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1. immunity, immunizing agents and immunization Presented by Deepa Manandhar Lecturer Community Health Nursing

2. Immunity Ability of the body to recognize, destroy and eliminating antigenic materials foreign to its own. The term immunity refers to the body’s specific protective response to an invading foreign agent or organism.

3. Classification of immunity

4. natural/innate immunity Immunity with which an individual is born or is acquired during growth by virtue of its species, racial or individual pecularities . It is natural resistance to illness which is developed before the contact with an antigen. It is divided into: species, racial and individual pecularities .

5. Classification of natural/innate immunity

6. Classification of natural/innate immunity Species immunity: Resistance to pathogen, shown by all members of a particular species. EG: Birds are resistant to anthrax but Human are susceptible .

7. Classification of natural/innate immunity Racial immunity: Racial differences are known to be genetic in origin. For examples; certain African race are more resistant to malaria and yellow fever where are Asian or Americans are susceptible to same infection.

8. Classification of natural/innate immunity 3. Individual immunity: If one individual of certain race or cast is resistant while other individuals of same race or cast are susceptible to certain infection, then it is called as individual immunity

9. Classification of natural/innate immunity 3. Individual immunity: Individual immunity is determined by various factors such as health status, nutritional status, previous illness, personal hygiene, genetic differences etc. For example; although many people exposed to infection, but only some develop the disease during the epidemic

10. MCQ What type of immunity is transferred to the fetus from mother? Active natural Active artificial Passive natural Passive artificial ANS: c

11. Classification of acquired immunity

12. Classification of immunity Herd immunity (community immunity) a type of immunity that occurs when the vaccination of a portion of population (or herd) provides protection to unprotected individuals.

13. Herd immunity (community immunity)

14. Immunizing agents Preparations administered to produce immunity are called immunizing agents.

15. Immunizing agents Classified into three main groups Vaccine Immunoglobulin Anti sera

16. MCQ First vaccine to be developed was? Polio Small pox BCG MMR ANS: b

17. History of vaccination

18. vaccine

19. vaccine prepared from disease causing agent or its toxic product that stimulate for the production of specific antibody. Types Live attenuated vaccine Dead or killed vaccine (inactivated) Toxoids Combination

20. vaccine Live attenuated vaccine prepared from live organism and these organisms are allowed to weaken (attenuated). Attenuation: reduced pathogenicity/virulence; Maintained antigenicity/immunogenicity.

21. vaccine Live attenuated vaccine As a result, after its administration an individual will contract only a very mild illness . Antibodies develops which will protect against the severe form of disease in the future. Examples: BGC, measles, mumps, rubella, oral polio, rota virus, Japanese encephalitis, typhoid etc.

22. vaccine Live attenuated vaccine Contraindications Pregnancy Immune deficiency disease (Leukemia, AIDS) Corticosteroid therapy

23. vaccine Death or killed vaccine Organisms killed by heat or chemically when injected into the body stimulate active immunity. Usually required a primary series of 3-5 doses of vaccine to produce adequate antibody response and most cases booster injection are required.

24. vaccine Death or killed vaccine Contraindication The only absolute contraindication to their administration is a several low or general reaction to previous dose. polio ( salk type), hepatitis A, rabies, hepatitis B etc

25. vaccine Toxoid vaccine Certain organisms produce exotoxin eg , Diptheria and tetanus. The toxin produced by these organisms are detoxicated and used in the preparation of vaccine.

26. vaccine Toxoid vaccine Toxoids are highly effective and usually safe. Examples: Diptheria , Tetanus

27. vaccine Cellular fraction Some vaccines are prepared from extracted cellular fractions eg , Meningococcal vaccine from the polysaccharide part of cell wall and the pneumococcal vaccine from the polysaccharide contained in the capsule of the organism. These are safe and effective.

28. vaccine Combination If more than one kind of immunizing agent is included in the vaccine, it is called mixed or combined vaccine. The aim is to simplify administration, reduce costs and minimize the number of contacts with the health center. Examples: DPT (diphtheria, pertusis , tetanus) MMR (Measles, Mumps, Rubella)

29. vaccine Salk vaccine is a: Live attenuated vaccine Killed vaccine Toxoid Cellular fraction ANS: b

30. vaccine Which vaccine is contraindicated in pregnancy? Rubella Diphtheria Tetanus Hepatitis B ANS: a

31. Immunoglobulin

32. Immunoglobulin Only class of immunoglobins which can transport across the placenta is: IgG IgA IgM IgD ANS: a

33. Immunoglobulin The human immunoglobulin system is composed of five major classes these are IgG, IgM, IgA, IgD and IgE . IgG : major immunoglobulin of serum, comprise about 8o% of total serum immunoglobulin. only class of immunoglobins which can transport across the placenta. Main blood antibody of secondary responses, neutralizes toxins.

34. Immunoglobulin IgM : it accounts about 10% of normal serum immunoglobulin. It represents antibody that is promptly formed with the exposure to antigen. Its present may be indicative of recent infection. (Main antibody of primary response)

35. Immunoglobulin IgA : Accounts about 15% of normal serum immunoglobulin. It is found in body secretions Eg . Saliva, milk colostrums, small intestine and vaginal secretion etc. It provides defense mechanism at the mucus membranes against local infection.

36. Immunoglobulin IgD : Present in lymphocytes cell surface. Its main function has not yet been determined. IgE : it is concentrated on submucous tissue. It is the major antibody responsible for immediate allergic anaphylactic reaction. Important in protection against parasites.

37. Immunoglobulin Two types immunoglobulin preparations are available for passive immunization: 1. Normal human immunoglobulin 2. Specific (hyper immune) human immunoglobulin

38. normal human immunoglobulin This is prepared from the pooled plasma of at least 1000 donors. It consists of IgG. It produces instantaneous but temporary immunity. It is used to prevent measles in highly susceptible individuals

39. normal human immunoglobulin This should not be given simultaneously along with live vaccines because this IgG will interfere with the development of immunity. If this is given first, live vaccine should not be given for 12 weeks and if live vaccines is given first, this should not be given for 2 weeks.

40. Specific (hyper immune) human immunoglobulin This is prepared from the plasma of those persons, who have been recently immunised of recovered from the disease. This is highly safe, effective and costly. Passive immunity lasts longer than normal human immunoglobulins. e.g. human rabies immunoglobulin ( HRIg ), human tetanus immunoglobulins ( HTIg ), hepatitis B immunoglobulin ( HBIg )

41. MCQ Active and passive immunization is done simultaneously in all except: Hepatitis B Measles Rabies Tetanus ANS: b

42. anti sera These are the specific immunoglobulins prepared from the plasma of immunized animals, such as horses. Immunity lasts for about 2-3 weeks only.

43. anti sera e.g. anti-tetanus serum (ATS), anti-diphtheria serum (ADS), anti-snake venom.

44. MCQ   Which of the following immunoglobulins are secretory and present in the milk? IgG IgM IgA IgE ANS: c

45. MCQ   Name the class of immunoglobulin which takes part in hypersensitivity reaction? IgG IgM IgA IgE ANS: d

46. National Immunization Programme

47. National immunization programme National Immunization Program of Nepal (Expanded Program on Immunization) was started in 2034 BS and is a priority 1 program. achieved several milestones contributing to reduction in morbidity and mortality associated with vaccine preventable diseases.

48. National immunization programme Currently, the program provides vaccination against 13 vaccine preventable diseases. Immunization services are delivered through 16,500 service delivery points in health facilities (fixed sessions), outreach sessions, and mobile clinics.

49. National immunization programme NIP has a very good track record of meeting the target for control, elimination and eradication of vaccine preventable diseases. Small pox has now become history due to eradication in 2034 BS (1977 AD). Maternal and neonatal tetanus (MNT) was eliminated in 2005 and the elimination status has been sustained since then.

50. National immunization programme The last case of polio in Nepal was in 2010, and along with other countries of the South East Asia Region, Nepal was certified polio free in 2014. This status has been maintained since then.

51. Comprehensive Multi-year plan for immunization ( cMYPI ) The cMYPI 2017- 2021 provides a plan for five years to achieve immunization related goals of the country. Provide the framework required to meet the goal of reducing infant and child mortality and morbidity with vaccine-preventable diseases.

52. Comprehensive Multi-year plan for immunization ( cMYPI ) Vision: Nepal: a country free of vaccine-preventable diseases. Mission: To provide every child and mother high-quality, safe and affordable vaccines and immunization services from the National Immunization Program in an equitable manner.

53. Comprehensive Multi-year plan for immunization ( cMYPI ) Goal: Reduction of morbidity, mortality and disability associated with vaccine preventable diseases.

54. Cold chain The ‘cold chain’ is the system of transporting and storing vaccines at recommended temperature from the point of manufacture to the point of use. To prevent vaccine failure (sensitive to temperature). Potency of the vaccine decreases when exposed to inappropriate temperatures.

55. Cold chain Deep freezer: •Temperature b/w -15° to -25°C. •Used for storing OPV vaccine and for freezing ice packs Ice lined refrigerator: •Temperature b/w +2° to +8°C. DPT, TT, HepB , IPV & pentavalent vaccines, BCG, measles, JE

56. Cold chain

57. Cold chain Among all vaccine oral polio is the most heat sensitive. At the health centers, most vaccines except polio can be stored at 2-8 deg Celsius for 5 weeks.

58. Cold chain

59. MCQ Most heat sensitive vaccine is: BCG Polio Measles DPT ANS: b

60. MCQ Which type of vaccine is MMR: Live attenuated killed Toxoid Cellular fraction ANS: a

61. MCQ BCG is given: Intramuscular Subcutaneous Intradermal Intravenous ANS: c

62. MCQ Active and passive immunity should be given in all except: a. Hepatitis B b. Tetanus c. Rabies d. Measles ANS: d

63. MCQ Toxoid is prepared from: Endotoxin Exotoxin Both None ANS: b

64. references Park, K. (2019). Park`s Textbook of Preventive and Social Medicine. M/s Banarsidas Bhanot publishers. Gupta, MC, Mahajan, BK. (2013). Mahajan and Gupta Textbook of Preventive and Social Medicine. Brothers Medical Publishers (P) Ltd. Jain, B. (2016). Review of Preventive and Social Medicine. The Health Sciences Publisher. Ghimire, B. (2019). A Textbook of Social Medicine. Jaypee Community Health Nursing. Vidyarthi Pustak Bhandar .