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Immunization Dr.T.V.Rao

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Immunization Dr.T.V.Rao

  1. 1. Immunization. Current Trends 2007 Dr.T.V.Rao MD
  2. 2. Immunization = Vaccination <ul><li>What is a Vaccine </li></ul><ul><li>A vaccine is a substance that is introduced into the body to prevent Infection or a certain Pathogen </li></ul><ul><li>Can be used in bacterial, Viral, Parasitic Infections. </li></ul>
  3. 3. History Guides the Future
  4. 4. Edward Jenner Vaccinating
  5. 5. Beginning of Vaccination . <ul><li>Vaccination ( Latin ; Vacca- Cow ) </li></ul><ul><li>Edward Jenner used the term Vaccination </li></ul><ul><li>Cow pox virus provided immunity in prevention of Small pox </li></ul>
  6. 6. Scientific Era of Vaccination . <ul><li>Louis Pasteur adopts the principles of Vaccination </li></ul><ul><li>For his scientific work. </li></ul><ul><li>Vaccination for prevention of Rabies creates awareness on Immunization with scientific fundamentals </li></ul>
  7. 7. Major Principles and Methods of Vaccination Biological events guide the Vaccination
  8. 8. Major content of Vaccines <ul><li>Toxoids </li></ul><ul><li>Inactivated vaccines. </li></ul><ul><li>Attenuated vaccines </li></ul><ul><li>Subunit vaccines </li></ul><ul><li>Hyper immune globulins. </li></ul>
  9. 9. What we have achieved with Vaccination <ul><li>Cost effective method in controlling the infectious diseases. </li></ul><ul><li>Small pox - Eradicated. </li></ul><ul><li>Immunization prevents many diseases </li></ul><ul><li>We have created Herd immunity in commonly prevalent diseases. </li></ul>
  10. 10. Eradication of Small Pox <ul><li>WHO efforts with various Governmental and Social Organizations have changed History of Medicine </li></ul>
  11. 11. Principles of Immunization Development of Immunology has foundations on Vaccines
  12. 12. Different protocols to Immunization <ul><li>Passive Immunization </li></ul><ul><li>Active Immunization . </li></ul>
  13. 13. Passive Immunization <ul><li>Passive immunization </li></ul><ul><li>Artificially created by passive method </li></ul><ul><li>Can be created at short notice, </li></ul><ul><li>Effective for limited periods, </li></ul><ul><li>Antibodies are created in various sources from animals to humans </li></ul><ul><li>Can be Antiviral ,Antibacterial, </li></ul><ul><li>Source can be Animals, or Humans </li></ul><ul><li>Human source will be effective for 3-6 months. </li></ul><ul><li>Animals ( Heterologus ) effective for few weeks, </li></ul>
  14. 14. Passive Immunization <ul><li>Diphtheria antitoxin - Horse- Equine Diptheriae antitoxin. </li></ul><ul><li>Botulism - Antitoxin </li></ul><ul><li>Tetanus – Antitoxin. – Equine </li></ul><ul><li>Human Tetanus Immunoglobulin, </li></ul><ul><li>Pooled Immunoglobulins </li></ul><ul><li>Human Normal Immunoglobulin </li></ul><ul><li>Used for short term prophylaxis, </li></ul><ul><li>Eg Hepatitis A Immunoglobulin, </li></ul>
  15. 15. Passive Immunization Highly Successful Saves in Acute Infections <ul><li>Diphtheria Antitoxin </li></ul><ul><li>Tetanus Antitoxin </li></ul><ul><li>Rabies Hyper immune Globulins( HRIG ) </li></ul><ul><li>Varicella Zoster Hyper Immune Globulins (HZIG) </li></ul>
  16. 16. Active Immunization . Most Ideal, Cost effective, method to prevent communicable Diseases.
  17. 17. Active Immunization with Toxoids <ul><li>Types 1 </li></ul><ul><li>Toxoids - Single Toxin Modified </li></ul><ul><li>Preserves Antigenicity, </li></ul><ul><li>Loses its Toxicity. </li></ul><ul><li>Eg 1 Tetanus Toxoid </li></ul><ul><li>2 Diphtheria Toxoid </li></ul>
  18. 18. Active Immunization <ul><li>Inactivated / Killed Vaccines , </li></ul><ul><li>Microbes are killed </li></ul><ul><li>Eg 1 Pertusis , (Whooping cough ) </li></ul><ul><li>2 Influenza ( Flu) </li></ul><ul><li>3 Salk - Killed vaccine for </li></ul><ul><li>(Poliomyelitis) , </li></ul>
  19. 19. Active Immunization <ul><li>Attenuated Live vaccine </li></ul><ul><li>Inactivation destroys pathogen city, </li></ul><ul><li>Protective immunity is retained </li></ul><ul><li>Contains living organisms with reduced virulance, </li></ul><ul><li>1 Live polio vaccines –Sabins, </li></ul><ul><li>2 Yellow fever vaccine 17D strain. </li></ul>
  20. 20. Different schedules of Vaccination May vary from Nation to Nation Depends on Geographic, Economic and prevalence of Specific Diseases
  21. 22. Herd Immunity <ul><li>Definition – When most of the People in a community are immune to particular infection-Natural transmission is inhibited. </li></ul><ul><li>Herd Immunity works in infections transmitted from person to person only. </li></ul><ul><li>The Mass oral polio vaccine creates a Herd Immunity and protects the Society . </li></ul>
  22. 23. Immunization Schedules <ul><li>Depend on </li></ul><ul><li>Need, </li></ul><ul><li>Efficacy, </li></ul><ul><li>Safety, </li></ul><ul><li>Ease of administration, </li></ul>
  23. 24. Vaccines which Changed the History of Medicine Vaccination for Polio, Tetanus Diphtheria, Pertusis. Rabies Universally accepted
  24. 25. Vaccination for Diphtheria, Tetanus and Pertusis <ul><li>Triple Antigen ( DTP ) </li></ul><ul><li>Contains Toxoids of Diphtheria and Tetanus </li></ul><ul><li>Pertusis component Contains whole Cell preparation from Bordetella pertusis. </li></ul><ul><li>Three Doses given at the interval of 4-6 weeks </li></ul><ul><li>Boosters at Later date </li></ul>
  25. 26. Vaccination for Poliomyelitis A great break through in Vaccine Research Millions saved from disabling Polio
  26. 27. Pioneers in Prevention of Poliomyelitis
  27. 28. Vaccination in Poliomyelitis <ul><li>Vaccination for Poliomyelitis, can be oral or inject able. </li></ul><ul><li>Sabins – Mixture of 3 types poliovirus1,2,3 </li></ul><ul><li>Live attenuated vaccine, A oral vaccine colonizes the gut produces the local immunity and antibody mediated immunity protects , Rarely hazardous, </li></ul><ul><li>Salk – vaccine a killed vaccine not used in routine immunization schedules. India </li></ul><ul><li>Sabin’s live polio vaccine is economical for mass vaccination in populous countries </li></ul><ul><li>Component of Mass Pulse Polio Immunization programme </li></ul>
  28. 29. Commonly used vaccines, <ul><li>MMR Vaccine </li></ul><ul><li>Used for the prevention of </li></ul><ul><li>Measles, Mumps, and Rubella. </li></ul><ul><li>Contains live attenuated strains, </li></ul><ul><li>Given at the age between 12-15 months, </li></ul><ul><li>But Measles vaccination is done early in India at 9 months. </li></ul><ul><li>Rubella </li></ul><ul><li>Rubella Vaccine is given separately to young women </li></ul><ul><li>Given to all sero negative women of child bearing age </li></ul>
  29. 30. Vaccination for Tuberculosis <ul><li>BCG – Attenuated strains of Bovine Tubercle Bacilli, ( Bacilli –Chalmette-Guerin) </li></ul><ul><li>Efficacy ? But useful in the prevention of Tuberculosis meningitis, and Leprosy </li></ul><ul><li>Given on lateral aspect of arm, at the deltoid insertion </li></ul><ul><li>To be given intradermally, </li></ul>
  30. 31. Emerging Vaccines Recently several persons benefited.
  31. 32. Haemophilus influenza <ul><li>Type b serotype is capsulated and highly pathogenic, </li></ul><ul><li>Produces Meningitis,Bacteremias, Epiglottis's. </li></ul><ul><li>Encapsulated strain b is selected for vaccination. </li></ul><ul><li>Vaccine contains capsular polysaccharide linked to a protein and protects against against type B strains. </li></ul><ul><li>In U K given along with DPT vaccine </li></ul><ul><li>When not given earlier A single dose for 1 – 4 years children. </li></ul><ul><li>Elder children and Adults do not need unless immunosupressed. </li></ul>
  32. 33. Meningococcal Vaccine Men C Vaccine <ul><li>The component of the vaccine is Meningococcal C antigen, </li></ul><ul><li>The polysaccharide component is linked to protein carrier, </li></ul><ul><li>In developed countries given at 2, 3, 4 months duration. </li></ul><ul><li>Produces prolonged immune response. </li></ul>
  33. 34. Vaccination in Hepatitis A Virus Infection <ul><li>A formaldehyde inactivated vaccine prepared from HAV grown in Diploid cells </li></ul><ul><li>A vaccination is effective for 10 years </li></ul><ul><li>Advised mainly in persons entering endemic areas with HAV Infection. </li></ul>
  34. 35. Bio-Engineering creates Vaccine Hepatitis B Vaccine
  35. 36. Molecular Biology and Genetic Engineering contributed for HBV Vaccine .
  36. 37. Vaccination for Hepatitis B Infection . <ul><li>Hepatitis B Vaccine </li></ul><ul><li>Bio Engineered vaccine, </li></ul><ul><li>0 - 1 - 6 months ( Dosage ) </li></ul><ul><li>Deltoid region </li></ul><ul><li>90% successful </li></ul><ul><li>Universal Immunization – an ideal goal in prevention of Hepatitis B infections . </li></ul>
  37. 38. Combined Vaccination for Hepatitis A and B Infections. <ul><li>Now a combined vaccine is available for prevention of Hepatitis A and B </li></ul><ul><li>Available as </li></ul><ul><li>TWINRIX ( GSK ) </li></ul>
  38. 39. Vaccination for Typhoid <ul><li>Oral – Live ( Typhoral ) </li></ul><ul><li>Stable mutant of S.typhi </li></ul><ul><li>Strain Ty2 ( Lacking enzyme UDP –Galactose 4 Epimerase). </li></ul><ul><li>Injectable vaccine ( Ty vi ) contains </li></ul><ul><li>Purified Vi polysaccharide Antigen </li></ul><ul><li>Efficacy lasts for 3 years </li></ul><ul><li>Needed for people traveling to Endemic areas </li></ul>
  39. 40. Other Vaccines <ul><li>Pneumococcal vaccine </li></ul><ul><li>A polyvalent polysaccharide containing capsular antigen with 23 Sero types </li></ul><ul><li>Gives 80 -90 % protection </li></ul><ul><li>Used in </li></ul><ul><li>Dysfunctional spleen </li></ul><ul><li>Sickle cell diseases, </li></ul><ul><li>Chronic diseases of Liver, lungs, heart, </li></ul><ul><li>Renal failure. </li></ul><ul><li>HIV infection </li></ul><ul><li>Effective in > 2 years old children, </li></ul>
  40. 41. Vaccine for Varicella zoster <ul><li>OKA strain, A live attenuated strain, </li></ul><ul><li>Single dose for children ( 1-12 years children) </li></ul><ul><li>Not to be given in Immune suppressed / HIV patients. </li></ul>
  41. 42. Vaccine for Influenza(virus ) <ul><li>Always use new vaccines with prevailing strains, </li></ul><ul><li>Now recombinant vaccines are available. </li></ul><ul><li>Made in embroyonated eggs. </li></ul>
  42. 43. New Vaccines Developed or on Trails
  43. 44. Vaccines for Rota Virus <ul><li>Rota Rix ( GSK ) </li></ul><ul><li>Introduced in Brazil, Elsalvador, Mexico, Panama and Venezuela </li></ul><ul><li>Under Phase III trails in Africa, and Malawi </li></ul><ul><li>Rota Teq ( MEREK) </li></ul><ul><li>Introduced in Nicaragua </li></ul>
  44. 45. Newer Pneumococcal Vaccine <ul><li>A Seven Valent conjugate vaccine (Prevenar ) </li></ul><ul><li>Effective against 7 strains prevalent in certain geographic locations </li></ul><ul><li>Effective in 83 % HIV uninfected. </li></ul><ul><li>Effective in 65 % of HIV infected. </li></ul>
  45. 46. Human Papilloma Virus Vaccine <ul><li>Gardasil ( HPV vaccine ) developed by Merck. </li></ul><ul><li>Effective against 4 common serotypes </li></ul><ul><li>( includes prominent serotypes 16 and 18 causing Cancer cervix ). </li></ul><ul><li>Adolescents and preadolescents considered for vaccination. </li></ul>
  46. 47. Newer Meningococcal Meningitis A Vaccine ( Men A ) <ul><li>Effective in Meningococcal Diseases </li></ul><ul><li>Phase I trails in India </li></ul><ul><li>Phase II trails , Mali, and Gambia </li></ul><ul><li>Phase III trails in Ethiopia /Senegal </li></ul>
  47. 48. Influenza Current Vaccine <ul><li>In view of changing strains the antigens configuration for Influenza need a new model vaccine every year / frequently </li></ul><ul><li>Currently CSL Biotherapies vaccine is licensed on 28 th Sept 2007 for current use. </li></ul>
  48. 49. Need for Vaccines in HIV/AIDS
  49. 50. Why Vaccines are Difficult to Development in AIDS <ul><li>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. </li></ul><ul><li>H I V is Genetically diverse. </li></ul><ul><li>New forms ( clades ) are emerging all through infection, </li></ul>
  50. 51. Vaccine Options <ul><li>1 Live attenuated or whole killed HIV virus Failed due to safety fears, Trails stopped . </li></ul><ul><li>2 Sub Unit vaccines ( gp 20 model ) </li></ul><ul><li>Failed in Major trails . </li></ul><ul><li>3 DNA vaccines </li></ul><ul><li>Isolated HIV genes used to stimulate </li></ul><ul><li>cell mediated Immunity . </li></ul>
  51. 52. Vaccine Options ( Contd ) <ul><li>4 Recombinant Vaccine - Isolated genes delivered through another viral vector, </li></ul><ul><li>Most trials use this method </li></ul>
  52. 53. Vaccine Options <ul><li>5 Combination Vaccines. </li></ul><ul><li>Multiples trails are in progress with combination of Designs, strategies, </li></ul><ul><li>And </li></ul><ul><li>Immunogens which can produce a broader more powerful, and more durable immune response. </li></ul>
  53. 54. The Quest for the AIDS vaccine continues Various National and International Organization are committed for development of a effective Vaccine
  54. 55. Present HIV Vaccination Trails
  55. 56. Vaccination for People at special risk <ul><li>Anthrax </li></ul><ul><li>Cholera </li></ul><ul><li>Hepatitis A </li></ul><ul><li>Hepatitis B </li></ul><ul><li>Influenza </li></ul><ul><li>Japanese B encephalitis </li></ul><ul><li>Meningococcal Infection </li></ul><ul><li>Plague </li></ul><ul><li>Pneumococcal infection </li></ul><ul><li>Q fever, </li></ul><ul><li>Rabies </li></ul><ul><li>Tick borne encephalitis. </li></ul><ul><li>Typhoid </li></ul><ul><li>Typhus </li></ul><ul><li>Varicella Zoster </li></ul><ul><li>Yellow fever. </li></ul>
  56. 57. Contraindication to Vaccination In spite of great success with many vaccines, yet a caution and wisdom are essential I
  57. 58. Contra -indications to Vaccination <ul><li>Do not give vaccines to acutely ill patients. </li></ul><ul><li>Avoid giving live vaccines to pregnant women </li></ul><ul><li>Avoid all types of vaccines in the first Trimester of pregnancy, </li></ul><ul><li>Do not give live vaccines to immunosupressed patients and patients suffering with RES malignancies, </li></ul>
  58. 59. Contraindication ( Cont ) <ul><li>In spite of Immune suppression in HIV infected, we can still give MMR and Oral polio drops ( But Salk killed vaccine is safe). </li></ul><ul><li>In HIV patients do not give BCG vaccine </li></ul>
  59. 60. What is an ideal vaccine. <ul><li>Promotes effective immunity. </li></ul><ul><li>Controls lifelong protection. </li></ul><ul><li>Safe, do not carry side effects. </li></ul><ul><li>Stable, cheap, </li></ul><ul><li>Acceptance by public. </li></ul><ul><li>Yet there is No Ideal Vaccine . </li></ul>
  60. 61. Care in Vaccination <ul><li>Some subjects may develop acute anaphylaxis with vaccination, </li></ul><ul><li>Be prepared to resuscitate the individuals, </li></ul>
  61. 62. Unresolved problems <ul><li>Nothing is perfect </li></ul><ul><li>No Vaccine is totally Protective </li></ul><ul><li>Influenza – Needs very frequent updating </li></ul><ul><li>Cholera vaccine –Little effective in reality </li></ul>
  62. 63. WHO Initiatives On Vaccine Strategies and Development
  63. 64. WHO <ul><li>Supports the Research of various Biological </li></ul><ul><li>Organizations which produce the Newer </li></ul><ul><li>Vaccines </li></ul><ul><li>Helps the Implementation various programmers related to Vaccines </li></ul>
  64. 65. Vaccine Research <ul><li>Now major research is focused on finding the safe and Socially acceptable vaccines </li></ul><ul><li>Refer for current knowledge on Vaccines. </li></ul><ul><li>VACCINE - is a International peer-reviewed journal of Vaccination Research </li></ul><ul><li>Indexed in Medline pISSN: 0264-410X </li></ul>
  65. 66. Science Hopes a Vaccine for every Disease
  66. 67. Vaccination created HOPE in Humanity
  67. 68. Created for awareness among Medical and Health care workers in Developing world. Dr.T.V.Rao MD [email_address]