L19: IMMUNISATION
Nor Afifah Supardy, Ph.D
Unit of Microbiology
Aimst University
LEARNING OBJECTIVES
To discuss the types of immunisation, vaccines, and national immunisation
schedules of Malaysia
TOPIC OUTOCOMES
19.1 Analyse the advantages and disadvantages of active immunisation and
passive immunsation
19.2 List the types of vaccines (live attenuated, inactivated, protein
based, viral vector and nucleic acid) with suitable examples
19.3 Discuss childhood immunisation with reference to Malaysian
immunization schedule
19.4 Recall primary and secondary immune response
19.5 Recognise the role of adjuvants
.
Immunisation
Definition: The process of giving a vaccine to a person to protect them
against diseases or resistant to an infectious disease, typically by
administering vaccines
Immunity by immunisation is similar to the immunity a person would
get from disease, but instead of getting the disease, you get a vaccine
Immunity - organism’s ability to protect itself from anything that it
does not recognize as self, such as a pathogen or toxin
Vaccine – a suspension of organisms or fractions of organisms used to
induce immunity
ADVANTAGES AND DISADVANTAGES OF ACTIVE
IMMUNIZATION AND PASSIVE IMMUNIZATION
Active immunisation – Immunity is acquired actively when a person is
exposed to microorganisms or foreign substances and the person’s
immune system responds
- Induction of immunity after exposure to an antigen
- Natural – exposure to microbe
- Artificial – use of vaccine
Passive immunisation – Immunity is acquired passively when antibodies
are transferred from one person to another
- the immunity in recipient lasts only as long as the antibodies are
present
- Natural – mother to fetus (transplacental transfer), colostrum
- Artificial – Use of immunoglobulins
Genetic or Acquired during
natural Immunity
lifetime as a result
immunity, born of exposure to
with antigens
Innate Adaptive
Immunity Immunity
Artificial
Natural
Active Passive
Active
Antigens enter the Passive
Antibodies pass Antigens are introduced
body naturally; from mother to Preformed
in vaccines; body
body induces fetus via placenta antibodies in
produces antibodies and
antibodies and or to infant via the immune serum are
specialized lymphocytes
specialized mother’s milk introduced by
lymphocytes injection
Innate Immunity Adaptive Immunity
Genetic or natural immunity, born Acquired during lifetime as a result of exposure
with to antigens (infection/vaccination)
Immediate response, lifelong - Slower, taking days or weeks to develop for first
protection time
- Retain a long term “memory” and faster
response if encountered again
Types Types
• First line & second line defenses • Third line defenses
• First line defenses - Physical and • Active immunity – acquired from first hand-
chemical barriers including skin, exposure through infection or vaccination
eyelashes, tears, mucous, stomach that activate individual immune system
acid • Passive immunity – acquired by receiving
• Second line defenses – external antibodies
interferons, interleukin 1, • natural - mother to baby through placenta
phagocytes, natural killer cells • artificial – from medicine, gamma globulin
injection
Advantages & Disadvantages
Chickenpox Covid-19 , influenza
Advantages:
- Last longer, create memory B Advantages:
cells - Immediate boost to fight disease
- Less costly
Disadvantages: Disadvantages:
- Longer development time for - Temporary immunity
immunity (days to weeks) - Costly
- No protection against mutations
DESCRIBE THE TYPES OF VACCINES
Principles & effects:
Vaccines: Weakened or dead form of a pathogen or its subunits used to stimulate the
immune system to generate an immune response
Vaccination: A simple, safe, and effective way of protecting you against harmful diseases,
before you come into contact with them.
Vaccines train the immune system to create antibodies, just as it does when the body is
exposed to a disease
How does a vaccine work? When you get a vaccine, your immune system;
1. Recognizes the invading germ (bacteria or virus)
2. Produces antibodies
3. Remembers the disease and how to fight it in future exposure. Immune system can
quickly destroy it.
Vaccines contain only killed/weakened forms of pathogen, they don not cause the
disease/risk of complications/illness
Types of Vaccines
1. Live attenuated vaccines
2. Inactivated/Killed vaccines
3. Subunit/Cellular fractions
4. Toxoid vaccines
5. DNA vaccines
6. Recombinant vector vaccines
1. Live Attenuated Vaccine
Live vaccines
Whole bacteria/virus that have been weakened (attenuated)
To create a protective immune response without cause disease in healthy people
More potent than other vaccines
Contain all major and minor antigenic components
Engage body tissues causing persistent & excellent immune response
Contraindication – immunocompromised/pregnancy – may cause infections
Examples: Chickenpox, measles, mumps, rubella, herpes zoster
Body creates
Virus is modified & antibodies to
weakened so it can still fight off the
replicate but no longer impaired form
cause illness of virus
2. Inactivated/Killed Vaccines
Organisms are killed by heat or chemical (formalin/phenol) and injected into
body
Pathogens are intact for immune system to recognize, but can not replicate
Safe, less efficacious, requires adjuvants
Requires booster dose
Examples: Hepatitis A, poliomyelitis, rabies
3. Subunit/Protein Vaccines
Contain selected antigenic fragments of pathogen that best stimulate immune
response
Can be bacteria/virus components OR desired antigenic fractions from genetically
modified nonpathogenic microbes (recombinant vaccines)
No risk of infection, safe to administer in immunocompromised, pregnant woman
Examples: Hepatitis B, human papillomavirus
3. Toxoid Vaccines
Contain inactivated toxins produced by pathogens
Toxicity is lost but antigenicity is retained
Antibody response against the inactivated toxins
Examples: Tetanus, diphtheria – part of standard childhood immunization
series
4. Nucleic Acid/DNA Vaccines
Newest & most promising
Virus DNA that encodes specific protein antigens is injected into
patient
Patient’s body synthesizes the antigen antigen is recognized as foreign
trigger immune system body produce antibody
In clinical trials: Influenza A, Ebola, West Nile Virus, SARS, Zika virus
5. Recombinant Vector Vaccines
Similar to DNA vaccines except use of a vector
Use of attenuated and live virus/bacterium as vector to introduce microbial
DNA to the body
Examples: Hepatitis B.
In clinical trials: Influenza, HIV,
Hepatitis C.
Bacterial cell
Figure: How DNA vaccine are produced and injected
CHILDHOOD IMMUNIZATION
(MALAYSIAN IMMUNIZATION SCHEDULE)
The Malaysian National Immunisation
Programme (NIP)
The NIP was introduced in early 1950s
Designed based on World Health Organisation (WHO) Expanded
Programme on Immunisation (EPI), recommend all countries immunise
against 6 childhood diseases
NIP protects Malaysian children against 13 major diseases
NIP vaccinations are free-of-charge at all government clinics & payable at
private clinics
When to get vaccinations? According to NIP schedule
13 Diseases Preventable Under NIP
Diseases Description
1. Diphteria An infectious disease caused by bacteria that live in the mouth and
throat of the infected person.
2. Haemophilus influenzae A serious infection that mainly affects children under 5 years.
type B (Hib)
3. Hepatitis B Infection of the liver by the Hepatitis B virus.
4. Human papillomavirus Most common sexually transmitted infection (STI) that causes
(HPV) cervical cancer which is the third most common cancer in women.
5. Japanese encephalitis Infection of the brain caused by JE virus.
(JE)
6. Measles A highly contagious viral disease.
7. Mumps A viral infection that is the most common cause of inflammation of
the brain (encephalitis).
8. Pertussis – Whooping Highly contagious, with violent and persistent coughing that may
Cough cause a child to struggle to breathe and, turn blue (cyanosed).
9. Poliomyelitis (polio) An infectious and incurable viral disease that attacks the nervous
system.
Diseases Description
10. Rubella Also known as German measles that may cause abnormalities to the
foetus.
11. Tetanus Also known as lockjaw, caused by bacteria toxins that attacks the body’s
nervous system.
12. Tuberculosis (TB) A disease that commonly infects the lungs, but can also attack other
parts such as the kidney, spine, skin, intestines and brain.
13. Pneumococcal A bacterial infection caused by Streptococcus pneumoniae that can
affect the lungs and other parts of the body.
Source: https://immunise4life.my/the-malaysian-national-immunisation-programme-nip/
Jadual Immunisasi Kebangsaan
Source: Ministry of Health, Malaysia
Uploaded on: Oct 5, 2023
RECOGNISES THE ROLE OF
ADJUVANTS
Adjuvant
Definition: Various compounds (mineral salts, microbial products, emulsions,
cytokines, liposomes) which enhances the body’s immune response to antigen and
allows vaccines to be more effective
Administered in conjunction with vaccine to boost immune response
1st adjuvant discovered in 1926 – Alexander Glenny found mixing aluminum salts
(alum) with antigens and injecting them into guinea pigs induced more antibodies
than administering antigens alone
Approved adjuvants for humans:
- alum and monophosphoryl lipid A (US)
- MF59 (an oil-and-water emulsion) (Europe, elsewhere
Mechanisms: enhance the adaptive immunity of vaccines by
i. Formation of depot at site of injection (associated with slow release of antigen)
ii. Induction of cytokines and chemokines
iii. Recruitment of immune cells
iv. Enhancement of antigen uptake and presentation
v. Promoting antigen transport to draining lymph nodes for activation of B cells or T
cells.
Pogostin, Brett H., and Kevin J. McHugh. (2021)
Role of Adjuvant
Increases the Increases the speed and
duration of the immune Strengthens the immune
immunogenicity of
response response
weak antigens
Eliminates antigen Saves money by
Role of
competition in reducing the required
Adjuvant antigen dose
combination vaccines
Increases the antigen Stimulates cellular Increases mucosal
affinity with the body immunity immunity
RECALL PRIMARY AND
SECONDARY IMMUNE RESPONSE
Primary Immune Response
Occurs after the first exposure to an antigen
Immune system recognize the antigen, produce antibodies against the antigen and
induce a long-term memory response against the antigen
Results in the generation of memory lymphocytes
Secondary Immune Response
Occurs as a result of a subsequent exposure (2nd, 3rd, 4th time) to the same antigen
This response is mediated by the memory lymphocytes (produced during primary
response)
The memory lymphocytes immediately produce antibodies
Antibody production level increase rapidly in a short time
Antigen will be eliminated quickly before it can cause disease
Vaccines are able to activate the adaptive immune system to create
‘memory' conferring long-lasting immunity specific to the
pathogen.
Memory cells
Lymphocytes are produced in response to the specific antigens on a pathogen
After the pathogen is removed, some of the lymphocytes continue to remain in
the immune system – memory cells
If the same pathogen invaded for the 2nd time, the response is much more rapid
How? Existing memory cells are able to multiply rapidly, producing clones of
the specific lymphocyte
Attack and destroy the pathogen before the individual exhibits symptoms
https://www.nagwa.com/en/explainers/530161683752/
Primary Immune Response Secondary Immune Response
Occurs as a result of primary contact with This occurs as a result of second and
an antigen subsequent exposure of the same antigen
Responding cell is naïve B-cell and T-cell. Responding cell is memory cell.
Lag phase longer (4-7 days or weeks, Lag phase is shorter (1-4 days) due to the
months) presence of memory cell.
Level of antibody reaches peak in 7 to 10 Level of antibody reaches peak in 3 to 5
days. days.
It takes longer time to establish immunity. Takes shorter time to establish immunity.
Amount of antibody produced depends on Usually 100-1000 times more antibodies are
nature of antigen. Usually produced in low produced.
amount.
Antibody level declines rapidly. Antibody level remain high for longer
period.
References
1. Active vs. Passive Immunity: Differences and Definition, Nicole Gleichmann & Karen
Steward, PhD (2023);
https://www.technologynetworks.com/immunology/articles/active-vs-passive-immunity-
differences-and-definition-335112
2. Tortora, G. J., Funke, B. R., & Case, C. L. (2019). Microbiology : an introduction
(Thirteenth edition). Pearson.
3. Atif M, Raheel U, Imran M, Arshad HU, Baloch FUH, et al. (2016) Dengue Virus: Host-
Pathogen Interactions and Emerging Role of DNA Vaccines. Journal of Human Virology &
Retrovirology 3(3): 00091. DOI: 10.15406/jhvrv.2016.03.00091
4. Pogostin, Brett H., and Kevin J. McHugh. 2021. "Novel Vaccine Adjuvants as Key Tools for
Improving Pandemic Preparedness" Bioengineering 8, no. 11: 155.
https://doi.org/10.3390/bioengineering8110155
5. Foumani, M.; Asadpour, L.; Azizi Saraji, A.; Sharifat Salmani, A.; Aghasadeghi, M. Adjuvants
and their mechanisms of action. J. Ardabil Univ. Med. Sci. 2012, 12, 276–291.
6. Awate S, Babiuk LA, Mutwiri G. Mechanisms of action of adjuvants. Front Immunol. 2013
May 16;4:114. doi: 10.3389/fimmu.2013.00114. PMID: 23720661; PMCID:
PMC3655441.
7. The Malaysian National Immunisation Programme (NIP)https://immunise4life.my/the-
malaysian-national-immunisation-programme-nip/
Covid-19 Vaccines
https://www.immunology.org/public-information/vaccine-resources/covid-19/covid-19-
vaccine-infographics/types-covid19-vaccines
