VACCINATION AND IMMUNIZATION
Public Health III
MUDr. Bohdana Rezková, Ph.D.
IMMUNIZATION
POSSIBILITIES OF IMMUNIZATION
IMMUNIZATION NATURALLY ACQUIRED ARTIFICIALLY ACQUIRED
ACTIVE AFTER INFECTION AFTER VACCINATION
PASSIVE TRANSPLACENTAL TRANSFER OF IG IG PREPARATIONS TRANSFER
PASSIVE IMMUNIZATION I.
• reception of pre-formed specific antibodies from an exogenous source homologous
(human) x heterologous (animal) antibodies, monoclonal
antibodies produced by biotechnology
• polyclonal Ig, hyper Ig, antitoxins
• temporary protection: 4 - 6 weeks
• risk of strong side effects at heterologous Ig (allergy, anaphylaxis, serum
sickness):
fractionated administration
during hospitalization with continual observation
only at very dangerous and necessary cases
• can inactivate live attenuated viral vaccines like varicella, measles, OPV,
and rotavirus vaccines.
PASSIVE IMMUNIZATION II.
Indications and preparations
1. Prophylaxis of dangerous infections or in individuals at risk
2. Therapy of severe acute infections and intoxications (tetanus, diphteria,…)
3. Protection for individuals who cannot be vaccinated because they
are immunodeficient or immunocompromised (intraveneous
polyclonal Ig - IVIG).
Tetanus immunisation and prophylaxis following injuries
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/820628/Tetanus_informat
ion_for_health_professionals_2019.pdf
ACTIVE IMMUNIZATION
• one of the most beneficial and cost-effective disease prevention
measures
• one of the most important inventions in medicine,
• method that used natural ways of bodies protection,
• key process – arising of immunological memory
faster and more powerful immunity response,
You do not need to have your children
vaccinated. When the epidemic comes,
we'll burn the witch.
Finally Jane found a real expert….
„Vaccination - the pros and cons“ (vitalia.cz):
• Question: Do you think it is normal to give a small child a vaccine in
which there are seven diseases at once? Even with poisonous
additives!
• Answer: It's not normal. It's a crime against humanity!
MUDr. Ludmila Elekova
• Is it possible for a vaccinated child
to get the disease against which it is
vaccinated?
• Is it true that vaccination reduces
immunity to other diseases?
• Can vaccines cause autism?
• Wouldn't it be better to postpone
some vaccinations until later? Little
child can hardly catch jaundice B….
• Isn't it dangerous to vaccinate so
many infections at once?
• Why is aluminum used in vaccines?
Isn't it dangerous for the baby?
HOW?
AGAINST
WHAT?
WHAT
THEN?
WHO? WHY?
BY WHAT?
WHOM?
WHEN
NOT?
WHEN?
OVERVIEW
I. INTRODUCTION TO VACCINOLOGY
• Importance of vaccination
• Composition of vaccine
• Classification of vaccines
• Immune response to vaccines
• Vaccination contraindications
• Side effects of immunization
• Principles of right vaccination
• Vaccination programs
II. SPECIAL VACCINOLOGY
• Vaccinations preventable
diseases
• Vaccinations for travellers
IMPORTANCE OF
VACCINATION
I. INTRODUCTION TO VACCINOLOGY
1796 - Edward Jenner showed efficacy of smallpox vaccine
1801 – vaccination commenced in the UK
1802 - vaccination started in the Czech lands
1959 – WHO accepted plan for eradication
MAIN STRATEGY:
• mass vaccination strategies: mass vaccination of the population with
a target of 80% vaccine coverage in each country,
• surveillance and anti-epidemic strategies: reporting of variegated
disease, regular screening actions, strict isolation of patients, rapid
vaccination of all persons in contact with the sick person
to interrupt the spread of the disease where vaccination is low.
Mass campaign Declaration of eradication
and vaccination
ONLY ONE
NOT
VACCINATED
HERD IMMUNITY
- percentage of immune people in the
population needed to prevent the
spread of the agent.
IMPACTS OF VACCINATION
DIRECT EFFECT
• resulted from immune response of
organisms to vaccine
creation of individual immunity
INDIRECT EFFECT
• impact on disease transmission in the
population
creation of herd immunity
• prevents the disease or its severe
course
• stops the spread of infections in the
population
• helps protect unvaccinated persons
Clinical Infectious Diseases, Volume 52, Issue 7, 1 April 2011, Pages 911–916, https://doi.org/10.1093/cid/cir007
The content of this slide may be subject to copyright: please see the slide notes for details.
Simple threshold concept of herd immunity
What defines the protective thresholds of herd
immunity and public health strategies?
• infectivity of the agent
• immunogenicity of the vaccine and type of immune response
• duration of infectiousness in the infected persons
• duration of vaccination induced immunity
• homogeneity of population (interaction between age group,…)
Clinical Infectious Diseases, Volume 52, Issue 7, 1 April 2011, Pages 911–916, https://doi.org/10.1093/cid/cir007
The content of this slide may be subject to copyright: please see the slide notes for details.
Diagram illustrating transmission of an infection with a
basic reproduction number R0 = 4
NOT
VACCINATED
PROTECTED
https://youtu.be/V9DinPkjbgo
IMPORTANCE OF
VACCINATION
COMPOSITION OF
VACCINES
I. INTRODUCTION TO VACCINOLOGY
VACCINE INGREDIENTS
ANTIGEN
STABILIZERS
RESIDUAL
SUBSTANCES
PRESERVATIVES
ADJUVANTS
ADJUVANTS
• added to some vaccines to enhance the immune response,
• benefit for people with compromised immune systems, the elderly,
and the very young,
use of less antigen (in short supply or costly),
reducing or eliminating the need for booster vaccinations
• Aluminum-containing adjuvants
• others: AS04, MF59, AS01B, …
RESIDUAL SUBSTANCES - ANTIBIOTICS
• in some vaccines,
• used to help prevent bacterial contamination during manufacturing
small amounts of antibiotics may be present in some vaccines,
• e.g. neomycin, polymyxin B, streptomycin, gentamicin,
• antibiotics most likely to cause severe allergic reactions (e.g.,
penicillins, cephalosporins and sulfa drugs) are not used in vaccine
production!
STABILIZERS
• help protect the vaccine from adverse conditions (e.g. temperature).
• various substances - e.g.:
➢sugars such as sucrose and lactose,
➢amino acids such as glycine or the monosodium salt of glutamic acid
➢proteins such as human serum albumin or gelatin.
ANTIGEN
• any substance inducing a desired immune response in a vaccinated
person,
• complex (live vaccines) or with one (HepB) or more components
(acellular pertussis vaccine),
• alone (≥ 5 kdal) or conjugated with some proteins (e.g. with a toxoid)
CONJUGATED VACCINES
PRESERVATIVES
• to prevent the growth of bacteria or fungi that may be introduced
into the vaccine during its use (e.g. repeated puncture of a multi-dose
vaccine vial with a needle).
• THIMEROSAL
IMPORTANCE OF
VACCINATION
CLASSIFICATION OF
VACCINES
I. INTRODUCTION TO VACCINOLOGY
TYPES OF VACCINES
1. Live-attenuated vaccines
2. Inactivated vaccines
3. Subunit, recombinant,
polysaccharide, and
conjugated vaccines
4. Toxoid vaccines
• Whole-Pathogen Vaccines
• Subunit Vaccines
• Nucleic Acid Vaccines
WHOLE – PATHOGEN VACCINES
LIVE-ATTENUATED VACCINES
• contain a version of the living
microbe that has been weakened
in the laboratory
• vaccine against measles, mumps
and rubella (MMR), varicella, TB,
oral polio, …
• elicit strong immune responses
• life-long immunity after only one
or two doses
• stronger and more frequent side
effects
INACTIVATED VACCINES
• produced by killing the pathogen
with chemicals, heat or radiation
• vaccine against rabies, hepatitis A,
TBE, polio - Salk, typhoid fever,…
• side effects are weaker
• immune response is not so strong
(need of 3 doses)
SUBUNIT VACCINES I
POLYSACCHARID VACCINES
• based on the polysaccharides, or
sugars, that form the outer coating of
bacteria
• activate only T – indep. immunity
• short – term immunity
• age limited indications
• CONJUGATED VACCINES
• polysaccharide is conjugated to a
protein antigen to offer improved
protection (e.g. toxoid)
• change immune response – useful for
young children and elderly people
• against Hib, pneumococcal and
meningococcal infections.
- include only the components, or antigens, that best stimulate the immune
system,
- antigens alone are not sufficient to induce adequate long-term immunity
+ adjuvants,
- are safer and easier to produce.
SUBUNIT VACCINES II
TOXOID VACCINES
• chemically inactivated toxins
(toxoids),
• elicit immune responses against
disease-causing proteins, or
toxins, secreted by the bacteria,
• against bacterial illnesses, such
as diphtheria and tetanus.
RECOMBINANT VACCINES
• recombinant DNA technology,
• genetic code for the viral protein
has been inserted into other
cells which then produce it,
• against hepatitis B, Men B, HPV
NUCLEIC ACID VACCINES
• use introduction of genetic materials encoding one or more antigens
of pathogen into the body cells, they then produce the antigen
stimulation of broad long-term immune responses,
• relative ease of large-scale vaccine manufacture,
• excellent vaccine stability,
• in the research pipeline, not currently licensed for human use,
• e.g. DNA plasmid vaccines
KINDS OF VACCINES
1. SIMPLE X COMBINED – against one or more infections (e.g. MMR,
hexavaccine,…)
2. MONOVALENT X POLY (…) VALENT – against one or more serotypes
of one pathogen (e.g. tetravalent vaccine against meningococcus
A,C,W,Y)
IMPORTANCE OF
VACCINATION
IMMUNE
RESPONSE TO
VACCINATION
I. INTRODUCTION TO VACCINOLOGY
3 ways of
interaction
between vaccine
antigens and
immune system
Source: J. Beran :Physiology of
immune response to
vaccination. Available at:
https://www.vakcinace.eu/pred
nasky-stud .
COMPARISON OF IMMUNE RESPONSE
POLYSACCHARID VACCINES
Ig M, no immunologic memory
CONJUGATED VACCINES:
Ig G, immunologic memory
IMPORTANCE OF
VACCINATION
SIDE EFFECTS OF
VACCINATION
IMMUNE
RESPONSE TO
VACCINATION
I. INTRODUCTION TO VACCINOLOGY
SIDE EFFECTS OF VACCINES
• Any vaccine can cause side effects.
• All side effects are monitored by national institution systems.
• Expected x unexpected
• Local x general
• From the view of severity:
1. Physiological side effects
2. Severe side effects (physiological or neurological)
3. Allergic side effects
CAUSALITY ASSESSMENT FOR POTENTIAL
ADVERSE EVENTS
1. Evidence convincingly supports a causal relationship
(e.g. the oral polio vaccine and vaccine-associated paralytic polio)
2. Evidence favors acceptance of a causal relationship
3. Evidence is inadequate to accept or reject a causal relationship
4. Evidence favors rejection of a causal relationship
https://www.nap.edu/catalog/13164/adverse-effects-of-vaccines-evidence-
and-causality
COMMON PHYSIOLOCIGAL SIDE EFFECTS
• Local reaction (redness and/or swelling around injection site)
• Mild temperature or fever
• Irritability, decreased appetite, sleepiness
• Vomiting and diarrhoea
• Fainting (uncommon; however, this may sometimes occur)
sometimes happen 1 to 3 days after the vaccination
SEVERE SIDE EFFECTS
Each side effect that causes:
• Death
• Life threat
• Severe alteration of organisms
• Long term damage
• Hospitalisation
• Congenital anomaly in descendants
NEUROLOGICAL SIDE EFFECTS
• febrile seizures
• Guillain-Barré Syndrome
• encephalitis
• encephalomyelitis
• non-stop crying for 3 hours or more
ANAPHYLACTIC REACTION
• usually occur within minutes of parenteral administration,
• most common signs and symptoms are cutaneous (e.g. urticaria,
angioedema, flushing, pruritus). However, 10 to 20% of patients have no
skin findings.
• rapid progression of symptoms, evidence of respiratory distress (e.g.,
stridor, wheezing, dyspnoea, increased work of breathing, retractions,
persistent cough, cyanosis), signs of poor perfusion, abdominal pain,
vomiting, dysrhythmia, hypotension, collapse,
• first and most important therapy - epinephrine,
• providers should have a plan in place to contact emergency medical
services.
IMPORTANCE OF
VACCINATION
CONTRAINDICATIONS
OF VACCINATION
SIDE EFFECTS OF
VACCINATION
IMMUNE
RESPONSE TO
VACCINATION
I. INTRODUCTION TO VACCINOLOGY
GENERAL CONTRAINDICATIONS
• Conditions in a recipient that increases the risk for a serious adverse
reaction.
• Persons who administer vaccines should screen patients for
contraindications!
1. Severe allergic reaction (e.g. anaphylaxis) after a previous dose or
to a vaccine component.
2. Severe reaction after previous dose with alteration of general
condition.
CONRAINDICATIONS FOR LIVE VACCINES
• Pregnant women
• General contraindications
• Diagnosed immunodeficiency
• Treatment by Corticosteroids (0,5 mg/kg/2 weeks)
• Specific biological treatment
• Selected haemato-oncological or haematological diagnosis
• 3 months after transfusion or passive immunization
PRECAUTIONS
• Condition in a recipient that might increase the risk of a serious
adverse reaction.
• In general, vaccinations should be deferred when a precaution is
present.
• Vaccination might be indicated in the presence of a precaution if the
benefit of protection from the vaccine outweighs the risk for an
adverse reaction.
1. Moderate or severe acute illness with or without fever.
2. Other specific precautions at various vaccines.
IMPORTANCE OF
VACCINATION
PRINCIPLES OF
RIGHT
IMMUNISATION
SIDE EFFECTS OF
VACCINATION
IMMUNE
RESPONSE TO
VACCINATION
I. INTRODUCTION TO VACCINOLOGY
CONTRAINDICATIONS
OF VACCINATION
PROPER VACCINE ADMINISTRATION
• critical to ensure that vaccination is safe and effective.
• Vaccine administration protocol (CDC):
1. Review vaccination history
2. Assess for Needed Immunizations
3. Screen for Contraindications and Precautions
4. Educate the Parent or Patient
5. Prepare the Vaccine(s)
6. Administer the Vaccine (use conventional or abbreviated scheme)
7. Document the Vaccination(s)
VACCINATION SCHEME
• basic (conventional) scheme) - number of doses needed for adequate
and prolonged protection, varies from vaccine to vaccine,
x abbreviated scheme
• booster dose - for some vaccines, later in life to maintain protection.
BEST PRACTICES FOR MULTIPLE INJECTIONS
• Label each syringe to identify the vaccine it contains.
• Separate injection sites by 1 inch or more, if possible.
• Administer vaccines that may be more likely to cause a local reaction
(e.g., tetanus-toxoid-containing and PCV13) in different limbs, if
possible.
• Use combination vaccines (e.g., DTaP-IPV-HepB or DTaP-IPV/Hib), if
appropriate, to decrease the number of injections.
https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html
CDC RECOMMENDED INTERVALS BETWEEN ADMINISTRATIONS
OF DIFFERENT TYPES OF VACCINES
(IF NOT ON SAME DAY)
COMBINATIONS OF
ANTIGENS
RECOMMENDED MINIMUM INTERVAL
≥ 2 INACTIVATED
NO INTERVAL, COULD BE AMINISTERED ANYTIME
INACTIVATED AND LIVE
NO INTERVAL, COULD BE ADMINISTERED ANYTIME
≥ 2 LIVE - ADMINISTRED
PARENTERALLY
4 WEEKS, IF NOT ADMINISTERED ON SAME DAY
AFTER BCG
PRIMOVACCINATION
8 WEEKS OR AFTER THE LESION HEALED
IMPORTANCE OF
VACCINATION
SIDE EFFECTS OF
VACCINATION
IMMUNIZATION
PROGRAMS
IMMUNE
RESPONSE TO
VACCINATION
I. INTRODUCTION TO VACCINOLOGY
CONTRAINDICATIONS
OF VACCINATION
IMMUNIZATION PROGRAMS
• All countries have a national immunization programme to protect the
population against vaccine-preventable diseases.
• WHO: the Expanded Programme on Immunization (EPI)
https://vaccine-schedule.ecdc.europa.eu/
VACCINATION PREVETABLE DISEASES
RUTINE VACCINATION
• BCG
• Measles
• Rubella
• Mumps
• Pertusiss
• Tetanus
• Diphteria
• Influenza
• TBE
• Meningococcal diseases
• Pneumococcal diseases
• Rotavirus
• Poliomyelitis
• Hepatitis A
• Hepatitis B
• HiB
• Varicella – Zoster
• HPV
MEASLES
https://www.youtube.com/watch?v=zBkVCpbNnkU
MEASLES I.
• Acute, highly contagious viral disease (infectivity is close to 100% in
susceptible individuals).
• CA: RNA virus of the genus Morbillivirus and the family
Paramyxoviridae.
• Transmitted mainly directly via respiratory droplets but also by air as
indirect way of transmission (several hours later).
• Infectiousness - from about five days before the onset of rash to four
days afterwards.
• Maximally contagious during the prodromal phase - lasts for 2–4 days
(intense coughing!).
MEASLLES II.
• Incubation period - 10–12-day.
• Prodromal phase - fever, conjunctivitis, coryza, cough and
bronchiolitis.
• Koplik’s spots, the enanthema believed to be pathognomic for
measles, appear on the buccal mucosa 1–2 days before the onset of
rash.
• The measles rash, an erythematous maculopapular exanthema,
develops 2–4 days after the onset of fever and spreads from the head
to the body over the next 3–4 days.
MEASLES III.
• The most common complications:
➢otitis media (7–9%),
➢pneumonia (1–6%),
➢diarrhoea (8%),
➢post-infectious encephalitis (1 per 1000 to 2000 cases),
➢subacute sclerosing panencephalitis (SSPE), which affects 1 per 100
000 cases.
• Case fatality is 1–3 per 1000 cases (predominantly caused by
complicating bacterial infections).
MEASLES IN EUROPE
MEASLES – EPIDEMIOLOGICAL RISK
• Vaccination coverage is below 95% in most countries!
• Measles cases in Europe primarily occur in unvaccinated populations
in both adults and children.
• Large outbreaks with fatalities are ongoing in countries that had
previously eliminated or interrupted endemic transmission!
MEASLES – VACCINATION
• MMR - a combination measles, mumps, and rubella vaccine.
• MMRV (ProQuad ) - a combination measles, mumps, rubella, and
varicella vaccine.
• Both vaccines contain live, attenuated viruses.
• CDC recommends two doses of measles-containing vaccine routinely
for children.
• The first dose at age 12 through 15 months and the second dose at
age 4 through 6 years before school entry.
VACCINATION FOR TRAVELLERS
• international travel can pose various risks to health,
• consultation - at least 4–8 weeks before the journey – at the travel
medicine clinic or medical practitioner.
VACCINES FOR TRAVELLERS (WHO)
SELECTIVE USE FOR TRAVELLERS
• Cholera
• Hepatitis A
• Hepatitis E
• Japanese encephalitis
• Meningococcal disease
• Rabies
• Tick-borne encephalitis
• Typhoid fever
• Yellow fever
REQUIRED VACCINATION
• Yellow fever (Country list)
• Meningococcal disease and polio
(required by Saudi Arabia for
pilgrims, updates are available
on www.who.int/wer)
YELLOW FEVER
• mosquito-borne infection of primates,
• caused by a virus of the Flavivirus genus,
• transmitted between monkeys by forest-dwelling primatophilic
Aedes mosquitoes Sylvatic infection of humans (hunt, gather
food) + Aedes aegypti in towns and villages human to human
transmission).
• in west, central and east Africa and in South America, from Panama
to the northern part of Argentina, never in Asia, once endemic in
Europe.
• a wide spectrum of symptoms, from mild to fatal.
• live attenuated vaccine, known as YF 17D – effective and safe.
CHOLERA
• acute diarrhoeal infection,
• caused by the bacterium Vibrio cholera of serogroups O1 or O139.
• humans are the only relevant reservoir, even though Vibrios can
survive for a long time in coastal waters contaminated by human
excreta,
• several countries in Africa, Asia and the Americas are reporting
cholera outbreaks,
• major outbreaks: Yemen, Nigeria, the DRC, Haiti,
• oral inactivated vaccine.
TYPHOID
• are systemic disease,
• caused by the bacteria Salmonella typhi,
• humans are the only reservoir,
• humans can carry the bacteria in the gut for very long times (chronic carriers),
and transmit the bacteria to other persons (either directly or via food or water
contamination),
• incubation period: 1-2 weeks,
• high fever, malaise, cough, rash and enlarged spleen develops (intestinal
perforation and haemorrhage may occur),
• untreated (x ATB) has a 10% death rate.
• vaccines : 1. inactivated (polysaccharid) vaccine (inj.),
2. live, attenuated (weakened) vaccine which is taken orally,
3. combined typhoid/hepatitis A vaccine.
HEPATITIS A
• caused by the hepatitis A virus (HAV).,
• usually transmitted through the fecal-oral route or by contaminated food
or water,
• most adults - symptoms, including fatigue, low appetite, stomach pain,
nausea, and jaundice, that usually resolve within 2 months of infection,
• most children less than 6 years of age do not have symptoms or have an
unrecognized infection,
• Ig produced in response to hepatitis A infection last for life and protect
against reinfection,
• inactivated single-antigen hepatitis A vaccines (HAVRIX), live vaccine and
combination vaccine A + B (TWINRIX).
Vaccines in research pipelines
Vaccines Against Viral Diseases
• Dengue Fever Prevention
• Ebola Vaccines
• Hepatitis Disease-Specific Research
• HIV Vaccine Development
• Influenza Vaccines
• MERS and SARS Therapeutics and Vaccines
• Respiratory Syncytial Virus (RSV) Prevention
• Smallpox Vaccine Supply and Strength
• West Nile Virus Vaccines
• Zika Virus Vaccines
Vaccines Against Bacterial and Parasitic
Diseases
• Cholera Treatment and Prevention
• Group A Streptococcus Vaccine
Research
• Lyme Disease Vaccines
• Pertussis Vaccines
• Tuberculosis Vaccine Development
• Leishmaniasis Vaccines
• Malaria Prevention, Treatment, and
Control Strategies
FOR X AGAINST?
TAKE AWAY MESSAGE…
• Vaccines are safe and effective.
•Any vaccine can cause side effects.
• Serious side effects from vaccines are extremely rare.
•Getting vaccinated is much safer than getting the
diseases vaccines prevent.
ANTIVACCINATION MOVEMENT – WHY?
AntiVaxxer
• A person who thinks they know more about medicine and public
health than the overwhelming majority of doctors, scientists,
immunologists, and every major health organization across the whole
entire planet.
• Pfffft, I don't need to believe in "evidence based medicine" & fancy
"science" made up by sheeple and shills! I'm an arrogant anti-vaxxer!
(https://www.urbandictionary.com)
https://measlesrubellainitiative.org/anti-vaccination-movement/