ALBERTO I GABRIEL, MD, DTM&H, MPA,

DPBMM, FPSMID, FPSVI, FPAMS, CFA

Department of Medicine-College of Medicine
Pamantasan Ng Lungsod Ng Maynila
 GENERAL PRINCIPLES OF VACCINATION

DEFINITIONS:
VACCINATION - denotes the administration of the
vaccines or toxoid

IMMUNIZATION - descibe the process of inducing or

providing immunity by any means, whether active or passive

ACTIVE IMMUNIZATION - refers to induction of the

immune defenses by the administration of antigens in
appropriate forms

PASSIVE IMMUNIZATION - the provision of

temporary protection by the administration of exogenously
produced immune substances
 GENERAL PRINCIPLES OF VACCINATION

Active Immunization comes in two forms:

1) the use of live, generally attenuated infectious agents
2) the use of inactivated agents of their products obtained by
genetic recombination

Passive Immunization comes in three types:

1) standard human immune globulin for general use (gammaglobulin)
2) special serum immune globulins with a known content of
antibody for specific agents (HBV or Varicella Zoster Imune Globulin)
3) animal sera and antitoxins
 ROUTINE ADULT IMMUNIZATION FOR FILIPINOS
VACCINE NAME INDIVIDUALS SCHEDULES CONTRAINDICATION

Tetanus-diptheria Recommended for 3 DOSES

0, 1, 6-12 Mos
Severe allergic reaction
PREGNANT WOMAN to vaccine component
Toxoid HEALTH CARE WORKERS BOOSTER EVERY 19 YRS

Hepatitis B Recommended for IMMIGRANT, HEMODIALYSIS,

HOMOSEXUALS, IV DRUG USER, HOUSEHOLD
3 DOSES
O, 1, 6 MONTHS
Severe allergic reaction

Inactivated Vaccine CONTACT, RECIPIENT OF BLOOD PRODUCT, 4 DOSES

HEALTHCARE WORKER 0, 1, 2, 12 MONTHS
BOOSTER IS NOT ROUTINELY
RECOMENDED

Varicella Recommended for <13 years – 1 dose Severe allergic rxn

Persons> 13 yrs of age without history of >13 years – 2 dose Pregnancy
Live attenuated Vaccine varicella, HEALTH CARE WORKERS, TEACHERS 0, 1 month Immunosuppression
OF YOUNG CHILDREN, NON-PREGNANT WOMEN, Recently received blood
INTERNATIONAL TRAVELLER, MILITARY products, Untreated active
TB, Severe Acute Illness

MMR Recommended for all adults particularly 2 doses Severe allergic reaction
All susceptible adoslescent s and adults 0, 1 month Severe Acute Illness
Live attenuated vaccine Non-pregnant women of child-bearing age Pregnancy, Received BT
Immunosuppression
Thrombocytopenia/ITP

Pneumococcal Vaccine Persons >60 yrs of age Single dose SAME AS ABOVE
Inactivated vaccine <60 yrs of age with Chronic Illness ( Cardio
Pulmo, Diabetes, Alcoholism, Cirrhosis ) Revaccination may be
Immunocompromised Conditions given after 5 years

Influenza Vaccine Persons at increased risk for complication: Given once a year Serious allergic reaction
- Pesons >50 yrs of age preferably from Severe acute illness
Inactivated vaccine February to June
- Chronic illness ( Cardio-pulmo, Diabetes, Guillain-Barre
Chronic Metabolic, Renal Dysfunction, Syndrome
- Immunosuppressed Patients
- Healthcare Workers
 ADDITIONAL VACCINES FOR HCW
VACCINE NAME INDIVIDUALS SCHEDULES CONTRAINDICATIO
and
PRECAUTION

TYPHOID ORAL – for Mod & Seevere Acute

A) Oral enteric coated cap
live attenuated Ty21a
1.
B) IM VI Capsular
2.
Polysaccharide Ty2 3.
Primary & booster Illness
1 cap on Day 0, 2, Vomiting or diarrhes
FOOD HANDLERS 4, before meals After alcohol intake
MICROBIOLOGY LAB TECHNICIANS Antibiotic intake
PERSONS WITH CONTACT WITH TYPHOID IM – for primary Immunocompromisd
CARRIERS OR PATIENTS & booster 0.5 ml
IM on deltoid
BOOSTER – every
2-3 years

RABIES HCW THAT TREAT DOGBITE VICTIMS POST-EXPOSURE Intake of

PVRV – Purified Verocell
Rabies Vaccine
PCECV – Purified Chick
Embryo Cell Vaccine
RABIES RESEARCH DIAGNOSTIC LAB WORKERS For IM Schedule Corticosteroids,
VETERINARY & VET STUDENTS D0, 3, 7, 14, 28 AntiMalarials, Anti
FIELD WORKERS AND DOG HANDLERS PRE-EXPOSURE Cancer Drugs
D0, 7, 21
For ID Schedule
D0, 3, 7, 28
 GENERAL PRINCIPLES OF VACCINATION

A. IMMUNITY
Ability of the body to tolerate the presence of material
indigenous to the body (self) and to eliminate foreign
material (non-self). This ability provides protection from
infectious diseases. Usually indicated by the presence of
antibody. Very specific to a single antigen.

ANTIGEN - a live or inactivated substance (e.g. protein, poly-

saccharide) capable of producing an immune response

ANTIBODY – protein molecules (immunoglobulins) produced by B

lymphocytes to help eliminate an antigen
 TWO BASIC MECHANISMS FOR
ACQUIRING IMMUNITY

1. Active Immunity
a) Protection produced by the person’s own immune system
b) usually permanent also produced by vaccination

2. Passive Immunity
a) Protection transferred from another person or animal as
antibody
b) transplacental most important source in infancy
c) usually temporary
 GENERAL PRINCIPLES OF VACCINATION

 CLASSIFICATION OF VACCINES
1. Live attenuated vaccines
 attenuated (weakened) form of the “wild” virus or bacteria
 Must replicate to be effective
 Immune response similar to natural infection
 Usually effective with one dose
 Severe reactions possible
 Interference from circulating antibody
 unstable

VIRUSES: MMR, Varicella, Polio, Yellow fever, Influenza nasal spray

BACTERIA: BCG, Oral Typhoid
 GENERAL PRINCIPLES OF VACCINATION

1. Inactivated Vaccines
 cannot replicate because not live

 minimal interference from circulating antibody

 generally NOT as effective as live vaccines

 generally requires 3-5 doses

 immune response mostly humoral

 antibody titer falls over time

VIRUSES: Influenza, Poliomyelitis, Rabies, Hepatitis A

BACTERIA: Pertussis, Typhoid, Cholera

THE IMMUNE RESPONSE
Primary Response
 detection of humoral and cell-mediated immunity
 measurable circulating antibodies appears beyond 7-10 days
 early appearance of IgM exhibit low affinity for the antigen
 late appearance of IgG shows high affinity for the antigen
 some would not response due to lack of histocompatibility
complex determinants

Secondary Response
 heightened humoral or cell-mediated responses by second
exposure to the same antigen
 responses usually with 4-5days with increased titers IgG
 GENERAL PRINCIPLES OF VACCINATION

C. Timing and spacing of vaccines

1. Interval between receipt of antibody containing blood products
and measles vaccine
• inactivated antigens are NOT substantially affected by circulating
antibody, so that they can be administered before, after, or at the
same time as the antibody.
• All live vaccines must replicate in order to cause an immune
response, so that antibody against live injected vaccine antigen may
interfere with replication.
• If the live vaccine is given first, it is necessary to wait for AT
LEAST 2 WEEKS before giving the antibody.
• If the interval between the vaccine and antibody is less than 2
weeks, the recipient should be tested for immunity or the vaccine
dose should be repeated.
• There is NO contraindication to the simultaneous administration
of any vaccines EXCEPT for cholera and yellow fever.
• Individual vaccines should NOT be mixed in the same syringe
unless they are licensed for mixing by the FDA
 GENERAL PRINCIPLES OF VACCINATION
ANTIBODY AND LIVE VACCINES
PRODUCT GIVEN FIRST ACTION
VACCINE Wait 2 weeks before giving
the antibody
ANTIBODY (blood/blood Wait >3 months before
products, immune globulin) giving the vaccine

2. Spacing of vaccine combinations not given simultaneously

COMBINATION MINIMUM INTERVAL

Two live vaccines 4 weeks

injected
All other vaccines None
 GENERAL PRINCIPLES OF VACCINATION

1. Spacing of live vaccines not given simultaneously

• If two live parenteral vaccine are given < 28 days apart, the
vaccine given second should be repeated.
• Exception is yellow fever vaccine given < 28 days after
measles vaccine

6. Interval between doses of the same vaccine

• Increasing the interval between doses of a multi-dose vaccine
does NOT diminish the effectiveness of the vaccine.
• Decreasing the interval between doses of the multi-dose
vaccine may interfere with antibody response and protection
 GENERAL PRINCIPLES OF VACCINATION

5. Minimum Intervals and Ages

Vaccine doses should NOT be given at intervals less than the
minimum intervals or earlier than the minimum age.

6. Extended Intervals
It is NOT necessary to restart the series of any vaccine due to
extended intervals between doses

• Number of Doses
• Live attenuated vaccines generally produce lasting
immunity with a single dose.
• Inactivated vaccines require multiple doses and may
require periodic boosting to maintain immunity.
 GENERAL PRINCIPLES OF VACCINATION

D. ADVERSE REACTIONS
LOCAL
• pain, swelling, redness at the site of injection
• common with inactivated vaccines
• usually mild and self-limited

SYSTEMIC
• fever, malaise, headache
• non-specific
• may be unrelated to vaccine

ALLERGIC
• due to vaccine or vaccine component
• rare
• risk minimized by screening
 GENERAL PRINCIPLES OF VACCINATION

E. CONTRAINDICATIONS & PRECAUTIONS

CONTRAINDICATION - is a condition in a recipient which
greatly increases the chance of a serious adverse reaction
EXAMPLE: Administering FLU VACCINE to a person with a true
anaphylactic allergy to egg could cause serious illness or death
in the recipient.

PRECAUTION - is a condition in a recipient which may

increase the chance or severity of an adverse event, or
may compromise the ability of the vaccine to produce
immunity
EXAMPLE: Administering MEASLES VACCINE to a person with passive
immunity to measles from a blood transfusion
 GENERAL PRINCIPLES OF VACCINATION

PERMANENT CONTRAINIDICATION TO VACCINATION

• severe allergy to a prior dose of vaccine or to a vaccine component
• encephalopathy following pertussis vaccine

CONDITION LIVE INACTIVATED

Allergy to vaccine component C C
Encephalopathy C
Pregnancy C V
Immunosuppression C V
Severe Illness P P
Recent blood product P V

C – contraindication P – precaution V – vaccinate if indicated

 GENERAL PRINCIPLES OF VACCINATION

IMMUNOSUPPRESSION
• Live vaccine can be given after chemotherapy has been discontinued
for at least 3 months
• Persons receiving large doses of corticosteroids should NOT receive
live vaccines e.g. ( >20 mg of prednisone per day or >2 mg/kg)
• NOT contraindicated with steroids given via aerosols, topical,
alternate day, short causes

RECENT BLOOD PRODUCTS

• Varicella and MMR vaccines should be given 14 days prior to the
blood product, or delayed until the antibody has degraded
• If MMR is given sooner than the minimum interval (3-7 months
depending blood products) the recipient should be tested for
immunity or the dose repeated after the appropriate interval
 GENERAL PRINCIPLES OF VACCINATION

F. INVALID CONTRAINDICATIONS TO VACCINATION

 mild illness – low grade fever, URTI, Otitis media
 disease exposure or convalescence
 antibiotic therapy
 pregnancy in the household
 breastfeeding
 allergies to products in the vaccine
 premature birth
 family history unrelated to immunosuppression
 need for TB skin testing
 need for multiple vaccines
 mild diarrhea
 GENERAL PRINCIPLES OF VACCINATION

SCREENING FOR CONTRAINDICATIONS AND

PRECAUTIONS TO VACCINATION

SCREENING QUESTIONS:
 Allergies to food or medications? If yes, when?
 How are you today?
 Any problem after the last shot?
 Any problem with your body resistance?
 Any blood products ( fresh whole blood, platelet concentrate )
received in the last year?
 Are you pregnant or trying to be pregnant?