IMMUNIZATION

PVC MDS2004

Immunization can be either natural or artificial. In the past, vaccines did not exit –
so how did the population survive? People contracted the diseases quite common in
childhood, but survived due to acquiring natural immunization against the
pathogens. One is exposed to these aetiological agents, develops the disease but
develops immunity. However immunization does not always follow the disease; this
is the case in Gonorrhoea; if one indulges repeatedly, one may contract gonorrhoea
several times – there is no immunity after the disease. Two organisms can be re-
exposed to produce what is called a sub-clinical infection – immunity is developed
which suppresses the full-blown disease. This is the case with Hepatitis A – in the
past the population was over-exposed to this virus; however the symptoms are not
severe as in the case of full-blown Hepatitis. The individual would have contracted
Hepatitis but possesses a range of immunity against it.

Immunization does not come with side-effects, but the main aim is to relieve pain,
suffering and offer complete protection. Artificial immunization involves man-made
agents (vaccines, toxoids) to induce immunity in an artificial way deliberately.
Passive immunization means that our IS is not participating actively against the
disease – for a defined period – and can either be natural or artificial. Natural
passive immunization is exemplified by a mother; bearing a child means sharing
with the baby her own IgG; the only IG that crosses the placental membrane. The
baby, once born, will possess IgG to which his mother was exposed. Because the IS
is still premature in neonates, the baby receives a boost throughout the pregnancy.
This lasts for 6-9 months; the baby after that has to fend on itself, warding off any
organisms which it will be exposed to. Another example includes the colostrum
which comes out from the breast – a sticky protein fluid which precedes lactation –
possessing antibodies which can cross the intestinal barrier. Later on, during
lactation (breast is better for baby), secretory IgA antibodies is found in the milk
produced by the glandular tissue of the breast (mostly fat). IgA coming from breast
milk acts as an antiseptic coating around the mucosa of the pharynx, conveying
protection against common bacterial and viral organisms. This is only for a certain
period of time, however it is quite known breast-fed milk do not suffer from
gastroenteritis, nor otitis media. The latter is caused by colonization of the throat by
bacteria which ascend the narrow, short, almost horizontal Eustachian tube to reach
the middle ear. The baby is thus preventing this from happening through the IgA
antibodies acquired from the mother’s milk. As the baby grows the Eustachian tube
becomes more vertical and longer – it is now difficult for organisms to ascend it and
cause otitis media.

Artificial passive immunization means pepping up the IS of an individual by giving

pre-formed antibody; donated by someone else – cell-mediated immunity cannot
be donated, but humoral immunity can. Heterologous antibody was widely used up
to 40 years ago – this means immunizing a horse against a pathogen, raise an
antiserum against it, purify it to a great extent to obtain the relevant IgG antibodies
which are specifically needed against the pathogen. The patient is at risk because he
is being injected with foreign protein – the risk arises on the second and subsequent
doses – after priming a reaction occurs: serum-sickness syndrome! This is a delayed
type of hypersensitivity reaction. Anaphylaxis can also occur – the patient can die
within a couple of minutes, or simply drop dead. Nowadays the diphtheria antitoxin
is still obtained from the horse – for emergency treatment it MUST be given (every
minute that is wasted has catastrophic effects – a very potent exotoxin is produced,
reaches the systemic circulation and targets cardiac muscle (toxic myocarditis, heart
failure), suprarenal glands and nervous tissue with resulting muscle paralysis),
however it is not justifiable to use it to prevent diphtheria. The risk outweighs any
potential benefit. Specific heterologous artificial passive immunization can be either
IM or IV.

Blood is obtained from screened individuals and the globulins are extracted from
this blood, put into vials which are labelled as IM or IV. This is known as normal
homologous immunization. This started off to prevent certain diseases after
contact;

 Hepatitis A - Vietnam war marine seals were young, healthy individuals –

the environment was hyper-endemic to Hepatitis A and many were bed-
ridden for over a year. Physician started giving normal pooled
immunoglobulin shots on a monthly basis
 Measles
 Rubella – the majority of the Maltese were practicing Catholic and thus
shunned abortion; pregnant women exposed to Rubella virus without
having underlying immunity put the foetus during the first trimester at a
great risk
 Varicella – chicken pox must be prevented because in adult persons is a
very severe disease when compared to a child, passive immunization is
offered and works perfectly, apart from the existence of an antiviral agent

Other indications include:

 Congenital agammaglobulinaemia
 ITP
 Kawasaki syndrome
 Bone marrow transplantation – grossly immunosuppressed patients to
prevent prophylaxis
 Recurrent bacterial infections in children with HIV – treated with a range of
retroviral agents
 Guillain-Barre syndrome – ranging from complete flaccid paralysis up to
complete recovery, from death to living on a wheelchair – the prognosis is
unpredictable
 Staphylococcal toxic shock syndrome
 Streptococcal toxic shock syndrome – possibly fatal
 PANDAS – a complication that is precipitated by Streptococcus pyogenes,
severe OCD