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IMMUNITY & Vaccination
IMMUNITY & Vaccination
&
VACCINATION
IMMUNE SYSTEM
• The immune system has evolved to protect the host from pathogens
while minimizing damage to self tissue.
• The immune system not only protects against infection, but also
influences healing and governs the responses that can lead to
autoimmune diseases.
• Immune defenses are normally categorized into the innate immune
response, which provides immediate protection against an invading
pathogen, and the adaptive or acquired immune response, which
takes more time to develop but confers exquisite specificity and long-
lasting protection
The innate immune system
• Sweat also contains lysozyme, an enzyme that destroys the structural integrity
of bacterial cell walls; ammonia, which has antibacterial properties; and several
antimicrobial peptides such as defensins.
• They include neutrophils, monocytes and macrophages, and are particularly important
for defences against bacterial and fungal infections.
• Opsonins include acute phase proteins such as C-reactive protein (CRP), antibodies
and complement.
• They bind both to the pathogen and to phagocyte receptors, acting as a bridge
between the two to facilitate phagocytosis
Neutrophils
• Complement proteins are produced in the liver and are present in the
circulation as inactive molecules. When triggered, they enzymatically
activate other proteins in a rapidly amplified biological cascade
analogous to the coagulation cascade
• Mast cells and basophils
• Mast cells and basophils are bone marrow-derived cells which play a central role in
allergic disorders.
• Mast cells reside predominantly in tissues exposed to the external environment, such as
the skin and gut,
• while basophils are located in the circulation and are recruited into tissues in response
to inflammation.
• Mast cells and basophils express IgE receptors on their cell surface.
• On encounter with specific antigen, the cell is triggered to release preformed mediators
and synthesis additional mediators, including leukotrienes, prostaglandins and cytokines.
• These trigger an inflammatory cascade which increases local blood flow and vascular
permeability, stimulates smooth muscle contraction, and increases secretion at mucosal
surfaces.
• Natural killer cells
• Natural killer (NK) cells are large granular lymphocytes which play a
major role in defense against tumors and viruses.
• These cells differentiate into either long lived memory cells, which reside
in the lymph nodes, or plasma cells, which produce antibody.
• Immunoglobulins
• Immunoglobulins (Ig) are soluble proteins made up of two heavy and
two light chains.
• The heavy chain determines the antibody class or isotype, i.e. IgG,
IgA, IgM, IgE or IgD.
• IgA
• Highly effective at neutralizing toxins
• Particularly important at mucosal surfaces
• IgM
• Highly effective at agglutinating pathogens
• IgE
• Mostly bound to mast cells, basophils and eosinophils
• Important in allergic disease and defences against parasite infection
Cellular immunity
• T lymphocytes (also known as T cells) mediate cellular immunity and
are important for defense against viruses, fungi and intracellular
bacteria
Active immunity
• Active immunity (the power to resist infections on your own) develops from
• 1. A clinical infection (as in measles)
• 2. A subclinical infection
• 3. Vaccination.
• The first time an antigen is encountered in life, the immune system of the
individual spends sometime figuring what it is up against, and then mounts a
feeble immune response by producing a small titer of predominantly IgM
antibodies. This is primary response which lasts only as long the antigen
lasts in blood
• However, the second time that particular antigen is encountered, the
immune system recognizes it instantly (due to immune memory, a
property of cell mediated immunity) and produces a plethora of
predominantly IgG antibodies for a much longer period, which is
known as secondary response. This is what give the individual
immunity to a previously exposed agent
Passive immunity
• Passive immunity (lending somebody else's antibodies) is acquired by:
• 1. Passive immunization (injection of ready made antibodies).
• 2. Maternal IgG transfer through placenta, which persists in child up
to 6 months.
• 3. Maternal IgA transfer through milk.
• Passive immunity is
• 1. Rapid
• 2. Temporary
• 3. Bereft (lack) of immune memory
• 4. Expensive (vaccines are cheaper than antibodies).
Herd immunity
• It is the level of resistance of a community to a disease.
• It is built up by
• 1. Clinical/ subclinical infections
• 2. Immunization of individuals
• 3. Herd structure (hosts, vectors, reservoirs, environment).
• When swine influenza first hit the world, it spread like wildfire. With time
however, as our herd immunity has grown, it is turning more and more
benign.
• Adjuvants
• An adjuvant is a compound that are added to potentate a vaccine
(they produce a local granuloma to retain the antigen and decelerate
its release) i.e. aluminium phosphate, aluminium hydroxide, water in
oil.
Freeze dried vaccines
• In 1995, WHO recommended a changed global policy on the use of opened vials
of vaccine as follows.
• 1. Opened vials of OPV, DPT, DT, TT and hepatitis B vaccines may be used in
subsequent immunization sessions until a new shipment of vaccine arrives,
provided that each of the following 3 conditions are met
• • The expiry date has not passed
• • The vaccines are stored under appropriate conditions (0 to +8°C)
• • Opened vials of vaccine which have been taken out of the health facility for
immunization activities (e.g. outreach, National Immunization Days) are discarded
at the end of the day.
• 2. Opened vials of measles, yellow fever and BCG vaccines must be discarded
within six hours.
• 3. An opened vial must be discarded immediately if sterile procedures have not
been fully observed, or there is even a suspicion that the opened vial has been
contaminated, or there is visible evidence of contamination, such as a change in
appearance, floating particles
Cold chain Equipments
• Walk in cold rooms. A cold room where people walk in and get the vaccine
• Deep freezers. Deep freezers create sub zero temperatures. They are suitable
• 1. to store for vaccines > 3 months
• 2. to make ice packs which are used in vaccine carriers.
• The deep freezer should be placed in a well ventilated room at least 10–20 cm from
the wall, and should not tilt on any side (should be perfectly horizontal).
• The power switch should be TAPED in the on position so that nobody can turn them
off accidentally.
• Its temperature should be recorded every morning and evening. The lid of the deep
freezer should be LOCKED when not in use.
• The device should be cleaned when ice has grown 4–6 mm thick over the inner walls
• After defrosting, clean the freezer and make it dry before loading vaccines again.
• Cold boxes. Cold boxes, packed with ice packs, are used for regional
transportation of vaccines.
• Vaccine carriers. These are packed with 4 fully frozen ice packs on the
day of vaccination.
• They can maintain the vaccine for 48 hours in 2–8° if not opened
• Ice packs. They are filled with salt free water (salt reduces freezing
point of water) up to a preset mark (if we fill up to the brink, water
will expand when frozen and crack the pack) and frozen in a deep
freezer.
• In all these devices, the T series vaccine and hepatitis vaccine should
never be placed in direct contact with ice.
Vaccine vial monitor
• It is a heat sensitive label to monitor cumulative heat exposure. It consists of round
piece of blue material inside which lies a heat sensitive square of lighter hue. The
square changes to darker shades with
• 1. high temperature, short exposure or 2. lower temperature, long exposure or 3.
high temperature, long exposure
• The vaccine is usable only until the inner square is lighter than the outer circle.
• DT and TT vaccine shipping indicators
• This is another type of indicator, which travels with the vaccines from manufacturer
to central store and is included with each 3,000 doses of DT, DPT and TT procured
through UNICEF. This indicator has a temperature sensitive dot that irreversibly
change from silver-gray to black at temperatures above +48°C, temperatures which
may be reached if vaccines are left in the sun or in poorly ventilated places.
• The shake test
• Before administering a T series vaccine, it is a must to shake it and see a uniform
mixture; any granules indicate freezing at some point of time, and the vial is
discarded.
• WHO recommendation on vaccine storage temperatures
• To summarize, if you work,
• At the national level. Keep your vaccines for a maximum of 6 months
• • Store OPV, measles, and mumps vaccines at –15 to –25°C
• • Store hepatitis B, DPT, DT, TT and BCG at 0 to +8°C
• • Send vaccines to regions in insulated containers at 0 to +8°
• At the regional level. Keep your vaccines for a maximum of 3 months
• • Store OPV, measles, and mumps vaccines at –15 to –25°
• • Store hepatitis B, DPT, DT, TT and BCG at 0 to +8°
• • Send vaccines to districts in insulated containers at 0 to +8°
• At the district level. Keep your vaccines for a maximum of 1 month,
• • Store OPV, measles, and mumps vaccines at –15 to –25°C, if possible
• • Store hepatitis B, DPT, DT, TT and BCG at 0 to +8°C
• • Send vaccines to health facilities in insulated containers at 0 to +8°C
• At the health facility level. Keep all your vaccines for a maximum of 1 month:
• Store all vaccines at 0 to +8°C.
• A fully immunized child
• 1. has completed primary doses before 1 year
• 2. has taken vaccines at least at 4 weeks interval
• 3. has taken no vaccine before time
THANK YOU