Download - Immunization Dr.T.V.Rao
Immunization.Immunization.
Current Trends Current Trends
2007 2007 Dr.T.V.Rao MDDr.T.V.Rao MD
ImmunizationImmunization = = VaccinationVaccination
What is a VaccineWhat is a Vaccine
A vaccine is a substance that is A vaccine is a substance that is introduced into the body to prevent introduced into the body to prevent Infection or a certain PathogenInfection or a certain Pathogen Can be used in bacterial, Viral, Can be used in bacterial, Viral,
Parasitic Infections.Parasitic Infections.
History GuidesHistory Guidesthe Futurethe Future
Edward Jenner Edward Jenner VaccinatingVaccinating
Beginning of VaccinationBeginning of Vaccination..
Vaccination ( Latin ; Vaccination ( Latin ; Vacca- Cow )Vacca- Cow )
Edward Jenner used Edward Jenner used the term the term VaccinationVaccination
Cow pox virus Cow pox virus provided immunity provided immunity in prevention of in prevention of Small poxSmall pox
Scientific Era of Scientific Era of VaccinationVaccination..
Louis Pasteur adopts the Louis Pasteur adopts the principles of principles of VaccinationVaccination
For his scientific work.For his scientific work.
Vaccination for prevention Vaccination for prevention of Rabies creates of Rabies creates awareness on awareness on Immunization with Immunization with scientific fundamentalsscientific fundamentals
Major Principles Major Principles and Methods of and Methods of
VaccinationVaccination
Biological events guide the Biological events guide the
VaccinationVaccination
Major content of Major content of Vaccines Vaccines
1.1. ToxoidsToxoids
2.2. Inactivated vaccines.Inactivated vaccines.
3.3. Attenuated vaccinesAttenuated vaccines
4.4. Subunit vaccinesSubunit vaccines
5.5. Hyper immune globulins.Hyper immune globulins.
What we have achieved What we have achieved withwith
VaccinationVaccination Cost effective method in controlling Cost effective method in controlling
the infectious diseases.the infectious diseases. Small pox - Eradicated.Small pox - Eradicated. Immunization prevents many Immunization prevents many
diseasesdiseases We have created Herd immunity in We have created Herd immunity in
commonly prevalent diseases.commonly prevalent diseases.
Eradication of Small PoxEradication of Small Pox
WHO efforts with WHO efforts with various various
Governmental and Governmental and Social Social
Organizations have Organizations have changed History of changed History of
MedicineMedicine
Principles of Immunization
Development of Immunology Development of Immunology has foundations on Vaccineshas foundations on Vaccines
Different protocols to Different protocols to ImmunizationImmunization
Passive ImmunizationPassive Immunization
Active ImmunizationActive Immunization..
Passive ImmunizationPassive Immunization Passive immunizationPassive immunization Artificially created by passive methodArtificially created by passive method Can be created at short notice,Can be created at short notice, Effective for limited periods,Effective for limited periods,
Antibodies are created in various sources from animals Antibodies are created in various sources from animals to humansto humans
Can be Antiviral ,Antibacterial,Can be Antiviral ,Antibacterial,Source can be Animals, or HumansSource can be Animals, or Humans
Human source will be effective for 3-6 months.Human source will be effective for 3-6 months.Animals ( Heterologus ) effective for few weeks,Animals ( Heterologus ) effective for few weeks,
Passive ImmunizationPassive Immunization
Diphtheria antitoxin - Horse- Equine Diptheriae Diphtheria antitoxin - Horse- Equine Diptheriae antitoxin.antitoxin.
Botulism - Antitoxin Botulism - Antitoxin Tetanus – Antitoxin. – Equine Tetanus – Antitoxin. – Equine
Human Tetanus Immunoglobulin,Human Tetanus Immunoglobulin,
Pooled Immunoglobulins Pooled Immunoglobulins
Human Normal Immunoglobulin Human Normal Immunoglobulin Used for short term prophylaxis,Used for short term prophylaxis, Eg Hepatitis A Immunoglobulin,Eg Hepatitis A Immunoglobulin,
Passive ImmunizationPassive ImmunizationHighly Successful Highly Successful
Saves in Acute InfectionsSaves in Acute Infections
Diphtheria AntitoxinDiphtheria Antitoxin
Tetanus AntitoxinTetanus Antitoxin
Rabies Hyper immune Rabies Hyper immune Globulins( HRIG )Globulins( HRIG )
Varicella Zoster Hyper Immune Varicella Zoster Hyper Immune Globulins (HZIG)Globulins (HZIG)
Active Active ImmunizationImmunization..
Most Ideal, Cost effective, method Most Ideal, Cost effective, method to prevent communicable to prevent communicable
Diseases.Diseases.
Active Immunization with Active Immunization with ToxoidsToxoids
Types 1Types 1
Toxoids - Single Toxin Modified Toxoids - Single Toxin Modified
Preserves Antigenicity,Preserves Antigenicity,
Loses its Toxicity.Loses its Toxicity.
Eg 1 Tetanus Toxoid Eg 1 Tetanus Toxoid
2 Diphtheria Toxoid2 Diphtheria Toxoid
Active ImmunizationActive Immunization
Inactivated / Killed Inactivated / Killed VaccinesVaccines,,
Microbes are killed Microbes are killed
Eg 1 Pertusis , (Whooping cough )Eg 1 Pertusis , (Whooping cough )
2 Influenza ( Flu) 2 Influenza ( Flu)
3 Salk - Killed vaccine for 3 Salk - Killed vaccine for
(Poliomyelitis) ,(Poliomyelitis) ,
Active ImmunizationActive Immunization
Attenuated Live vaccineAttenuated Live vaccine Inactivation destroys pathogen city,Inactivation destroys pathogen city,
Protective immunity is retained Protective immunity is retained
Contains living organisms with reduced Contains living organisms with reduced virulance,virulance,
1 Live polio vaccines –Sabins,1 Live polio vaccines –Sabins,
2 Yellow fever vaccine 17D strain.2 Yellow fever vaccine 17D strain.
Different Different schedules of schedules of VaccinationVaccinationMay vary from Nation to May vary from Nation to
NationNation
Depends on Geographic, Depends on Geographic, Economic and prevalence of Economic and prevalence of
Specific DiseasesSpecific Diseases
Herd ImmunityHerd Immunity Definition – When most of the People in a Definition – When most of the People in a
community are immune to particular community are immune to particular infection-Natural transmission is inhibited.infection-Natural transmission is inhibited.
Herd Immunity works in infections Herd Immunity works in infections transmitted from person to person only.transmitted from person to person only.
The Mass oral polio vaccine creates a The Mass oral polio vaccine creates a Herd Immunity and protects the SocietyHerd Immunity and protects the Society..
Immunization Immunization SchedulesSchedules
Depend onDepend on
Need,Need,
Efficacy,Efficacy,
Safety,Safety,
Ease of administration,Ease of administration,
Vaccines which Vaccines which Changed the Changed the
History of History of MedicineMedicine
Vaccination for Polio, Tetanus Vaccination for Polio, Tetanus Diphtheria, Pertusis. Rabies Diphtheria, Pertusis. Rabies
Universally acceptedUniversally accepted
Vaccination for Diphtheria, Vaccination for Diphtheria, Tetanus and PertusisTetanus and Pertusis
Triple Antigen ( DTP )Triple Antigen ( DTP ) Contains Toxoids of Diphtheria and Contains Toxoids of Diphtheria and
Tetanus Tetanus Pertusis component Contains whole Pertusis component Contains whole
Cell preparation from Bordetella Cell preparation from Bordetella pertusis.pertusis.
Three Doses given at the interval of 4-6 Three Doses given at the interval of 4-6 weeksweeks
Boosters at Later dateBoosters at Later date
Vaccination for Vaccination for PoliomyelitisPoliomyelitis
A great break through in A great break through in Vaccine ResearchVaccine Research
Millions saved from disabling Millions saved from disabling PolioPolio
Pioneers in Prevention of Pioneers in Prevention of PoliomyelitisPoliomyelitis
Vaccination in Vaccination in PoliomyelitisPoliomyelitis
Vaccination for Poliomyelitis, can be oral or inject able.Vaccination for Poliomyelitis, can be oral or inject able. Sabins – Mixture of 3 types poliovirus1,2,3Sabins – Mixture of 3 types poliovirus1,2,3 Live attenuated vaccine, A oral vaccine colonizes the gut Live attenuated vaccine, A oral vaccine colonizes the gut
produces the local immunity and antibody mediated produces the local immunity and antibody mediated immunity protects , Rarely hazardous,immunity protects , Rarely hazardous,
Salk – vaccine a killed vaccine not used in routine Salk – vaccine a killed vaccine not used in routine immunization schedules. Indiaimmunization schedules. India
Sabin’s live polio vaccine is economical for mass vaccination Sabin’s live polio vaccine is economical for mass vaccination in populous countriesin populous countries
Component of Mass Pulse Polio Immunization programmeComponent of Mass Pulse Polio Immunization programme
Commonly used Commonly used vaccines,vaccines,
MMR VaccineMMR VaccineUsed for the prevention of Used for the prevention of Measles, Mumps, and Rubella.Measles, Mumps, and Rubella.Contains live attenuated strains,Contains live attenuated strains,Given at the age between 12-15 months,Given at the age between 12-15 months,But Measles vaccination is done early in India at 9 But Measles vaccination is done early in India at 9
months.months.
RubellaRubella Rubella Vaccine is given separately to young Rubella Vaccine is given separately to young
womenwomen Given to all sero negative women of child bearing Given to all sero negative women of child bearing
age age
Vaccination for Vaccination for TuberculosisTuberculosis
BCG – Attenuated strains of Bovine BCG – Attenuated strains of Bovine Tubercle Bacilli, ( Bacilli –Chalmette-Tubercle Bacilli, ( Bacilli –Chalmette-Guerin)Guerin)
Efficacy ? But useful in the prevention Efficacy ? But useful in the prevention of Tuberculosis meningitis, and of Tuberculosis meningitis, and LeprosyLeprosy
Given on lateral aspect of arm, at the Given on lateral aspect of arm, at the deltoid insertion deltoid insertion
To be given intradermally,To be given intradermally,
Emerging Emerging VaccinesVaccines
Recently several persons Recently several persons benefited.benefited.
Haemophilus influenzaHaemophilus influenza Type b serotype is capsulated and highly Type b serotype is capsulated and highly
pathogenic,pathogenic, Produces Meningitis,Bacteremias, Epiglottis's.Produces Meningitis,Bacteremias, Epiglottis's. Encapsulated strain b is selected for vaccination.Encapsulated strain b is selected for vaccination. Vaccine contains capsular polysaccharide linked Vaccine contains capsular polysaccharide linked
to a protein and protects against against type B to a protein and protects against against type B strains.strains.
In U K given along with DPT vaccineIn U K given along with DPT vaccine When not given earlier A single dose for 1 – 4 When not given earlier A single dose for 1 – 4
years children.years children. Elder children and Adults do not need unless Elder children and Adults do not need unless
immunosupressed. immunosupressed.
Meningococcal VaccineMeningococcal VaccineMen C VaccineMen C Vaccine
The component of the vaccine is The component of the vaccine is Meningococcal C antigen,Meningococcal C antigen,
The polysaccharide component is The polysaccharide component is linked to protein carrier,linked to protein carrier,
In developed countries given at 2, 3, In developed countries given at 2, 3, 4 months duration.4 months duration.
Produces prolonged immune Produces prolonged immune response.response.
Vaccination in Hepatitis A Vaccination in Hepatitis A Virus Infection Virus Infection
A formaldehyde inactivated vaccine A formaldehyde inactivated vaccine prepared from HAV grown in Diploid cellsprepared from HAV grown in Diploid cells
A vaccination is effective for 10 A vaccination is effective for 10 yearsyears
Advised mainly in persons entering Advised mainly in persons entering endemic areas with HAV Infection.endemic areas with HAV Infection.
Bio-Engineering Bio-Engineering createscreates VaccineVaccine
Hepatitis B VaccineHepatitis B Vaccine
Molecular Biology and Molecular Biology and Genetic Engineering Genetic Engineering contributed for HBV contributed for HBV
VaccineVaccine..
Vaccination for Hepatitis B Vaccination for Hepatitis B InfectionInfection..
Hepatitis B VaccineHepatitis B Vaccine Bio Engineered vaccine,Bio Engineered vaccine,
0 - 1 - 6 months 0 - 1 - 6 months ( Dosage )( Dosage )
Deltoid region Deltoid region 90% successful90% successful Universal Immunization – Universal Immunization – an ideal goal an ideal goal
in prevention of Hepatitis B infectionsin prevention of Hepatitis B infections..
Combined Vaccination for Combined Vaccination for Hepatitis A and B Hepatitis A and B
Infections.Infections.
Now a combined vaccine is available Now a combined vaccine is available for prevention of Hepatitis A and B for prevention of Hepatitis A and B
Available as Available as
TWINRIX ( GSK )TWINRIX ( GSK )
Vaccination for TyphoidVaccination for Typhoid Oral – Live ( Typhoral )Oral – Live ( Typhoral ) Stable mutant of S.typhiStable mutant of S.typhi Strain Ty2 ( Lacking enzyme UDP –Strain Ty2 ( Lacking enzyme UDP –
Galactose 4 Epimerase).Galactose 4 Epimerase).
Injectable vaccine ( Ty vi ) containsInjectable vaccine ( Ty vi ) contains Purified Vi polysaccharide AntigenPurified Vi polysaccharide Antigen Efficacy lasts for 3 yearsEfficacy lasts for 3 years
Needed for people traveling to Endemic Needed for people traveling to Endemic areasareas
Other VaccinesOther Vaccines Pneumococcal vaccinePneumococcal vaccine A polyvalent polysaccharide containing capsular A polyvalent polysaccharide containing capsular
antigen with 23 Sero typesantigen with 23 Sero types Gives 80 -90 % protectionGives 80 -90 % protection Used inUsed in Dysfunctional spleenDysfunctional spleen Sickle cell diseases,Sickle cell diseases, Chronic diseases of Liver, lungs, heart,Chronic diseases of Liver, lungs, heart, Renal failure.Renal failure. HIV infection HIV infection Effective in > 2 years old children, Effective in > 2 years old children,
Vaccine for Varicella Vaccine for Varicella zosterzoster
OKA strain, A live attenuated strain,OKA strain, A live attenuated strain, Single dose for children ( 1-12 years Single dose for children ( 1-12 years
children)children) Not to be given in Immune Not to be given in Immune
suppressed / HIV patients.suppressed / HIV patients.
Vaccine for Vaccine for Influenza(virus )Influenza(virus )
Always use new vaccines with Always use new vaccines with prevailing strains,prevailing strains,
Now recombinant vaccines are Now recombinant vaccines are available.available.
Made in embroyonated eggs.Made in embroyonated eggs.
New VaccinesNew VaccinesDeveloped or on TrailsDeveloped or on Trails
Vaccines for Rota VirusVaccines for Rota Virus
Rota Rix ( GSK )Rota Rix ( GSK ) Introduced in Brazil, Elsalvador, Mexico, Introduced in Brazil, Elsalvador, Mexico,
Panama and VenezuelaPanama and Venezuela Under Phase III trails in Africa, and MalawiUnder Phase III trails in Africa, and Malawi Rota Teq ( MEREK)Rota Teq ( MEREK) Introduced in NicaraguaIntroduced in Nicaragua
Newer Pneumococcal Newer Pneumococcal VaccineVaccine
A Seven Valent conjugate vaccine A Seven Valent conjugate vaccine (Prevenar )(Prevenar )
Effective against 7 strains prevalent Effective against 7 strains prevalent in certain geographic locationsin certain geographic locations
Effective in 83 % HIV uninfected.Effective in 83 % HIV uninfected.
Effective in 65 % of HIV infected.Effective in 65 % of HIV infected.
Human Papilloma Virus Human Papilloma Virus VaccineVaccine
Gardasil ( HPV vaccine ) developed by Gardasil ( HPV vaccine ) developed by Merck.Merck.
Effective against 4 common serotypesEffective against 4 common serotypes
( includes prominent serotypes 16 and ( includes prominent serotypes 16 and 18 causing Cancer cervix ).18 causing Cancer cervix ).
Adolescents and preadolescents Adolescents and preadolescents considered for vaccination.considered for vaccination.
Newer Meningococcal Newer Meningococcal Meningitis A Vaccine ( Men Meningitis A Vaccine ( Men
A )A )
Effective in Meningococcal Diseases Effective in Meningococcal Diseases
Phase I trails in IndiaPhase I trails in India
Phase II trails , Mali, and GambiaPhase II trails , Mali, and Gambia
Phase III trails in Ethiopia /SenegalPhase III trails in Ethiopia /Senegal
Influenza Influenza Current VaccineCurrent Vaccine
In view of changing strains the In view of changing strains the
antigens configuration for Influenza antigens configuration for Influenza need a new model vaccine every year / need a new model vaccine every year / frequentlyfrequently
Currently CSL Biotherapies vaccine is Currently CSL Biotherapies vaccine is licensed on 28licensed on 28thth Sept 2007 for current Sept 2007 for current use.use.
Need for Vaccines in HIV/AIDS
Why Vaccines are Difficult to Why Vaccines are Difficult to Development in AIDSDevelopment in AIDS
H I V infection is produced by most H I V infection is produced by most complex virus ever identified and it is complex virus ever identified and it is extremely good at evading any Immune extremely good at evading any Immune Mediated strategy detected against.Mediated strategy detected against.
H I V is Genetically diverse.H I V is Genetically diverse.
New forms ( clades ) are emerging all New forms ( clades ) are emerging all through infection,through infection,
Vaccine OptionsVaccine Options
1 Live attenuated or whole killed HIV 1 Live attenuated or whole killed HIV virus virus Failed due to safety fears, Failed due to safety fears, Trails stoppedTrails stopped..
2 Sub Unit vaccines ( gp 20 model ) 2 Sub Unit vaccines ( gp 20 model )
Failed in Major trailsFailed in Major trails..
3 DNA vaccines 3 DNA vaccines
Isolated HIV genes used to stimulate Isolated HIV genes used to stimulate
cell mediated Immunitycell mediated Immunity..
Vaccine Options ( Contd )Vaccine Options ( Contd )
4 Recombinant Vaccine - Isolated 4 Recombinant Vaccine - Isolated genes delivered through another viral genes delivered through another viral vector,vector,
Most trials use this methodMost trials use this method
Vaccine OptionsVaccine Options
5 Combination Vaccines.5 Combination Vaccines.
Multiples trails are in progress Multiples trails are in progress with combination of Designs, with combination of Designs, strategies, strategies,
And And
Immunogens which can produce a Immunogens which can produce a broader more powerful, and more broader more powerful, and more durable immune response.durable immune response.
The Quest for the The Quest for the AIDS vaccine AIDS vaccine
continuescontinues
Various National and International Various National and International Organization are committed for Organization are committed for
development of a effective development of a effective VaccineVaccine
Present HIV Vaccination Present HIV Vaccination TrailsTrails
Vaccination for Vaccination for People at special riskPeople at special risk
AnthraxAnthrax CholeraCholera Hepatitis AHepatitis A Hepatitis BHepatitis B InfluenzaInfluenza Japanese B Japanese B
encephalitisencephalitis Meningococcal Meningococcal
InfectionInfection PlaguePlague
Pneumococcal Pneumococcal infectioninfection
Q fever,Q fever, Rabies Rabies Tick borne Tick borne
encephalitis.encephalitis. TyphoidTyphoid Typhus Typhus Varicella ZosterVaricella Zoster Yellow fever.Yellow fever.
Contraindication to Contraindication to VaccinationVaccination
In spite of great success with In spite of great success with many vaccines, yet a caution many vaccines, yet a caution
and wisdom are essentialand wisdom are essential
II
Contra -indications to Contra -indications to VaccinationVaccination
Do not give vaccines to acutely ill Do not give vaccines to acutely ill patients.patients.
Avoid giving live vaccines to pregnant Avoid giving live vaccines to pregnant womenwomen
Avoid all types of vaccines in the first Avoid all types of vaccines in the first Trimester of pregnancy,Trimester of pregnancy,
Do not give live vaccines to Do not give live vaccines to immunosupressed patients and patients immunosupressed patients and patients suffering with RES malignancies,suffering with RES malignancies,
Contraindication ( Cont )Contraindication ( Cont )
In spite of Immune suppression in In spite of Immune suppression in HIV infected, we can still give MMR HIV infected, we can still give MMR and Oral polio drops ( But Salk killed and Oral polio drops ( But Salk killed vaccine is safe).vaccine is safe).
In HIV patients do not give BCG In HIV patients do not give BCG vaccinevaccine
What is an ideal What is an ideal vaccine.vaccine.
Promotes effective immunity.Promotes effective immunity. Controls lifelong protection.Controls lifelong protection. Safe, do not carry side effects.Safe, do not carry side effects. Stable, cheap,Stable, cheap, Acceptance by public.Acceptance by public.
Yet there is No Ideal Yet there is No Ideal VaccineVaccine..
Care in VaccinationCare in Vaccination Some subjects may develop acute Some subjects may develop acute
anaphylaxis with vaccination,anaphylaxis with vaccination, Be prepared to resuscitate the Be prepared to resuscitate the
individuals,individuals,
Unresolved Unresolved problemsproblems
Nothing is perfectNothing is perfect No Vaccine is totally ProtectiveNo Vaccine is totally Protective Influenza – Needs very frequent Influenza – Needs very frequent
updating updating Cholera vaccine –Little effective in Cholera vaccine –Little effective in
realityreality
WHOWHO InitiativesInitiatives
On Vaccine Strategies On Vaccine Strategies and Developmentand Development
WHOWHO
Supports the Research of various Biological Supports the Research of various Biological Organizations which produce the Newer Organizations which produce the Newer VaccinesVaccines
Helps the Implementation Helps the Implementation various programmers various programmers
related to Vaccinesrelated to Vaccines
Vaccine ResearchVaccine Research
Now major research is focused on finding Now major research is focused on finding the safe and Socially acceptable vaccinesthe safe and Socially acceptable vaccines
Refer for current knowledge on Vaccines.Refer for current knowledge on Vaccines.
VACCINEVACCINE - is a International peer- - is a International peer-reviewed journal of Vaccination Research reviewed journal of Vaccination Research
Indexed in Medline pISSN: 0264-410XIndexed in Medline pISSN: 0264-410X
Science Hopes a Vaccine Science Hopes a Vaccine for every Diseasefor every Disease
Vaccination created HOPE in Vaccination created HOPE in HumanityHumanity
Created for Created for awareness among awareness among Medical and Health Medical and Health
care workers in care workers in Developing world.Developing world.
Dr.T.V.Rao MDDr.T.V.Rao MD
[email protected]@yahoo.co.in