Immunization

Workineh T.(MD)

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Objectives
 At the end of the lecture students should able to
 Define vaccine/immunization
 Define active /passive immunization
 Enumerate different vaccine type
 know the EPI schedules
 Catch up vaccination
 Know contraindications to vaccination
 Cold chain
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Outline
 Definitions(immunization ,vaccination )
 Type of immunization/vaccine
 Schedule of vaccine
 Special recommendation
 Precautions and contraindications
 Cold chain
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Introduction
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Immunization
 Immunization helps prevent diseases that can
cause illness, severe disability or even death.

 Forsome diseases, immunizing the whole

population can eradicate the disease completely
or make it very rare.
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Immunization
 Is the process of inducing immunity by active or
passive immunization.
 active immunization- administration of any
vaccine or toxoid for prevention of disease.
 passive immunization-administration of antibody
to individuals
 passive immunization can be natural or
artificial
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Immunization…
a. Passive immunization : providing temporary
protection through administration of
exogenously produced antibody or through
transplacental transmission of antibodies that
occurs naturally.

b. Active immunization : involves stimulating the

immune system to produce antibodies and
cellular immune response by introducing a
vaccine.
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Active Immunization
 Vaccines are defined as whole or parts of
microorganisms administered to prevent an
infectious disease.
 Vaccines can consist of
 whole inactivated microorganisms
 parts of the organism
 polysaccharide capsules
 toxoids
o Most immunizing agents contain;

- preservatives and stabilizers

- antibiotics
- adjutants and suspending fluid
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Active immunization…
 Vaccines can induce immunity by stimulating
antibody formation, cellular immunity, or both.

 Protection induced by most vaccines is thought to

be mediated primarily by B -lymphocytes, which
produce antibody.
 T lymphocyte–dependent vaccines
 induce good immune responses (eg. protein
moieties)
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T lymphocyte–independent vaccines
( eg. polysaccharide antigens)
 induce B-cell responses in the absence of T- cells
 associated with poor immune responses in <2 yr
 short-term immunity
 absence of an enhanced or booster response on
repeat exposure to the antigen.
o To overcome such problems ,polysaccharides have
been conjugated, or covalently linked, to protein
carriers, converting the vaccine to a T lymphocyte–
dependent vaccine
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 Serum antibodies may be detected as soon as 7-

10 days after injection of antigen.

 Early antibodies are usually of the IgM class that

tend to decline as IgG antibodies increase

 The IgG antibodies tend to peak approximately 1

mo after vaccination and with most vaccines
persist for some time after a primary vaccine
course.
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General considerations

 Immediate goal of immunization is to prevent

disease in individuals
 Ultimate goal is to eliminate/eradicate a
communicable diseases and Prevention of
crippling deformity (eg; Polio)
 Maternal antibodies transferred through the
placenta protect the infant up to 3-4months AND
if vaccine is given before 1month of age,
circulating antibodies may neutralize the antigens
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• No antibody interference with BCG

( protection of TB depends on cell-mediated
immunity )
 Antibodies against measles persist unto 9-12months
of age(can interfere with effectiveness )
 Premature babies are vaccinated like other babies
(response to antigens is dependent on postnatal
age)
 Minimum interval b/n multiple doses should be 4wks
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 All EPI antigens are safe & effective if administered

simultaneously(give at different sites on the same
day)
 If 2 live vaccines are not given on the same day in
different sites, there will be problem of interference
so that they should be spaced at least 4wks apart
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Diseases for which vaccination is routinely recommended

 Meningococcal disease
 Diphtheria
 Hib  Mumps
 Hepatitis A  Pertussis

 Hepatitis B  Pneumococcal disease

 Herpes zoster (shingles)  Polio

 HPV  Rotavirus

 Influenza  Rubella

 Measles  Tetanus
 Varicella (chickenpox)
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EPI
(Expanded programme on Immunization)
 World health organization initiated the EPI in
1974
 The EPI remains committed to its goal of universal
access to all relevant vaccines for all at risk.
 Six vaccine-preventable diseases were initially
included in the EPI (TB,poliomyelitis, diphtheria,
tetanus, pertussis and measles).
 Later hepB,Hib,PCV and rotavirus vaccines
added.
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EPI in Ethiopia covers

 BCG  Pertussis
 Diphtheria  Pneumococcal disease
 Hib  Polio
 Hepatitis B  Rotavirus
 Measles  Tetanus
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EPI in Eth.

Vaccine Schedule

BCG, Hep B birth dose, OPV-O At Birth

6 weeks
Pentavalent (DPT + Hep B + Hib),
OPV1,PCV1,rotavirus
Pentavalent2,OPV2,PCV2,rotaviru 10 weeks
s
Pentavalent3,OPV3,PCV3 14 weeks

Measles 9months
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Immunization schedule of Eth

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Catch up vaccines
 Ifa child comes unimmunized at completing
12 months of age, what vaccines would you
give?
Issues to be considered when 21
planning catch-up
vaccination

 Plan the catch-up on the basis of the available, and

preferably documented, evidence of previous
vaccination.
 Vaccine doses should not be administered at less
than the minimal intervals or less than the minimum
age
 Doses administered earlier than the minimum
interval or age should not be counted as valid doses
and should be repeated as age-appropriate using
the minimum interval
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Issues…..
 When commencing the recommended catch-up
vaccination schedule the interval between doses may
be reduced or extended and the numbers of doses
required may reduce with age. E.g. from 15ms of
age, only one dose of Hib vaccine is required.
 As a child gets older the recommended vaccines change or they

might need to be omitted from the schedule .

 If more than one vaccine is overdue, it will often be

appropriate to give all the vaccines at one visit
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BCG(Bacille Calmette Guerin)

 live-attenuated strain of [Link]
 Effective in decreasing the liklihood and severity of
TB
 Ideal age of vaccination is in the 1st wk of age but
can be given at older age if PPD is negative.
 Vaccine efficacy
 0-80% for pulmonary
 75-90% for severe TBC
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Complications of BCG vaccine

- deep abscess
- erythema nodosum
- lymphadenitis
- disseminated TB
. Contraindication- severe immunodeficiency
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Polio vaccine
 poliomyelitis causes paralysis
 Vaccination is the only effective method of
preventing poliomyelitis
 Two type of polio vaccine(OPV&IPV)
 Both vaccines induce production of antibodies
against the 3 strains of poliovirus
 Even if a child has paralysis due to polio, he/she
should be vaccinated to prevent other 2types of polio
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Polio …

 OPV-live attenuated vaccine but IPV-killed

inactivated vaccine
 Advantages of OPV over IPV
. Easy to administer
.superior antibody response
. Provides rapid immunity within 1wk
. Provides Herd Immunity
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Eradication of polio
 WHO used 4 basic strategies to eradicate polio(2000)
 routine immunization
 National Immunization Days (NIDs)
 acute flaccid paralysis surveillance and
 “mop-up” immunization -door-to-door immunizations
that are carried out in specific focal areas
 The OPV is the only vaccine recommended by the
WHO for eradication of the disease.
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Polio
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Pentavalent Vaccine
 The pentavalent vaccine protects against five
potential killers ( Diptheria, Tetanus, Pertusis, Hib, and Hepatitis B)

 Lyophilized Hib + DTP + Hepatitis B vaccine

comes in two separate vials:
 One vial contains liquid DTP + Hepatitis B vaccine (used as a

diluent)
 The second vial contains a lyophilized (freeze-dried) Hib vaccine
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Diphteria-pertussis-tetanus vaccines
 There are four combination vaccines used to
prevent diphtheria, tetanus and pertussis
 DTPa and DT- for children <7years
 Tdpa and Td- children older than7years and
adults
 DTaP is not licensed for anyone over the age of six
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DTaP
 The DTaP series consists of 5 doses.
 The first 3 doses according to EPI
 The 4th dose of DTaP may be administered as
early as 12 mo of age, provided 6 mo has elapsed
since the 3rd dose and the child is unlikely to
return at 15-18 mo of age.
 Fifth dose at 4-6 years
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Diphteria toxoid vaccine

 a modified bacterial toxin that induces protective
antitoxin antibodies of the IgG type.
 Toxin-producing C. diphtheriae is grown in liquid
media and the toxin converted to the inactive toxoid
by treatment with formalin.
 Almost always given with tetanus & pertussis as DPT
 Efficacy= 80-90%
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Diphteria
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Pertussis Vaccine
 DTaP is given to children younger than 7 years of
age
 whole cell vaccines prevent serious illness
 do not protect completely against infection
 efficacy & antibody levels wane with time
 Efficacy= 80%
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Tetanus toxoid
 Immunization against tetanus is recommended for all infants
6 weeks of age and older, all children, and all adults.
 Immunization against tetanus consists first of a series of at
least 3 injections .
 To be protected throughout life, an individual should receive
three doses of DTP in infancy, followed by a booster
containing TT – at school-entry age (4–7 years), in
adolescence (12–15 years), and in early adulthood.
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Tetanus
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Hepatitis B Vaccine
 Consists of purified inactive sub-unit of the virus
 HBV- 85% effective in perinatally acqired infection
- 80-95% effective in postnatally acquired
infection
 Routine vaccination is given to all infants &
children
 Given with immunoglobulin for infants of HBsAg-
positive mother within 12hrs of birth at separate
site
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Hib vaccine
o Hib mostly U5 children(4-18months)
o Hib causes meningitis,pneumonia,epiglottitis,sepsis,arthritis
 Universal immunization with Hib conjugate vaccine
is recommended for all infants
 Can be given combined with other vaccines(DPT)
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Hib…
 Hib vaccine can prevent over a third of
pneumonia cases and 90% of Hib meningitis
cases
 Generally, all children aged up to 1 year (after 6
weeks and less than 1 year) should receive Hib
vaccine as part of routine immunization
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Measles vaccine
 Live-attenuated

 Efficacy=85% for single dose

 Contraindication

.anaphylaxis
.immunodeficiency
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 Itis given at the age of completed 9 months

 Giving vaccine before 9 months may not be very
effective due to interference by the maternal
antibodies
 During epidemics of measles the vaccine can be
given as early as 6 months, but this should be
followed by one more measles vaccine at 9
months.
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measles
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Pneumoccocal vaccine
 Two types of pneumococcal vaccines are available:
 PPSV23
 PCVs
 PCV stimulates mucosal immunity, resulting in the
prevention of nasopharyngeal colonisation that
results in a reduction of pneumococcal disease in
the unvaccinated community( i.e. “herd effect”)
 PCV is given routinely to infants according to EPI.
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PCVs
 The WHO recommends 3 primary doses of PCVs
that is given from six weeks of age, with a
minimum interval of four weeks between doses
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PCVs
 PCVs provoke “protective” antibody responses in
90% of infants after 3 doses of 6,10 & 14 wks
 PCVs reduce nasopharyngeal carriage of vaccine
serotypes by up to 60-70%.
 In efficacy trials in the USA, infant immunization
with PCV7 decreased invasive infections from
PCVs serotypes by >93% and lobar pneumonias
by >73%.
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Vaccines in Special Circumstances

 Several vaccines are recommended for children
at increased risk for complications from vaccine-
preventable diseases or children who have an
increased risk for exposure to these diseases
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Special recommenation
 PCV13 is recommended for all children <5 yr of
age who have conditions that increase risk for
pneumococcal disease
 sickle cell disease (SCD)
 functionally or anatomically asplenic children
 children with HIV infection
 children with chronic disease:chronic cardiac &
pulmonary disease,DM or
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Precautions and Contraindications

 Observation of valid precautions & contraindications
is critical to ensure that vaccines are used in the safest
manner possible and to obtain optimal immunogenicity.
 When a child presents for immunization with a clinical
condition considered a precaution, the physician must
weigh benefits and risks to that individual child
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A general contraindication for all vaccines is

anaphylactic reaction to a prior dose.
 Anaphylactic hypersensitivity to vaccine
constituents is also a contraindication
 Vaccines usually should be deferred in children
with moderate to severe acute illnesses,
regardless of the presence of fever, until the child
recovers
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Cold chain
 “Cold Chain” refers to the process used to maintain
optimal conditions during the transport, storage, and
handling of vaccines starting at the manufacturer and
ending with the administration to the patient or client.
 As vaccines are sensitive, their potency and
effectiveness may be negatively impacted if they are
exposed to freezing temperatures, Heat or direct
sunlight
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 The optimum temperature for refrigerated vaccines

is between +2°C and +8°C.
 For frozen vaccines the optimum temperature is -
15°C or lower.
 In addition, protection from light is a necessary
condition for some vaccines.
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The Effective Cold Chain

 Three main elements combine to ensure proper

vaccine transport, storage, and handling
 Trained personnel
 Transport and storage equipment
 Efficient management procedures