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Immunization.

Immunization. Current Trends 2007 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 or a certain Pathogen Can be used in bacterial, Viral, Parasitic Infections.

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Immunization.

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  1. Immunization. Current Trends 2007 Dr.T.V.Rao MD

  2. Immunization = Vaccination What is a Vaccine A vaccine is a substance that is introduced into the body to prevent Infection or a certain Pathogen Can be used in bacterial, Viral, Parasitic Infections.

  3. History Guidesthe Future

  4. Edward Jenner Vaccinating

  5. Beginning of Vaccination. Vaccination ( Latin ; Vacca- Cow ) Edward Jenner used the term Vaccination Cow pox virus provided immunity in prevention of Small pox

  6. 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

  7. Major Principles and Methods of Vaccination Biological events guide the Vaccination

  8. Major content of Vaccines • Toxoids • Inactivated vaccines. • Attenuated vaccines • Subunit vaccines • Hyper immune globulins.

  9. What we have achieved withVaccination • Cost effective method in controlling the infectious diseases. • Small pox - Eradicated. • Immunization prevents many diseases • We have created Herd immunity in commonly prevalent diseases.

  10. Eradication of Small Pox WHO efforts with various Governmental and Social Organizations have changed History of Medicine

  11. Principles of Immunization Development of Immunology has foundations on Vaccines

  12. Different protocols to Immunization Passive Immunization Active Immunization.

  13. 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,

  14. 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,

  15. Passive ImmunizationHighly Successful Saves in Acute Infections Diphtheria Antitoxin Tetanus Antitoxin Rabies Hyper immune Globulins( HRIG ) Varicella Zoster Hyper Immune Globulins (HZIG)

  16. Active Immunization. Most Ideal, Cost effective, method to prevent communicable Diseases.

  17. Active Immunization with Toxoids • Types 1 Toxoids - Single Toxin Modified Preserves Antigenicity, Loses its Toxicity. Eg 1 Tetanus Toxoid 2 Diphtheria Toxoid

  18. Active Immunization Inactivated / Killed Vaccines, Microbes are killed Eg 1 Pertusis , (Whooping cough ) 2 Influenza ( Flu) 3 Salk - Killed vaccine for (Poliomyelitis) ,

  19. Active Immunization Attenuated Live vaccine Inactivation destroys pathogen city, Protective immunity is retained Contains living organisms with reduced virulance, 1 Live polio vaccines –Sabins, 2 Yellow fever vaccine 17D strain.

  20. Different schedules of Vaccination May vary from Nation to Nation Depends on Geographic, Economic and prevalence of Specific Diseases

  21. 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.

  22. Immunization Schedules Depend on Need, Efficacy, Safety, Ease of administration,

  23. Vaccines which Changed the History of Medicine Vaccination for Polio, Tetanus Diphtheria, Pertusis. Rabies Universally accepted

  24. Vaccination for Diphtheria, Tetanus and Pertusis • Triple Antigen ( DTP ) • Contains Toxoids of Diphtheria and Tetanus • Pertusis component Contains whole Cell preparation from Bordetella pertusis. • Three Doses given at the interval of 4-6 weeks • Boosters at Later date

  25. Vaccination for Poliomyelitis A great break through in Vaccine Research Millions saved from disabling Polio

  26. Pioneers in Prevention of Poliomyelitis

  27. Vaccination in Poliomyelitis • Vaccination for Poliomyelitis, can be oral or inject able. • Sabins – Mixture of 3 types poliovirus1,2,3 • Live attenuated vaccine, A oral vaccine colonizes the gut produces the local immunity and antibody mediated immunity protects , Rarely hazardous, • Salk – vaccine a killed vaccine not used in routine immunization schedules. India Sabin’s live polio vaccine is economical for mass vaccination in populous countries Component of Mass Pulse Polio Immunization programme

  28. 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

  29. Vaccination for Tuberculosis • BCG – Attenuated strains of Bovine Tubercle Bacilli, ( Bacilli –Chalmette-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,

  30. Emerging Vaccines Recently several persons benefited.

  31. Haemophilus influenza • Type b serotype is capsulated and highly pathogenic, • Produces Meningitis,Bacteremias, Epiglottis's. • Encapsulated strain b is selected for vaccination. • Vaccine contains capsular polysaccharide linked to a protein and protects against against type B strains. • In U K 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.

  32. Meningococcal VaccineMen 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.

  33. Vaccination in Hepatitis A Virus Infection A formaldehyde inactivated vaccine prepared from HAV grown in Diploid cells A vaccination is effective for 10 years Advised mainly in persons entering endemic areas with HAV Infection.

  34. Bio-Engineering createsVaccine Hepatitis B Vaccine

  35. Molecular Biology and Genetic Engineering contributed for HBV Vaccine.

  36. 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.

  37. 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 )

  38. 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

  39. 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,

  40. Vaccine for Varicella zoster • OKA strain, A live attenuated strain, • Single dose for children ( 1-12 years children) • Not to be given in Immune suppressed / HIV patients.

  41. Vaccine for Influenza(virus ) • Always use new vaccines with prevailing strains, • Now recombinant vaccines are available. • Made in embroyonated eggs.

  42. New Vaccines Developed or on Trails

  43. Vaccines for Rota Virus Rota Rix ( GSK ) Introduced in Brazil, Elsalvador, Mexico, Panama and Venezuela Under Phase III trails in Africa, and Malawi Rota Teq ( MEREK) Introduced in Nicaragua

  44. 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.

  45. 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.

  46. Newer Meningococcal Meningitis A Vaccine ( Men A ) Effective in Meningococcal Diseases Phase I trails in India Phase II trails , Mali, and Gambia Phase III trails in Ethiopia /Senegal

  47. 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.

  48. Need for Vaccines in HIV/AIDS

  49. 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,

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