PUBLIC HEALTH

Immunity
and
Vaccination

Presented by

Dr. Azzam El Sourani

 Definitions
 Immune system:
Cells, tissues, and molecules that mediate
resistance to infections.
 Immunology:
Study of structure and function of the immune
system.
 Immunity:
Resistance of a host to pathogens and their toxic
effects.
 Immune response:
Collective and coordinated response to the
introduction of foreign substances in an individual
mediated by the cells and molecules of the
immune system.
 Immune System
1. Organs

2. Cells

3. Molecules
 Immune System
(1) organs
 Tonsils and adenoids
 Thymus
 Lymph nodes
 Spleen
 Payer’s patches
 Appendix
 Lymphatic vessels
 Bone marrow
 Immune system
(2) cells
Lymphocytes
 T-lymphocytes
 B-Lymphocytes, plasma cells
 natural killer lymphocytes
Monocytes, Macrophage
Granulocytes
 neutrophils
 eosinophils
 basophils
 Immune system
(3) molecules
 Antibodies
 Complement
 Cytokines
 Interleukines
 Interferons
 Role of the Immune System
 Defense against microbes.

 Defense against the growth of tumor

cells.
 Kills the growth of tumor cells

 Homeostasis.
 Destruction of abnormal or dead cells
(e.g. dead red or white blood cells, antigen-
antibody complex)
Immunity
Immunity is a state of having
sufficient biological defenses
to
avoid infection, disease,
or
other unwanted biological invasion,
and
is related to the functions of the
immune system
 Concepts of Immunity

 Traditional concept
Immunity refers to protection against
infectious diseases.

 Modern concept
Immunity is a function of which an
individual recognizes and excludes
antigenic foreign substances. It is
normally beneficial, but sometimes, it
is injurious.
 Types of Immunity
 Innate Immunity
(Native immunity/ non-specific
immunity /congenital immunity)

 Adaptive Immunity
(Acquired immunity/specific immunity)
 Immunity Mechanism

Innate, General Specific, Acquired

Passive acquired immunity Active acquired immunity

Sero-
Maternal Natural Artificial
Prophylaxis
Immunity Infection Vaccination
Ig
 Innate Immunity
(Natural Immunity/ Non-Specific
Immunity)
 Exists at birth.

 Be the first line of defense against infection.

 Protection against infection that relies on

mechanisms that exist before infection.

 Capable of a rapid response to microbes,

and react in essentially the same way to
repeated infections.
 Innate Immunity
Characteristics
 Exists naturally.
 Non–specific.
 No immune memory (innate immunity can’t
be enhanced by the second stimulation of
the same antigen).
 Immune memory: Exposure of the immune
system to a foreign antigen enhances its
ability to respond again to that antigen.
 Hereditable.
 No racial difference.
 Innate Immunity
Composition
(1) Barriers:
 Physical barrier: skin and mucosa.

 Chemical barrier: antimicrobial substances

in secretion of skin & mucosa.

 Biotic barrier: normal flora existing on the

surface of skin & mucosa.

 Anatomic barrier:
blood- brain barrier
blood- placental barrier
blood- thymus barrier
 Innate Immunity
Composition
 Health & intact skin & mucous membrane prevent
invasion of microorganism.

 Sticky mucous that cover the mucous membrane trap

any foreign body.

 Respiratory system: cilia, coughing & sneezing reflex

sweep out the foreign material & microorganism.

 Eye: blinking reflex & tears can prevent infection.

 Alimentary tract: saliva, mucous secretion (lysozyme),

gastric acidity & diarrhea prevent infection.

 Genitourinary: acidic PH of the vagina inhibits growth

of organism.
 Innate Immunity
Composition
(2) Humoral defense factors:
 Lysozyme which lead to lysis of bacteria.
 Interferons(IFN) which is non specific defense mechanism
against viral infections.
 Complement which is considered as a natural innate
immunity.
 Plasma dilute toxins.
 C-reactive protein.

(3) Cells participating in innate immunity:

 Phagocyte: endocytosis & phagocytosis, mononuclear
phagocytes, Monocytes, Macrophages, Neutrophils.
 Nature killer cells (NK).
 Dentritic cells (DC).

(4) Inflammatory reaction occur during inflammation as

vasodilatation & cellular infiltration.
 Macrophage

Natural Killer Neutrophil

 Adaptive Immunity
(Acquired immunity/specific immunity)

 The form of immunity that is

mediated by T or B lymphocytes and
stimulated by exposure to infectious
agents.

 Take effects after innate immune

response.

 Be the second line of defense against

infection.
 Adaptive Immunity
Characteristics
 Specificity.

 Acquired (set up after birth).

 Immune memory
(Adaptive immunity can be enhanced by the
second stimulation of the same antigen).

 Transferable.

 Self-limitation.
 Adaptive Immunity
Composition

 T cell : Cell-mediated immunity (CMI).

 B cell : Humoral immunity (HI) or

antibody-mediated immunity.
 Acquired Specific Immune Mechanism
Acquired by two methods

Passive acquired immunity Active acquired immunity

 Passive Acquired Immunity
 Passive Maternal Immunity:
 Maternal antibodies (IgG)
 Transfer to fetus across the placenta in the last few
weeks of pregnancy.
 Maternal immunity due to previous exposure to
infections or immunization.
 The fetus is born with inherited antibodies 6-9
months of age.
 IgA antibodies, lysozymes, macrophages are
secreted in colostrum & breast milk.

 Seroprophylaxis (passive immunity):

 Artificially passive acquired immunity, induced on
injection of already manufactured Ig, antibodies,
antitoxins, to induce humoral or cellular immunity.
 Immunoglobulin
 Animal (equine) preparation:
 Antisera prepared in animal (horses)
against some diseases (diphteria, tetanus,
gas gangrene, antirabies, antisnake).

 Human immunoglobulin, prepared from

human sources:
 Normal human immunoglobulin.
 Specific human immunoglobulin.
 HBIG
 VZIG
 Active Acquired Immunity

 It is the ability of the body to recognize,

destroy, & or eliminate foreign antigen.
 The body acquired this immunity during life
either from infection or vaccination.

 There are two types:

 Natural active acquired immunity:
It follows infection either clinical or subclinical.

 Artificial active acquired immunity:

Induced after vaccination.
 Acquired Immunity
 Antigen or immunogen is any foreign molecule that can
stimulate immune response either humeral or cellular
mediated, & react specifically with the product of this
response.

 Antigen of medical importance may be:

 Bacterial antigen as, somatic (O), flagellar (H), surface
(Vi & C), fimbrial capsular antigen, bacterial toxins,
enzymes & other bacterial products.
 Viral antigen protein (influenza, mumps, HbsAg).
 Tissue antigen as in blood group antigen on the surface of
red blood cells.
 Other antigens as some drugs & some food protein which
are important allergens in hypersensitivity reactions.
 The Specific Immune Response

Takes two forms of immunity:

 Humoral or antibody mediated
immunity.

 Cellular mediated immunity.

 Humoral Immunity
 Is mediated by glycoproteins known as immunoglobulin or
antibodies.
 Ig produced by B lymphocytes in response to antigen
stimulation.
 Lymphocyte plasma cell Ig

 Immunoglobulin:
 IgG form 75% of Ig, found in serum & tissue fluid, pass
placental barrier.
 IgA, serum IgA & secretory IgA present in mucosal
secretion.
 IgM, predominant antibody in pry immune response.
 IgD
 IgE, present in hypersensitivity reactions.
 Immune Response
 Pry immune response
 When an antigen is administered to a person for the first
time there is a latent period (induction) before antibodies
appear in the blood.

 The first Ig produced by plasma cell is IgM.

 The nature & extent of pry response of an antigen is

determined by:
 Nature of an antigen
 Dose, route of administration
 Nutrition status of host

 As a result of pry antigen stimulation, there is education of

reticuloendothelial system to produce memory cells which
responsible for:
 Secondary immune response
Cellular Mediated Immunity
 Produced by T lymphocytes.
 Action of cell mediated immunity.
 Control some intracellular bacterial
infections.
 Provide cell cooperation with B
lymphocytes.
 Delayed hypersensitivity reactions
 Destroying malignant cells.
 Autoimmune diseases.
 Active Acquired Immunity
Natural active acquired immunity:
 It follows infection.

 Absolute immunity as in yellow fever.

 Solid immunity or long lasting immunity as measles,

mumps, chicken pox.

 Mild or short lived immunity as influenza.

 Persistent or dormant focus of infection in the body

lead to continuous stimulation & cellular immune
response as TB.
 Active Acquired Immunity
Artificial active acquired immunity:
 This type of immunity induced after vaccination
by different types of vaccines, which are
immunizing agents prepared from:
 Live attenuated organism
 Inactivated or killed organism
 Extracted cellular fractions, toxoids

 Live vaccine:
 Small pox prepared from cow pox which gives
cross immunity with variola virus of small pox.
 Active Acquired Immunity
Artificial active acquired immunity:
 Live attenuated vaccines:
 Should not be given to persons with
immunodeficient diseases or persons whose
immunity is suppressed in case of pregnancy or
cortisone therapy.
 It is usually given for only one dose except for polio.
 Must properly stored to retain its effect.
 Examples:
 Measles
 Rubella
 Mumps
 Sabin oral polio vaccine (OPV)
 Yellow fever
 Tuberculosis
 Active Acquired Immunity
Artificial active acquired immunity:
 Killed or inactivated vaccines:
 killed by heat or chemicals.
 Generally, killed vaccines are less effective than live
vaccine.
 Killed vaccines usually require primary series of 2-3
doses to produce adequate antibodies response.
 Usually given by s.c or i.m injections.

 Examples:
 Salk vaccine of polio
 Pertussis vaccine
 Typhoid vaccine
 Cholera vaccine
 Active Acquired Immunity
Artificial active acquired immunity:
 Toxoid:
 Diphtheria & tetanus produce toxins, which are
detoxicated (losses toxicity & retaining antigenicity).

 Cellular fraction:
 Meningococcal vaccine of the polysaccharide antigen
of the cell wall.
 Pneumococcal vaccine from polysaccharide
contained in the capsule of the organism.
 Polysaccharide B hemophilus influenza.

 Surface antigen:
 HbsAg
 Immunodeficiency
 Loss or inadequate function of various
components of the immune system.

 Can occur in any part or state of the immune

system
 Physical barrier, phagocytes, B lymphocytes,
T lymphocytes, complement, natural killer cells.

 The immuno-compromised host

 Has an impaired function of immune system.
 Is at high risk of infection.
 Immunodeficiency

 Congenital (primary) immunodeficiency

 Genetic abnormality
• Defect in lymphocyte maturation
 Acquired (secondary) immunodeficiency
 Results from infections, nutritional
deficiencies or treatments
• AIDS, chronic leukemia
 Summary (1)
 Innate immunity:
 Relies on mechanisms already existing
before microbe infects host.
 Is the first line of defense.
 Has no memory for subsequent exposure.
 Relies on non specific mechanisms.
 Summary (2)
 Adaptive immunity:
 Develops following entry of microbe into
the host.
 Comes into action after innate immunity
fails to get rid of microbe.
 Has memory to deal with subsequent
exposure.
 Happens through specific cells.
• T cells (cell mediated)
• B cells (antibody mediated)
 Summary (3)
 Primary immune response:
 Short lasting
 Smaller in magnitude
 Secondary immune response:
 Longer in duration
 Larger in magnitude
 Develop ‘memory cells’ following primary
response
 Failure of immune response can result in:
 Hypersensitivity
 Immunodeficiency