0616 Immuniz


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  • On August 8, 1721, 7 death row prisoners were subjected to the procedure. They came down with a very mild case of small pox, all recovered and were immune to small pox. They were granted full pardon. In 1776, George Washington ordered inoculation of all his soldiers, and the procedure was a success.
  • In 1798, Jenner introduced 1 st vaccination ( vacca : cow) following his experimentation with isolates of cow pox virus from ‘Blossom’.
  • The mass vaccination against became a standard practice.
  • DPT: 15-59% vaccinated Polio: 55-88% MMR: 80-90%
  • Immunization is the means of providing specific protection against most common and damaging pathogens. Specific immunity can be acquired either by passive or by active immunization and both modes of immunization can occur by natural or artificial means (Figure 1).
  • Artificially acquired passive immunity : Immunity is often artificially transferred by injection with gamma‑globulins from other individuals or gamma‑globulin from an immune animal . Passive transfer of immunity with immune globulins or gamma‑globulins is practiced in numerous acute situations of poisoning (insects, reptiles, botulism), infections (tetanus, measles, rabies, etc.) and as a prophylactic measure hypo-gamma-globulinemia ). In these situations, gamma‑globulins of human origin are preferable although specific antibodies raised in other species are effective and used in some cases (acute poisoning and tetanus and diphtheria infections. Passive transfer of cell mediated immunity can also be accomplished in certain diseases (cancer, immunodeficiency). The donor cells must be histocompatible.
  • This refers to immunity produced by the body in consequence of exposure to antigens. Naturally acquired active immunity : Exposure to different pathogens leads to sub-clinical or clinical infections which result in a protective immune response against these pathogens.
  • Active immunization may cause fever, malaise and discomfort. Some vaccine may also cause joint pains or arthritis (rubella), convulsions, sometimes fatal (pertussis), or neurological disorders (influenza). Allergies to egg may develop as a consequence of viral vaccines produced in egg (measles, mumps, influenza, yellow fever). Live vaccines although innocuous in normal individuals may produce serious infections in immunodeficient individuals and hence should be avoided in such cases . Table 3 summarizes frequencies of undesirable effects of diphtheria‑tetanus‑polio (DTP) vaccine.
  • 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