APPLIED MICROBIOLOGY

Immunoprophylaxis against Infectious Diseases

Prevention of infections depends upon three concepts:

• Elimination of source of infection

• Prevention of transmission of infective agents
• Protection of susceptible persons by active or passive immunization

Vaccine is an immunobiological substance designed to confer specific protection against a disease. It

stimulates the immune system (either humoral or cell mediated or both) to generate specific protection
against an infectious agent. Vaccines may be prepared from live modified organisms, inactivated or killed
organisms, toxoids or combination of these.

Live Versus Killed Vaccines

Live attenuated as well as inactivated vaccines for different diseases are available. The former are also
called as replicating and the latter as non-replicating vaccines. The live vaccines are prepared from live
and generally attenuated organisms which have lost their ability to induce disease but retain their
immunogenicity. In general, live vaccines are more potent immunizing agents because of following
reasons:
a. Can multiply in the host thus increasing the antigen dose manifold.
b. Possess all major and minor antigenic components.
c. Occupy natural niches for the pathogen in the body thus blocking colonization by the pathogen.
d. May persist for longer time in the body in latent stages.

The killed vaccines are prepared by subjecting the organism to the action of physical or chemical agents.
These are usually safe but generally less efficacious than the live vaccines.

Differences between Attenuated and Inactivated vaccines

Feature Attenuated Inactivated

Preparation Attenuation Inactivation
Administration
Route Usually natural route Parenteral
Dose May be single Usually multiple
Adjuvant Not required Usually required
Safety May revert to virulence Safe
Cold chain requirement ++++ ++
Cost Low High
Duration of immunity Usually long May long or short
Immune response
Humoral IgG, IgA Mainly IgG
CMI + Little or no

Adverse reactions to vaccines

Normal toxicity
Faulty production Abnormal inherent toxicity
Presence of foreign toxin
Bacterial contamination
Wrong culture used
Viral contamination

Faulty administration Use of nonsterile apparatus

 Contamination from operator

Allergy Local
Serum sickness
Neurological illness
General anaphylaxis

Other causes Abnormal sensitivity of vaccine

Indirect effects
Damage to fetus
Provocation of disease

Contraindications to Vaccinations
WHO has recommended a limited number of contraindications to vaccinations as summarized below:
a. Immunization should be delayed in case of severe illness with fever, so that any sign of illness will
not be attributed to the vaccination.
Malnutrition, moderate fever, respiratory infections, common diarrhoea and any other benign
ailment do not constitute contraindication for vaccination.
Hospitalized children may receive necessary vaccinations before their discharge, and, in some
cases, immediately following admission, particularly in the presence of nosocomial measles risk.
b. Discontinuation of DPT immunization is recommended in case of occurrence of a severe
postvaccinal reaction as collapse, shock, fever above 40.5°C, convulsions and other neurological
symptoms.
Diarrhoea is not considered a contraindication for oral poliomyelitis vaccination. Extra doses cor-
responding to those administered during the bout of diarrhoea should be given.
c. No live vaccine is to be given to a person with an immunodeficiency or undergoing
immunosuppressive treatment, corticosteroids therapy, radiotherapy, antimetabolite therapy, etc.
d. Measles, mumps or rubella immunization should be delayed for at least six weeks when a recent
injection of polyvalent immunoglobulin has been given.

IMMUNOGLOBULINS AND ANTISERA Immunoglobulins (Ig)

Two types of immunoglobulins are available: normal human Ig and specific human Ig. Normal human Ig
is an antibody rich fraction obtained from a pool of at least 1000 people. The preparation is rich in IgG,
almost whole of which is in free form (and not in aggregates). It contains very little of IgA. Normal
human Ig is administered to prevent measles in highly susceptible individuals and to provide temporary
protection (up to 12 weeks) against hepatitis A infection for travelers to endemic area and to contacts of
case of hepatitis A in an outbreak. There should be a gap of 3 months between the administration of
normal Ig and any live vaccine.
Specific human immunoglobulins are prepared from the plasma of patients who have recently recovered
from infection or who have been immunized against a specific infection. The plasma of donor should
contain at least five times the amount of specific antibody as is present in standard reference serum.
The immunoglobulins are usually given intramuscularly. Peak blood levels are reached in two days after
intramuscular injection. The average half-life is 20-35 days. Generally immunoglobulins should not be
given just before or after active immunization.

National Immunization Schedule

Every country has devised a schedule for immunizing children against common infectious diseases (which
have been included in EPI of WHO) to obtain optimal results with the available resources. As per WHO
recommendations one dose of BCG, three doses of combined OPT vaccine, three (if possible additional
zero dose at birth) doses of oral poliovaccine and one dose of measles vaccine is to be given to the child in
his first year of life to protect him against these six diseases. Of these BCG is given as soon after the birth
as is possible along with a dose of OPV. OPT is injected from the age of 6 weeks onwards with a gap of
four weeks each between three doses. Each injection of OPT is accompanied by a dose of OPV to reduce
the contact of child with health functionary. Vaccine against measles is given on the completion of 9
months of age. Upto the age of 9 months, a child is protected against measles by the antibodies passively
transferred to child from the mother.