Immunization

Faiq Isho Gorial

Assistant professor in Rheumatology
Consultant rheumatologist
Objectives
To define immunization
To classify immunity and immunizing agents
To list: types of vaccines
To know the scheme of vaccination
To state period of maintained immunity, level of
effectiveness
To list complications of immunization
To state indications of active immunization
To describe immunization schedule in Iraq
 Immunization

• Is the process of making a person immune or resistant

to an infectious disease, typically by giving vaccine.
Immunity

Specific defenses
Immunity

Active immunity Passive immunity

Following clinical infection natural Transfer of maternal

Antibodies Through placenta

Following subclinical infection Transfer of maternal

Antibodies Through milk
acquired
Following vaccination Following administration of
Immunoglobulin or antiserum
Immunizing agents

Immunizing agents

Vaccines Immunoglobulins Antisera

Immunoglobulins

• Soluble proteins, consist of 2 chains

: heavy and two light chains
• There are 5 major classes: IgM, IgA, IgG, IgE, IgD.
• Two types of immunoglobulin preparations are
available for passive immunization:
• Normal human immunoglobulin: use of a mixture
of immunoglobulins to treat a number of health
conditions
• Specific (hyper-immune) human immunoglobulin:
plasma of donors with high titers of antibody against
a specific organism or antigen.
Antisera or antitoxins

• Are materials prepared in animals or non human

sources such as horses.
Immunoglobulin and antiserum

Human normal Human specific Non human ig

immunoglobulin immunoglobulin (antisera)
Hepatitis A Hepatitis B Diphtheria
Measles Varicella Tetanus
Rabies Diphtheria Gas gangrene
Tetanus Botulism
Mumps Rabies
 Vaccination

• Vaccination is a method of giving antigen to

stimulate the immune response through active
immunization.

• A vaccine is an immuno-biological substance

designed to produce specific protection against a
given disease.
• A vaccine is “antigenic” but not “pathogenic”.
Types of vaccines
1) Live vaccines
2) Attenuated live vaccines
3) killed vaccines (Inactivated)
4) Toxoids
5) Polysaccharide and polypeptide (cellular
fraction) vaccines
6) Recombinant vaccines(Surface antigen)
1) Live vaccines

• Vaccines made from live infectious agents

without any amendment.
2) Live attenuated (avirulent) vaccines

• Virulent pathogenic organisms are treated to

become attenuated and avirulent but antigenic.
• Contraindication:
• Leukemia and lymphoma
• Other malignancies
• Receiving corticosteroids and anti-metabolic
agents
• Radiation
• pregnancy
3) killed (Inactivated )vaccines

• Organisms are killed (or inactivated) by heat or

chemicals but remain antigenic.
• usually safe but less effective than live
attenuated vaccines.
• only absolute contraindication is a severe local
or general reaction to a previous dose.
 4)Toxoids

• A toxoid is a bacterial toxin (usually an exotoxin) whose

toxicity has been inactivated or suppressed either by
chemical (formalin) or heat treatment, while other
properties, typically immunogenicity, are maintained.
• Detoxifying exotoxins of some bacteria rendering
them antigenic but not pathogenic.
• Are highly effective and safe.
5) Polysaccharide and polypeptide
(cellular fraction) vaccines

• Prepared from extracted cellular fractions

• e.g. meningococcal vaccine, pneumococcal
vaccine, and hepatitis B polypeptide vaccine.

• Efficacy and safety: high.

 6) Recombinant vaccines(Surface
antigen)

• It is prepared by cloning HBsAg gene in yeast

cells where it is expressed. HBsAg produced is
then used for vaccine preparations.

• Efficacy and safety: high.

 Types of vaccines
Live Live Killed Toxoids Cellular Recombina
vaccines Attenuate Inactivated fraction nt vaccines
d vaccines vaccines
vaccines
•Small pox •BCG •Typhoid •Diphtheria •Meningococcal •Hepatitis B
variola •Typhoid •Cholera •Tetanus polysaccharide vaccine
vaccine oral •Pertussis vaccine
•Plague •Plague •Pneumococcal
•Oral polio polysaccharide
•Rabies vaccine
•Yellow •Salk polio
fever •Hepatitis B
•Intra- polypeptide
•Measles muscular vaccine
•Mumps influenza
•Rubella •Japanise
•Intranasal encephalitis
Influenza
•Typhus
Routes of administration

• Deep subcutaneous or intramuscular route

(most vaccines)
• Oral route (oral BCG vaccine)
• Intradermal route (BCG vaccine)
• Scarification (small pox vaccine)
• Intranasal route (live attenuated influenza
vaccine)
 Scheme of immunization

• Primary vaccination
• One dose vaccines (BCG, variola, measles,
mumps, rubella, yellow fever)
• Multiple dose vaccines (polio, DPT, hepatitis B)

• Booster vaccination
To maintain immunity level after it declines after
some time has elapsed (DT, MMR).
Periods of maintained immunity due to
vaccines

• Short period (months): cholera vaccine

• Two years: TAB vaccine
• Three to five years: DPT vaccine
• Five or more years: BCG vaccine
• Ten years: yellow fever vaccine
• Solid immunity: measles, mumps, and rubella
vaccines.
Levels of effectiveness

• Absolutely protective(100%): yellow fever

vaccine
• Almost absolutely protective (99%): Variola,
measles, mumps, rubella vaccines, and
diphtheria and tetanus toxoids.
• Highly protective (80-95%): polio, BCG,
Hepatitis B, and pertussis vaccines.
• Moderately protective (40-60%) TAB, cholera
vaccine, and influenza killed vaccine.
Complications of immunization
1.local .
2. systemic reaction .
3.skin reaction .
4. Renal complication .
5 . Neurological complication .
6.Paralytic complication .
7. encephalitic complication .
8. Joinit involvement .
9. Lymphadeno pathy .
10 . Teratogenic effect .
11. skeletal complication .
12. hematological complication
Indications of active immunization

1) Infants and children expanded immunization

program (schedule)
2) adult females
3) special occupations and life styles
4) special environmental situations
5) special health status persons
6) in travel
7) against bioterrorism
1) Compulsory vaccination for infants, and
booster vaccination for children (Expanded
immunization program)

• See local schedule of vaccination

• Note (children failing to complete childhood

vaccination schedule)
2) Active immunization for adult females
• MMR vaccine is given in adolescence before or
after marriage, but not during pregnancy and has
to be before 3 months of conception

• Tetanus toxoid in pregnancy to prevent tetanus

neonatorum in the newborn. In the first
pregnancy on the third month and after 1 month.
The third dose in the second pregnancy, and the
fourth on the third pregnancy with a maximum of
5 doses. If 10 years elapse, and then pregnancy
occurs, the doses are given from the start.
• Live attenuated vaccines should not be given
during pregnancy.
3)Vaccination for special occupations
• Health care workers: hepatitis B, influenza, MMR,
polio
• Public safety personnel (police, fire fighters) and staff
of institutions for the developmentally disabled:
hepatitis B, influenza
• Vets and animal handlers: rabies, plague and anthrax
• Sewage workers: DT, hepatitis A, polio, TAB
• Food handlers: TAB(typhoid, paratyphoid A, and
paratyphoid B. )
• Military troops and camp dwellers: pneumococcal,
meningococcal, influenza, BCG (for non reactors),
tetanus
4) Vaccination for special life styles and
special environmental situations

• Homosexually active males, Heterosexual with

promiscus sexual partner specially who has STDs,
and Injecting drug users
• Inmates of long term correctional institutes,
residents of institutions for the developmentally
disabled, and household contacts of HBV carriers
or patients
All should receive hepatitis B vaccine
5) Vaccinations for special health status
persons

• Immuno-compromised persons ( Leukemia,

lymphoma, HIV, malignancy…)
• Hemodialysis and transplantation
Should receive the following vaccines according to
their situation:
HBV, Influenza, Pneuomococcal vaccines
6) Vaccinations in travel

• Specific vaccine according to the country

traveled to:
• cholera, meningiococcal, pneuomococcal,
influenza, rabies, plague, Japanese
encephalitis.
• Haj for instance necessates meningococcal
vaccination from all over, and YF from
places like south Africa, and cholera from
places like India.
Vaccination schedule in Iraq
Acronyms
• BCG Bacillus Calmette-Guerin
• DPT Diphtheria, Tetanus, Pertussis
• HipB Haemophillus influenza type B
• HEXA HEXAVALENT Vaccine: (Diphtheria, Tetanus, Pertussis +Hepatitis
B + Haemophillus influenza type B) + injectable Polio Vaccine.
• MMR Measles, Mumps, Rubella
• OPV Oral Polio Vaccine
• Penta Diphtheria, Tetanus, Pertussis +Hepatitis B + Haemophillus
influenza type B DTP + IPV
• Tetra Tetravalent Vaccine: DPT (Diphtheria, Tetanus, and Pertussis) +
Haemophillus influenza type B
 Questions

• 1) What is your opinion on clinical immunology

lectures? And on the teacher?

• 2) How to improve it?

THANK YOU 33