IMMUNITY

DR SADAF KHALID
 IMMUNOLOGY
The science of Immunology encompasses the
study of the development, anatomy functions
and malfunctions of the immune system, all of
which are of fundamental importance to the
understanding of human disease.
 USES OF IMMUNOLOGY
• Immunization program
• Forecasting epidemics
• Hypersensitivity and adverse reactions
• Carrier detection
• Serological diagnosis and blood grouping
 CLASSIFICATION OF IMMUNITY
• Innate or non-specific immunity
• Acquired or specific immunity
–Active immunity
–Passive immunity
 INNATE OR NON-SPECIFIC IMMUNITY
• It is the resistance not acquired through
contact with an antigen.
• It is present in all living things irrespective of
their stage in evolution
• Can be initiated immediately against any
invader.
ACQUIRED OR SPECIFIC IMMUNITY
• Occurs after exposure to an agent.
• It is specific and is mediated by antibody and
by lymphoid cells.
• It is of following types:
– Active immunity
– Passive immunity
 ACTIVE IMMUNITY
• Associated with presence of antibodies or
lymphoid cells.
• Depends on humoral and cellular response of
the host.
• Develop
– Naturally by disease or sub clinical infection
– Artificially by immunization with antigen
• Killed or live attenuated vaccine
• Toxoid
 PASSIVE IMMUNITY
• Produced when preformed antibodies in one
body (human or animal) are transferred to
others.
• Induced:
– Naturally by maternal antibodies during
pregnancy, breast milk and colostrums
– Artificially by administration of antibody
containing preparation or inoculation of immune
blood or serum from convalescent
 IMMUNIZATION
• process whereby a person is made immune or
resistant to an infectious disease by the
administration of a vaccine
• proven tool for controlling and eliminating life-
threatening infectious diseases
• estimated to avert between 2- 3 million
deaths/ year.
 IMMUNIZATION
• Most cost-effective health investments with
proven strategies
• Accessible to even the most hard-to-reach and
vulnerable populations
• has clearly defined target groups; it
• can be delivered effectively through outreach
activities
• vaccination does not require any major lifestyle
change.
 HERD IMMUNITY

Form of indirect protection from infectious

disease that occurs when a large percentage of a
population has become immune to an infection,
thereby providing a measure of protection for
individuals who are not immune
 IMMUNIZING AGENTS

• Vaccines • Immunoglobulin • Anti-sera

 VACCINE
• It is an immunological substance designed to
produce specific protection against a given
disease
• Types
– Live attenuated vaccines
– Inactivated or killed vaccines
– Toxoid
– Combined preparations
 LIVE ATTENUATED VACCINES
Organisms are alive and they have the power of
multiplications although they are attenuated.
These organisms have lost their virulence but
retained their antigencity and are prepared by
treatment or repeated subcultures.

Route: mostly intramuscularly (I/M)

 LIVE VACCINE TYPES
These are used for active immunizations e.g.
• Bacterial:
– BCG,
– Typhoid oral
– plague
• Viral:
– oral polio,
– yellow fever
– measles
– mumps
 CHARACTERISTICS
• Multiply in the host and resulting antigenic dose is
larger then what is injected
• Has all the minor and major components of
antigencity
• Single dose is required to produce effect with
exception of polio where 4 doses are required
• Produces durable immunity but not always as long
as natural infection
• Mild risk of reversion to virulent form, e.g. polio
vaccine, One in 2 million children may develop
vaccine induced polio
 PRECAUTIONS
• Should not be administered to persons
– immune deficiency diseases
– pregnant women
• When two live vaccines are required they
should be given simultaneously at different
sites or with an interval or 3 weeks
• must be properly stored to retain its
effectiveness.
INACTIVATED OR KILLED VACCINES
These are vaccines in which organisms are killed
by heat, formulated by other chemicals such
that their antigencity is maintained but
pathogenecity is lost.

They produce antibodies when injected to

human beings
 TYPES
• Bacterial: • Viral:
– Typhoid – rabies,
– Cholera – Salk (polio),
– Pertussis – hepatitis B, and
– Meningitis – Japanese encephalitis
– Haemophilus
influenza
 CHARACTERISTICS
• Generally 2-3 doses require to produce
antibody response
• Usually safe but less efficacious then live
vaccine
• Nearly all dangerous diseases have killed
vaccines
 TOXOIDS
• Exotoxin produced by certain organisms are
defoliated by treating with formalin in such a
way that toxicity is destroyed but their
antigencity is retained and used in the
preparation of vaccines
 MECHANISM
The antibodies produced neutralize toxic moiety
of the organisms during infections rather then
they act upon the organism. Toxoid are
produced for active immunization e.g.
Diphtheria and Tetanus Toxoid
 COMBINATIONS
• If more than one kind of immunizing agent is
included in the vaccine, it is called mixed or
combined vaccines.
• Aim: to simplify administration, reduce cost and
minimize the contact of patient with the health
system e.g.
• DPT (Diphtheria-Pertussis-Tetanus)
• DT (Diphtheria-Tetanus)
• MMR (Measles-Mumps-Rubella)
• DPTP (DPT plus inactivated polio)
 AUTOGENOUS VACCINES
• The term auto or autogenous vaccine is
applied when the organism in the vaccine is
obtained from the same patient
 ADJUVANT VACCINES
• Adjuvant are substances that are added to
vaccines with the intention of potentiating the
immune response so that a greater amount of
antibody is produced.
• A lesser quantity of antigen is required and
fewer doses to be given e.g.
– Aluminum phosphate
– Aluminum hydroxide
– Water-in-oil
 IMMUNOGLOBULIN
• These are the immunizing agents, which are
responsible for passive immunization.
• The human immunoglobulin system is
composed of 5 major classes and sub classes
within them. These are:
– IgG: 10% of total serum immunoglobulin,
– IgA: 15% of total serum immunoglobulin.
– IgM
– IgE: 10-130 microgram/100ml.
– IgD: 0.3-0.4 mg/100ml of serum. Its half life is 2-8
days
 TYPES OF IMMUNOGLOBULINS
• Two types of immunoglobulin preparation are
available for passive immunization:
– Normal Human Ig
– Specific Human Ig
 ANTI SERA OR ANTI -TOXINS
• It is serum containing antibody or antibodies
obtained from an animal that has been
immunized either by injection of antigen into
the body or by infection with microorganisms
containing the antigen.
• Types
– Monovalent
– Polyvalent
 POLYVALENT
• The term polyvalent is applied to vaccines
(polio, influenza vaccines), which are prepared
from two or more strains of the same species
 EXPANDED PROGRAM ON
IMMUNIZATION (EPI)
• Established in 1978
• Objectives:
Reduction of mortality and morbidity resulting from
the Nine EPI target diseases by immunizing children
of the age 0-11 months and women of child bearing
age.
 TARGETED 9 PREVENTABLE DISEASES
• Childhood Tuberculosis
• Poliomyelitis
• Diphtheria
• Pertussis
• Tetanus
• Hepatitis B
• Haemophilus Influenza Type b,
• Pneumonia
• Measles
• Tetanus (Pregnant ladies
 COLD CHAIN EQUIPMENT
• Cold Box
• Vaccine Carrier
• Flasks
• Ice pack
• Freezer/ Refrigerator
 EFFECTIVE COLD CHAIN
Following three main elements are required to
ensure proper vaccine transport, storage, and
handling.
• Trained personnel
• Transport and storage equipment
• Efficient management procedures
 COLD CHAIN
• System of storage and transport of vaccine at
low temperature from manufactures to actual
vaccine site.
• Recommended temperature is required to
keep vaccine potent.
• Recommended temperature -2 to -8 C.
Manufacturer

Transport

Central vaccine stores

Regional Stores

District Hospital

Health Centre

Dispensary
 PROTOCOLS FOLLOWED IN EPI
• All immunization providers are responsible for
– ensuring the vaccines they administer have been correctly stored.
– storing vaccines must use a pharmaceutical refrigerator.
– must have an electronic temperature recording device.
– must have a written cold chain management policy and allocate
overall responsibility for cold chain management (including
temperature monitoring) to a designated person(s).
– should review and update their cold chain management policy on
need basis.
• The vaccine refrigerator temperatures must be monitored and
recorded on a daily basis. The data loggers should be reviewed
in accordance with the National Guidelines for Vaccine Storage
and Distribution.
 SOURCES OF FUNDING
• The annual PSDP allocation for EPI stands at
Rs. 2,792.693 million
– foreign exchange component of Rs.477.000 million
coming as GAVI assistance.
– in kind assistance in the shape of Pentavalent and
Pneumococcal vaccines with corresponding
quantities of syringes and safety boxes

GAVI- Global Alliance for vaccines and immunization

 ROLE OF THE FEDERAL EPI CELL
• Draw up, review and update EPI Policy, guidelines and SOPs for
the provision of Immunization Services
• Coordinate with international partners/donors to secure
resources
• Liaise with international professional organizations such as WHO,
UNICEF, CDC etc. for technical updates and capacity building
• Collect and analyze coverage data received from the Provinces
and provide feedback
• Coordinate disease surveillance to gauge the burden of various
EPI diseases
• Facilitate procurement/storage of Vaccines, Syringes, Safety
Boxes, Cold Chain Equipment etc. as required
Provincial/ District/ Area Responsibilities

• Planning, financing, implementation of immunization

activities
• Collection of vaccine, syringes and other logistics from
Federal EPI and distribution to district level
• Allocation of resources for operations and management
• Ensuring all health facilities to run as EPI fixed centre and
regular outreach vaccination service
• Repair and maintenance of cold chain equipment and
vehicles including the provision of POL etc.
• Conduct capacity building at various levels
• Supervision, monitoring, evaluation and reporting
 REFERENCES
• Park’s textbook of Preventive and Social
Medicine. K.Park
• Expanded Program on Immunization. Ministry
of National Health Services Regulation and
Coordination. http://epi.gov.pk/