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IMMUNOLOGICAL ASPECT OF

IMMUNIZATION

dr. Rahmawati Minhajat, Ph.D, Sp.PD

Medical Faculty Hasanuddin University

Immunization

the

way

to

increase

someone’s

immunity to a certain cause of disease if exposed to the germ maybe not ill or mildly ill

Vaccination versus Immunization

Vaccination

Vaccination is a process of inoculating the vaccine/ antigen into the body irrespective of seroconversion

Immunization

Immunization is the process of inducing immune response in an individual either humoral or cell mediated

Vaccines

Vaccines are whole or parts of microorganisms administered to

prevent an infectious disease

Vaccines are whole or parts of microorganisms administered to prevent an infectious disease

AIM OF IMMUNIZATION (VACCINATION)

1. To reduce the number of illness (morbidity)

  • 2. To reduce the number of deaths (mortality)

  • 3. To reduce the number of disability (sequelae)

  • 4. Noble : eradication of certain disease

small pox eliminated

PIN polio and measles ?

  • Passive immunity : immunity from outside, short duration, congenital or artificial

  • Active immunity : from the body itself after exposure to some antigen, whether it’s naturally / artificially

(vaccination); last longer / lifetime

The Immune System and Passive Immunization

The transfer of antibodies will not trigger the immune system

There is NO presence of memory cells

Risks are included

Recognition of the immunoglobulin epitope by self immunoglobluin paratopes

Some individuals produce IgE molecules specific for passive antibody, leading to mast cell degranulation

Some individuals produce IgG or IgM molecules specific for passive antibody, leading to hypersensitive reactions

Passive immunization transfer of anti (antibody or immunity cell)non immune person Natural passive immunity

  • Mother’s immunity placenta foetus Antiviral, antitoxin, antibacterial

  • Mother’s immunity breast milk baby Colostrum >> permanent breast milk Spesific immunity: E. Coli, Shigella, Polio, etc

  • Non spesific immunity :

Lisozyme, Lactoferin, Interferon, etc

  • Cell mediated immunity ?

    • Artificial passive immunity

      • Heterolog antibody

      • From horse

      • Can induce allergic reaction ( Type I or III serum sickness)

      • First SKIN TEST/ EYE TEST Negative direct injection Positive desensitization

  • Homolog antibody Gammaglobulin

    • Immune serum globulin ( Human Normal

Immunoglobulin/ HNI )

  • From healthy donor (without noticing

vaccination procedure, recovery time)

  • Tourist to tropical region

  • ITP, Kawasaki disease, Steven Johnson Syndrome

  • Guillai n Barre Syndrome

  • Specific human immune serum

    • Immunized donor

      • Tetanus immune globulin

      • Rabies immune globulin

      • Hep. B immune globulin

Active immunization/vaccination:

The body

made the anti

body after getting

stimulus from the outside, ex: natural

infection or vaccination. Natural infection

including symptomatic or asymptomatic

Active Immunization

Natural Infection with

microorganism or artificial

acquisition (vaccine)

Both stimulate the proliferation of

T and B cells, resulting in the

formation of effector and memory cells

The formation of memory cells is

the basis for the relatively

permanent effects of vaccinations

Active Immunization • Natural Infection with microorganism or artificial acquisition (vaccine) • Both stimulate the proliferation

Vaccine :

  • Bacteria/ virus:

    • Patogenicity (-) but immunogenicity (+)

      • Toxoid :

        • toxicity (-), immunogenicity (+)

IMMUNIZATION

Passive

Active

Route

- Parenteral

- Parenteral

- Oral

Immnune effect
Immnune effect

- Immediately after immunization - Acute

- After a few time - Prolong

Age

- Immediately after delivery or exposure

- A few

time

/ exposure or after passive immunization

Side effect Indication
Side effect
Indication

-

Frequent (heterolog)

- Therapeutic - Prevention

- Rare

- Prevention

Effective vaccine

1. Induction of the appropriate shape of immunity

  • 2. Stable in reservation, especially living vaccine

  • 3. Enough immunogenicity dead vaccine often need adjuvant

VACCINATION IMMUNE RESPONSE

1. Primary immune response (PIR) :

  • First exposure to antigen

  • Long lag phase

  • Especially IgM

  • Forming memory cells (B cell & T cell)

2. Secondary immune response (SIR) :

  • The next exposure with the same antigen

  • Shorter lag phase (memory cell formed)

  • Especially IgG & sel T active

  • Forming many effector cells and memory cells

  • SIR give adequate response to the same antigen exposure in the future

  • “BOOSTER” to maintain the effective immune response

VACCINATION IMMUNE RESPONSE INFLUENCED BY
VACCINATION IMMUNE RESPONSE INFLUENCED BY

1. Host Immune Status

  • Maternal immunity can reduce immune response, example antibody to measles

  • Age < 2 months and old person less response

  • Immune status immune deficiency :

    • R/ immunosupression

    • Congenital immune deficiency

    • Severe illness

  • Nutritional status malnutrition

    • Cellular response decreasing

    • Spesific humoral response decreasing

  • Immune deficiency contraindication of living

  • vaccine

    2. Host genetical factor well responder, enough & low

    3. Vaccine quality and quantity :

    • a. Ways of administration

      • Polio Sabin vaccine local/systemic immunty

      • Polio Salk vaccine systemic immunity

  • b. Dosage suggestive dose

  • c. Frequency & administration interval

  • d. Vaccine type living vaccine > dead vaccine

  • e. Adjuvant : increasing vaccination immune response

  • f. Reservation influencing the vaccine potency

  • Different type of adverse events following

    immunization

    Vaccine reaction

    Event caused/precipitated by the inherent

    properties of the vaccine (active component, adjuvant, preservative, stabilizer) when given correctly

    Program errors

    Event caused by an error in vaccine preparation, handling or administration

    Coincidental

    Event that happens after immunization but is

    not caused by the vaccine

    Injection

    Event arising from anxiety about, or pain

    reaction

    from, the injection itself rather than the vaccine

    Unknown

    The cause of the event cannot be determined

    Injection site

    Intramuscular Injections

    Site

    Preterms & neonates

    Anterolateral thigh (junction of

    Infants

    middle & lower third)

    Toddlers & older children

    Deltoid or Anterolateral thigh

    Adolescents & adults

    Deltoid

    Subcutaneous Injections

    Site

    Infants

    thigh

    >12 months

    Outer triceps

    Intradermal Injections

    Site

    All age

    Left deltoid