Methods of acquiring immunity

and Immunization
Prof Anura Weerasinghe
MD, FRCP(UK), DCH,
DTM&H(London), PhD(Japan)
Professor of Physiology
Faculty of Medicine
Ragama

Objectives

Methods of acquiring immunity

Immunological basis for vaccination
Schedule of EPI vaccination
Non-EPI vaccines available in Sri Lanka

History of Immunization
Inoculation
Ancient times in India - Atharva Veda
A history of Medicine in Sri Lanka
by C. G. Uragoda
A centenary publication
Sri Lanka Medical Association

History of Immunization
1796 - First vaccination by Edward Jenner
1802 - First vaccination in Sri Lanka
1886 - compulsory vaccination
H. White, The Ceylon manual, 1908
1900 - Bacteriological Institute, Colombo
1967 - Last definitive case in Sri Lanka
1977 - Last endemic case in the world
- EPI/WHO
1991 - Hepatitis B and yellow fever

Methods of acquiring immunity

Natural

Artificial

Active

Passive

Infection

Utero

Neonatal

Types of Artificial Immunity

Passive

Active
Vaccines

Immunoglobulins Antisera

Normal(IM) Specific
Rabies
Hepatitis B
Tetanus
Anti-D

Immunological basis
of
Immunization

Immunization policy

Immune response
logistics

Epidemiology

Factors affecting the immune

response
Host
presence of maternal antibodies
immune competence

Vaccine
Type of vaccine
mode of administration
Interval between doses
presence of other vaccines

Changes in maternal and neonatal IgG levels

before and after birth

Factors affecting the immune

response
Host
presence of maternal antibodies
immune competence

Vaccine
Type of vaccine
mode of administration
Interval between doses
presence of other vaccines

Types of vaccines
Live attenuated
BCG, measles, OPV

Killed
Pertussis, Japanese encephalitis

Toxoids
Tetanus, Diphtheria

Genetically engineered
Hepatitis B

Expanded Programme of
Immunization; schedule in Sri Lanka

BCG - At birth
Hepatitis B 2,4 & 6 months
DPT & OPV - 2,4,6 & 18 months
DT & OPV - School entry
Measles - 9 months & 3 years (as MR)
aTD & Rubella - 10 to 15 years

Vaccines in selected groups

Japanese encephalitis
In endemic districts

Yellow fever
Travelers to Africa and South America

Non-EPI vaccines

Hib vaccine
MMR
Varicella
Typhoid
Cholera
Hepatitis A
Meningococcal
Pneumococcal
Rabies

New Combined vaccines

DPT+Hib
DPT+Hep B
Hepatitis A & B
aTd

Adjuvants prolong the antigenic stimulus

Eg; oil in water

Objectives

Methods of acquiring immunity

Immunological basis for vaccination
Schedule of EPI vaccination
Non-EPI vaccines available in Sri Lanka

Contraindications to DPT
Severe adverse event to DPT

anaphylaxis
collapse
encephalitis
non-febrile convulsion

Evolving neurological disease

uncontrolled epilepsy
progressive encephalopathy

Immunization policy, WHO 1995

Allergy and vaccination

Anaphylactic raection following egg
ingestion
avoid vaccines prepared on hens egg
tissues (yellow fever & influenza)
Vaccine viruses propagated in chicken fibroblast
cells (measles or MMR) can usually be given to
such individuals.

Conditions which are not

contraindications to
immunization

Minor illnesses such as upper RTI or diarrhoes with

fever <38.50C
Allergy, asthma or other atopy
Prematurity or small for dates
Malnutrition
Child being breastfed
Family h/o convulsion
Treatment with antibiotics, low dose steroid including
topical and inhaled preparation

Conditions which are not

contraindications to
immunization
Dermatoses, eczema or localized skin
infection
Chronic diseases of heart, lung, kidney and
liver
Stable neurological condition, such as
cerebral palsy and Downs syndrome
History of jaundice after birth
Immunization policy, WHO 1995

Contraindications to live
vaccines
SCID
pregnancy
AIDS

HIV is not a contraindication.

Future vaccines

HIV
malaria
adult tuberculosis
cancer

Discuss the immunological basis of the vaccines

in the EPI schedule.