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BY
DR . MUNEEBA FAISAL
PGT , FCPS II,
COMMUNITY MEDICINE

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 The branch of biological science concerned
with the study of immunity .

The branch of biomedical science dealing

with the components of the immune system,
immunity from disease, the immune
response, and immunologic techniques of
analysis .

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 The system of complex defence mechanism of the
body against foreign invading agents.

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 The state of resistance or insusceptibility of the
body to toxic molecules, micro-organisms and
foreign cells.

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 IMMUNITY

ACQUIRED INNATE

ACTIVE PASSIVE

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 Operates regardless of individuals past exposure.
Outer defense:
Mechanical barriers- skin & mucous membrane
Mechanical removal- by coughing, sneezing,
sniffing, blinking & watering of eyes.
Germicidal activity- of gastric juice, skin, prostatic
and vaginal secretions

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 Inner defense:
Body fluids like lysozyme
Phagocytosis by polymorphonuclear leukocytes and
macrophages of reticulo-endothelial system.

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 Genetic factors
Age
Hormones
Nutrition
Temperature
Fatigue
Trauma, surgical operations, malignancies,
irradiations etc.

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 Occurs after previous contact with micro-
organisms
Acquired by clinical and subclinical infection
and by vaccination.
Is of 2 types:
Active immunity
Passive immunity

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 CELL MEDIATED IMMUNITY(CELLULAR)
ACTIVE ANTIBODY MEDIATED
IMMUNITY(HUMORAL)

IMMUNITY

NATURALLY ACQUIRED(BY BREAST

PASSIVE FEEDING)
ARTIFICIALLY ACQUIRED(BY IG AND

IMMUNITY ANTISERA)

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 Any substance which on introduction into any
human or animal tissues, is capable of initiating an
immune response.

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 Is an immunoglobulin produced on
introduction of an antigen into the tissues of
an animal.
It neutralizes and eliminates an antigen from
the body.
It is produced by plasma cells

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 5 major types: Ig G,Ig A,Ig M,Ig E,I g D.

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1) IgG:
Main immunoglobulin of the serum.
85% of total serum Ig i.e., 8-16 gm/L.
Mol. Weight is 150,000 Daltons.
Diffuses all body tissues except CSF.
Only Ig that can cross the placental barrier.
Most effective for neutralizing exotoxins, viruses
and bacteria.
Produced in secondary response to an antigen.

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 IgM:
Constitutes only 10% of total serum Ig.
First to appear in response to an antigen.
Mol. Weight is 900,000 Daltons.
High titer indicates recent infection.
Cannot cross placental barrier

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 IgA:
15% of total serum Ig.
In body secretions like saliva, milk, tears,
bronchial, vaginal and prostatic secretions.
Prevents attachment of bacteria & viruses to
mucous membrane.
Mol. Weight is 160,000 Daltons.

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 IgD:
Its function has not yet been determined.
IgE:
Concentrates in sub mucosal tissues.
Responsible for immediate allergic or
anaphylactic reaction.

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 PRIMARY
IMMUNE RESPONSE
RESPONSE SECONDARY
PESPONSE

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PRIMARY RESPONSE
ANTIGEN INTRODUCED FOR THE
FIRST TIME TO AN ANIMAL OR
HUMAN
LATENT PERIOD OF 3 TO 10 DAYS
BEFORE ANTIBODIES APPEAR IN
THE BLOOD
Ig M APPEARS PRIMARILY(2 TO 3
DAYS) , IF ANTIGENIC STIMULUS IS MORE RAPID AND ABUNDANT.
STRONG ENOUGH THEN , Ig G(7 TO
10 DAYS) WILL ALSO APPEAR .
Ig M DELINES VERY RAPIDLY WHILE
Ig G DECLINES OVER A PERIOD OF
WEEKS OR MONTHS.
OUTCOME IS PRODUCTION OF
MEMORY CELLS.
SECONDARY RESPONSE
SEDONDARY/BOOSTER EXPOSURE
TO YHE SAME ANTIGEN
SHORTER LATENT PERIOD
PRODUCTION OF ANTIBODIES
ANTIBODY RESPONSE MAINTAINED
AT A HIGHER LEVEL FOR A MUCH
LONGER PERIOD OF TIME.
ACCELERATED RESPONSE IS
ATTRIBUTED TO IMMUNOLOGICAL
MEMORY. 20
 HUMORAL IMMUNITY
Comes from B cells(bone marrow derived
lymphocytes) which proliferate and
manufacture specific antibodies after antigen
presentation by macrophages.
The antibodies are specific.

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 CELL MEDIATED IMMUNITY
Comes from T cells(thymus derived
lymphocytes)
T cells initiate a chain of responses on
contact with antigen e.g.,activation of
macrophages,mononuclear inflammatory
reactions,release of cytotoxic factors etc.

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 A child born with a defect in humoral
antibody production may survive for 6 years
but the one with a severe defect in cell
mediated immunity may die within first 6
months of life.

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 When antibodies produced in one body
(human or animal) are transferred to another
to induce protection against disease , it is
known as passive immunity.
Acquired by administration of an antibody
containing preparation (immune globlin or
antiserum) OR by maternal antibodies OR by
transfer of lymphocytes(experimental)

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 It is the procedure of inducing artificial immunity
through introduction of antigens/ toxoids or
prepared antibodies.

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 ACTIVE PASSIVE
IMMUNIZATION IMMUNIZATION

Provided by
Provided by immunoglobulins
vaccines and antisera

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DURATION OF PROTECTION IS
LONG LASTING AND MORE
SEVERE REACTIONS ARE RARE
EFFECTIVE THAN PASSIVE
IMMUNIZATION

ACTIVE
IMMUNIZATION

LESS EXPENSIVE THAN PASSIVE

TAKES TIME TO DEVELOP
IMMUNIZATION

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 IMMUNITY IS
RAPIDLY
ESTABLISHED

PASSIVE
IMMUNIZATION
NO
IMMUNITY IS
EDUCATION
TEMPORARY
OF RES

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 VACCINATION
It is the process of inducing artificial immunity
through introduction of antigens / toxoids.
VACCINE
It is an immunological substance designed to
produce specific protection against a given
disease.

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 Vaccines are of 3 types:
Toxoids

Live attenuated vaccine

Killed / inactivated vaccine

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 LIVE ATTENUATED VACCINE:
They are prepared from live (generally attenuated)
organisms.these organisms are passed repeatedly
in the laboratory in tissue culture or chick embryos
and thus loose their capacity to induce full blown
disease but retain their immunogenecity.

Viral: measles, mumps, rubella, influenza, polio

(OPV), yellow fever.
Bacterial: B.C.G, typhoid, plague.

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 Advantages of live vaccines:
More potent than killed vaccines
Antigenic dose is larger than what is injected.
Live vaccines have all major & minor components.
Live vaccines engage certain tissues of body.

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 Disadvantages of live vaccines:
Cannot be administered to immuno-deficient or
immuno-suppressed persons.
Cannot be given to patients taking corticosteroids,
alkylating agents, antimetabolic agents or
radiations.
Pregnancy is another contraindication.
Cannot be given to persons with persistent of
latent virus.

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 KILLED/INACTIVATED VACCINE
Organisms killed by heat or chemicals , when
infected into the body stimulate active
immunity.
Viral: rabies, polio (IPV), influenza, hepatitis-B,
Japanese encephalitis.
Bacterial: TAB, Cholera, Pertussis, C.S. meningitis,
plague.

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 Advantages of killed vaccines:
Safe
Administered by S/C or I/M route.
Disadvantages:
Less efficacy than live vaccines.
Duration of immunity is less than live vaccines

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 TOXOIDS
Exotoxins produced by certain bacteria are
detoxicated and used in the preparation of
vaccines.
The antibodies thus produced react against the
toxic moiety rather than the organism
Highly efficacious and safe.
Examples are dt and tt.

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 Two types
NORMAL HUMAN Ig
An antibody rich fraction (cohn fraction II) ,
abtained from a pool of atleast 1000 donors.
WHO has laid down definite standards for its
preparation.
E.g. measles n hep A
Live vaccine not to be given for 12 weeks
after an injection of normal human Ig

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 SPECIFIC HUMAN Ig
They should contain atleast 5 times the
antibody potential of standard p[reparation
per unit volume.
Made from the plasma of recently recovered
patients or immunized individuals.

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This term is applied to materials prepared in
animals.
e.g. tetanus , diphtheria , botulism , gas
gangrene , snake bite

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 Reactions--- local and general
Hypersensitivity with antisera leading to
anaphylactic shock
Neurological involvement--- encephalitis &
encepahlopathy
Provocative reactions--- emergence of new
disease
Others e.g., fetal defect after rubella
vaccination

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 It is a system of storage and transport of
vaccine AT LOW TEMPERATURE from
manufacturer to actual vaccination site.

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Manufacture --- Airport --- Central vaccine

store --- Regional store --- District hospital

--- Health centre --- Dispensary --- Mother

& child

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 The Expanded Programme on Immunization (EPI)
is a disease prevention act against 9 target
diseases which cause millions of ailments,
disabilities & deaths each year.

Neonatal Tetanus
Measles
Diphtheria
Pertussis (Whooping Cough)
Hepatitis-B
Hib Pneumonia
Meningitis
Childhood Tuberculosis
Poliomyelitis

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 Historical Development

Pilot Project 1978

Integrated into regular Health Services
1983
Accelerated Health Programme (AHP) 1985
Addition of Vaccine for HepB 2002
Addition of Vaccine for Hib Meningitis &
Pneumonia 2008
Addition of Pneumococcal 2012

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 TT1 : at first contact or as early as possible
during pregnancy
TT2 : 4 weeks after TT1
TT3 : 6-12 months after TT2
TT4 : at least 1 year after TT3
TT5 : at least 1 year after TT4

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 It is the level of resistance of a community or
group of people to a particular disease.
It provides an immunological barrier to the
spread of the disease.
When a critical portion of a community is
immunized against a contagious disease, most
members of the community are protected against
that disease because there is little opportunity
for an outbreak. Even those who are not eligible
for certain vaccinessuch as infants, pregnant
women, or immunocompromised individuals
get some protection because the spread of
contagious disease is contained.

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ELEMENTS CONTRIBUTING TO HERD IMMUNITY

OCCURRENCE OF CLINICAL
AND SUBCLINICAL
INFECTION IN THE HERD

INNUNIZATION OF THE
HERD

HERD STRUCTURE

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 The vaccination of all susceptible individuals
in a prescribed area around an outbreak of an
infectious disease. Ring vaccination controls
an outbreak by vaccinating and monitoring a
ring of people around each infected
individual. The idea is to form a buffer of
immune individuals to prevent the spread of
the disease.
Small pox was eradicated by this technique

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