Immunization

ATHAR SHIBLI
ZAINAB HASHEM
ALIAA HASSAN
Immunization:

Immunization is the process of inducing
immunity artificially by either vaccination
(active imm.)or administration of antibodies
(passive imm.)

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Active immunization
Active immunization entails the introduction
of a foreign molecule into the body, which
causes the body itself to generate immunity
against the target. This immunity comes from
the T cells and the B cells with their antibodies

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Passive immunization

This method of immunization begins to work very
quickly, but it is short lasting, because the antibodies
are naturally broken down, and if there are no B cells to
produce more antibodies, they will disappear.
The antibodies can be produced in animals ("serum
therapy") although there is a high chance of
anaphylactic shock because of immunity against animal
serum itself. Thus, humanized antibodies produced in
vitro by cell culture are used instead if available. this
basically means 87 different are being affected

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important of immunization
eradication of disease EX: smallpox
Elimination of disease EX: polio
Control of disease EX: diphtheria

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Immunizing agent:

Vaccine :a protein, polysaccharide or nucleic
acid delivered to body to produce immunity
Toxoid :a modified bacterial toxin (not toxic
but capable of producing antitoxin)
Antitoxin: antibodies derived from human or animal
serum after stimulation with specific antigen

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Constituents of vaccine :
Protein , polysaccharide ,nucleic acid
Preservative/stabilizer/antibiotics
Adjuvant (salts)
Suspending fluid
Component of organism: like influenza vaccine

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Types of vaccines:
Live attenuated:
Prepared from attenuated strains that render
them non-pathogenic .
Usually effective with one dose as they
replicate in the host and provide antigenic
stimulation for long time.

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Types of vaccines:
Reversion to original pathogenic form causing
full-blown is rare but possible especially in
immunocompromised individuals,so we
prefer to avoid live vaccine in most
immunocompromised patients.
EX: BCG, MMR, OPV, Varicella, Measles.

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Inactivated or killed :
1. Inactivated whole organism :
Hepatitis A, whole cell pertusses
2. Detoxified exotoxins : Tetanus , Diphtheria
3. Purified protein antigen: Acelluar pertusses , Hepatitis B
4. Polysaccharide : Capsular Meningococcal
5. Capsular polysaccharide conjugated to
protien: Hib, Pnemoccocal conjugated vaccine
6. Component of organism: Influenza vaccine
Generally require3-5 doses to be effective
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Immune response to vaccine:
In live attenuated vaccines ,the organisms
multiply in recipient so it is more like the
natural infection ,so it is likely to produce life
long protection after 1st dose of vaccine.
Killed vaccines :less antigenic so usually need
booster doses.
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Nature and magnitude of immune response
depend on many factors:
1. Age at administration
2. Presence of maternal antibodies younger than 6
months
3. Relative immaturity of immune system
4. Host factors: nutrition, immunity
5. Route of administration:
IPV ,OPV
Subcutaneous hepatitis B at buttock less
immunogenic than IM at deltoid
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T cell independent antigens are those that
produce B cells proliferation and antibody
production without help of T cells
T cell independent antigens are poor
immunogenic in younger than 2 years
So conjugation with protein carrier will induce
more immunity like Hib ,Conjugated
pneumoccocal vaccine.
Primary response to a vaccine :
IGM serum antibody is usually detected 7-10
days then IGG type peaks at 2-6 weeks.

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Vaccine schedules:
Generally a vaccine is recommended at the
youngest age at which significant risk of a
disease and complication exist and at which
protective immune response is expected.

Either universal schedules or for selected
populations e.g. :
specific diseases (nephrotic syndrome)
travel (yellow fever vaccine)
post exposure (rabies)
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The Jordanian National Immunization Program
Age Recommended Vaccines
First Month BCG
61 Days DPT-HBV-Hib IPV
91 Days DPT-HBV-Hib IPV OPV
121 Days DPT-HBV-Hib OPV
9 Months Measles OPV
18 Months DPT OPV MMR
6 Years (First Grade) Td OPV
15 Years (10th Grade) Td
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Special conditions:
Most vaccines can be given simultaneously
without impairment of vaccines effectiveness
or safety

Breast feeding is not a contraindication to any
vaccine ,although most live attenuated
vaccines replicate in mother they are not
excreted in human milk.
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Special conditions:
Lapsed immunizations:
If interval between vaccine doses exceed
those recommended ,this does not adversely
affect the immune response provided the
series is completed, so no need to restart the
series or to give extra doses.
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Preterm infants:
Immune response to vaccination is a function
of postnatal age rather than gestational age
Prematurity does not increase the incidence
of vaccine related adverse effects
Doses are same as those for term infants (NOT
reduced)
Should be vaccinated at same chronological
age as full term ,according to schedule .

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Corticosteroids:
Physiologic or low doses (less than 2mg/kg/day)
of prednisone ,inhaled or topical steroids the
child can be immunized while on steroid.

More than 2mg/kg/day,or alternate-day steroid
for less than 14 days ,should have live vaccine
deferred until at least stoping steroid. If more
than 14 days defer the vaccine for at least 1
month.



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Immunodeficiency:
Depends on degree of immunodeficiency and
underlying cause.
Generally ,live attenuated vaccines are
contraindicated e.g. OPV
Some other vaccines are indicated e.g.
Influenza vaccine and Pneumoccocal vaccine
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General notes:
Contraindications:
Severe allergic reactions after a vaccine dose or to
some vaccine component

Precautions:
Moderate or severe acute illness with or with out fever
(benefits & risks of a vaccine is individualized)

Adverse effects:
Usually Mild Problems :
Redness, warmth, swelling ,Fever


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The Jordanian National Immunization Program
Age Recommended Vaccines
First Month BCG
61 Days DPT-HBV-Hib IPV
91 Days DPT-HBV-Hib IPV OPV
121 Days DPT-HBV-Hib OPV
9 Months Measles OPV
18 Months DPT OPV MMR
6 Years (First Grade) Td OPV
15 Years (10th Grade) Td
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2,3,4
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5
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BCG:
There is evidence that BCG provides
appreciable protection against tuberculosis
meningitis (50-80%) and miliary disease.
Intra-dermal injection
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BCG:
Local lesion, papule, 2 weeks after
vaccination.
Small abscess might develop, 4-6 weeks.
At 6 weeks (crust, detaches, ulcerates) ,then a
scar (typically round and slightly depressed)
remains
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BCG:
Complications:
1. Local abscess
2. Not so serious Lymphadenitis
Non-suppurative ,Suppurative
3. Serious Lymphadenitis :
Persistent, recurrent or multiple
4. BCG osteitis
5. Disseminated BCGosis in immune compromised
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BCG:
Contraindications:

only symptomatic HIV infection (i.e. AIDS) is a
contraindication for BCG according to WHO.

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DTP Vaccine

The Jordanian National Immunization Program
Age Recommended Vaccines
First Month BCG
61 Days DPT-HBV-Hib IPV
91 Days DPT-HBV-Hib IPV OPV
121 Days DPT-HBV-Hib OPV
9 Months Measles OPV
18 Months DPT OPV MMR
6 Years (First Grade) Td OPV
15 Years (10th Grade) Td
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DTP Vaccine:
Inactivated whole organism vaccine DTP or
Acellular vaccine DTaP
Acellular type has less side effects
After 6 years of age only Td is given
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DTP Vaccine:
Side effects :
Mild Problems (Common):
Fever, Redness, swelling, Soreness (1 in 4)
Fussiness ,Tiredness or poor appetite and
Vomiting (1 in 50)
These problems occur more often after the
4th and 5th doses of the DTP series than after
earlier doses.

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DTP Vaccine:
Moderate Problems (Uncommon):
Seizure (1 in 14,000), Non-stop crying for 3 hours
or more (1 in 1,000), High fever (1in 16,000)
Severe Problems (Very Rare) :
Serious allergic reaction (1 in a million dose)
Long-term seizures, coma, or lowered
consciousness , Permanent brain damage.
so RARE that it is hard to tell if they are caused by
the vaccine.
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DTP Vaccine:
Contraindications:
1. Encephalopathy (coma ,altered level of
consciousness ,prolonged seizures ) within 7
days of previous dose

2. Progressive neurological disorder till
neurological state is clarified.

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Precautions:
1. Fever more than 40.5,during 48 hrs of
previous dose
2. Collapsed or shock like state during 48 hrs
of previous vaccine dose
3. Seizures during 3 days or less of previous
vaccine dose
4. Persistent inconsolable crying more than 3
hr during 48 hr of previous vaccine dose


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Hepatitis B vaccine

The Jordanian National Immunization Program
Age Recommended Vaccines
First Month BCG
61 Days DPT-HBV-Hib IPV
91 Days DPT-HBV-Hib IPV OPV
121 Days DPT-HBV-Hib OPV
9 Months Measles OPV
18 Months DPT OPV MMR
6 Years (First Grade) Td OPV
15 Years (10th Grade) Td
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Hepatitis B vaccine:
Is a very safe vaccine
Very effective
Infants born to HBsAg-positive mothers should
receive the vaccine and HBIG within 12hr of
birth.
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Hib Vaccine

The Jordanian National Immunization Program
Age Recommended Vaccines
First Month BCG
61 Days DPT-HBV-Hib IPV
91 Days DPT-HBV-Hib IPV OPV
121 Days DPT-HBV-Hib OPV
9 Months Measles OPV
18 Months DPT OPV MMR
6 Years (First Grade) Td OPV
15 Years (10th Grade) Td
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Hib Vaccine:
Capsular polysaccharide conjugated to protein
carrier
Contraindicated in less than 6 weeks of age
Children over 5 years old usually do not need
Hib vaccine


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Need, dont? 10
OPV, IPV

The Jordanian National Immunization Program
Age Recommended Vaccines
First Month BCG
61 Days DPT-HBV-Hib IPV
91 Days DPT-HBV-Hib IPV OPV
121 Days DPT-HBV-Hib OPV
9 Months Measles OPV
18 Months DPT OPV MMR
6 Years (First Grade) Td OPV
15 Years (10th Grade) Td
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OPV, IPV:
live attenuated oral polio vaccine (OPV)
IPV is inactivated vaccine
IPV elicit higher serum IgG antibody levels but
OPV also produce mucosal IgA immunity and
limit virus replication in gastrointestinal
system
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11 Type of vaccine
OPV, IPV:
Side effects :
IPV has no adverse effects
OPV may cause (vaccine associated paralytic
polio) in 1 in 6.2 million doses.
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MMR vaccine

The Jordanian National Immunization Program
Age Recommended Vaccines
First Month BCG
61 Days DPT-HBV-Hib IPV
91 Days DPT-HBV-Hib IPV OPV
121 Days DPT-HBV-Hib OPV
9 Months Measles OPV
18 Months DPT OPV MMR
6 Years (First Grade) Td OPV
15 Years (10th Grade) Td
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MMR vaccine:
Live attenuated vaccine
Subcutaneous injection
Side effects :
Mild Problems :
1. Mild rash (1 in 20)
2. Swelling of glands in the cheeks or neck (rare)
If these problems occur, it is usually within 7-12
days after the shot.
They occur less often after the second dose
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MMR vaccine:
Moderate Problems :
1. Seizure caused by fever (1 in 3,000 doses)
2. Temporary pain and stiffness in the joints,
mostly in teenage or adult women (up to 1
out of 4)
3.Temporary low platelet count (1 in 30,000
doses)
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MMR vaccine:
Severe Problems (Very Rare) :
Serious allergic reaction (1 in a million doses)
Several other severe problems have been
known to occur after a child gets MMR
vaccine. But this happens so rarely, experts
cannot be sure whether they are caused by
the vaccine or not

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Contraindications:
1. A life-threatening allergic reaction to gelatin,
neomycin, or to a previous dose of MMR vaccine
2. Pregnant women
3. known severe immunodeficiency like severely
symptomatic HIV infection
Precautions:
Recent blood transfusion or were given other
blood products less than 11 months
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Other Vaccines
Pneumococcal polysaccharide vaccine
23 valent vaccine
Usually 2 doses
Help prevent serious pneumococcal disease
e.g.meningitis, bacteremia, pneumonia
Anyone older than 2 years with:
heart disease, lung disease, sickle cell disease,
diabetes, cirrhosis ,lymphoma, leukemia , kidney
failure ,nephrotic syndrome , asplenia, HIV
infection or AIDS
Minor side effects
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Pneumococcal Conjugate Vaccine
7 valent vaccine
Help prevent serious pneumococcal disease
e.g.meningitis, bacteremia, pneumonia
Also prevent some otitis media
Children under 2 years of age:
2 months - 4 months - 6 months
12 to 15 months
Minor side effects
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Varicella vaccine:
Can prevent chickenpox and if got chickenpox it is
mild, fewer spots, less likely to have a fever, and
will recover faster

First dose: 12- 15 months of age
Second dose: 4- 6 years of age (may be given
earlier if at least 3 months after the first dose)

Minor side effects, moderate: (Seizure 1 in
1000),severe :Pneumonia (very rare)
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Varicella vaccine:
Contraindications:
1. A life-threatening allergic reaction to gelatin,
neomycin, or to a previous dose of Varicella
vaccine
2. Pregnant women
3. known severe immunodeficiency
Precautions:
Recent blood transfusion or were given other
blood products less than 11 months
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Influenza Vaccine :
Inactivated vaccine.
Influenza viruses are always changing ,so
influenza vaccines are updated every year, and
an annual vaccination is recommended in
October or November .

It is recommended for anyone who is at risk of
complications from influenza AND older than
6 months of age
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Influenza Vaccine :
Minor side effects

Contraindications:
Influenza vaccine virus is grown in eggs.
People with a severe egg allergy should not
get the vaccine


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Meningococcal Vaccines:
Meningococcal polysaccharide vaccine
A/C/Y/W-135
Recommended to children older than 2 years
AND at risk (terminal complement
component deficiency, asplenia, military
recruits ,traveling
Meningococcal conjugate vaccine A/C used in
Europe for infants
Minor side effects


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Rotavirus Vaccine :
An oral live vaccine
Children should get 3 doses :
First Dose: 2 months of age
Second Dose:4 months of age
Third Dose: 6 months of age
Contraindications :
immunodeficiency
Minor side effects


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Thank you





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