II: IMMUNIZATION

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Definition of terms  
Immunity: Resistance to development of infection and/or clinical
disease due to presence of specific antibodies and/or cellular immunity
 
Immunization: The process whereby a person is made immune
typically by the administration of a vaccine

What is its difference from vaccination?

 
Vaccination: The administration of vaccine/s to susceptible individual/s
to stimulate immunity
 
Vaccine: Artificially altered microorganism or its products used for
vaccination

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 Types of immunity

Depending on type of response

◦ Cellular – conferred by T-lymphocytes
◦ Humoral – conferred by antibodies (B-cells)

Depending on mechanism of development

Natural
◦ Active – following natural infection
◦ Passive – transfer of antibodies through the placenta or
breast milk
Artificial
◦ Active – through vaccination
◦ Passive – administration of antibodies
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 Types of Vaccines
Live attenuated infectious agent
 Stimulates natural infection
 Induces both humoral and cellular immunity
 More durable resistance – due to immunologic memory
Killed suspension of infectious agent
 Induces humoral immunity
 Very high concentration and frequent booster doses are
required
Toxoids – inactivated toxins
Other types

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Vaccine preventable diseases (VPDs)

Measles Homophiles influenza

Pertussis type b
Tetanus Meningococcal

Tuberculosis meningitis
Yellow fever
Poliomyelitis
Mumps
Diphtheria
Rubella
Hepatitis B
Japanese encephalitis

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 Herd Immunity

Refersto resistance to spread of infection as a result

of immunity of large proportion of the population

Requirements for maximal operation of herd

immunity:
◦ Direct transmission
◦ Single reservoir
◦ Uniform distribution of immunized
◦ No overcrowding
◦ Full immunity/No carrier state

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Immunization Programs and Maintenance
of Vaccine Stability
Immunization programs
◦ Small-pox eradication program in the past

◦ Expanded program of immunization (EPI)

◦ EPI Plus
◦ Polio eradication program

◦ National immunization programs

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Expanded program of immunization

It was established by WHO in 1974 with the

objectives of
◦ Reducing morbidity and mortality from six
major VPDs which are: Diphtheria, Pertussis,
Tetanus, Measles, Poliomyelitis and Tb.

◦ Promoting national and regional self-reliance

The vaccines in the EPI program were originally
against the six VPDs but currently two new
vaccines against Homophiles influenza and
Hepatitis B are added.

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EPI plus

Refers to delivering other health

interventions integrated with EPI. The
interventions to be added include

 vitamin A supplementation

 ITN distribution

 anti- helmintics

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EPI Strategies

Static – vaccinating client coming to health units

as part of health units routine activity

Outreach– staff of health unit go out to

catchment areas to administer vaccines

Mobile – single dose vaccination in settlement

areas and for controlling epidemics E.g. – BCG,
measles vaccine

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EPI in Ethiopia

It was started in 1980

it targets infants
EPI coverage in Ethiopia according to Health and
Health Related Indicators published by MOH in
2006/07 were:
DPT3 - 72.6%
Measles - 64.9 %
Fully immunized - 52.5%

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Maintaining vaccine stability - The Cold Chain

Vaccines are damaged by effect of

temperature.
The potency of vaccines could be maintained
by keeping vaccines below 80c throughout
their course starting from manufacturing site,
during transporting and storage until they
reach to the people to be vaccinated.
This system of maintaining potency of
vaccines is termed as cold chain.
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Cont’d
EPI vaccines divided into two in terms of
storage temperature requirements:
◦ Those which should be kept between 00c and
80c: DPT and TT and

◦ Those which should be kept below 80c but not

damaged by freezing: the other EPI vaccines

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Maintaining Cold Chain

The cold chain should be maintained at each

level through keeping appropriate
 Procedures, personnel and equipment
The precautions at peripheral level in the
process to maintain potency of vaccines include:

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Cont’d
◦ using refrigerators for vaccine storage only

◦ Vaccines should be carried to local level in

vaccine carriers

◦ Not for more than 1-2 days and

◦ Keeping out of direct sunlight exposure

◦ Monitoring temperature morning and evening

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Thank You

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