Dr.

Zainab Abdullah
Lecturer (Pharmaceutics)
Lahore College of Pharmaceutical Sciences

Vaccination or Immunization
&
current practice
 Discussion Objectives
• Vaccine and Vaccination
• Historical background
• Aims
• Development
• Types
• Current practicing vaccination in Pakistan
• Controversies
• Importance
 Vaccine and Vaccination
Vaccine “is a biological preparation that improves immunity to a
particular disease.” A vaccine typically contains an agent that resembles a
disease-causing microorganism, and is often made from weakened or killed
forms of the microbe. The agent stimulates the body's immune system to
recognize the agent as foreign, destroy it, and “remember” it, so that the
immune system can more easily recognize and destroy any of these
microorganisms that it later encounters
It stimulates Immune System.
it is a suspension of organisms
or fractions of organisms that is
used to induce immunity.
Vaccination
is the process of administering weakened or dead pathogens to a
healthy person or animal, with the intent of conferring immunity
against a targeted form of a related disease agent.
 History of Vaccination
In 1798 Edward Jenner
showed that inoculation
with cowpox virus
produced protection
Against smallpox.
He called the
inoculation material
“vaccine” from the Latin
word for cow “vacca”
giving birth to the process
of vaccination. The initial response to vaccination was positive, but its popularity
declined due to problems with unintended transmission of infections and failure
to induce immunity. During the period 1860-1890 Louis Pasteur produced
vaccines against chickenpox, cholera, diphtheria, anthrax and rabies.
 Timeline of Vaccines
18th century
1796 First vaccine for smallpox - first vaccine for any disease
19th century
1882 First vaccine for rabies
20th century
1932 First vaccine for yellow fever
1945 First vaccine for influenza
1952 First vaccine for polio
1954 First vaccine for Japanese encephalitis
1957 First vaccine for adenovirus -4 and 7
1962 First oral polio vaccine
1964 First vaccine for measles
1967 First vaccine for mumps
1970 First vaccine for rubella
1974 First vaccine for chicken pox
1977 First vaccine for pneumonia
1978 First vaccine for meningitis
1981 First vaccine for hepatitis B
1992 First vaccine for hepatitis A
1998 First vaccine for rotavirus
 Aims of Vaccination
The aim of Vaccination is the prevention of disease in individuals or groups.
The World Health Organization (WHO)
announced the global elimination of smallpox in 1980
and in 1991 announced the elimination of
poliomyelitis from the Americas. These
achievements were only possible through provision
of a comprehensive vaccination programme
providing high levels of vaccine coverage combined
with intensive surveillance of these diseases.
 Stages of Vaccine
development
Stages of Vaccine Development Vaccine development proceeds through discovery, process
engineering, toxicology and animal studies to human Phase I, II, and III trials. The process
can take more than 10 years, depending on the disease.

Stage I Development The human trials focus

initially on safety, involving small groups of people.

Stage II of Development Progress to moderate-sized

“target” populations (persons close to the age and
other characteristics for whom the vaccine is
intended) to determine both safety and the stimulation
of immune response.

Stage III of Development Finally to large target populations to establish whether a vaccine
actually prevents a disease as intended (efficacy)
 Types of Vaccines
1. Live, Attenuated whole-agent Vaccines

2. Inactivate Whole-agent Vaccines

3. Toxoids

4. Subunit Vaccine

5. Conjugated Vaccines

6. Nucleic Acid Vaccine

 Types Of Vaccines
Live, Attenuated whole-agent Vaccines use living but attenuated (weakened)
microbes. Live vaccines more closely mimic viruses, is often achieved without booster
immunizations and an effectiveness probably occurs because the attenuated viruses
replicate in the body, increasing the original dose and acting as a series secondary (booster)
immunizations.
Examples ;
o Sabin polio vaccine (oral)
o Measles , Mumps & Rubella MMR
o Widely used vaccines against Tuberculosis bacillus
o Typhoid vaccines (oral)
Attenuated microbes are usually derived from mutations accumulated during long term
artificial culture.
Despite the advantages of live, attenuated vaccines, there are some downsides.

• It is the nature of living things to change, or mutate, and the organisms used in live,
attenuated vaccines are no different

• The remote possibility exists that an attenuated microbe in the vaccine could revert to a
virulent form and cause disease. Also, not everyone can safely receive live, attenuated
vaccines. For their own protection, people who have damaged or weakened immune
systems—because they have undergone chemotherapy or have HIV, for example—
cannot be given live vaccines.

• Another limitation is that live, attenuated vaccines usually need to be refrigerated to

stay potent.

• Live, attenuated vaccines are more difficult to create for bacteria. Bacteria have
thousands of genes and thus are much harder to control.
I n a c t i v a t e W h o l e - a g e n t V a c c i n e s : use microbes that have been killed,
usually by formalin or phenol or may be by radiation or heat.
Examples;
o Vaccines against Rabies
o Influenza
o Polio Salk (IM)
o Pneumococcal Pneumonia
o Cholera
o Pertussis (whooping cough)
o Typhoid
• Such vaccines are more stable and safer than live vaccines.
• The dead microbes can not mutate back to their disease-causing state.
• Inactivated vaccines usually don’t require refrigeration, and they can be easily stored
and transported in a freeze-dried form.
Drawback of Inactivated whole-agent vaccines
• Most inactivated vaccines, however, stimulate a weaker immune system response than
do live vaccines. So it would likely take several additional doses, or booster shots, to
maintain a person’s immunity. This could be a drawback in areas where people don’t
have regular access to health care and can’t get booster shots on time.
H1 N1 old infection and New Threat , H1N1 is a new virus that was first detected in
people in April 2009. It was originally referred as “swine flu” because many of the
genes in this new virus were similar to influenza viruses that occur in pigs .

Successful and Safe Vaccine for H1N1 The National Institute of Allergy and Infectious
Diseases, part of the National Institutes of Health, has conducted swine flu clinical
trials to make sure the new swine flu vaccines are safe and effective. They were
conducted at eight university research hospitals and medical organizations across the
United States
T o x o i d s which are inactivated toxins, are vaccines directed at the toxins produced by
the pathogen.

Examples;
o Diphtheria
o Tetanus

• They require a series of injections or full immunity, followed by boosters every 10

years. Many older adults have not received boosters; they are likely to have a low levels
of protection.

• These vaccines are used when a bacterial toxin is the main cause of illness.

• When the immune system receives a vaccine containing a harmless toxoid, it learns how
to fight off the natural toxin. The immune system produces antibodies that lock onto
and block the toxin.
S u b u n i t V a c c i n e use only those antigenic fragments of a microorganism that best
stimulates an immune response.
• Subunit vaccines that are produced by genetic modification techniques, meaning that
other microbes are programmed to produce the desired antigenic fraction, are called
recombinant vaccines.
Example;

the vaccine against Hepatitis B virus consists o f a portion of the viral protein coat that is
produced by genetically modified yeast.

• Subunit vaccines are safe because they cannot reproduce in the recipient.

• They also contain little or no extraneous material and therefore tend to produce fewer
adverse effects.

• these vaccines use epitopes(the very specific parts of the antigen that antibodies or T
cells recognize and bind to).

• Research is continuing on a recombinant subunit vaccine against hepatitis C virus.

C o n j u g a t e d V a c c i n e s have been developed in recent years to deal with the poor
immune response of children to vaccine based on capsular polysaccharides.

Polysaccharides are T-independent antigens; children’s immune systems do not respond

well to these antigens until the age of 15 to 24 months. Therefore, polysaccharides are
combined with proteins such as diphtheria toxoid; this approach has led to very successful
vaccine for;
Haemophilus influenzae type B

Which gives significant protection even at 2 months.

N u c l e i c A c i d V a c c i n e or DNA vaccines are among the newest and most
promising vaccines, although at this time they have not yet resulted in any commercial
vaccine for humans. Experiments with animals show that plasmids of “Naked” DNA injected
into muscle results in the production of the protein encoded in the DNA.

• The “gene gun” method for injecting nucleic acids into plant cells. The proteins persist
and stimulate an immune response.

• The problem with this type of vaccine is that the DNA remains effective only until it is
degraded. Indications are that RNA, which could replicate in the recipient, might be
more effective agent.
• The DNA vaccine couldn’t cause the disease because it wouldn’t contain the microbe,
just copies of a few of its genes. In addition, DNA vaccines are relatively easy and
inexpensive to design and produce.
 Current Practicing Vaccines in
Currently there are few
Pakistan
common vaccines are
under practice, such as
Shown in the table :-
Polio The poliomyelitis (polio ) vaccine protects against poliovirus infections. The
vaccine helps the body produce antibodies (protective substances) that will prevent an
individual from contracting polio

• Polio is caused by intestinal viruses that spread from person to person in stool and
saliva.
• Most people infected with polio (approximately 95%) show no symptoms. Minor
symptoms can include sore throat, low-grade fever, nausea, and vomiting.
• Some infected persons (1 to 2%) will have stiffness in the neck, back, or legs
without paralysis.
• Less than 1% of polio infections (about 1 of every 1,000 cases) cause paralysis. In
some cases, the poliovirus will paralyze the muscles used to breathe, leaving the
victim unable to breathe on his or her own.
• Many paralyzed persons recover completely. Those who do recover from paralytic
polio may be affected 30 to 40 years later, with muscle pain and
progressive weakness.
• Recent Polio Vaccine
• 1.Name of the medicinal product.
• Polio Sabin TM (Oral)
• Poliomyelitis vaccine, live (Oral)

• Side effects that usually do not require immediate medical attention, unless
they persist and are bothersome, include:
• Fussiness decreased appetite
• low-grade fever (102°F [39° C] or less)
• pain, tenderness, redness
• swelling, or a “knot” at the injection site, fatigue
• vomiting
• Side effects that should be reported as soon as possible are:
• limp, pale, or less alert child
• difficulty breathing, shortness of breath, or wheezing
• difficulty swallowing
• high fever (103°F [39.4°C] or more)
• inconsolable crying for three hours or more
• seizures (convulsions)
• severe skin rash, hives , or itching
• swelling of eyes or face
• unusual sleepiness
• Interactions

• Dosage:
2-3 drops
At birth
At 6 weeks
At 10 weeks
At 14 weeks
At 9 Month
And booster dose 20 to 23 month
• MMR Vaccine Measles, mumps and rubella are highly infectious, common
conditions that can have serious, potentially fatal, complications, including meningitis,
swelling of the brain (encephalitis) and deafness. They can also lead to complications in
pregnancy that affect the unborn baby and can lead to miscarriage.
• Measles, mumps, and rubella are serious diseases. Before vaccines they were very
common, especially among children.
Measles:
• Measles virus causes rash, cough, runny nose, eye irritation, and fever.
• It can lead to ear infection, pneumonia, seizures (jerking and staring), brain damage, and
death.
Mumps:
• Mumps virus causes fever, headache, muscle pain, loss of appetite, and swollen glands.
It can lead to deafness, meningitis (infection of the brain and spinal cord covering),
Rubella :
• Rubella virus causes rash, arthritis (mostly in women), and mild fever.
• If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby
could be born with serious birth defects.
• These diseases spread from person to person through the air. You can easily catch them
by being around someone who is already infected.
• Dosage:
• Children should get 2 doses of MMR vaccine:
• First Dose: 12 to 15 months of age
• Second Dose: 4 to 6 years of age (may be given earlier, if at least 28 days after the 1st
dose)
• Some infants younger than 12 months should get a dose of MMR if they are traveling out
of the country. (This dose will not count toward their routine series.)
• Some adults should also get MMR vaccine: Generally, anyone 18 years of age or older
who was born after 1956 should get at least one dose of MMR vaccine, unless they can
show that they have either been vaccinated or had all three diseases.
• MMR vaccine may be given at the same time as other vaccines.
• Children between 1 and 12 years of age can get a combination vaccine called MMRV,
which contains both MMR and varicella (chickenpox) vaccines. There is a separate
Vaccine Information Statement for MMRV.
• A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic
reactions.
• The risk of MMR vaccine causing serious harm, or death, is extremely small.
• Getting MMR vaccine is much safer than getting measles, mumps or rubella.
• Most people who get MMR vaccine do not have any serious problems with it.
Mild problems:
• Fever (up to 1 person out of 6)
• Mild rash (about 1 person out of 20)
• Swelling of glands in the cheeks or neck (about 1 person out of 75)
• If these problems occur, it is usually within 6 to 14 days after the shot. They occur less often after
the second dose.
Moderate Problems:
• Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
• Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
• Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)
• Severe Problems (Very Rare):
• Serious allergic reaction (less than 1 out of a million doses)
• Several other severe problems have been reported after a child gets MMR vaccine, including:
Deafness; long-term seizures, coma, or lowered consciousness; permanent brain damage. These are
so rare that it is hard to tell whether they are caused by the vaccine.
D P T V a c c i n e s A combined vaccine to protect against diphtheria and tetanus. The
DPT (DTP) vaccine also protects against pertussis.

•
Vaccine Information
The DPT (DTP) vaccine is a "3-in-1" vaccine that protects against diphtheria, pertussis,
and tetanus. It can be given to children less than 7 years old. It is given by injection,
usually into the arm or the thigh.

Immunization Schedule
DPT (DTP) vaccination is one of the recommended childhood immunizations and should
begin during infancy. In most parts of the United States, DPT immunization is required
before starting school. A minimum of 3 injections should be given, and 5 injections is
strongly recommended.

DPT (DTP) immunization is usually a series of injections given to children at ages 2

months, 4 months, 6 months, and 15 to 18 months. A booster is given before starting
school (age 4 to 6). DPT is recommended unless there is a reason that the child should
not receive the pertussis vaccine (such as allergic reaction), in which case the DT
should be given.

After the initial series of immunizations, a booster of Td vaccine should be given at age
14 to 16 and every 10 years thereafter.
• Benefits
Receiving a minimum of 3, preferably 5, DPT (DTP) vaccines prior to school
entry will protect (for up to 10 years):
• 85% of those children immunized from getting diphtheria
• 70 to 90% of those children immunized from getting pertussis. (Even those
who do contract the disease, despite being immunized, will have a milder
course of illness.)
• 95% of those children immunized from getting tetanus
• DPT (DTP) vaccine can be safely given to infants. As a general rule, any drugs or
vaccines are not recommended for pregnant women; however, a pregnant
woman who needs the Td vaccine can safely receive it (there have been no
documented problems for the woman or the fetus).
• Risks
• DTP (DPT), can cause these severe complications in about 1 out of 1,750 immunizations:
• convulsions (seizures)
• febrile seizure (children)
• shock or collapse (blue or pale, limp, nonresponsive)
 Vaccine Controversies
• The public health benefits of vaccinations are exaggerated. Critics of vaccination
policy point out that the mortality rates of some illnesses were already dramatically
reduced before vaccines were introduced, and claim that further reductions cannot
immediately be attributed to vaccines.

• Secondary and long-term effects on

the immune system from introducing
Immunogens directly into the bloodstream
are not fully understood.
• Vaccinations contain chemical components that are known to be toxic, such as
formaldehyde, aluminum in various compounds, acetone, glyceride, ethylene glycol,
and neomycin when injected in large enough quantities

• Can some vaccines cause Cancers ? Some researchers hypothesize possible links
between the increasing incidence of cancer and use of vaccines
 Importance of Vaccines
Why we should support vaccination?

We don't vaccinate just to protect our children. We also vaccinate to protect our
grandchildren and their grandchildren. With one disease, smallpox, we “stopped the leak”
in the boat by eradicating the disease. Our children don't have to get smallpox shots any
more because the disease no longer exists. If we keep vaccinating now, parents in the
future may be able to trust that diseases like polio and meningitis won't infect, cripple, or
kill children.

•Vaccination can save your child’s life

•Vaccination is very safe and effective
• Vaccination protects other you care about
• Vaccination can save your Life, Time and Family
• Vaccination protects future generations
 Top Reasons to Protect Lives Through
Vaccination
• Vaccines save lives! Vaccination saves the lives of more than 3 million people
worldwide each year and prevents millions of others from suffering from diseases
and permanent disabilities.

• Vaccines work well and have few side effects

• Vaccine-preventable diseases, such as measles, mumps, and whooping cough, are

infecting children world wide. Vaccination protects children from the very serious
complications of vaccine-preventable diseases. Possible complications include
hospitalization, amputation, brain damage, paralysis, meningitis, seizures, deafness,
and even death.

• Vaccines are only given to children after a long and careful review by scientists,
doctors, and healthcare professionals.

• Vaccines will involve some discomfort and may cause pain, redness, or tenderness at
the site of injection but this is minimal compared to the pain, discomfort, and trauma
of the diseases these vaccines prevent. Serious side effects following vaccination, such
as severe allergic reaction, are very rare. The disease-prevention benefits of getting
vaccines are much greater than the possible side effects for almost all children.
 References
Microbiology- an introduction
Tortora
Funk
Case
http://www.vaccineinformation.org