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Active
Passive
Passive
Subclinical Infection Clinical Infection
Toxoid
Homologous
Transplacental
Live Vacc
Heterologous
Killed vacc
IMMUNITY
Immunity refers to the ability of the human body to resist disease agents and their toxins through possession of antibodies.
Ab Titre
20
40
60
2) The secondary (booster) response: the response to a booster dose of the same Ag differs in a number of ways from the primary response: - has a shorter latent period and more rapid production of Abs. - Abs are produced in abundance and a high level is maintained for a longer period. - the Abs produced tend to have a greater capacity to bind to the Ags. The accelerated response is attributed to the immunological memory.
(i)
It is widely distributed in the tissue fluids and are equally available in the intra and extravascular spaces. It can cross the placenta, and so it provides passive immunity to the newborn. (ii) IgM: This is the first type produced by the maturing foetus, and it is the main type responsible for the primary
immune response.
It is mainly intravascular but it does not cross the placenta.
Rechallenge by a subsequent infection evokes a secondary response more rapid and of greater intensity. This type of immunity is responsible for intracellular infection (due to viruses and some bacteria e.g.
which serve to control clotting, laying down of fibrin and dilatation of local capillaries to facilitate passage of WBCs. When functioning efficiently, the body is usually
Congenital and acquired immune-deficiencies. Certain infections like mumps and measles. Presence of passive immunity (maternal Abs). Treatment with immuno suppressive drugs (e.g. steroids) Malnutrition Diabetes mellitus Old age
IMMUNIZATION
Immunization is more inclusive term denoting the process of inducing or providing immunity artificially. Immunization can be active or passive. Infectious diseases can be prevented by stimulating the individual to develop an active immunologic defence in
In
1979G/1399H
the
vaccination
against
certain
childhood diseases became obligatory secondary to the issue of a Royal Decree which dictated the sustain of birth certificates until the completion of the primary series of vaccination against: T.B., Diphtheria, Tetanus neonatorum, whooping cough, measles, and poliomyelitis. Latter on the list included coverage against mumps, rubella , hepatitis B viral infections and hib. .
In 1991G/1411H a change in the schedule of vaccine administration was implemented (table 1), and continued until the a subsequent schedule of vaccination was approved and implemented in Shawal 17th 1422H/January 1st 2002. The most recent schedule is applied starting Jan. 2008. The changes included in the new vaccination schedule reflect the efforts of continuous monitoring and evaluation of the previous system. It depended largely on the incidence of certain diseases and their impact. It also followed the most recent developments in the manufacturing and industry of vaccines internationally employed.
- IPV has been recommended for the first time since ever.
- Hepatitis A ,and Varicella vaccines have been recently added. - Measles (mono) vaccine has been indicated at an earlier age. -The two MMR doses are partially considered as boosters to measles vaccine. (see the attached schedule).
The routine schedules for active immunization of normal infants and children, and of children not immunized in early infancy have recently been revised by the immunization Practices Advisory Committee, Ministry of Health. The birth certificate will not be issued until the child has completed the recommended primary
immunization of infancy period including ( MMR, Varicella and OPV ) at 12 months of age.
Modification of the recommended schedule may be necessary because of missed appointment or intercurrent illness. Interruption of a recommended series does not require starting the series over again or adding extra doses, regardless of the interval elapsed. If a dose of DPT or OPV is missed, immunization should occur on the next visit as if the usual interval had elapsed.
In contrast, giving doses of a vaccine or toxoid at less than recommended intervals may lessen the antibody response and therefore should be avoided.
of antigen-antibody complexes.
* Td = Adult tetanus toxoid (full dose) and diphtheria toxoid (reduced dose) for adult use. * DT = Diphtheria and tetanus toxoids for use in children aged < 7 years old.
Table 1: Routine immunization schedule for normal infants and children in Saudi Arabia applied 1991. Recommen Vaccine(s)** Comments ded Age
Birth 6 weeks 3 months 5 months 6 months 12 months BCG, HBV DTP, OPV, HBV DTP, OPV DTP, OPV HBV, Measles MMR Completion of primary series of DTP and OPV. Completion of HBV series. Should not be given before 12 months of age. DTP and OPV can be initiated as age 2 wk during epidemics.
18 months
4-6 years
DTP, OPV
DTP, OPV
Table (2): Recent schedule for Vaccination of Newborns in Saudi Arabia.( Jan. 2002-Jan.2008)
Visit No.
First Second At birth
Age
Vaccines **(dose)
BCG HBV(1) DPT(1) OPV(1) Hib(1) HBV DPT(2) OPV(2) Hib(2) DPT(3) OPV(3) Hib(3) HBV(3) MMR(1) DPT (Booster1) OPV (Booster1) Hib (Booster1) DPT (Booster2) OPVBooster2) MMR (Booster2)
At two months
Third
At four months
Fourth
Fifth Sixth
Seventh
The DPT + Hib vaccine is a tetraimmune adjuvant vaccine that has been introduced for the first time in Saudi Arabia in 2002 and is given in one injectable dose.
*
Table (3): Recent schedule for Vaccination of Newborns in Saudi Arabia. Starting January 2008.
Age at visit
At birth
Vaccines
BCG HepB IPV [ DTP, HepB , Hib ] OPV [ DTP, HepB, Hib ] OPV, [ DTP, HepB , Hib ] Measles ( mono )
2 - Months
4 - Months 6 - Months 9 - Months 12 - Months
18 - Months
OPV ,MMR Varicella OPV DTP, Hib Hepatitis (A) Hepatitis (A) OPV,DTP, MMR, Varicella.
24 - Months 4 - 6 Years
Type
Live Bacteria
Route
Intradermal (preferred) subcutaneous Intramuscular or
DTP
D&T = Toxoids
P = inactivated bacteria
Hepatitis B(HBV)
Intramuscular
Polysaccharide
Intramuscular
Subcutaneous
OPV
Oral
BCG = Bacillus Calmette Guerin vaccine (tuberculosis). DPT = Diphtheria, pertussis and tetanus vaccine. MMR = Live measles, mumps and rubella viruses in a combined vaccine. OPV = Oral Poliovirus vaccines containing attenuated poliovirus types 1,2 and 3.
** Vaccines must be kept constantly cold throughout the chain of storage and transport which they have to pass through before reaching the child. Breaks in this "cold chain", as it has come to be called, may be due to a batch of vaccine delivery to a Ministry of Health depot or to a hospital or health centre.
It can happen as a result of the breakdown of the refrigerating system. Great care must be taken to try to avoid this happening, and it is always better to have a refrigerator which can run on two different sources of power. Live vaccines are also damaged by sunlight, which is especially likely to happen after they have been prepared (reconstituted) for injection in the clinic or at the school.
Vaccines should always be kept in the shade. They can also be affected by detergents or antiseptics in syringes which have not been
container.
(This is the date after which the manufactures cannot guarantee the power of the vaccine).
The chances that such expired vaccines will fail to protect increase the longer the interval after the expiry date. Live vaccines for injection should be used on the same day that they are reconstituted for injection, that is, after the water (diluent) has been added. Oral poliomyelitis vaccine can be used after opening until the vial is all used up, so long as it is returned to the refrigerator after clinic and kept in the shade.
The End
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