Immunity of human body and vaccines

1. Immunity:
It is the ability of the body to recognize, destroy
and eliminate the external antigenic material
foreign to it.
Types:-
1. Active immunity
a. Humoral immunity
b. Cellular immunity
c. Combination of the above
2. Passive immunity
a.Normal human Ig
b.Specific human Ig

2. Antigen: These are molecules that
reacts with antibodies
Antibody: These are globulin protein
(immunoglobulin) that react specifically
with the antigen that stimulated their
production.

3. Humoral immunity: It comes from B-cells( Bone
marrow derived lymphocytes) which proliferate &
manufacture specific antibody like IgG, IgM, IgA,
IgD, & IgE.
These antibodies are specific & that is why they
react with the same antigen which provoked their
production.
These antibodies neutralize the microbes directly
or render the microbes susceptible to attack by
polymorph nuclear leucocytes & monocytes.

4. Cellular immunity:-It is mediated by T-cells.
T-cells does not produce antibody but
recognize the antigen.
It initiates a chain of reaction i.e. activation
of macrophage, release of cytotoxins.
Thus it performs phagocytic action on M.
tuberculosis, M. leprae organisms.

5. How active immunity is developed?
• Following clinical infection i.e. Chicken pox
• Following sub clinical infection i.e. polio
• Following immunization with an antigen i.e.
vaccine or toxoid. (viva)

6. How passive immunity is acquired?
• By administration of an antibody : Ig or anti-
serum (VIVA)
• By transfer of a maternal antibody across the
placenta. i.e. Ig A through human milk.
Immune response:
Primary response: IgM antibody appears first
after a latent period of induction of 3 to 10 days
> steadily rises next 2to 3 days or more then
declines as fast as it developed.

7. IgG appears next. It reaches peak within 7 to 10
days , then gradually declines. The antigenic dose
required for induction of IgG is about 50 times that
which is required to induce IgM antibody
ACTIVE immunity PASSIVE immunity
1) Immunity slowly established 1) Rapidly established
2) Long protection 2) Short protection
3) High efficacy of protection 3) Lower efficacy of
protection
4) Less expensive 4) More expensive
5) Education to RE system 5) No education to RE

8. Herd immunity: - It is level of resistance
of a community or group of people to a
particular disease.
Herd immunity provides an
immunological barrier to the spread of
disease in human herd.

9. A herd structure is not constant due to new
birth, death and population mobility.
It includes not only human hosts but also
animal hosts and insect vectors as well as
environment and social factors that are
responsible for the spread of disease.

10. Herd immunity depends on
•Occurrence of clinical & sub clinical
infection in the herd
•Immunization of the herd
•Herd structure

11. If an infection occurs in virgin population
herd immunity is build up following it.
If there is increased herd immunity the
occurrence of epidemic is highly unlikely.

12. VIVA: How elimination of disease is possible?
If a high level of immunity is maintained &
stepped-up it by
ongoing immunization program to the point
where susceptible persons are reduced to a
small proportion of population, it may lead
to elimination of disease in due course.

13. IMMUNIZING AGENTS
A) Vaccines B) Immunoglobulin C) Antiserum
A) Vaccines:-
1) live attenuated: BCG, Oral polio, MMR.
These vaccines are prepared by repeated
passage of organism in tissue culture or
chick embryo. (Viva)

14. 2.Inactivated or killed: Typhoid, Rabies,
Hepatitis B, Salk polio.
3.Toxoid: Exotoxins of diphtheria & tetanus
are detoxicated & used in the preparation
of vaccines. This antibody neutralizes the
toxin moity of the organism rather than act
upon it.
4.Cellular fraction: Meningococcal
vaccine, Pneumococcal vaccine, hepatitis B
5. Combination: Polyvalent (Polio+Influenza)
Pentavalent ( DPT+Hepatitis B + Hib), MR
(Measles + Rubella).

15. Mode of action of live vaccine:
1.Multiplication: It increases the
antigenic dose.
2.Have all major and minor antigenic
components
3.It engages certain tissue of body
i.e. Polio

16. Contraindication of Live vaccine:
•Person with immunodeficiency diseases i.e.
AIDS
•Decreased immune response due to
leukemia, lymphoma, malignancy and
radiation
•Pregnancy

17. VIVA: Advantage of combined
vaccine?
2.Low cost
• Simple to administer
3.Minimum number of contact of the
patients with the health system.

18. VIVA: Live vaccine……..3 weeks
apart……….Live vaccine.
VIVA: Difference btw live & killed vaccine
Immunization is achieved by single dose of live
vaccine
except polio,
in contrast killed vaccine requires series of
doses
(booster) to produce adequate antibody
response.

19. B)Immunoglobulin:-
Human: a) Normal: Hepatitis A, MMR
b) Specific: Hepatitis B, Diphtheria
Non-human: Diphtheria, Rabies, Tetanus
C) Antisera/antitoxin: It is applied to material prepared
in animals (non-human source).
Antiserums prepared from non-human source are
tetanus, diphtheria, botulism, gas gangrene, snake
bites etc.

20. IgM: It comprises 10% of the total IgGs.
It is the antibody which appears promptly
with exposure to antigen thereby
indicates recent infection. (VIVA).
It has high agglutinating and compliment
fixing ability.
It does not cross placenta but neutralizes
virus.

21. PASSIVE IMMUNIZATION
IMMUNOGLOBULINS (IgGs):
The human immunoglobulin system is
composed of 5 major classes( IgG, IgM,
IgA, IgD, IgE) and their subclasses.

22. IgG: It comprises 75% of the total serum
immunoglobulin.
It is the only class of IgGs which crosses
placenta.
It fixes with compliment & neutralizes
viruses.
It is found in tissue fluid.

23. IgA: It constitutes 15% of the total serum IgGs.
It is found in the body secretions i.e. saliva, milk,
colostrums, tears, bronchial secretion, prostatic fluid
and vaginal secretion.
It provides primary defense mechanism at the
mucous membrane against local infection.
It does not cross placenta, nor fix with compliments
and does not neutralize virus.

24. IgD: It is found in serum in minute amount.
It does not cross placenta & does not
neutralize virus.
IgE: It is also found in minute amount
(0.1mg/dl). It’s functional property is as
same as IgA. It is the major antibody
responsible for immediate allergic
anaphylactic reaction (VIVA).

25. Use of immunoglobulin:-
Normal Ig:
• To prevent measles
• To provide temporary protection (up to 12
months) against hepatitis -A for travelers
and to control household and institutional
outbreak.
Specific Ig: It is 5 times potent than normal
Ig.
• For chicken pox prophylaxis
• Post exposure prophylaxis for hepatitis B
and rabies.

27. EPI schedule has 10 preventable diseases vaccine:
1. Childhood Tuberculosis
2. Polio
3. Diphtheria
4. whooping cough
5. Tetanus
6. Hepatitis B
7. Hemophilus Influenza type b, Pneumonia &
meningitis
8. Measles
9. Rubella
10.Pneumococcal Pneumonia

28. Targeted People :
0-11 Months old all babies
15th-Month-old babies
15 years old all girls
15-49 years all child-bearing females

29. Polyvalent versus pentavalent vaccine:
Pentavalent vaccine: More than one kind of
immunizing agent is included in one vaccine.
Polyvalent vaccine: Vaccine which is prepared from
two or more strains of the same specie

30. Left Out :
A child or a woman, who has not taken any vaccine,
even for which he/she is eligible, is known as Left Out
Vaccine.
Vaccine Dropout :
Dropout is defined as a child or a woman who failed to
return for subsequent doses of immunizations for which
he/she is eligible.

33. NID
National immunization day
It is the nationwide vaccination program started in
Bangladesh since 1995.
Schedule:
•2 doses of OPV given to all <5 children in the
country with an interval of 1 month without
accounting their previous vaccination status
•Two doses are given in 2 rounds of 1 month apart
•1 cap. High dose vit. A(2 lac) given to children >1
year age in the 2nd round

34. After completion of 1st day of NID next 3-5
days are spent for child to child search to
vaccinate the drop out children.
It is a widely practiced multisectoral approach
Aims & objectives of NID:
•Interruption of polio transmission
•Achievement & maintenance of high
immunization coverage

35. •Reporting and investigating of all AFP cases
•Supplementary administration of polio vaccine
Role of NID in polio eradication:
•Repeated vaccination enhances achievement
& maintenance of high immunization coverage
•Vaccine virus takes the upper hand rather
than wild polio virus, so interruption of polio
transmission occurs

36. •Herd immunity develops which prevents
further transmission
•Routine coverage of polio in our country and
also the border with the neighboring countries
are still burning question for us. So NID has a
great role in polio eradication.
•AFP surveillance can be done through NID

37. 1.Interruption of polio transmission
2.Achievement & maintenance of high
immunization coverage, Reporting &
investigating all AFP cases.
3.Supplementary administration of polio
vaccine
Aims & objectives of NID

38. COLD CHAIN
Def.:- It is the system of storage and transport of
vaccine at optimum cold temperature from the l
manufacture site to actual vaccination site.
Preservation: Polio & measles are kept in
freezer part(-15 to -25 degree C).
DPT, Typhoid, TT, BCG and diluents are kept in
cold part( +2 to +8 degree C).

39. Cold chain equipments:-
1.WIC( Walk in cold room):- At regional where
vaccines are preserved for 3 months.
2.Deep freezer(300) with ILR(300/240):-
• To prepare ice pack
• To store OPV, Measles at district and regional
levels(-15 to -25 degree C)

40. 3. Small deep freezer & ILR (140 liter):- Widely
used in Upazilla level.
Use: To prepare ice pack
TT, DPT, DT, HBV vaccines are kept in a
basket without touching the floor.
4.Cold Box:- To carry vaccines from district to
upazilla, and upazilla to vaccination site.

41. 5. Vaccine carrier:- To carry vaccines to out
reach stations.
6. Ice pack:- To maintain the optimum
temperature in cold box and in vaccine carrier
7. Dial thermometer:- It is used in ILR to record
internal temperature

42. Vaccines National District Upazilla Vac. site
DPT/TT/
BCG
+2 to +8
deg c
+2 to +8
deg c
+2 to +8
deg c
+2 to +8
deg c
OPV/
Measles
-15 to -
25 deg
C
-15 to -
25 deg
C
+2 to +8
deg c
+2 to +8
deg c
Pentavalent +2 to +8
deg c
+2 to +8
deg c
+2 to +8
deg c
+2 to +8
deg c
Storage
time
12
months
3 months 1 month 1 day

43. Complications of vaccination:
1.Reaction at the inoculation site:-
Pain, swelling, redness, cold nodule and sterile
abscess.
2. Reaction due to faulty technique:-
a) Faulty vaccine production i.e inadequate
detoxication.
3.Increased dose of vaccine i.e 0.5 ml>>>>1 ml.
4.Inappropriate vaccination site. OPV>>> IM

44. b) Faulty dilution of vaccine
c) Contamination of the diluents
d) Incorrect storage of vaccines
e) Contraindication ignored
3. Hypersensitivity reaction:- Bronchospasm,
dyspnoea, pallor, low BP, collapse.
4. Neuralgic involvement:- GBS by swine flu
vaccine, encephalitis and encephalopathy by
ARV vaccine.

45. 5. Provocative reaction:- polio caused by
diphtheria vaccine which induces
Latent polio virus>shortening of incubation
period>clinical infection
6. Others: Fetal damage by rubella vaccine

46. Contraindications to vaccination
• Vaccines are very rarely contraindicated.
However, it is important to check for
contraindications to avoid serious reactions. For
example, vaccines are contraindicated if there
is serious allergy to the vaccine or its
components. Live vaccines should not be given
to immune-deficient children.
• The main contraindication to the administration
of vaccines are summarized in Table.

47. vaccine Contraindications
All An anaphylactic reaction' following a previous
dose of a particular vaccine OR, Current serious
illness.
Live vaccines
(MMR, BCG,
yellow fever)
Pregnancy.
Radiation therapy (i.e. total-body radiation).
BCG, Symptomatic HIV infection
Pertussis-containing anaphylactic reaction' to a previous dose.
Evolving neurological disease (e.g. uncontrolled
epilepsy or progressive encephalopathy). Vaccines
containing the whole-cell pertussis component
should not be given to children with this problem.

48. Adverse events following
immunization(AEFI):
“AEFI is any untoward medical occurrence
which following immunization and which does not
necessarily have a causal relationship with the
usage of vaccine”.
1. Vaccine reactions
a. Vaccine product- related reactions.
b. Vaccine quality defect–related reaction
2. Immunization error related reactions
3. Immunization anxiety related reactions
4. Coincidental events

49. 1.Vaccine reactions:
1.Vaccine product- related reactions:
vaccine product-related reaction, is a reaction in an
individual's response to the inherent properties of the
vaccine, even when the vaccine has been prepared,
handled and administered correctly.
2.Vaccine quality defect–related reaction:
is the defect in a vaccine that occurred during
manufacturing process including its administration
device.

50. 1.Vaccine reactions
Common, minor vaccine
reactions:
a) Local reactions:
• Pain
• Swelling
• Tenderness, redness
• Small nodules(BCG)
• Sterile abscess
b) Systemic reactions:
• Fever
• Malaise
• Headache & other
constitutional symptoms
Rare or more serious vaccine
reaction :
• Anaphylaxis ,
• Seizures,
• Thrombocytopenia,
• Hypo responsive episodes,
• Encephalopathy
(DPT/measles /MR)

51. 2. Immunization error related reactions
1.Error in vaccine handling:
* Exposure to excess heat or cold as a result of inappropriate
transport, storage or handling of the vaccine (and its diluent)
* Use of a product after the expiry date.
2.Error in vaccine prescribing or non-adherence to
recommendations for use:
* Failure to adhere to a contraindication.
* Failure to adhere to vaccine indications or prescription (dose or
schedule).
3.Error in administration:
* Use of an incorrect diluents
* injection of a product other than the intended vaccine.
* Incorrect sterile technique or inappropriate procedure
* Infection at the site of injection.

52. 3. Immunization anxiety related
reactions:
Individuals and groups can react in anticipation to
and as a result of an injection of any kind. This
reaction is unrelated to content of the vaccine.
Fainting is relatively common after immunization
of adults and adolescents, but very rare in young
children. It is managed by simply placing the
patient in a recumbent position.

53. 4. Coincidental events
Occasionally following immunization there may occur a
disease totally unconnected with the immunizing agent.
Vaccines are normally scheduled early in life, when
infections and other illnesses are common, including
manifestations of an underlying congenital or
neurological condition. The mechanism seems to be that
the individual is harboring the infectious agent and the
administration of the vaccine shortens the incubation
period and produces the disease or what may have
been otherwise only a latent infection is converted into a
clinical attack.

54. Anaphylaxis: Diagnostic features of anaphylaxis
a) Respiratory :
Airway: Throat and tongue swelling , Hoarse voice. Stridor.
Breathing: Bronchospasm, Respiratory distress, Grunting, Respiratory arrest .
b) Cardiovascular: 1.Hypotension
2.Shock-indicated by the combination of at least three of the
following; Tachycardia
Capillary refill time >3 seconds
Reduced central pulse volume
Decreased level of consciousness or loss of consciousness
3. Bradycardia
4.Cardiac arrest
c) CNS: Confusion/Agitation , Headache, Loss of consciousness
d) Dermatologic or mucosal: 1.Tingling of lips
2. Generalized urticaria or generalized erythema
3. Angioedema, localized or generalized
Treatment:Inj. Adrenalin(1:1000), 0.5 ml IM followed by 0.5ml every 20
min till SBP<100 mm hg
•Inj. Chlorpheniremine 10-20 mg IM
•Inj. Oradexon I/M

55. Disinfection :
Thermal or chemical destruction of pathogen and
other types of microorganisms. Disinfection is less lethal than
sterilization because it destroys most recognized pathogenic
microorganisms but not necessarily all microbial forms
(e.g.bacterial spores).
Sterilization:
Validated process used to render a product free of
all forms of viable microorganisms including bacterial spores.
Sterilizer is the apparatus used to sterilize medical devices,
equipment or supplies by direct exposure to the sterilizing agent.
Antiseptic:
Substance that prevents or arrests the growth or
action of micro-organisms by inhibiting their activity or by
destroying them. The term is used especially for preparations
applied topically to living tissue.

56. Type of disinfection:-
a)Concurrent:- Urine, feces, vomit, contaminated linens.
b) Terminal:- Airing and sunning of the rooms, furniture
and bedding.
c) Precurrent:- water by chlorine, pasteurization of milk,
hand washing

57. Agents of disinfection:-
1)Natural:- sunlight, air
2) Physical:- Burning, hot air, boiling, autoclaving,
radiation
3) Chemical:- Phenol, dettol, savlon, bleaching powder,
formaldehyde.

58. How to sterilize?
•Hospital wards and O.T:- by U-V radiation
•Surgical instruments, dressing, gloves,
culture media:- By autoclave.
•Bed pan, urinals, linen:- By boiling for 30
mints, chlorine.

59. Swab, contaminated dressing, faeces:- By
burning
Floor moping:- by 5% crude phenol
Sharp instruments:- Dettol for 15 mints.
Mattress & pillow:- Incineration

60. Disinfect Sterilize
Definition To disinfect means to eliminate most harmful
microorganisms (not including their spores)
from surfaces or objects;
inactivate viruses.
To sterilize means to kill ALL
microbes - whether harmful
or not - and their spores
present on a surface or
object.
Methods Phenolic disinfectants, heavy metals,
halogens (e.g. chlorine), bleach, alcohols,
hydrogen peroxide, detergents, heating and
pasteurization.
Heat, chemicals, irradiation,
high pressure, and filtration.
Types Air disinfectants, alcohols, aldehydes,
oxidizing agents, phenolics.
Steam, heating, chemical
sterilization, radiation
sterilization, sterile filtration.

61. Fumigation:
It is a process of gaseous disinfection by using
formaldehyde in the form of vapor.
Uses:
1) Disinfection of operation theatre (OT) and hospital
ward.
2) Disinfection of books, shoes, leather goods, silk,
woolen cloths, toys etc.
3) Also used as insecticide e.g. killing of mosquitoes,
flies, lice etc.
Condition of the room: For efficient fumigation, the
temperature of the room should be around 70°F and
humidity should be around 75%

62. Incineration:
Incineration is a high temperature dry oxidation process,
that reduces organic and combustible waste to inorganic
incombustible matter and results in a very significant
reduction of waste volume and weight.
Use:
The process is usually selected to treat wastes that
cannot be recycled, reused or disposed off in a land fill
site. Hospital refuse which is particularly dangerous is
best disposed by incineration.

63. Autoclave:
Sterilizers which operate at high temperatures (in excess of
100°C) and pressure are called autoclaves.
Types of autoclave: They fall into two categories -- 1) Double
chamber autoclave &
2) Single chamber autoclave
Time, temperature & pressure used in autoclave:
121°C temperature under 15 lbs/sq inch pressure for 15 minutes.
Uses of autoclaving:
Autoclaving is widely used in hospital and laboratory practice.
Destroys all forms of organisms including spores.
Most effective method for sterilization of linen, dressings, gloves,
syringes, blunt surgical instruments and culture media.
Not suitable for sterilization of plastics and sharp instruments.

64. Pasteurization of milk
Def.:- It may be defined as the heating of milk
to such a temperature and for such a period
of time as required to destroy any pathogen
that may be present with causing minimum
changes in composition, flavor and nutrition
value.

65. Mechanism
Methods Temperature Duration Cooled at
1) Holder 63-66 deg.C 30 min 5 deg.C
2) HTST 72 deg. C 15 sec 4 deg.C
3) UHT 125 deg. C Few sec Rapid

66. Importance:-It kills 90% of the bacteria.
Why cooled rapidly at 4 deg. C?
Because increased rise of temperature
enhances multiplication of bacteria.