Chapter 16

Immunizations and Immunity

Amazing Fact
An estimated 2.1 million people around the world
died in 2002 of diseases preventable by widely
used vaccines.1 With an investment of 3 billion
USD a year, every child in the developing world
could receive complete immunization
coverage. 2
World Health Organization. Immunization Against Diseases of Public Health
Importance. March 2005.)
2
UNICEF. Immunize Every Child: GAVI Strategy for Immunization Services. February
2000)
1

History
Edward Jenner
Cowpox and smallpox experiments

Louis Pasteur
Cholera work
Originator of term vaccine

Mechanisms of Immunity
Innate immune system
Present from birth
Does not differentiate challenge

Adaptive immune system

Synonyms: acquired or specific immunity
Responds to specific challenges

Innate Immunity
Nonspecific response
Anatomic barriers
Skin and mucosal membranes

Physiologic barriers
Acidity and chemical mediators

Phagocytosis
Neutrophils and macrophages

Inflammation
Antibacterial and stimulatory effects

Natural killer cells

Tumor cytotoxicity

Figure 1: Phagocytosis

Adaptive Immunity
Responds to specific antigenic challenge
Cells involved
T lymphocytes (T cells)
B lymphocytes (B cells)

Types of adaptive responses

Cell-mediated (cellular) immunity
Humoral immunity

Cell-mediated Immunity
Involves T lymphocytes
Derived from cells in the bone marrow
Mature and differentiate in the thymus
Help eliminate intracellular organisms
Present protein antigens to B cells
Secrete cytokines
Develop specific functions after antigenic
exposure

Figure 2: Functional lymphoid populations following antigenic stimulation

Memory cell
T lymphocyte

Antigen

Cytotoxic cell

Helper cell

Suppressor cell

Lymphocytic
stem cell
Antibody
producing cell

B lymphocyte

Memory cell
Antigen

Humoral Immunity
Involves B lymphocytes
Primary defense against extracellular
organisms
Recognize antigenic determinants (epitopes)
leading to antibody production by plasma cells
Antibodies produced
IgM, IgG, IgA, IgD, IgE

Humoral Immunity
Chief functions of antibodies
Neutralize bacterial toxins
Neutralize viruses
Promote phagocytosis
Activate inflammatory response

Antibodies at work
Primary and secondary responses

Figure 3: Primary and secondary response curves

1st exposure to
antigen
Antibody
Titer

2nd exposure to
antigen

Time

Active and Passive Immunity

Active immunity
Immunocompetent individual produces
immune products after exposure to foreign
organism
Immune products: antibodies, memory cells

May be naturally developed (natural infection)

or artificially acquired (vaccine)

Active and Passive Immunity

Passive immunity
Involves transfer of preformed antibodies
May involve natural acquisition (maternalfetal transfer) or may be acquired (injection of
immunoglobulin)

Active and Passive Immunity

Differences in protection
Active immunity
Long-term protection due to production of memory
cells

Passive immunity
Short-term protection due to lack of memory cell
production

Vaccines
Mimic natural infection
Stimulate the immune system
Key requirements for success
Immunologic memory
Specificity

Vaccines
Goal
Stimulate memory T and B cells
To induce specific immunity
Eliminate organisms
Neutralize bacterial toxins

Vaccines
Live, attenuated vaccine
Contains weakened (attenuated) form of live
organisms
Advantage:
produces strong cellular and humoral responses

Disadvantages:
chance organism may become virulent again
requires refrigeration

Vaccines
Inactivated vaccines
Killed organisms
Advantages:
Safer and more stable than live vaccines
Usually do not require refrigeration
Some may be freeze-dried

Disadvantage:
May stimulate weaker response than live vaccines

Vaccines
Toxoid vaccines
Treated microbial toxins
Advantage:
Stimulate strong antibody responses that eliminate
harmful toxins

Vaccines
Subunit vaccines
Composed of selected microbial epitopes
Often administered with adjuvants such as
aluminum salts
Advantages:
Greater specificity
Adverse reactions less likely

Vaccines
Conjugate vaccines
Couple polysaccharide antigens to protein
carrier
Advantage:
Better recognition by the immune system to
stimulate strong immune response especially in
infants and children

Table 3: Types of Vaccines

Vaccine Type
Live, attenuated vaccine

Examples of Vaccines
Measles, mumps, rubella, polio (Sabin)
vaccine, varicella

Inactivated (killed) vaccine

Cholera, rabies, influenza, hepatitis A,

polio (Salk) vaccine

Toxoid vaccine

Tetanus, diphtheria

Subunit vaccine

Hepatitis B, pertussis, pneumococcus

(Streptococcus pneumoniae)

Conjugate vaccine

Haemophilus influenzae type B,

pneumococcus (Streptococcus
pneumoniae)

Future Vaccines
DNA vaccines
Use organisms genes to invoke antigen
expression in host

Recombinant vector vaccines

Use attenuated organism to introduce
organisms DNA into host

Hurdles to vaccine development

Mutation of organisms especially viruses
Genetic complexity of certain organisms

Immunization of Selected Groups

Childhood immunizations
Recommendations approved yearly by
Centers for Disease Control and Prevention (CDC)
American Academy of Pediatrics
American Academy of Family Physicians

Immunization Schedule

Immunization of Selected Groups

Adult immunizations
Influenza
Pneumococcal

Travelers
Depends on site of travel

Workers exposed to biological agents in

work environment
Anthrax
Smallpox

Effectiveness of Vaccines
Generally effective in most populations
Poor-responders
Small group of individuals
Herd (community) immunity
Immunity developed by group of vaccinated
individuals
Impediments to achieving herd immunity
Concerns regarding adverse side effects
Costs of vaccines

Barriers to Widespread Coverage

Developed world
Access and cost issues among certain
populations
Language barriers
Failure to obtain booster shots or complete
series
Fears concerning vaccination
Underestimation of disease risk

Barriers to Widespread Coverage

Developing Countries
Logistical issues
Storage requirements
Poor infrastructure
Lack of roads

Personnel issues
Shortage of health care workers