Immunization Ataei Behrooz,MD.MPH Medical University Isfahan Department of Infectious Diseases

O The two most effective means of preventing disease, disability, and death from infectious diseases have been: O Sanitation O Immunization 3

O Immunization is the act of artificially inducing immunity or providing protection from disease; it can be active or passive. O Active immunization consists of inducing the body to develop defenses against disease. 4

O This is usually accomplished by the administration of vaccines or toxoids that stimulate the body's immune system to produce antibodies or cell-mediated immunity, or both, which protects against the infectious agent. 5

O Passive immunization consists of providing temporary protection through the administration of exogenously produced antibody. O Two situations in which passive immunization commonly occurs: O Transplacental transfer of antibodies to the fetus, which may provide protection against certain diseases for the first 3 to 6 months of life, O Immunoglobulins for specific preventive purposes. 6

O Vaccine: a suspension of attenuated live or killed microorganisms (bacteria, viruses, or rickettsiae), or fractions thereof, administered to induce immunity and thereby prevent infectious disease 7

O Toxoid: a modified bacterial toxin that has been rendered nontoxic but retains the ability to stimulate the formation of antitoxin 8

O Immunoglobulin: a sterile solution for intramuscular administration containing antibody from human blood. O Immune globulin intravenous (IGIV), a specialized preparation allowing intravenous administration, is indicated primarily for replacement therapy in immunoglobulin G (IgG) deficiency, treatment of Kawasaki disease, and idiopathic thrombocytopenic purpura 9

IGIV is approved by the FDA for six conditions: O Primary immunodeficiency status, O Kawasaki disease, O Immune-mediated thrombocytopenia, O Pediatric HIV infection, O Secondary immunodeficiency in chronic lymphocytic leukemia, O prevention of graft-versus-host disease and infection in hematopoietic cell transplantation in adults. 10

O Specific immunoglobulin: special preparations obtained from donor pools preselected for high antibody content against a specific disease, O Hepatitis B immune globulin (HBIG), O Varicella-zoster immune globulin (VZIG), O Rabies immune globulin (RIG), O Tetanus immune globulin (TIG) 11

Specific Immune Globulins for Intravenous Use O Cytomegalovirus (CMV) IGIV, O Botulism IGIV (for infant botulism), O vaccinia immune globulin. O An intramuscular humanized mouse monoclonal antibody preparation used to prevent respiratory syncytial virus (RSV) is available. 12

Respiratory Syncytial Virus Immune Globulin and Palivizumab O Palivizumab is a humanized monoclonal antibody against the F protein of RSV and is produced by recombinant DNA technology. O The recommended dosage is 15mg/kg administered intramuscularly monthly throughout the RSV season. 13

Intramuscular Immune Globulin O Intramuscular immune globulin is prepared from pooled human adult plasma by an alcohol- fractionation procedure. O Immune globulin consists primarily of IgG and trace amounts of IgA and IgM, is sterile, and is not known to transmit any infectious agents, including hepatotropic viruses and HIV 14

Intramuscular Immune Globulin O Immune globulin is licensed and recommended for administration deep into a large muscle mass such as the gluteal region or into the anterior thigh of a child. O Intravenous use of human immune globulin is contraindicated. 15

Indications for Use of Intramuscular Immune Globulin. O The three indications for use of immune globulin are replacement therapy for antibody deficiency disorders and for prophylaxis against hepatitis A and measles viruses. 16

Indications for Use of Intramuscular Immune Globulin O In persons aged 12 months through 40 years, hepatitis A immunization is preferred over immune globulin for postexposure prophylaxis (PEP) against hepatitis A virus infections and for protection of persons traveling to areas where hepatitis A is endemic. 17

Indications for Use of Intramuscular Immune Globulin O For persons younger than 12 months of age or older than 40 years of age, immunocompromised persons of all ages, and patients with chronic liver disease, immune globulin is preferred over hepatitis A immunization. 18

Indications for Use of Intramuscular Immune Globulin O Immune globulin is effective in preventing hepatitis A when administered within 14 days of exposure (a dose of 0.02 ml/kg) or when given before exposure in somewhat larger quantities (dose of 0.02 ml/kg for trips of 1to 2 months, 0.06 mL/kg every 5 months for longer trips). 19

Indications for Use of Intramuscular Immune Globulin O Immune globulin administered to exposed, measles-susceptible people will prevent or modify measles if administered within 6 days of exposure (a dose of 0.25 ML/kg for immunocompetent people, 0.5 mL/kg for immunocompromised hosts, up to a maximum of 15 mL) 20

Specific Intramuscular Immune Globulin Preparations O Hepatitis B Immune Globulin.(HBIG) O The dose is 0.06 Ml/kg given immediately for both sexual contacts and people exposed percutaneously. O HBIG is recommended for infants born to HBsAg- positive women. A dose of 0.5 mL should be given as soon as possible after birth but within 12hours of delivery in conjunction with a dose of hepatitis Bvaccine. 21

Specific Intramuscular Immune Globulin Preparations O Rabies Immune Globulin.(RIG) O Tetanus Immune Globulin.(TIG) O Varicella-Zoster Immune Globulin.(VZIG) O VariZIG is given intramuscularly at the recommended dose of 125 units per 10 kg of body weight up to 625 units (i.e., five vials). 22

Adverse Reactions to Immune Globulin Preparations O most common adverse effects of intramuscularly administered immune globulin include local pain at the injection site and, less commonly, flushing, headache, chills, and nausea. O Immune globulin inhibits response to certain live virus vaccines (e.g., measles and rubella vaccines) for between 3 and 9 months, depending on the dose administered. 23

Adverse Reactions to Immune Globulin Preparations O Adverse events after intravenous administration of immune globulin are common and include minor systemic reactions, pyrogenic reactions (high fever and systemic symptoms), vasomotor or cardiovascular manifestations (change in blood pressure and heart rate), and infrequent but serious reactions (aseptic meningitis, acute renal failure, hypersensitivity reactions, and anaphylaxis). 24

Vaccination O The live attenuated viruses (e.g., measles, mumps, and rubella) generally are believed to confer lifelong protection in those who respond. O Killed vaccines generally do not induce permanent immunity with one dose, making repeated vaccination and subsequent boosters necessary to develop and maintain high levels of antibody (e.g., diphtheria, tetanus, rabies, typhoid). 25

Vaccination O purified bacterial capsular polysaccharide vaccines induce a T-cell-independent immune response, which does not lead to immune memory and cannot be boosted with repeated injections. O Polysaccharide vaccines have poor immunogenicity in infants and young children. 26

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