Pharmacist in Immunization Part 1-2

IMMUNITY

Body’s ability to prevent the invasion of pathogens.

IMMUNIZATION

A process by which a person becomes protected against a disease through vaccination

VACCINE

A preparation that is used to stimulate the body’s immune response against diseases.

VACCINATION

The act of introducing a vaccine into the body to produce protection from a specific disease.

ACTIVE IMMUNITY

Results when exposure to a disease organism triggers the immune system to produce antibodies to that disease.

PASSIVE IMMUNITY

is provided when a person is given antibodies to a disease rather than producing them through his or her own immune system

NATURAL

Infection 

Exposure to a pathogen

Ex. Chickenpox in summer

ARTIFICIAL

Vaccination

Antigen is injected into the body to trigger antibody production.

NATURAL

Maternal antibodies

 Colostrum from the first few months of breastfeeding provides immunity

ARTIFICIAL

Monoclonal antibodies

Infection

Active Immunity that is natural

Vaccination

Active Immunity that is artificial

Maternal antibodies

Passive Immunity that is natural

Monoclonal antibodies

Passive Immunity that is artificial

Vaccine

a tiny weakened non-dangerous fragment of the organism and includes parts of the antigen.

Vaccine

It’s enough that our body can learn to build the specific antibody. Then if the body encounters the real antigen later, as part of the real organism, it already knows how to defeat it

community

Vaccinating not only protects yourself, but also protects those in the _ who are unable to be vaccinated

Vaccine

A _ protects an individual

Community vaccine

protects the whole community

HERD IMMUNITY

80% of the population is vaccinated.

INACTIVATED VACCINES

Killed form of the pathogen

INACTIVATED VACCINES

Does not provide immunity as strong as live vaccines

INACTIVATED VACCINES

Requires several doses

LIVE-ATTENUATED VACCINES

Weakened (attenuated) form of the pathogen

LIVE-ATTENUATED VACCINES

Typically 1-2 doses can give lifetime protection

LIVE-ATTENUATED VACCINES

Example: MMR vaccine, rotavirus, Oral polio vaccine BCG vaccine, yellow fever, Varicella vaccine

mRNA VACCINES

Creates proteins in order to trigger response

mRNA VACCINES

Example: COVID-19 vaccine (Pfizer and Moderna)

SUBUNIT VACCINES

Contain killed, antigenic component of pathogen

SUBUNIT VACCINES

Require several doses (booster shots)

SUBUNIT VACCINES

Require several doses (booster shots)

TOXOID VACCINES

Contain toxin made by pathogen

TOXOID VACCINES

May require booster shots

TOXOID VACCINES

Example: Tetanus toxoid, Diptheria toxoid, Rabies toxoid

VIRAL VECTOR VACCINES

Modified version of a different pathogen as a vector to deliver protection

VIRAL VECTOR VACCINES

The viral vector is a virus that does not cause serious illness

VIRAL VECTOR VACCINES

Example: COVID-19 (Janssen/Johnson&Johnson and AstraZeneca)

ANTIGEN

Derived from the disease-causing organisms

STABILIZERS

Maintain the effectiveness by maintaining stability of the product during storage, particularly where the cold chain is unreliable.

STABILIZERS

• Examples given:

  • MgCl2 (for OPV)

  • MgSO4 (for measles)

  • lactose-sorbitol 

  • sorbitol-gelatin

  • 2-phenoxy ethanol

ADJUVANTS

To stimulate the production of antibodies against the vaccine to make it more effective

ADJUVANTS

Ability to enhance the immune response

ADJUVANTS

Example: Aluminum gels or Aluminum salts

ANTIBIOTICS

Used during the manufacturing phase to prevent bacterial contamination of the tissue culture cells in which the viruses are grown

ANTIBIOTICS

In trace amounts

PRESERVATIVES

Added to multi-dose vaccines

PRESERVATIVES

• Example:

  • Thimerosal (ethyl mercury-containing compound)

  • Formaldehyde — to inactivate viruses (IPV), to detoxify bacterial toxins (diphtheria and tetanus)

PRESERVATIVES

During production, a purification process removes all formaldehyde in vaccines.

TRIPLE BURDEN OF DISEASES

Infectious Diseases are still common
Non-communicable diseases are on rise
Disaster-related health problems increasingly affect the country

13 out of 17

High incidences of all key communicable diseases with _ WHO recognized neglected tropical diseases remaining endemic

HEALTH INDICATOR

Increasing levels of non- communicable diseases and high prevalence of all risk-factors

third

Being the _ highest disaster-prone country in the world. 

• 50% of the population: living on less than $2 a day despite a 4% GDP growth annually for the past decade

malnutrition

Prevalence of _ plays a part in lowering resistance to infections

immunocompromised

Increased number of _ patients due to NCDs

hospitalizations

Increased _ predispose patients to nosocomial infections

Emergency situations

_ during disasters like lack of potable water, poor sanitation, malnutrition and increased concentration of the population in evacuation: outbreaks

Poverty and heavy burden

_ on individuals and the health system to respond to treatment needs of the population highlight the importance of preventive measures

Prevention of Infection and Infectious Diseases

• Protecting against establishment of an infection 

  • E.g., Hepatitis A Vaccine: 90% protection against symptomatic disease and asymptomatic infections

Prevention of Infection and Infectious Diseases

• Sterilizing immunity (complete prevention of infection)

  • E.g., HPV Human papillomavirus virus: ability to completely prevent persistent vaccine-type infection

PRE-EXPOSURE ADMINISTRATION

Pre-exposure vaccination with a combination of several antigens have been found to be successful

POST-EXPOSURE ADMINISTRATION

Rabies, hepatitis A and B, measles, and varicella

Control of Mortality, Morbidity and Complications

Groups that are most vulnerable to infections and with greatest need (pregnant women, cancer patients, immunocompromised individual)

Control of Mortality, Morbidity and Complications

Vaccines can annually prevent almost 6 million deaths worldwide.

Control of Mortality, Morbidity and Complications

Failure to prevent infections: congenital rubella syndrome, liver cirrhosis and cancer. Measles and mumps may lead to neurological problems

FIRST MECHANISM

Reducing amount and/or duration of pathogen shedding, thereby retarding transmission

SECOND MECHANISM

• Through what is called contact immunization

• Where vaccine viruses may infect more individuals than those administered vaccine

Protection of the Unvaccinated Population

“HERD PROTECTION” OF UNIMMUNIZED INDIVIDUAL

Societal and Economic Benefits of Immunization

Protective effects of vaccines translate into long-term cost savings

Safe Travel and Mobility

• Most common vaccine-preventable diseases among travelers are influenza and hepatitis A

  • Others: Rabies, Hepatitis B, typhoid, cholera, yellow fever, Japanese encephalitis, and measles

Protection Against Bioterrorism

Cessation in the potential use of smallpox virus in bioterrorism

Enhancing Equity

“Perinatal and early infancy period”

DISEASE ERADICATION

TOTALLY ERADICATED

DISEASE ERADICATION

Smallpox

DISEASE ELIMINATION

Locally achieving immunity in more than 95% if the population

DISEASE ELIMINATION

Combined measles, mumps and rubella (MMR) vaccine could eliminate rubella and mumps.

DISEASE ELIMINATION

Disease is removed from a specific geographic area, but may still exist elsewhere. It requires continued efforts (like vaccination) to prevent reintroduction

DISEASE ERADICATION

Complete and permanent removal of a disease worldwide, hence, no further interventions needed

reservoir

With environmental xx (Tetanus) or those coming from animal xx (Japanese encephalitis and rabies)

CHALLENGES

Misconceptions and the rise of the anti-vaccination movement