PRESENTED BY GROUP 11

Members
Murtaza,Saqib,Faheem,Rehan,Ilyas,ibrahim
 Define immunity ,and its types
 Define immunization, and its types
 Discuss vaccination and its types
 Explain cold chain and hazards of

immunization
 Overview on expanded program of

immunization (EPI).
• Immunity is derived from the Latin word
“immunis”, meaning exemption from military
service, tax payments or other public services
• The ability of an organism to resist a particular

infection or toxin by the action of specific antibodies

or sensitized white blood cells.
Two main types of immunity are:
• Innate immunity
• Adaptive immunity
• Innate immunity is the natural resistances with which a
person is born.
• Innate immunity include

1. Physical and chemical barriers

-skin and mucous membrane
-antimicrobial substance in body secreations
2. The action of WBCs
3. Inflammatory response.
• Usually develops as a result of prior exposure to
an antigen through immunization by or
contracting a disease.
• Weeks or months after exposure to the disease
or vaccine, the body produces an immune
response that is sufficient to defend against the
disease upon re-exposure to it.
 1. Active immunity: Active immunity means
that the individual has responded to an
antigen and produced his own antibodies,
lymphocytes are activated and the memory
cells formed provide long lasting resistance.

 2. Passive immunity: In passive immunity the

individual is given antibodies produced by
someone else
• Immunization is defined as the procedure by which the
body is prepared to fight against a specific disease. It is
used to induce the immune resistance of the body to a
specific disease.
Immunization is of two types:
• Passive immunization
• Active immunization.
 Active Passive
•Killed live or attenuated organism injected •Transfer of
which can induce immune response preformed
•Long term antibodies
•Immune system plays role •Short term
•Ex-Hepatitis B vaccine •No role of immune
•Diphtheria-pertussis(acellular)-tetanus system
(DPaT) •Ex- diptheria
•Inactivated (Salk) polio vaccine (IPV) • Hepatitis A
•Measles-mumps-rubella (MMR) &B
combined vaccine • Measles
•Haemophilus influenzae (Hib) vaccine • Rabies
 Vaccination is a method of
giving antigen to stimulate the
immune response through
active immunization.
 A vaccine is an immuno-biological
substance designed to produce specific
protection against a given disease.

 A vaccine is “antigenic” but not

“pathogenic”.

 Vaccine is a form of Active

immunization
 During the late 1760s whilst serving
his apprenticeship as a surgeon
Edward Jenner learned of the story,
common in rural areas, that dairy
workers would never have the often-
fatal or disfiguring disease smallpox.
 Because they had already had cowpox,
which has a very mild effect in
humans.
 In 1796, Jenner took pus from the
hand of a milkmaid with cowpox,
scratched it into the arm of an 8-year-
old boy. Edward Jenner
 Six weeks later inoculated the boy with smallpox,
afterwards observing that he did not catch smallpox.
 Jenner extended his studies and in 1798 reported that his
vaccine was safe in children and adults.
 The second generation of vaccines was introduced in the
1880s by Louis Pasteur who developed vaccines for
chicken cholera and anthrax.
 From the late nineteenth century vaccines were
considered a matter of national prestige, and compulsory
vaccination laws were passed.
 Live, attenuated vaccines
 Inactivated vaccines
 Subunit vaccines
 Toxoid vaccines
 Conjugate vaccines
 DNA vaccines
 Recombinant vector vaccines
 Live, attenuated vaccines contain a
version of the living microbe that has
been weakened in the lab so it can’t
cause disease.
 Because a live, attenuated vaccine is

the closest thing to a natural infection,

these vaccines are good “teachers” of
the immune system.
 Example: Vaccines against measles,

mumps, and chickenpox

 Scientists produce inactivated vaccines by killing the
disease-causing microbe with chemicals, heat, or
radiation. Such vaccines are more stable and safer
than live vaccines.
 Because dead microbes can’t mutate back to their

disease-causing state.
 Example: Vaccines against influenza, polio, hepatitis

A and rabies.
• Instead of the entire microbe,
subunit vaccines include only the
antigens that best stimulate the
immune system.
• In some cases, these vaccines use
epitopes the very specific parts of
the antigen that antibodies or T
cells recognize and bind to it.

• Example: Plague immunization.

•These vaccines are used when a bacterial toxin is the
main cause of illness.
•Scientists have found that they can inactivate toxins by

treating them with formalin. Such “detoxified” toxins,

called toxoids, are safe for use in vaccines.
•Example: Crotalus atrox toxoid is used to vaccinate dogs

against rattlesnake bites.
 If a bacterium possesses an outer coating of sugar
molecules called polysaccharides, as many harmful
bacteria do, researchers may try making a conjugate
vaccine for it.
 Polysaccharide coatings disguise a bacterium’s

antigens so that the immature immune systems of

infants and younger children can’t recognize or
respond to them.
 Example : Haemophilus influenzae type B vaccine.
 Still in the experimental stages, these vaccines show
great promise, and several types are being tested in
humans.
 DNA vaccines take immunization to a new

technological level.
 These vaccines dispense with both the whole organism

and its parts and get right down to the essentials: the
microbe’s genetic material.
 Example: Influenza vaccine.
• Recombinant vector vaccines are experimental
vaccines similar to DNA vaccines
• But they use an attenuated virus or bacterium to
introduce microbial DNA to cells of the body.

• Example : DPT
 There are two main vaccine manufacturing strategies:
 In-vivo
 In-vitro
 Some vaccines can be produced using any one of the

three methods while for other vaccines, only one

method will work.
 In in-vivo manufacturing, the vaccine
is produced inside a living organism.
 Embryonated Chicken eggs are

commonly used, particularly in

producing flu vaccines.
 Vaccines can also be produced in lab

animals, such as mice.

 There are even some species of plant,

such as bananas, that have been

genetically engineered to produce a
vaccine.
• In this method recombinant DNA
technology is used, vaccines can be
produced in yeast cultures, bacterial
cultures or cell cultures.
Examples are:
• Recombinant vaccines.
• Attenuated virus/bacteria vaccines.
 Deep subcutaneous or intramuscular route (most
vaccines)
 Oral route (sabine vaccine, oral BCG vaccine)
 Intradermal route (BCG vaccine)
 Scarification (small pox vaccine)
 Intranasal route (live attenuated influenza vaccine)
 Short period (months): cholera vaccine
 Two years: TAB vaccine
 Three to five years: DPT vaccine
 Five or more years: BCG vaccine
 Ten years: yellow fever vaccine
 Solid immunity: measles, mumps, and rubella vaccines
 The "cold chain" is a system of storage
and transport of vaccines at low
temperature from the manufacturer to
the actual vaccination site.
 The cold chain system is necessary

because vaccine failure may occur due

to failure to store and transport under
strict temperature controls.
Cold chain equipment consists of the following:
•Icelined-Refrigerators supply to all districts and the

WIC locations to store vaccines.

•Deep freezers are used for making ice packs and to store

OPV and measles vaccines.

•Cold boxes: Cold boxes are supplied to all peripheral

centers. These are used mainly for transportation of the

vaccines.
•Vaccine carriers: Vaccine carriers are used to carry

small quantities of vaccines (16-20 vials) for the out of

reach sessions.
 The CHN have to play major role in maintain cold chain
after vaccines reach the Health Centre.
 Cold chain system is necessary.
 Temperature maintenance e.g polio sensitive to heat and
store at -20C and DPT is sensitive to freezing and stored at
2-8 C.
 Expiry date should be checked.
 Stock vaccine neatly that air can move between the boxes.
 Keep measles and polio vaccines on top shelf near freezer or
in freezer.
 Keep DPT, TT and BCG on the middle shelf.
 Keep the diluents in the refrigerator.
 Keep spare bottles or ice packs in lower shelf .
 No food should ever be kept in this refrigerator.
 Only one person is responsible for daily checking and

recording temperature.
 No immune response is entirely free from the risk
of adverse reactions. The adverse reactions that
may occur may be grouped under the following
heads:

1. Reactions inherent to inoculation

2. Reactions due to faulty techniques
3. Neurological involvement
4. Others
 1. Reactions inherent to inoculation:
 These may be local general reactions.
The local reactions may be
.pain
.swelling
.redness

.tenderness
.nodule or sterile abscess at the site of injection
.fever
.headache
 Typhoid vaccine causes local and general reactions.
 Polio vaccine cause little reaction
 2. Reactions due to faulty techniques:
 Faulty techniques may relate to faulty production of
vaccine (e.g. inadequate inactivation of the
microbe, inadequate detoxication),
 too much vaccine given in one dose,
 improper immunization site or route,
 Use of improperly sterilized syringes and needles
carry the hazard of hepatitis B virus, and staphylo -
and streptococcal infection
 wrong amount of diluents used
 3. Neurological involvement:
 Neuritics manifestations may be seen after the
administration of vaccine.
 Examples
 the post ­vaccinal encephalitis and encephalopathy
following administration of anti -rabies and smallpox
vaccines.
 Guillain­Barre syndrome in association with the hepatitis
B vaccine.

 Others:
 These may comprise damage to the fetus (e.g., with
rubella vaccination);
 A potential problem in mass vaccination against
measles, rubella and mumps).
EXPANDED PROGRAM
ON IMMUNIZATION
(EPI) PAKISTAN
 Global EPI Launched By WHO in MAY 1974.
 With objective of reducing to a negligible level

morbidity & Mortality from Diphtheria, Pertussis,

Tetanus, Poliomyelitis, TB and Measles to make
immunization against these disease available to
every child in the world by 1997.
 Pakistan Started its EPI Programme in June-July

1978 With Help Of WHO and UNICEF.

 Hep B was also inducted in Pakistan Epi in August

2002.
 Then Hib and Pneumococcal Vaccines in 2008.
 In EPI program only Active Immunization is done.

 EPI program has two parts:

o Child Immunization

o Female Immunization
 Vaccination Schedule for Females 15- 45
years (Child Bearing Age - CBA)