Epidemiology and Prevention of Vaccine-Preventable Diseases

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• Principles of Vaccination

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Center for Immunization and
Respiratory Diseases Centers for Disease Control
and Prevention
Revised April 2009
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Diphtheria
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Tetanus
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Whooping cought
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Meningitis Hib, Streptococcus, Neisseria
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Measels
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Poliomyelitis
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Iron lung after poliomyelitis
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Jenner, Variolisation, Ramses, eradication
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Principles of Vaccination
Immunity

• Self vs. nonself
• Protection from infectious disease
• Usually indicated by the presence of antibody
• Very specific to a single organism

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Principles of Vaccination
Active Immunity

• Protection produced by the person's own immune
  system
• Usually permanent
• Protection transferred from another person or
  animal
• Temporary protection that wanes with time

Passive Immunity
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Way to get immunised
Aktívna imunita Pasívna imunita
passively transplacentarly immunisation
immunotherapy immune sera
actively disease vaccination
Prirodzene získaná Prirodzene získaná
Naturally
Artificially
Umelo navodená Umelo navodená
Stávame sa imúnnymi prirodzenou cestou alebo
umelo. Ockovaním si vytvárame umelo získanú
aktívnu imunitu voci chorobám.
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Principles of Vaccination
Antigen

• A live or inactivated substance (e.g., protein,
  polysaccharide) capable of producing an immune
  response
• Protein molecules (immuno-globulin) produced by B
  lymphocytes to help eliminate an antigen

Antibody
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Protilátky Antigény Epitopy
Protilátky produkované bunkami imunitného systému
rozpoznávajú cudzie antigény ich
charakteristické molekuly antigénne
determinanty - epitopy
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Passive Immunity

• Transfer of antibody produced by one human or
  other animal to another
• Temporary protection
• Transplacental most important source in infancy

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Sources of Passive Immunity

• Almost all blood or blood products
• Homologous pooled human antibody (immune
  globulin)
• Homologous human hyperimmune globulin
• Heterologous hyperimmune serum (antitoxin)

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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

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Vaccination

• Active immunity produced by vaccine
• Immunity and immunologic memory similar to
  natural infection but without risk of disease

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Classification of Vaccines

• Live attenuated
• viral
• bacterial
• Inactivated

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Inactivated Vaccines
Whole

• viruses
• bacteria
• protein-based
• toxoid
• subunit
• polysaccharide-based
• pure
• conjugate

Fractional
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• 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
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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
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Live Attenuated Vaccines

• Severe reactions possible
• Interference from circulating antibody
• Fragile must be stored and handled carefully

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Live Attenuated Vaccines

• Viral measles, mumps, rubella,
  varicella/zoster, yellow fever, rotavirus,
  intranasal influenza, rotavirus,
  vaccinia
• Bacterial BCG, oral typhoid

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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

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Inactivated Vaccines
Whole-cell vaccines

• Viral polio, hepatitis A, rabies,
  influenza
• Bacterial pertussis, typhoid cholera,
  plague

not available in the United States
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Inactivated Vaccines
Fractional vaccines

• Subunit hepatitis B, influenza, acellular
  pertussis, human papillomavirus, anthrax
• Toxoid diphtheria, tetanus

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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

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Polysaccharide Vaccines
Pure polysaccharide

• pneumococcal
• meningococcal
• Salmonella Typhi (Vi)
• Haemophilus influenzae type b
• pneumococcal
• meningococcal

Conjugate polysaccharide
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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

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Fases of new vaccines development laboratory,
preclinical
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Field, clinical study
Skôr ako je vakcíne udelená licencia, prebieha
testovanie jej bezpecnosti a stanovenie úcinnosti
u dobrovolníkov v niekolkých fázach s presne
stanovenými podmienkami
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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

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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

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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

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Decrease of morbidity for DTP after introduction
of DTP vaccination
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INCIDENCE of HIb MENINGITIS - decrease influenced
by the amount of applicated vaccines
všetky 0 rokov 1- 4 rokov
94 95 96 97 98 99 00 01 02
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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

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Kontraindikácie ockovania

• Akútne ochorenie, horúcka
• Individuálne u pacientov s neurologickým
  postihutím, predchádzajúcou reakciou na ockovanie
• Nepodávat živú OL tehotným alebo
  imunosuprimovaným (BCG?)
• Jasne vyhodnotit riziko ockovania a jeho
  odmietnutia