Immunity and its Types.pptx (Mumtaz Ali Khan

Immunity and its Types

1. Immunization Mumtaz Ali Khan Lecturer-MCN Matta Swat

2. Objectives Overview of expanded Expended programme for Immunization(EPI) in Pakistan. Review different types of immunity. Enlist vaccines preventable diseases. Explain the types of vaccines. Identify contraindications of vaccines. Tabulate vaccination schedule. Discuss the importance of cold chain cold chain. Discuss the responsibilities of a nurse to maintain cold chain.

3. Immunization Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.(WHO)

4. Expanded Programme on Immunization (EPI) Expanded program on immunization  is mainly designed for delivering vaccines to children all over the world to control potential health disorders. Established by world health organization in 1974. It is a disease prevention activity aiming at reducing illness, disability and mortality from childhood diseases preventable by immunization.

5. Immunity Immunity is the body's ability to fight off harmful microorganisms (Pathogens) that invade it. The immune system produces antibodies or cells that can deactivate pathogens. Fungi, protozoans, bacteria, and viruses are all potential pathogens.

6. Types of immunity

7. Types of immunity

8. Innate immunity It is inborn or natural immunity. One may inherit some form of immunity like resistance of skin to the invasion by bacteria, destruction of germs in the stomach by its acidic secretion & enzymes and phagocytosis of bacteria and other invaders by WBCs.

9. Active Immunity Active Immunity occurs when one makes his/her own antibodies. This type of immunity is long term. It has two subtypes Naturally-Acquired Active Immunity: If you get an infectious disease (like VARICELLA), often times, that stimulates the production of MEMORY cells which are then stored to prevent the infection in the future. Artificially-Acquired Active Immunity: Injecting or taking antigens by mouth. Takes time for T and B cells to be activated but gives long lasting immunity.

10. Passive Immunity Passive Immunity occurs when the antibodies come from some other source. This type of immunity is short term. It has further divided in to two types. Natural passive:  Mother to child through placenta or milk. Artificial passive:  Used during potentially fatal diseases. Provides an instant response but only temporary as antibodies are not the body's own so memory cells are not created. E.g. tetanus - injection of antitoxins given.

11. Vaccine P reventable D iseases Vaccine preventable diseases includes: Poliomyelitis Neonatal Tetanus Measles Diphtheria Pertussis (Whooping Cough) Hepatitis-B Childhood Tuberculosis These diseases are preventable and can be eradicated like Smallpox, as very safe & effective vaccines are available.

12. V accine A  vaccine  is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins.

13. Types of vaccines Live vaccines Inactivated (killed vaccines) Toxoids Cellular fraction Combinations

14. Types of vaccines Live attenuated vaccines are produced by modifying a disease-producing virus or bacteria in a laboratory. The resulting vaccine organism retains the ability to replicate (grow) and produce immunity, but usually does not cause illness. Live attenuated vaccines include BCG, Oral polio, Measles, Mumps and Rubella etc.

15. Types of vaccines Inactivated vaccines can be composed of either whole viruses or bacteria, or fractions of either: Fractional vaccines are either protein-based or polysaccharide-based. Protein-based vaccines include toxoids (inactivated bacterial toxin), and subunit or subvirion products. Most polysaccharide-based vaccines are composed of pure cell-wall polysaccharide from bacteria.

16. Types of vaccines Conjugate polysaccharide vaccines are those in which the polysaccharide is chemically linked to a protein. This linkage makes the polysaccharide a more potent vaccine. Inactivated vaccines includes pertussis, influenza, hepatitis B etc.

17. Types of vaccines Toxoids Certain organism produce exotoxins e.g. diphtheria and tetanus bacilli. The toxins produce in these organisms are detoxicated and used in the preparation of vaccines. The antibody produced neutralize the toxic moiety produced during infection rather then act upon the organism. These vaccine are safe and effective.

18. Types of vaccines Cellular Fraction Some vaccine are prepared from extracted cellular fraction, e.g. meningococcal, vaccine from the polysaccharide part of the cell wall, the pneumococcal vaccine from the polysaccharide contained in the capsule of the organism. These vaccine are safe and effective.

19. Age of vaccination Type of vaccination Dose Mode of administration At birth BCG 0.05 ml right deltoid; intradermal OPV0 2 drops Oral 6 weeks OPV-I Pneumococcal-I Rotavirus-I Pentavalent-I 0.5 ml Oral Front outer side of the thigh muscle (intramuscular) OPV1 2 drops Oral 10 weeks Pneumococcal-II Rotavirus-II Pentavalent-Il 0.5 ml Front outer side of the thigh muscle (intramuscular) OPV-II 2 drops Oral 14 weeks Pneumococcal-III IPV I Pentavalent-III 0.5 ml Front outer side of the thigh muscle (intramuscular) OPV-III 2 drops Oral 9 months MR-I Typhoid IPV – II 0.5 ml Upper right arm; subcutaneous 15 months MR-II 0.5ml Upper right arm; subcutaneous EPI Schedule

20. EPI Schedule At Birth Vaccine Disease Type of vaccine Dose Rout of administration BCG TB Live attenuated variant 0.01ml intradermal  OPV (0)  Polio   Live Attenuated   2drops   Oral

21. EPI Schedule 06- weeks vaccine Disease Type of Vaccine Dose Rout of vaccine OPV (1) polio Live attenuated 2 drops Oral HiB Hib disease Polysaccharide conjugate 0.5ml IM thigh HBV Hepatitis B Recombinant, yeast Derived HBs antigen 0.5ml IM thigh DPT Diphtheria Pertussis Tetanus   Toxoid Toxoid Killed Pertussis 0.5 IM thigh

22. EPI Schedule 10 weeks Vaccine Disease Type of vaccine Dose Rout of administration OPV(2) Polio Live attenuated 2 drops Oral HiB Hib disease Polysaccharide conjugate 0.5mal IM thigh DPT Diphtheria pertussis Tetanus Toxoid Toxoid Killed pertussis 0.5ml IM thigh

23. EPI SCHEDULE 14 weeks Vaccine Disease Type of vaccine Dose Rout of administration OPV (3) Polio Live attenuated 2 drops Oral HiB Hib disease Polysaccharide conjugate 0.5ml IM thigh HBV Hepatitis B Recombinant, yeast Derived HBs antigen 0.5ml IM thigh DPT Diphtheria pertussis Tetanus Toxoid Toxoid Killed pertussis 0.5ml IM thigh

24. 09 month Vaccine The Disease Type of the Vaccine Dose Mode of administration Measles   Measles   All Live attenuated 0.5ml Subcutaneous

25. 15 month Vaccine The Disease Type of the Vaccine Dose Mode of administration MMR Measles Mumps German Measles All Live attenuated 0.5ml Subcutaneous

26. Contraindications In very few conditions, vaccination is contraindicated All vaccines are contraindicated in those who have had: An anaphylactic reaction to a previous dose Inactivated or killed vaccines are contraindicated in people with known allergy to vaccines. Live vaccines are contraindicated in pregnancy and in those who are on systemic steroid therapy or immunosuppressed for any reason. Avoid during acute febrile illnesses.

27. Action for reactions after Immunization Explain to mother that the reaction after BCG vaccination should be small lump or papule which will appear in the third or fourth week, will form puss in sixth week this is normal.it should not be touch or scratched. Small scar will appear at the end of 10 t0 12 weeks. Explain some of the more common reactions such as fever, mild swelling and pain at the vaccination spot.

28. 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 of the vaccine to the client. The optimum temperature for refrigerated vaccines is between +2°C and +8°C. For frozen vaccines the optimum temperature is -15°C or lower.

29. Manufacturer Air port Central vaccine store Regional store District store Health Center Immunization staff The level of cold chain

30. The administrative levels of cold chain according to the duration of the storage and temperature required to keep the vaccine potent The administrative level Storage period temperature The vaccine Central and regional store Maximum three month -20 to 30 C OPV, Measles, MMR, BCG +2 to +8 C DPT, DT, TT, HB, HiB Districts stores and local immunization center Maximum three month 0 C to 8 C OPV, Measles, MMR, BCG +2 to + 8 C DPT, DT, TT, HB, HiB

31. 33 Components of the cold chai n The equipment and tool Procedure Staff

32. Equipment and tools Refrigerator Cold boxes Vaccine carriers Ice Packs Cards Register

33. Tools for monitoring the cold chain Cold chain monitor card Freeze watch indicator Cold chain refrigerator graph Vaccine vial monitors Shak test

34. Care of refrigerator Placed in the coolest place of the health centers away from sunlight Well ventilated and adequate air circulation around it Kept locked and open only when necessary Defrosted regularly Ice packs are kept in the freezer Record temperature two time daily Do not place food in the freezer The temperature chart should stuck on the door out side the refrigerator Diluent should be kept on the lowest shelf

35. Vaccine Vial Monitor

36. Nurses Role During Immunization An estimation of beneficiaries Identifying non participants and dropouts Meet with the community Identification of influence Identify communication site Schedule for immunization session Organize immunization session

37. References Basavanthappa , B. T. (2008). communnity health nursing (2nd ed.). india newdehli : jaypee brothers medical publisher (p) Ltd Cochi S, Bilous J, Cutts F. “ Vaccination Programs in Developing Countries.” Chapter 55 Communicable Diseases HEAT Module Centre for disease control and prevention (CDC). Immunization Against Infectious Disease - " The Green Book". Chapter 6 Contraindications and special considerations (January 2013) Introduction to Communicable Diseases (include epidemiology) Website: http://clinicalgroupbncm.blogspot.com/ Website ; http://www.cdc.gov/ophss/csels/dsepd/SS1978/Lesson1/Section10.html 41

38. Thank you