1. Immunisation

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3. If you understand basic immunology you can explain... How vaccines work and why vaccine failures occur Adverse events and their timing Why the schedule is as it is Why vaccines cannot overload the immune system

4. Physical barriers Skin – 2 m² Mucosal membranes – digestive, respiratory, reproductive tract – 400 m²

5. Innate immunity Phagocytosis Macrophage - WBC Rapid action 0-4 hours Non-specific – same response each time No memory – same response at each encounter May destruct the antigen

7. Adaptive immunity Second level of defence Effectiveness increases with each encounter Specific immune response

8. Types of (adaptive) immunity Active Immunity Passive Immunity

9. Transfer of maternal antibodies Administration of antibodies

10. Active Immunity Antibodies produced in response to an infection Antibodies produced in response to a vaccination

11. Types of antibody IgG – the only type that crosses the placenta (after 32 weeks) IgA – in breast milk – gives some mucosal protection IgE – over production associated with anaphylaxis Also IgM – maybe further reading!

12. Active versus passive immunity ACTIVE Long lasting Takes time to be effective PASSIVE Only short term Immediate protection

13. Vaccination is based on specificity & memory

15. Vaccination schedule 2012 AgeDiseases protected against 2 monthsDiphtheria, tetanus, whooping cough, polio, Hib, pneumococcal disease 3 monthsDiphtheria, tetanus, whooping cough, polio, Hib, meningococcal disease type C 4 monthsDiphtheria, tetanus, whooping cough, polio, Hib, pneumococcal & meningococcal disease type C 12-13 months Hib/meningococcal disease type C pneumococcal disease Measles, mumps & rubella (MMR) 3yrs 4mDiphtheria, tetanus, whooping cough, polio MMR (pre-school immunisations) 12-13yrsHPV (cervical cancer) girls only 13-18yrsDiphtheria, tetanus, polio (school leavers immunisations)

16. Vaccine overload? Part of bodyBacteria Scalp1,000,000/cm 2 Surface of skin1000/cm 2 Saliva100,000,000/g Nasal mucus10,000,000/g FaecesOver 100,000,000/g

17. Contraindications Immunosuppression & treatment Some steroid use Unstable neurological condition Previous anaphylactic reaction Care with live vaccines Pyrexia Acute illness Side effects??

18. Vaccine trials Pre-clinical laboratory based work Phase I – (small scale – adults) Phase II – (population specific) Phase III – (100s-1000s participants) Phase IV vaccines – MHRA reporting

19. Getting to the schedule Research and development JCVI Recommendations to DH Cost and feasibility studies Supply and delivery Awareness and training issues

20. References/further reading Immunisation against infectious disease (Green Book) [online] http://immunisation.dh.gov.uk/category/the- green-book/ http://immunisation.dh.gov.uk/category/the- green-book/ Health Protection Agency website http://www.hpa.org.uk/HPAwebHome http://www.hpa.org.uk/HPAwebHome

21. Thank you!