Immunization

Current Trends
2008
Dr.T.V.Rao MD
Immunization = Vaccination

What is a Vaccine
A vaccine is a substance that is
introduced into the body to prevent
Infection by a certain Pathogen
Can be used in bacterial, Viral,
Parasitic Infections.
History Guides
the Future
Edward Jenner Vaccinating
 Beginning of Vaccination.

Vaccination ( Latin ;
Vacca- Cow )
Edward Jenner used
the term Vaccination
Cow pox virus
provided immunity in
prevention of Small
pox
Scientific Era 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
 Major Principles and
Methods of Vaccination

Biological events guide the

Vaccination
 Major content of Vaccines

 Toxoids
 Inactivated vaccines.
 Attenuated vaccines
 Subunit vaccines
 Hyper immune globulins.
 What we have achieved with
Vaccination
Cost effective method in controlling the
infectious diseases.
Small pox - Eradicated.
Immunization prevents many diseases
We have created Herd immunity in
commonly prevalent diseases.
Eradication of Small Pox

WHO efforts with

various Governmental
and Social
Organizations have
changed History of
Medicine
Principles of Immunization

Development of Immunology
has foundations on Vaccines
Different protocols to Immunization

Passive Immunization

Active Immunization.
 Passive Immunization
Passive immunization
Artificially created by passive method
Can be created at short notice,
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,
 Passive Immunization
Diphtheria antitoxin - Horse- Equine Diptheriae antitoxin.
Botulism - Antitoxin
Tetanus – Antitoxin. – Equine

Human Tetanus Immunoglobulin

Pooled Immunoglobulins

Human Normal Immunoglobulin

Used for short term prophylaxis,
Eg Hepatitis A Immunoglobulin,
 Passive Immunization
Highly Successful
Saves in Acute Infections

Diphtheria Antitoxin
Tetanus Antitoxin
Rabies Hyper immune Globulins( HRIG )
Varicella Zoster Hyper Immune Globulins
(HZIG)
Active Immunization.

Most Ideal, Cost effective, method

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

Inactivated / Killed Vaccines,

Microbes are killed
Eg 1 Pertusis (Whooping cough )
2 Influenza ( Flu)
3 Salk - Killed vaccine for
(Poliomyelitis)
 Active Immunization
Attenuated Live vaccine
Inactivation destroys pathogenicity,
Protective immunity is retained
Contains living organisms with reduced
virulence
1 Live polio vaccines –Sabin's
2 Yellow fever vaccine 17D strain.
Different schedules of
Vaccination
May vary from Nation to
Nation
Depends on Geographic,
Economic and prevalence of
Specific Diseases
 Herd Immunity
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.

The Mass oral polio vaccine creates a

Herd Immunity and protects the Society.
Immunization Schedules
Depend on
Need,
Efficacy,
Safety,
Ease of administration,
 Vaccines which
Changed the History of
Medicine
Vaccination for Polio, Tetanus
Diphtheria, Pertusis. Rabies
Universally accepted
 Vaccination for Diphtheria,
Tetanus and Pertusis
Triple Antigen ( DTP )
Contains Toxoids of Diphtheria and
Tetanus
Pertussis component Contains whole
Cell preparation from Bordetella
pertussis.
Three Doses given at the interval of 4-6
weeks
Boosters at Later date
 Vaccination for
Poliomyelitis

A great break through in

Vaccine Research
Millions saved from disabling
Polio
Pioneers in Prevention of
Poliomyelitis
 Vaccination in
Poliomyelitis
Vaccination for Poliomyelitis, can be oral or inject able.
Sabins – Mixture of 3 types poliovirus1,2,3
Live attenuated vaccine, oral vaccine colonizes the gut
produces the local immunity and antibody mediated immunity
protects , Rarely hazardous.

Salk – killed vaccine not used in routine immunization schedules in

India

Sabin’s live polio vaccine is economical for mass vaccination in

populous countries

Component of Mass Pulse Polio Immunization programs.

 Commonly used vaccines
MMR Vaccine
Used for the prevention of
Measles, Mumps, and Rubella.
Contains live attenuated strains,
Given at the age between 12-15 months
But Measles vaccination is done early in India at 9 months.

Rubella
Rubella Vaccine is given separately to young women
Given to all sero negative women of child bearing age
Vaccination for Tuberculosis
BCG – Attenuated strains of Bovine
Tubercle Bacilli, ( Bacilli –Calmette-
Guerin)
Efficacy ? But useful in the prevention of
Tuberculosis meningitis, and Leprosy
Given on lateral aspect of arm, at the
deltoid insertion
To be given intradermally
Emerging Vaccines

Recently several persons

benefited.
 Haemophilus influenza
Type b serotype is capsulated and highly
pathogenic,
Produces Meningitis,Bacteremias, Epiglottis.
Encapsulated strain b is selected for vaccination.
Vaccine contains capsular polysaccharide linked
to a protein and protects against type B strains.
In UK given along with DPT vaccine
When not given earlier A single dose for 1 – 4
years children.
Elder children and Adults do not need unless
immunosupressed.
 Meningococcal Vaccine
Men C Vaccine
The component of the vaccine is
Meningococcal C antigen,
The polysaccharide component is linked to
protein carrier,
In developed countries given at 2, 3, 4
months duration.
Produces prolonged immune response.
 Vaccination in Hepatitis A
Virus Infection

A formaldehyde inactivated vaccine

prepared from HAV grown in Diploid cells

vaccination is effective for 10 years

Advised mainly in persons entering
endemic areas with HAV Infection.
Bio-Engineering creates
Vaccine

Hepatitis B Vaccine
 Molecular Biology and Genetic
Engineering contributed for HBV
Vaccine.
 Vaccination for Hepatitis B
Infection.
Hepatitis B Vaccine
Bio Engineered vaccine,
0 - 1 - 6 months ( Dosage )
Deltoid region
90% successful
Universal Immunization – an ideal goal in
prevention of Hepatitis B infections.
 Combined Vaccination for
Hepatitis A and B Infections.

Now a combined vaccine is available for

prevention of Hepatitis A and B
Available as
TWINRIX ( GSK )
 Vaccination for Typhoid
Oral – Live ( Typhoral )
Stable mutant of S.typhi
Strain Ty2 ( Lacking enzyme UDP –Galactose
4 Epimerase).

Injectable vaccine ( Ty vi ) contains

Purified Vi polysaccharide Antigen
Efficacy lasts for 3 years

Needed for people traveling to Endemic areas

 Other Vaccines
Pneumococcal vaccine
A polyvalent polysaccharide containing capsular antigen
with 23 Sero types
Gives 80 -90 % protection
Used in
Dysfunctional spleen
Sickle cell diseases,
Chronic diseases of Liver, lungs, heart
Renal failure.
HIV infection
Effective in > 2 years old children
Vaccine for Varicella zoster
OKA strain, A live attenuated strain,
Single dose for children ( 1-12 years
children)
Not to be given in Immunosuppressed /
HIV patients.
Vaccine for Influenza(virus )

Always use new vaccines with prevailing

strains
Now recombinant vaccines are available.
Made in embroyonated eggs.
New Vaccines

Developed / on Trails
 Vaccines for Rota Virus

Rota Rix ( GSK )

Introduced in Brazil, Elsalvador, Mexico,
Panama and Venezuela
Under Phase III trials in Africa, and Malawi

Rota Teq ( MEREK)

Introduced in Nicaragua
Newer Pneumococcal Vaccine

A Seven Valent conjugate vaccine

(Prevenar )
Effective against 7 strains prevalent in
certain geographic locations

Effective in 83 % HIV uninfected.

Effective in 65 % of HIV infected.
 Human Papilloma Virus
Vaccine

Gardasil ( HPV vaccine ) developed by

Merck.
Effective against 4 common serotypes
( includes prominent serotypes 16 and 18
causing Cancer cervix ).
Adolescents and preadolescents
considered for vaccination.
Newer Meningococcal Meningitis
A Vaccine ( Men A )

Effective in Meningococcal Diseases

Phase I trials in India

Phase II trials , Mali, and Gambia
Phase III trials in Ethiopia /Senegal
 Influenza
Current Vaccine

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 28th Sept 2007 for current
use.
Need for Vaccines in
HIV/AIDS
 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 is Genetically diverse.

New forms ( clades ) are emerging all through

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

4. Recombinant Vaccine - Isolated genes

delivered through another viral vector

Most trials use this method

 Vaccine Options

5 Combination Vaccines.
Multiple trials are in progress
with combination of Designs, strategies,
And
Immunogens which can produce a
broader more powerful, and more durable
immune response.
The Quest for the AIDS
vaccine continues

Various National and International

Organization are committed for
development of an effective Vaccine
Present HIV Vaccination Trials
 Vaccination for
People at special risk
Anthrax Pneumococcal
Cholera infection
Hepatitis A Q fever,
Hepatitis B Rabies
Influenza Tick borne
Japanese B encephalitis.
encephalitis Typhoid
Meningococcal Typhus
Infection Varicella Zoster
Plague Yellow fever.
Contraindication to
Vaccination
I
In spite of great success with
many vaccines, yet a caution
and wisdom are essential
 Contra -indications to
Vaccination
Do not give vaccines to acutely ill patients.
Avoid giving live vaccines to pregnant
women
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
 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 HIV patients do not give BCG vaccine
What is an ideal vaccine.
Promotes effective immunity.
Controls lifelong protection.
Safe, do not carry side effects.
Stable, cheap,
Acceptance by public.

Yet there is No Ideal Vaccine.

 Care in Vaccination

Some subjects may develop acute

anaphylaxis with vaccination

Be prepared to resuscitate the individuals

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

On Vaccine Strategies
and Development
 WHO
Supports the Research of various Biological
Organizations which produce the Newer
Vaccines

Helps the Implementation of various

programs related to Vaccines
 Vaccine Research

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
Indexed in Medline pISSN: 0264-410X
Science Hopes a Vaccine for
every Disease
Vaccination created HOPE in
Humanity
Created for awareness among
Medical and Health care
workers in Developing world.

Dr.T.V.Rao MD
Email
doctortvrao@gmail.com