Milestones in immunization by qvs59240

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									    Milestones in immunization
3000BC                        1700AD
     Evidence   of sniffing       Introductionof variolation
     powdered small pox            in England and later in the
     crust in Egypt                US

2000BC                        1780AD

    Sniffing of small pox         Edward   Jenner discovers
    crust in China                 small pox vaccine

   1500BC                        1885AD
       Turks introduce               Pasteur discovers rabies
        variolation                    attenuated vaccine


                                                                  1
  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.

                                                2
 Edward Jenner




Discovery of small pox vaccine
                                 3
         Edward Jenner
Among patients awaiting small pox vaccination




                                                4
Modern era of the vaccine

1920s               1960s
   Diphtheria and      Mumps measles
   Tetanus             and rubella virus
                       Sabin polio
1934
    Pertussis       1985
                       Haemophilus
1955
                    1990s
   Salk polio
                       Hepatitis and
                       varicella
                                           5
Pre- & post-vaccine incidence of
 common preventable diseases




                                   6
Different modes of acquiring
          immunity

              Immunity

    Innate       Acuired

      Passive                 Active

Artificial   Natural   Artificial   Natural


                                              7
   Passive Immunity

 Natura             Artificia
 l                  l
Placental         Antibodies or
transfer of IgG   immunoglobulins

Colostral         Immune cells
transfer of IgA




                                    8
          Passive Immunization

  disease              antibody           indication
                       source
diphtheria, tetanus    human, horse   prophylaxis, therapy
vericella zoster       human          immunodeficiencies
gas gangrene,
botulism, snake        horse          post-exposure
bite, scorpion sting
rabies,                human          post-exposure
hypogamma-             human          prophylaxis
globulinemia
                                                           9
Advantages and Disadvantages
   of Passive Immunization
 Advantages      Disadvantages
                   no long term
                   protection
                   serum sickness
    immediate
    protection      risk of hepatitis
                    and Aids
                   graft vs. host
                   disease (cell
                   graft only)

                                        10
     Active Immunization

  Natural             Artificial
                      Attenuated
                      organisms
                      killed organisms
exposure to sub-      sub-cellular
clinical infections   fragments
                      toxins
                       others

                                         11
     Live Attenuated Vaccines

   polio*                          hepatitis A
   not used in std.                not required in
   schedule                        SC
measles, mumps & rubella         yellow fever
Varicella zoster                  Military and travelers
children with no history
of chicken pox
                    tuberculosis
                    not used in this country

                                                           12
Killed Whole-Organism Vaccines


  polio                  Q fever
                         population at risk
  influenza              typhoid, cholera, plague
   elderly and at risk   epidemics and travelers
  rabies                 pertussis
  post exposure           replaced by the
                         acellular vaccine



                                                13
Microbial Fragment Vaccines

     Bordetella. Pertussis
     virulence factor protein
    Haemophilus influenzae B
    protein conjugated polysaccharide
     Streptococcus pneumoniae
    Polysaccharide mixture
     Neisseria meningitidis
     polysaccharide


                                        14
Microbial Fragment Vaccines

    Clostridium tetani (tetanus)
    inactivated toxin (toxoid)

    Corynebacterium diphtheriae
    inactivated toxin (toxoid)
     Vibrio cholerae
     toxin subunits

     Hepatitis B virus
     cloned in yeast

                                   15
Modification of Toxin to Toxoid


   Toxin                            Toxoid

                  chemical
                 modification



  toxin moiety             antigenic determinants


                                                    16
Future Vaccines



  anti-Idiotype Vaccine

  DNA

 Immuno-dominant peptide



                           17
  Recommended Childhood
Immunization Schedule (2001)




                               18
     Adverse Events Occurring
Within 48 Hours DTP of Vaccination
        Event                     Frequency
local
 redness, swelling, pain          1 in 2-3 doses

systemic: Mild/moderate
 fever, drowsiness, fretfulness   1 in 2-3 doses
 vomiting
  anorexia                        1 in 5-15 doses
systemic: more serious
 persistent crying, fever         1 in 100-300 doses
 collapse, convulsions            1 in 1750 doses
 acute encephalopathy             1 in 100,000 doses
 permanent neurological deficit   1 in 300,000 doses
                                                       19
    Adverse event occurring
within 48 hours DTP vaccination
                   Event                           Frequency

Local:
   redness, swelling, pain                     1 in 2-3 doses

Mild/moderate systemic:
    fever, drowsiness, fretfulness vomiting,   1 in 2-3 doses
    anorexia                                   1 in 5-15 doses

More serious systemic:
   persistent crying, fever                    1 in 100-300 doses
   collapse, convulsions                       1 in 1750 doses
   acute encephalopathy permanent              1 in 100,000 doses
   neurological deficit                        1 in 300,000 doses


                                                                    20

								
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