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Immunization

Immunization. Milestones in immunization. 3000BC Evidence of sniffing powdered small pox crust in Egypt. 1500BC Turks introduce variolation. 1700AD Introduction of variolation in England and later in the US. 2000BC Sniffing of small pox crust in China. Introduction of variolation.

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Immunization

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  1. Immunization

  2. Milestones in immunization • 3000BC • Evidence of sniffing powdered small pox crust in Egypt • 1500BC • Turks introduce variolation • 1700AD • Introduction of variolation in England and later in the US • 2000BC • Sniffing of small pox crust in China

  3. Introduction of variolation The wife of the British Ambassador in Turkey, in March 1717 wrote, following the variolation of her son, to a friend in England: “The small pox, so fatal, so general amongst us, is entirely harmless here by the invention of ingrafting….I am patriot enough to bring this invention into fashion in England.

  4. Milestones in immunization • 1780AD • Edward Jenner discovers small pox vaccine

  5. Edward Jenner Discovery of small pox vaccine

  6. Edward JennerAmong patients awaiting small pox vaccination

  7. Modern era of the vaccine • 1885 • Rabies vaccine (Pasteur) • 1934 • Pertussis • 1955 • Salk polio • 1920s • Diphtheria and Tetanus

  8. Modern era of the vaccine • 1960s • Mumps measles and rubella virus • Sabin polio • 1985 • Haemophilus • 1990s • Hepatitis and varicella • 2000 • Human Papillomavirus • (HPV)

  9. Pre- & post-vaccine incidence of common preventable diseases

  10. Acquired Natural resistance Passive Active Artificial Artificial Natural Natural Different modes of acquiring immunity Immunity

  11. Natural Artificial Passive Immunity Placental transfer of IgG Antibodies or immunoglobulins Colostral transfer of IgA Immune cells

  12.  disease diphtheria, tetanus human, horse antibody source  indication human vericella zoster horse gas gangrene, botulism, snake bite, scorpion sting prophylaxis, therapy immunodeficiencies post-exposure post-exposure human human rabies, prophylaxis hypogamma-globulinemia Passive Immunization

  13. Disadvantages Advantages Advantages and Disadvantages of Passive Immunization no long term protection serum sickness immediate protection risk of hepatitis and Aids graft vs. host disease (cell graft only)

  14. Artificial Natural Active Immunization Attenuated organisms killed organisms exposure to sub-clinical infections sub-cellular fragments toxins others

  15. Live Attenuated Vaccines • polio* • not used in std. schedule • hepatitis A • standard 2006 measles, mumps & rubella • yellow fever • Military and travelers • Varicella zoster • children with no history of chicken pox • Influenza • selected age group (5-49) • tuberculosis • not used in this country

  16. Killed Whole-Organism Vaccines polio • Q fever • population at risk • influenza • elderly and at risk • typhoid, cholera, plague • epidemics and travelers • pertussis • replaced by the acellular vaccine • rabies • post exposure

  17. Microbial Fragment Vaccines • Bordetella. Pertussis • virulence factor protein • Haemophilus influenzae B • protein conjugated polysaccharide • Streptococcus pneumoniae • Polysaccharide mixture • Neisseria meningitidis • polysaccharide

  18. Microbial Fragment Vaccines • Clostridium tetani (tetanus) • inactivated toxin (toxoid) • Corynebacterium diphtheriae • inactivated toxin (toxoid) • Vibrio cholerae • toxin subunits • Hepatitis B virus • cloned in yeast

  19. chemical modification toxin moiety antigenic determinants Modification of Toxin to Toxoid Toxin Toxoid

  20. Future Vaccines • anti-Idiotype Vaccine DNA Immuno-dominant peptide

  21. anti-Idiotype Vaccine

  22. Antiidiotype antibody in tolerance Antiidiotype antibody production Antiidiotype mediated tolerance

  23. Adjuvants Adjuvant type Human use Mode of action • Salts: • Al(OH)3; AlPO4; CaPO4 • Be(OH)2 • Yes • Yes • No Slow release of antigen; TLR interaction and cytokine induction • Mineral oils without bacteria • No Slow release of antigen • Bacteria in Mineral oils (Mycobacteria, Nocardia) Slow release of antigen TLR interaction and cytokine induction • Yes • No

  24. Adjuvants Adjuvant type Human use Mode of action • Bacteria: • Bordetella pertussis • Mycobacterium bovis • (BCG and others) • Yes TLR interaction and cytokine induction • No • Bacterial products: • Myramyl peptides TLR interaction and cytokine induction • No • Synthetic polymers: • Liposomes • ISCOM • Poly-lactate • No Slow release of antigen

  25. Adjuvants Adjuvant type Human use Mode of action • Poly-nucleotides: • CpG TLR interaction and cytokine induction • No* • Cytokines: • IL-1, IL-2, IL-12, IFN-γ, etc. Activation of T and B cells and APC • No* • *Used in experimental immunotherapy of human malignancies

  26. Recommended Childhood Immunization Schedule Recommended age range Catch-up immunization Certainigh risk groups MMWR, 55: Jan 5, 2007

  27. Recommended Immunization Schedule for Ages 7-18 Recommended age range Catch-up immunization Certainigh risk groups MMWR, 55: Jan 5, 2007

  28.  Event Frequency • local • redness, swelling, pain 1 in 2-3 doses • systemic: Mild/moderate • fever, drowsiness, fretfulness vomiting • anorexia 1 in 2-3 doses 1 in 5-15 doses • systemic: more serious • persistent crying, fever • collapse, convulsions • acute encephalopathy • permanent neurological deficit 1 in 100-300 doses 1 in 1750 doses 1 in 100,000 doses 1 in 300,000 doses Adverse Events OccurringWithin 48 Hours DTP of Vaccination

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