function?

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A. STIMULATE the Immune System of the body.
B. It becomes able to RECOGNIZE the invading microbe /
pathogen (antigen) and PRODUCE antibodies to DESTROY
or DISABLE this antigen; and to
C. REMEMBER the antigen to prevent or milder the effects
of a future infection by the same pathogen = antigen.

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Vaccines can be used: prophylactic or
therapeutic
Vaccines can be given as:

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Initial Dose = First Dose.
Booster Dose: Periodically repeated doses
• Active vaccine takes time to develop!
• It is GREATER to Passive Immunity because:
longer lasting protection.
sever reactions are rare.
 very high protection ; efficacy approaches 100%
- production of vaccines cheaper than of antisera?
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 Valence
Vaccines may be:
1.Monovalent = univalent.
A monovalent vaccine is designed to

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immunize against a single antigen =
single microorganism.
2. Multivalent = polyvalent.
A multivalent or polyvalent vaccine is
designed to immunize against two or more
strains of the same microorganism = two or
more microorganisms.
A monovalent vaccine may be preferable for rapidly 10
developing a strong immune response.
Types of vaccines
1) Live
2) Live Attenuated
3) Killed
4) Toxoid
5) Cellular fraction
6) Surface antigen
11/4/2018 PHC 2015-2016 Lecture-12 Immu. 11
 Live vaccine
Live vaccines are made from live infectious agents
The only example is smallpox vaccine (Variola)
which is made of live Vaccinia cow-pox
It is eradicated

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Live attenuated vaccine
• Pathogenic organisms are treated
to become attenuated (weakened),
• it means that they lost their
capacity to induce disease, but
remain their immunogenicity.
• Examples: BCG, MMR

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 Killed vaccine
• Organisms are killed or inactivated by heat or
chemicals but remain antigenic.
• They are usually safe but less effective than live
attenuated vaccines
• Example :
• TAB (of typhoid, paratyphoid A and B)
• Cholera,
• Pertussis
• Rabies
• Salk of poliomyelitis
• Influenza.
Toxoid vaccine
• They are prepared by detoxifying the exotoxins
of some bacteria
e.g. diphtheria and tetanus
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• Polysaccharide and polypeptide (cellular
fraction) vaccines
They are prepared from extracted
cellular fractions: e.g. Meningococcal
polysaccharide vaccine
• Pneumococcal polysaccharide
vaccine
• Hepatitis B polypeptide vaccine
Surface antigen vaccine
produced with recombinant
DNA techniques where genetic code
is inserted to yeast cell.
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 Types of vaccines
Live Live Killed Toxoids Cellular fraction Surface
vaccin Attenuate Inactivated vaccines antigen
es d vaccines vaccines vaccine

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•Small •BCG •Typhoid •Diphtheria •Meningococcal •Hepatitis B
pox •Typhoid •Cholera •Tetanus polysaccharide vaccine
vaccin oral •Pertussis vaccine
e •Plague •Pneumococcal
•Plague
•Oral polio polysaccharide
•Rabies vaccine
•Yellow •Salk polio
fever •Hepatitis B
•Intra- polypeptide
•Measles muscular vaccine
•Mumps influenza
•Rubella •Japanise
•Intranasa encephaliti
l s 23
Influenza
•Typhus
 Immunoglobulin and antiserum

Human normal Human specific Non human ig

immunoglobulin immunoglobulin (antisera)

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Hepatitis A Hepatitis B Diphtheria
Measles Varicella Tetanus
Rabies Diphtheria Gas gangrene
Tetanus Botulism
Mumps Rabies
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 Hazards of Immunization
1. Failures at factory / production level.
2. Transport: Cold Chain Failure.
3. Wrong administration technique.

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4. Contamination!
5. Hypersensitivity especially antisera / antitoxins.
6. Neurological reactions encephalitis, encephalopathy.
7. Provocative reactions activate other organism
incubation period.

8. Others: damage to foetus, contradictions, wrong / more / less /

material and/ diluents, hypersensitivity to preparation material,…..
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 Routes of administration
• Deep subcutaneous or intramuscular route
(most vaccines)
• Oral route
(sabine vaccine, oral BCG vaccine)
• Intradermal route
(BCG vaccine)
• Scarification
(small pox vaccine)
• Intranasal route
(live attenuated influenza vaccine)
 Periods of maintained
immunity due to vaccines
• Short period (months): cholera vaccine

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• Two years: TAB vaccine
• Three to five years: DPT vaccine
• Five or more years: BCG vaccine
• Ten years: yellow fever vaccine
• Solid immunity: measles, mumps, and rubella
vaccines. 25
 Vaccination Schedule
Vaccination schedule
is country-specific depending on

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Vaccination Policy.

ASSIGMENT :
SCHADUL OF IMMUNIZATION IN
YEMEN 21
 Scheme of immunization
• Primary vaccination
•One dose vaccines
(BCG, variola , measles, mumps, rubella, yellow fever)
•Multiple dose vaccines
(polio, DPT, hepatitis B)
• Booster vaccination
To maintain immunity level after it declines after some
time has elapsed (DT, MMR).
 COLD CHAIN
• It is a ‘system’ for transport and storage of
vaccines under strict temperatures control
(suitable low temperatures) from ‘production

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site’ till ‘vaccine administration site’.
• Some most be frozen: polio, measles
• Cold but not freeze: tetanus, typhoid,…
• The “Risk of Cold Chain Failure”.
• The cold chain system is necessary because vaccine
failure may occur due to failure to store and
transport under strict temperature controls. 20
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