1. Immunization. Unit

2. Immunization = Vaccination What is a Vaccine What is a Vaccine A vaccine is a substance that is introduced into the body to prevent Infection or a certain Pathogen A vaccine is a substance that is introduced into the body to prevent Infection or a certain Pathogen Can be used in bacterial, Viral, Parasitic Infections. Can be used in bacterial, Viral, Parasitic Infections.

3. History Guides the Future

4. Edward Jenner Vaccinating

5. Beginning of Vaccination. Vaccination ( Latin ; Vacca- Cow ) Vaccination ( Latin ; Vacca- Cow ) Edward Jenner used the term Vaccination Edward Jenner used the term Vaccination Cow pox virus provided immunity in prevention of Small pox Cow pox virus provided immunity in prevention of Small pox

6. Scientific Era of Vaccination. Louis Pasteur adopts the principles of Vaccination Louis Pasteur adopts the principles of Vaccination For his scientific work. Vaccination for prevention of Rabies creates awareness on Immunization with scientific fundamentals

7. Major Principles and Methods of Vaccination Biological events guide the Vaccination

8. Major content of Vaccines 1. Toxoids 2. Inactivated vaccines. 3. Attenuated vaccines 4. Subunit vaccines 5. Hyper immune globulins.

9. What we have achieved with Vaccination Cost effective method in controlling the infectious diseases. Cost effective method in controlling the infectious diseases. Small pox - Eradicated. Small pox - Eradicated. Immunization prevents many diseases Immunization prevents many diseases We have created Herd immunity in commonly prevalent diseases. We have created Herd immunity in commonly prevalent diseases.

10. Eradication of Small Pox WHO efforts with various Governmental and Social Organizations have changed History of Medicine WHO efforts with various Governmental and Social Organizations have changed History of Medicine

11. Principles of Immunization Development of Immunology has foundations on Vaccines

12. Different protocols to Immunization Passive Immunization Passive Immunization Active Immunization. Active Immunization.

13. Passive Immunization Passive immunization Passive immunization Artificially created by passive method Artificially created by passive method Can be created at short notice, Can be created at short notice, Effective for limited periods, Effective for limited periods, Antibodies are created in various sources from animals to humans Can be Antiviral,Antibacterial, Source can be Animals, or Humans Human source will be effective for 3-6 months. Animals ( Heterologus ) effective for few weeks,

14. Passive Immunization Diphtheria antitoxin - Horse- Equine Diptheriae antitoxin. Diphtheria antitoxin - Horse- Equine Diptheriae antitoxin. Botulism - Antitoxin Botulism - Antitoxin Tetanus – Antitoxin. – Equine Tetanus – Antitoxin. – Equine Human Tetanus Immunoglobulin, Human Tetanus Immunoglobulin, Pooled Immunoglobulins Pooled Immunoglobulins Human Normal Immunoglobulin Human Normal Immunoglobulin Used for short term prophylaxis, Used for short term prophylaxis, Eg Hepatitis A Immunoglobulin, Eg Hepatitis A Immunoglobulin,

15. Passive Immunization Highly Successful Saves in Acute Infections Diphtheria Antitoxin Diphtheria Antitoxin Tetanus Antitoxin Tetanus Antitoxin Rabies Hyper immune Globulins( HRIG ) Rabies Hyper immune Globulins( HRIG ) Varicella Zoster Hyper Immune Globulins (HZIG) Varicella Zoster Hyper Immune Globulins (HZIG)

16. Active Immunization. Most Ideal, Cost effective, method to prevent communicable Diseases.

17. Active Immunization with Toxoids Types 1 Types 1 Toxoids - Single Toxin Modified Toxoids - Single Toxin Modified Preserves Antigenicity, Preserves Antigenicity, Loses its Toxicity. Loses its Toxicity. Eg 1 Tetanus Toxoid Eg 1 Tetanus Toxoid 2 Diphtheria Toxoid 2 Diphtheria Toxoid

18. Active Immunization Inactivated / Killed Vaccines, Inactivated / Killed Vaccines, Microbes are killed Microbes are killed Eg 1 Pertusis, (Whooping cough ) Eg 1 Pertusis, (Whooping cough ) 2 Influenza ( Flu) 2 Influenza ( Flu) 3 Salk - Killed vaccine for 3 Salk - Killed vaccine for (Poliomyelitis), (Poliomyelitis),

19. Active Immunization Attenuated Live vaccine Attenuated Live vaccine Inactivation destroys pathogen city, Inactivation destroys pathogen city, Protective immunity is retained Protective immunity is retained Contains living organisms with reduced virulance, 1 Live polio vaccines –Sabins, 1 Live polio vaccines –Sabins, 2 Yellow fever vaccine 17D strain. 2 Yellow fever vaccine 17D strain.

20. Different schedules of Vaccination May vary from Nation to Nation Depends on Geographic, Economic and prevalence of Specific Diseases

22. Herd Immunity Definition – When most of the People in a community are immune to particular infection-Natural transmission is inhibited. Definition – When most of the People in a community are immune to particular infection-Natural transmission is inhibited. Herd Immunity works in infections transmitted from person to person only. Herd Immunity works in infections transmitted from person to person only. The Mass oral polio vaccine creates a Herd Immunity and protects the Society. The Mass oral polio vaccine creates a Herd Immunity and protects the Society.

23. Immunization Schedules Depend on Need, Need, Efficacy, Efficacy, Safety, Safety, Ease of administration, Ease of administration,

24. Vaccines which Changed the History of Medicine Vaccination for Polio, Tetanus Diphtheria, Pertusis. Rabies Universally accepted

25. Vaccination for Diphtheria, Tetanus and Pertusis Triple Antigen ( DTP ) Triple Antigen ( DTP ) Contains Toxoids of Diphtheria and Tetanus Contains Toxoids of Diphtheria and Tetanus Pertusis component Contains whole Cell preparation from Bordetella pertusis. Pertusis component Contains whole Cell preparation from Bordetella pertusis. Three Doses given at the interval of 4-6 weeks Three Doses given at the interval of 4-6 weeks Boosters at Later date Boosters at Later date

26. Vaccination for Poliomyelitis A great break through in Vaccine Research Millions saved from disabling Polio

27. Pioneers in Prevention of Poliomyelitis

28. Vaccination in Poliomyelitis Vaccination for Poliomyelitis, can be oral or inject able. Vaccination for Poliomyelitis, can be oral or inject able. Sabins – Mixture of 3 types poliovirus1,2,3 Sabins – Mixture of 3 types poliovirus1,2,3 Live attenuated vaccine, A oral vaccine colonizes the gut produces the local immunity and antibody mediated immunity protects, Rarely hazardous, Live attenuated vaccine, A oral vaccine colonizes the gut produces the local immunity and antibody mediated immunity protects, Rarely hazardous, Salk – vaccine a killed vaccine not used in routine immunization schedules. Salk – vaccine a killed vaccine not used in routine immunization schedules. Sabin’s live polio vaccine is economical for mass vaccination in populous countries Sabin’s live polio vaccine is economical for mass vaccination in populous countries Component of Mass Pulse Polio Immunization programme Component of Mass Pulse Polio Immunization programme

29. Commonly used vaccines, MMR Vaccine MMR Vaccine Used for the prevention of Measles, Mumps, and Rubella. Measles, Mumps, and Rubella. Contains live attenuated strains, Given at the age between 12-15 months, But Measles vaccination is done early in Palestine at 9 months. Rubella Rubella Rubella Vaccine is given separately to young women Rubella Vaccine is given separately to young women Given to all sero negative women of child bearing age Given to all sero negative women of child bearing age

30. Vaccination for Tuberculosis BCG – Attenuated strains of Bovine Tubercle Bacilli, ( Bacilli –Chalmette- Guerin) BCG – Attenuated strains of Bovine Tubercle Bacilli, ( Bacilli –Chalmette- Guerin) Efficacy ? But useful in the prevention of Tuberculosis meningitis, and Leprosy Efficacy ? But useful in the prevention of Tuberculosis meningitis, and Leprosy Given on lateral aspect of arm, at the deltoid insertion Given on lateral aspect of arm, at the deltoid insertion To be given intradermally, To be given intradermally,

31. Emerging Vaccines Recently several persons benefited.

32. Haemophilus influenza Type b serotype is capsulated and highly pathogenic, Type b serotype is capsulated and highly pathogenic, Produces Meningitis,Bacteremias, Epiglottis's. Produces Meningitis,Bacteremias, Epiglottis's. Encapsulated strain b is selected for vaccination. Encapsulated strain b is selected for vaccination. Vaccine contains capsular polysaccharide linked to a protein and protects against against type B strains. Vaccine contains capsular polysaccharide linked to a protein and protects against against type B strains. In U K given along with DPT vaccine In U K given along with DPT vaccine When not given earlier A single dose for 1 – 4 years children. When not given earlier A single dose for 1 – 4 years children. Elder children and Adults do not need unless immunosupressed. Elder children and Adults do not need unless immunosupressed.

33. Meningococcal Vaccine Men C Vaccine The component of the vaccine is Meningococcal C antigen, The component of the vaccine is Meningococcal C antigen, The polysaccharide component is linked to protein carrier, The polysaccharide component is linked to protein carrier, In developed countries given at 2, 3, 4 months duration. In developed countries given at 2, 3, 4 months duration. Produces prolonged immune response. Produces prolonged immune response.

34. Vaccination in Hepatitis A Virus Infection A formaldehyde inactivated vaccine prepared from HAV grown in Diploid cells A formaldehyde inactivated vaccine prepared from HAV grown in Diploid cells A vaccination is effective for 10 years A vaccination is effective for 10 years Advised mainly in persons entering endemic areas with HAV Infection. Advised mainly in persons entering endemic areas with HAV Infection.

35. Bio-Engineering creates Vaccine Hepatitis B Vaccine

36. Molecular Biology and Genetic Engineering contributed for HBV Vaccine.

37. Vaccination for Hepatitis B Infection. Hepatitis B Vaccine Hepatitis B Vaccine Bio Engineered vaccine, Bio Engineered vaccine, 0 - 1 - 6 months ( Dosage ) 0 - 1 - 6 months ( Dosage ) Deltoid region Deltoid region 90% successful 90% successful Universal Immunization – an ideal goal in prevention of Hepatitis B infections. Universal Immunization – an ideal goal in prevention of Hepatitis B infections.

38. Combined Vaccination for Hepatitis A and B Infections. Now a combined vaccine is available for prevention of Hepatitis A and B Now a combined vaccine is available for prevention of Hepatitis A and B Available as Available as TWINRIX ( GSK ) TWINRIX ( GSK )

39. Vaccination for Typhoid Oral – Live ( Typhoral ) Oral – Live ( Typhoral ) Stable mutant of S.typhi Stable mutant of S.typhi Strain Ty2 ( Lacking enzyme UDP –Galactose 4 Epimerase). Strain Ty2 ( Lacking enzyme UDP –Galactose 4 Epimerase). Injectable vaccine ( Ty vi ) contains Injectable vaccine ( Ty vi ) contains Purified Vi polysaccharide Antigen Purified Vi polysaccharide Antigen Efficacy lasts for 3 years Efficacy lasts for 3 years Needed for people traveling to Endemic areas Needed for people traveling to Endemic areas

40. Other Vaccines Pneumococcal vaccine Pneumococcal vaccine A polyvalent polysaccharide containing capsular antigen with 23 Sero types A polyvalent polysaccharide containing capsular antigen with 23 Sero types Gives 80 -90 % protection Gives 80 -90 % protection Used in Used in Dysfunctional spleen Dysfunctional spleen Sickle cell diseases, Sickle cell diseases, Chronic diseases of Liver, lungs, heart, Chronic diseases of Liver, lungs, heart, Renal failure. Renal failure. HIV infection HIV infection Effective in > 2 years old children,

41. Vaccine for Varicella zoster OKA strain, A live attenuated strain, OKA strain, A live attenuated strain, Single dose for children ( 1-12 years children) Single dose for children ( 1-12 years children) Not to be given in Immune suppressed / HIV patients. Not to be given in Immune suppressed / HIV patients.

42. Vaccine for Influenza(virus ) Always use new vaccines with prevailing strains, Always use new vaccines with prevailing strains, Now recombinant vaccines are available. Now recombinant vaccines are available. Made in embroyonated eggs. Made in embroyonated eggs.

43. New Vaccines Developed or on Trails

44. Vaccines for Rota Virus Rota Rix ( GSK ) Rota Rix ( GSK ) Introduced in Brazil, Elsalvador, Mexico, Panama and Venezuela Introduced in Brazil, Elsalvador, Mexico, Panama and Venezuela Under Phase III trails in Africa, and Malawi Under Phase III trails in Africa, and Malawi Rota Teq ( MEREK) Rota Teq ( MEREK) Introduced in Nicaragua Introduced in Nicaragua

45. Newer Pneumococcal Vaccine A Seven Valent conjugate vaccine (Prevenar ) A Seven Valent conjugate vaccine (Prevenar ) Effective against 7 strains prevalent in certain geographic locations Effective against 7 strains prevalent in certain geographic locations Effective in 83 % HIV uninfected. Effective in 83 % HIV uninfected. Effective in 65 % of HIV infected. Effective in 65 % of HIV infected.

46. Human Papilloma Virus Vaccine Gardasil ( HPV vaccine ) developed by Merck. Gardasil ( HPV vaccine ) developed by Merck. Effective against 4 common serotypes Effective against 4 common serotypes ( includes prominent serotypes 16 and 18 causing Cancer cervix ). ( includes prominent serotypes 16 and 18 causing Cancer cervix ). Adolescents and preadolescents considered for vaccination. Adolescents and preadolescents considered for vaccination.

47. Newer Meningococcal Meningitis A Vaccine ( Men A ) Effective in Meningococcal Diseases Effective in Meningococcal Diseases Phase I trails in India Phase II trails, Mali, and Gambia Phase III trails in Ethiopia /Senegal

48. Influenza Current Vaccine In view of changing strains the antigens configuration for Influenza need a new model vaccine every year / frequently In view of changing strains the antigens configuration for Influenza need a new model vaccine every year / frequently Currently CSL Biotherapies vaccine is licensed on 28 th Sept 2007 for current use. Currently CSL Biotherapies vaccine is licensed on 28 th Sept 2007 for current use.

49. Need for Vaccines in HIV/AIDS

50. Why Vaccines are Difficult to Development in AIDS H I V infection is produced by most complex virus ever identified and it is extremely good at evading any Immune Mediated strategy detected against. H I V infection is produced by most complex virus ever identified and it is extremely good at evading any Immune Mediated strategy detected against. H I V is Genetically diverse. H I V is Genetically diverse. New forms ( clades ) are emerging all through infection, New forms ( clades ) are emerging all through infection,

51. Vaccine Options 1 Live attenuated or whole killed HIV virus Failed due to safety fears, Trails stopped. 2 Sub Unit vaccines ( gp 20 model ) 2 Sub Unit vaccines ( gp 20 model ) Failed in Major trails. Failed in Major trails. 3 DNA vaccines 3 DNA vaccines Isolated HIV genes used to stimulate Isolated HIV genes used to stimulate cell mediated Immunity. cell mediated Immunity.

52. Vaccine Options ( Contd ) 4 Recombinant Vaccine - Isolated genes delivered through another viral vector, Most trials use this method Most trials use this method

53. Vaccine Options 5 Combination Vaccines. 5 Combination Vaccines. Multiples trails are in progress with combination of Designs, strategies, Multiples trails are in progress with combination of Designs, strategies, And And Immunogens which can produce a broader more powerful, and more durable immune response. Immunogens which can produce a broader more powerful, and more durable immune response.

54. The Quest for the AIDS vaccine continues Various National and International Organization are committed for development of a effective Vaccine

55. Vaccination for People at special risk Anthrax Anthrax Cholera Cholera Hepatitis A Hepatitis A Hepatitis B Hepatitis B Influenza Influenza Japanese B encephalitis Japanese B encephalitis Meningococcal Infection Meningococcal Infection Plague Plague Pneumococcal infection Pneumococcal infection Q fever, Q fever, Rabies Rabies Tick borne encephalitis. Tick borne encephalitis. Typhoid Typhoid Typhus Typhus Varicella Zoster Varicella Zoster Yellow fever. Yellow fever.

56. Contraindication to Vaccination In spite of great success with many vaccines, yet a caution and wisdom are essential I

57. Contra -indications to Vaccination Do not give vaccines to acutely ill patients. Do not give vaccines to acutely ill patients. Avoid giving live vaccines to pregnant women Avoid giving live vaccines to pregnant women Avoid all types of vaccines in the first Trimester of pregnancy, Avoid all types of vaccines in the first Trimester of pregnancy, Do not give live vaccines to immunosupressed patients and patients suffering with RES malignancies, Do not give live vaccines to immunosupressed patients and patients suffering with RES malignancies,

58. Contraindication ( Cont ) In spite of Immune suppression in HIV infected, we can still give MMR and Oral polio drops ( But Salk killed vaccine is safe). In spite of Immune suppression in HIV infected, we can still give MMR and Oral polio drops ( But Salk killed vaccine is safe). In HIV patients do not give BCG vaccine In HIV patients do not give BCG vaccine

59. What is an ideal vaccine. Promotes effective immunity. Promotes effective immunity. Controls lifelong protection. Controls lifelong protection. Safe, do not carry side effects. Safe, do not carry side effects. Stable, cheap, Stable, cheap, Acceptance by public. Acceptance by public. Yet there is No Ideal Vaccine. Yet there is No Ideal Vaccine.

60. Care in Vaccination Some subjects may develop acute anaphylaxis with vaccination, Some subjects may develop acute anaphylaxis with vaccination, Be prepared to resuscitate the individuals, Be prepared to resuscitate the individuals,

61. Unresolved problems Nothing is perfect Nothing is perfect No Vaccine is totally Protective No Vaccine is totally Protective Influenza – Needs very frequent updating Influenza – Needs very frequent updating Cholera vaccine –Little effective in reality Cholera vaccine –Little effective in reality

62. WHO Initiatives On Vaccine Strategies and Development

63. WHO Supports the Research of various Biological Supports the Research of various Biological Organizations which produce the Newer Organizations which produce the Newer Vaccines Vaccines Helps the Implementation various programmers related to Vaccines Helps the Implementation various programmers related to Vaccines

64. Vaccine Research Now major research is focused on finding the safe and Socially acceptable vaccines Now major research is focused on finding the safe and Socially acceptable vaccines Refer for current knowledge on Vaccines. VACCINE - is a International peer-reviewed journal of Vaccination Research VACCINE - is a International peer-reviewed journal of Vaccination Research Indexed in Medline pISSN: 0264-410X Indexed in Medline pISSN: 0264-410X

65. Vaccination created HOPE in Humanity