COLLEGE OF ALLIED MEDICAL PROFESSIONS

Department of Pharmacy
CLINICAL PHARMACY

ILARDE, KRYZZLE PRINCESS V.

ClinPhar 5A

IMMUNOGENECITY AND IMMUNIZATION

IMMUNOGENECITY
I.INTRODUCTION
- Ability of a foreign substance to enter a person's body and cause an immune response (humoral
or cellular) and such substances are called immunogenic.
 HUMORAL IMMUNE RESPONSE:
 ANTIGEN + B-cell  effector cells (plasma cells) ANTIBODY & memory B-
cells
 CELLULAR IMMUNE RESPONSE:
 ANTIGEN + T-cells  T-cell subset T- Helper and Cytotoxic T-cells & memory
T-cells
Example:
When a person gets vaccinated, they are injected with a very tiny amount of a specific disease
(ANTIGENS). Once a person receives the injection, their immune system can safely learn to
recognize them as hostile invaders and will begin to create antibodies, and remember them for
the future.

II. CHARACTERISTICS OF AN IMMUNOGEN

Foreignness
Antigens must be recognized as non-self by the
biological system

Degree of immunogenicity depends on the degree of

foreignness    i.e. the more foreign the molecule is, more
is its immunogenicity

E.g. If a person receives a blood transfusion that does

not contain the same antigens as their own blood, their
body will start an immune response and try to kill and
destroy this new blood and its antigens.

***Note that it is also possible for self "antigens" to be immunogenic. Thus the foreignness requirement
can be overcome.    When this happens it results in  autoimmunity. (RA, SLE).

Chemical Composition and Molecular Complexity

Antigens can be:
 Carbohydrate  they are immunogenic only if they have complex polysaccharide structure or
associated with protein carriers
  Lipids, Nucleic acid  linear carbon chains with no defined tertiary structure, are rarely
immunogenic because they lack structural rigidity.
 Proteins  powerful immunogens, it has complex rigid structures with a conformation defined
by primary, secondary, tertiary and quaternary structures thus, molecules with complex nature
are more immunogenic.

Size
Large macromolecules are better immunogens because they are insoluble and more easily ingested and
processed by macrophages for presentation to lymphocytes.
Exceptions: Haptens (small molecules) become immunogenic only when linked to a carrier
protein.

III. FACTORS INFLUENCING IMMUNOGENICITY

Geneti cs
Genetics influences a person’s ability to respond to specific immunogens.
Genetic unresponsiveness is the result of two defects:
1. Some individuals lack a lymphocyte clone with a T cell receptor (TCR) directed at the antigen.
2. Other individuals have a defect in antigen processing and cannot present the antigen to T cells.

Age

Usually the very young and the very old have a diminished ability to mount an immune response in
response to an immunogen.
*** An infant’s immune system becomes fully functional between 6 and 12 months of age.

IV. PROS AND CONS OF IMMUNOGENICITY

 The concepts of immunogenicity are important for designing vaccines which enhancing
immunogenicity is the key
Adjuvant can be added in vaccines to enhance its immunogenicity because an adjuvant can
stimulate the immune response by facilitating uptake into APCs (antigen presenting cells).

 Reduction of immunogenicity should also be considered in protein drug design.

Eg. Recombinant protein or Monoclonal antibody
Stimulation of immune response against the therapeutic antigen (recombinant protein
or monoclonal antibody) which leads to production of anti-drug-antibodies (ADAs) inactivating
the therapeutic effects of the treatment and, in rare cases, inducing adverse effects

IMMUNIZATION
I.INTRODUCTION
- Process whereby a person is made immune or resistant to an infectious disease, typically by the
administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the
person against subsequent infection or disease.
- proven tool for controlling and eliminating life-threatening infectious diseases
II. CLASSIFICATIONS OF VACCINES
a. LIVE ATTENUATED VACCINES
- contain whole bacteria or viruses which have been “weakened” so that they create a protective
immune response but do not cause disease in healthy people.
-create a strong and lasting immune response
-potential harm to individuals with compromised immune system (eg. HIV)

Specific Vaccines:

 BCG
 Oral Polio Vaccine
 Measles, mumps, rubella (MMR combined vaccine)
 Chickenpox (Varicella)
 Yellow fever
 Rotavirus

b. INACTIVATED VACCINES
-contain whole bacteria or viruses which have been “killed”, or small parts of bacteria or viruses,
such as proteins or sugars, which cannot cause disease.
- do not always create such a strong or long-lasting immune response as live vaccines (require
repeated doses and/or booster doses)
-have no live components, no risk of inducing the disease
- Adjuvants (aluminum salts) are often added to inactivated vaccines
These are substances help to strengthen and lengthen the immune response to the vaccine.

Specific Vaccines:

 Hepatitis A
 Polio (IPV)
 Rabies

c. SUBUNIT VACCINES
 Do not contain live components of the pathogen
 Contain only antigenic parts of the pathogen which are necessary to elicit a protective immune
response.
 Can be further categorized into:

PROTEIN-BASED VACCINES
Eg.
Acellular pertussis
Hepatitis B
POLYSACCHARIDE VACCINES
Eg.
Meningococcal
Pneumcoccal
 CONJUGATE VACCINES
Eg.
Hib (Haemophilus influenzae type b)
Pneumococcal conjugate (7,10,13)
d. TOXOID VACCINES
 “detoxified” toxins
 made by inactivating toxins by treating them with formalin, a solution of formaldehyde and
sterilized water.
 Toxoid vaccines are made for bacteria that secrete illness-causing toxins, or harmful chemicals.
When the immune system receives a vaccine containing a harmless toxoid, it learns how to fight
off the natural bacterial toxin, which causes an illness.
Specific Vaccines:
 Diphtheria
 Tetanus Toxoid
***Tetanus: its symptoms are not caused by the bacteria  Clostridium tetani, but by a neurotoxin
(tetanospasmin) it produces.

III.IMMUNIZATION SCHEDULE

Bacille Calmette-Guerin (BCG)

• Given intradermally (ID)
• The dose of BCG is 0.05 ml for children < 12 months of age and 0.1 ml for children > 12 months of age
• Given at the earliest possible age after birth preferably within the first 2months of life
• For healthy infants and children > 2 months who were not given BCG at birth, PPD prior to BCG
vaccination is not necessary.
However, PPD is recommended prior to BCG vaccination if any of the following is present:
− Congenital TB
− History of close contact to known or suspected infectious TB cases
− Clinical findings suggestive of TB and/or chest x-ray suggestive of TB
***In the presence of any of these conditions, an induration of ≥ 5mm is considered positive
and BCG is no longer recommended

Hepatitis B Vaccine (HBV)

• Given intramuscularly (IM)
• Administer the first dose of monovalent HBV to all newborns >2kgs within 24hours of life.
• A 2nd dose is given 1-2 months after the birth dose
• The final dose is administered not earlier than 24 weeks of age. Another dose is needed if the last dose
was given at age <24 week

For infants born to HBsAg (+) mothers:

• Administer HBV and HBIG (0.5ml) within 12 hours of life. HBIG should be administered not
later than 7 days of age if not immediately available.

For infants born to mothers with unknown HBsAg status:

• birth weight >2kgs, administer HBV within 12 hours of birth and determine the mother’s
HBsAg as soon as possible. If HBsAg (+), administer also HBIG not later than 7 days of age.
• birth weight <2kgs, administer HBIG in addition to HBV within 12 hours of life.

For preterm infants:

• If born to HBsAg (-) mothers and medically stable
1st dose of HBV may be given at 30 days of chronological age regardless of weight, and this can
be counted as part of the 3-dose primary series.
• For those <2 kgs, the 1st dose received at birth is not counted as part of the vaccine series.
Additional 3 HBV doses are needed.

Haemophilus influenzae Type b Conjugate Vaccine (Hib)

• Given intramuscularly (IM)
• Given as a 3-dose primary series with a minimum age of 6 weeks and a minimum interval of 4 weeks
• A booster dose is given between 12-15 months of age with an interval of 6months from the 3rd dose.

Diphtheria and Tetanus Toxoid and Pertussis Vaccine (DTP)

• Given intramuscularly (IM)
• Given at a minimum age of 6 weeks with a minimum interval of 4 weeks
• Complete a 5-dose series at ages 2, 4, 6, 15 through 18 months, and 4through 6 years. The
recommended interval between the 3rd and 4th dose is 6months, but a minimum interval of 4 months is
valid
• The 5th dose of DTaP vaccine may not be given if the 4th dose was administered at age 4 years or
older.

Inactivated Poliovirus Vaccine (IPV)

• Given intramuscularly (IM)
• Usually given in combination with DTaP and Hib, with or without Hep B
• Given at a minimum age of 6 weeks with a minimum interval of 4 weeks
• The primary series consists of 3 doses
• A booster dose should be given on or after the 4th birthday and at least 6months from the previous
dose

Measles Vaccine
• Given subcutaneously (SC)
• Given at the age of 9 months
Outbreak: may be given as early as 6 months of age
• If monovalent measles is not available, MMR may be given

Influenza Vaccine (Trivalent/Quadrivalent Influenza Vaccine)

• Trivalent influenza vaccine (TIV)  IM / SC
• Quadrivalent influenza vaccine (QIV) - IM
• Given at a minimum age of 6 months
• Dose: 0.25 ml for children 6 months - 35 months
0.5 ml for children 36 months - 18 years

FULLY IMMUNIZED CHILD:

When a child receives:
 1 dose BCG
 1 dose measles
 3 doses HepB
 3 doses OPV
 3 doses DPT
**Before child’s 1st birthday

CONTRAINDICTION TO VACCINATION
 Anaphylaxis or severe hypersensitivity reaction to a previous dose of vaccine
 DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1.
 Do not give live vaccines like BCG to an individual who are immunocompromised
 A child with severe dehydration
 Fever 38.5 C and above
References:
 Immunogenicity and Antigenicity. Retrieved: January 10, 2020 from
https://clinicalgate.com/immunogenicity-and-antigenicity/
 World Health Organization Health Topis: Immunization. Retrieved: January 10, 2020 from
https://www.who.int/topics/immunization/en/
 CDC: 2019 Recommended Vaccinations for Infants and Children (birth through 6 years) Parent-
Friendly Format. Retrieved: January 11, 2020 from
https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html
 Immunogenicity -Properties determining immunogenicity of a substance (FL-Immuno/21)
https://www.youtube.com/watch?v=_8klM011790&t=54s
 World Health Organization: Types of Vaccine and Adverse reaction. Retrieved: January 11, 2020
https://vaccine-safety-training.org/overview-and-outcomes-2.html