The document discusses immunization principles including the classification of vaccines, general recommendations, adverse reactions, and principles of passive immunization. It provides comparisons of morbidity from vaccine-preventable diseases in the 20th century versus currently. It also describes various vaccine types, immunoglobulins including indications and administration, and how vaccines work to induce immunity.
The document discusses immunization principles including the classification of vaccines, general recommendations, adverse reactions, and principles of passive immunization. It provides comparisons of morbidity from vaccine-preventable diseases in the 20th century versus currently. It also describes various vaccine types, immunoglobulins including indications and administration, and how vaccines work to induce immunity.
The document discusses immunization principles including the classification of vaccines, general recommendations, adverse reactions, and principles of passive immunization. It provides comparisons of morbidity from vaccine-preventable diseases in the 20th century versus currently. It also describes various vaccine types, immunoglobulins including indications and administration, and how vaccines work to induce immunity.
The document discusses immunization principles including the classification of vaccines, general recommendations, adverse reactions, and principles of passive immunization. It provides comparisons of morbidity from vaccine-preventable diseases in the 20th century versus currently. It also describes various vaccine types, immunoglobulins including indications and administration, and how vaccines work to induce immunity.
based on immunologic and biochemical responses To classify the basic types of vaccines To discuss the general recommendations on immunization To describe adverse reactions of immunization To know and discuss the available vaccines To explain the principles of passive immunization The process of inducing immunity against a specific disease One of the most beneficial and cost- effective disease prevention measures available ---smallpox has been eradicated ---polio is close to worldwide eradication (but we recently had cases of polio here in the Philippines) ---measles and rubella no longer endemic in the US (but there had been recent outbreaks of measles, rubella and pertussis in the US and even here in the Philippines)
---incidence of most vaccine-preventable
diseases has remarkably decreased Comparison Of 20th Century Annual Morbidity And Current Morbidity For Vaccine-preventable Diseases Disease 20th century 2016 Percent annual reported decrease morbidity cases Smallpox 29,005 0 100%
Diphtheria 21,053 0 100%
Measles 530,217 122 >99%
Mumps 162,344 5,629 96%
Pertussis 200,752 15,808 92%
Polio (paralytic) 16,316 0 100%
Rubella 47,745 9 >99%
Congenital Rubella 152 2 99%
Tetanus 580 31 95%
Haemophilus 20,000 22 >99%
influenza Comparison Of Pre Vaccine Era Estimated Annual Morbidity With Current Estimate For Vaccine- Preventable Diseases Disease Pre-vaccine era 2016 % decrease annual estimate estimate
Hepatitis A 117,333 4,000 97%
Hepatitis B (acute) 66,232 20,900 68%
Pneumococcus –invasive All ages 63,067 30,400 52% <5yrs of age 16,069 1,700 89%
Passive – administration of antibody- containing preparations
Active – administration of a vaccine or
toxoid to stimulate the immune system to produce a prolonged humoral and/or cellular immune response Administration of preformed antibodies
Protection is immediate but transient (weeks
to months)
To induce transient protection against an
infectious agent Products used include—
- immunoglobulin (Ig) given intramuscularly
(IGIM), intravenously (IGIV), subcutaneously (IGSC) - specific or hyperimmune globulin – IM, IV - antibodies of animal origin - monoclonal antibodies Transplacental transfer of maternal antibodies (IgG) during pregnancy
Protection may last for 1 month and
longer during breastfeeding
Protection lasts for one year in some
diseases depending on the quantity of antibody transferred Major indications –
Immunodeficient children with B-lymphocyte
defects, can’t make their own antibodies
People exposed to infectious diseases
Imminent risk of exposure, not enough time
to develop an active immune response to a vaccine
Part of specific therapy of an infectious
disease Sterile antibody-containing solution, derived from human plasma Contains 15-18% proteins Predominantly IgG
Major indications: ◦ Replacement therapy for antibody deficiency disorders ◦ Measles prophylaxis ◦ Hepatitis A prophylaxis IM IMMUNOGLOBULIN
Replacement therapy –
◦ 100mg/kg or 0.66 ml/kg monthly
◦ Usual interval between doses is 2-4 weeks
◦ IVIG has replaced IM Ig for replacement therapy
IM IMMUNOGLOBULIN
Measles prophylaxis – 0.5 ml/kg, max 15 ml,
administered within 6 days of exposure
Recommended dose for IVIG is 400 ml/kg
Measles vaccine if given within 72 hrs of
exposure may provide protection
Measles vaccine and immunoglobulin should
not be administered at the same time IM IMMUNOGLOBULIN
Hepatitis A prophylaxis – post
exposure and people travelling to endemic areas
◦ 12 months to 40 years – hepatitis A vaccine
is preferred over immunoglobulin
◦ Less than 12 months and more than 40
years – 0.06 ml/kg Most common adverse reactions – ◦ Pain and discomfort at injection site ◦ Flushing, headache, chills, nausea
Serious adverse reactions - chest pain,
dyspnea, anaphylaxis, systemic collapse Hepatitis B immunoglobulin IM – post exposure prophylaxis, prevention of perinatal infection in infants born to hepatitis B surface antigen-positive mothers
Rabies immunoglobulin IM – post exposure
prophylaxis
Tetanus immunoglobulin IM – wound
prophylaxis, treatment of tetanus Varicella-zoster immunoglobulin IM or IVIG – postexposure prophylaxis of susceptible people at high risk for complications from varicella
Cytomegalovirus IVIG – prophylaxis of disease in
seronegative transplant recipients
Vaccinia immunoglobulin IV – prevent or modify
serious adverse events following smallpox vaccination caused by vaccinia replication Highly purified preparation of immunoglobulin antibodies
More than 95% IgG
Replacement therapy for primary immunodeficiency disorders
Kawasaki disease to prevent coronary
artery abnormalities and shorten clinical course
Replacement therapy for prevention of
serious bacterial infections in HIV Prevention of serious bacterial infections in hypogammaglobulinemia in chronic B lymphocyte leukemia
Immune-mediated thrombocytopenia to increase platelet count
Prophylaxis following bone marrow
transplantation Severe toxic shock syndrome
Guillian-Barre syndrome
Anemia due to parvovirus B19
Varicella post-exposure Up to 25%, may be related to the rate of infusion
dysfunction Safe and effective – in primary immune deficiency disorders Smaller doses administered weekly Less frequent systemic reactions than with IVIG Most common adverse effect – injection site reactions Derived from horses
Two equine antisera preparations:
◦ Diphtheria antitoxin – treatment of diphtheria, can be obtained from CDC ◦ Heptavalent (A-G) botulinum antitoxin – treatment of food & wound botulism, used for adults – CDC
* for infant botulism, IVIG (BabyBIG), a human-
derived antitoxin is available Potential for severe allergic reactions
Test for sensitivity before administration
Desensitization
Potential reactions – febrile events, serum
sickness, anaphylaxis Antibody preparations against a single antigen
Mass produced from a hybridoma –
created by fusing an antibody producing B lymphocyte with a fast-growing immortal cell Palivizumab – prevents severe disease from respiratory syncytial virus (RSV) among children 24 mos and younger with chronic lung disease
Prevent transplant rejection
Treatment of malignant and autoimmune
diseases and asthma 15 mg/kg IM once a month – RSV season
Infants born before 20 wks of gestation in the 1st
year of life
Infants born before 32 wks of gestation who
have chronic lung disease of prematurity in the 1st year of life
Infants younger than I yr of age with
hemodynamically significant congenital heart disease Immunocompromised children 24 months or younger
Infants in the 1st yr of life with congenital
abnormalities of the airway or neuromuscular disease
During the 2nd yr of life for children who
required 28 days or more of oxygen after birth Vaccines – whole or part of microorganisms administered to prevent an infectious disease
◦ Whole or inactivated – IPV, hepatitis A
◦ Parts of the organism – acellular pertussis,
HPV, hepatitis B
◦ Polysaccharide capsules – pneumococcal,
meningococcal polysaccharide vaccines ◦ Polysaccharide capsules conjugated to protein carriers – Hib, pneumococcal, meningococcal
◦ Live attenuated – measles, MMR, varicella,
rotavirus, influenza
◦ Toxoids –bacterial toxin rendered
nontoxic but can induce an immune response- tetanus, diphtheria Suspending fluids – sterile water or saline, or complex fluid which may contain proteins
Preservatives, stabilizers & antimicrobials –
inhibit bacterial growth & prevent degradation of the antigen (gelatin, 2- phenoxyethanol, antimicrobial agents) - usually added to multidose vials - thimerosal, contain ethyl mercury Adjuvants- enhance the immune response, aluminum salts and arsenate licensed by FDA - should be injected deep IM to avoid local irritation, granuloma formation and necrosis
*immunizing antigen Induce immunity by stimulating antibody formation, cellular immunity or both
Mediated primarily by B lymphocytes, which
produce antibodies- inactivate toxins, neutralize viruses and prevent their attachment, facilitate phagocytosis and killing the bacteria Most B lymphocyte responses require the assistance of CD4 helper T lymphocytes
T lymphocyte-dependent responses tend to
induce high levels of functional antibodies, good response even in infants
T lymphocyte-independent vaccines – poor
immune response in children <2yrs, short term immunity, no enhanced or booster response to repeat exposure to antigen -polysaccharide vaccines Polysaccharides have been conjugated to protein carriers – converting the vaccine to a T-lymphocyte dependent vaccine
◦ Higher-avidity antibody ◦ Immunologic memory leading to booster response to repeated exposure ◦ Long-term immunity ◦ Herd protection by decreasing carriage of the organism ◦ E.g. Hib, pneumococcal, meningococcal Serum antibodies can be detected 7-10days after injection
Early antibodies – IgM class
IgM antibodies tend to decrease as IgG
antibodies increase
IgG tend to peak 1 month after injection
Serum antibodies can be measured to assess
immune response Measles, mumps, rubella – MMR
MMR and varicella – MMRV
Rotavirus
Varicella
Live attenuated influenza vaccine (LAIV)
Yellow fever -induce long-term immune response
-administered in 1 or 2 dose schedules
-2nd dose of MMR- to induce a primary
immune response in those who failed to respond to the 1st dose Require multiple doses Need booster doses to maintain the immunity
Hepatitis A – whole virus
Japanese encephalitis – whole virus that is purified Poliomyelitis (enhanced potency, IPV) – whole virus Rabies vaccine (human diploid and purified chick embryo cell) – whole virus Diphtheria and tetanus toxoid and acellular pertussis (DTaP) DTaP-Inactivated polio vaccine - tetravalent DTaP–Inactivated polio vaccine-H. influenza type B - pentavalent DTaP-Inactivated polio vaccine-H. influenza type B-Hepatitis B –hexavalent Tetanus and diphtheria toxoids adsorbed plus acellular pertussis (Tdap) Bacille Calmette-Guerin (BCG) – Live- attenuated mycobacterial strain, to prevent tuberculosis in very limited circumstances
Human papilloma virus vaccine HPV –
◦ Bivalent – L1 capsid proteins of HPV types 16 & 18 ◦ Quadrivalent – HPV types 6, 11 (warts) 16 & 18 for cervical cancer ◦ 9valent– HPV types 6, 11, 16, 18, 31, 33,45, 52, 58 Pneumococcal – 23valent (PPSV23) – 23 serotypes for 85-90% of bacteremic diseases in the US
Meningococcal – serogroups A, C, W135, Y
Pneumococcal conjugated to a nontoxic form of diphtheria toxin CRM 197 – 13 valent PCV13, contain 13 serotypes that accounted for more than 80% of invasive disease in young children
Meningococcal conjugate vaccine
Characteristic Conjugate Polysaccharide T-lymphocyte dependent immune Yes No response
Immune memory Yes No
Persistence of protection Yes No Booster effect Yes No Reduction of carriage Yes No Herd protection Yes No
Lack of hyporesponsiveness Yes No
Intradermal Given at birth or within first 2 months PPD prior to BCG is recommended in – ◦ Suspected congenital TB ◦ History of close contact to known or suspected infectious cases of TB ◦ Clinical findings suggestive of TB and/or chest x- ray suggestive of TB Affords approximately 80% protection against TB meningitis and miliary TB in infancy and young children
Possible reactions – ◦ Keloid scar formation ◦ Suppurative regional adenitis ◦ Disseminated BCG infection ◦ Osteomyelitis Intramuscular First dose given within 24 hrs of life Birth dose may be used as 1st dose in a 3- dose primary series Doses are given at least 4 weeks apart Fourth dose needed – ◦ If 3rd dose is given <24weeks of age ◦ Preterms <2kg
Possible reactions – soreness, erythema, swelling
Close to 100% efficacy Intramuscular
Starting 6 weeks of age, may be given as
early as 4 weeks in outbreaks/epidemics
Primary series – 3doses given at 6, 10, 14
weeks or 2, 4, 6 months
Booster doses given 1 yr after the last dose of
primary series and between 4-6 yrs of age Endotoxin component of the whole cell pertussis vaccine causes neuroparalytic reactions
Other reactions – fever, restlessness,
irritability, local signs of inflammation
Almost 100% efficacy
Confers 10 yrs immunity
2 forms available – ◦ Live attentuated trivalent oral polio (OPV or Sabin) ◦ Inactivated polio (IPV or Salk)
Indications for IPV:
◦ immunocompromised persons who are unimmunized or partially immunized ◦ Household contacts of immunodeficient individual ◦ Unimmunized adults at future risk of exposure to poliomeylitis
More than 95% efficacy
Lifelong immunity Subcutaneous Given at 9 months, or as early as 6 months during outbreaks Booster doses at 12 months and 4-6 yrs old as MMR Possible reactions: fever, rash 5-10 days after 95% efficacy Intramuscular Starting 6 weeks of age, may be given together with DPT Primary series – 3doses given at 6, 10, 14 weeks or 2, 4, 6 months Booster dose given 1 yr after the last dose Given to children up to 5 yrs Given to children older than 5 yrs who have ◦ Sickle cell disease ◦ Leukemia ◦ HIV infection ◦ Hodgkin’s disease ◦ Post-splenectomy
Possible reactions – pain, redness, swelling, fever,
irritability
90-100% effective Subcutaneous 1 year of age Repeat dose at 4-6yrs old but may be given earlier More than 95% efficacy Long lasting immunity, probably lifetime Possible reactions Due to measles component – fever, rash 5-10 days after dose Due to mumps component – febrile seizures, nerve deafness, encephalitis, rash, pruritus Due to rubella component – arthralgia, lympadenopathy, mild rash 2-4 weeks after dose Oral Monovalent human rotavirus (RV1) – 2doses Pentavalent human bovine rotavirus vaccine (RV5) – 3 doses First dose of RV1 must be given 6-20 wks of age First dose of RV5 must be given 6 wks - 14wks and 6days Last dose should be given not later than 32 wks 85-95% efficacy Intramuscular PCV – 6 weeks minimum age – 3 doses+1 PPV – 2 years, revaccination after the 1st dose ◦ Chronic heart, lung and kidney disease ◦ Chronic renal failure ◦ CSF leak ◦ Cochlear implant ◦ Sickle cell disease and other hemoglobinopathies ◦ Anatomic or functional asplenia ◦ HIV & congenital immunodeficiency ◦ Immunosuppression ◦ Solid organ transplant 10valent – serotypes 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F 13valent – serotypes 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F, 3, 6A, 19A
Primary series – 3 doses at 4-8weeks interval,
plus a booster dose at 6 months after the 3rd dose Intramuscular Primary vaccination – 3 doses, minimum age 9 yrs Subcutaneous Minimum age of 9 months, booster dose after 12-24 months 18 yrs or older – 1 dose Subcutaneous First dose at 12-15 months Second dose at 4-6 years or at an earlier age provided the interval between the 2 doses is at least 3 months For 13 yrs and older – 2 doses at least 4 wks apart Possible reactions – fever, maculopapular eruptions in 3% Close to 100% efficacy Intramuscular First dose given at 12 months 2nd dose given 6 months after the 1st dose 99% effective Intramuscular 7-18 years of age who are not fully immunized with DPT should be given a single dose Td booster given every 10 years Almost 100% efficacy 10 years immunity Intramuscular (quadrivalent) IM/SC (trivalent) 6-35 months – 0.25 ml 36 months to adults – 0.5 ml High risk conditions: ◦ Chronic cardiovascular disease ◦ Chronic metabolic and renal disorders ◦ Chronic lung disease – asthma ◦ Hemoglobinopathies ◦ Long term aspirin therapy Children 6 months to 8 years receiving influenza vaccine for the first time should receive 2 doses of the vaccine given at least 4 weeks apart initially then one dose yearly Children 6-18 years – annual dose Children who received only 1 dose of influenza vaccine in the first year of life should receive 2 doses the following year 90% efficacy 1 year immunity Thank you
