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0616 Immuniz


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0616 Immuniz

  1. 1. Immunization Abdul Ghaffar Microbiology and Immunology
  2. 2. Milestones in immunization <ul><li>1500BC </li></ul><ul><ul><li>Turks introduce variolation </li></ul></ul><ul><li>3000BC </li></ul><ul><ul><li>Evidence of sniffing powdered small pox crust in Egypt </li></ul></ul><ul><li>2000BC </li></ul><ul><ul><li>Sniffing of small pox crust in China </li></ul></ul><ul><li>1700AD </li></ul><ul><ul><li>Introduction of variolation in England and later in the US </li></ul></ul>
  3. 3. <ul><li>The wife of the British Ambassador in </li></ul><ul><li>Turkey, in March 1717 wrote, following </li></ul><ul><li>the variolation of her son, to a friend in </li></ul><ul><li>England: “The small pox, so fatal, so general </li></ul><ul><li>amongst us, is entirely harmless here </li></ul><ul><li>by the invention of ingrafting….I am </li></ul><ul><li>patriot enough to bring this invention into </li></ul><ul><li>fashion in England. </li></ul>Introduction of variolation
  4. 4. Milestones in immunization <ul><li>1780AD </li></ul><ul><ul><li>Edward Jenner discovers small pox vaccine </li></ul></ul>
  5. 5. Edward Jenner Discovery of small pox vaccine
  6. 6. Edward Jenner Among patients awaiting small pox vaccination
  7. 7. Modern era of the vaccine <ul><li>1920s </li></ul><ul><ul><li>Diphtheria and Tetanus </li></ul></ul><ul><li>1934 </li></ul><ul><ul><li>Pertussis </li></ul></ul><ul><li>1955 </li></ul><ul><ul><li>Salk polio </li></ul></ul><ul><li>1885 </li></ul><ul><ul><li>Rabies vaccine (Pasteur) </li></ul></ul>
  8. 8. Modern era of the vaccine <ul><li>1960s </li></ul><ul><ul><li>Mumps measles and rubella virus </li></ul></ul><ul><ul><li>Sabin polio </li></ul></ul><ul><li>1990s </li></ul><ul><ul><li>Hepatitis and varicella </li></ul></ul><ul><li>1985 </li></ul><ul><ul><li>Haemophilus </li></ul></ul>
  9. 9. Pre- & post-vaccine incidence of common preventable diseases
  10. 10. Different modes of acquiring immunity Immunity Natural resistance Artificial Natural Passive Artificial Natural Active Acquired
  11. 11. Passive Immunity <ul><li>Colostral transfer of IgA </li></ul><ul><li>Placental transfer of IgG </li></ul><ul><li>Antibodies or immunoglobulins </li></ul><ul><li>Immune cells </li></ul>Natural Artificial
  12. 12. Passive Immunization   disease   indication antibody source human, horse diphtheria, tetanus prophylaxis, therapy vericella zoster human immunodeficiencies gas gangrene, botulism, snake bite, scorpion sting horse post-exposure rabies, human post-exposure hypogamma-globulinemia human prophylaxis
  13. 13. Advantages and Disadvantages of Passive Immunization <ul><li>serum sickness </li></ul><ul><li>immediate protection </li></ul><ul><li>no long term protection </li></ul><ul><li>graft vs. host disease ( cell graft only ) </li></ul><ul><li>risk of hepatitis and Aids </li></ul>Advantages Disadvantages
  14. 14. Active Immunization <ul><li>exposure to sub-clinical infections </li></ul><ul><li>Attenuated organisms </li></ul><ul><li>killed organisms </li></ul><ul><li>sub-cellular fragments </li></ul><ul><li>toxins </li></ul><ul><li>others </li></ul>Natural Artificial
  15. 15. Live Attenuated Vaccines <ul><li>tuberculosis </li></ul><ul><ul><li>not used in this country </li></ul></ul><ul><li>polio* </li></ul><ul><ul><li>not used in std. schedule </li></ul></ul><ul><li>measles, mumps & rubella </li></ul><ul><li>yellow fever </li></ul><ul><ul><li>Military and travelers </li></ul></ul><ul><ul><li>Varicella zoster </li></ul></ul><ul><ul><li>children with no history of chicken pox </li></ul></ul><ul><li>hepatitis A </li></ul><ul><ul><li>not required in SC </li></ul></ul>
  16. 16. Killed Whole-Organism Vaccines <ul><li>polio </li></ul><ul><li>influenza </li></ul><ul><ul><li>elderly and at risk </li></ul></ul><ul><li>typhoid, cholera, plague </li></ul><ul><ul><li>epidemics and travelers </li></ul></ul><ul><ul><li>rabies </li></ul></ul><ul><ul><ul><li>post exposure </li></ul></ul></ul><ul><li>pertussis </li></ul><ul><ul><li>replaced by the acellular vaccine </li></ul></ul><ul><li>Q fever </li></ul><ul><ul><li>population at risk </li></ul></ul>
  17. 17. Microbial Fragment Vaccines <ul><li>Bordetella. Pertussis </li></ul><ul><ul><li>virulence factor protein </li></ul></ul><ul><li>Haemophilus influenzae B </li></ul><ul><ul><li>protein conjugated polysaccharide </li></ul></ul><ul><li>Streptococcus pneumoniae </li></ul><ul><ul><li>Polysaccharide mixture </li></ul></ul><ul><li>Neisseria meningitidis </li></ul><ul><ul><li>polysaccharide </li></ul></ul>
  18. 18. Microbial Fragment Vaccines <ul><li>Clostridium tetani (tetanus) </li></ul><ul><ul><li>inactivated toxin (toxoid) </li></ul></ul><ul><li>Corynebacterium diphtheriae </li></ul><ul><ul><li>inactivated toxin (toxoid) </li></ul></ul><ul><li>Vibrio cholerae </li></ul><ul><ul><li>toxin subunits </li></ul></ul><ul><li>Hepatitis B virus </li></ul><ul><ul><li>cloned in yeast </li></ul></ul>
  19. 19. Modification of Toxin to Toxoid Toxin toxin moiety antigenic determinants chemical modification Toxoid
  20. 20. <ul><li>anti-Idiotype Vaccine </li></ul>Future Vaccines <ul><li>Immuno-dominant peptide </li></ul><ul><li>DNA </li></ul>
  21. 21. Recommended Childhood Immunization Schedule
  22. 22. Adverse Events Occurring Within 48 Hours DTP of Vaccination   Event   Frequency <ul><li>local </li></ul><ul><ul><li>redness, swelling, pain </li></ul></ul>1 in 2-3 doses <ul><li>systemic: Mild/moderate </li></ul><ul><ul><li>fever, drowsiness, fretfulness vomiting </li></ul></ul><ul><ul><li>anorexia </li></ul></ul>1 in 2-3 doses 1 in 5-15 doses <ul><li>systemic: more serious </li></ul><ul><ul><li>persistent crying, fever </li></ul></ul><ul><ul><li>collapse, convulsions </li></ul></ul><ul><ul><li>acute encephalopathy </li></ul></ul><ul><ul><li>permanent neurological deficit </li></ul></ul>1 in 100-300 doses 1 in 1750 doses 1 in 100,000 doses 1 in 300,000 doses