Dr. Fawzia Abo Ali teaches internal medicine and immunology at Ain Shams University Faculty of Medicine. She discusses various topics related to immunoprophylaxis including vaccines, immunoglobulins, and immunostimulants. Vaccines can be live attenuated, killed/inactivated, toxoid, or subunit/conjugate and are used to prevent infectious diseases in infants, children, adults, pregnant women, healthcare workers, and travelers. Immunoglobulins including hepatitis B and rabies immunoglobulin are used for passive immunization. Immunostimulants such as cytokines, bacterial extracts, levamisole, BCG, echinacea, and thalidomide can boost immune function for

2. Dr. fawzia abo ali
Prof. of internal medicine&immunology
Ain shams faculty of medicine

3. 1. immunoprophylaxis
2. Vaccines: types, Applications ,non infectious diseases
3. Immunoglobulins:
– Normal human immunoglobulin
– Specific (hyper-immune) human immunoglobulin
1. immunostimulants:
o Oral bacterial extracts
o Levamisole .
o BCG
o Echinacea
o Thalidomide
Objectives

4. Prevention of diseases by the administration of vaccines,
immunoglobulins or immunostimulants
• Immunoprophylaxis have led to a significant decline in
worldwide morbidity and mortality .
immunoprophylaxis:

6. Specific immune defenses
Passive immunityActive immunity
Following clinical or subclinical
infection
Following vaccination
Following administration of
Immunoglobulin or antiserum
Transfer of maternal
Antibodies Through placenta or milk
natural
acquired

7. picasso
vaccines

8. A vaccine is any preparation intended to produce
immunity to a disease by stimulating the production
of antibodies.
Types of vaccines
1. Live pathogens – attenuated
2. Killed micro-orgs
3. Microbial extracts
4. Vaccine conjugates
5. Toxoids

9. Types of vaccines
Live
vaccines
Live
Attenuated
vaccines
Killed
Inactivated
vaccines
Toxoids Cellular fraction
vaccines
Recombina
nt vaccines
•Small pox
variola
vaccine
•BCG
•Typhoid
oral
•Plague
•Oral polio
•Yellow
fever
•Measles
•Mumps
•Rubella
•Intranasal
Influenza
•Typhus
•Typhoid
•Cholera
•Pertussis
•Plague
•Rabies
•Salk polio
•Intra-
muscular
influenza
•Japanise
encephalitis
•Diphtheria
•Tetanus
•Meningococcal
polysaccharide
vaccine
•Pneumococcal
polysaccharide
vaccine
•Hepatitis B
polypeptide
vaccine
•Hepatitis B
vaccine

10. Application of vaccines
• Infants and children expanded immunization.
• Active immunization for adults
• Active immunization for adult females
• Immunizing pregnant women
• Vaccines for Healthcare Workers
• Vaccinations in travel
• Vaccinations for immunocompromised persons.

12. Recommended Adult Immunization Schedule
by Age

13. Intranasal live attenuated
influenza vaccine”
Intramuscular inactivated
influenza vaccine”
Swine flu vaccine

14. Vaccination for adult female
1. HPV vaccine is recommended for females
ages 9 – 26
• Three dose series –0-------2---------6months
2. MMR vaccine is given in adolescence
before or after marriage, but not during
pregnancy and has to be before 3 months of
conception.

15. Immunoprophylaxis in pregnancy:
• Safe vaccines :
Diphtheria, Tetanus, Influenza, and Hepatitis B.
• Contraindicated vaccines :
Measles, Mumps, and Rubella; Varicella and (BCG)
• Immunoglobulins :
• Considered in pregnant women exposed to hepatitis
B , rabies, tetanus, varicella, and hepatitis A.
• Tetanus toxoid :
• appear safe during pregnancy and are
administered to prevent neonatal tetanus.

16. Vaccination for healthcare workers :
• Hepatitis B
• Influenza
• MMR
• Varicella (chickenpox)
• Tetanus, diphtheria, pertussis
• Meningococcal :For specific healthcare
personnel

17. Traveller's Vaccines :
Specific vaccine according to the country
traveled to:
• TAB, YF, cholera, meningiococcal,
pneuomococcal, HIB, influenza, rabies, plague,
Japanese encephalitis.
• Hajj for instance necessates meningococcal
vaccination from all over, and YF from places
like south Africa, and cholera from places like
India.

18. Vaccination for special occupations
• Vets and animal handlers: rabies, plague and
anthrax
• Sewage workers: DT, hepatitis A, polio, TAB
• Food handlers: TAB
• Military troops and camp dwellers:
pneumococcal, meningococcal, influenza, BCG
(for non reactors), tetanus

19. Vaccinations for Immuno-
compromised persons
Poppies, c.1886
Vincent Van Gogh

21. General Principles
• Killed or inactivated vaccines do not represent a danger to
immunocompromised .
• Live vaccines are absolutely contraindicated
• For specific immunocompromising conditions (e.g.,
asplenia), additional vaccines, particularly bacterial
polysaccharide vaccines .
• Frequently, the immune response of
immunocompromised persons to these vaccine antigens is
not as good as that of immunocompetent persons;
• higher doses or more frequent boosters may be required.
• Should receive the following vaccines according to their
situation: HBV, Influenza, Pneuomococcal vaccines

23. Vincent van Gogh, Starry Night,
1889
Vaccines for Noninfectious
Problems

24. Cancer Vaccines
Therapeutic vaccines
To induce tumor- antigen specific responses in patients that
will destroy primary tumors and/or metastatic tumors.
Prophylactic vaccines:
Injected to prevent development of cancer :
1. Anti-oncogenic viral vaccines .
2. antitumor vaccines (melanoma, prostate Ca,)is made up of
whole, inactive cancer cells .
3. Nonspecific stimulation of innate immunity by BCG

25. • Vaccines for Alzheimer’s Disease:
Vaccine targeted against Amyloid beta-peptide in the
brain of AD patients which is responsible forneuronal
damage
• Vaccines for Autoimmune Diseases :
T cell or T cell receptor/peptide aim to induce T cell
tolerance.
• Vaccine for allergy:
• Protein-based immunotherapy-desensitization-best for
insect venoms
• Allegens specific vaccines.
• non-antigen specific methods show promise as
therapeutic vaccines.

26. Anti drug vaccine
• Most are aimed at inducing antibodies that bind active
drug components and prevent passage through the BBB.
Anti-obesity vaccines
 aimed at reducing blood levels of ghrellin, which
promotes weight gain and fat storage.
A vaccine against atherosclerosis —
• the vaccine designed to recognise a type of cholesterol
(LDL) that forms plaques as foreign and attack it.
Parasitic and tropical infections
• Malaria – DNA vaccines are showing promise.
• Shistosomiasis:The administration of radiation-
attenuated cercariae to laboratory animals provided
protection against experimental S. mansoni infection.

27. Immunoglobulins
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28. Immunoglobulins:
Two types of immunoglobulin preparations
are available for passive immunization:
1. Normal human immunoglobulin
2. Specific (hyper-immune) human
immunoglobulin

29. HNIG is used for:
• Hepatitis A contact in immuno-compromised patients, preferably
given within 72 hours, together with HAV vaccine
• Rubella contact in non-immune pregnant women where
termination is unacceptable
• Measles &Mumps contact, within 72 hours of exposure .
• congenital immunoglobulin deficiencies,
• autoimmune disorders, e.g. thrombocytopenic purpura (where
temporary rapid rise in platelets needed.
• following bone-marrow transplantation,
• children with HIV,
• Guillain-Barre Syndrome,
• myasthenia gravis .

30. Human specific immunoglobulins
These are made from plasma containing high levels
of certain antibodies.
1. Anti-D (Rh0) immunoglobulin, can be given to
rhesus-negative mothers to block fetal RhD-cells
from stimulating antibodies
2. Hepatitis B immunoglobulin :is used after needle-
stick or sexual exposure and in infants born to
infected mothers.
3. Zoster immunoglobulin is given to the non-immune
exposed to chickenpox in Immuno-compromised
individuals.

31. 4. Rabies immune globulin is indicated for an
unimmunised person exposed to a bite from an
animal from a high risk country
5. Tetanus immunoglobulin is given for tetanus-
prone wounds. Tetanus vaccine should also be
given.
6. Cytomegalovirus immune globulin :for patients
receiving immunosuppressive treatment.

32. Toxoid&antisera

33. Active – Toxoids;
• Derivatives of bacterial exotoxins, e.g
• Tetanus
• Diphtheria
Antisera or antitoxins: materials prepared in animals :
(1)Antitoxin: prevention & ttt of diphtheria, tetanus, gas
gangrene, botulism
(2)Antiviral serum

34. Immunostimulants

35. Immunostimulants
Immunomodulators used in immunodeficiency disorders,
chronic infections and cancer.
1)Cytokines like INF alpha, INF beta, INF gamma
2)IL-2 –malignant melanoma.
3)TNF alpha- malignant melanoma and soft tissue
sarcoma of extremity.
4)Oral bacterial extracts
5)Levamisole – anti helminthic.
6)BCG – used as intravesical therapy
7)Echinacea
8)Thalidomide

36. Oral bacterial extracts :
• Bacterial immunostimulants (ISs) containing bacterial
or components of bacterial cells were shown to induce
a non-specific response (i.e. intensification of
phagocytosis) but also to orchestrate both B, and T cell
responses .
• The use of bacterialextracts in patients with chronic
bronchitisor COPD is not recommended
(Guidelines for the management of
adult lower respiratory tract infections
Eur Respir J 2005; 26:1138-1180.)
although treatment significantly reduced the rate of
URTIs, particularly in children with a history of
frequent URTIs.

37. Echinacea :
• Echinacea plant extract is widely used for the
prevention and treatment of upper respiratory
tract infections.
• Many of the compounds in echinacea stimulate
various aspects of the immune system including
macrophage and lymphocyte function. Natural
killer cell activity is increased and there may be
an increase in interferon production .
• an "over-stimulated" immune system could cause
autoimmunity.

38. Levamisole
• Levamisole is a synthetic anti-helmintic agent.
• Current studies have been focused upon its effect on
immune response and on cancer treatment.
• levamisole has great effect in the activation and
maturation of dendritic cells (DC) and human T cells, as
well as (IL)-12 and IL-10.
• Used to treat immunodeficiency associated with
Hodgkins disease & autoimmune diseases and in
maintaining remission in frequent relapsers of nephrotic
syndrome
• used for cancer treatment, particularly colon cancer.

39. BCG
• BCG is useful in the treatment of superficial forms of
bladder cancer, since the late 1980s.
• BCG as an adjuvant to a number of cancer vaccines .
• Clinical trials use BCG to induce production of TNF-α
which can supress the T-cells responsible for Type 1
diabetes.
• Interstitial Cystitis / Painful Bladder Syndrome
• multiple sclerosis (MS)
• Asthma ; induction of TH-1 response.

40. Thalidomide
• inhibits angiogenesis, reduces
phagocytosis, enhances cell
mediated immunity
• Increases levels of IL-10.
• Used in multiple myeloma, graft versus host
disease, myelodysplastic syndrome,
prostate Ca, colon Ca.
• thalidomide is approved for the treatment of
erythema nodosum.& oral ulcers.

41. References
o http://www.who.com
o http://www.cdc.gov
o Bertino JS and MS Hayney. Vaccines, Toxoids, and Other Immunobiologics.
Pharmacotherapy: A Pathiophysiologic Approach. 5th
ed. Dipiro, JT, Talbert, RL,
and GC YEE, eds. New York: Appleton and Lange; 2002: 2123-2142.
o Reisinger KS, Block SL, Laycano-Ponce E et al. Safety and Persistent
Immunogenicity of a Quadrivalent Human Papillomavirus Types 6,11,16,18 Virus.
Journal of Pediatric Infectious Disease. 2007; 26(3): 201-209. U. B. Schaad
o Prevention of paediatric respiratory tract infections: emphasis on the role of OM-
85 ERR December 1, 2005 14:74-77;
o Gardner P, Pickering LK, Orenstein WA. Quality Standards of Immunization. CID
2008:35 (1 September).