Principles of immunization

Merertu Temesgen (MD pediatrician,pediatric

emergency and critical care fellow,Jan 2017)
Definition

 Immunization is the process of inducing

immunity against a specific disease.
 Immunity can be induced either by active or
passive immunization.
 Active immunization is :administering a vaccine
or toxoid to stimulate the immune system to
produce a prolonged humoral and/or cellular
immune response.
 Passive immunization is: administration of
preformed antibodies to induce transient protection
against an infectious agent.
Definition continued
 Active or passive immunization can be achieved by
natural or artificial ways.
 Natural :
 An individual makes his/her active natural immunity
after he /she had the disease.
 An individual gets a natural passive immunity following
trance placental transfer of antibodies.
 Artificial :
 An individual makes his/her active artificial immunity
after given a vaccine.
 An individual gets his/her passive artificial immunity
after given an immunoglobulin.
Definition continued
 The immediate goal of immunization is to
prevent disease in individuals but the ultimate
goal is to eliminate or eradicate a
communicable disease.
 Immunization is one of the most beneficial
and cost-effective disease-prevention measures.
 As a result of effective and safe vaccines,
smallpox has been eradicated.
Active immunization
 Vaccines: are defined as whole or parts of
microorganisms administered to prevent an
infectious disease.
 Types of vaccines:
 live-attenuated vaccine: a virulent organisms is
weakened to produce antigenic response without
causing serious infection. (e.g measles, mumps,
rubella, varicella, rotavirus , OPV, BCG ).
Whole killed or inactivated vaccine:
( e.g. pertussis,polio(IPV), HepA,ingectable
typhoid )
Vaccines containing parts of the organism (e.g.,
acellular pertussis, HPV, and HepB),
Vaccines continued
Toxiods :a modified bacterial toxin that is made nontoxic
but is still able to induce an active immune response
against the toxin.(e.g tetanus and diphtheria).
Conjugate vaccines: polysaccharide capsules conjugated
to protein carriers to enhance its immunogenicity.
(e.g., Hib, pneumococcal, and meningococcal conjugate
vaccines).
 Immunizing agents can contain a variety of other
constituents such as Suspending fluids , Preservatives,
stabilizers, and antimicrobial agents are used to inhibit
bacterial growth and to prevent degradation of the
antigen.
Commonly used vaccines.
Most developing countries follow the immunization schedules promulgated

by the World Health Organization's Immunization Programme.
Expanded programme of immunization in Ethiopia.
BCG vaccine:
Contains attenuated strains of M bovis.
 Is effective in reducing the likelihood and severity of TBC in children.
Given at birth or 1st week of life
Given in the RT deltoid intra dermally(0.05ml)
Efficacy :ranges from 0-80% for pul TBC average being 50%
50-80% for sever form of TBC like meningitis and miliary
TBC.
Duration of immunity: unknown ,some evidence suggests immunity wanes
after 10-15 yrs.
C/I :child with sever immunodeficiency.
Vaccines continued
 Polio vaccine:
 OPV or sabin( is a live vaccine);used in our setting.
 Contain attenuated polio virus type 1,2 and 3.
 Given orally in three doses at 6,10 and 14 Wks.
 Provides local protection(IgA antibody in GI tract).
 Causes paralytic disease(VAPP)1 case/6.2 million doses
both in recipients and their contacts.
 Efficacy: >90% in industrialized countries.
Factors that decrease efficacy in developing countries
includes loss of cold chain and interference with other
enteroviruses.
 OPV vaccines are no longer licensed in the United
States.
Vaccines continued

Inactivated /killed (salk) polio vaccine:
given by injection.
Does not need freezing
Efficacy is >93 % after two doses.
Not associated with paralytic disease.
Diphtheria vccine:
Is a toxoid prepared by formaldehyde inactivation of
diphtheria toxin.
Is administered IM with tetanus and pertussis(DPT) in
three dose series.
Efficacy :> 87%
Duration of immunity :variable probably around 5 yrs.
Side effects:no significant adverse reaction.
Vaccines continued
Pertussis
 vaccine:
killed whole vaccine.
Given IM with DPT in 3 doses series.

Efficacy: around 80% with 3 doses

Duration of immunity :unknown but it wanes over

time may be 3-5 yrs.
Side effects;fever,drousiness, persistent cry,
fever>40, seizure and hypotonia.
C/I: encephalopathy within seven days of

administration DPT.
Vaccines continued
Tetanus vaccine:
 Is inactivated toxin with formaldehyde.
 Given IM with DPT in three doses.
 Vaccine efficacy :>90% with two doses.
 Duration of immunity:5yrs after primary series.
 Booster doses should be given every 5-10yrs.
 Side effect: safe preparation. Rare side effects
includes anaphylaxis ,GBS and brachial
neuritis.
Vaccines continued
Measles vaccine:
 Is a life attenuated vaccine.
 Given subcutaneously in the left deltoid at 9
months of age.
 Efficacy:>90% at 12 months and >85% at 9
months(lower efficacy when maternal antibody
presents).
 Duration of immunity: life long.
 Side effects: mild febrile illness or morbilifom
rash,febrile convulsion.
 C/I : immunodeficiency and pregnancy.
Vaccines continued
Heamophilius influenzae type b vaccine:
 Is a polysaccharide conjugate vaccine.
 Hib polysaccharide conjugated to diphtheria to
tetanus toxiod or to an outer membrane protein
complex of Neisseria meningitis group B.
 Administered in intramuscular at 6,10 and 14Wks.
 It is virtually free of side effect.
 Efficacy : ≥95 percent against invasive Hib disease
after completion of the two- or three-dose.
Vaccines continued
Pneumococcal vaccine:
 Is a polysaccharide conjugate vaccine.
 It contains a polysaccharide of 10 serotypes of
pneumococcus (10-valent vaccine ) conjugated to carrier
protein, tetanus and diphtheria toxin.
 It is given intramuscular in children <2yrs of age at 6,10
and 14 Wks.
 Efficacy: decrease infection caused by the serotype by
60-70%
 Side effect :rarely injection site hematoma, fever and
rash.
Vaccines continued
Hepatitis B vaccine:
 Contains a purified inactive sub-unit of the virus.
 Given intramuscular at 6, 10 and 12Wks.
 Efficacy: 85% effective in preventing perinatally
acquired infection and 80-95%effective in
preventing postnatally acquired infection .
 Infants born from HbsAg positive mother should
receive the vaccine at birth ,1-2 months and at 6
months.
Vaccines continued
Rota virus vaccine:
 Is al life a attenuated vaccine.
 is a monovalent vaccine derived from the most common
human rotavirus serotype(G1P stains) .
 is administered orally in two doses at 6 and 10 wks.
 It should be given to children who have had rotavirus
gastroenteritis before. Two-dose series has to be given because
the initial infection frequently provides only partial immunity.
 Side effect:vomiting,diarrhea,rhinorhea
 C/I: anaphylactic RXN, history of intussusception after 1 st
dose and immunodeficiency.
 Efficacy: efficacy against gastroenteritis caused by G1P
strains was 92 %.
Precaution and recommendation
A general
 contraindication for all vaccines is anaphylactic reaction
to a prior dose.
Anaphylactic hypersensitivity to vaccine constituents is also a

contraindication
Live vaccine should not be given to immunodeficient children.

Administration of life vaccine should be delayed for at least six

weeks when there recent administration of immunogobulin.
Vaccines usually should be deferred in children with moderate to

severe acute illnesses, regardless of the presence of fever, until the
child recovers.
Simultaneous administration of multiple vaccines generally is safe

and effective
In events of an epidemic or high risk measles vaccine can be given

at 6 month.
Thank you