Principles of Vaccination
Kolářová Marie, EPI
Autumn 2015
Revised 2007
The word “vaccine” comes from the Latin word
vaccinus, which means “pertaining to cows.”
What do cows have to do with vaccines? The
first vaccine was based on the relatively mild
cowpox virus, which infected cows as well as
people. This vaccine protected people
against the related, but much more
dangerous, smallpox virus.
More than 200 years ago (in 1789), Edward Jenner, a
country physician practicing in England, noticed that
milkmaids rarely suffered from smallpox.
The milkmaids often did get cowpox, a related but far
less serious disease, and those who did never
became ill with smallpox.
In an experiment that laid the foundation for modern
vaccines, Jenner took a few drops of fluid from a skin
sore of a woman who had cowpox and injected the
fluid into the arm of a healthy young boy who had
never had cowpox or smallpox.
Six weeks later, Jenner injected the boy with fluid from a
smallpox sore, but the boy remained free of smallpox.
Dr. Edward Jenner
Dr. Jenner had discovered one of the fundamental
principles of immunization.
He had used a relatively harmless foreign substance to
evoke an immune response that protected someone
from an infectious disease.
His discovery would ease the suffering of people
around the world and eventually lead to the
elimination of smallpox, a disease that killed a million
people, mostly children, each year in Europe.
By the beginning of the 20th century, vaccines were in
use for diseases that had nothing to do with cows—
rabies, diphtheria, typhoid fever, and plague—but the
name stuck.
Remembering an Old Disease
Smallpox
Variola virus, which causes smallpox, was once the scourge of the world.
This virus passes from person to person through the air.
A smallpox infection results in fever, severe aches and pains, scarring
sores that cover the body, blindness in many cases, and, often, death.
There is no effective treatment.
Although vaccination and outbreak control eliminated smallpox in the
United States by 1949, the disease still struck an estimated 50 million
people worldwide each year during the 1950s.
In 1967, the World Health Organization (WHO) launched a massive
vaccination campaign to rid the world of smallpox —and succeeded.
The last natural case of smallpox occurred in Somalia in 1977.
Ali Maow Maalin, cook twenty-three of the hospitals in the Somali Merce.
He contracted when he showed the path of the ambulance chauffeur who drove
two sick children to camp insulation.
In 1978 was ill photographer Medical School in Birmingham, England. She was killed
by a virus that escaped from a neighboring lab.
Eradication of smallpox
Czech experts
A key figure in the global eradication program
smallpox was prof. MUDr. Karel Raska, MD.,
who drove in the sixties division
Communicative Diseases of the WHO
Secretariat in Geneva.
He promoted the establishment of a new, independent units
"Eradication of smallpox"and ensure its initial financial and
material support, not only in Geneva,
but also in regional offices of WHO.
With its support of the program also attended the 20
Czechoslovak health professionals (14 Czechs and Slovaks 6),
mainly epidemiologists.
They participated in both the preparation methodology and
procedures, thus working directly in infested areas.
Remembering an Old Disease
Diphtheria:
Diphtheria:
Remembering an Old Disease
In 1900, diphtheria killed more people in the United States
than cancer did.
Caused by the toxic bacterium Corynebacterium
diphtheriae, this upper airway infection often results in a
grayish, thick membrane that grows in the throat and
obstructs breathing. Other symptoms include fever,
hoarseness, and coughing.
Most diphtheria deaths resulted not from blocked airways
but from the paralyzing toxin the bacterium secretes,
which can cause the heart or other organs to fail.
During the 1990s, an average of only three diphtheria
cases among U.S. residents were reported each year.
Diphtheria: Remembering an Old Disease
Diphtheria once was a major cause of illness and death among children.
 The U.S. recorded 206,000 cases of diphtheria in 1921, resulting in
15,520 deaths. Starting in the 1920s, diphtheria rates dropped quickly
in the U.S. and other countries that began widely vaccinating.
Between 2004 and 2008, no cases of diphtheria were recorded in the U.S.
 However, the disease continues to play a role globally.
In 2011, 4,887 cases of diphtheria were reported worldwide to the World
Health Organization (WHO), but many more cases likely go unreported.
 The case-fatality rate for diphtheria has changed very little during the
last 50 years. The overall case-fatality rate for diphtheria is 5%–10%,
with higher death rates (up to 20%) among persons younger than 5
and older than 40 years of age.
 Before there was treatment for diphtheria, the disease was fatal in up
to half of cases.
In the EU/EEA.
The reported number of cases of diphtheria remains low.
During 2009–2013, 102 cases of diphtheria were reported in the EU/EEA with 55
cases of C. diphtheriae. There has been an increase in the number of C.
diphtheriae cases reported at EU level since 2011.
Latvia is the only EU Member State that reports indigenous transmission.
In a recent European study, ten European countries each screened between 968
and 8551 throat swabs from patients with upper respiratory tract infections for C.
diphtheriae during 2007–2008.
Six toxigenic strains of C. diphtheriae were identified: two from symptomatic
patients in Latvia and four from Lithuania (two cases, two carriers).
Among the toxigenic isolates, the Sankt Petersburg epidemic clone that caused
large diphtheria outbreaks in Russia and the NIS* countries in the 1990s was still
in circulation .
Carriage rates among household contacts of a laboratory-confirmed case may
be as high as 25% .
A case of diphtheria in Spain
15 June 2015
The detection, management and public health response to the first case of
diphtheria in Spain in nearly 30 years has highlighted challenges for
preparedness against diphtheria in the European Union.
The case is a 6-year-old unvaccinated child. A case of diphtheria in an
unvaccinated individual within a highly protected population is not unexpected,
because vaccinated people can be asymptomatic carriers of toxigenic C.
diphtheriae.
The challenges for diphtheria case management, preparedness and public
health response experienced in Spain are shared by many EU Member States.
The most urgent critical issue is the shortage of diphtheria antitoxin (DAT) for
immediate use when clinicians suspect diphtheria.
DAT must be given as early as possible to be effective, often on the suspicion
of diphtheria before a laboratory confirmation.
EU Member States have for a number of years reported difficulties with
sourcing and maintaining adequate stockpiles of DAT for emergency use, a
problem they share with many countries around the world. EU Member States
have on occasion been forced to arrange emergency deliveries of DAT for
patients with diphtheria.
10.12.2015
Remembering an Old Disease
Tetanus:
TETANUS DISEASE
 Tetanus, commonly called lockjaw, is caused by a bacterium
that is mostly present in soil, manure, and in the digestive tracts
of humans and animals. Tetanus bacteria enter the body
through a wound - sometimes as small as a pinprick or deep
scratch but most often through a deep puncture wound or
laceration such as those made by rusty nails or dirty knives.
Such wounds are difficult to clean adequately and, if tetanus
bacteria were present on the nail or knife, the bacteria can
remain deep in the wound where they can grow and produce
several toxins that attack the body's red and white blood cells
and central nervous system. Tetanus bacteria do not grow well
in the presence of oxygen, which is why deep puncture wounds
are a perfect environment for them to grow in.
TETANUS DISEASE
 The incubation period for symptoms of tetanus to
begin can range from one to three weeks. The first
symptoms are likely to be headache, irritability,
fever, chills, and muscular stiffness of the jaw and
neck. As the poison increases and spreads, the
body becomes rigid and locked in spasm with head
drawn back, legs and feet extended, arms stiff,
hands clenched and the jaw unable to open with
difficulty in swallowing. The stomach muscles also
become rigid and convulsions may occur.
TETANUS DISEASE
 In 1948 there were 601 cases of tetanus
reported in the U.S., the highest number of
cases reported in one year. In 2002 there
were 25 cases of tetanus and 3 deaths
reported in the U.S. Tetanus is a much more
serious problem in underdeveloped
countries, especially among newborn babies
born in unsanitary conditions whose umbilical
cords can become infected with tetanus.
TETANUS DISEASE
 TETANUS VACCINE: The most common reactions
reported to occur following DT vaccine include
swelling and pain at the injection site; sleepiness;
irritability; vomiting; loss of appetite; persistent
crying; and fever.
 Paleness, cold skin, collapse, rash, and joint pain
have also been reported.
 In 1994 the Institute of Medicine concluded that
there is compelling scientific evidence to conclude
that tetanus, DT and Td vaccines can cause
Guillain-Barre syndrome including death; brachial
neuritis; and death from anaphylaxis (shock).
Tetanus—United States, 1947-2008
Remembering an Old Disease
Poliomyelitis:
The highly infectious poliovirus, the cause of polio,
once crippled 13,000 to 20,000 people every year in
the United States. In 1 out of 200 cases, this virus
attacks the spinal cord, paralyzing limbs or leaving
victims unable to breathe on their own. In 1954, the
year before the first polio vaccine was introduced,
doctors reported more than 18,000 cases of
paralyzing polio in the United States. Just 3 years
later, vaccination brought that figure down to about
2,500. Today, the disease has been eliminated from
the Western Hemisphere, and public health officials
hope to soon eradicate it from the globe. In 2001,
only 537 cases of polio were reported worldwide,
according to WHO.
Polio eradication
In 1988, the forty-first World Health Assembly adopted a resolution for the worldwide eradication of
polio, the Global Polio Eradication Initiative (GPEI). Since then, the number of cases has fallen by over
99% from an estimated 350 000 to 416 reported cases in 2013.
In 2014, only three countries in the world remained polio-endemic: Nigeria, Pakistan and Afghanistan.
In 2015 to date, two countries have together reported 37 cases: Pakistan (29 cases) and Afghanistan
(eight cases), all due to wild poliovirus type 1.
The last natural circulation of WPV2 was in India in 1999 and the last WPV3 case was detected in
Nigeria in November 2012.
 Since then, WPV1 has been the only circulating wild type virus.
The last case of endemic paralytic polio in the WHO European Region (i.e. with the source of the
infection originating in the Region) was reported in Turkey in November 1998,
and the Region was declared polio-free in June 2002.
The most recent outbreaks linked to importations into the WHO European Region occurred in 2010 in
Tajikistan and in 2013–2014 in Israel where WPV1 was circulating in the environment without causing
clinical cases .
The most recent polio outbreaks in what today constitutes EU/EEA were in the Netherlands in 1992, in
a religious community opposed to vaccination,
and in 2001, when three polio cases were reported among Roma children in Bulgaria .
On 5 May 2014, WHO declared the international spread of wild poliovirus in 2014 a Public Health
Emergency of International Concern (PHEIC) following the confirmed circulation of wild poliovirus in
several countries and the documented exportation of wild poliovirus to other countries.
The Polio Eradication and Endgame Strategic Plan 2013–2018 sets out the actions required for a poliofree
world by 2018 and beyond.
Outbreak of circulating vaccine-derived poliovirus type 1
(cVDPV1) in Ukraine
2 September 2015
Two cases of paralytic poliomyelitis caused by circulating vaccinederived
poliovirus type 1 (cVDPV1) were confirmed in Ukraine on 28
August 2015.
The cases, a 4-year-old child and a 10-month-old infant, had onset
of paralysis on 30 June and 7 July respectively and the positive stool
samples were collected from 5–10 July 2015.
The genetic similarity between the isolates indicates active
transmission of cVDPV1.
Both children are from the Zakarpatskaya oblast [region], in southwestern
Ukraine, bordering Romania, Hungary, Slovakia and
Poland.
Ukraine has been at high risk of vaccine-preventable diseases
outbreaks for several years due to persistent low routine vaccination
coverage.
Pertussis
Pertussis is an acute bacterial infection of the respiratory tract, caused by the
bacterium Bordetella pertussis. The disease is characterised by a severe cough,
which can last two months or even longer.
Humans are the only reservoir. Infected adults usually have only mild symptoms,
but can shed bacteria for weeks. Following infection (by inhalation of droplets),
susceptible individuals develop symptoms after an incubation period of about 10
days. The typical paroxysmal cough is usually seen in young children. Babies
less than six months old may not cough, but they manifest dyspnea and
paroxysmal asphyxia and are the most likely to die of the disease unless they
receive suitable treatment.
Affected children are also exposed to complications such as pneumonia,
atelectasia, weight loss, hernia, seizures, encephalopathy (probably due to
hypoxia). Antibiotics may reduce the duration of the disease, especially if
administered in its early stages.
This graph shows reported pertussis incidence (per 100,000 persons) by age group in the
United States from 1990–2014. Infants aged <1 year, who are at greatest risk for serious
disease and death, continue to have the highest reported rate of pertussis. School-aged
children 7 to 10 years continue to contribute a significant proportion of reported pertussis
cases.
This graph illustrates the number of pertussis cases reported to CDC from 1922 to 2014.
Following the introduction of pertussis vaccines in the 1940s when case counts frequently
exceeded 100,000 cases per year, reports declined dramatically to fewer than 10,000 by 1965.
During the 1980s pertussis reports began increasing gradually, and by 2014 more than 32,000
cases were reported nationwide.
Measles
During the 12-month period from July 2014 to June 2015, a total of 4 224 cases was reported by
30 EU/EEA countries. Twenty-three countries reported consistently throughout this period.
 • Germany accounted for 58.2% of the cases reported during this period.
In 10 of the countries reporting consistently, the measles notification rate was less than one case
per million population, including six countries which reported zero cases during the 12-month
period.
The diagnosis of measles was confirmed by positive laboratory results (serology, virus detection
or isolation) in 63.4% of all cases.
Of all cases, 89.2% had a known vaccination status and of these, 83.8% were unvaccinated.
In the target group for routine childhood MMR vaccination (1–4-year-old children), 76.9% of the
cases were unvaccinated.
One measles-related death was reported during the period July 2014–June 2015, and eight
cases were complicated by acute measles encephalitis.
Since the previous report, outbreaks of measles have been detected in several countries in the
WHO European Region: Austria, Belarus, Lithuania, Denmark, Norway, the United Kingdom,
France, Sweden and Belgium.
Outside of Europe, measles outbreaks are reported from the Democratic Republic of Congo,
Guinea, Sudan, South Sudan, Brazil, Australia, Mali, Algeria, Chile, Peru, Cameroon, Taiwan,
Iraq and Malaysia.
10.12.2015
Rubella
• Twenty-eight EU/EEA countries reported a total of 2 808 rubella
cases during the period July 2014 to June 2015.
• In 18 of the countries reporting consistently, the rubella
notification rate was less than one case per million population,
including 11 countries reporting zero cases during the 12-month
period.
• Poland accounted for 93.9% of all reported rubella cases in the
12-month period.
The highest number of cases was observed in 5–9- and 1–4-yearolds.
28.5% of the cases were unvaccinated.
However, this figure needs to be interpreted with caution as only 37
cases were confirmed through laboratory testing.
• No outbreaks of rubella have been detected by epidemic
intelligence since the last report.
MUMPS
Mumps is an acute illness caused by the mumps virus. It is characterised by fever
and swelling of one or more salivary glands (mumps is the only cause of epidemic
infectious parotitis).
Humans are the only reservoirs of the virus, which is transmitted from person to
person via droplets and/or saliva. Following infection, the incubation period lasts on
average 16–18 days. Salivary glands apart, other organs may be involved and
symptoms might include infection in the testicles (in post-pubertal males), prostate
gland, thyroid gland, and pancreas. Brain involvement is frequent, but mostly
without symptoms. Brain infection is believed to occur in only one in 10 000 cases,
but it often leads to death.
Mumps is preventable by a vaccine, which is most often administered in association
with anti-rubella and anti-measles vaccines (MMR).
Haemophilus influenzae type b (Hib).
Other familiar diseases that vaccines protect against
include chickenpox, hepatitis A and B, and
Haemophilus influenzae type b (Hib). Hib causes
meningitis, an inflammation of the fluid-filled
membranes that surround the brain and spinal cord.
Meningitis can be fatal, or it can cause severe
disabilities such as deafness or mental retardation.
This disease has nearly disappeared among babies
and children in the United States since the Hib
vaccine became widely used in 1989.
Invasive Haemophilus influenzae disease
Invasive Haemophilus influenzae disease has become rare; the notification rate in Europe was
0.49 per
100 000 population, with a slightly ascending trend which may be attributed to improved
surveillance in most countries.
Country-specific rates were highest in northern Europe and in the United Kingdom;
age-specific rates were highest in children under one year and adults aged 65 years or over.
The national immunisation schedules of all EU/EEA countries include the Hib vaccine, which
has led to a
 progressive reduction of type b serotype infections.
Even though there appears to be a trend towards an increase in disease due to noncapsulated
(nontypeable) strains, European data is too scarce to draw conclusions on serotype
replacement.
Continued monitoring of strains, together with their associated clinical syndromes, is essential
for assessing the effect of interventions.
In 2012, 2 545 confirmed cases of invasive Haemophilus influenzae disease (all serotypes)
were reported by 27 countries, 24 of which have surveillance systems with national coverage.
Belgium, France and Spain reported data from sentinel surveillance and therefore had to be
excluded from the notification rates analysis, while no confirmed cases were reported from
Malta for 2012.
10.12.2015
Vaccine-Preventable Infectious Diseases:
 Anthrax
 Bacterial meningitis
 Chickenpox
 Cholera
 Diphtheria
 Haemophilus influenzae type b
 Hepatitis A
 Hepatitis B
 Influenza
 Measles
 Mumps
 Pertussis
 Pneumococcal pneumonia
 Polio
 Rabies
 Rubella
 Tetanus
 Yellow fever
Immunity
 Self vs. nonself
 Protection from infectious disease
 Usually indicated by the presence of antibody
 Very specific to a single organism
Immunity
Principles of Vaccination
 Protection produced by the person's own immune
system
 Usually permanent
 Protection transferred from another person or animal
 Temporary protection that wanes with time
Active Immunity
Passive Immunisation
 Transfer of antibody produced by one human
or other animal to another
 Temporary protection
 Transplacental most important source in
infancy
Sources of Passive Immunity
 Almost all blood or blood products
 Homologous pooled human antibody
(immune globulin)
 Homologous human hyperimmune globulin
 Heterologous hyperimmune serum (antitoxin)
Monoclonal Antibody
 Derived from a single type, or clone, of antibodyproducing
cells (B cells)
 Antibody is specific to a single antigen or closely
related group of antigens
 Used for diagnosis and therapy of certain cancers
and autoimmune and infectious diseases
Active Immunisation
 A live or inactivated substance (e.g., protein,
polysaccharide) capable of producing an immune
response
 Protein molecules (immunoglobulin) produced by
B lymphocytes to help eliminate an antigen
Contraindications
 Generaly
 Acute illnes
 Reaction after last vaccination
 Anaphylactic reactions
 Recovery time
 Incubation period of some infectious diseases
 Pregnancy
 Immunosupression – therapy
 Hemoblastosis and other oncologic disease
Contraindications
 Specific
 Depends on the types of vaccine (exampl.- alergic
reaction on the some substances
Apliccation
 Under aseptic conditions !
 i.m.
 s.c.
 intradermal (epidermis)
 p.o.
 scarification
 …..
After aplication - 30 min - under oversight !
Reaction after apliccation
 Fysiolocal reaction
 Local
– erythema, swelling, soreness …
 Generally
- higher temperature, fever, tiredness, hedeache,
- pain of the muscles, joints,
- Indigestion
 Alergic reaction
Vaccination
 Active immunity produced by vaccine
 Immunity and immunologic memory similar to
natural infection but without risk of disease
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
 Severe reactions possible
 Interference from circulating antibody
 Fragile – must be stored and handled
carefully
Live Attenuated Vaccines
 Viral measles, mumps,
rubella, vaccinia,
varicella, yellow fever,
intranasal influenza,
(oral polio)
(rotavirus)
 Bacterial BCG, oral typhoid
Vaccines in (parenthesis) are not available in the United States.
Inactivated Vaccines
 Cannot replicate
 Less interference from circulating antibody than
live vaccines
 Generally require 3-5 doses
 Immune response mostly humoral
 Antibody titer diminishes with time
Inactivated Vaccines
 Viral polio, hepatitis A,
rabies (influenza)
 Bacterial (pertussis) (typhoid)
(cholera) (plague)
Whole-cell vaccines
Inactivated Vaccines
 Subunit hepatitis B, influenza,
acellular pertussis,
(Lyme) (HPV)
 Toxoid diphtheria, tetanus
Fractional vaccines
Polysaccharide Vaccines
 pneumococcal
 meningococcal
 Salmonella Typhi (Vi)
 Haemophilus influenzae type b
 pneumococcal
 meningococcal
Pure polysaccharide
Pure Polysaccharide Vaccines
 Not consistently immunogenic in children <2
years of age
 No booster response
 Antibody with less functional activity
 Immunogenicity improved by conjugation
Immunisation in Czech Republic
Regulary vaccination – (refunding the state)
 (TBC) form 2010 only by indicated group
 Diphteria, Tetanus, Pertussis, Hemophillus
influenzae B, Poliomyelitis, Viral hepatitis B (VHB),
 Morbilli, Rubeola, Parotitis epidemica
 Inluenza, Pneumoccus
(for specific groups – by low )
 VHB (healths workers )
TBC only - indication
Di,Te,P(a), from 13th week 3 times in 1 year (each after 1 months)
Hib, VHB,IPV 4th dosis 6th months after 3th dosis
MMR 1st dosis from 15th months
2nd dosis from 6th to 10th months after 1st dosis
Di,Te,P(a) 5 years
Di,Te,P(a),IPV 10 years
VHB 12 years
Te 25 years, revaccination each after 10 - 15 years
Poznámka: TBC , Di (Diphteria), Tetanus (Te), P (Pertussis), Hib (Haemophilus influenzae b), HB (VHB),
IPV (poliomyelitis), MMR (measles, mumps, Rubella).
Illness The beginning of vaccination
Variolla 1919
Diphtheria 1946
TBC 1953
Tetanus 1956
Pertussis 1958
Poliomyelitis 1960
Morbilli 1969
Parotitis 1987
Rubella 1982 (12 years girls)
1986 (2 years children)
Haemophilus influenzae b 2001
VHB 2001
Future vaccines may be squirted up the nose,
worn as a patch, or eaten at the dinner table.