Immunization

Definition
• Immunization: A process by which a person
becomes protected against a disease through
vaccination.
• A process of inducing immunity artificially by
either
• Vaccination(Passive)-administration of
Antibodies
• vaccination(Active) - administration of any
vaccine or toxoid for prevention of disease
 National Immunization Implementation
Guideline
• The Ethiopian immunization implementation
guideline has been revised in 2015.
• Children of <1year of age and women of
reproductive age group (15-49 years age) are
the targets for the currently available EPI
vaccines in Ethiopia i.e
• (BCG, Measles,DPT-HepB-Hib or penta- valent,
Rotavirus, Pneumococcus vaccine (PCV), OPV
and TT).
• Moreover, it is directed in the implementation
guideline to introduce
-Inactivated Polio Virus (IPV),
-measles-rubella,
-meningitis and yellow fever vaccines for less
than one year children and
-Human Papilloma Virus (HPV) and Td
vaccines between 2015 to 2019.
• Ethiopia's Expanded Programme for
Immunization (EPI) aims to administer 11
different antigens to the more than 3 million
infants born in the country each year.
• Vaccines are administered routinely at almost
20,000 health facilities throughout the
country.
Passive & active immunity
 The ideal vaccine ….
• Is affordable & accessible to all
• Is immunogenic and protective
• Provides long-lasting protection
• Does not require frequent boosters
• Has an acceptable reactogenicity profile
• Can be integrated into EPI
• Is stable in field use
 Benefits of vaccination
• Reduces morbidity & mortality
• Is a cost-effective intervention
• Protection of the individual
• Protection of communities (herd immunity)
• Control of disease
• Elimination of diseases
• Eradication of disease & the pathogen
 Types of vaccines: three groups
• Immunizing agents:
- Could be: intact-organisms, Toxoids, Antigens,
Abs/Igs…
• live-attenuated vaccines
• polio Sabin (OPV), measles, mumps, Rubella, varicella,
yellow fever,
• BCG, cholera, oral typhoid fever ….
• killed, inactivated vaccines
• polio Salk (IPV), hepatitis A, whole cell pertussis (Pw),
Influenzae, Rabies, Injectable typhoid fever ….
 Types of vaccines…
• sub-unit vaccines.
• diphtheria, tetanus, pertussis toxoids
• purified acellular pertussis (Pa) components
• HBsAg, HPV, malaria
• polysaccharides (Vi, Men, Pneumo)
• conjugated polysaccharides (Hib, Men, Pneumo)
• split or sub-unit influenza vaccines H1N1, H3N2
(H5NI)
• Combined vaccines
• DTPw-HepB (Tetra); DTPw-HepB/Hib (Penta)
• DTPw-HepB/Hib-MenAC (Hepta)
• DTPa-HepB-IPV/Hib (Hepta)
• Hib-MenC; Hib-MenCY; Hib-MenAC(W?)
• Men ACWY polysaccaride vaccines
• MenACWY conjugate PS vaccines
• HepA/Vi; HepAHepB ….
 Type of vaccine
• Inactivated vaccines
• Live-attenuated vaccines
• Messenger RNA (mRNA) vaccines
• Subunit, recombinant, polysaccharide, and
conjugate vaccines
• Toxoid vaccines
• Viral vector vaccines
 a. Live-attenuated vaccines
• Live vaccines use a weakened (or attenuated)
form of the germ that causes a disease.
• vaccines are so similar to the natural infection
,they create a strong and long-lasting immune
response.
• Just 1 or 2 doses of most live vaccines can give
you a lifetime of protection against a germ and
the disease it causes.
• Live vaccines are used to protect against:
• Measles, mumps, rubella (MMR combined
vaccine)
• Rotavirus
• Smallpox
• Chickenpox
• Yellow fever
 Live-attenuated…
Disadvantages
• may retain some pathogenicity Or
• may revert to virulence.
• It’s not infrequent to actually get a weakened
disease pattern in a small proportion of
vaccinees.
• may not be safe enough to vaccinate highly
immuno-compromised subjects
• Require a good cold chain
 Live-attenuated…
Advantages
• mimic natural infection; that is
it replicate & highly
immunogenic
• produce a large antigenic
stimulus
• generally induce T&B
lymphocyte responses
• provide long-lasting protection
• Inactivated vaccines use the killed version of
the germ that causes a disease.
• Inactivated vaccines usually don’t provide
immunity (protection) that’s as strong as live
vaccines.
• So you may need several doses over time
(booster shots) in order to get ongoing
immunity against diseases.
 Killed, inactivated…
Disadvantage
• often less effective than live-attenuated
vaccines
• several doses needed for long-term protection
(boosters)
• repeat administration may increase
reactogenicity
• limited production capacity & higher price
(costy)
• Inactivated vaccines are used to protect
against:
• Hepatitis A
• Flu (shot only)
• Polio (shot only)
• Rabies
 c. Sub-unit vaccines

• Sub-unit vaccines are vaccines that contain only part

or parts of a pathogenic micro-organism.
• Toxoids are some of the most successful sub-unit
vaccines.
• It is a bacterial exotoxin that has been chemically
modified to make it harmless, without destroying its
antigenic properties.
• If this response is important in preventing disease, it
may be possible to extract, purify and use this
antigen in a vaccine.
 Subunit, recombinant, polysaccharide, and
conjugate vaccines

• These vaccines use only specific pieces of the germ(like

its protein, sugar) they give a very strong immune
response that’s targeted to key parts of the germ.
• They can also be used on almost everyone who needs
them, including people with weakened immune systems
and long-term health problems.

• One limitation of these vaccines is that you may need

booster shots to get ongoing protection against diseases.
• These vaccines are used to protect against:

• Hib (Haemophilus influenzae type b) disease

• Hepatitis B
• HPV (Human papillomavirus)
• Whooping cough (part of the DTaP combined vaccine)
• Pneumococcal disease
• Meningococcal disease
• Shingles
• Toxoid vaccines are used to protect against:

• Diphtheria
• Tetanus
 Viral vector vaccines

• For decades, scientists studied viral vector

vaccines.
• Some vaccines recently used for Ebola
outbreaks have used viral vector technology,
and a number of studies have focused on viral
vector vaccines against other infectious
diseases such as Zika, flu, and HIV.
• Scientists used this technology to make
COVID-19 vaccines as well.
 Vaccine administration: route
• Vaccines are usually given by injection.
• Sc: Most live-attenuated viral vaccines or non-
adjuvanted vaccines
• Im: Adjuvanted and sub-unit, combined
vaccines
• antero-lateral muscle of the thigh in babies
(Infants)
• deltoid muscle of the upper arm in older
subjects.
• Id: BCG tuberculosis vaccine is injected.
• Oral: Sabin polio, live-attenuated typhoid fever
• Never to the buttocks because tend to be deposited
in fat layers which reduces their immunogenicity.
• Never Iv: There is a serious risk of a severe reaction
if antigens were to be administered directly into the
blood stream.
• Adrenalin or epinephrin solutions should always be
readily available in case of rare anaphylactic
reactions.
 General considerations
• Immediate goal of immunization is to prevent
disease in individuals
• Ultimate goal is to eliminate/eradicate a
communicable disease, such as crippling
deformity(eg; Polio)
• minimum interval b/n each schedule is 4weeks
• If a vaccine is given before 4wks of the previous
dose, it shouldn’t be counted as part of the series
• even if months have lapsed b/n doses, just
complete the course
• Longer than recommended intervals b/n doses
do not reduce final antibody concentration
• in a child who have not been vaccinated during
infancy and still below 5 years of age, vaccinate
as
• BCG once(if PPD is negative)
• DPT & OPV today, after 4ks and 6th month.
• No antibody interference with BCG, b/c protection of TBC depends
on cell-mediated immunity so that BCG can be given at birth.
• Antibodies from mother will circulate in the blood of infant up to
3-4months of age & if vaccine is given before 1month of age, the
antigens will be neutralized.
• Though concentration variably decreases, Antibodies against
measles persist unto 9-12months of age
• Premature babies are vaccinated like other babies b/c response to
antigens is dependent on postnatal age not gestational age.
• If mother is positive for HBsAg, HBV1 should be given at birth & if
possible with IG & HBV2, HBV3 at 1month, 4 – 6 month
respectively.
• All EPI antigens are safe & effective if
administered simultaneously (give at different
sites on the same day)
• If 2 live vaccines are not given on the same
day in different sites, there will be problem of
interference so that they should be spaced at
least 4wks apart
• Live vaccines shouldn't be given to severely
immunocompromised children
• Deep injection and massage may reduce
antigenic efficacy
• Pertussis vaccine is not recommended after
the age of 6years
• Even if a child has paralysis due to polio,
he/she should be vaccinated to prevent other
2types of polio
• Even if there was previous disease, tetanus,
the child should be vaccinated since disease
doesn’t confirm immunity.
 Vaccine efficacies
• BCG : Effective in decreasing the liklihood and severity
of Tuberculosis
• pulmonary 0 – 80%
• sever Tbc 75-90%
• Tetanus : 85-95% (neonatal tetanus : 80% by TT2)
• Diphtheria toxoid : 80-90%
• pertussis : 80%
• Measles : 85%
• HBV : 85% in perinatally, & 80-95% effective in
postnatally acquired infections respectively.
 Adverse reactions
• local reactions
• pain at injection site, redness
• swelling
• systemic reactions
• fever, malaise ...
• risk of infection due to poor techniques or practices
-Use sterile technique
-Use auto-disposable
 Contra-indications
• Hypersensitivity
-Known hrxn to same vaccine or its component
-B/s another more serous rxn occurs.
-A solution of 1:10000 adrenalin/epinephrin should
always be at hand
• Symptomatic HIV infection (BCG)
• Pregnancy (except for vaccination against
neonatal tetanus)
• High grade fever? 1st be controlled.
 Cold chain
• A network of refrigerators, cold stores,
freezers and cold boxes organized and
maintained so that vaccines are kept at the
right temperature to remain potent during
orders, supplies, transportation, storage,
distribution to the point of administration to
the target population.
• some vaccines are cryostable (stable if frozen)

• some vaccines are cryolabile (unstable if frozen)

• most vaccines are thermolabile (unstable if

exposed to temperatures above +2°C to +8°C)

• some vaccines are more thermostable than

others (DTP > measles > OPV).
 Storage and distribution
• live-attenuated vaccines
• vaccine (but not diluent) can be stored in a
freezer or at +2°C to +8°C
• after reconstitution, use as soon as possible;
discard after 6 hours
or at the end of the session
• Never freeze BCG if the diluent and the
vaccine are packed together

• Freezing causes damage to: DPT-HepB-Hib, TT,

inactivated polio, HepB.
THANK YOU
• Yoseph kumlachew
• josh2ku4@gmail.com
• BSC IN FOOD &Biochemical Tech
• BSC in public Health
• And MBA