The document discusses immunity, immunizing agents, and immunization, detailing the classifications of natural and acquired immunity, including herd immunity and immunoglobulin functions. It outlines the history and types of vaccines, including live attenuated, killed, and toxoid vaccines, and describes the national immunization program of Nepal and its achievements. Additionally, it emphasizes the importance of cold chain management for vaccine storage and delivers a series of multiple-choice questions related to the content.

1. immunity, immunizing
agents and immunization
Presented by
Deepa Manandhar
Lecturer
Community Health Nursing

2. Immunity
• Ability of the body to recognize, destroy and eliminating antigenic
materials foreign to its own.
• The term immunity refers to the body’s specific protective response to
an invading foreign agent or organism.

3. Classification of
immunity

4. natural/innate immunity
• Immunity with which an individual is born or is acquired during
growth by virtue of its species, racial or individual pecularities.
• It is natural resistance to illness which is developed before the contact
with an antigen.
• It is divided into: species, racial and individual pecularities.

5. Classification of
natural/innate immunity

6. Classification of
natural/innate immunity
1. Species immunity:
Resistance to pathogen, shown by all members of a particular species.
EG: Birds are resistant to anthrax but Human are susceptible.

7. Classification of
natural/innate immunity
2. Racial immunity:
Racial differences are known to be genetic in origin.
For examples; certain African race are more resistant to malaria and
yellow fever where are Asian or Americans are susceptible to same
infection.

8. Classification of
natural/innate immunity
3. Individual immunity:
If one individual of certain race or cast is resistant while other
individuals of same race or cast are susceptible to certain infection, then
it is called as individual immunity

9. Classification of
natural/innate immunity
3. Individual immunity:
• Individual immunity is determined by various factors such as health
status, nutritional status, previous illness, personal hygiene, genetic
differences etc.
• For example; although many people exposed to infection, but only
some develop the disease during the epidemic

10. MCQ
What type of immunity is transferred to the fetus from mother?
a. Active natural
b. Active artificial
c. Passive natural
d. Passive artificial
ANS: c

11. Classification of acquired
immunity

12. Classification of
immunity
Herd immunity (community immunity)
a type of immunity that occurs when the vaccination of a portion of
population (or herd) provides protection to unprotected individuals.

13. Herd immunity (community
immunity)

14. Immunizing agents
Preparations administered to produce immunity are called immunizing
agents.

15. Immunizing agents
Classified into three main groups
1. Vaccine
2. Immunoglobulin
3. Anti sera

16. MCQ
First vaccine to be developed was?
a. Polio
b. Small pox
c. BCG
d. MMR
ANS: b

17. History of vaccination

18. vaccine

19. vaccine
• prepared from disease causing agent or its toxic product that
stimulate for the production of specific antibody.
Types
 Live attenuated vaccine
 Dead or killed vaccine (inactivated)
 Toxoids
 Combination

20. vaccine
Live attenuated vaccine
 prepared from live organism and these organisms are allowed to
weaken (attenuated).
 Attenuation: reduced pathogenicity/virulence; Maintained
antigenicity/immunogenicity.

21. vaccine
Live attenuated vaccine
As a result, after its administration an individual will contract only a
very mild illness.
Antibodies develops which will protect against the severe form of
disease in the future.
 Examples: BGC, measles, mumps, rubella, oral polio, rota virus,
Japanese encephalitis, typhoid etc.

22. vaccine
Live attenuated vaccine
Contraindications
• Pregnancy
• Immune deficiency disease (Leukemia, AIDS)
• Corticosteroid therapy

23. vaccine
Death or killed vaccine
 Organisms killed by heat or chemically when injected into the body
stimulate active immunity.
 Usually required a primary series of 3-5 doses of vaccine to produce
adequate antibody response and most cases booster injection are
required.

24. vaccine
Death or killed vaccine
Contraindication
• The only absolute contraindication to their administration is a several
low or general reaction to previous dose.
• polio (salk type), hepatitis A, rabies, hepatitis B etc

25. vaccine
Toxoid vaccine
 Certain organisms produce exotoxin eg, Diptheria and tetanus.
 The toxin produced by these organisms are detoxicated and used in
the preparation of vaccine.

26. vaccine
Toxoid vaccine
 Toxoids are highly effective and usually safe.
 Examples: Diptheria, Tetanus

27. vaccine
Cellular fraction
 Some vaccines are prepared from extracted cellular fractions eg,
Meningococcal vaccine from the polysaccharide part of cell wall and
the pneumococcal vaccine from the polysaccharide contained in the
capsule of the organism.
 These are safe and effective.

28. vaccine
Combination
• If more than one kind of immunizing agent is included in the vaccine,
it is called mixed or combined vaccine.
• The aim is to simplify administration, reduce costs and minimize the
number of contacts with the health center.
• Examples: DPT (diphtheria, pertusis, tetanus)
MMR (Measles, Mumps, Rubella)

29. vaccine
Salk vaccine is a:
a. Live attenuated vaccine
b. Killed vaccine
c. Toxoid
d. Cellular fraction
ANS: b

30. vaccine
Which vaccine is contraindicated in pregnancy?
a. Rubella
b. Diphtheria
c. Tetanus
d. Hepatitis B
ANS: a

31. Immunoglobulin

32. Immunoglobulin
Only class of immunoglobins which can transport across the placenta is:
a. IgG
b. IgA
c. IgM
d. IgD
ANS: a

33. Immunoglobulin
The human immunoglobulin system is composed of five major classes
these are IgG, IgM, IgA, IgD and IgE.
IgG:
 major immunoglobulin of serum, comprise about 8o% of total
serum immunoglobulin.
 only class of immunoglobins which can transport across the
placenta.
 Main blood antibody of secondary responses, neutralizes toxins.

34. Immunoglobulin
IgM:
it accounts about 10% of normal serum immunoglobulin.
 It represents antibody that is promptly formed with the exposure to
antigen.
Its present may be indicative of recent infection. (Main antibody of
primary response)

35. Immunoglobulin
IgA:
 Accounts about 15% of normal serum immunoglobulin. It is found
in body secretions
 Eg. Saliva, milk colostrums, small intestine and vaginal secretion
etc.
 It provides defense mechanism at the mucus membranes against
local infection.

36. Immunoglobulin
• IgD: Present in lymphocytes cell surface. Its main function has not yet
been determined.
• IgE:
• it is concentrated on submucous tissue.
• It is the major antibody responsible for immediate allergic
anaphylactic reaction.
• Important in protection against parasites.

37. Immunoglobulin
Two types immunoglobulin preparations are available for passive
immunization:
1. Normal human immunoglobulin
2. Specific (hyper immune) human immunoglobulin

38. normal human immunoglobulin
 This is prepared from the pooled plasma of at least 1000 donors.
 It consists of IgG.
 It produces instantaneous but temporary immunity.
 It is used to prevent measles in highly susceptible individuals

39. normal human immunoglobulin
 This should not be given simultaneously along with live vaccines
because this IgG will interfere with the development of immunity.
 If this is given first, live vaccine should not be given for 12 weeks and
if live vaccines is given first, this should not be given for 2 weeks.

40. Specific (hyper immune) human
immunoglobulin
 This is prepared from the plasma of those persons, who have been
recently immunised of recovered from the disease.
 This is highly safe, effective and costly.
 Passive immunity lasts longer than normal human immunoglobulins.
 e.g. human rabies immunoglobulin (HRIg), human tetanus
immunoglobulins (HTIg), hepatitis B immunoglobulin (HBIg)

41. MCQ
Active and passive immunization is done simultaneously in all except:
a. Hepatitis B
b. Measles
c. Rabies
d. Tetanus
ANS: b

42. anti sera
 These are the specific immunoglobulins prepared from the plasma of
immunized animals, such as horses.
 Immunity lasts for about 2-3 weeks only.

43. anti sera
e.g. anti-tetanus serum (ATS), anti-diphtheria serum (ADS), anti-snake
venom.

44. MCQ
Which of the following immunoglobulins are secretory and present in
the milk?
a. IgG
b. IgM
c. IgA
d. IgE
ANS: c

45. MCQ
Name the class of immunoglobulin which takes part in hypersensitivity
reaction?
a. IgG
b. IgM
c. IgA
d. IgE
ANS: d

46. National Immunization
Programme

47. National immunization
programme
 National Immunization Program of Nepal (Expanded Program on
Immunization) was started in 2034 BS and is a priority 1 program.
 achieved several milestones contributing to reduction in morbidity
and mortality associated with vaccine preventable diseases.

48. National immunization
programme
 Currently, the program provides vaccination against 13 vaccine
preventable diseases.
 Immunization services are delivered through 16,500 service delivery
points in health facilities (fixed sessions), outreach sessions, and
mobile clinics.

49. National immunization
programme
 NIP has a very good track record of meeting the target for control,
elimination and eradication of vaccine preventable diseases.
 Small pox has now become history due to eradication in 2034 BS
(1977 AD).
 Maternal and neonatal tetanus (MNT) was eliminated in 2005 and
the elimination status has been sustained since then.

50. National immunization
programme
 The last case of polio in Nepal was in 2010, and along with other
countries of the South East Asia Region, Nepal was certified polio
free in 2014.
 This status has been maintained since then.

51. Comprehensive Multi-year plan for
immunization (cMYPI)
 The cMYPI 2017- 2021 provides a plan for five years to achieve
immunization related goals of the country.
 Provide the framework required to meet the goal of reducing infant
and child mortality and morbidity with vaccine-preventable diseases.

52. Comprehensive Multi-year plan for
immunization (cMYPI)
Vision:
Nepal: a country free of vaccine-preventable diseases.
Mission:
To provide every child and mother high-quality, safe and affordable
vaccines and immunization services from the National Immunization
Program in an equitable manner.

53. Comprehensive Multi-year plan for
immunization (cMYPI)
Goal:
Reduction of morbidity, mortality and disability associated with vaccine
preventable diseases.

55. Cold chain
 The ‘cold chain’ is the system of transporting and storing vaccines at
recommended temperature from the point of manufacture to the point
of use.
 To prevent vaccine failure (sensitive to temperature).
 Potency of the vaccine decreases when exposed to inappropriate
temperatures.

56. Cold chain
Deep freezer:
•Temperature b/w -15° to -25°C.
•Used for storing OPV vaccine and for freezing ice packs
Ice lined refrigerator:
•Temperature b/w +2° to +8°C.
DPT, TT, HepB, IPV & pentavalent vaccines, BCG, measles, JE

57. Cold chain

58. Cold chain
Among all vaccine oral polio is the most heat sensitive.
At the health centers, most vaccines except polio can be stored at 2-8
deg Celsius for 5 weeks.

59. Cold chain

60. MCQ
Most heat sensitive vaccine is:
a. BCG
b. Polio
c. Measles
d. DPT
ANS: b

61. MCQ
Which type of vaccine is MMR:
a. Live attenuated
b. killed
c. Toxoid
d. Cellular fraction
ANS: a

62. MCQ
BCG is given:
a. Intramuscular
b. Subcutaneous
c. Intradermal
d. Intravenous
ANS: c

63. MCQ
Active and passive immunity should be given in all except:
a. Hepatitis B
b. Tetanus
c. Rabies
d. Measles
ANS: d

64. MCQ
Toxoid is prepared from:
a. Endotoxin
b. Exotoxin
c. Both
d. None
ANS: b

65. references
Park, K. (2019). Park`s Textbook of Preventive and Social Medicine.
M/s Banarsidas Bhanot publishers.
Gupta, MC, Mahajan, BK. (2013). Mahajan and Gupta Textbook of
Preventive and Social Medicine. Brothers Medical Publishers (P) Ltd.
Jain, B. (2016). Review of Preventive and Social Medicine. The
Health Sciences Publisher.
Ghimire, B. (2019). A Textbook of Social Medicine. Jaypee
Community Health Nursing. Vidyarthi Pustak Bhandar.