VACCINATION

JO Y A N N E C . N IC O D E M U S , M D
Principles of Vaccination

 Immunity
 Ability of the human body to tolerate the
presence of material indigenous to the
body (self), and to eliminate foreign
(nonself) material
 Protection from infectious disease

 Usually indicated by the presence of an

antibody
 Very specific to a single organism

Antigen vs. antibody
 Antigen
 Liveor inactivated substances capable of
producing an immune response
 Antibodies
 Protein molecules produced in response
to an immune response by B
lymphocytes to eliminate an antigen

Immune response…
1.Cells called macrophages gobble up
the invading virus and sound the
alarm by showing pieces of invader to
T-cells & B-cells
2.B cells produce defensive molecules
called antibodies that “stick” to the
virus.

Immune response…
3.To overcome the virus, B cells turn into
“plasma cells factories” that
produce antibodies. Cytotic T cells
eliminate cells infected with virus.
Helper T cells direct the action with
chemical signals.

Passive immunity vs. active immunity

 Passive Immunity
 Protection by products produced by an
animal or human and transferred to
another human, usually by injection
 This protection wanes with time, usually
within a few weeks or months

Passive immunity vs. active immunity

 Active Immunity
 Protectionthat is produced by the
person’s own immune system
 Usually permanent

Passive immunity
 Transfer of antibody produced by one
human or other animal to another
 Temporary protection

 Most common form is by transplacental

transfer
A full term infant may have the same
antibodies as the mother

Sources of passive immunity
 Almost all blood or blood products
 Intravenous immune globulin and plasma
products vs washed or reconstituted red
blood cells
 Homologous pooled human antibody
(immune globulin)
 Produced by combining (pooling) IgG
antibody fraction from different donors
 Used primarily for post-exposure
prophylaxis for Hepatitis A and measles
Sources of passive immunity
 Homologous human hyperimmune
globulin
 Antibody products that contain high titers
of specific antibodies
 Made from the donated plasma of
humans with high levels of the antibody
of interest
 Since main source is from humans  may
contain lesser amounts of antibodies
 Used for post-exposure prophylaxis
(Hepatitis B, rabies, tetanus, varicella)
Sources of passive immunity
 Heterologous hyperimmune serum
(antitoxins)
 Produced in animals usually horses
 Contains antibodies against only one
antigen

Active immunity
 Stimulation of the immune system to
produce antigen-specific humoral
(antibodies) and cellular immunity
 Usually lasts for many years (as
compared to passive immunity) often
for a lifetime

Achieving Active Immunity…

1.Exposure and recovery from infectious

disease
 “Immunologic memory”
 Memory B cells continue to circulate in the
blood and reside in the bone marrow
following exposure of the immune
system to an antigen
 Upon re-exposure to the antigen, the
memory cells replicate and produce
antibodies rapidly to establish protection
Achieving Active Immunity…
2.Vaccination
 Vaccines interact with the immune
system and produce an immune
response similar to that produced by
natural infection
 Also produce immunologic memory
similar to that acquired by having
a natural disease



Factors that Influence Immune
Response to Vaccination

 Presence of maternal 

antibodies  Host factors

 Nature and dose of  Age
the antigen  Nutritional factors

 Route of  Genetics

administration  Coexisting disease

 Presence of 

adjuvants
 Aluminum-
containing
materials to
improve
Classification of Vaccines

1. Live attenuated 2. Inactivated Vaccines

 Produced by modifying  Composed of either
a disease-producing whole viruses or
(“wild”) virus or bacteria or their
bacterium in the fractions
laboratory  Produced by growing the
 Resulting vaccine bacterium or virus in
organism retains the culture media, then
ability to replicate inactivating it with
and produce heat and/or chemicals
immunity, but usually (usually formalin) -
does not cause illness Whole-cell vaccines
 Must replicate in the  Fractional vaccines
vaccinated person in  Organism further
order to produce an treated to purify
immune response only those
components to be
 included in the
vaccine (e.g.
GENERAL RULE
The more similar a vaccine is to
the disease-causing form of the
organism, the better the
immune response to the
vaccine.
examples
 Live attenuated  Bacterial
 Viral  BCG
 Measles  Oral typhoid
 Mumps 

 Rubella
 Vaccinia
 Varicella
 Zoster
 Yellow fever
 Rotavirus
 Influenza
intranasal
 Oral polio
examples
 Inactivated Vaccines  Fractional
 Whole-cell Inactivated
Inactivated Vaccines
Vaccines  Subunit
 Viral  Hepatitis B
 Polio  Influenza
 Hepatitis A  Acellular pertussis
 Rabies  Human
papillomavirus
 Influenza
 Lyme disease
 Bacterial
 Pertussis
 Toxoid
 Diphtheria
 Typhoid
 Cholera  Tetanus
 Plague 


RECOMMENDED ADULT IMMUNIZATION
SCHEDULE
RECOMMENDED ADULT IMMUNIZATION
SCHEDULE – special population
RECOMMENDED CHILDHOOD
IMMUNIZATION SCHEDULE
RECOMMENDED ADOLESCENT
IMMUNIZATION SCHEDULE
Pre Immunization Checklist
1. Have had a vaccine
containing live viruses
(e.g., measles, mumps,
rubella, oral polio)
2. Are unwell on day of
immunization
3. Have had previous reaction to
any vaccine
4. Have had reaction to any
vaccine components
5. Are taking steroids of any sort
6. Have had immunoglobulin or
a blood transfusion in the
last 3 months
7. Have a disease or are having
treatment which causes
low immunity
(radiotherapy,
chemotherapy, etc)
8. Live with someone who has a
disease or is having
treatment which causes
low immunity
9. Have a condition of the CNS
which is still being
investigated
10.Live with someone who is not
immunized
11.Are pregnant
 Adult Immunization
PSMID RECOMMENDATION FOR ALL ADULTS

 Tetanus booster every 10 years

 Rubella
 Varicella- 2 doses one month apart
 Hepatitis B – after screening

 Elderly


 Influenza annually
 Pneumonia every 5 years



HEALTH CARE WORKERS
 CATEGORY A
 DIRECT CONTACT WITH BLOOD O BODY
SUBSTANCES( health practitioners, health
care students, emergency personnel,
central supply staff responsible for
decontamination, mortuary technician,
maintenance engineers who service
equipment)
 CATEGORY B
 INDIRECT CONTACT WITH BLOOD OR BODY
SUBSTANCES ( exposed to infections spread
by droplet; catering staff and ward clerks)
 CATEGORY C
 LABORATORY STAFF
 CATEGORY D
 MINIMAL PATIENT CONTACT (clerical admin
staff )
HEPATITIS B
 essential for all categories A-C
 Post serological testing maybe done 3 months
after vaccination. Those who are still
negative should be offered another round.
 PERSISTENT NON RESPONDERS should receive
HBIg within 48 hours of parenteral exposure
to Hepa B
 Booster doses not needed since primary
course offers life long protection
Hepatitis A
 Higher risk for
 nursing staff
 Those in contact with patients in
 pediatric ward
 Infectious disease ward

 Emergency rooms

 Intensive care units


INFLUENZA
 Offer annually to Category A health care
workers
POST IMMUNIZATION REACTION
 Let the patient remain in the clinic 15-30 minutes
after vaccination.
 Mild temperature (< 39) may occur DPT, Hep B, HiB
soon after and in MMR even 6-11 days after. If
temperature goes up higher than 38’C may give
Paracetamol.
 Drowsiness may follow DPT
 Nausea, feeling unwell and joint pain may complicate
HepB vaccination
 MMR may cause faint rash (not infectious), runny
nose, cough, puffy eyes 6-11 days after but will not
last longer than 48 hours. Swelling of the salivary
gland may occur 3 weeks after immunization
“Love your calling with passion,
It is the meaning of your life.”
Thank you…