Immunization

Plan of Presentation
Specific Defences
Immunizing agents
Adverse events following immunization
Immunization Programmes & Schedules
Cold Chain

1. Immunization Dr. Nidhi Fotedar Department of Community Medicine KIMS, Bangalore ‹#›

2. Plan of Presentation Specific Defences Immunizing agents Adverse events following immunization Immunization Programmes & Schedules Cold Chain ‹#›

3. Specific Defences A person is said to be immune when he possesses “ specific protective antibodies or cellular immunity as a result of previous infection or immunization, or is so conditioned by such previous experience as to respond adequately to prevent infection and/or clinical illness following exposure to a specific infectious agent” ‹#›

4. Specific Defences Active immunity Humoral immunity Cellular immunity Combination of the above Passive immunity Normal human Ig Specific human Ig Animal antitoxins or antisera ‹#›

5. Specific Defences Active immunity “ It is the immunity which an individual develops as a result of infection or by specific immunization and is usually associated with presence of antibodies or cells having a specific action on the microorganisms concerned with a particular infectious disease or on its to xin ” It may be acquired in 3 ways: Following clinical infections e.g chickenpox, rubella & Measles Following subclinical or inapparent infection e.g polio, diphtheria Following immunization with an antigen which may be killed vaccine, a live attenuated vaccine or toxoid. ‹#›

6. Specific Defences 2. Passive immunity: When antibodies produced in one body( human or animal) are transferred to another to induce protection against disease. 3. Herd immunity: type of immunity that occurs when the vaccination of a portion of population(or herd) provides protection to unprotected individuals. ‹#›

7. Immunizing Agents “ I mmunization is a procedure in which immunobiological substances are administered to strengthen the defense mechanism as to protect the individual against the disease” Immunizing agents are classified into three groups : Vaccines Immunoglobulins Antisera ‹#›

8. Immunizing Agents Vaccines: Antigenic substances, which when administered in an individual, stimulate the production of specific antibodies and protect the individual against that particular disease. Live vaccines, killed vaccines, toxoids, recombinant vaccines, combined vaccines, tissue culture vaccines, and related vaccines ‹#›

9. Immunizing Agents Live vaccines: Live vaccines are prepared from live or wild( generally attenuated) organisms; they are made to retain the antigenicity and to loose pathogenicity. E.g Bacillus calmette- Guerin( BCG), OPV, Measles vaccine Measles-mumps-rubella (MMR) ‹#›

10. Immunizing Agents Killed Vaccine; Inactivated or killed vaccines are produced by growing virus or bacteria in culture media and then inactivating them with heat and chemicals( usually formalin) Usually they are given in multiple doses in the primary course(2-3 doses), followed by booster dose subsequently) E.g Cholera vaccine, anti rabies vaccine, salk polio vaccine ‹#›

11. Immunizing Agents Toxoids: Toxins of the organisms are modified( detoxified) so as to maintain only antigenicity and not pathogenicity(toxicity) E.g Td Cellular fractions: These vaccines are prepared from the extract of the bacterial cell wall or capsule.They are also safe, effective and require booster doses E.g Meningococcal vaccine, pneumococcal vaccine ‹#›

12. Immunizing Agents Subunit vaccine: This is prepared from a component of the virus. E.g Influenza Vaccine Recombinant Vaccine: These are genetically engineered recombinant deoxyribonucleic acid (DNA) vaccines, i.e the subunit of the virus (antigen) is inserted into the genome of another a virulent virus and vaccine is prepared.E.g Hep B vaccine. ‹#›

13. Immunizing Agents Combined vaccines: Preparation contains more than one antigen. Therefore they are also called “mixed vaccines”. E.g Pentavalent-Diphtheria, pertussis, tetanus, hepatitis B and Hib. Merits: Individual is simultaneously protected against two to three diseases One antigen enhances the effect of other antigen Reduces number of visits to clinic ‹#›

14. Immunizing Agents Tissue culture vaccines: These are prepared by culturing the seed viruses in special cells, such as chick embryo cells, vero cells of kidneys of monkeys, human embryonic lung fibroblasts, etc. Highly safe, highly antigenic, highly effective, highly stable, highly protective and highly purified E.g purified chick embryo cell vaccine and purified vero cell rabies vaccine ‹#›

15. Immunizing Agents Immunoglobulins: These are readymade antibody preparations, obtained from the human beings and produce immunity instantaneously Two types: Human normal Immunoglobulins Human-specific Immunoglobulins ‹#›

16. Immunizing Agents Human normal immunoglobulins : This is prepared from the pooled plasma of multiple donors. It’s a general antibody preparation and consists of IgG. E.g against measles, it is given to susceptible contacts. Against viral hepatitis A, it is given to those who are travelling to endemic areas. This should not be given simultaneously along with live vaccines because IgG will interfere with the development of immunity ‹#›

17. Immunizing Agents Human-specific immunoglobulins: This is prepared from the plasma of those persons, who have been recently immunized or recovered from the disease. This is highly safe, effective, and costly Not only it is used for passive immunization i.e post exposure prophylaxis, but also it is used as a part of treatment to neutralize the circulating toxins in the patient E.g HRIG, HTIG,VZIG ‹#›

18. Immunizing Agents Antisera: These are the specific Igs prepared from the plasma of immunized animals, such as horses. Cheap and less effective;Immunity lasts for about 2-3 weeks only. Reactions are frequent because of animal protein, so test dose is a must E.g Equine rabies immunoglobulin, anti snake venom, anti tetanus serum, anti diphtheria serum and anti gas gangrene serum ‹#›

19. The Cold Chain The “ cold chain ” is a system of storage and transport of vaccines at low temperature from the manufacturer to the actual site of vaccination. Vaccines are sensitive biological products (sensitive to heat and light)i.e they lose their potency, when exposed to heat and light.All vaccines retain their potency at temperatures between +2℃ and +8℃ ‹#›

20. The Cold Chain ‹#›

21. The Cold Chain walk-in-freezer(WIF): prefabricated modular polyurethane foam insulated panel assembled cold room with two identical refrigeration units and a standby generator set to provide uninterrupted power supply Start as soon as power cuts off; maintains temperature between - 15℃ to -25℃ WIF are usually used for bulk storage of OPV vaccine and preparation of frozen ice packs for vaccine transportation ‹#›

22. The Cold Chain 2. walk-in-coolers(WIC): Air-conditioned cold rooms, maintaining the temperature between +2℃ and +8℃ . 3.Deep freezer(DF): An equipment which operates on a vapour compression system similar to any conventional type of refrigerator operating on 220 volts A.C. main supply. DF has top opening lid to prevent loss of cold air during door opening Cabinet temperature is maintained between - 15℃ to -25℃ It’s used for storing OPV vaccine for 3 months( district level and above only) ‹#›

23. The Cold Chain 4. Ice-lined refrigerator: ILRs are to maintain cabinet temperature between +2℃ to +8℃ and are used to store vaccines at district and sub-district level. It can keep vaccine safe with minimum 8 hours continuous electricity supply in a minimum 8 hours continuous electricity supply in a 24-hour period. Available in different sizes. Larger ILR is supplied to district headquarters and smaller ILR to PHC headquarters, based on the size and population. ‹#›

24. The Cold Chain ‹#›

25. The Cold Chain 5. Cold Box: Big, rectangular box(90 cms x 60 cms) made up of insulated material, lined with 24 ice packs, which act as buffer and maintain the cold life inside the box for about 5 days. Such boxes are used to collect, store, and transport large quantities of vaccines from one place to another place by refrigerator vans. ‹#›

26. Open Vial Policy 2015 ‹#›

27. Open Vial Policy 2015 A Vaccine vial monitors is a chemical indicator label attached to the vaccine container( vial, ampoule or dropper) by the vaccine manufacturer. ‹#›

28. Immunization Programme In May 1974, the WHO officially launched a global immunization programme, known as Expanded Programme on Immunization to protect all children of the world against six- vaccine- preventable diseases, namely- Diphtheria, whooping cough, tetanus, polio, tuberculosis and measles by year 2000. Beneficiaries were all expectant mothers and children upto the age of 16 years ‹#›

29. Immunization Programme Programme is now called Universal child Immunization-1990- that’s the name given to a declaration sponsored by UNICEF as part of the United nations’ 40th anniversary in october 1985. In 1995, Pulse polio Immunization Programme was launched as a strategy to eradicate poliomyelitis In 2005, immunization schedule was revised incorporating Hep B vaccine and 2 doses of measles vaccine and 2 doses of JE in endemic areas. ‹#›

30. National Immunization Schedule ‹#›

31. Immunization Programme Mission Indradhanush: MI is a health mission with positive initiative to intensify the existing UIP with the objective of accelerating the process of immunization and to fully immunize every child and to protect all the children against seven vaccine preventable disease- diphtheria, pertussis, tetanus, poliomyelitis, measles, Hep B and childhood tuberculosis, depicting 7 colours of rainbow. ‹#›

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