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Principles of Vaccination Epidemiology and Prevention of VaccinePreventable Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Revised April 2009 Diphtheria Tetanus Whooping cought Meningitis – Hib, Streptococcus, Neisseria Measels Poliomyelitis Iron lung – after poliomyelitis Jenner, Variolisation, Ramses, eradication Principles of Vaccination Immunity • Self vs. nonself • Protection from infectious disease • Usually indicated by the presence of antibody • Very specific to a single organism Principles of Vaccination Active Immunity • Protection produced by the person's • own immune system Usually permanent Passive Immunity • Protection transferred from another • person or animal Temporary protection that wanes with time Way to get immunised actively Aktívna imunita Pasívna imunita passively transplacentarly disease Prirodzene získaná Prirodzene získaná Naturally vaccination immunisation immunotherapy immune sera Umelo navodená Umelo Artificially navodená Stávame sa imúnnymi prirodzenou cestou alebo umelo. Očkovaním si vytvárame umelo získanú aktívnu imunitu voči chorobám. Principles of Vaccination Antigen • A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response Antibody • Protein molecules (immunoglobulin) produced by B lymphocytes to help eliminate an antigen Protilátky Antigény Epitopy Protilátky produkované bunkami imunitného systému rozpoznávajú cudzie antigény – ich charakteristické molekuly – antigénne determinanty - epitopy Passive Immunity • Transfer of antibody produced by one human or other animal to another • Temporary protection • Transplacental most important source in infancy Sources of Passive Immunity • Almost all blood or blood products • Homologous pooled human antibody (immune globulin) • Homologous human hyperimmune globulin • Heterologous hyperimmune serum (antitoxin) Monoclonal Antibody • Derived from a single type, or clone, of antibody-producing cells (B cells) • Antibody is specific to a single antigen or closely related group of antigens • Used for diagnosis and therapy of certain cancers and autoimmune and infectious diseases Vaccination • Active immunity produced by vaccine • Immunity and immunologic memory similar to natural infection but without risk of disease Classification of Vaccines • Live attenuated – viral – bacterial • Inactivated Inactivated Vaccines Whole • viruses • bacteria Fractional • protein-based – toxoid – subunit • polysaccharide-based – pure – conjugate Principles of Vaccination General Rule The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine Live Attenuated Vaccines • Attenuated (weakened) form of the "wild" virus or bacterium • Must replicate to be effective • Immune response similar to natural infection • Usually produce immunity with one dose* *except those administered orally Live Attenuated Vaccines • Severe reactions possible • Interference from circulating antibody • Fragile – must be stored and handled carefully Live Attenuated Vaccines • Viral • Bacterial measles, mumps, rubella, varicella/zoster, yellow fever, rotavirus, intranasal influenza, rotavirus, vaccinia BCG, oral typhoid Inactivated Vaccines • Cannot replicate • Generally not as effective as live • • • • vaccines Less interference from circulating antibody than live vaccines Generally require 3-5 doses Immune response mostly humoral Antibody titer may diminish with time Inactivated Vaccines Whole-cell vaccines • Viral • Bacterial polio, hepatitis A, rabies, influenza* pertussis*, typhoid* cholera*, plague* *not available in the United States Inactivated Vaccines Fractional vaccines • Subunit • Toxoid hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax diphtheria, tetanus Pure Polysaccharide Vaccines • Not consistently immunogenic in children younger than 2 years of age • No booster response • Antibody with less functional activity • Immunogenicity improved by conjugation Polysaccharide Vaccines Pure polysaccharide • pneumococcal • meningococcal • Salmonella Typhi (Vi) Conjugate polysaccharide • Haemophilus influenzae type b • pneumococcal • meningococcal Future of vaccine • Antiidiotype vaccines, DNA vaccines, • One, not hurting, for everybody, immunogenic, not harming, protecting against all diseases, only one disadvantage = not real • Multivalent vaccines – more immunogenic Fases of new vaccines development – laboratory, preclinical Field, clinical study Skôr ako je vakcíne udelená licencia, prebieha testovanie jej bezpečnosti a stanovenie účinnosti u dobrovoľníkov v niekoľkých fázach s presne stanovenými podmienkami Risks of immunisation • Side effects on any part of vaccine redness, indurance, ache, fever, cry, alergy • Immunisation – small regulated infection - mild reaction, not target tissue infection • Not real expectances Population immunity • Collectove immunity – more than 85% vaccinated against infection spread from 1 to the other • Protection of not immunisable or not immunised „herd effect“ • Not present for tetanus, rabies Surveillance a immunological surveys • Surveillance – system of epidemiological patrolling • Immunological surveys – targeted sampling of sera from different age groups to find not protected groups, to organise aimed vaccination - mopping, or catch up vaccination or changes of immunisation schedule Decrease of morbidity for DTP after introduction of DTP vaccination INCIDENCE of HIb MENINGITIS - decrease influenced by the amount of applicated vaccines 20 15 10 všetky 5 0 rokov 1- 4 rokov 0 1 2 5 ´00 6 7 ´94 ´95 ´96 ´97 3 ´984 ´99 ´01 8 ´02 200 000 150 000 100 000 50 000 0 1 9 Antivaccination activity • Vaccination mostly in child population • very sesitive topic, period of discovery of • • • • many diseases and handicapes in children demagogical arguments, not causal connection, medialisation, not medically graduated people, usually educated in other vague topics – ecology, homeopathy..... Dangerous – more people affected by vaccination preventable diseases in USA and Germany then for bioterroristic threat Kontraindikácie očkovania • Akútne ochorenie, horúčka • Individuálne u pacientov s neurologickým postihutím, predchádzajúcou reakciou na očkovanie • Nepodávať živú OL tehotným alebo • imunosuprimovaným (BCG?) Jasne vyhodnotiť riziko očkovania a jeho odmietnutia