IMMUNOLOGICAL ASPECT OF

IMMUNIZATION

dr. Rahmawati Minhajat, Ph.D, Sp.PD

Medical Faculty Hasanuddin University

Immunization  the way to increase someone’s
immunity to a certain cause of disease  if exposed to
the germ  maybe not ill or mildly ill
 Vaccination versus Immunization

Vaccination

• Vaccination is a process of inoculating the

vaccine/ antigen into the body irrespective of
seroconversion

Immunization

• Immunization is the process of inducing

immune response in an individual either
humoral or cell mediated
 Vaccines

Vaccines are whole or parts of

microorganisms administered to
prevent an infectious disease
AIM OF IMMUNIZATION (VACCINATION)

1. To reduce the number of illness (morbidity)

2. To reduce the number of deaths (mortality)

3. To reduce the number of disability (sequelae)

4. Noble : eradication of certain disease

small pox  eliminated

PIN  polio and measles  ?

Passive immunity : immunity from outside, short

duration, congenital or artificial

Active immunity : from the body itself after exposure

to some antigen, whether it’s naturally / artificially

(vaccination); last longer / lifetime

 The Immune System and Passive
Immunization
• The transfer of antibodies will not trigger the immune system

• There is NO presence of memory cells

• Risks are included

• Recognition of the immunoglobulin epitope by self
immunoglobluin paratopes
• Some individuals produce IgE molecules specific for
passive antibody, leading to mast cell degranulation
• Some individuals produce IgG or IgM molecules specific
for passive antibody, leading to hypersensitive reactions
• Passive immunization
transfer of anti (antibody or immunity cell) non immune
person
Natural passive immunity
Mother’s immunity  placenta  foetus
Antiviral, antitoxin, antibacterial
Mother’s immunity  breast milk  baby
Colostrum >> permanent breast milk
Spesific immunity: E. Coli, Shigella, Polio, etc
 Non spesific immunity :
Lisozyme, Lactoferin, Interferon, etc
Cell mediated immunity ?
 Artificial passive immunity
Heterolog antibody
From horse
Can induce allergic reaction
( Type I or III serum sickness)
First SKIN TEST/ EYE TEST
Negative  direct injection
Positive  desensitization
 Homolog antibody  Gammaglobulin
Immune serum globulin ( Human Normal
Immunoglobulin/ HNI )
From healthy donor (without noticing
vaccination procedure, recovery time)
Tourist to tropical region
ITP, Kawasaki disease, Steven Johnson
Syndrome
Guillain Barre Syndrome
Specific human immune serum
Immunized donor
Tetanus immune globulin
Rabies immune globulin
Hep. B immune globulin
• Active immunization/vaccination:
The body made the anti body after getting
stimulus from the outside, ex: natural
infection or vaccination. Natural infection
including symptomatic or asymptomatic
 Active Immunization
• Natural Infection with
microorganism or artificial
acquisition (vaccine)

• Both stimulate the proliferation of

T and B cells, resulting in the
formation of effector and memory
cells

• The formation of memory cells is

the basis for the relatively
permanent effects of vaccinations
SOURCE OF ANTIGEN  VACCINE
Vaccine :

 Bacteria/ virus:

 Patogenicity (-) but immunogenicity (+)

 Toxoid :

 toxicity (-), immunogenicity (+)

 IMMUNIZATION
Passive Active

• Route - Parenteral - Parenteral

- Oral

• Immnune effect - Immediately after immunization - After a few time

- Acute - Prolong

• Age - Immediately after delivery - A few time

or exposure / exposure or after
passive immunization

• Side effect - Frequent (heterolog) - Rare

• Indication - Therapeutic - Prevention

- Prevention
Effective vaccine

1. Induction of the appropriate shape of immunity

2. Stable in reservation, especially living vaccine

3. Enough immunogenicity  dead vaccine often

need adjuvant
 VACCINATION IMMUNE RESPONSE

1. Primary immune response (PIR) :

First exposure to antigen

Long lag phase

Especially IgM

Forming memory cells (B cell & T cell)

2. Secondary immune response (SIR) :

The next exposure with the same antigen

Shorter lag phase (memory cell formed)

Especially IgG & sel T active

Forming many effector cells and memory cells

SIR  give adequate response to the same antigen

exposure in the future

“BOOSTER”  to maintain the effective immune

response
 VACCINATION IMMUNE RESPONSE INFLUENCED BY

1. Host Immune Status

Maternal immunity can reduce immune response,
example antibody to measles
Age  < 2 months and old person less response
Immune status  immune deficiency :
 R/ immunosupression
 Congenital immune deficiency
 Severe illness
 Nutritional status  malnutrition

 Cellular response decreasing

 Spesific humoral response decreasing

Immune deficiency  contraindication of living

vaccine

2. Host genetical factor  well responder, enough & low

3. Vaccine quality and quantity :

a. Ways of administration

Polio Sabin vaccine  local/systemic immunty

Polio Salk vaccine  systemic immunity

b. Dosage  suggestive dose

c. Frequency & administration interval

d. Vaccine type  living vaccine > dead vaccine

e. Adjuvant : increasing vaccination immune

response

f. Reservation influencing the vaccine potency

 Different type of adverse events following
immunization

Vaccine reaction Event caused/precipitated by the inherent

properties of the vaccine (active component,
adjuvant, preservative, stabilizer) when given
correctly
Program errors Event caused by an error in vaccine
preparation, handling or administration
Coincidental Event that happens after immunization but is
not caused by the vaccine
Injection Event arising from anxiety about, or pain
reaction from, the injection itself rather than the
vaccine
Unknown The cause of the event cannot be determined
 Injection site

Intramuscular Injections Site

Preterms & neonates Anterolateral thigh (junction of
Infants middle & lower third)

Toddlers & older children Deltoid or Anterolateral thigh

Adolescents & adults Deltoid
Subcutaneous Injections Site
Infants thigh
>12 months Outer triceps
Intradermal Injections Site
All age Left deltoid