DISEASE PREVENTION

Prevention

Primary Prevention - preventing the occurrence

of disease and injury, for example by
immunizations.

Secondary Prevention - early detection and

intervention, by reversing, halting or retarding the
progression of a condition.

Tertiary Prevention - minimizing the the effects of

disease and disability by surveillance and
maintenance to prevent complications.

Principles of Immunity
Active Immunity
Protection produced by the person's own
immune system
Usually permanent

Passive Immunity
Protection transferred from another person or
animal
Temporary protection that wanes with time

Passive Immunity
Transfer of antibody produced by one
human or other animal to another
Temporary protection (weeks months)
Transplacental most important source in
infancy

Sources of Passive Immunity

Almost all blood or blood products
Homologous human hyperimmune globulin
(HepB, tetanus, varicella, rabies)
Heterologous hyperimmune serum (antitoxindiphtheria, botulism)

Passive Immunization
Polymeric vs Monomeric antibodies
IM preps ~ contain antibodies aggregates and
other serum components
If given IV they can activate complement system
anaphylaxis and cardiovascular collapse
IV preps ~ stabilizers added to give monomeric
IgG
Okay in blood stream

WHAT IS A VACCINE?
A suspension of live attenuated (replicating) or
killed (non-replicating) microorganisms or
subunit / fractions (non-replicating) thereof (i.e.
purified protein subunits, polysaccharides, or
split virions) that are administered (IM, SC, ID,
mucosal, or oral), for the prevention or
treatment of infectious diseases

Vaccination
Active immunity produced by vaccine
Immunity and immunologic memory
similar to natural infection but without risk
of disease

Principles of Vaccination
General Rule

The more similar a vaccine is to the

disease-causing form of the organism,
the better the immune response to the
vaccine.

Classification of Vaccines
Live attenuated
viral
bacterial

Inactivated

Inactivated Vaccines
Whole
viruses
bacteria
Fractional
protein-based
toxoid
subunit

polysaccharide-based
pure
conjugate

Types of Vaccines

Killed virus vaccines

Live-attenuated vaccines
Recombinant DNA vaccines
Genetic vaccines
Subunit vaccines
Polytope/multi-epitope vaccines
Synthetic peptide vaccines

Live Attenuated Vaccines

Attenuated (weakened) form of the "wild"
virus or bacterium
Must replicate to be effective
Immune response similar to natural
infection
Usually effective with one dose*
*except those administered orally

Live Attenuated Vaccines

Viral : measles, mumps,rubella, vaccinia,
varicella/zoster, yellow fever, rotavirus,
intranasal influenza, oral polio
Bacterial : BCG, oral typhoid

Inactivated Vaccines
Cannot replicate
Generally not as effective as live vaccines
Less interference from circulating antibody
than live vaccines
Generally require 3-5 doses
Immune response mostly humoral
Antibody titer may diminish with time

Inactivated Vaccines
Whole-cell vaccines
Viral : polio, hepatitis A, rabies, influenza
Bacterial : pertussis, typhoid, cholera,
plague

Fractional Vaccines
Subunit : hepatitis B, influenza, acellular pertussis,
human papillomavirus,

Toxoid : diphtheria, tetanus

Pure Polysaccharide Vaccines

Not consistently immunogenic in children
younger than 2 years of age
No booster response
Antibody with less functional activity
Immunogenicity improved by conjugation

Polysaccharide Vaccines
Polysaccharide vaccine,
A vaccine composed of purified bacterial capsule
carbohydrate fragments;
in children under 2 years of age the T cell memory
response to unconjugated polysaccharide vaccines, as
compared with those conjugated to protein antigens,
may be reduced or absent
Conjugated vaccine,
A vaccine in which a polysaccharide antigen is
chemically joined with a protein molecule to improve the
immunogenicity of the polysaccharide component,

Polysaccharide Vaccines
Pure polysaccharide
pneumococcal
meningococcal
Salmonella Typhi (Vi)

Conjugate polysaccharide
Haemophilus influenzae type b
pneumococcal
meningococcal

Vaccine components
Attenuated
pathogen

Killed
pathogen

Microbial
extract /
product

Bacterial
Diseases

Typhoid (PO)
BCG (M. bovis)
(Salmonella)
Anthrax (vet.used)

Typhoid fever
Cholera
Pertussis
Plague (Y. pestis)
Anthrax

B. pertussis Ag
*Hib
Diphtheria (Tox.)
*Meningococcal
*Pneumococcal
Tetanus (Tox.)

Viral
Diseases

Measles
Mumps
Rubella
Chickenpox
Polio (Sabin - PO)
Yellow fever

Polio (Salk)
Hep. A
Influenza
Rabies
Japanese encephalitis

Hep. B