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IMMUNIZATION

PVC MDS2004
Immunization can be either natural or artificial. In the past,
vaccines did not exit so how did the population survive? People
contracted the diseases quite common in childhood, but survived
due to acquiring natural immunization against the pathogens. One
is exposed to these aetiological agents, develops the disease but
develops immunity. However immunization does not always follow
the disease; this is the case in Gonorrhoea; if one indulges
repeatedly, one may contract gonorrhoea several times there is
no immunity after the disease. Two organisms can be re-exposed to
produce what is called a sub-clinical infection immunity is
developed which suppresses the full-blown disease. This is the case
with Hepatitis A in the past the population was over-exposed to
this virus; however the symptoms are not severe as in the case of
full-blown Hepatitis. The individual would have contracted Hepatitis
but possesses a range of immunity against it.
Immunization does not come with side-effects, but the main aim is
to relieve pain, suffering and offer complete protection. Artificial
immunization involves man-made agents (vaccines, toxoids) to
induce immunity in an artificial way deliberately. Passive
immunization means that our IS is not participating actively against
the disease for a defined period and can either be natural or
artificial. Natural passive immunization is exemplified by a mother;
bearing a child means sharing with the baby her own IgG; the only
IG that crosses the placental membrane. The baby, once born, will
possess IgG to which his mother was exposed. Because the IS is still
premature in neonates, the baby receives a boost throughout the
pregnancy. This lasts for 6-9 months; the baby after that has to fend
on itself, warding off any organisms which it will be exposed to.
Another example includes the colostrum which comes out from the
breast a sticky protein fluid which precedes lactation possessing
antibodies which can cross the intestinal barrier. Later on, during
lactation (breast is better for baby), secretory IgA antibodies is
found in the milk produced by the glandular tissue of the breast
(mostly fat). IgA coming from breast milk acts as an antiseptic
coating around the mucosa of the pharynx, conveying protection
against common bacterial and viral organisms. This is only for a
certain period of time, however it is quite known breast-fed milk do
not suffer from gastroenteritis, nor otitis media. The latter is caused
by colonization of the throat by bacteria which ascend the narrow,
short, almost horizontal Eustachian tube to reach the middle ear.
The baby is thus preventing this from happening through the IgA

antibodies acquired from the mothers milk. As the baby grows the
Eustachian tube becomes more vertical and longer it is now
difficult for organisms to ascend it and cause otitis media.
Artificial passive immunization means pepping up the IS of an
individual by giving pre-formed antibody; donated by someone else
cell-mediated immunity cannot be donated, but humoral
immunity can. Heterologous antibody was widely used up to 40
years ago this means immunizing a horse against a pathogen,
raise an antiserum against it, purify it to a great extent to obtain
the relevant IgG antibodies which are specifically needed against
the pathogen. The patient is at risk because he is being injected
with foreign protein the risk arises on the second and subsequent
doses after priming a reaction occurs: serum-sickness syndrome!
This is a delayed type of hypersensitivity reaction. Anaphylaxis can
also occur the patient can die within a couple of minutes, or
simply drop dead. Nowadays the diphtheria antitoxin is still
obtained from the horse for emergency treatment it MUST be
given (every minute that is wasted has catastrophic effects a very
potent exotoxin is produced, reaches the systemic circulation and
targets cardiac muscle (toxic myocarditis, heart failure), suprarenal
glands and nervous tissue with resulting muscle paralysis), however
it is not justifiable to use it to prevent diphtheria. The risk
outweighs any potential benefit. Specific heterologous artificial
passive immunization can be either IM or IV.
Blood is obtained from screened individuals and the globulins are
extracted from this blood, put into vials which are labelled as IM or
IV. This is known as normal homologous immunization. This started
off to prevent certain diseases after contact;

Hepatitis A - Vietnam war marine seals were young, healthy


individuals the environment was hyper-endemic to
Hepatitis A and many were bed-ridden for over a year.
Physician started giving normal pooled immunoglobulin
shots on a monthly basis
Measles
Rubella the majority of the Maltese were practicing
Catholic and thus shunned abortion; pregnant women
exposed to Rubella virus without having underlying
immunity put the foetus during the first trimester at a great
risk
Varicella chicken pox must be prevented because in adult
persons is a very severe disease when compared to a child,
passive immunization is offered and works perfectly, apart
from the existence of an antiviral agent

Other indications include:

Congenital agammaglobulinaemia
ITP
Kawasaki syndrome

Bone marrow transplantation grossly immunosuppressed


patients to prevent prophylaxis
Recurrent bacterial infections in children with HIV treated
with a range of retroviral agents
Guillain-Barre syndrome ranging from complete flaccid
paralysis up to complete recovery, from death to living on a
wheelchair the prognosis is unpredictable
Staphylococcal toxic shock syndrome
Streptococcal toxic shock syndrome possibly fatal
PANDAS a complication that is precipitated by
Streptococcus pyogenes, severe OCD