Immunization

Immunization, or immunization, is the process by which an individual's

immune system becomes fortified against an agent (known as the
immunogen).
When this system is exposed to molecules that are foreign to the body (nonself), it will orchestrate an immune response, but it can also develop the
ability to quickly respond to a subsequent encounter (through immunological
memory). This is a function of the adaptive immune system. Therefore, by
exposing an animal to an immunogen in a controlled way, its body can learn
to protect itself: this is called active immunization.
The most important elements of the immune system that are improved by
immunization are the B cells (and the antibodies they produce) and T cells.
Memory B cell and memory T cells are responsible for a swift response to a
second encounter with a foreign molecule. Passive immunization is when
these elements are introduced directly into the body, instead of when the
body itself has to make these elements.
Immunization be done through various techniques, most commonly
vaccination. Vaccines against microorganisms that cause diseases can
prepare the body's immune system, thus helping to fight or prevent an
infection. The fact that mutations can cause cancercells to produce proteins
or other molecules that are unknown to the body forms the theoretical basis
for therapeutic cancer vaccines. Other molecules can be used for
immunization as well, for example in experimental vaccines against nicotine
(NicVAX) or the hormone ghrelin (in experiments to create an obesity
vaccine).
Passive and active immunization
Immunization can be achieved in an active or passive fashion: vaccination is
an active form of immunization.
Active immunization
ACTIVE
Active immunization entails the introduction of a foreign molecule into the
body, which causes the body itself to generate immunity against the target.
This immunity comes from the T cells and the B cells with their antibodies.

Active immunization can occur naturally when a person comes in contact

with, for example, a microbe. If the person has not yet come into contact
with the microbe and has no pre-made antibodies for defense (like in passive
immunization), the person becomes immunized. The immune system will
eventually create antibodies and other defenses against the microbe. The
next time, the immune response against this microbe can be very efficient;
this is the case in many of the childhood infections that a person only
contracts once, but then is immune.
Artificial active immunization is where the microbe, or parts of it, are injected
into the person before they are able to take it in naturally. If whole microbes
are used, they are pre-treated, Attenuated vaccine.
Passive immunization
PASSIVE
Passive immunization is where pre-synthesized elements of the immune
system are transferred to a person so that the body does not need to
produce these elements itself. Currently, antibodies can be used for passive
immunization. This method of immunization begins to work very quickly, but
it is short lasting, because the antibodies are naturally broken down, and if
there are no B cells to produce more antibodies, they will disappear.
Passive immunization occurs physiologically, when antibodies are transferred
from mother to fetus during pregnancy, to protect the fetus before and
shortly after birth.
Artificial passive immunization is normally administered by injections and is
used if there has been a recent outbreak of a particular disease or as an
emergency treatment for toxicity (for example, for tetanus). The antibodies
can be produced in animals ("serum therapy") although there is a high
chance of anaphylactic shock because of immunity against animal serum
itself. Thus, humanized antibodies produced in vitro by cell culture are used
instead if available.

Routine immunization schedule

BCG - At birth or as soon as possible after birth

OPV - At birth and at 6, 10 and 14 weeks of age

DPT - At 6, 10 and 14 weeks of age

Hepatitis B - At birth, 6 and 14 weeks

Measles - At 9 months of age

Yellow Fever - At 9 months of age

Vitamin A - At 9 months and 15 months of age

United States Vaccine Schedule: 2010[29][30][31]

Vaccine

Hepatitis B

1
Bir
mo
th
nth

He
pB

2
m
o.

4
m
o.

6
m
o.

HepB

1
2
m
o.

1
5
m
o.

1
8
m
o.

1
92
3
m
o.

4-6
yrs.

11

1927
12 26
ye
yr yrs.
ars
s.

DTaP

DT Td (every
aP 10 years)

HepB

Rotavirus

RV

RV

RV

Diphtheria,
Pertussis,
Tetanus

DT DT DT
aP aP aP

Haemophilusi
nfluenzae
type b

Hi
b

Hi
b

Hi
b

Hib

Pneumococca
l

PC
V

PC
V

PC
V

PCV

Polio vaccine
(inactivated)

IPV IPV

DTaP

PPS
V4

IPV

IPV

Measles,
Mumps,
Rubella

MMR

MMR

1 or 2
doses5

Varicella
(chickenpox)

Varic
ella

Varic
ella

2 doses5

Hepatitis A
Meningococcu

HepA (2
doses)
MC

Human
papillomaviru
s vaccine

3
do
se
s

Influenza

3
dos
es5,6

Influenza (yearly)

Yea
rly

50

The Advisory Committee on Immunization Practices of the Department of

Health and Human Services through the U.S. Centers for Disease Control and
Prevention (CDC) made the following recommendations about annual
vaccines needed by all adults:
Vaccines needed for all adults
o

Varicella (chickenpox) vaccine

Hepatitis B vaccines (adults at risk)

Measles-Mumps-Rubella (MMR) vaccine

Tetanus-Diphtheria-pertussis vaccine

Vaccines needed for those aged 50 years and older: influenza vaccine
(for the flu)
Vaccines needed for those aged 65 years and older: Pneumococcal
vaccine
Vaccines needed for all health-care workers: influenza vaccine (for the
flu)
Annual updates are made each year by the CDC.
SOME ADULT IMMUNIZABLE DISEASES
Tetanus-Diphtheria; Tetanus-Diphtheria-Pertussis (Td/Tdap)
Tetanus is disease caused by bacteria. These bacteria live in all outdoor
environments, most commonly in soil. Any open injury to the skin (for

example, from a dirty cut, puncture wound, or animal bite) can produce a
port of entry into the body. Once inside, the bacteria may germinate and
produce a poisonous substance that interferes with nerve conduction. This
can result in uncontrolled muscle spasms and may be fatal. Adults younger
than 65 years may receive the tetanus, reduced diphtheria, and pertussis
vaccine (Tdap) as a one-time alternative to tetanus and diphtheria (Td) if the
pertussis component is indicated. The combination vaccine (Tdap) is
composed of vaccines against diphtheria, tetanus (lockjaw), and pertussis,
another bacterial disease (whooping cough). This vaccine is given routinely
to children and is recommended for adults under 65 years of age who have
never received a dose of Tdap.
The incubation period (time from exposure to the bacteria to
symptoms) is 48 hours to three or more weeks, with a median of seven
days. With such a long incubation period, it is not surprising that the victim
may not even remember the wound. The most common symptom is
stiffness of the jaw (that's why tetanus is also called lockjaw). Neck
stiffness and difficulty swallowing are also common. Complications include
airway obstruction, respiratory arrest, heart failure, urinary retention, and
constipation due to spasms of the muscles that control the release of urine
and bowel.
Diphtheria is an infection caused by bacteria. The bacteria usually attack
the respiratory tract, especially the throat. Toxins produced by the bacteria
cause damage to nerve fibers and to the heart that can result in an irregular
or very slow heartbeat or heart failure.
Who gets the vaccine: Children are given the standard vaccine for
tetanus and diphtheria plus protection against pertussis (whooping cough).
For adults, a booster shot of just tetanus and diphtheria (Td) is needed
every 10 years after the primary series in childhood. Because tetanus can
cause death, a shot should be given within the first three days of a
suspicious injury whenever you cannot remember when you had your last
tetanus shot or if more than five years has passed since your last booster
shot. The vaccine is for all adolescents and adults.

When given: A booster dose is needed every 10 years after the

primary doses given during childhood. For people with suspicious wounds,
boosters are given if the last shot was more than five years before the
injury. Certain clean, minor wounds may not require a booster if the last
booster was within 10 years.

Side effects: Pain, redness, swelling may occur at the site of the shot.
Fever, drowsiness, anxiousness, and loss of appetite occur frequently.

The vaccine should not be given to people who have had major
reactions to the vaccine or any of its components in the past. Pregnant or
breastfeeding women should receive the vaccine.
Pneumococcal Vaccine
Many bacteria can cause respiratory tract infections such as pneumonia.
Pneumococcal organisms are the most common bacteria causing pneumonia.
Pneumonia is especially dangerous for people with other serious medical
conditions. Each year, about 1 million people are hospitalized for pneumonia.
The pneumonia vaccine immunizes against the 23 most common strains of
the pneumococcus bacteria. It does not contain any live bacteria. The
healthier the immune system of the vaccine recipient, the better their
immunity after the vaccine. Healthy young people have an excellent
response compared to those who are older or those with a weakened
immune system (such as people with diabetes, alcoholism, or cancer).
Who gets the vaccine: The immunization is recommended for adults
65 years and older; for anyone aged 2-64 years who has a chronic illness
or other risk factors such as diabetes, lung, heart, or liver disease; for
Alaska Natives, certain American Indian populations; for people who had
their spleen removed; for people with sickle cell disease; for those with
weakened immune systems (HIV, cancer, chronic kidney failure, organ
transplantation); and for people receiving chemotherapy for cancer.

When given: The shot is routinely given as a onetime dose. It gives

lifelong immunity. It can be given to someone who doesn't know if he or
she has had the vaccine before. If the first dose was given before the age
of 65 years and it has been more than five years since, another shot can
be given. For those at highest risk, a onetime revaccination after five years
is recommended.

Hepatitis A and B
Hepatitis is inflammation of the liver. It may be caused by medications,
toxins, alcohol, or viruses. The inflammation results in injury to liver cells.

The injured liver may be unable to perform functions such as toxin removal,
processing of nutrients, removal of old red blood cells, or production of bile
to aid in fat digestion.
Viral hepatitis is caused by the hepatitis A virus (HAV), hepatitis B virus
(HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), hepatitis E virus
(HEV), and hepatitis G virus (HGV). However, the only vaccines available are
for hepatitis A and B.
Some people with viral hepatitis may have no symptoms. Others have a
severe form that leads to death in a few days. Many are somewhere in
between. Initially, fatigue, muscle and joint aches, upper respiratory tract
symptoms (nasal discharge or sore throat), and loss of appetite occur.
Nausea and vomiting are frequent. A slight fever generally is present. Pain is
usually present in the upper right part of the abdomen. Five to 10 days later,
jaundice (yellowing of the skin and whites of the eyes) may be present.
Hepatitis can last just a short time, with symptoms going away after two to
three weeks, or it can become a chronic, lifelong disease.
Hepatitis A: Also known as infectious hepatitis, hepatitis A does not
become a long-term illness. Transmission occurs via a fecal-oral route due
to such things as contaminated food or water or improper hand washing.
The virus is in the stool of infected persons and if swallowed by another
person may cause disease. This is more likely in crowded or unsanitary
conditions. Close contact with infected people is also a mode of
transmission. Death seldom occurs from hepatitis A. Especially in children,
hepatitis A tends to show no symptoms. Symptoms are often more severe
in adults.
Side effects: The vaccine is very safe and effective, but mild allergies may
occur. Anyone who has had a previous reaction should avoid the vaccine.
Safety for pregnant women has not been determined. Breastfeeding women
may take the vaccine.

Hepatitis B and D: Also known as serum hepatitis, this form can be

found in blood, saliva, semen, and vaginal secretions. The virus is
transmitted via blood transfusions, sexual contact, or contaminated
needles. It is common in homosexual men and IV drug users. Infected
mothers can also pass it on to their babies at the time of delivery. Between
1-10% of people with this form of hepatitis will develop chronic hepatitis.
These people have a 25-40% greater risk of developing cirrhosis and liver
cancer. Hepatitis D can only occur when there is also infection with
Hepatitis B. Hepatitis D is uncommon in the United States, except in those
requiring multiple transfusions or in IV drug users.

o Who gets the vaccine: Primary vaccination now takes place during
infancy. If not immunized during childhood, the following at-risk people
should receive the vaccine: all adolescents; and high-risk adults (those
who have household contact with infected people; sex partners of
infected people; heterosexuals with multiple sex partners in less than six
months; IV drug users; people with recently diagnosed sexually
transmitted diseases; people on hemodialysis for kidney failure; healthcare workers exposed to blood products; inmates of correctional
facilities).

o When given: Three doses are needed. After the first dose, four weeks are
needed between doses #1 and #2 and eight weeks needed between
doses #2 and #3.

o Side effects: Soreness at the site of injection is common. There have

been reports of nerve inflammation.

Measles/Mumps/Rubella (MMR)
Measles: In the past, measles was a common childhood disease. It
was a major worldwide cause of illness and death. Measles is a viral
infection transmitted through the air. Symptoms similar to upper
respiratory infections (nasal congestion, sneezing, sore throat) and high
fevers lasting five to seven days mark the initial stage. Tiny white spots
appear on the inside of the cheeks two days before the appearance of a
rash. The rash first appears on the face and behind the ears. It then
spreads to the trunk, followed by the extremities, including the palms and
soles. It fades in the order of appearance. Complications include
inflammation of the brain (encephalitis), seizures, and death.
o

By 1983, the development and implementation of the measles

vaccine decreased the annual number of reported cases to 3,600.

Mumps: Mumps is caused by the mumps virus. Usual symptoms

include fever, weakness, and body aches. The most distinctive feature of
mumps is swelling of one or both parotid glands (salivary glands). The
illness generally runs its course without complications, but meningitis
(inflammation of the lining of the brain) may appear in 15% of cases.

Although swelling of the testicles may occur in 20-30% of males, sterility is

rare. One person in 20,000 cases will suffer deafness in one ear.
o

The incubation period is generally 14-18 days. Most cases occur

in the spring. The virus is spread through infected salivary or urinary
secretions.

The introduction of the vaccine in the late 1960s dramatically

decreased the occurrence of mumps by 98% over the next 20 years.

Rubella: Rubella is a viral disease caused by inhalation of viruscontaining droplets in the air. It is characterized by rash, fever, and painful
swollen lymph nodes. There may be a variety of other symptoms. The
most devastating complication is infection of the fetus during the first
trimester of pregnancy. This usually leads to development of congenital
rubella. Exposed babies can later develop a variety of disorders such as
cataracts at a young age, glaucoma, hearing loss, retardation, and heart
defects. Pregnant women may also have an increased rate of miscarriage.
In 1967, the licensing of the vaccine dramatically decreased the number of
reported cases.

Who gets the vaccine: The measles, mumps, and rubella

vaccines contain live viruses. They are usually combined into a single
vaccine (MMR) given as a first dose to children aged 12-15 months; the
second dose is given prior to kindergarten (or the first opportunity
thereafter). In adults, the MMR vaccine is recommended for these
groups:

Adults born in 1957 or later and who are older than 18

years should receive one dose.
High-risk groups, such as health-care workers, college
entrants, and international travelers, should receive two doses total.

Adults born before 1957 are typically considered immune

to mumps and measles if proof is provided.

Females of childbearing age (regardless of age and year

of birth) without evidence of immunity should be immunized. Women
should not receive an MMR vaccination while pregnant or if they may
become pregnant within four weeks of receiving the vaccine.

Side effects: Rash, itching, fever, and joint pains are

common. Anyone who has had a previous reaction to the vaccine
should avoid it. Women anticipating pregnancy within four weeks of
vaccination and people with weakened immune systems should also
avoid it. Breastfeeding is not a contraindication. Allow four to six
weeks between doses.
Varicella (Chickenpox)
Varicella-zoster virus (VZV) is a member of the herpesvirus family. It can
cause either chickenpox (varicella) or herpes zoster (shingles). Chickenpox is
a common childhood disease that tends to be mild. However, it can be
serious when occurring during adulthood. The virus is spread from person to
person through the air or by contact with fluid from chickenpox blisters. The
virus causes a rash, itching, fever, and tiredness. A person who previously
had chickenpox can develop shingles years later. This happens because the
VZV infects part of certain nerves. The virus "sleeps" there and may become
reactivated in the future.
Who gets the vaccine: susceptible adults and adolescents; susceptible
health-care workers; susceptible family contacts of people with weakened
immune systems; those at high risk for exposure such as day-care
employees, employees in institutional settings such as prisons, college
students, and military personnel; and international travelers.

Females of childbearing age (regardless of age and year of birth)

without evidence of immunity should be immunized. Women should not
receive varicella while pregnant or may if they may become pregnant
within four weeks of receiving the vaccine.

When given: For those younger than 13 years of age, one dose is
needed. If older than 13, two doses are given four to eight weeks apart.

Side effects: pain, swelling, redness at site of injection; a small rash

may develop that can spread chickenpox to others; and chickenpox may
develop years later, although less severe than the naturally occurring type.
Avoid this vaccine if you have had a previous reaction to gelatin or the
antibioticneomycin or had a severe reaction, if you are pregnant or
anticipate being pregnant in one month, if you have untreated, active
tuberculosis, or if you have a weakened immune system (including HIV).
Breastfeeding women may take the vaccine. Aspirin-containing products
should be avoided for six weeks after the vaccine to avoid the rare risk of
Reye syndrome (rapid liver failure, brain function abnormalities; 30% death
rate
Meningococcal Infections
Meningococcal infections are most common in close living conditions (such
as college dormitories, military barracks, or child-care centers). The infection
may invade the bloodstream or the brain (meningitis). Symptoms come on
rapidly and can sometimes be quite severe (leading to shock, coma, or
death). Meningitis caused by meningococcal bacteria is difficult to distinguish
from that of other bacteria that cause meningitis, making the disease more
difficult to recognize and treat. Routine immunization in children is not
recommended because the infection is rare, response to the vaccine is poor
in young children, the immunity to meningococcal does not last in young
children, and early vaccination may later impair response to the vaccine.
Types of meningococcal vaccine:

Meningococcal polysaccharide vaccine (MPSV4): used for

children 2-10 years of age

Meningococcal conjugate vaccine (MCV4): used for adolescents

and adults (although MPSV4 is an acceptable alternative)

Who gets the vaccine:

Children 2 years of age or older in high-risk groups (those who

have had their spleen removed or those with suppressed immune
system, such as terminal complement deficiencies)

Adolescents 11-12 years of age and unvaccinated adolescents

entering high school

College students, military recruits, laboratory workers exposed

to meningococcal vaccine components, and those traveling to
hyperendemic or epidemic areas

Side effects: Pain, swelling and redness at site of injection may occur
one to two days following immunization.
o