Book reference: Essentials of Medical Pharmacology by K. D. Tripathi Images and Charts: Google Search Results Presentation for teaching in a 2nd Year MBBS class

1. VACCINES, TOXOIDS,
ANTISERA AND
IMMUNOGLOBULINS
Dr. Bikram Tewari
Assistant Professor
Department of
Pharmacology

3. INTRODUCTION
Vaccines, Antisera and Toxoids are biological
products which act by reinforcing the
immunological defence of the body against
foreign agencies.
Mostly used in public health programmes
Potentially dangerous, strictly supervised and
highly standardised production, distribution and
administration.
Need cold storage to maintain potency

4. HISTORY
Small Pox-
1798
Rabies-1885
Typhoid -
1896
Cholera- 1896
Plague-1897
Polio-1955 JONAS SALKEDWARD JENNER

5. VACCINES:
Active
immunity,
prophylactic,
latent
period.
ANTISERA
and
IMMUNO-
GLOBULINS:
Passive
immunity,
curative,
immediate

6. ACTIVE
IMMUNITY
Bacterial
• Live attenuated
• Killed Inactivated
Viral
• Live attenuated
• Killed Inactivated
Toxoid
Combined
Vaccine

7. PASSIVE
IMMUNITY
•ANTISERA
•IMMUNOGLOBULIN

12. BACTERIAL VACCINE
• Bacillus Calmette – Guerin (BCG)
• Typhoid – Ty21a
LIVE ATTENUATED
• Typhoid- Parathyphoid (TAB)
• Vi Polysaccharide
• Cholera
• Whooping Cough
• Meningococcal
• Haemophilus Influenzae Type b
• Plague
KILLED INACTIVATED

13. BACILLUS CALMETTE-GUERIN
(BCG) VACCINE

14. BACILLUS CALMETTE-GUERIN
(BCG) VACCINE
Live vaccine, attenuated bovine strain of M.
tuberculosis
Calmette and Guerin – 1921, France
Supplied as 0.5 to 1mg dry powder to be
suspended in 1ml sterile water
Neonate: 0.05ml and Older individuals: 0.1ml,
intra-cutaneous in deltoid region
Tuberculin sensitivity testing required in children
and adults

15. TUBERCULIN SENSITIVITY TESTING
 Evaluation of
testing Site:
48-72 hrs
 Also known
as Mantoux
Screening
Test, Mendel
Mantoux,
Pirquet, PPD
test

16. TUBERCULIN SENSITIVITY TESTING
- RESULTS

17. BCG
Vaccinati
on

18. SCAR

19. BACILLUS CALMETTE-GUERIN
(BCG) VACCINE
Injection Site
o7-10 days: red painless papule
o5 weeks: reaches 8mm, axillary L/N swelling
o3 months: Scales and dries
o6 Months: total heal
Partial, non permanent, non predictable.
Children benefited more
Also used for enhancement of immunity (non
specifically)
C/I: tuberculin positive, compromised host

20. VIRAL VACCINE
•Poliomyelitis Oral Live (OPV, Sabin)
•Measles, Mumps and Rubella
LIVE ATTENUATED
•Poliomyelitis inactivated (IPV, Salk)
•Rabies (Brain Substance, Chick embryo cell, Human diploid Cell-HDCV, Vero
Cell)
•Influenza
•Hepatitis B
•Hepatitis A
KILLED INACTIVATED

21. VACCINE FOR POLIOMYELITIS
Virus type 1, 2 and 3
Grown in monkey kidney cell culture
Two vaccines
oOral Polio Vaccine (OPV; Sabin vaccine): 0.5ml oral
drops at 6 10 and 14 weeks. Booster dose in15 to 18
months
oInactivated Poliomyelitis Vaccine (IPV, Salk Vaccine): 3
doses of 1ml s.c. injection in deltoid region at 4-6
weeks intervals. 4th dose 6-12 months later. Booster
dose every 5 years.

23. RABIES VACCINE
Four vaccine types
1. Antirabic vaccine carbolized
(Semple Vaccine)
2. Purified chick embryo cell
vaccine (PCEV)
3. Human diploid cell vaccine
(HDCV)
4. Purified vero cell mrabies
vaccine (PVRV)

25. POST EXPOSURE
PROPHYLAXIS
1ml of PCEV or
HDCV or 0.5ml of
PVRV per dose
given on day 0, 3,
7, 14, 30, 90
PRIMARY
IMMUNIZATION
PCEV: 3 doses of
1ml inj. at intervals
of 1 month.
Booster: 1 year
HDCV: 3 doses 1ml
injection at 1week

26. HEPATITIS VACCINES
HEPATITIS B
•Aluminium
hydroxide
adsorbed Hep B
virus surface
antigen
•Prepared in yeast
cells
•1ml i.m. deltoid at
0, 1 and 6 months
•Children: 0.5ml in
HEPATITIS A
•Inactivating with
formaldehyde
•Hep A virus grown
in Human Diploid
Cell Culture
•0.5ml injection
i.m. deltoid
•Booster: 6 months

27. COMBINED
VACCINE
Measles-
Mumps-
Rubella (MMR)
Pentavalent
Vaccine
Double
antigen
DT-DA
Triple Antigen
DPT

28. 4. MEASLES-MUMPS-RUBELLA
(MMR) VACCINE
Two preparations available
1
2

29. MEASLES-MUMPS-RUBELLA (MMR)
VACCINE
MUMPS VIRUS VACCINE LIVE ATTENUATED
•Virus grown in chick embryo cell culture
•Live attenuated, dose of 5000 TCID50
•Affords protection for up to 10 years
•Not to be given in immune deficiency syndrome
or after exposure
•Occasional febrile reaction

30. MEASLES-MUMPS-RUBELLA (MMR)
VACCINE
MEASLES VACCINE LIVE ATTENUATED
•Virus grown in chick embryo cell culture –
Edmonston Schwarz strain or Edmonston
Zagreb strain
•Live attenuated, dose of 1000 TCID50
•Affords protection for up to 8 years
•Not to be given in immune deficiency, history
of febrile convulsion or family history of
epilepsy
•Affords some protection even when given post

31. MEASLES-MUMPS-RUBELLA (MMR)
VACCINE
RUBELLA VACCINE
•Live attenuated, Wistar RA27/3 strain
•1000 TCID50 , more specifically for girls
•Contraindicated in pregnancy, febrile illness and
untreated tuberculosis
•A/E: fever, malaise, sore throat, joint pain and
lymphadenopathy

32. PENTAVALENT VACCINE

33. PENTAVALENT VACCINE
DIPTHERIA TOXOID ADSORBED
•Modified diphtheria exotoxin
adsorbed onto aluminium
hydroxide
•Reactions: local erythema, pain
and induration, axillary lymph
nodes may enlarge, fever, chills,
malaise, aches and pains

34. PENTAVALENT VACCINE
PERTUSIS (WHOOPING CHOUGH)
VACCINE
•Killed B. pertussis
•Also induces diminished adrenergic
reactivity and aids sensitization to
other antigens
•Reactions: local pain, induration,
rarely severe systemic reactions –
high fever, shock like state,
convulsions, altered consciousness,
focal neurological signs

35. PENTAVALENT VACCINE
TETANUS TOXOID
•Formalin treated exotoxin of tetanus bacilli
•Two types: fluid and adsorbed
•Reactions are similar to diphtheria toxoid
adsorbed
•Concomitant administration of chloramphenicol is
avoided as it interferes with antibody response
•Unimmunized or inadequately immunized
individual: inject after every injury that is likely to

36. PENTAVALENT VACCINE
INFLUEZAE VIRUS VACCINE
•Contains inactivated influenza virus A and B
•Efficacy inconsistent because of the frequent
antigenic changes
•A/E: Local induration and tenderness, fever,
malaise and myalgia, allergic reactions to egg
protein

40. PASSIVE
IMMUNITY
•ANTISERA
•IMMUNOGLOBULIN

41. ANTISERA
Purified and concentrated preparations of serum of
horses actively immunized against a specific antigen
A/E
1.Immediate type of allergic reactions: adrenaline
1:1000 on standby, proper sensitivity history, intra-
cutaneous/scratch test required – C/I in positive
2.Serum Sickness: with large doses and frequent
administration. Fever, rash, joint pain,
lymphadenopathy 7-12 days later

42. IMMUNOGLOBULINS
oSeparated human gamma globulins which carry
the antibodies.
oNon specific (normal) or specific (hyperimmune)
against a particular antigen
oMore efficacious than antisera
oUsually no hypersensitivity
oTendency increases with large and repeated
dosing: adrenaline to be kept on standby

43. ANTISERA (From
Horse)
oTetanus antitoxin (ATS)
oGas Gangrene Antitoxin
(AGS)
oAnti Rabies Serum (ARS)
oAnti-snake venom
polyvalent
IMMUNOGLOBULINS
(Humans)
oNormal Human Gamma
Globulin
oAnti – D immunoglobulin
oTetanus immunoglobulin
oRabies Immunoglobulin
oHepatitis-B
immunoglobulin

44. ANTI-SNAKE VENOM POLYVALENT
Purified, enzyme refined and concentrated equine
globulins
Lyophilized vials with 10 ml ampule of distilled
water
ml neutralizes
1. 0.6 mg of standard Cobra(Naja naja) venom
2. 0.6 mg of standard Russel’s Viper (Vipera russelli)
venom
3. 0.45 mg of standard Sawscaled viper (Echis

45. 1
3
2
4

46. ANTI-SNAKE VENOM POLYVALENT
Dose: 20ml i.v. (1ml/min injections) repeated at
1-6 hourly intervals till symptoms of envenomation
disappear
Upto 300ml/patient. Max
In viper bite: some serum around the bite site as
well
Allergic reactions including anaphylactic shock
possible
Sensitivity testing or adrenaline s.c injection
according to the situation

47. NORMAL HUMAN GAMMA GLOBULIN

48. NORMAL HUMAN GAMMA GLOBULIN
Concentrated IG obtained by fractionation in cold
From pooled human plasma
Indicated use in: Viral hepatitis A and B, Measles,
Mumps, Poliomyelitis, Chicken Pox
Valuable in agammaglobinemia, premature infants,
leukaemia, immunosuppression
Also augments response to antibiotics
Dose: 0.02 – 1ml/kg i.m

49. THANK YOU