ALBERTO I GABRIEL, MD, DTM&H, MPA,
DPBMM, FPSMID, FPSVI, FPAMS, CFA
Department of Medicine-College of Medicine
Pamantasan Ng Lungsod Ng Maynila
GENERAL PRINCIPLES OF VACCINATION
DEFINITIONS:
VACCINATION - denotes the administration of the
vaccines or toxoid
IMMUNIZATION - descibe the process of inducing or
providing immunity by any means, whether active or passive
ACTIVE IMMUNIZATION - refers to induction of the
immune defenses by the administration of antigens in
appropriate forms
PASSIVE IMMUNIZATION - the provision of
temporary protection by the administration of exogenously
produced immune substances
GENERAL PRINCIPLES OF VACCINATION
Active Immunization comes in two forms:
1) the use of live, generally attenuated infectious agents
2) the use of inactivated agents of their products obtained by
genetic recombination
Passive Immunization comes in three types:
1) standard human immune globulin for general use (gammaglobulin)
2) special serum immune globulins with a known content of
antibody for specific agents (HBV or Varicella Zoster Imune Globulin)
3) animal sera and antitoxins
ROUTINE ADULT IMMUNIZATION FOR FILIPINOS
VACCINE NAME INDIVIDUALS SCHEDULES CONTRAINDICATION
Tetanus-diptheria Recommended for 3 DOSES
0, 1, 6-12 Mos
Severe allergic reaction
PREGNANT WOMAN to vaccine component
Toxoid HEALTH CARE WORKERS BOOSTER EVERY 19 YRS
Hepatitis B Recommended for IMMIGRANT, HEMODIALYSIS,
HOMOSEXUALS, IV DRUG USER, HOUSEHOLD
3 DOSES
O, 1, 6 MONTHS
Severe allergic reaction
Inactivated Vaccine CONTACT, RECIPIENT OF BLOOD PRODUCT, 4 DOSES
HEALTHCARE WORKER 0, 1, 2, 12 MONTHS
BOOSTER IS NOT ROUTINELY
RECOMENDED
Varicella Recommended for <13 years – 1 dose Severe allergic rxn
Persons> 13 yrs of age without history of >13 years – 2 dose Pregnancy
Live attenuated Vaccine varicella, HEALTH CARE WORKERS, TEACHERS 0, 1 month Immunosuppression
OF YOUNG CHILDREN, NON-PREGNANT WOMEN, Recently received blood
INTERNATIONAL TRAVELLER, MILITARY products, Untreated active
TB, Severe Acute Illness
MMR Recommended for all adults particularly 2 doses Severe allergic reaction
All susceptible adoslescent s and adults 0, 1 month Severe Acute Illness
Live attenuated vaccine Non-pregnant women of child-bearing age Pregnancy, Received BT
Immunosuppression
Thrombocytopenia/ITP
Pneumococcal Vaccine Persons >60 yrs of age Single dose SAME AS ABOVE
Inactivated vaccine <60 yrs of age with Chronic Illness ( Cardio
Pulmo, Diabetes, Alcoholism, Cirrhosis ) Revaccination may be
Immunocompromised Conditions given after 5 years
Influenza Vaccine Persons at increased risk for complication: Given once a year Serious allergic reaction
- Pesons >50 yrs of age preferably from Severe acute illness
Inactivated vaccine February to June
- Chronic illness ( Cardio-pulmo, Diabetes, Guillain-Barre
Chronic Metabolic, Renal Dysfunction, Syndrome
- Immunosuppressed Patients
- Healthcare Workers
ADDITIONAL VACCINES FOR HCW
VACCINE NAME INDIVIDUALS SCHEDULES CONTRAINDICATIO
and
PRECAUTION
TYPHOID ORAL – for Mod & Seevere Acute
Primary & booster Illness
A) Oral enteric coated cap
1 cap on Day 0, 2, Vomiting or diarrhes
live attenuated Ty21a
1. FOOD HANDLERS 4, before meals After alcohol intake
B) IM VI Capsular
2. MICROBIOLOGY LAB TECHNICIANS Antibiotic intake
Polysaccharide Ty2 3. PERSONS WITH CONTACT WITH TYPHOID IM – for primary Immunocompromisd
CARRIERS OR PATIENTS & booster 0.5 ml
IM on deltoid
BOOSTER – every
2-3 years
RABIES HCW THAT TREAT DOGBITE VICTIMS POST-EXPOSURE Intake of
RABIES RESEARCH DIAGNOSTIC LAB WORKERS For IM Schedule Corticosteroids,
PVRV – Purified Verocell VETERINARY & VET STUDENTS D0, 3, 7, 14, 28 AntiMalarials, Anti
Rabies Vaccine FIELD WORKERS AND DOG HANDLERS PRE-EXPOSURE Cancer Drugs
PCECV – Purified Chick D0, 7, 21
Embryo Cell Vaccine
For ID Schedule
D0, 3, 7, 28
GENERAL PRINCIPLES OF VACCINATION
A. IMMUNITY
Ability of the body to tolerate the presence of material
indigenous to the body (self) and to eliminate foreign
material (non-self). This ability provides protection from
infectious diseases. Usually indicated by the presence of
antibody. Very specific to a single antigen.
ANTIGEN - a live or inactivated substance (e.g. protein, poly-
saccharide) capable of producing an immune response
ANTIBODY – protein molecules (immunoglobulins) produced by B
lymphocytes to help eliminate an antigen
TWO BASIC MECHANISMS FOR
ACQUIRING IMMUNITY
1. Active Immunity
a) Protection produced by the person’s own immune system
b) usually permanent also produced by vaccination
2. Passive Immunity
a) Protection transferred from another person or animal as
antibody
b) transplacental most important source in infancy
c) usually temporary
GENERAL PRINCIPLES OF VACCINATION
CLASSIFICATION OF VACCINES
1. Live attenuated vaccines
attenuated (weakened) form of the “wild” virus or bacteria
Must replicate to be effective
Immune response similar to natural infection
Usually effective with one dose
Severe reactions possible
Interference from circulating antibody
unstable
VIRUSES: MMR, Varicella, Polio, Yellow fever, Influenza nasal spray
BACTERIA: BCG, Oral Typhoid
GENERAL PRINCIPLES OF VACCINATION
1. Inactivated Vaccines
cannot replicate because not live
minimal interference from circulating antibody
generally NOT as effective as live vaccines
generally requires 3-5 doses
immune response mostly humoral
antibody titer falls over time
VIRUSES: Influenza, Poliomyelitis, Rabies, Hepatitis A
BACTERIA: Pertussis, Typhoid, Cholera
THE IMMUNE RESPONSE
Primary Response
detection of humoral and cell-mediated immunity
measurable circulating antibodies appears beyond 7-10 days
early appearance of IgM exhibit low affinity for the antigen
late appearance of IgG shows high affinity for the antigen
some would not response due to lack of histocompatibility
complex determinants
Secondary Response
heightened humoral or cell-mediated responses by second
exposure to the same antigen
responses usually with 4-5days with increased titers IgG
GENERAL PRINCIPLES OF VACCINATION
C. Timing and spacing of vaccines
1. Interval between receipt of antibody containing blood products
and measles vaccine
• inactivated antigens are NOT substantially affected by circulating
antibody, so that they can be administered before, after, or at the
same time as the antibody.
• All live vaccines must replicate in order to cause an immune
response, so that antibody against live injected vaccine antigen may
interfere with replication.
• If the live vaccine is given first, it is necessary to wait for AT
LEAST 2 WEEKS before giving the antibody.
• If the interval between the vaccine and antibody is less than 2
weeks, the recipient should be tested for immunity or the vaccine
dose should be repeated.
• There is NO contraindication to the simultaneous administration
of any vaccines EXCEPT for cholera and yellow fever.
• Individual vaccines should NOT be mixed in the same syringe
unless they are licensed for mixing by the FDA
GENERAL PRINCIPLES OF VACCINATION
ANTIBODY AND LIVE VACCINES
PRODUCT GIVEN FIRST ACTION
VACCINE Wait 2 weeks before giving
the antibody
ANTIBODY (blood/blood Wait >3 months before
products, immune globulin) giving the vaccine
2. Spacing of vaccine combinations not given simultaneously
COMBINATION MINIMUM INTERVAL
Two live vaccines 4 weeks
injected
All other vaccines None
GENERAL PRINCIPLES OF VACCINATION
1. Spacing of live vaccines not given simultaneously
• If two live parenteral vaccine are given < 28 days apart, the
vaccine given second should be repeated.
• Exception is yellow fever vaccine given < 28 days after
measles vaccine
6. Interval between doses of the same vaccine
• Increasing the interval between doses of a multi-dose vaccine
does NOT diminish the effectiveness of the vaccine.
• Decreasing the interval between doses of the multi-dose
vaccine may interfere with antibody response and protection
GENERAL PRINCIPLES OF VACCINATION
5. Minimum Intervals and Ages
Vaccine doses should NOT be given at intervals less than the
minimum intervals or earlier than the minimum age.
6. Extended Intervals
It is NOT necessary to restart the series of any vaccine due to
extended intervals between doses
• Number of Doses
• Live attenuated vaccines generally produce lasting
immunity with a single dose.
• Inactivated vaccines require multiple doses and may
require periodic boosting to maintain immunity.
GENERAL PRINCIPLES OF VACCINATION
D. ADVERSE REACTIONS
LOCAL
• pain, swelling, redness at the site of injection
• common with inactivated vaccines
• usually mild and self-limited
SYSTEMIC
• fever, malaise, headache
• non-specific
• may be unrelated to vaccine
ALLERGIC
• due to vaccine or vaccine component
• rare
• risk minimized by screening
GENERAL PRINCIPLES OF VACCINATION
E. CONTRAINDICATIONS & PRECAUTIONS
CONTRAINDICATION - is a condition in a recipient which
greatly increases the chance of a serious adverse reaction
EXAMPLE: Administering FLU VACCINE to a person with a true
anaphylactic allergy to egg could cause serious illness or death
in the recipient.
PRECAUTION - is a condition in a recipient which may
increase the chance or severity of an adverse event, or
may compromise the ability of the vaccine to produce
immunity
EXAMPLE: Administering MEASLES VACCINE to a person with passive
immunity to measles from a blood transfusion
GENERAL PRINCIPLES OF VACCINATION
PERMANENT CONTRAINIDICATION TO VACCINATION
• severe allergy to a prior dose of vaccine or to a vaccine component
• encephalopathy following pertussis vaccine
CONDITION LIVE INACTIVATED
Allergy to vaccine component C C
Encephalopathy C
Pregnancy C V
Immunosuppression C V
Severe Illness P P
Recent blood product P V
C – contraindication P – precaution V – vaccinate if indicated
GENERAL PRINCIPLES OF VACCINATION
IMMUNOSUPPRESSION
• Live vaccine can be given after chemotherapy has been discontinued
for at least 3 months
• Persons receiving large doses of corticosteroids should NOT receive
live vaccines e.g. ( >20 mg of prednisone per day or >2 mg/kg)
• NOT contraindicated with steroids given via aerosols, topical,
alternate day, short causes
RECENT BLOOD PRODUCTS
• Varicella and MMR vaccines should be given 14 days prior to the
blood product, or delayed until the antibody has degraded
• If MMR is given sooner than the minimum interval (3-7 months
depending blood products) the recipient should be tested for
immunity or the dose repeated after the appropriate interval
GENERAL PRINCIPLES OF VACCINATION
F. INVALID CONTRAINDICATIONS TO VACCINATION
mild illness – low grade fever, URTI, Otitis media
disease exposure or convalescence
antibiotic therapy
pregnancy in the household
breastfeeding
allergies to products in the vaccine
premature birth
family history unrelated to immunosuppression
need for TB skin testing
need for multiple vaccines
mild diarrhea
GENERAL PRINCIPLES OF VACCINATION
SCREENING FOR CONTRAINDICATIONS AND
PRECAUTIONS TO VACCINATION
SCREENING QUESTIONS:
Allergies to food or medications? If yes, when?
How are you today?
Any problem after the last shot?
Any problem with your body resistance?
Any blood products ( fresh whole blood, platelet concentrate )
received in the last year?
Are you pregnant or trying to be pregnant?
