LECTURE I
IMMUNIZATION
Immunization is the process whereby a person is made immune or resistant to an infectious
disease, typically by the administration of a vaccine. It can also be said to be the process of
protecting a person from infectious disease by the introduction of a substance into
the body to make it produce antibodies. The individual's immune system becomes fortified
against the substance known as the immunogen.
Immunization is a proven tool for controlling and eliminating life-threatening infectious
diseases and is estimated to avert between 2 and 3 million deaths each year. It is done
through various techniques, most commonly vaccination. Vaccines
against microorganisms that cause diseases can prepare the body's immune system, thus
helping to fight or prevent an infection. It is one of the most cost-effective health
investments, with proven strategies that make it accessible to even the most hard-to-reach
and vulnerable populations.
Immunizations work by stimulating the immune system, the natural disease-fighting
system of the body. It prepares the immune system to ward off a disease. The healthy
immune system can recognize invading bacteria and viruses and produce substances
(antibodies) to destroy or disable them. To immunize against viral diseases, the virus used
in the vaccine has been weakened or killed. To immunize against bacterial diseases, it is
generally possible to use only a small portion of the dead bacteria to stimulate the
formation of antibodies against the whole bacteria. In addition to the initial immunization
process, it has been found that the effectiveness of immunizations can be improved by
periodic repeat injections or "boosters."
Importantly, immunization is important for both adults and children in that they can protect
from many diseases. It does not only protect children against deadly diseases but also helps
in developing children's immune systems. Through the use of immunizations, some
infections and diseases have almost completely been eradicated throughout the world. One
example is polio. Polio is still found in other parts of the world so certain people could still
be at risk of getting it. This includes those people who have never had the vaccine, those
who didn't receive all doses of the vaccine, or those traveling to areas of the world where
polio is still prevalent.
Immunity through immunization
Immunity through immunization happens without the consequence of being ill and without
the risk of potentially life-threatening complications from the disease. Once a person is
immunized, specific immune cells called memory cells prevent re-infection when they
encounter that disease again in the future. However, not all vaccines provide lifelong
immunity. Vaccines such as the tetanus vaccine require booster doses every ten years for
adults to maintain immunity. Since the introduction of vaccines, many serious illnesses
have been brought under control.
Examples of diseases immunization can protect include Blood infection, Diphtheria, Ear
infection, Haemophilus influenzae type b, Hepatitis A, Hepatitis B, Human papillomavirus
(HPV) infection, Influenza, Measles (red measles), Meningitis, Mumps, Pertussis
(whooping cough), Pneumonia, Polio, Rotavirus, Rubella (German measles), Tetanus
(lockjaw), Varicella (chickenpox).
BIOLOGICAL PRODUCTS FOR IMMUNIZATION
Biological Product: A biological product is a substance derived from a living organism or
contains components of living organisms used for the prevention or treatment of disease in
humans. They are large complex molecules, composed of sugars, proteins, nucleic acids, or
complex combinations of these substances and these characteristics create potential safety
concerns, especially with the possibility of immune response. Biologicals are usually too
complex for chemical synthesis in a laboratory. These products include antitoxins, bacterial
and viral vaccines, blood, blood products, hormone extracts, gene therapies, tissues,
somatic cells, allergens, and recombinant proteins. Biological products offer the hope of
treatments for many debilitating diseases. The future of medicine may well involve the
ability of researchers to investigate new treatments derived from these products.
Characteristics of Biological Products
(i) They are composed of large complex molecules.
(ii) Very sensitive to heat
(iii) Unique
(iv)Vulnerable to microbial adulteration thus requiring aseptic techniques from initial
manufacturing stages.
(v) They offer means to treat medical conditions currently having no treatment options/
create new options for treatable disease states.
Classes of Biological Products
(1) Those extracted from living systems. Examples of biological products extracted from
the bodies of animals and other humans include:
-White blood and other blood components
- Organ transplantation and tissue transplant
- Antibodies for passive immunity (to treat viral infections)
- Human reproductive cells
- Human breast milk
(2) Those produced by recombinant DNA- These biological products are produced using
biological processes involving DNA technology. Examples include hormones, monoclonal
antibodies, and fusion proteins.
Types of biological products
(1) Vaccine: A product that stimulates a person’s immune system to produce immunity to
a specific disease, protecting the person from that disease. Vaccines are usually
administered through needle injections, but can also be administered by mouth or sprayed
into the nose.
Types of vaccines
Viral Vaccines: These are vaccines made from a virus that has been weakened so as not to
cause disease usually caused by the same virus. Viral vaccines have developed in recent
years to treat and prevent several diseases. These vaccines include those engineered for
RNA viruses, rotavirus, Influenza A and B, human papillomavirus (HPV), and
varicella-zoster virus (shingles). Researchers anticipate the development of vaccines for
human immunodeficiency virus (HIV) and hepatitis C through the use of biological
products in the future.
Live attenuated vaccines have decreased pathogenicity. Their effectiveness depends on the
immune system’s ability to replicate and elicit a response similar to natural infection. It is
usually effective with a single dose. Examples of live, attenuated vaccines
include measles, mumps, rubella, MMR, yellow fever, varicella, rotavirus,
and influenza (LAIV).
Bacterial Vaccines
Bacterial vaccines are of 3 basic types:
(i) Killed whole organisms or bacterins, including those for pertussis (whooping cough)
(ii) Those for use in the veterinary or aquaculture fields; single-antigen vaccines extracted
from bacteria or prepared by genetic engineering;
(iii) Toxoids. Many bacteria, such as those that cause tetanus, pertussis, or diphtheria,
release toxins that cause cellular damage. These toxins have been purified and inactivated,
usually with chemicals to produce toxoids. When injected, toxoids induce the formation of
antibodies against the original toxin.
Some other bacterial vaccines produced include typhus, typhoid, cholera, Haemophilus
influenza type B, pneumococcus, meningococcus, and Bacille Calmette-Guérin (BCG,
used for the prevention of tuberculosis). Vaccines for veterinary use include those for
household pets, farm animals, and other cultivated species, such as mink or fish.
(2) Blood Fractions and Serums- Blood serum (the fluid that remains after blood is
clotted) is collected and freeze-dried. When reconstituted with water, this product can then
be used in the treatment of blood loss and shock resulting from trauma. Products prepared
from donated blood include red cells, white cells, platelets, and plasma which is
fractionated to albumin, immune serum globulins (including specialized products such as
tetanus, Rh, and rabies immunoglobulins), and coagulation factor concentrates for the
treatment of hemophilia A and B.
(3) Hormones: They are organic substance secreted by plants and animals that functions in
the regulation of physiological activities and in maintaining homeostasis (which is a
self-regulating process by which biological systems tend to maintain stability while
adjusting to conditions that are optimal for survival).
The processes regulated by hormones include heart rate, body temperature, metabolism,
appetite, reproductive cycles and sexual functions, sleep cycles, and general well-being (i.e.
growth and development, mood, and stress levels. Hormones are used in the prevention of
hypertension, and the treatment of cancer, infertility, growth disorders, and so on.
(4) Monoclonal Antibodies- Monoclonal antibodies are used to treat a variety of diseases
caused by cancer cells, infectious agents, or toxic inflammatory substances. These
antibodies are produced in laboratories in a cell culture to create multiple identical forms of
the same cell. This results in very pure antibodies that act against specific antigens.
(5) Gene-based and cellular biologics (Gene therapies) – This involves artificial
manipulation of a gene of an organism to produce a desirable piece of genetical
materials. They are used to treat a variety of medical conditions for which no other
treatments are available. It involves genes, cells or tissues, and somatic cells which are
specifically engineered macromolecules used to produce products like protein and nucleic
acid-based drugs.
LECTURE 2
RECOMMENDED IMMUNIZATION SCHEDULES
Some of the most commonly administered vaccines are briefly discussed below:
1. Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed (DTap) (Brand
Names: Daptacel and Infrarix)
- Prevents the bacterial infections of diphtheria, tetanus (lockjaw), and pertussis (whooping
cough). Diphtheria and pertussis spread from person to person. Tetanus enters the body
through cuts or wounds.
- DTaP is only for children younger than 7 years old. This combination vaccine is given as
a series in infants and children 6 weeks through 6 years of age, before their 7th birthday. It
is recommended that children receive 5 doses of DTaP, usually at the following ages: 2
months, 4 months, 6 months, 15-18 months, and 4-6 years. It can be given along with other
vaccines at the same time.
- Common side effects may include Fever, drowsiness, fussiness/ irritability, and redness,
soreness, or swelling at the injection site.
2. Tetanus Toxoid, Reduced Diptheria Toxoid, and Acellular Pertussis Vaccine
Adsorbed (Tdap) (Brand Names: Adacel and Boostrix)
- This is a noninfectious, sterile, vaccine for intramuscular administration.
- Booster shot for kids at 10 or 11 years of age to prevent the bacterial infections of
diphtheria, tetanus (lockjaw), and pertussis (whooping cough).
- In addition, Boostrix is approved for all individuals of 10 years of age and older,
(including the elderly). Adacel is approved for use in people ages 10 through 64 years.
- Common side effects may include Pain, redness, and swelling at the injection site,
headache, and tiredness.
3. Haemophilus b: Conjugate Vaccine (Hib) (Brand Names: ActHIB, Hiberix,
PedvaxHIB)
- The Hib vaccine prevents Haemophilus influenzae type b (Hib) invasive disease.
- The bacteria can cause many different kinds of infections and mild illnesses, such as ear
infections or bronchitis, or they can cause severe illnesses, such as infections of the blood.
- These infections usually affect children under 5 years of age but can also affect adults
with certain medical conditions.
- Both ActHIB and PedvaxHIB are approved for routine administration as a four-dose
series in infants and children 2 months through 5 years of age. Infants will usually get their
first dose of Hib vaccine at 2 months of age and will usually complete the series at 12–15
months of age.
- Hiberix is approved as a booster shot in children from 15 months through the age of 4
years before their 5th birthday. Hib vaccine is usually given in 3 or 4 doses (depending on
brand).
- Children over 5 years old and adults usually do not receive Hib vaccine, but it might be
recommended for older children or adults whose spleen is damaged or has been removed,
including people with sickle cell disease, before surgery to remove the spleen, or following
a bone marrow transplant. Hib vaccine may also be recommended for people 5 through 18
years old with HIV.
- Common side effects may include: fussiness, sleepiness, soreness, swelling, and redness
at the injection site
4. Hepatitis B vaccine (Brand Names: Engerix-B and Recombinant HB)
- The vaccines are approved for individuals of all ages, including newborns.
- It is particularly important for those at increased risk of exposure to hepatitis B virus such
as a baby born to a mother who is infected with the virus.
- Prevents infection caused by hepatitis B virus. Common side effects may include soreness,
redness, swelling at the injection site, irritability, fever, diarrhea, fatigue/weakness, loss of
appetite, and headache.
5. Human Papillomavirus Vaccine (Brand Names: Cervix, Gardasil and Gardasil 9)
- HPV vaccines protect against infection with human papillomaviruses (HPV). HPV is a
group of more than 200 related viruses, of which more than 40 are spread through direct
sexual contact. Among these, two HPV types cause genital warts, and about a dozen HPV
types can cause certain types of cancer—cervical, anal, oropharyngeal, penile, vulvar,
and vaginal.
-Three HPV vaccines that prevent infection with disease-causing HPV
are Gardasil, Gardasil 9, and Cervarix. All three HPV vaccines protect against HPV types
16 and 18 which cause most HPV cancers. However, the Gardasil 9 vaccine prevents
infection and protects against nine HPV types (6, 11, 16, 18, 31, 33, 45, 52, and 58). HPV
types 6 and 11, which cause 90% of genital warts, HPV types 16 and 18, two high-risk
HPVs that cause about 70% of cervical cancers and an even higher percentage of some of
the other HPV-caused cancers. HPV types 31, 33, 45, 52, and 58, are high-risk HPVs that
account for an additional 10% to 20% of cervical cancers.
- Gardasil 9 (Human Papillomavirus 9-valent Vaccine, Recombinant) helps protect
individuals ages 9 to 45 against the following diseases caused by 9 types of HPV: cervical,
vaginal, and vulvar cancers in females, anal cancer, certain head and neck cancers, such as
throat and back of mouth cancers and genital warts in both males and females.
- Gardasil 9 is a shot that is usually given in the arm muscle. It may be given as 2 or 3 shots.
CDC recommends that 11 to 12-year-olds receive two doses of HPV vaccine 6 to 12
months apart i.e. Children who start the vaccine series before their 15th birthday need only
two doses to be fully protected. People who start the series at age 15 or older and people
who have certain conditions that weaken the immune system need three doses to be fully
protected.
The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on
Immunization Practices (ACIP) current recommendations for HPV vaccination are:
(i) Children and adults ages 9 through 26 years. HPV vaccination is routinely
recommended at age 11 or 12 years; vaccination can be started at age 9 years. HPV
vaccination is recommended for all persons through age 26 years who were not adequately
vaccinated earlier.
(ii) Adults ages 27 through 45 years. Food and Drug Administration (FDA) approved
HPV vaccine to be given through age 45 years, HPV vaccination is not recommended for
all adults ages 27 through 45 years. Instead, ACIP recommends that clinicians consider
discussing with their patients in this age group who were not adequately vaccinated earlier
whether HPV vaccination is right for them. HPV vaccination in this age range provides
less benefit because more people have already been exposed to the virus.
(iii) Persons who are pregnant. HPV vaccination should be delayed until after pregnancy,
but pregnancy testing is not required before vaccination. There is no evidence that
vaccination will affect a pregnancy or harm a fetus.
- The side effects include pain, swelling, redness, itching, bruising, bleeding, sore arm,
lump where the shot is given, headache or feeling tired, fever, nausea, and dizziness or
fainting, muscle or joint pain.
6(a) Influenza Vaccine (administered with a needle) (Brand Names (for children):
AFLURIA Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Flucelvax
Quadrivalent and Fluzone Quadrivalent
- Influenza vaccines, also known as flu shots, are vaccines that protect against infection
by influenza viruses.
- Different vaccines are approved for different age groups to prevent influenza disease,
commonly called “flu, caused by the strains of influenza virus. The strains of influenza
viruses that cause diseases in people frequently change, so yearly vaccination is needed to
protect against the influenza viruses likely to cause illness each winter.
- Children 6 months of age and older are recommended to get an annual influenza vaccine.
Children younger than 5 years old especially those younger than 2 are at higher risk of
developing serious influenza-related complications.
- Children can get vaccinated as soon as flu vaccines become available. Children 6 months
to 8 years of age receiving their first influenza vaccine, who have not previously received a
total of two or more doses in their lives, or whose influenza vaccination history is
unknown need two doses. For those children, it is recommended to get the first dose as
soon as the vaccine is available because the second needs to be given at least four weeks
after the first.
- Adults are recommended to get an annual influenza vaccine, including even healthy
adults. Vaccination is especially important for people at higher risk of serious influenza
complications or people who live with or care for people at higher risk for serious
influenza complications.
- Persons working in health care settings also should be vaccinated annually against
influenza.
- Common side effects may include Pain, redness, and swelling at the injection site,
low-grade fever, muscle aches, headache, fatigue, and general feeling of being unwell.
(b) Influenza Vaccine, Intranasal (nasal spray) (Brand Names (for children): FluMist
Quadrivalent)
- Protects against four different strains of influenza virus included in the vaccine; (for
children and adults from ages 2 through 49 years of age.
- Common side effects may include a runny or stuffy nose and cough.
7. Measles, Mumps and Rubella Vaccine (Brand Name: M-M-R- II)
- Measles, mumps, and rubella are serious diseases caused by viruses spread from person to
person. The measles, mumps, and rubella (MMR) vaccine is used to help prevent these
diseases by causing the body to develop immunity to the disease. This vaccine will not
treat an active infection that has already developed in the body.
- The vaccine prevents measles, mumps, and rubella in those 12 months of age and older.
- Common side effects may include Fever, mild rash, fainting, headache, dizziness,
irritability (fussiness in a young child) burning/ stinging, redness, swelling, and tenderness
at the injection site, nausea, vomiting, diarrhea, runny nose, sore throat.
8. Meningococcal Vaccine (Brand Names: Bexsero, Menactra, Menveo and
Trumenba)
- Prevents certain types of meningococcal disease, a life-threatening illness caused by the
bacteria Neisseria meningitidis that infects the bloodstream and the lining that surrounds
the brain and spinal cord (meningitis).
- The CDC recommends all 11 to 12-year-olds should get a MenACWY vaccine (Menactra,
Menveo, and MenQuadfi), with a booster dose at 16 years old. Teens and young adults (16
through 23 years old) also may get a MenB vaccine. Also recommends meningococcal
vaccination for other children and adults who are at increased risk for meningococcal
disease.
-MenB vaccines (Bexsero and Trumenba) are recommended for people 10 years or older at
increased risk for meningococcal disease
- Bexsero is approved for use in those ages 10 through 25 years of age to prevent invasive
meningococcal diseases caused by N. meningitidis serogroup B.
- Menactra is approved for use in infants and children beginning at 9 months of age, as well
as for adults through 55 years of age.
- Menvero is approved for use in those of 2 months through 55 years of age. Both Menactra
and Menvero prevent meningococcal diseases caused by N. meningitidis serogroups A, C,
Y, and W.
- Trumenba is approved for use in those 10 through 25 years of age to prevent invasive
meningococcal disease caused by N. meningitidis serogroup B.
- Common side effects may include tenderness, pain, redness and swelling at the injection
site, irritability, headache, fever, tiredness, chills, diarrhea, and loss of appetite for a short
while.
9. Pneumococcal 13-valent Conjugate Vaccine (Brand Name: Prevnar 13)
- A pneumococcal conjugate vaccine containing 13 different strains of the bacterium
Streptococcus pneumoniae, used in children and immunocompromised patients for the
prevention of pneumococcal disease.
- Pneumococcal disease refers to any illness caused by pneumococcal bacteria. These
bacteria can cause many types of illnesses, including pneumonia (infection of the lungs),
ear infections, sinus infections, meningitis (infection of the tissue covering the brain and
spinal cord), and bacteremia (infection of the blood).
- Pneumococcal conjugate vaccine PCV13 is given to Infants and young children, who
usually need 4 doses, at ages 2, 4, 6, and 12–15 months, and to older children who need it.
Older children (through age 59 months) may be vaccinated if they do not receive the
recommended doses.
- Children and adolescents 6–18 years of age with certain medical conditions should
receive a single dose of PCV13 if they have not already received it.
- The vaccine helps protect against 13 types of pneumococcal bacteria that can cause
serious infections in children and adults.
- Common side effects may include redness, swelling, pain or tenderness, fever, loss of
appetite, fussiness (irritability), feeling tired, headache, muscle aches or joint pain, and
chills.
10. Rotavirus Vaccine (Brand Names: Rotarix and RotaTeq)
- Rotavirus causes severe diarrhea and vomiting. It affects mostly babies and young
children. Diarrhea and vomiting can lead to serious dehydration (loss of body fluid). If
dehydration is not treated, it can be deadly.
The rotavirus vaccine protects your baby from rotavirus, a potentially serious disease, from
developing diarrhea, vomiting, and stomach pain caused by rotavirus.
- There are two brands of rotavirus vaccine: RotaTeq and Rotarix. Both brands of the
rotavirus vaccines are given by mouth (drops), not by a shot.
- RotaTeq (RV5) is given in three doses at ages 2 months, 4 months, and 6 months.
- Rotarix® (RV1) is given in two doses at ages 2 months, and 4 months.
- Common side effects are rare, usually mild, and may include fussiness, diarrhea, and
vomiting.
11. Varicella Virus Vaccine (Brand Name: Varivax)
- The Varicella virus (Chickenpox) vaccine is used to protect against Chickenpox
(varicella), a common and very contagious childhood viral illness. It is a
live attenuated vaccine, which means it contains a weakened form of the virus.
- This is a vaccine indicated for active immunization for the prevention of varicella in
children 12 months of age or older.
- Children 12 months through 12 years old are given 2 doses of varicella vaccine
subcutaneously, separated by at least 3 months.
- Common side effects may include soreness, pain, redness or swelling at the injection site,
high fever, irritability, chicken-pox like rash on the body or at the site of the shot, seizure,
weakness, dizziness, cough, difficulty breathing, swelling of the face, lips, tongue, or
throat,
12. Polio Vaccine (Brand Name: IPol)
- Polio is a highly infectious disease, mostly affecting young children, which attacks the
nervous system and can lead to spinal and respiratory paralysis, and in some cases death.
-Two types are used: an inactivated poliovirus given by injection (IPV) and an
attenuated/weakened poliovirus given by mouth (OPV).
-The vaccine is used as a single-antigen vaccine called IPOL for active immunization of
infants (as young as 6 weeks of age), children, and adults for the prevention of
poliomyelitis caused by poliovirus types 1, 2, and 3.
- IPV is given by injection in the leg or arm, depending on the person’s age. It can be given
at the same time as other vaccines. CDC recommends that children get four doses of polio
vaccine, one dose at each of the following ages: 2 months, 4 months, 6 through 18 months,
and 4 through 6 years old.
- Children who have not started their polio vaccine series or who are delayed in getting all
recommended doses should start as soon as possible or finish their series by following the
recommended catch-up schedule.
- Adults at increased risk of exposure to poliovirus who have never been vaccinated against
polio should get three doses of IPV: The first dose at any time, the second dose 1 to 2
months later, the third dose 6 to 12 months after the second
- Adults at increased risk of exposure to poliovirus who have had one or two doses of polio
vaccine in the past should get the remaining one or two doses
LECTURE 3
INTERNATIONAL CONTROL OF INFECTIOUS DISEASES
Infectious diseases are transmitted beyond country boundaries thus could be of
international concern. To control infectious diseases internationally, World Health
Organization (WHO), was established after the Second World War to steer of the control
and management of infectious disease across the globe. Member states of the world health
organization WHO) are mandated by the International Health Regulations (IHR) to notify
WHO of outbreaks of diseases and manages programmes designed to contain and minimize
their effects. The ministry works closely with the WHO, providing her with health statistics
and other information. In addition, WHO member states reserve the right to take restrictive
trade and travel measures against other member states experiencing disease outbreaks that
exceed the measures permitted by the revised International Health Regulation (IHR).
Under General Agreement on Tariffs and Trade (GATT), import restriction to protect
animals, plant and human health are justified if they are necessary and do not represent
arbitrary discrimination or a disguised restriction on trade. The World Trade Organization
(WTO) Agreement in the application of sanitary and phytosanitary measures imposes
further disciplines on using trade restrictions to protect legitimately without hurting trade
flow needlessly. The IHR and trade treaties share the general interests of protecting
populations against diseases spread with minimal interference with world traffic.
Emerging and re-emerging diseases has resulted in a number of national and international
initiatives to restore and improves surveillance and control of communicable diseases.
World Health Organization (WHO) expressed their concern in a resolution of the World
Health Assembly in 1995, urging all member states to strengthen surveillance for
infectious diseases. The world health assembly recognized that the success of this
resolution depends on the ability to obtain information on infectious disease and the
willingness to communicate this information nationally and internationally.
The rapid global reach in telecommunications, media and internet access has created an
information society permitting public health professionals to communications more
effectively. Once a communicable disease outbreak has been confirmed, pertinent
information is placed on the World Wide Web and can be accessed by the general public
(http:http://www.who.int/csr/don/en/). At the same time, an international response, with the
input of technical and humanitarian partners, is mounted if required. A WHO team arrives
on site within 24 hours of outbreak confirmation to make an initial assessment and begin
immediate control measures and prepare the ground for the larger international response if
needed. By linking the international response to systematic global surveillance, a
worldwide “network of networks’’ is available from which to solicit support, thus
ensuring that no one country, technical or humanitarian partner must bear the entire
burden.
