ASPEK IMUNOLOGI IMUNISASI

Dr. Julius Roma, Sp.A BIKA FK UNHAS

IMUNISASI Salah satu cara yang terbaik, termurah,praktis untuk mencegah penyakit IMUNISASI IMUNITAS IMUN :

Sakit ringan biaya <<< Tidak sakit

HUMORAL
IMUNITAS (IMUNISASI) SELULER

B
AKTIF PASIF

ALAMIAH
BUATAN BUATAN

KONGENITAL

VAKSINASI

TUJUAN IMUNISASI (VAKSINASI) :

1. 2. 3. 4.

Menurunkan angka kesakitan Menurunkan angka kematian Menurunkan angka kecacatan (sequele) Eradikasi suatu penyakit tertentu : Cacar (variola) Polio PIN ?

ANTIGEN

IMUNITAS :

KUMAN HIDUP YG DILEMAHKAN KUMAN MATI

PRODUK KUMAN TOKSOID

PARTIKEL (Bagian) KUMAN / KONYUGASI

PATOGENESISNYA (-)
IMUNOGENITASNYA (+)

THE MAIN ANTIGENIC PREPARATIONS

Type of antigen natural Vaccine examples Vaccinia (for smallfox) vole bacillus (for TB; historical) *Polio (Sabin; oral polio vaccine) *measles, *mumps, * rubella yellow fever 17D varicella-zoster (human herpes virus 3) *BCG (for TB) *polio (Salk), rabies, influenza, hepatitis A, typhus *pertussis, typhoid, cholera, plague pneumococcus Meningococcus Haemophilus influenzae *hepatitis B *tetanus, *diphtheria *hepatitis B (yeast-derived) experimental

Living organisms attenuated

Intact but non- living organisms subcellular fragments toxoids

viruses bacteria Capsular polysaccharides Surface antigen

Recombinant DNA-based Anti-idiotype

Gene cloned and expressed Genes expressed in vectors Naked DNA

experimental experimental

* Standard in most countries

LIVE ATTENUATED VACCINES

Disease Polio Measles Mumps Rubella Yellow fever Varicella-zoster Hepatitis A Remarks types 2,3 may revert; also killed vaccine 80% effective now given to both sexes stable since 1937 mainly in leukemia also killed vaccine stable since 1924; also some protection against leprosy

viruses

bacteria

tuberculosis

TOXIN-BASED VACCINES
ORGANISM Clostridium tetani Corynebacterium diphtheriae Vibrio cholerae Clostridium perfringens VACCINE REMARKS

3 doses, alum-precipitated; inactivated toxin boost every 10 years (formalin) Usually givenwith tetanus toxin, B subunit inactived toxin (formalin) sometimes combined with whole killed organisms for newborn lambs

SUBUNIT VACCINES
Organism Hepatitis B virus Remarks surface antigen can be purified from blood of carriers or produced in yeast by recombinant DNA technology capsular polysaccharides or conjugates of group A and C are effective; group B is non-immunogenic 84 serotypes; capsular polysaccharide vaccines contain 23 serotypes; conjugates with 5 or 7 serotypes are being tested good conjugate vaccines now available

viruses

Neisseria meningitidis Streptococcus pneumonies

bacteria

Haemophilus Influenzae B

KILLED (WHOLE-ORGANISM) VACCINES

Disease Polio Remarks preferred in Scandinavia; safe in immunocompromised can be given post-exposure, with passive antiserum strain-specific also attenuated vaccine potential to cause brain damage (controversial) about 70% protection protection dubious; may be combined with toxin subunit short-term protection only good protection

Rabies
viruses Influenza Hepatitis A pertussis typhoid cholera plague Q fever

bacteria

RESPONS IMUN : RESPONS IMUN PRIMER : pada pajanan pertama >> Ig M : - titer/afinitas rendah - Lag interval panjang terbentuk sel-sel memori

RESPONS IMUN SEKUNDER : pada pajanan berikutnya dengan antigen yang sama >> Ig G : - titer/afinitas tinggi - Lag interval pendek sel memori blast plasma sel antibodi sel T blast sel T aktif sel efektor & memori > banyak memberi respons pada pajanan berikutnya

Imunisasi ulangan (booster) mendapat titer antibodi yang tinggi & mencapai nilai protektif.

Beberapa faktor yang mempengaruhi Keberhasilan imunisasi : I. Status Imun Host a. vaksinasi campak pada umur 9 bulan b. ASI tidak bersamaan dengan vaksin polio c. vaksinasi dimulai umur 2 bulan d. Imuno kompromis :
defisiensi imun kongenital defisiensi imun didapat :
Imunosupresif Infeksi sistemik Keganasan Malnutrisi berat

indikasi kontra vaksin hidup

II.

Faktor genetik host :

Variabilitas genetik pengaruhi interaksi antara selsel sistem imun Responder baik, cukup dan kurang

III.

Kualitas dan kuantitas vaksin :

a. Cara pemberian b. Dosis vaksin c. Frekuensi pemberian d. Jenis vaksin e. Ajuvan : Menetap pada tempat suntikan (depo) Mengefektifkan sel-sel APC Produksi sitokin sel imunokompeten

ADJUVANTS
Adjuvant type Routinely used human aluminium hydroxide (alhydrogel) aluminium phosphate calcium phosphate Experimental * or Toxic for human used

Inorganic salts

beryllium hydroxide Liposomes* ISCOMS* Block polymers Slow release formulations* BCG Mycobacterium bovis & oil (complete Freunds adjuvant)

delivery systems Bordetella pertussis (with diphtheria, tetanus toxoids)

Bacterial products Natural Mediators (cytokines)

IL-1 IL-2 IL-12 IFN

Syarat-syarat vaksin secara imunologis : 1. mengaktivasi APC - mengekspresikan antigen - memproduksi sitokin 2. mengaktivasi sel T & sel B >> sel memori 3. mengaktivasi sel T & sel Tc terhadap beberapa epitop untuk mengatasi variasi respons imun 4. memberi antigen persistent di dalam sel folikuler dendrit

SAFETY PROBLEMS WITH VACCINES

Type of vaccine Potential safety problems reversion to wild type severe disease in immunodeficiency patients persistent infection hypersensitivity to viral antigens hypersensitivity to egg antigens vaccine not killed yeast contaminant Contamination with animal viruses Contamination with endotoxin Examples especially polio types 2 and 3 vaccinia, BCG, measles varicella-zoster measles measles, mumps

Attenuated vaccines

delivery systems

polio accidents in the past hepatitis B polio pertussis