VACCINATION AND IMMUNIZATION
MUDr. Bohdana Rezková, Ph.D.
TIME FOR YOU – TASK 1
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,
• number of doses needed for adequate and prolonged protection (basic
scheme) varies from vaccine to vaccine,
• booster dose - for some vaccines, later in life to maintain protection.
„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
You do not need to have your children
vaccinated. When the epidemic comes,
we'll burn the witch.
Finally Jane found a real expert….
• 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
• Vaccination programs
II. SPECIAL VACCINOLOGY
• Vaccinations preventable
diseases
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,…)
NOT
VACCINATED
PROTECTED
IMPORTANCE OF
VACCINATION
COMPOSITION OF
VACCINES
I. INTRODUCTION TO VACCINOLOGY
• https://www.youtube.com/watch?v=zBkVCpbNnkU
VACCINE INGREDIENTS
ANTIGEN
STABILIZERS
ANTIBIOTICS
PRESERVATIVES
ADJUVANTS
ANTIGEN
• any substance inducing a desired immune response in a vaccinated
person,
• protective immune response is directed against individual epitopes of
the antigen,
• complex (live vaccines) or with one (HepB) or more components
(acellular pertussis vaccine),
• alone (≥ 5 kdal) or conjugated (e.g. with a toxoid)
ADJUVANTS
• added to some vaccines to enhance the immune response,
• people with compromised immune systems, the elderly, and the very
young particularly benefit from vaccines with adjuvants,
• allow to use less antigen which, in some cases, may be in short supply
or costly,
• reducing or eliminating the need for booster vaccinations
• Aluminum-containing adjuvants! - safely used in vaccines since the
1930s and are still widely used today, not readily absorbed.
• others: AS04, MF59, AS01B, …
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).
• sugars such as sucrose and lactose, amino acids such as glycine or the
monosodium salt of glutamic acid and proteins such as human serum
albumin or gelatin.
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! - mercury-containing compound, no association with
autism has been confirmed!
IMPORTANCE OF
VACCINATION
CLASSIFICATION OF
VACCINES
I. INTRODUCTION TO VACCINOLOGY
CLASSIFICATION OF VACCINES
TYPES X KINDS
TYPES OF VACCINES
• Live-attenuated vaccines
• Inactivated vaccines
• Subunit, recombinant,
polysaccharide, and conjugated
vaccines
• 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
• 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 hepatitis A, TBE,
polio - Salk, typhoid fever,…
• + chimeric vaccines/chimeric
viruses
• 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
• 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
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
Assessment - each side effect that causes:
• Death
• Life threat
• Sever alteration of organisms
• Long term damage
• Hospitalisation
• Congenital anomaly in descendants
NEUROLOGICAL SIDE EFFECTS
• non-stop crying for 3 hours or more
• febrile seizures
• Guillain-Barré Syndrome
• encephalitis
• encephalomyelitis
ANAPHYLACTIC REACTION
• usually occur within minutes of parenteral administration,
• most common signs and symptoms are cutaneous (e.g. sudden onset of
generalized 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 in anaphylaxis is epinephrine,
• providers should have a plan in place to contact emergency medical
services immediately in the event of a severe acute vaccine reaction.
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
• 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
• Pregnant woman!
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 precaution 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)s
ROUTS OF ADMINISTRATION OF THE
VACCINE(S)
• Each vaccine has a recommended administration route and site.
• Health care personnel should always perform hand hygiene before
administering vaccines by any route.
1. Oral route: administered by mouth
2. Subcutaneous route: injected into the area just beneath the skin
into the fatty, connective tissue
3. Intramuscular route: injected into muscle tissue
4. Intradermal route: injected into layers of the skin
5. Intranasal route: administered into the nose
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
TIME FOR YOU
TASK 2
BREAK FOR 20 MINUTES
https://youtu.be/V9DinPkjbgo
MEASLES I.
https://www.youtube.com/watch?time_continue=33&v=sGKL4NPzdJY
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.
• The virus is transmitted from person to person via respiratory droplets
produced when sick people cough and sneeze. Virus-containing droplets
can remain in the air for several hours and the virus remains infectious on
contaminated surfaces for up to two hours.
• Infected people are considered contagious from about five days before the
onset of rash to four days afterwards. Measles is maximally contagious
during the prodromal phase which lasts for 2–4 days and is characterised
by intense coughing.
MEASLLES II.
• The prodrome starts after a 10–12-day incubation period and is
characterised by fever, conjunctivitis, coryza, cough and bronchiolitis.
Nearly all infected susceptible individuals develop clinical disease.
• 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, fades in the order of appearance
during the next 3–4 days.
MEASLES III.
• Mortality predominantly caused by complicating bacterial infections.
• Complications are likely to have developed if the fever does not drop
within 1 or 2 days after the onset of the rash.
• The most common complications of measles: otitis media (7–9%),
pneumonia (1–6%), diarrhoea (8%), post-infectious encephalitis (1
per 1000 to 2000 cases), and subacute sclerosing panencephalitis
(SSPE), which affects 1 per 100 000 cases.
• Case fatality is 1–3 per 1000 cases and highest in those younger than
five years of age and among
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 is a combination measles, mumps, and rubella vaccine.
• MMRV (ProQuad )is a combination measles, mumps, rubella, and
varicella vaccine.
• Both vaccines contain live, attenuated measles, mumps, and rubella
virus. MMRV also contains live, attenuated varicella-zoster virus.
• CDC recommends two doses of measles-containing vaccine routinely
for children, starting with 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)
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
TIME FOR YOU
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/