1.Immunization Abdul Ghaffar Microbiology and Immunology

2. Milestones in immunization

1500BC

• Turks introduce variolation

3000BC

• Evidence of sniffing powdered small pox crust in Egypt

2000BC

• Sniffing of small pox crust in China

1700AD

• Introduction of variolation in England and later in the US

3.

The wife of the British Ambassador in

Turkey, in March 1717 wrote, following

the variolation of her son, to a friend in

England: The small pox, so fatal, so general

amongst us, is entirely harmless here

by the invention of ingrafting.I am

patriot enough to bring this invention into

fashion in England.

Introduction of variolation 4. Milestones in immunization

1780AD

• Edward Jenner discovers small pox vaccine

5. Edward Jenner Discovery of small pox vaccine 6. Edward Jenner Among patients awaiting small pox vaccination 7. Modern era of the vaccine

1920s

• Diphtheria and Tetanus

1934

• Pertussis

1955

• Salk polio

1885

• Rabies vaccine (Pasteur)

8. Modern era of the vaccine

1960s

• Mumps measles and rubella virus

• Sabin polio

1990s

• Hepatitis and varicella

1985

• Haemophilus

9. Pre- & post-vaccine incidence of common preventable diseases 10. Different modes of acquiring immunity Immunity Natural resistance Artificial Natural Passive Artificial Natural Active Acquired 11. Passive Immunity

Colostral transfer of IgA

Placental transfer of IgG

Antibodies or immunoglobulins

Immune cells

Natural Artificial 12. Passive Immunization disease indication antibody source human, horse diphtheria, tetanus prophylaxis, therapy vericella zoster human immunodeficiencies gas gangrene, botulism, snake bite, scorpion sting horse post-exposure rabies, human post-exposure hypogamma-globulinemia human prophylaxis 13. Advantages and Disadvantages of Passive Immunization

serum sickness

immediate protection

no long term protection

graft vs. host disease ( cell graft only )

risk of hepatitis and Aids

Advantages Disadvantages 14. Active Immunization

exposure to sub-clinical infections

Attenuated organisms

killed organisms

sub-cellular fragments

toxins

others

Natural Artificial 15. Live Attenuated Vaccines

tuberculosis

• not used in this country

polio*

• not used in std. schedule

measles, mumps & rubella

yellow fever

• Military and travelers

• Varicella zoster

• children with no history of chicken pox

hepatitis A

• not required in SC

16. Killed Whole-Organism Vaccines

polio

influenza

• elderly and at risk

typhoid, cholera, plague

• epidemics and travelers

• rabies

• • post exposure

pertussis

• replaced by the acellular vaccine

Q fever

• population at risk

17. Microbial Fragment Vaccines

Bordetella. Pertussis

• virulence factor protein

Haemophilus influenzae B

• protein conjugated polysaccharide

Streptococcus pneumoniae

• Polysaccharide mixture

Neisseria meningitidis

• polysaccharide

18. Microbial Fragment Vaccines

Clostridiumtetani (tetanus)

• inactivated toxin (toxoid)

Corynebacterium diphtheriae

• inactivated toxin (toxoid)

Vibrio cholerae

• toxin subunits

Hepatitis B virus

• cloned in yeast

19. Modification of Toxin to Toxoid Toxin toxin moiety antigenic determinants chemical modification Toxoid 20.

anti-Idiotype Vaccine

Future Vaccines

Immuno-dominant peptide

DNA

21. Recommended Childhood Immunization Schedule 22. Adverse Events Occurring Within 48 Hours DTP of Vaccination Event Frequency

local

• redness, swelling, pain

1 in 2-3 doses

systemic: Mild/moderate

• fever, drowsiness, fretfulness vomiting

• anorexia

1 in 2-3 doses 1 in 5-15 doses

systemic: more serious

• persistent crying, fever

• collapse, convulsions

• acute encephalopathy

• permanent neurological deficit

1 in 100-300 doses 1 in 1750 doses 1 in 100,000 doses 1 in 300,000 doses