VACCINATION

Immune system

Vaccination Immunization Antigen

Vaccine Immunity Antibodies

 Immunization:
The process of inducing immunity or resistance to an infectious disease.

 Immunity:
The state of being protected against a particular disease.

Active Immunization/Immunity
Passive Immunization/Immunity
 Active Immunization/Immunity
Exposure to a disease organism triggers the immune system to
produce antibodies to that disease.
Takes time to develop
Lasts for many years (lifetime).

Natural Immunization: Vaccine-induced Immunization:

Exposure to the disease organism through Introduction of a killed or weakened

infection with the actual disease. form of the disease organism through
vaccination.
 Passive Immunization
Administration of immunoglobulin or immunoglobulin -containing
preparations.

Produced without challenging the immune system of the body.

Effective but wanes with time (weeks or months).
(High risk, Exposure, Time)

Passive natural immunization : Passive Artificial Immunization:

Transplacental transfer of maternal Injecting previously prepared

antibodies antibodies (serum from humans or
animals).
Through breast milk. Provide immediate protection against
acute infections.
• Vaccination
The act of introducing a vaccine into the body to produce immunity
to a specific disease.

• Vaccine:
A preparation that is used to stimulate the body’s immune response
against diseases.

Live attenuated vaccines

Inactivated vaccines
Action - Vaccination

Process - Immunization

Goal - Immunity
 THANKS TO VACCINES

• Poliomyelitis
• Tetanus
• Pertussis
• Diphtheria
• Measles
• Mumps
• Rubella
• Haemophilus influenzae type b
• Hepatitis B
• Hepatitis A
• Chickenpox (Varicella)
Measles

Poliomyelitis

Tetanus (Lockjaw)
 C LA S S I F I C AT I O N O F VA C C I N E S

• Live attenuated vaccines:

Modifying a disease-producing (wild) virus or bacterium in a laboratory.
Replicate in the body to produce an immune response.
Do not cause illness.
One or two doses are required

Live Viruses: measles, mumps, rubella, varicella, rotavirus, intranasal influenza, OPV

Live Bacterial vaccines: Oral typhoid and BCG

 C LA S S I F I C AT I O N O F VA C C I N E S

• Inactivated vaccines:

- whole-cell inactivated vaccines:

Bacteria or viruses that have been killed through a physical or chemical
process
Hepatitis A,, inactivated polio vaccine (IPV)

- Fractions:
Protein-based vaccines:
Toxoids: Diphtheria, Tetanus
Subunit products: Hepatitis B, Acellular Pertussis, Influenza.

Polysaccharide-based vaccines:
Pure cell wall polysaccharide from bacteria.
 Conjugate polysaccharide vaccines:
Polysaccharide that is chemically linked to a protein.
More potent vaccine.
Haemophilus influenzae type b and pneumococcal conjugate vaccines

• Inactivated vaccines can not replicate.

• Inactivated vaccines can not cause disease, even in an immunocompromised patients.
• Multiple doses are required.
• Supplemental doses to “boost,” antibody titers.
 W H O S H O U LD R E C E I V E VA C C I N AT I O N ?

• Proper Age
• Adequate intervals
• No contraindications (?)
• No prior severe adverse reaction
• Inactivated vaccine if immunocompromised person
 VA C C I N AT I O N P R I N C I P L E S

S PA C I N G A N D T I M I N G

• Routine Schedule and Catch-up schedule

Minimal Age and Intervals Between Different Doses

• Intervals Between Different Vaccines Not Administered Simultaneously

All vaccines can safely and effectively be given simultaneously at separate sites.

If not administered simultaneously (?)

- Inactivated vaccines and orally given live vaccines:
may be given without regard to intervals

- Live injected vaccines (eg, MMR, varicella)

Should be separated by at least 4 weeks
 VA C C I N AT I O N P R I N C I P L E S

S PA C I N G A N D T I M I N G

• Intervals Between Vaccines and immune globulin–containing products:

- Live injected vaccines:

Should be delayed until the passive antibody has degraded.
The duration of inhibition is related to the dose of Igs in the product.

Administered >2 weeks before receipt of the Igs-containg product

or delayed 3–11 months after receipt of the Igs-containg product

Interval depends on the dose and type of blood product e.g. Whole blood: 6 mo.
 VA C C I N AT I O N P R I N C I P L E S

S PA C I N G A N D T I M I N G

• Intervals Between Vaccines and Antibody-Containing Blood Products:

- Inactivated vaccines:
Given simultaneously, or at any time interval before or after an Igs-containing product.
At different injection sites.
 Routes of Administration
Oral Route (PO) Rotavirus vaccine RV1
[Rotarix], RV5 [RotaTeq]

Oral Polio vaccine (OPV)

Intranasal Route LAIV [FluMist]
(NAS)

Subcutaneous Route MMR, Varicella vaccine, Fatty tissue of thigh

(SC) MMRV, (IPV, PPSV23)* or Upper outer triceps
area for older children

Intramuscular Route Diphtheria, Tetanus, Pertussis Vastus Lateralis

(IM) vaccines (DTaP, Tdap, Td) (Anterolateral thigh)
HepA, HepB, Hib
Meningococcal vaccines or Deltoid muscle for
Pneumococcal conjugate older children
vaccine (PCV13)
(PPSV23, IPV)*
Intradermal Route BCG Left deltoid
(ID)
IM/SC site of administration: anterolateral thigh
Birth to 12 months
IM site of administration: deltoid
12 months and older
 VA C C I N AT I O N P R I N C I P L E S

• Lapse of schedule of immunization does not necessitate reinstitution of the total

course.

• If immunization status of a child is unknown, there is no harm in giving appropriate

vaccines again.

• Live viruses of all types should not be given to patients with immunodeficiency
status.

• The following are not contraindications of vaccination:

Mild acute illness
Low grade fever
Mild diarrhea
Current antibiotic therapy
Prematurity
 BCG (BACILLUS CALMETTE GUERIN)

• Live attenuated bacterial vaccine.

• Prepared from Mycobacterium bovis.

• Protect from Mycobacterium tuberculosis, the etiological agent of tuberculosis

(TB)

• Provides protection against TB meningitis and miliary disease in children.

• One dose is given within the 1st month of life.
• Intradermal injection in left deltoid.

• Induces delayed T cell response. Its reaction is not acute:

- 2 weeks after vaccine injection; Local lesion, and papule develops.

- 4-6 weeks Small abscess might develop. (no intervention is needed)
- 6 weeks (crust, detaches, ulcerates), then a scar.
 P O L I O V I R U S VA C C I N E

• Protect from Poliovirus, the causative agent of poliomyelitis.

• IPV: Inactivated poliovirus vaccine (Killed).

Injectable (IM or SC).
More expensive than OPV.

• OPV: Oral poliovirus vaccine

(live attenuated)
Can cause VAPP (vaccine associated paralytic polio)/First dose.
• Two doses of (IPV) = 90% effective
Three doses are 99% to 100% effective

• 4 doses recommended.

• 2, 4, and 6-18 mo, booster dose at 4-6 yr.

• Some “combination” vaccines contain IPV.

• Recommended for adults who are at greater risk for exposure to polioviruses.
- International travelers.
- Laboratory workers.
- Healthcare professionals.

• Side effects: Redness and soreness at site of injection.

• Herd immunity:
OPV shed in the stool & this lead to immunize the individuals around in the same
community.
• Contraindications:

 OPV: Immunocompromised patients.

Family member who is immunocompromised.

 Severe allergic (anaphylactic) reactions after a previous dose.
 Severe allergy to neomycin, sterptomycin & polymixin B.
(IPV contains trace amounts)
 H E PAT I T I S A VA C C I N E

• Killed virus
• 94-100% Prevention.
• 2 doses (6 mo apart), IM.

• Recommended for:
1. All children at age 1 yr.
2. Increased risk for infection (occupational risk, travelers).
3. Increased risk for complications from HepA.(clotting factor disorders, chronic
liver disease)
4. Any person wishing to obtain immunity.
• Side effects:
- Pain or swelling at site of injection (50%).
- Fatigue or mild fever (<10%).

• Post-exposure prophylaxis:
One dose of hepatitis A vaccine OR immunoglobulins
as soon as possible, within 2 weeks after exposure.

 Hepatitis A vaccine: healthy children aged >12 months.

 IG: Children aged <12 mo.

Immunocompromised persons.
Chronic liver disease.
Allergy to the vaccine or a vaccine component.
 H E PAT I T I S B V I R U S ( H B V )

• Killed vaccine.
• Recombinant DNA surface antigens.

• Given as 3 or 4 shots over a 6-month period.

• 3 doses are given at day 61, day 91, day 121
• IM injection.

• Hepatitis B vaccine is recommended for unvaccinated adults who are at risk

for hepatitis B virus infection.
• C/I:
Life-threatening allergic reaction.
Moderately to severe ill child.

• SE:
Soreness at injection site.
Fever
Anaphylaxis (rare)

• Infant born to HBs Ag positive mothers:

HBV vaccine and HB Ig within 1st 12 hours of birth.
 DTaP VACCINE

• Diphtheria, Tetanus, Acellular Pertussis.

• Killed vaccine.
• 6 doses are given at days: 61, 91, 121, then:18 mo, 6 yr &15 years.
• IM injection.

• DTaP Versus DTP (DTwP)

• 80-85% protection from pertussis

• 95% protection from diphtheria.
• 100% tetanus.

• Immunity decreases over time (booster doses).

• DTaP: < 7 years of age.
• Tdap or Td: > 7 years or older = Booster dose

• Tetanus vaccine is effective for 10 yrs (repeat it every 10 yrs).

• SE:
- 1/3 of cases: local reaction, pain, swelling and redness.
- large local reaction after the 4th or 5th dose.
- Fever (5% ).

• Rare SE:
- Prolonged crying for 3 hours or more.
- High fever.
- Febrile seizure.
(very rare with DTaP)

• Severe + Very Rare SE:

- Serious allergic reaction (1 in a million doses).
- Encephalopathy that develops within 7 days/Long-term seizures.
 MMR: MEASLES, MUMPS, RUBELLA

• Live attenuated vaccine .

• 2 doses.
• Measles -9 months.
• MMR at 12 mo and 18 months.
• SC injection .
• A few may still get the diseases.
• During measles and mumps outbreaks: additional dose of MMR.
• SE:
20% fever, 5% rash.
Adenopathy (less common)
Arthralgia (25% of adult female, related to rubella component)
Thrombocytopenia (rare)

• C/I:
- Life-threatening allergic reaction to the neomycin, or any other component of
MMR vaccine or to a previous dose of MMR.
- Immunocompromised state.
- Recent blood transfusion or blood product during the previous 3 to 11 months.
 H A EM O PH IL U S I N F L U E N Z A T Y P E B ( H I B )

• Polysaccharide conjugate vaccine. (inactivated bacterial vaccine)

• Does not provide protection against other types of Haemophilus

influenzae disease (nontypable)

• Protect against epiglottitis and meningitis .

• 3 doses given at day 61 , day 91 , day 121 .

• IM injection
• 95% effective after a primary series of 2 or 3 doses.

• Invasive HiB disease in a completely vaccinated infant is not common.

• Indicated for children with functional /anatomical asplenia.

• C/I:
- Severe allergic reaction after a previous dose or any vaccine component.
- Younger than 6 wk (potential development of immunologic tolerance)

• SE (not common):
- Swelling, redness, or pain 5%-30% (usually resolve within 12-24 hours).
- Fever and irritability.
- Serious reactions (v. rare.)
 R O T A VA C C I N E

• Rota Virus is the most common cause of severe diarrhea.

• 500,000 deaths worldwide.
• Oral live attenuated vaccine.
• Most children (9 out of 10) who get the vaccine will be protected from severe
rotavirus illness.
• 7 out of 10 children will be protected from any rotavirus illness.
• RotaTeq (RV5) (2006)
3 doses (2 months, 4 months, and 6 months)

• Rotarix (RV1) (2008)

given in 2 doses at ages 2 months and 4 months.

• Given by mouth (orally).

• The first dose is most effective if it is given before a child is 15 weeks of
age.

• All doses of rotavirus vaccine before age of 8 months.

NO catch-up if behind.
Min. age 6wk, max. 32wk.
• C/I:
- Immunocompromised state.
- Severe (life-threatening) allergic reaction to a dose of rotavirus vaccine or to any
component of rotavirus vaccine.
- Previous episode of intussusception.
 P N EU M O C O C C A L VA C C I N E

• Pneumococcal conjugate vaccine.

• Pneumococcal polysaccharide vaccine.
• Pneumococcal conjugate vaccines (PCVs)
PCV13, PCV15 or PCV20

Purified capsular polysaccharide of different serotypes of S.pneumoniae

(1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 19A, 19F, 18C, and 23F)
(1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F)
(1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F)

Conjugated to a nontoxic variant of diphtheria toxin.

• PCV7 (the first pneumococcal conjugate vaccine that was licensed in the US in 2000).

• Reduce invasive disease caused by vaccine serotypes by 97%.

• Recommended routine administration of pneumococcal conjugate vaccines:

4 doses: 2 months, 4 months, 6 months, and (booster) 12 through 15 months.
Pneumococcal Polysaccharide Vaccine: PPSV23

• Purified preparations of pneumococcal capsular polysaccharide.

• Contains polysaccharide antigen from 23 types of pneumococcal bacteria.

• 60% to 70% effective in preventing invasive disease caused by serotypes

included in the vaccine.

• Poor antibody response in children younger than 2 years of age.

 VARICELLA VACCINE

• Live-attenuated varicella-zoster virus

• Protect from chickenpox.

• Children 12 months through 12 years old:

2 doses of varicella vaccine separated by at least 3 months.
First dose: between 12th-15th month.
Second dose: between 4th-6th year old age.

• SC injection.
• Older children or adults: 2 doses (4 to 8 weeks apart)
• C/I:

• Anaphylactic reaction to gelatin, neomycin, or any other component of the vaccine.

• Immunocompromised status.
• Recent blood transfusion or blood product during the previous 3 to 11 months.
 M E N I N G O C O C C A L VA C C I N E

• Neisseria meningitides.
• Polysaccharide-protein conjugate vaccine.
• Single dose.
• Indicated for use in persons 2–55 years of age.
• Indicated for children with asplenia or persistent terminal complement
deficiency.
 I N F L U E N Z A V I R U S VA C C I N E

• Inactivated Influenza Virus Vaccine :

 IM.
 Annual influenza vaccination is indicated for all children older than 6
months of age.

 High-risk groups and their contacts and caregivers:

Chronic diseases: chronic pulmonary, cardiovascular, renal, hepatic,
neurologic, hematologic, or metabolic disorders.
Immunocompromised pts.
Health care personnel.
 Children younger < 9 years + first time:
require 2 doses ( ≥4 weeks apart).

 subsequent seasons require single doses.

 Older children receiving vaccine for the first time require only a
single dose.
• Live influenza vaccine:

 Intranasally.
 Contraindicated in immunocompromised pts.
 Given only to healthy people 2-49 yrs of age who are not
pregnant and do not have certain health conditions .
THANK YOU