Immunization

Approach for prevention of infectious diseases

Improvement and maintenance of good socioeconomic conditions Preventive engineering Prompt management Surveillance and diagnostic awareness Immunization

Rationale of Immunization
The objective is to produce, without harm to the recipients a degree of resistance sufficient to prevent a clinical attack of the natural infection and to prevent the spread of infections to susceptible in the community.

Passive immunization
1) Artificial passive immunization
Homologous Heterologus

2) Immunoglobulins

Active immunization
Vaccines are of various types Attenuated whole cell vaccine Killed whole cell vaccine Toxoids Recombinant vaccines Subunit vaccines Conjugated vaccines DNA based vaccines Anti idiotype vaccines Plant based vaccines

Properties of an ideal vaccine

Promotes effective immunity Confers lifelong protection Safe ( no side effects) Stable Cheap Seen to be good and effective by the public

Live vaccine
Viral attenuation
Serial passage in cell culture. Eg Polio, Measles, Mumps Variants from other species. eg Smallpox, Rotavirus Resorted genomes. Eg Rota virus, Influenza Temperature selected mutants. Eg Influenza Recombinant virus. Eg HSV Recombinant viral vector. Eg Vaccinia, Adenovirus

Live vaccine - Bacterial

Serial subculture BCG Recombinant Bacteria Eg S typhi (Ty21a) Recombinant bacterial vector Eg Salmonella, Vibrio

Live vaccine - Advantages

They activate all phases of immune system. They raise immune response to all protective antigens. They offer more durable immunity and are more cross-reactive. They cost less to produce They give quick immunity in majority of vaccinees Administration is easy They can lead to elimination of wild type

Live vaccine Disadvantages

Mutation. This may lead to reversion to virulence Spread of the vaccine virus that is not standardized and may be mutated Sometimes there is poor "take" in tropics Cannot be administered to patients with immunodeficiency.

Killed Vaccine
Whole Cell Bacteria Pertusis, Cholera Virus Polio, Rabies Protein based Natural Hepatitis B Chemically inactivated TT & DT Genetically inactivated Pertusis Recombinant polypeptide Hepatitis B

Killed Vaccine
Peptide based eg Malaria, Anti Fertility Polysaccharide based - Hemophilus influenzae b (Hib), Pneumococcal and Meningococcal

Killed vaccine - Advantages

They give sufficient humoral immunity if boosters given There is no mutation or reversion (This is a big advantage) They can be used with immuno-deficient patients Sometimes they perform better in tropical areas

Killed vaccine - Disadvantages

Some vaccinees do not raise immunity Boosters tend to be needed There is little mucosal / local immunity (IgA) Higher cost failures in inactivation leading to immunization with virulent virus eg Smallpox

Newer Strategies - DNA based vaccination

Based on the deliberate introduction of a DNA plasmid into the vaccinee. The plasmid carries a protein-coding gene that transfects cells in vivo at very low efficiency and expresses an antigen that causes an immune response.

DNA vaccination - Advantages

Plasmids are easily manufactured in large amounts DNA is very stable Storage and transport are straight forward Sequence can be changed easily in the laboratory. Antigen produced by this method behaves in the same way as antigen produced in natural infection would behave The plasmid does not replicate

DNA vaccination - Problems

Potential integration of plasmid into host genome leading to insertional mutagenesis Induction of autoimmune responses (e.g. pathogenic anti-DNA antibodies) Induction of immunologic tolerance

Newer Strategies Anti idiotype antibodies

Idiotype - unique amino acid structure in the antibody complementary to epitope is known as the idiotype

New methods
Anti-idiotype vaccine
Virus epitope antibody

Antibody with epitope binding site

Antibodies (anti-ids) can be raised against the idiotype by injecting the antibody into another animal, these anti idiotype antibodies have a structure that mimics antigenic epitope structure.

Anti-idiotype vaccine cont

Antiidiotype antibody

Make antibody against antibody idiotype Anti-idiotype antibody mimics the epitope

antibody

The anti-idiotype antibody is injected into a vaccinee, anti-anti-idiotype antiobodies are formed that recognize a structure similar to part of the virus and might potentially neutralize the virus

Anti-idiotype antibody cont

2 Use anti-idiotype antibody as injectable vaccine
Anti-idiotype antibody Use as vaccine Binds and neutralizes virus Anti-anti-idiotype antibody Anti-anti-idiotype antibody Antibody to antiidiotype antibody Anti-anti-idiotype antibody